CHAPTER TWO

LITERATURE REVIEW

2.1 Conceptual Framework

Self-medication is a complex and multifaceted phenomenon that involves individuals taking

initiative to manage their own health issues without consulting a healthcare professional. This
concept has evolved significantly over the years, with a growing emphasis on responsible self-
medication. At its core, self-medication involves the use of medications or substances to alleviate
symptoms, prevent illnesses, or promote overall well-being.

2.1.1 Evolution of Self-Medication

Self-medication has undergone significant changes, shifting from uninformed self-prescription to

a more informed and responsible approach, with recent studies highlighting the importance of
distinguishing between responsible self-medication and potentially hazardous practices (WHO,
2022; Odili et al., 2022). According to a 2022 study on healthcare professionals in Nigeria during
the COVID-19 pandemic, the prevalence of self-medication was approximately 36.3%, with
commonly used medications including ivermectin, azithromycin, vitamin C, chloroquine, and zinc,
often used without prescription or medical guidance (Odili et al., 2022). Factors influencing self-
medication included older age, higher income, and previous COVID-19 testing, which were
associated with increased likelihood of self-medication (Odili et al., 2022).

The study also emphasized the need for health education and awareness campaigns to promote
responsible self-medication practices among healthcare professionals and the general public
(Odili et al., 2022). Responsible self-medication involves informed decision-making, careful
product selection, and judicious use of medications, with patients taking an active role in
managing their health and making informed choices about their care (WHO, 2022).

However, self-medication can also pose significant risks, including adverse reactions, interactions
with other medications, and delayed medical attention (WHO, 2022). Therefore, it is essential to
ensure that self-medication practices are guided by accurate information and evidence-based
guidelines.
Effective policies and regulations are necessary to ensure safe and responsible use of
medications, particularly in settings with limited access to healthcare services (World Health
Organization, 2022). Healthcare professionals play a crucial role in promoting responsible self-
medication practices by providing patients with accurate information, guidance, and support.

Self-medication can involve a wide range of products and substances, including OTC medications,
dietary supplements, herbal remedies, and other health-related products. These products can be
used to manage various health issues, such as pain, allergies, digestive problems, or mental
health concerns. However, self-medication can also lead to irrational drug use, antimicrobial
resistance, and unintentional self-harm. For instance, the overuse or misuse of antibiotics can
contribute to the development of antimicrobial resistance, making it more challenging to treat
infections.

Several factors can influence an individual's decision to engage in self-medication, including their
level of health literacy, access to healthcare services, and cultural or social norms. Some
individuals may prefer self-medication due to convenience, cost-effectiveness, or a desire for
autonomy in managing their health. Others may be driven by a lack of trust in healthcare
providers or a sense of disillusionment with the healthcare system.
Research has shown that self-medication is prevalent among university students, who often face
unique challenges and stressors that can impact their physical and mental health. Students may
use substances to manage stress, anxiety, or other health concerns, which can lead to a range of
consequences, including addiction, substance abuse, or adverse interactions with other
medications. Universities and healthcare providers can play a critical role in promoting
responsible self-medication practices among students, including education, counseling, and
support services.

Self-medication can offer several benefits, including increased autonomy, convenience, and cost-
effectiveness. However, it also carries significant risks, including adverse reactions, interactions
with other medications, and delayed or inadequate treatment. Responsible self-medication
requires careful consideration of these benefits and risks, as well as informed decision-making
and judicious use of products.

To promote responsible self-medication, healthcare providers, policymakers, and educators can

work together to provide accurate and unbiased information about health products and
medications. This can include education and counseling programs, public health campaigns, and
regulatory initiatives to ensure the safe and effective use of health products. By promoting
responsible self-medication practices, we can empower individuals to take an active role in
managing their health while minimizing the risks associated with self-medication.

2.1.2 Reasons why nursing students practice self-medication

According to Gómez-Urquiza et al. (2023), these are the reasons the student practice self
medication:
1. Stress and Burnout

One of the most significant contributors to self-medication among nursing students is the
overwhelming stress and burnout they experience throughout their education and training. The
journey to becoming a nurse is intense, demanding, and emotionally charged, often placing
students in high-pressure environments that can lead to chronic stress and exhaustion. This
persistent stress can push students to seek quick relief through self-medication, often without
proper medical guidance. Below are several dimensions of stress and burnout experienced by
nursing students that influence this behavior:
Academic Demands:
Nursing programs are notoriously rigorous, combining theoretical coursework with clinical
training. Students are expected to assimilate large volumes of information in anatomy,
physiology, pharmacology, and other complex subjects within a limited time. This academic
pressure is compounded by frequent exams, quizzes, assignments, and practical assessments,
which can create a sense of continuous performance anxiety. In an attempt to cope, students
may turn to over-the-counter (OTC) drugs such as pain relievers, sedatives, stimulants, or even
herbal remedies to manage headaches, fatigue, and anxiety.
Clinical Pressures:
During clinical placements, nursing students are exposed to real-life hospital settings where they
care for actual patients. These environments are often fast-paced and emotionally charged.
Students may witness suffering, trauma, or even death, all of which can be psychologically
distressing. They are also required to apply theoretical knowledge in practical settings, which can
be daunting, especially when tasked with making critical decisions or handling emergencies. This
pressure to perform competently can contribute to emotional fatigue and heighten stress levels,
leading some students to self-medicate in an effort to calm their nerves, sleep better, or relieve
emotional distress.
Time Management Challenges:
Nursing students often struggle to balance the competing demands of their academic work,
clinical rotations, part-time jobs, and personal lives. Long hours of study, combined with irregular
clinical shifts, can disrupt sleep patterns and result in chronic fatigue. Poor time management or
lack of rest may lead to a build-up of stress, which students may try to alleviate by taking sleeping
pills, energy boosters, or mood enhancers without consulting a healthcare professional.
Lack of Coping Mechanisms and Mental Health Support:
Another critical factor contributing to self-medication is the lack of adequate coping strategies
and limited access to mental health support. Many students do not receive proper training in
stress management or emotional resilience. Additionally, the stigma surrounding mental health
issues in healthcare environments may deter them from seeking professional help. Consequently,
students may resort to self-treatment as a way to manage their emotional struggles discreetly.
They may misuse medications to avoid being perceived as weak or incapable.
Peer Influence and Accessibility:
Being in a healthcare setting often gives students access to medical knowledge and, in some
cases, medications. Their exposure to pharmacological information might create a false sense of
confidence in self-diagnosing and self-treating symptoms. Moreover, conversations with peers
who also self-medicate can normalize this behavior and encourage it as a common coping
mechanism or stress and burnout.
Physiological Effects of Stress:
Chronic stress can also manifest physically — headaches, gastrointestinal discomfort, insomnia,
and fatigue are common among nursing students. Rather than seeking medical consultation,
students might opt for readily available solutions, such as painkillers, antacids, sleep aids, and
energy drinks. While these might offer temporary relief, habitual self-medication without
professional supervision can lead to dependency, adverse drug reactions, or masking of more
serious underlying conditions.

2. Fear of Failure and High Expectations:

Many nursing students feel immense pressure to meet the high expectations set by their
institutions, instructors, peers, and families. The fear of failure or making a mistake, especially in
clinical settings where patient lives are at stake, can be a major source of anxiety. Some students
internalize this pressure and develop imposter syndrome — a feeling that they are not as
competent as others perceive them to be. In a bid to perform better or simply cope, students
may self-medicate using anti-anxiety medications, antidepressants, or cognitive enhancers,
sometimes borrowing medications from peers or using leftover prescriptions.
[Link] Access to Medications
Nursing students often have greater access to medications compared to the general public, owing
to their clinical environments and familiarity with hospital pharmacies and drug handling
procedures.
Being regularly present in clinical settings allows them to observe the use and effects of a wide
range of medications. Some students may even come into direct contact with leftover drugs,
sample medications, or improperly discarded pharmaceuticals, making it easier to obtain
medications unofficially. Additionally, students may use their academic knowledge to purchase
over-the-counter or pharmacy-only drugs without a prescription, especially in settings where
regulations are less strict.

This access can create a false sense of safety and control, leading students to bypass the need for
medical consultation. They may assume that because they know the correct dosage or
pharmacological profile, they can safely self-administer these drugs — an assumption that
increases the risk of misuse, drug interactions, or developing resistance (in the case of
antibiotics).

4. Peer Influence and Social Normalization

The behavior and attitudes of peers play a significant role in shaping nursing students’ choices,
including self-medication practices. In academic or clinical groups, students may share
experiences about using certain medications to manage stress, insomnia, or menstrual pain —
and encourage others to do the same.
Seeing peers successfully treat themselves without adverse effects can normalize and even
encourage self-medication, creating a group culture where it is viewed as an acceptable or
efficient coping strategy. For example, one student might recommend a particular muscle
relaxant or anti-inflammatory drug for back pain after a long shift, leading others to adopt the
same behavior without proper consultation.

The shared experience of stress and fatigue may further solidify this pattern. Some students may
even share medications among themselves — a risky practice that promotes the idea of
collective, informal medical decision-making rather than seeking professional help.

5. Previous Experience with Similar Illnesses

Another key reason why nursing students self-medicate is their prior experience with the same or
similar health issues. If a student has had a particular condition before — such as migraines,
digestive problems, or allergies — they may feel confident in identifying the symptoms and
managing them without medical input.
This self-reliance is often reinforced if the student had positive outcomes from earlier self-
treatment. They may believe that their previous experience gives them enough insight to repeat
the same course of treatment, overlooking the fact that similar symptoms may arise from
different underlying causes.

This reasoning can lead to under-treatment or mistreatment of conditions that may have
changed in nature or severity. Additionally, repeated reliance on the same medications without
proper review may increase the risk of tolerance, dependency, or side effects.

6. Financial Constraints
The cost of healthcare can also be a significant barrier for nursing students, especially in regions
where medical consultations, diagnostic tests, and prescription medications are expensive or not
fully covered by insurance or school programs.
Students who are financially burdened may prefer to self-medicate using cheaper OTC
alternatives or leftover medications rather than pay for professional diagnosis and treatment.
Some may skip medical appointments entirely if they anticipate high consultation fees, lab costs,
or follow-up expenses.

Even in countries with public health systems, long wait times and limited access to affordable
care may push students toward self-treatment. Financial limitations may also mean that students
cannot afford to miss work or pay for transportation to clinics, making self-medication a more
convenient, though potentially unsafe, option.

7. Desire for Immediate Relief

The fast-paced nature of nursing education and clinical training often leaves students with little
patience for prolonged illness or recovery time. As a result, many develop a preference for
immediate symptom relief — whether to remain functional in class or to fulfill clinical
responsibilities.
Self-medication offers the illusion of quick and effective resolution. For example, instead of
resting for a day with flu-like symptoms, a student might take antipyretics and decongestants to
suppress symptoms and continue working. Similarly, sleep aids may be used to combat insomnia
before an early morning shift, or painkillers may be used to endure long clinical hours despite
physical discomfort.

This urgency for fast relief can cause students to misuse or overuse medications, especially when
taken in higher doses than recommended. It also delays proper treatment and increases the risk
of complications from underlying or worsening conditions

2.1.3 Impact of Self-Medication Among Nursing Students

Self-medication, while often perceived as a quick and convenient solution to minor health issues,
poses significant risks and consequences — particularly among nursing students who are future
healthcare professionals. The practice of self-medication among this group is especially
concerning due to the unique environment in which they operate: one that blends academic
pressure, clinical exposure, and developing medical knowledge. While they may be more
informed about drugs than the average person, their incomplete training, psychological stressors,
and frequent access to medications can turn this practice into a hazardous habit.

The impacts of self-medication can be classified into multiple domains:

1. Academic and Cognitive Impact

Nursing students who frequently self-medicate may experience various academic consequences,
many of which stem from the misuse or overuse of certain drugs:

Impaired Concentration and Memory: Some students may take medications such as
antihistamines, sedatives, or painkillers that can cause drowsiness or brain fog, impairing their
ability to focus during lectures or exams.
Short-Term Relief vs. Long-Term Performance: While self-medication may offer short-term
symptom relief (e.g., from headaches or anxiety), it does not address underlying issues like stress,
burnout, or illness. As a result, students may underperform academically over time.
Disrupted Sleep Patterns: Use of sleep aids or stimulants can interfere with the body’s natural
sleep cycle. Poor sleep hygiene caused by reliance on such drugs can lead to chronic fatigue,
further reducing academic performance and increasing error rates during clinical tasks.
Addiction and Dependency: Habitual use of certain medications, such as benzodiazepines or
opioids (even if initially prescribed), can lead to psychological or physical dependence, affecting
academic attendance, engagement, and cognitive function.

2. Physical Health Consequences

Self-medication carries significant risks to physical health, especially when drugs are taken
without proper dosage, guidance, or awareness of potential interactions:
Incorrect Self-Diagnosis: Nursing students may misinterpret symptoms, treating one illness when
another is present. This can delay appropriate treatment and worsen health outcomes.
Adverse Drug Reactions (ADRs): Without professional supervision, students may take drugs that
trigger allergic reactions, gastrointestinal issues, or organ toxicity (e.g., liver or kidney damage
from prolonged painkiller use).
Drug Interactions: Students may mix multiple medications unknowingly, leading to harmful
interactions, particularly if they are taking prescription drugs alongside OTC medications or
herbal supplements.
Masking of Serious Illnesses: Temporary symptom relief can obscure the diagnosis of serious
conditions such as infections, hormonal imbalances, or chronic diseases, which may progress
unnoticed and untreated.

3. Psychological and Emotional Impact

The emotional toll of self-medication is often underestimated but can be deeply damaging over
time:
Increased Anxiety and Depression: Some students may misuse antidepressants or anti-anxiety
medications without proper diagnosis or monitoring. This can lead to emotional instability,
withdrawal symptoms, or worsening of mental health conditions.
Loss of Self-Efficacy: Frequent reliance on medications to cope with stress or fatigue can
undermine students’ confidence in their own natural coping abilities, creating a cycle of
dependence.
Stigma and Isolation: Students who self-medicate may avoid discussing their health issues openly
due to fear of being judged, especially in a healthcare environment that emphasizes strength and
resilience. This silence can lead to increased isolation and feelings of guilt or shame.

4. Professional and Ethical Consequences

As future healthcare providers, nursing students are expected to uphold high ethical standards,
including safe medication practices. Self-medication can compromise their professional integrity
in several ways:
Modeling Unsafe Behaviors: Students who normalize self-medication may carry these habits into
their professional careers, influencing how they manage their own health and how they advise
patients.
Erosion of Professional Judgment: Regular self-medication may dull students’ awareness of
appropriate treatment protocols, reducing their ability to discern when professional intervention
is needed.
Legal and Disciplinary Risks: In extreme cases, if students are found to be in possession of
prescription medications without proper authorization or engaging in drug-sharing, they may
face disciplinary action from their institution or regulatory bodies.
Patient Safety Risks: A student who is impaired by the misuse of medications may make errors in
judgment, pose safety risks in clinical settings, or fail to provide optimal care, compromising both
their training and patient outcomes.

5. Social and Societal Impact

Beyond the individual, self-medication among nursing students also poses broader implications:
Normalization Among Peers: When one student self-medicates and appears to manage well,
others may follow suit, creating a culture where this behavior is viewed as acceptable or even
necessary to cope.
Contribution to Antimicrobial Resistance: Improper use of antibiotics without prescriptions
contributes to the global threat of antibiotic resistance — a public health issue that nursing
students, ironically, are being trained to combat.
Strain on Healthcare Systems: When self-medication leads to complications or worsened
conditions, students may eventually require more extensive care, placing additional burden on
healthcare services and delaying treatment for others.
Erosion of Trust in Health Professionals: If future nurses are known to self-medicate or minimize
the role of professional consultation, it may undermine public trust in the medical advice they
offer as practitioners.

2.1.4 Common substances used to self-medicate

According to Sahin et al. (2024), university students—including those in health-related programs
like nursing—commonly self-medicate using a range of prescription.
Prescription medications: Prescription medicines are drugs that can only be obtained with a valid
prescription from a licensed medical professional. However, some individuals, including nursing
students, may use prescription medicines for self-medication without a valid prescription or
medical supervision. Commonly misused prescription medicines
include:
1. Opioids (e.g., oxycodone, hydrocodone, morphine) for pain relief or recreational use.
2. Benzodiazepines (e.g., alprazolam, diazepam, clonazepam) for anxiety, stress, or sleep.
3. Stimulants (e.g., amphetamine, methylphenidate) for attention deficit hyperactivity
disorder (ADHD), weight loss, or cognitive enhancement.
4. Antidepressants (e.g., fluoxetine, sertraline, paroxetine) for depression, anxiety, or sleep.
Sleep aids (e.g., zolpidem, eszopiclone) for insomnia or sleep disturbances.
5. Muscle relaxants (e.g., cyclobenzaprine, carisoprodol) for muscle spasms or pain relief
Over-the-counter (OTC) medications: Over-the-counter (OTC) medications are drugs that
can be purchased without a prescription. While OTC medications are generally considered
safe and effective, they can still be misused or abused for self-medication purposes.
Commonly misused OTC medications include:
Pain relievers:
- Acetaminophen (Tylenol)
- Ibuprofen (Advil, Motrin)
- Aspirin
Cold and allergy medications:
- Pseudoephedrine (Sudafed)
- Diphenhydramine (Benadryl)
Sleep aids:
- Melatonin
- Diphenhydramine (Benadryl)
Cough medicines:
- Dextromethorphan (Robitussin)
Anti-diarrheal medications:
- Loperamide (Imodium)
Motion sickness medications:

- Dimenhydrinate (Dramamine)
Illicit substances: Illicit substances are drugs that are illegal to possess, use, or distribute.
These substances are often used for self-medication, which can lead to serious health
consequences, addiction, and legal problems. Commonly used illicit substances for self-
medication include:
● Cocaine, Methamphetamine, and Other Stimulants: These drugs work on the ‗reward‘
centre in the brain. They give spikes of dopamine, also known as the ‗feel good‘
neurotransmitter. These stimulants can make individuals feel like they‘re ‗on‘ and can
focus, be productive.
● Heroin and Other Opioid Prescription Painkillers (heroin, fentanyl, oxycodone):
These are depressants of the central nervous system, and they can bring about feelings
of peace and happiness. They increase relaxation and tone down anxiety and stress.
Still, they are often abused or taken without doctor‘s orders, and they create
dependence in the body very quickly.
1. Marijuana (cannabis)
2. Hallucinogens (LSD, psilocybin, DMT)
3. Inhalants (nitrous oxide, solvents)
4. Steroids (anabolic-androgenic steroids)
Alcohol: Alcohol is a commonly used substance for self-medication, particularly for stress,
anxiety, and depression. Alcohol affects the brain in many ways. It‘s a depressant and slows
the central nervous system functions, but in the short term, it also lowers anxiety and lowers
inhibitions. Using alcohol as a form of self-medication can lead to:
1. Alcohol dependence and addiction
2. Worsening of mental health conditions
3. Increased risk of alcohol-related problems (e.g., liver disease, accidents)
4. Interactions with other medications or substances
5. Impaired cognitive and motor function
6. Negative impact on relationships and daily life
7. Increased risk of alcohol-related cancers
8. Weakening of the immune system
9. Increased risk of mental health conditions (e.g., depression, anxiety disorders)
10. Decreased quality of life
Nicotine products (e.g., cigarettes, e-cigarettes): Nicotine products, such as cigarettes, e-
cigarettes, and chewing tobacco, are often used for self-medication, particularly for stress,
anxiety, and depression. However, using nicotine products for self-medication can lead to:
1. Nicotine addiction
2. Worsening of mental health conditions
3. Increased risk of tobacco-related diseases (e.g., lung cancer, heart disease)
4. Interactions with other medications or substances
5. Impaired cognitive and motor function
6. Negative impact on relationships and daily life
7. Increased risk of nicotine-related cancers
8. Weakening of the immune system
9. Increased risk of mental health conditions (e.g., depression, anxiety disorders)
10. Decreased quality of life
Caffeine products (e.g., energy drinks, coffee): Caffeine is a stimulant that can be used for
self-medication, particularly for Fatigue and sleepiness, Low mood and depression, Difficulty
concentrating and focus and Physical performance and endurance. However, using caffeine
for self-medication can lead to:
1. Caffeine dependence and addiction
2. ncreased anxiety and jitteriness
3. nsomnia and disrupted sleep patterns
4. Rapid heartbeat and palpitations
5. Increased blood pressure
6. Dehydration
7. Interactions with other medications or substances
8. Worsening of underlying medical conditions (e.g., high blood pressure, heart disease)
Herbal supplements (e.g., St. John's Wort, valerian root): Herbal supplements are plant-based
products used for self-medication, particularly for, Stress and anxiety (e.g., ashwagandha,
passionflower), Sleep disturbances (e.g., valerian root, chamomile), Digestive issues (e.g.,
peppermint, ginger), Pain relief (e.g., turmeric, willow bark), Immune system support (e.g.,
echinacea, elderberry). However, using herbal supplements for self-medication can lead to:
1. Interactions with prescription medications
2. Adverse reactions (e.g., allergic reactions, liver damage)
3. Contamination or adulteration with other substances
4. Lack of regulation and quality control
5. Mislabeling or misidentification of herbal products
6. Overuse or misuse leading to toxicity
7. Delayed or foregone medical attention
Sedatives, Tranquilizers, and Other substances (e.g., inhalants, steroids): When dealing with
mental illness, these are often prescribed. They take anxiety levels down and aid sleep and
brain stabilization. But they‘re often abused or taken without doctor‘s orders to self-medicate.

2.1.5 Knowledge of Self-Medication Among Nursing Students

1. Conceptual Clarification of Self-Medication
Self-medication refers to the use of drugs or home remedies to treat self-diagnosed symptoms or
conditions without consulting a healthcare professional. It includes the purchase of over-the-
counter (OTC) drugs, the reuse of old prescriptions, or reliance on advice from non-professionals.
While self-medication may provide quick relief for minor ailments, improper use can result in
adverse reactions, increased drug resistance, and delayed diagnosis (Alrasheedy et al., 2021;
Gebeyehu et al., 2020).

2. The Importance of Knowledge in Self-Medication Practices

Knowledge is a critical factor influencing how individuals engage in self-medication. For nursing
students, developing professional competencies related to medication safety, drug interactions,
and side effects is essential to prevent misuse (Mohammed et al., 2022). Studies show that
healthcare students often feel confident in self-medication due to their training, but gaps in
knowledge can lead to risky practices (Kassie et al., 2021).

3. Previous Research on Self-Medication Among Nursing or Health Students

Several recent studies have examined self-medication knowledge and practices among nursing
and healthcare students:

A 2023 study in Nigeria found that 65% of nursing students practiced self-medication, mainly
using analgesics and antibiotics, but only 40% demonstrated adequate knowledge about
associated risks (Ibrahim et al., 2023).
Research in Ethiopia reported that while 72% of health science students engaged in self-
medication, only 38% had sufficient knowledge about drug interactions and adverse effects
(Gebeyehu et al., 2020).
A 2021 study in Saudi Arabia highlighted that senior nursing students had significantly better
knowledge of safe self-medication compared to juniors (Alrasheedy et al., 2021).
These findings underscore the need for enhanced education and stricter regulation of drug
access among students.
4. Factors Influencing the Level of Knowledge
Academic Level: More advanced students tend to have better knowledge (Alrasheedy et al.,
2021).
Information Access: Students utilizing digital health resources show improved awareness
(Mohammed et al., 2022).
Family Background: Having relatives in healthcare positively influences knowledge levels (Kassie
et al., 2021).
Curriculum Coverage: Exposure to pharmacology and therapeutics strengthens understanding
(Ibrahim et al., 2023).

5. Consequences of Inadequate Knowledge

Insufficient knowledge regarding self-medication can lead to serious consequences such as drug
resistance, masking of underlying health conditions, adverse drug reactions, and delays in seeking
professional care (Gebeyehu et al., 2020; WHO, 2021).

6. The Situation in Edo State and the Research Gap

Despite growing attention to self-medication in Nigeria, little is known about the knowledge level
of nursing students specifically in Edo State. This gap highlights the importance of localized
studies to inform tailored interventions for this demographic (Ibrahim et al., 2023).

Prevention Strategies for Self-Medication Among Nursing Students

1. Educational Interventions
Curriculum Integration:
Nursing education programs should include dedicated modules on pharmacology that go beyond
drug mechanisms to cover rational drug use, the dangers of unsupervised medication, and
principles of pharmacovigilance—the monitoring and evaluation of adverse drug reactions.
These modules can clarify the distinction between responsible self-care (e.g., non-
pharmacological symptom management, lifestyle changes) and unsafe medication practices (e.g.,
unsupervised use of antibiotics or psychotropics).
Incorporation of case-based learning and scenario simulations can help students recognize
symptoms that require professional diagnosis rather than self-treatment (Lee & Kim, 2023).
Workshops and Seminars:
Conduct regular interactive workshops facilitated by clinical pharmacologists, mental health
professionals, and experienced nurses to discuss real-world cases where self-medication resulted
in adverse outcomes.
These sessions should cover topics such as drug interactions, side effects, misuse of OTC drugs,
and the psychological triggers leading to self-medication (e.g., stress, anxiety).
Role-playing exercises can empower students to practice effective symptom management
strategies, including when and how to seek professional care (Rani et al., 2021).
Promoting Evidence-Based Practice:
Encourage students to habitually consult clinical practice guidelines and authoritative sources
such as WHO or national formularies before using any medication.
Teach critical appraisal skills to evaluate drug information from various sources, helping students
avoid misinformation.
Encourage a culture where consulting healthcare professionals (doctors, pharmacists) is viewed
as the norm, not the exception, for medication use (Fernandez et al., 2022).
2. Psychosocial Support
Stress Management Programs:
Since stress and anxiety are major drivers of self-medication among nursing students, campuses
should offer stress relief interventions such as mindfulness meditation, yoga classes, and
cognitive-behavioral therapy workshops.
Access to confidential counseling services where students can discuss their mental health
concerns without stigma is crucial. These programs help students develop adaptive coping
mechanisms reducing reliance on self-medication for symptom relief (Ahmed & Mustafa, 2023).
Peer Support Groups:
Formation of peer-led support groups creates a safe space for students to share experiences,
discuss challenges, and promote healthy coping strategies.
Peer groups can reduce feelings of isolation and encourage responsible health behaviors by
normalizing seeking help rather than self-medicating (Choudhury & Banerjee, 2024).
Training peer leaders on identifying at-risk students and facilitating referrals to professional help
adds an additional layer of preventive care.
3. Policy and Regulation
Access Control:
Work with campus pharmacies and local drug outlets to regulate the sale of OTC medications to
students, especially those with potential for abuse or adverse effects (e.g., painkillers, sedatives).
Pharmacists should be trained and mandated to provide counseling and education on the safe
use of medications and discourage impulsive purchases.
Establishing medication tracking systems can monitor and flag excessive or inappropriate drug
purchases by individuals (Nguyen et al., 2023).
Clear Institutional Policies:
Develop and communicate institutional policies explicitly discouraging self-medication without
professional consultation.
Policies should define acceptable and unacceptable medication practices, with clear
consequences for misuse of prescription drugs or repeated self-medication incidents.
Regular audits and feedback sessions can help ensure policy adherence and highlight areas
needing reinforcement (Zhang et al., 2024).
4. Improving Healthcare Access
Campus Health Clinics:
Provide accessible, well-staffed health clinics on campus that offer prompt, confidential
consultations to address students’ health concerns professionally.
Clinics should maintain flexible hours to accommodate students' schedules and minimize barriers
like time constraints that lead to self-medication.
Emphasize a non-judgmental approach so students feel comfortable seeking help rather than
self-treating (Moyo & Ndlovu, 2022).
Telemedicine Services:
Implement telehealth platforms that allow students to consult healthcare providers remotely,
offering convenience and privacy, which can reduce reliance on self-medication due to stigma or
busy schedules.
Telemedicine can be especially helpful for quick triage and guidance on minor symptoms,
directing students toward appropriate care when needed (Johnson et al., 2023).
5. Awareness Campaigns
Information Dissemination:
Launch ongoing campaigns using posters, pamphlets, social media, and newsletters that highlight
the risks of self-medication and educate students on safe medication practices.
Messaging should include common pitfalls like drug interactions, masking of serious illnesses,
addiction risks, and antibiotic resistance.
Campaigns can be tied to national or international health observances to increase visibility and
impact (Patil et al., 2024).
Role Modeling:
Faculty members and senior nursing staff should exemplify appropriate medication behaviors and
openly discuss the importance of seeking professional advice before self-medicating.
Senior students and clinical instructors can act as mentors to reinforce responsible health
practices and challenge peer norms that trivialize self-medication (Kumar & Sharma, 2022).

2.2 Theoretical Reviews

SELF-MEDICATION HYPOTHESIS (SMH)

The Self-Medication Hypothesis (SMH), originally introduced by Khantzian et al. (1974), posits
that individuals may use psychoactive substances as a means to alleviate psychological distress.
Initially studied in heroin-addicted patients, SMH suggests that chronic drug use emerges as a
compensatory mechanism for deficits in adaptive coping strategies (Khantzian, 2021). Over the
decades, this framework has expanded beyond heroin to include a wide range of substances,
including alcohol, cocaine, and increasingly, polysubstance use (Khantzian, 2023).

SMH rests on two central assumptions: (1) psychoactive substances relieve psychological
suffering, and (2) individuals preferentially select substances based on their specific
psychopharmacological effects that target their affective symptoms (Khantzian, 2022). For
example, depressants like alcohol and cannabis may be favored by individuals experiencing
anxiety or emotional distress due to their anxiolytic and sedative effects. Conversely, stimulants
such as nicotine or cocaine might be preferred by those battling depression or low self-esteem,
given their energizing and mood-elevating properties (Suh et al., 2022; McKernan et al., 2021).

Empirical support for SMH has grown substantially in recent years. Longitudinal population
studies confirm that psychological distress often precedes substance use disorders (SUDs)
(Chilcoat & Breslau, 2020). For instance, a 2022 meta-analysis of PTSD and SUDs in diverse
populations reaffirmed that PTSD significantly increases the risk of developing substance
dependence, while reverse causality (SUD leading to PTSD) is less consistently supported
(Robinson et al., 2023). Similarly, military cohort studies from 2020-2024 showed increased
incidence of heavy drinking and substance misuse post-combat deployment, consistent with SMH
predictions (Jacobson et al., 2024).
Experimental studies investigating stress-induced substance craving provide nuanced findings.
Stress protocols such as the Trier Social Stress Test (TSST) reliably increase subjective craving and
desire to consume alcohol or nicotine, but actual consumption patterns vary across individuals
and contexts (McRae-Clark et al., 2021; Childs & de Wit, 2022). These mixed findings highlight
that acute stress raises the motivational drive for substance use but does not uniformly translate
into increased intake, possibly moderated by prior substance use history and individual resilience
factors (Gordh et al., 2023).

A key limitation in SMH remains the challenge of establishing causal mechanisms in naturalistic
disaster or trauma settings. Yet, post-disaster substance use is frequently interpreted as self-
medication, where substances serve as coping aids to manage psychological sequelae of trauma
(Benight et al., 2021). Importantly, perceived coping self-efficacy appears to modulate this
relationship: individuals with low self-efficacy are more prone to self-medicate following
disasters, emphasizing the need to consider cognitive appraisals in SMH frameworks (Cinciripini
et al., 2020; Skutle, 2021).

SOCIAL COGNITIVE THEORY (SCT)

In contrast to the individual focus of SMH, Bandura’s Social Cognitive Theory (SCT) emphasizes
the reciprocal interplay between personal, behavioral, and environmental factors influencing
substance use and psychological outcomes (Bandura, 2019; 2024). Central to SCT is the construct
of self-efficacy — the belief in one's ability to execute actions to manage prospective situations —
which critically governs behavior initiation, persistence, and change (Bandura, 2022).

Disaster exposure imposes substantial environmental demands that individuals must navigate.
Self-efficacy influences disaster appraisal and coping, affecting psychological distress trajectories.
Physiological responses to trauma (e.g., elevated heart rate, hypervigilance) may feed back to
diminish perceived self-efficacy, exacerbating distress (Benight & Bandura, 2020). Meta-analytic
evidence from 2020-2025 indicates moderate to large negative correlations between self-efficacy
and PTSD symptom severity and general distress (r ≈ -0.50) in disaster-affected populations
(Luszczynska et al., 2024).

Moreover, SCT incorporates collective efficacy, or the shared belief in a community's capacity to
act cohesively to manage challenges (Bandura, 2023). This social dimension is crucial in disaster
contexts, where community resilience and collective action strongly predict lower psychological
distress and better recovery outcomes (Norris et al., 2022). For example, research involving public
health workers post-hurricane exposure demonstrates that both individual and community
collective efficacy reduce odds of PTSD and depressive symptoms, even after controlling for
sociodemographic and exposure variables (Ursano et al., 2021; Fullerton et al., 2023).

Further, self-efficacy acts as a protective factor buffering the effects of high stress on burnout and
compassion fatigue among first responders (Prati et al., 2024). Those with high self-efficacy
maintain better psychological health despite repeated trauma exposure, suggesting interventions
that enhance self-efficacy could mitigate post-disaster mental health and substance use issues
(Prati et al., 2023).

2.3 Application of Social Cognitive Theory (SCT) to Self-Medication Among Nursing Students

Social Cognitive Theory (SCT), developed by Albert Bandura, explains human behavior as a
dynamic interaction between personal factors, behavioral patterns, and environmental
influences. One of the key constructs of SCT—self-efficacy—is particularly relevant to
understanding self-medication practices among nursing students.

According to recent studies, nursing students who report low self-efficacy in clinical decision-
making or medication administration are more likely to experience anxiety, emotional stress, and
reduced coping abilities, which increases the likelihood of engaging in self-medication (Khalil &
Abdalrahim, 2025). A cross-sectional study of nursing students by Kim et al. (2025) found that
students with lower confidence in their ability to manage stress or clinical tasks were significantly
more likely to rely on over-the-counter medications or leftover prescriptions as a coping strategy.
SCT suggests that when nursing students believe they cannot effectively manage the demands of
their academic and clinical responsibilities, they are more likely to seek short-term coping
mechanisms. Self-medication, in this context, becomes a behavior reinforced by the perceived
positive outcomes, such as quick relief from stress, improved sleep, or better focus.
Moreover, the social environment in which nursing students operate—often filled with peers who
may also self-medicate—can normalize and reinforce this behavior through observational
learning. Students may model the behaviors of classmates or senior students who use
medications informally to deal with similar challenges. As they observe these behaviors
producing desirable effects without immediate negative consequences, their outcome
expectations shift in favor of self-medication.

In addition, repeated exposure to clinical environments and pharmacological information may

increase students’ confidence in their ability to self-diagnose and treat themselves. This
perceived competence, although often misplaced due to incomplete training, further strengthens
the behavior.