Substance Abuse Among Healthcare Students: The Interplay of Stress, Knowledge, and Awareness
- Rania Magableh
- Sep 3
- 6 min read
By Rania Magableh
If healthcare students know the risks of substance abuse, why do some still fall into it?
Picture this: you’re a healthcare student, you wake up, go to classes, study for exams, push through demanding courses and endless clinical hours. The whispers don’t stop: “I can’t do this anymore. I need help. I can’t give up.” Then you sleep, wake up, and repeat.
You think of trying sports, wellness programs, or creative outlets, but they’re scarce, expensive, or impossible to fit into your timetable. Maybe mental health services could help, but fear strikes: “What if my friends or family find out? They’ll see me as weak and a disgrace.”
This is the reality of many healthcare students particularly in countries in the Middle East like Jordan, Palestine, Saudi Arabia, or Egypt. Academic-life balance collapses under the weight of stress . Mental health services are hard to find and even when it exists, stigma and judgment loom large. So, students turn inward, carrying the burden alone. And when healthy coping mechanisms are out of reach, the situation combined with the accessibility of substances may trick them into thinking their use is a reasonable way to get through another exam season.
But is this simply just a transient misjudgment fueled by stress, or there are neurobiological factors at play?
Ever wonder how stress might slowly reshape your brain?
It helps to look at the issue through a neurobiological lens. Chronic stress isn’t just a mood killer, it can physically alter the brain.
Multiple neuroimaging studies have shown that prolonged stress damages specific brain regions responsible for functions like learning, memory, self-awareness, emotional regulation, and decision-making. By weakening these functions, harmful coping strategies, like substance abuse, might become more tempting and harder to consciously recognise and resist.
But then one might ask: if this is a case of neurobiological changes, why do some knowledgeable healthcare students engage in substance abuse while others don’t? Part of the answer lies in other factors, such as the distinction between knowledge and awareness, and how these two concepts shape someone’s beliefs.
Knowledge vs. Awareness
Knowing something doesn’t necessarily mean being aware of it. Knowledge is informational, factual, and often impersonal. It’s what a healthcare student learns in lectures or textbooks. Awareness, on the other hand, is experiential and personal. It’s the ability to connect that knowledge to one’s own perceptions, emotions, and triggers. For example, a healthcare student might have the knowledge that smoking cigarettes damages their lungs. While awareness would be recognising that they smoke to fit in with their group of friends. This self-recognition, often called conscious self-awareness is important for understanding how risk factors like stress, trauma or peer pressure could influence personal behaviour.
The Impact of knowledge and awareness on behaviour
Diagram 1: Conceptual framework inspired by Psychology Town (2024) and Samraj (2022), developed and presented by Rania Magableh.
As presented in the diagram, the way knowledge and awareness interact helps shape a student’s beliefs which then influence their behaviour.
Research among healthcare students in Jordan, a Middle Eastern country, found that students who believed that risk factors such as peer pressure, loneliness, or childhood trauma could lead to substance abuse were more aware of these risks and, as a result, were less likely to abuse substances themselves. In contrast, students who were less likely to believe in or be aware of these factors were more likely to abuse. suggesting that inadequate awareness of risk factors may be directly linked to greater vulnerability to substance abuse.
This distinction between knowing something and truly being aware of it reveals that, although education and knowledge are important in preventing substance abuse, they may not be sufficient on their own. It is also essential to foster awareness through self-reflection, emotional understanding, and the ability to recognize one’s own triggers before they lead to harmful behaviour.
Conclusion and Recommendations
While the challenge of unbalanced stressful environment is more profound in Middle Eastern regions , the application of self-awareness intervention programs in mental health education is a global gap that is essential to be tackled in a demanding, vulnerable and critical environment of healthcare students.
To reduce risks of substance abuse and foster a healthier, more resilient future healthcare workforce, the following actions are recommended to policy makers and public health advocates:
Recommendation | Expected Outcome | Example / Implementation |
Integrate self-awareness with knowledge and education in student programs | Foster beliefs that positively influence students' behaviour | The Self-Awareness Intervention Program (SAIP) is a five-day program that directs participants' attention inward, increases self-talk vigilance, and encourages understanding the self beyond external pressures. It resulted in significant improvements in well-being and self-awareness measures compared with those who didn't participate. |
Integrate digital platforms based on awareness principles, especially in stigma and judgment prone regions | Private, accessible, and personalised mental health care | The Foojan App is a telehealth platform delivering personalized, affordable, and accessible mental health support worldwide. It offers guided self-awareness journaling, skill-building videos, and professional psychotherapy/coaching, helping users make measurable improvements in life domains. |
Include stress-reduction and wellness practices within educational programs | Help healthcare students manage stress effectively. | Rajiv Ghandi University of Health and Sciences, India, implements mandatory programs including yoga and mindfulness practices for healthcare students. |
Incorporate knowledge of the neurobiological mechanisms underlying substance use disorder (SUD) risk factors into educational and treatment strategies | Improved, neuroscience-informed prevention and treatment of SUD | While there is a lack in global programs integrating neuroscience fully into substance use treatment, a neuroscience-informed framework based on the Research Domain Criteria (RDoC) has been proposed to classify and guide prevention interventions by targeting neurocognitive processes underlying substance use risk. |
Finally, healthcare providers are the guardians of our well-being. When we protect their health, we protect us all. To build resilient healthcare systems that uphold the ethical and professional standards of this noble profession, we must ask: who is taking care of the future caregivers? finding the right answers will ultimately enhance their ability to deliver safe, compassionate, and effective care to their patients.
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