Psychoactive Substances (PAS) encompass a group of products that, when consumed by an individual, lead to modifications in brain function, affecting cognition, emotions, perception, or behaviour [1] . These substances include tobacco and its derivatives, alcoholic products, drugs (cannabis, cocaine, etc.), stimulants, sedatives and sleeping pills, hallucinogens, inhalants, opioids, etc. [2] . The consequences of PAS consumption are manifold and depend on the specific substance, quantity consumed, and frequency of use, ranging from temporary effects on mood and perception to social and health problems, including fatalities [3] [4] [5] [6] [7] . In 2019, globally, approximately 19% of Disability-Adjusted Life Years (DALYs) and 23% of deaths among individuals aged 20 and above were attributed to the consumption of PAS (tobacco, alcohol, and drugs) [8] . Despite the strategies adopted and implemented at both international and national levels (strengthening legislation, enforcement, WHO Framework Convention on Tobacco Control, MPOWER program, SDG 3, etc.), recent data suggest an upward trend in non-tobacco PAS consumption [9] [10] [11] [12] .

The main motivations cited by consumers of these products include seeking performance enhancement, fatigue reduction, coping with stress, depression, and anxiety, enhancing social connections, seeking pleasure, and recreational purposes [13] [14] [15] . However, fatigue, stress, and loneliness are part of routine life for many professionals, including Heavy Goods Vehicle (HGV) drivers, making them particularly susceptible to consuming PAS. A systematic review across America, Europe, Asia, and Africa reported the following prevalence of PAS consumption among truck drivers: 21.3% for amphetamines, 5.9% for cannabis, 4.3% for opioids, 4.1% for stimulants, 2.2% for cocaine, and 1.0% for benzodiazepines [16] . Nevertheless, an HGV driver operating under the influence of PAS poses a substantial risk to himself and other road users [17] [18] . It is all the more worrying as road accidents involving HGVs are more lethal than those involving other types of vehicles. Factors determining PAS consumption among HGV drivers are related to their socio-demographic characteristics and the professional context in which they work [19] [20] [21] [22] [23] . Younger and less experienced drivers appear more likely to consume PAS than older and experienced counterparts [20] [21] [23] . Similarly, drivers with longer working hours and distances covered, and those reporting sleep disturbances and night driving, seem to be at a higher risk of PAS use [19] [20] [21] [22] .

In Benin, as in most countries with access to the sea and port infrastructure, HGV drivers play a crucial role in the logistics chain, facilitating the transportation of goods within the country or between other countries in the sub-region. In recent years, with the development of road infrastructure, there has been an increase in the number of registered and operating HGVs on Benin’s roads [24] [25] . According to the Transport Statistics Yearbooks, 2962 HGVs were registered in Benin between 2010 and 2018 [24] [25] . A literature review suggests that besides the extent of PAS consumption among HGV drivers in Benin, the determinants of this behaviour are not well-documented. It constitutes a significant gap in the efforts to combat PAS consumption among HGV drivers. While road accidents involving HGV are less frequent than other road collisions in Benin, they are among the most severe and claim many victims [24] [25] . This study aimed to fill these gaps by estimating the prevalence of PAS misuse among HGV drivers and identifying associated factors. The results will aid in designing context-specific interventions and guide future research endeavours.

Investigating the level of PAS misuse among HGV drivers is part of an effort to improve their living and working conditions. It is a professional group exposed to lifestyles and working conditions that are not conducive to good health [19] [30] [31] .

In the scientific literature, two approaches are generally adopted to assess PAS consumption among HGV drivers. The first one involves evaluating recent consumption based on drivers’ self-reports using questionnaires or conducting urine or blood tests. The second one aims to determine past consumption (over the previous weeks or months), which better accounts for the social and health consequences. Besides, there is variability in the range of substances considered from one study to another, with some focusing on a particular one, typically alcohol, while others examine multiple ones. As a result, the opportunities for comparing the level of PAS misuse among HGV drivers, as highlighted by different studies on the subject, are limited. It emphasizes the need for standardization of data collection methods to facilitate comparisons. We assessed PAS misuse using the ASSIST, which considers the three months preceding the survey date. As a screening tool, the ASSIST offers the advantage of easy administration and comprehensive coverage of most PAS categories. We included the following PAS: tobacco, alcohol, cannabis, cocaine, amphetamine-type stimulants, sedatives and sleeping pills (benzodiazepines), hallucinogens, inhalants, and opioids. Among the surveyed drivers, we observed that 12.47 were experiencing PAS misuse. Besides, high-risk consumption was observed for alcohol, amphetamines, and opioids in 0.24% to 0.47% of drivers. A study in Brazil in 2022, using the same screening tool, reported a prevalence of high-risk consumption of at least one PAS at 23% [19] . This difference could be explained by greater accessibility to illicit drugs in that geographical area compared to Benin.

We observed that the odds of PAS misuse were significantly higher among young drivers, especially those under 35. This finding corroborates the conclusions of other studies [20] [21] . In Brazil (2015), drivers under 40 were 2.11 times more likely to consume PAS than their counterparts aged 40 and above [21] . Similarly, in Ethiopia in 2021, drivers aged 38 and above were 60% less likely to consume PAS than their counterparts under 38 [20] . Young individuals may be more inclined to work longer hours and irregular schedules than their older or married colleagues, which increases the risk of higher workloads and consequent use of products to maintain good performance [21] . In contrast, older individuals are more likely to have family responsibilities, which leads them to be more responsible in their behaviour and lead a healthy lifestyle [21] . It is well-known that most people who consume PAS start during adolescence [32] .

The findings suggest a significant negative relationship between educational level and PAS misuse. Drivers with a primary education were less likely to misuse PAS than those with no formal education. Educational level is a social determinant of health that influences individuals’ ability to make health-favorable decisions for themselves and their loved ones [33] . Well-educated drivers would be more aware of the health, social, legal, or financial issues associated with PAS. In the present study, just over half of the surveyed drivers had a primary education, and nearly one in five drivers had received no formal education. For this group, whose educational level may not be significantly improved at an advanced age, implementing information, education, and communication campaigns on PAS with peer support is a promising approach [34] . The requirement for HGV drivers to hold a specific driving license provides the opportunity to focus on PAS prevention by reinforcing their knowledge during the training phase. In a study conducted in Ethiopia in 2021, which reported a contrary relationship to what we found, the authors emphasized that the consumption of PAS may be seen as a manifestation of modernity and success, leading to higher consumption rates among groups with relatively higher educational levels [20] .

We also observed PAS misuse among drivers who reported taking breaks during driving. These drivers were three times more likely to misuse PAS than others. Similarly, a study conducted in Ethiopia in 2021 found that truck drivers who took breaks between trips were twice as likely to consume PAS than those who did not take breaks between trips [20] . It could be explained by the fact that after long hours of driving, some drivers experience a decline in performance (reduced attention and reactivity, drowsiness, accumulated fatigue) and decide to take a rest during which they may be tempted to consume PAS to accelerate the recovery process [20] [31] . For other drivers, it could signify a progression towards dependence, where they develop a need to take regular breaks to be able to consume PAS.

We found that PAS misuse was more prevalent among individuals with cardiovascular diseases. Those with cardiovascular diseases were three times more likely to have PAS misuse than non-affected individuals. Having a history of cardiovascular illness can be a source of stress and anxiety for some drivers, which creates a conducive environment for PAS consumption. Additionally, in the context of Benin, self-medication and the use of traditional remedies passed down by elders or based on rumours are widespread practices. Some HGV drivers may be motivated to consume PAS based on the belief or perception that these substances are effective in treating ailments. Further research is needed to document why people with chronic illnesses misuse PAS.

We can identify some limitations of this study. The cross-sectional design does not allow for establishing a causal relationship between the considered exposures and the dependent variable. As previously mentioned, we assessed PAS misuse using the ASSIST. The responses to the ASSIST’s questions were self-reported by participants, which could introduce desirability bias, leading to an underestimation of the prevalence of their risk behaviours. Besides, the retrospective nature of the ASSIST’s questions (covering the past three months) relying on memory could introduce recall bias. Despite these limitations, the findings of this study remain of great interest in a professional sector with significant individual and population risks, which has been somewhat sidelined in public health terms in Benin.

We found that a significant proportion of HGV drivers misused PAS. Therefore, addressing the issue of PAS consumption among HGV drivers should receive greater attention from public authorities. Driving under the influence of PAS is recognized as a primary risk factor for the occurrence and severity of road accidents. This study also suggests that this behaviour is associated with other factors. The PAS misuse among HGV drivers varied according to their socio-demographic characteristics, health status and professional characteristics. Considering all these factors in prevention strategies based on an integrated approach would likely yield more effective results. Special attention should be given to implementing interventions targeting young HGV drivers, those without formal education, those who take regular breaks while driving, and those with a history of cardiovascular conditions.

The authors declare no conflicts of interest regarding the publication of this paper.

Glèlè-Ahanhanzo, Y., Mohammed, N., Daddah, D., Gaffan, N., Salami, L. and Kpozehouen, A. (2023) Prevalence and Factors Associated with Psychoactive Substance Misuse among Heavy Goods Vehicle Drivers in Cotonou, Benin. Open Journal of Epidemiology, 13, 260-275. https://doi.org/10.4236/ojepi.2023.134020