Substance abuse, as defined by the World Health Organization [1], refers to the harmful or hazardous use of psychoactive substances, including both alcohol and illicit drugs. In Juba, South Sudan, substance abuse among secondary school students represents a significant public health concern. This escalating problem threatens students’ health and safety and also undermines academic performance and future career opportunities. Consequences for young people can be particularly severe and may include an increased risk of engaging in risky sexual behaviors, development of personality disorders, and exposure to sexual violence, criminal tendencies, and difficulties with academic achievement, mental health-related problems, and progression to drug dependence.

Globally, the burden of substance abuse is alarming. The WHO (2014) reports that harmful alcohol use leads to approximately 3.3 million deaths annually and that at least 15.3 million people experience drug use disorders. Additionally, a report by the United Nations Office on Drugs and Crime (UNODC) on World Drugs highlights that, in 2021, approximately 1 in every 17 individuals aged 15 - 64 worldwide reported drug use in the past year, with the estimated number of drug users rising from 240 million in 2011 to 296 million in 2021, representing about 5.8% of the global population within this age group.

Cannabis remains the most widely used psychoactive substance, with an estimated 219 million users globally in 2021, accounting for 4.3% of the adult population. Notably, the demographic profile of cannabis users is changing: although men comprise about 70% of users, the gender gap is narrowing in some regions. For example, women account for 42% of cannabis users in North America.

Importantly, the prevalence of psychoactive substance use among school-going adolescents is often higher than in the general population. The UNODC World Drug Report indicates that approximately 5.3% of 15 - 16-year-olds globally (about 13.5 million individuals) reported using cannabis in 2021. Despite global evidence on substance abuse, South Sudan, a fragile state, remains underrepresented in the literature; this gap motivates the present research. Evidence from other regions underscores the relevance of this issue for young people. For instance, the European School Survey Project on Alcohol and Other Drugs (ESPAD) reported that in 2019, about 73% of 15 - 16-year-old students had consumed alcohol at least once in their lifetime, and 45% reported use in the past 30 days [2].

Furthermore, evidence indicates a consistent association between substance use and poor mental health among adolescents. A systematic review and meta-analysis by Esmaeelzadeh et al. (2018) found that depression and anxiety were significantly associated with substance use among adolescents and young adults in the United States and Canada [3]. In addition, Bugbee et al. (2019) reported a strong association between substance abuse and poor academic performance, including declines in grades and school attendance [4]. Broader treatment-seeking patterns also suggest youth vulnerability: in South America, more than half of individuals seeking drug treatment are under 25 years old, and in Africa, 70% are under 35 years old. Specifically, for Juba, South Sudan, a WHO study (2020) reported that approximately 25% of youth had engaged in substance use by the end of secondary school [5].

Social dynamics and peer influence play a critical role in shaping students’ attitudes toward substance use. Adolescents may select friends who share similar attitudes and behaviors and may subsequently adopt or reinforce the substance-use behaviors and norms of their peer group. A systematic review by Mathys et al. (2020) found that both peer selection and peer socialization contribute to alcohol and tobacco use among adolescents [6]. Similarly, a meta-analysis by Watts et al. (2024) reported a significant overall association between peer influence and adolescent substance use, suggesting that adolescents may modify their substance-use behaviors in response to their friends’ actual or perceived substance use [7].

Students’ attitudes and perceptions may further influence their substance-use behaviors. Griffin and Botvin (2010) observed that adolescents may overestimate the number of their peers who use alcohol, tobacco, or other drugs. Such misperceptions can make substance use appear normal or socially acceptable, reduce perceived risk, and increase the likelihood of experimentation [8]. Prevention programs should therefore incorporate normative education that corrects inaccurate beliefs about peer substance use while strengthening students’ capacity to make informed, independent, and health-promoting decisions.

Studies among school-going adolescents have also identified substantial gaps in knowledge of substance use and prevention. Nurmala et al. (2021) reported that more than half of the high-school students in their study had inadequate knowledge of drugs and drug-prevention strategies [9]. Although students may be aware of common substances, such as alcohol and marijuana, they may lack detailed information about long-term consequences and legal implications. These knowledge deficits may hinder informed decision-making and increase the likelihood of experimentation and subsequent abuse. Therefore, this study aims to examine knowledge and attitudes toward substance abuse among secondary school students in Juba, South Sudan, and to explore the underlying factors contributing to substance use.

The study was conducted among secondary school students in Juba, South Sudan. We selected 20 out of 36 public secondary schools in Juba, South Sudan, using a random sampling method. Each school was listed on paper, rolled, and randomly picked. Each school was assigned a unique identification number from 1 to 20 using a list of eligible schools obtained from the relevant education authorities. Of the 20 selected schools, eight agreed to participate, whereas 12 did not participate. The study records did not document standardized reasons for non-participation; therefore, specific reasons for refusal could not be reported. Within each participating school, the school administration assisted in identifying eligible students enrolled in Senior Two, Senior Three, and Senior Four. Approximately 53 students were selected from each school; however, one school contributed 59 students because of the availability of eligible students and school-level arrangements during data collection. Overall, 430 students from eight public secondary schools, including boys’ and girls’ schools, completed the survey. The non-participation of 12 selected schools may have introduced selection bias, as participating schools may have differed from non-participating schools in characteristics such as administrative support, student enrollment, socioeconomic composition, and availability of health-education activities. Therefore, the findings should be interpreted as representing students in the eight participating schools and may not be generalizable to all public secondary school students in Juba.

This section presents the findings of the study based on a survey of 430 students. Figures, pie charts, and tables are used to illustrate the key findings and trends. The results cover students’ knowledge of substance abuse in relation to their socio-demographic characteristics, attitudes toward substance use, commonly used substances, and perceived factors influencing substance use.

This study provided important insights into secondary school students’ perceived knowledge and attitudes toward substance abuse in Juba, South Sudan. Approximately 70% of respondents reported lacking essential information about substance abuse, indicating a need for targeted and contextually appropriate educational interventions. Perceived knowledge appeared to vary according to sociodemographic characteristics, including age and annual household income. Previous studies have suggested that lower socioeconomic status may limit access to educational resources and reduce awareness of the risks associated with substance use [10].

Most respondents were between 17 and 25 years of age. This age distribution is noteworthy because, as Castellanos-Ryan et al. (2013) point out, adolescence and early adulthood are recognized as critical developmental periods for the initiation and escalation of substance use [11]. Awareness also appeared to differ by grade level, with Senior 4 students demonstrating greater knowledge than Senior 2 students. This pattern is consistent with evidence from a systematic review by Onrust et al. (2016), which found that the effectiveness of school-based substance-use prevention programs differs across age groups, supporting the need to match program content and delivery to students’ developmental stage [12].

Peer effect was identified as an important perceived contributor to substance use. Most respondents indicated that linking with peers who use substances may increase an individual’s vulnerability to substance abuse. This finding is consistent with social learning theory, which proposes that people learn behaviors by observing and interacting with others, particularly their peers [13]. Prevention programs should therefore promote positive peer networks and strengthen students’ ability to resist negative social pressure.

Many respondents perceived substance abuse as criminal behavior. However, El Hayek et al. (2024) explained that criminalizing drug use may reinforce stigma, social marginalization, fear of legal consequences, and delayed access to health care [14]. Such framing may discourage adolescents from disclosing substance-use experiences or seeking support. Stigma can further prevent individuals from accessing appropriate support and treatment. McGinty et al. (2020) recommended stigma-reduction communication that uses person-first, non-stigmatizing language and presents substance-use disorders as treatable public-health conditions rather than moral or criminal failings [15].

Nicotine/cigarettes/cannabis/marijuana was identified as the most commonly used substance, followed by Ice, or methamphetamine, cocaine and morphine, and alcohol. The reported use of Ice, locally known as telich, in domestic settings or before sporting activities highlights the influence of social environments on substance-use patterns. Prevention efforts should therefore address substance use within the specific contexts in which students encounter or use these substances [16].

Lack of family support was perceived as the most influential factor contributing to substance use among the respondents. This finding is consistent with evidence reported by Horigian et al. (2016), who emphasized that supportive parenting, effective parental monitoring, positive parent-adolescent communication, and strong family attachment are important protective factors against adolescent substance use [17]. Mental health challenges were also identified as significant contributing factors, highlighting the need for integrated interventions that address both mental health and substance use among adolescents. Such interventions should involve families, schools, communities, and relevant health and social services.

This study identified substantial gaps in secondary school students’ knowledge of substance-related risks in Juba, South Sudan. These gaps were particularly evident among students aged 17 - 25 years and appeared to vary across socioeconomic and educational backgrounds. The findings highlight the need for accessible, age-appropriate, and culturally relevant prevention programs.

Peer influence, limited family support, and mental health challenges were perceived as major contributors to substance use. In addition, the perception of substance abuse as criminal behavior may contribute to stigma and discourage affected students from seeking help. Prevention efforts should therefore combine accurate health education with psychosocial support, family engagement, positive peer influence, and clear information about legal and social consequences.

Overall, substance-use prevention should follow a coordinated, school- and community-based approach. This approach should include comprehensive education, early identification of students at risk, mental health services, family involvement, positive peer programs, and accessible referral pathways for students who require further assistance.

Implement comprehensive, age-appropriate education programs. Schools, in collaboration with community organizations and health authorities, should provide structured substance-use education that is appropriate to students’ age, grade level, and socioeconomic context. These programs should provide accurate information on the health, academic, social, and legal consequences of substance use, with particular attention to ice, nicotine products, cannabis, alcohol, cocaine, and morphine.

Strengthen family engagement and support. Schools should establish parent- and caregiver-focused workshops, counseling opportunities, and communication initiatives to improve family awareness, supervision, and supportive relationships. Strengthening family communication may reduce students’ vulnerability to substance use and improve early identification of behavioral or emotional difficulties.

Integrate school-based mental health services. Education authorities should prioritize accessible counseling and psychosocial support within secondary schools. Schools should train relevant staff to identify students experiencing emotional distress, establish confidential referral systems, and promote mental health literacy as part of substance-use prevention.

Establish peer mentorship and student-support initiatives. Schools should develop peer mentorship programs in which trained senior students support younger students. These initiatives should promote positive peer norms, provide practical strategies for resisting peer pressure, and create safe spaces for students to discuss substance-related concerns without fear of stigma.

Adopt a public health-oriented policy approach. Policymakers should address substance abuse as a public health, educational, and social welfare priority rather than solely as a criminal matter. This approach should increase investment in prevention, counseling, early intervention, community awareness, and referral services for young people.

Promote multisector coordination and monitoring. Effective prevention requires collaboration among schools, parents, health professionals, community leaders, civil society organizations, and relevant government institutions. Stakeholders should establish mechanisms to monitor substance use trends, evaluate prevention programs, and adapt interventions in response to emerging student needs.

The author gratefully acknowledges the National Ministry of General Education and Instruction, the State Ministry of Education and Instruction in Central Equatoria State, Juba, and the authorities of the selected secondary schools for granting permission to conduct this study in their schools. The author also expresses sincere gratitude to the three University of Juba students who assisted with data collection.