INTRODUCTION:

Substance abuse among adolescents remains a profound global health challenge, affecting not only the individuals involved but also their families and communities. Adolescence is recognized as a developmental stage marked by increased vulnerability to risk behaviors such as drug and alcohol use, which can lead to significant long-term consequences including mental health disorders, academic difficulties, and higher rates of addiction in adulthood. According to recent data, more than 40 million people worldwide are regular substance abusers. The substances most frequently misused by adolescents include alcohol, tobacco, cannabis, prescription medications, and various illicit drugs such as amphetamines and opioids.^1-4

Adolescence is considered a vulnerable period for the initiation of substance use due to curiosity, peer pressure, and lack of awareness regarding its ill effects. Several studies have highlighted that adolescents often possess incomplete or erroneous knowledge about substance abuse, which increases the risk of experimentation and habituation. A descriptive study conducted in Amritsar revealed inadequate awareness among higher secondary school students, thereby emphasizing the need for innovative educational strategies targeting this age group¹⁸. Similarly, another review reported that early identification and appropriate interventions, such as role play and peer-led activities, can contribute to meaningful behavioral change, especially when integrated into school health programs¹⁹. Knowledge reinforcement through interactive methods thus plays a crucial role in prevention.²⁰

The issue is particularly critical in India, where recent surveys have shown that the prevalence of substance abuse among adolescents is alarmingly high. For instance, national and regional studies indicate a growing trend in the use of alcohol and other substances among youth, with prevalence rates reported between 23% and 80% in some populations. Kerala, a state traditionally known for its progressive health indicators, is now facing a drug crisis with the highest rate of drug-related cases in India, outpacing even Punjab, the long-time epicenter of the problem. In 2024 alone, Kerala documented over 27,000 cases under the Narcotic Drugs and Psychotropic Substances (NDPS) Act, more than triple those of Punjab, signaling a pressing need for effective prevention and intervention strategies.^5-7

Multiple factors contribute to substance abuse among adolescents, including family history, low self-esteem, curiosity, peer pressure, easy access to substances, and socio-economic challenges. Social and environmental influences such as parental attitudes, academic stress, and exposure to high-risk environments play defining roles in shaping adolescent behavior and substance-related choices. The impact of substance use at this age extends beyond the individual, resulting in increased risk of violence, legal problems, accidents, and long-term health complications—burdens that ultimately affect the broader community and strain public health systems.^3,8,9

The prevention of adolescent substance abuse requires a multifaceted approach, with school-based education identified as a cornerstone of effective intervention. Various educational methods have been assessed for their ability to improve knowledge, attitudes, and self-efficacy related to substance use. Notably, interactive and participatory strategies such as role play have gained traction for their efficacy. Role play fosters active learning by simulating real-life scenarios, enhancing students' skills in resisting peer pressure, making informed decisions, and building self-confidence to refuse substance offers. Empirical studies have demonstrated that scenario-based or role-playing interventions can significantly increase knowledge and self-efficacy among students, as reflected by improvements in pre- and post-test scores.^10-12

Various teaching strategies have been employed to enhance adolescents’ knowledge of substance abuse. Structured teaching programs and video-assisted interventions have shown significant improvement in awareness levels among school and college students^21-24. For example, Manisha and Nain demonstrated the effectiveness of structured teaching modules among adolescents in a government school setting, with measurable gains in post-test scores²¹. Other studies have corroborated the effectiveness of interactive teaching, wherein students reported increased retention and better comprehension when exposed to role play activities, mock sessions, and scenario-based discussions^22,23. Compared to passive learning, role play fosters active participation, thereby equipping students with the cognitive and behavioral tools needed to resist peer pressure and substance experimentation.

A recent pilot study in Kerala, employing a pre-experimental one group pre-test/post-test research design, explored the effectiveness of role play on substance abuse knowledge among higher secondary students. The study found a notable increase in the mean knowledge score from 18.25±2.79 pre-intervention to 23.75±4.37 post-intervention (t=5.95, p<0.05), with nearly half the students achieving excellent knowledge post-intervention compared to none prior. This supports the growing body of evidence that structured, interactive teaching methods—especially those incorporating role play—can be instrumental in preventing and controlling substance abuse during adolescence.^13,14

In addition to educational interventions, psychosocial approaches such as mindfulness meditation and physical exercises have been found beneficial in reducing stress and anxiety among individuals with substance use disorders^20,27. However, in the context of prevention, role play holds unique potential among higher secondary school students as it not only enhances knowledge but also builds confidence in real-life refusal skills when confronted with social situations involving drugs or alcohol^25,26. By simulating practical scenarios, students learn to identify high-risk behaviors and respond appropriately, thus bridging the gap between theoretical knowledge and real-life practice. This evidence underlines the importance of incorporating role play as an effective teaching-learning method in schools to address the growing concern of substance abuse among adolescents.

These findings are corroborated by a variety of national and international studies, all of which reinforce the necessity for innovative educational strategies tailored to the needs of young people. Such approaches not only help fill critical gaps in knowledge but also empower adolescents with the social and cognitive skills needed to resist substance abuse. Continued evaluation and integration of participatory learning within school curricula, combined with community and policy-level initiatives, are fundamental for mitigating the ongoing substance abuse crisis among youth.^15-16

MATERIALS AND METHODS:

Study Design

A pre-experimental, one-group pretest–posttest design was used to examine the effectiveness of a role play intervention on students’ knowledge about substance abuse. This design allowed for baseline assessment, intervention, and reassessment within the same group, enabling measurement of the educational impact of role play activities.

Setting:

The study was conducted in Ramanattukara Higher Secondary School located at Vaidyarangadi, Kerala, India. This institution is approximately 6km away from the Red Crescent College of Nursing, Kozhikode.

Participants and Sampling:

The study population included students in the first year of higher secondary education aged 15 to 18 years. Participants were selected through a non-probability convenience sampling approach. Inclusion criteria comprised students within the specified age range, those willing to provide informed consent, and those present during the data collection period. Exclusion criteria encompassed students unwilling to participate or absent at the time of data collection. Ultimately, 40 students were recruited for the study.

Tools and Instruments:

Demographic Data Collection:

A structured questionnaire gathered demographic information such as age, gender, religion, educational attainment of parents, parental occupation, family type, and socio-economic classification.

Knowledge Assessment Tool:

Knowledge regarding substance abuse was assessed using a semi-structured, multiple-choice questionnaire developed following a comprehensive review of literature and evaluation by subject experts. The instrument consisted of 30 questions with one correct answer each, scored as 1 for correct and 0 for incorrect responses (maximum score: 30). Knowledge levels were categorized as follows: Excellent (25–30), Good (20–24), Average (15–19), and Poor (<14).

Instrument Validation and Reliability:

Content validity was established through review by a panel of three subject experts. The reliability of the knowledge questionnaire was confirmed using the Brown Spearman split-half technique, yielding a coefficient of 0.85.

Data Collection Procedure:

Data collection spanned two weeks. After receiving ethical clearance and necessary permissions, researchers introduced the study and obtained written informed consent from participants. During phase one, baseline knowledge (pretest) was measured by administering the questionnaire. Immediately following the pretest, students participated in a structured role play session designed to simulate real-life substance abuse scenarios and promote knowledge, refusal skills, and awareness.

After a period of 7 days, the same questionnaire was re-administered as a posttest to assess changes in knowledge. Throughout the process, confidentiality was ensured and participation was voluntary.

Data Analysis:

Colleted data were coded and entered electronically for analysis. Descriptive statistics including frequency, percentage, mean, and standard deviation were calculated for demographic and knowledge variables. Paired t-tests determined differences between pretest and posttest knowledge scores. Associations between demographic factors and posttest scores were evaluated using the chi-square test. A significance threshold of p<0.05 was applied.

Ethical Considerations:

The study obtained prior ethical approval from the institutional ethics review committee. Written informed consent was secured from all participants after explaining the study objectives and procedures. Confidentiality of participant data and the option to withdraw from the study at any stage were ensured throughout the research process

RESULT:

The present study analyzed the data collected from 40 higher secondary students of Ramanattukara Higher Secondary School at Viadyarangadi to evaluate the effectiveness of role play on knowledge regarding substance abuse. The results are presented under the following headings:

Demographic Profile of Participants:

The demographic characteristics of the participants are summarized in Table 1.

Table 1: Frequency and percentage distribution of demographic characteristics of participants

Demographic Variable	Frequency (n=40)	Percentage (%)
Age Group
15–16 years	30	75
17–18 years	10	25
Religion
Hindu	25	62.5
Muslim	10	25
Christian	5	12.5
Sex
Male	20	50
Female	20	50
Education status of father
Primary education	10	25
High school	12	30
Higher secondary	8	20
Degree and above	10	25
Education status of mother
Primary education	12	30
High school	10	25
Higher secondary	12	30
Degree and above	6	15
Occupation of father
Government	5	12.5
Private	15	37.5
Coolie	20	50
Occupation of mother
Government	3	7.5
Private	10	25
Coolie	10	25
Type of family
Nuclear	28	70
Joint	12	30
Socio-economic status
Above Poverty Line (APL)	15	37.5
Below Poverty Line (BPL)	25	62.5

Knowledge Level on Substance Abuse Before and After Role Play Intervention

The knowledge levels assessed by the semi-structured questionnaire before (pretest) and after (posttest) the role play intervention are summarized in Table 2.

The intervention significantly improved participants’ knowledge. Initially, the majority (75%) had average knowledge, and none exhibited excellent knowledge. Following role play, 47.5% demonstrated excellent knowledge, and 30% had good knowledge (Figure 1).

Figure 1: Distribution of knowledge level before and after intervention

Statistical Analysis of Effectiveness of Role Play

The effectiveness of the role play intervention was quantitatively analyzed using paired t-test (Table 3).

Table 3: Effectiveness of the role-play intervention

Asse-ssment Type	Mean Score	Stan-dard Devi-ation	Mean Diff-erence	SD Diff-erence	t-value	Critical t-value (df=39, p<0.05)
Pretest	18.25	2.79	5.5	1.58	5.95	2.70
Posttest	23.75	4.37

The mean knowledge score significantly increased from 18.25 in the pretest to 23.75 in the posttest (t=5.95, p<0.05), indicating that the role play intervention was effective in enhancing knowledge regarding substance abuse among higher secondary students.

Association Between Posttest Knowledge Scores and Demographic Variables:

Chi-square tests were conducted to evaluate associations between posttest knowledge levels and demographic factors . None of the demographic variables showed a statistically significant association with the knowledge scores post-intervention (p > 0.05 in all cases).

Key results include:

· Age (χ² = 2.743, p > 0.05)

· Religion (χ² = 3.175, p > 0.05)

· Sex (χ² = 0.476, p > 0.05)

· Education status of father (χ² = 6.342, p > 0.05)

· Education status of mother (χ² = 2.005, p > 0.05)

· Occupation of father (χ² = 5.564, p > 0.05)

· Occupation of mother (χ² = 1.311, p > 0.05)

· Type of family (χ² = 0.152, p > 0.05)

· Socio-economic status (χ² = 0.045, p > 0.05)

These results suggest that the improved knowledge levels after role play were independent of the demographic characteristics examined.

SUMMARY OF KEY FINDINGS:

· Majority of students initially had average knowledge about substance abuse, with poor and excellent knowledge levels being less common.

· Following the role play intervention, a substantial proportion of students demonstrated excellent and good knowledge levels.

· The role play significantly increased the mean knowledge score (p < 0.05).

· No significant association was found between post-intervention knowledge and demographic variables.

These findings underscore the positive impact of role play as an educational strategy to enhance knowledge regarding substance abuse among adolescents in higher secondary school. The intervention appears to be effective regardless of age, sex, religion, parental education or occupation, family type, or socio-economic background

DISCUSSION:

The findings from this study demonstrated a significant improvement in the knowledge levels of higher secondary students regarding substance abuse following a role play intervention. Prior to the intervention, a substantial proportion of participants exhibited only average knowledge, with a small percentage displaying poor knowledge. After the role play, nearly half of the students attained an excellent level of knowledge, while levels of poor knowledge were completely eliminated. Statistical analysis affirmed that the observed gains were significant, as indicated by the large mean difference in test scores and the associated t-test results, signaling the effectiveness of the role play as a teaching-learning strategy.

This outcome is consistent with previous research conducted across various educational settings, where structured teaching interventions, including role plays and awareness programmes, have been shown to foster greater understanding and retention of information about substance abuse among adolescents. The interactive nature of role play likely facilitated deeper engagement and active participation, enabling students to internalize knowledge through both observation and enactment. By simulating real-world scenarios and peer interactions, this method helped demystify the subject, making the content accessible and relatable for young learners.

An important aspect of the present study is that demographic factors such as age, gender, parental education, socio-economic status, and type of family did not show any significant correlation with the post-intervention knowledge outcomes. This suggests that role play as an educational approach can effectively bridge knowledge gaps across different groups, making it a universally adaptable tool in adolescent health education. The lack of demographic influence also implies that the format is inclusive and can be deployed in culturally and socioeconomically diverse classrooms.

Implications for nursing practice are substantial. Nurses, particularly those working in school health and community health settings, can act as facilitators for similar educational interventions. Incorporating role play into health education not only enhances student knowledge but also supports early prevention efforts, which are crucial in addressing the growing public health challenge of substance abuse. Additionally, this strategy aligns with the principles of evidence-based practice, underscoring the need for interactive, student-centered approaches in nursing education and community outreach. Such programs not only benefit the target population but also empower nurses to adopt creative, impactful methods of health promotion.

CONCLUSION:

The present study clearly demonstrated that role play is an effective instructional method for enhancing knowledge about substance abuse among higher secondary school students. Before the intervention, most participants exhibited only average awareness, with a notable proportion showing limited understanding of the consequences and risks associated with substance use. Following the targeted role play session, there was a marked and statistically significant increase in knowledge scores, with nearly half of the students achieving an excellent level of understanding on post-test assessment. This improvement underscores the value of interactive, student-centered educational strategies in addressing critical health topics among adolescents.

Furthermore, the analysis did not reveal any significant association between post-intervention knowledge gains and demographic variables such as age, gender, parental education, or socio-economic status. This finding suggests that role play can be universally effective across diverse groups of students, making it a highly adaptable approach for health educators and school nurses working in varied settings. The non-significant effect of demographics also indicates that knowledge gaps related to substance abuse can be bridged regardless of background factors, provided quality educational interventions are implemented.

For nursing practice, these findings highlight the importance of integrating innovative teaching methods like role play into substance abuse prevention programs targeting adolescents. Nurses and nurse educators are well-positioned to utilize such approaches—in schools, communities, and clinical environments—to empower young people with accurate information and practical skills to make informed choices. By leveraging experiential learning and peer engagement, nurses can enhance the impact of health education and contribute to early prevention of substance misuse.

In summary, this study provides evidence that role play is a powerful tool for improving substance abuse knowledge among adolescents. Widespread adoption of this method in nursing education and community health initiatives could play a crucial role in curbing substance abuse trends, fostering healthier behaviors, and supporting the overall well-being of youth populations. Continued research is recommended to further explore long-term outcomes and to adapt the intervention for broader application in different educational and cultural contexts.

CONFLICT OF INTEREST:

The authors of this study declare that there were no potential conflicts of interest with respect to the research, authorship, and publication of this article. All procedures were carried out independently, without any external financial support, influence from third parties, or personal relationships that could have inappropriately affected the conduct or outcomes of the study. The research was conducted solely for academic and scientific purposes.

ACKNOWLEDGMENTS:

The author would like to thank Dr. Nisha. S, Principal, Red Crescent College of Nursing, Kerala.

REFERENCES:

1. Substance Abuse/Chemical Dependence in Adolescents. SENDE

2. tanford Children’s Health. 2024 Feb 13.

3. Substance Use in Adolescents. MSD Manuals. 2025 May 4.

4. Nath B, Kant S, Kumar V, et al. Substance Abuse Amongst Adolescents: An Issue of Public Health Importance. J Public Health. 2022 Nov 7; PubMed PMID: 36505140.

5. Indian Academy of Pediatrics Delhi. Substance Abuse in Children & Adolescents. 2021.

6. Raveendran R, Sajna MV. Prevalence and determinants of substance abuse among youth in central Kerala. Indian J Public Health. 2017; 61(3): 747-752.

7. Kerala's drug crisis: A call for collective action. New Indian Express. 2025 Apr 10.

8. Kerala is in the grip of a surging drug crisis. The Economic Times. 2025 Mar 23.

9. Mayo Clinic. Teen drug abuse: Help your teen avoid drugs. 2023 Feb 22.

10. Tripathi BM, Lal R. Substance abuse in children and adolescents. Indian J Med Res. 2010; 132(6): 683-4.

11. Karatay G, Gürarslan Baş N. Effects of Role-Playing Scenarios on the Self-efficacy of Students in Resisting Against Substance Addiction: A Pilot Study. Inquiry. 2017; 54: 46958017720624.

12. Kasturkar PR. Efficacy of Role Play on Ill Effects of Alcoholism among High School Children. Int J Community Med Public Health. 2020.

13. Siva RS. Effectiveness of structured teaching programme on knowledge regarding substance abuse. Zenodo. 2025 May 15.

14. Jose AM et al. A study to assess the effectiveness of role play on knowledge regarding substance abuse among higher secondary students of Ramanattukara Higher Secondary School at Vaidyarangadi. Kerala Univ Health Sci. 2020.

15. A study to evaluate the effectiveness of structured teaching programme on knowledge regarding problems of substance abuse among higher secondary school students. Int J Adv Nurs Manag. 2019 Jul 4.

16. Bagley SM. Substance Use in Adolescents. Boston University Chobanian & Avedisian School of Medicine. 2025.

17. Preventing Substance Abuse in Adolescents: A Review of High School Programs. PMC. 2022 Jul 27.

18. Kaur Jasdeep, Kaur Kiranjit. A Descriptive study to assess the knowledge regarding substance abuse among adolescent students of selected schools in Amritsar, Punjab with a view to develop information booklet. Asian J. Nur. Edu. and Research. 2015; 5(4): 463-466.

19. Bivin J.B., Riaz KM. Assessment of Substance Abuse among Teenagers: Review of Instruments Commonly Used in Healthcare and Research. Asian J. Nur. Edu. and Research. 2017; 7(2): 248-254.

20. T. Venkateshwaran. A Study to assess the effectiveness of Mindfulness Meditation Techniques on stress among the clients with substance abuse in fire – Jeevodhaya de Addiction cum Rehabilitation Centre, Coimbatore, Tamilnadu. Asian J. Nursing Education and Research. 2021; 11(1): 105-106.

21. Manisha Rani, Neelam Nain. Assess the Effectiveness of Structured Teaching Programme on Knowledge regarding the substance abuse among the Adolescents in Government Sr. Sec. School, Aherwan, Fatehabad (Haryana). Int. J. of Advances in Nur. Management. 2019; 7(4): 305-308.

22. Bindu Kumari, Nisha C.K, Manohari. A Study to Assess the Knowledge regarding Substance Abuse in Adolescents among teachers in selected PU Colleges at Bangalore with a view to develop a Video. International Journal of Advances in Nursing Management. 2021; 9(3): 289-1.

23. L. Josephine Sutha. Effectiveness of Structured Teaching Programme on Substance Abuse among Nursing Students. International Journal of Advances in Nursing Management. 2024; 12(3): 123-6.

24. Asha Sajji, Abhiya Bijers, Anjala James, Anumol Varghese, Ashmini R.. Effectiveness of Video Assisted Teaching Programme on Knowledge regarding Ill effects of Substance Abuse among nursing students of selected Nursing College, Bangalore. International Journal of Advances in Nursing Management. 2024; 12(4): 181-4.

25. Debajani Nayak. Knowledge and practice of substance abuse among the adolescent group - A descriptive study. Int. J. Nur. Edu. and Research.2016; 4(2): 119-121

26. Anilkumar B. Jarali, Patrick O. Ogoncho. Knowledge on Substance Abuse among Adolescents. Int. J. Adv. Nur. Management. 2016; 4(3): 371-375.

27. A study to assess the Effectiveness of Aerobic Exercises on Anxiety among Substance Abuse Patients at Selected Psychiatric Rehabilitation Centre, Dehradun. Int. J. Nur. Edu. and Research. 2017; 5(1): 77-82.

Received on 04.08.2025 Revised on 28.08.2025

Accepted on 16.09.2025 Published on 25.10.2025

Available online from November 04, 2025

Asian J. Nursing Education and Research. 2025;15(4):215-220.

DOI: 10.52711/2349-2996.2025.00044

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.

Level of Knowledge	Pretest Frequency	Pretest Percentage	Posttest Frequency	Posttest Percentage
Excellent (25–30)	0	0%	19	47.5%
Good (20–24)	8	20%	12	30%
Average (15–19)	30	75%	9	22.5%
Poor (<14)	2	5%	0	0%