“A Study to Assess the Effectiveness of Behavioural Intervention
Bundle on Substance Refusal Skills among College Students in a
Selected College in Kozhikode
Amrutha P1, Anagha NS1, Swathi P1, Shebin Roshan1, Amith Krishna1, Prof. Shine Thomas2, Prof.
R.Mageswari3
1BSc Nursing students, KMCT College of Nursing, Kozhikode, Kerala, India
2Research Scholar, Malwanchal University, Indore and Professor, KMCT College of Nursing
3Principal, KMCT College of Nursing, Kozhikode, Kerala, India
Received: 21 November 2025; Accepted: 28 November 2025; Published: 03 December 2025
ABSTRACT
Substance abuse continues to be a growing global concern, underscoring the need for early identification and
effective intervention, particularly within the Indian context. This study aimed to assess the effectiveness of a
behavioural intervention bundle on substance refusal skills among college students in the Kozhikode district. A
quasi-experimental one-group pretest–post-test design was adopted, involving 80 students aged 18–26 years
selected through convenience sampling. Data were collected using the Drug and Alcohol Refusal Self-Efficacy
Scale (DASES). Before the intervention, 71.25% of participants demonstrated moderate refusal skills, while
28.75% exhibited low skills; none reported high refusal skills. Following the intervention, 13.75% showed high
refusal skills, 73.75% moderate skills, and 12.5% low skills. A significant improvement was observed in refusal
skills (mean difference = 9.76, p < 0.05). A significant association was found between prior information on
substance use and refusal skills, whereas no association was noted with other demographic variables. The
findings indicate that the behavioural intervention bundle was effective in enhancing substance refusal skills
among college students.
Keywords: Behavioural intervention bundle, Substance refusal skills, College students
INTRODUCTION
Substance abuse refers to the harmful or hazardous use of psychoactive substances, including alcohol and illicit
drugs, in a manner that is not medically intended or prescribed. Such misuse often results in adverse
consequences for an individual’s physical health, psychological well-being, interpersonal relationships, and
social and occupational functioning. Commonly abused substances include alcohol, tobacco, amphetamines,
barbiturates, benzodiazepines, cannabis, cocaine, hallucinogens, methaqualone, and opioids. Evidence from
various countries indicates that rising crime rates have been significantly associated with substance abuse.
The health implications of substance misuse are extensive. A weakened immune system increases vulnerability
to infections, while cardiovascular complications may range from arrhythmias to myocardial infarction. Injected
drug use further contributes to complications such as collapsed veins and infections of blood vessels. Individuals
with substance use disorders (SUDs) are also at heightened risk for comorbid health conditions, including lung
and heart diseases, stroke, cancer, and mental health disorders. Diagnostic tools such as imaging scans, chest
radiography, and laboratory tests often reveal the physiological damage caused by long-term drug use.
Management of SUDs aligns with treatment approaches for other chronic illnesses, emphasising a
comprehensive and sustained care model. Essential components of treatment include pharmacological
interventions, behavioural therapies, counselling, and recovery support services (RSS). Peer-support groups such
as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) also play a crucial role in promoting long-term
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