6 Discussion
A number of studies have indicated that training on drugs and alcohol in Brazilian undergraduate nursing education is
inadequate. The present study data support this observation. Most participants revealed that the class and training time
required to work in this area did not exceed three hours during the undergraduate program, less than the average time
devoted to drug and alcohol education in earlier studies, which ranged from four to six hours . As earlier research
involved samples of public college students , these results demonstrate that alcohol and other drugs have received even
less attention at private colleges. This fact is a source of concern when considering that most nursing schools in Brazil are
affiliated with private colleges.
The analysis of the percentages of participants who scored above the median on the three factors studied shows a slight
predominance of positive attitudes towards alcohol, alcoholism and alcohol addicts, indicating that participants are in
favor of drinking, agree that people should drink if they want to and consider drinking to be normal . These attitudes,
however, seem to be restricted to moderate alcohol use; according to the same students, some people drink and are able to
control their alcohol intake, whereas others are not, indicating that this attitude does not extend to people who are not able to control this behavior. Despite their positive attitudes towards moderate alcohol use, students do not consider alcohol use
to be risk free and are in doubt as to whether small alcohol doses can cause addiction. Despite the presence of
above-median scores for all factors, the percentage of students who scored below the median was significant, ranging
between 43% and 47%. This result is consistent with the notes of Howard and Chung , who concluded that, although
recent changes have enhanced nurses’ acceptance of misusers, a significant number of nurses still consider alcoholics are
immoral, have a weak character and a small probability of recovery. Whereas the percentage difference between the two
groups (positive versus negative attitudes) was small, the methods used in this study may not have been able to detect
possible differences between these groups or other variables that influenced attitudes. Hence, further studies of this kind
are needed to clarify these issues.
As researchers have highlighted in recent decades , the number of undergraduate lectures on drugs and alcohol
exerts a positive influence on students’ attitudes towards alcohol addicts. The results of this study indicated that students
with the largest number of lectures on alcohol and other drugs showed an OR value of 3.53, indicating that these students
have more positive attitudes towards alcohol addicts than those who reported having participated in fewer hours of lectures
on alcohol and drugs during their education.
The general linear model analysis showed no significant influence of gender and race on the participants’ mean scores in
the three factors. However, when analyzing the association between participants’ gender and attitudes through binary
logistic regression, a significant association was found between gender and positive attitudes. In addition, females were
more likely to have a positive attitude towards alcohol (OR=3.42) than male students. A positive influence of age on
students' responses was also found; younger students were more likely to have positive attitudes towards alcoholics
(OR=2.18). Research by Hagemaster et al. revealed similar results, showing that older participants were more prone to
negative and stereotypical views of alcoholics than younger nurses.
This study had many limitations, including the sample size and the fact that it was conducted in just two private nursing
schools in one region of Brazil, indicating that the results cannot be generalized. Future studies should consider including
other socio-demographic and behavioral variables. Most of the variables examined in this study were not significantly
associated with the students’ attitudes and thus, other factors, such as participants’ alcohol and drugs consumption should
be examined to determine whether these factors influence the study results. Despite these limitations, this study presents
advances in Brazilian and international nursing and significantly contributes to the Brazilian literature. The results of this
study are particularly useful in view of the lack of research on nursing and nursing students’ attitudes towards alcohol and
drugs use in Brazil and Latin America. Moreover, this research examines attitudes in regions and institutions that have not
been studied yet. Thus, it contributes to knowledge in this area by providing data that can support future research on
nursing teaching and care with regard to substance misuse.
The first Brazilian conference for mental health nurses and addiction specialists on drugs and alcohol, which was held in
2000 at the University of São Paulo, hosted countless discussions and resulted in many recommendations. Although
integrating and including substance misuse content was considered a priority in nursing curricula at that time [18], little has
been achieved in Brazil in this respect. Ten years after these recommendations, schools have incorporated few of the
recommendations, and those that did were primarily public schools. Hence, one could say that private schools continue
paying little or no attention to substance misuse in nursing education. Brazilian addiction specialists need to pressure
authorities to incorporate expert recommendations into nurse education laws, as the recommendations are currently not
obligatory in course curricula and hence, remain secondary priorities at most training institutions.