Future Nurses Misjudge Substance Use Risks, Study of 320 Students Finds

Nursing students are the people we expect to understand health risks better than almost anyone else. They spend years studying pharmacology, anatomy, and the physiology of addiction, and they will eventually stand at the bedside of patients whose lives have been damaged by tobacco, alcohol, and other substances. Yet a new cross-sectional study from India suggests that even this highly trained group carries substantial blind spots. Researchers at SUM Nursing College, part of Siksha ‘O’ Anusandhan Deemed to be University in Bhubaneswar, Odisha, surveyed 320 nursing students and found that more than half showed a moderate level of misinterpretation about substance use behaviour, while nearly half showed severe misinterpretation. The findings, published in BMC Psychiatry, raise uncomfortable questions about how future healthcare providers perceive the very behaviours they will be tasked with treating.

The study, led by Shreya Mandal of the Department of Mental Health Nursing, set out with a deceptively simple question: how do nursing students actually interpret substance use, and how risky do they believe it to be? The distinction matters because perception shapes practice. A nurse who misreads the motivations behind a patient’s substance use, or who underestimates or overestimates the dangers involved, may respond with judgment rather than clinical care, or with complacency rather than vigilance. Attitudes formed during training years can persist for an entire career, influencing everything from screening behaviour to the therapeutic relationship.

To capture these attitudes, the researchers used a descriptive cross-sectional design with non-probability purposive sampling, recruiting participants through a socio-demographic questionnaire alongside two structured instruments: a misinterpretation scale and a perceived risk scale. Both tools underwent content validation, with item-level and scale-level content validity indices confirming their relevance and clarity before deployment. The team then applied a battery of statistical tests, including the Mann-Whitney U test, the Kruskal-Wallis test, Spearman’s rank correlation, chi-square analysis, and linear regression, to map the landscape of belief and identify its predictors. Ethical approval came from the Institutional Review Board of Sum Nursing College, and all participants gave written informed consent, with participation entirely voluntary and data kept in coded, password-protected files.

The headline numbers are striking. Among the 320 students, 52.8 percent demonstrated moderate misinterpretation of substance use behaviour, and 47.2 percent fell into the severe misinterpretation category. In other words, every single participant in the study held at least a moderate level of misunderstanding about substance use. When it came to perceived risk, the picture was somewhat more reassuring but still uneven: 60 percent of students rated substance use as highly risky, while the remaining 40 percent perceived only moderate risk. No participant registered a low perception of risk, which the authors note is a positive signal, yet the fact that four in ten future nurses stopped short of viewing substance use as a high-risk behaviour leaves considerable room for concern.

Perhaps the most intriguing statistical finding was the relationship between the two variables. Spearman’s correlation revealed a moderate positive association between misinterpretation and perceived risk, with a correlation coefficient of 0.427 and a p-value below 0.001, indicating that the relationship is unlikely to be a statistical fluke. Students who held more misconceptions about substance use also tended to perceive greater risk. Linear regression analysis confirmed the pattern: misinterpretation significantly and positively predicted perceived risk, with a standardized beta of 0.427, and the model accounted for 18.2 percent of the variance in perceived risk scores. The regression model itself was statistically significant, with an F statistic of 70.822 and a p-value below 0.001.

That correlation direction deserves careful thought. Intuitively, one might assume that misunderstanding would lead to underestimating danger, but the data suggest the opposite: distorted beliefs about substance use appear to inflate risk perception. This could mean that students who misinterpret the nature of addiction, perhaps viewing it through moral or sensationalized lenses, attach exaggerated dangers to it. While heightened caution might seem harmless, inflated or misdirected risk perception can be as problematic as complacency. It may fuel stigma, discourage honest conversations with patients who use substances, and undermine the non-judgmental clinical stance that modern addiction medicine demands. Alternatively, the relationship may be bidirectional or shaped by unmeasured factors, something a cross-sectional design cannot untangle.

Equally notable was what the study did not find. The researchers tested associations between substance use perceptions and a range of socio-demographic factors, including age, gender, educational program, and other background characteristics, using chi-square, Mann-Whitney, and Kruskal-Wallis tests. None of these reached statistical significance, with all p-values exceeding 0.05. In practical terms, misconceptions were not confined to any particular subgroup of students. First-year and senior students, men and women, and those from different nursing pathways all carried similar levels of misinterpretation. This uniformity suggests that the problem is structural rather than demographic, embedded perhaps in curricula, social norms, or the broader cultural messaging that surrounds substance use in India and beyond.

The participants came from two main educational tracks common in Indian nursing education: Bachelor of Science in Nursing and General Nursing and Midwifery programs. That the findings held across these pathways strengthens the case that nursing education as a whole may need to revisit how it teaches about substance use. The study was conducted at a single institution, which limits generalizability, and the purposive sampling method means the sample was not randomly selected from the wider student population. The authors acknowledge these constraints implicitly through their design choices, and readers should interpret the percentages as a snapshot of one college rather than a national estimate. Still, the internal consistency of the findings, from the validation of the scales to the strength of the regression model, gives the results credibility as a signal worth investigating further.

Why should the general public care about the beliefs of a few hundred nursing students in Odisha? The answer lies in the pipeline between training and practice. Nurses deliver the majority of direct patient care worldwide, and in many settings they are the first, and sometimes the only, health professionals a person with a substance use disorder will encounter. Research in addiction medicine has repeatedly shown that clinician attitudes influence whether patients disclose their substance use, whether they are offered evidence-based treatments, and whether they return for follow-up care. If a meaningful share of the nursing workforce enters practice with moderate to severe misinterpretations of substance use, the consequences could ripple quietly through emergency departments, psychiatric wards, and community clinics for decades.

The authors argue that their findings point toward a clear intervention: targeted educational programs that correct misconceptions and calibrate risk perception during the formative training years. Because misinterpretation predicted a substantial portion of perceived risk in their regression model, addressing distorted beliefs could, in theory, reshape risk attitudes as well. Future research, they and others in the field suggest, should move beyond single-institution cross-sectional surveys toward longitudinal and multi-site designs that can track how perceptions evolve through training and into practice. For now, the study stands as a reminder that expertise is not immunity to misconception, and that the people charged with caring for those affected by substance use may themselves need care in the form of better education, honest self-examination, and curricula that confront stigma head-on rather than assuming it will dissolve with clinical exposure.

Subject of Research: Misinterpretation and perceived risk of substance use behaviour among nursing students

Article Title: Youth perception and substance use: a study of misinterpretation and perceived risk among nursing students

Article References: Mandal, S., Pradhan, R., Sarkar, A., & Samal, K. (2026). Youth perception and substance use: a study of misinterpretation and perceived risk among nursing students. BMC Psychiatry. https://doi.org/10.1186/s12888-026-08696-5

Image Credits: AI Generated

DOI: 10.1186/s12888-026-08696-5

Keywords: substance use, nursing students, perceived risk, misinterpretation, cross-sectional study, nursing education, risk perception, BMC Psychiatry, India, mental health nursing, stigma, public health