Association between substance use disorder and risky behavior among students in Indonesia: a cross-sectional study.

Background: Substance use is prohibited in Indonesia; however, adolescents continue to consume these substances, creating a significant public health challenge. This study examines behavioral and demographic factors associated with general drug use, including cannabis and amphetamine use, among Indonesian adolescents, using nationally representative data. Methods: A cross-sectional study used data from the 2023 Indonesia Global School-based Student Health Survey, which included 10,059 students aged 13 to 17 years. A two-stage cluster sampling was applied, and descriptive and regression analyses were conducted to identify factors associated with substance use. Results: Overall, 3.03% of students reported drug use, 1.45% reported cannabis use, and 1.33% reported amphetamine use. Age and school level were not significantly associated with substance use. However, male sex, residence outside the Java-Bali region, alcohol use, and tobacco use were consistently linked to higher odds of drug, cannabis, and amphetamine use. Alcohol consumption was the strongest predictor for all types of substance use. These findings indicate that risky behaviors tend to cluster, supporting the pattern of polysubstance use among youth. Conclusion: The study findings highlight the need for risk-specific, gender-responsive, school-based prevention programs that actively involve parents and regulate adolescents' access to alcohol and tobacco. Enhancing life skills and character education in both school and family settings may also help students avoid risky behaviors.