Prevention and treatment of college student drug use: A review of the literature
Introduction
Nationwide surveys reveal that rates of illicit drug use peak in adolescence and young adulthood and that college students account for approximately 50% of this high-risk group (SAMHSA, 2010). Alcohol and illicit drug use among college students are major public health problems. There has been extensive research on alcohol use in college students, including recent review papers (e.g., Carey et al., 2007, Cronce and Larimer, 2011, Ham and Hope, 2003), but drug use prevention and treatment has received less attention, especially for drugs other than marijuana. The primary goal of this paper is to provide a comprehensive review of prevention and treatment studies of college student illicit drug use in order to inform and stimulate new research in this area. Because effective prevention and intervention approaches should take into account the factors that may contribute to drug use, this paper will begin with a review of established risk factors in college students. Although non-college students are also at high risk for drug use, these populations may have unique risk and protective factors related their distinct environment and role-functioning characteristics (Cleveland, Mallett, White, Turrisi, & Favero, 2013). Therefore, this review was limited to prevention and intervention studies for college students. Due to the paucity of research in this area, we included all studies in which an intervention or prevention program that targeted drugs was implemented and at least one behavioral outcome was measured. Articles were identified using PsychINFO and PubMed with search terms college, drug, drug use, and substance use as well as common and scientific names (where applicable) for each drug class (e.g. marijuana and cannabis).
There have been several large-scale studies of the prevalence of drug use among college students in recent years and the most comprehensive data sets are available from the Core Institute (CORE), Monitoring the Future (MTF), and National Household Survey on Drug Abuse (NHSDA). Prevalence rates listed reflect drug use from 2010 to 2011. Past year prevalence of marijuana use was 31.3–33.2% and 11.0–16.8% for illicit drug use other than marijuana (CORE, 2010, Johnston et al., 2012) (see Table 1 for prevalence rates from each study). The most commonly used drugs other than marijuana were Adderall (9.8%), amphetamines (9.3%), and synthetic marijuana (8.5%) (Johnston et al., 2012). Prevalence of current use (past 30 days) was estimated to be 21.4–22.0% for any drug use, 18.1–20.3% for marijuana use only, and 5.5–8.2% for drug use other than marijuana (CORE, 2010, Johnston et al., 2012, SAMHSA, Substance Abuse and Mental Health Services Administration, 2010). For current use, the most commonly used drugs after marijuana were misused prescriptions drugs (6.3%) (SAMHSA, 2010) and amphetamines (2.7–4.5%) (CORE, 2010, Johnston et al., 2012). Among current marijuana users, 7.2% of students reported using marijuana 3 times a week or more frequently, and 4.7% reported using marijuana at least 20 days every month (CORE, 2010, Johnston et al., 2012). Overall, although current prevalence rates for each individual drug type other than marijuana are low, about 1 in 5 college students use drugs (including marijuana) each month, and approximately 5% of students report near daily use.
Drug use puts college students at risk for experiencing a range of adverse health, behavioral, and social consequences. Although there is a lack of representative data on drug use morbidity and mortality among college students, based on CDC estimates approximately 1000 college students die from drug overdoses each year (Hingson & White, 2010). College drug users are also at risk for developing a drug use disorder, characterized by the development of physiological and psychological tolerance, use of the drug even in the presence of adverse effects, and forgoing social, occupational, or recreational activities because of drug use (Budney, 2007). A recent study of college freshman found that 9.4% of students met criteria for cannabis use disorder, and that this number jumped to 24.6% among past-year marijuana users (Caldeira, Arria, O'Grady, Vincent, & Wish, 2008).
Even in absence of a diagnosable disorder, the use of marijuana is associated with a wide range of consequences including legal and health problems (Presley, Meilman, & Cashin, 1996). Students who reported using marijuana and alcohol perform more poorly on tests, are more likely to miss class, and self-report more memory problems than students who reported only using alcohol (Rhodes et al., 2008, Shillington and Clapp, 2001). Among students who reported using marijuana 5 or more times in the past year, 40.1% reported experiencing concentration problems and 13.9% reported missing class due to marijuana use (Caldeira et al., 2008). Marijuana users also receive lower grades in college and are more likely to drop out (Arria et al., 2013, Bell et al., 1997, Buckner et al., 2010). A longitudinal study that followed students over four years of college found that drug use overall was predictive of college attrition even after controlling for parental level of education (Martinez, Sher, Krull, & Wood, 2009). Researchers have found that nonmedical users of prescription stimulants and analgesics skipped more classes (21%) than non-users (9%) (Arria, Caldeira, O'Grady, Vincent, Fitzelle, et al., 2008, Arria, Caldeira, O'Grady, Vincent, Johnson, et al., 2008). Furthermore, after controlling for high school GPA, nonmedical use of prescription drugs was associated with lower GPAs by the end of the freshman year of college and skipping classes partially mediated this relationship.
Drug use has also been linked to a number of risky behaviors. Caldeira et al. (2008) found of the students who reported using marijuana 5 or more times in the past year, 24.3% reported putting themselves at risk for physical injury high. In one study, 47% of current marijuana users reporting driving after smoking marijuana (McCarthy, Lynch, & Pederson, 2007), and in another 18.6% reported driving while high (Caldeira et al., 2008). Drug use has also been linked to risky sexual behavior (Simons, Maisto, & Wray, 2010), including not using condoms (Caldeira et al., 2009), and STI diagnosis (Vivancos, Abubakar, & Hunter, 2008). Thus, although most college student drug users use drugs relatively infrequently, they are nevertheless at significant risk for a variety of adverse social, legal, academic, and health-related consequences.
Section snippets
Demographic and lifestyle factors
College men have higher annual prevalence rates of marijuana and most other drugs than women (Johnston et al., 2012, McCabe, Cranford, et al., 2007, McCabe, Morales, et al., 2007); however, findings are less consistent for nonmedical use of prescription drugs (Matzger and Weisner, 2007, McCabe, 2005, McCabe et al., 2006). Caucasian students tend to have higher rates of drug use than ethnic minority students (McCabe, 2005, McCabe, Knight, et al., 2005, Mohler-Kuo et al., 2003), although more
Drug use prevention studies for college students
Colleges and universities are especially critical settings for prevention and early intervention given that it is the gateway to adulthood for nearly half of the US population and the period during which most young adults initiate or increase drug use (Johnston et al., 2012). Colleges are also well equipped to implement fairly large scale prevention and brief intervention programs. Many now do so for alcohol abuse but very few colleges have systematic approaches to preventing or reducing drug
Uncontrolled studies
Brief motivational interventions (BMIs) with personalized feedback have been shown to be efficacious in reducing alcohol use in college students (Cronce & Larimer, 2011), but very few studies have examined drug use outcomes. One study examined the efficacy of a BMI with students recruited through the University Health and Counseling Services (Amaro et al., 2010). Participants were either referred by the campus health center providers (33%) or self-referred (67%). To be eligible for the study,
Summary
The research thus far suggests that campus wide educational approaches are unlikely to be successful (Licciardone, 2003), but that brief counselor delivered motivational interventions may be an effective method for helping college students to reduce their drug use. Although several preliminary studies suggest that brief motivational and skills-based interventions may be effective in helping students reduce their marijuana use, little is known about interventions that identify students on the
Future directions in college drug use prevention and intervention
Almost 50% of college students report lifetime use of drugs and many experience negative consequences associated with their drug use such as lower academic performance, risky behaviors such as unprotected sex or driving after using drugs, and legal and health problems. Men, European Americans or Latinos, students involved in Greek organizations, GLB students, and non-religious students are more likely to use drugs. Personality factors such as high levels of neuroticism, psychoticism,
Role of funding sources
No grant funding was provided for this study.
Contributors
Author AD conducted literature searches and wrote the first draft of the manuscript. Author JM contributed substantially to subsequent drafts. Both authors have approved the final manuscript.
Conflict of interest
All authors declare that they have no conflicts of interest.
Acknowledgements
The authors wish to thank Ms. Lindsey Gilbert who assisted in conducting literature searches for this article.
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