College Students, Prescription Stimulant, and Other Substance Abuse

By Johnson, Brandon; Newcorn, Jeffrey H. | International Public Health Journal, April 1, 2015 | Go to article overview

College Students, Prescription Stimulant, and Other Substance Abuse


Johnson, Brandon, Newcorn, Jeffrey H., International Public Health Journal


Introduction

Substance abuse among college students requires specific attention because of the unique circumstances and characteristics of drug-taking behavior in this population. In 20ll, the rate of illicit substance use among full-time college students was 22% (1). In addition to frank substance abuse, there are significantly higher rates of binge alcohol use among full-time college students as opposed to others aged 18-22 years. The risk of substance use in the college population is potentiated by decreased parental supervision, a new and complex social structure that often includes communal living, and a view of substance intoxication as being relatively normative.

Consequences of substance use can have a profound impact on young adults, and are a major public health concern in the United States. Alcohol related deaths alone in college students reached 1,825 in 2005. In 2001, 10.5% of college students reported being injured because of drinking, 12% were hit or assaulted by another college student, and 2% reported sexual assault related to alcohol. Furthermore, 28.9% of college students reported driving while under the influence of alcohol, suggesting there is a significant risk of alcohol-related motor vehicle accidents (2). Another significant aspect of substance abuse in college students is its relation to comorbid mental health disorders and suicide. One study found that suicidal ideation was higher in students with nicotine dependence, alcohol related problems, and illicit drug use (3). Prevention and treatment of substance use disorders in college students may help to diminish these adverse outcomes and reduce the public health burden from this population.

Certain trends highlight the environmental influences of college life and their role in substance use. For example, college-bound 12th graders were found to have a lower than average use of all illicit substances while they were in high school compared to those who did not attend college. However, the eventual use of illicit substances by this group when they reached college was found to equal or in some cases exceed the use of their non-college peers. This "catching up" effect may in part be related to important contextual issues; the fact that college students often leave the parental home for the first time and tend to defer marriage leaves them more independent than they were in high school, but also not grounded in either their family of origin or a new family (4).

Increased academic demands and pressure to succeed may drive some college students to use substances as a coping mechanism, or even to misuse substances in an attempt to enhance academic performance. Of note, a national health survey found that college students reported the highest use in the past year of Adderall (i.e., mixed amphetamine salts, a stimulant medication prescribed for attention-deficit/hyperactivity disorder; see below) compared to several other demographic groups. This increased use among college students may be attributable to the desire to stay awake and focused during study time, as well as completion of course work (Johnston, 2011). Issues related to abuse of prescription stimulants will be covered in detail below.

The goals of this chapter are to discuss use of various licit and illicit substances of abuse by the college student population, including demographics and recent trends of use, relationship to use of other substances, co-occurrence of psychiatric disorders, consequences of using specific substances, and implications for prevention and treatment.

Alcohol

In addition to the types of alcohol abuse seen in other populations, binge drinking is particularly common in the college age population. Binge drinking is usually defined as having 5 or more drinks in a row on a single occasion for men, or 4 or more drinks for women (5). As this type of drinking is one of the main forms of alcohol use during the college years, it should be specifically queried in clinical assessment. …

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