College students are one of the largest groups of substance abusers in the United States. Many turn to substances to deal with mental illness and academic stress, particularly using study drugs to help with their academics. Students are exposed to drugs because of party culture and Greek life, where substance abuse is much more common. Substance abuse impacts many of these students’ education, leading them to get lower grades and struggle academically. It also results in more emergency room visits due to substance abuse and addictions. Long-term drug abuse often leads to long-term health problems as well. Universities and outside companies are beginning to educate students more about the dangers of substance abuse and addiction to help rectify the issue, and treatment centers are also working to help those with addictions recover. However, currently there are not many practices focusing specifically on the college student population.
The rates of substance abuse (also referred to as drug abuse in this brief) among college students in the United States have risen significantly over the last 2 decades. Drugs such as alcohol, marijuana, prescription pills, and others are becoming more popular on campuses around the country. In 2017, researchers found that college students are much more likely to use drugs than their peers who are not enrolled in college, and they are one of the largest groups of substance abusers in the country. 1 2 The number of college students abusing substances is also rising; Columbia University conducted a study analyzing the changes in consumption of drugs around universities in the United States and found a significant increase in drug use from 1993 to 2005. Due to this increase of drug use in college students, over 1 in 4 college students had a dependence on drugs in 2005. 3 The study didn’t note much change in the rate of drinking on college campuses over the last twenty years, but the chance of becoming addicted to alcohol rose throughout the years. In 1993, around 8.5% of college students had an alcohol addiction. In 2003, 22.9% of students were addicted to alcohol. 4 In 2014, the Substance Abuse and Mental Health Services Administration (SAMHSA) studied the frequency of substance abuse in college students to identify how many are currently binge drinking and using drugs. Using sample sizes of around 21,000 full-time students, they determined that out of 9 million students, 60% of them consumed alcohol in the last month, and around 22% of these students had used an illicit drug in the last month. 5
A variety of drugs are used by college students, but the 5 most common drugs among college students are, in sequential order, alcohol, marijuana, prescription pills, ecstasy, and cocaine. 6 While alcohol is legal for those above the age of 21 and marijuana is legal in varying degrees in certain states, these drugs can still easily be abused. Additionally, drugs like ecstasy and cocaine are illegal no matter the circumstances.
Mental illness is a growing issue in the United States, particularly with those in college. One reason that drug abuse has increased may be that substance abuse is more common for students that have a mental illness. 7 It is unclear exactly why mental illness has risen so much in recent years among college students, 8 but it has been found that students that struggle with mental illness and feelings of being overwhelmed, anxious, sad, or hopeless often turn to drugs to find relief. 9
Not only do students turn to prescription drugs in order to find solutions for their mental illness, but many may also use alcohol, marijuana, or other illegal drugs. Marijuana is often used to help with anxiety and insomnia. 10 Students often turn to alcohol when dealing with depression; its depressive effects bring a numbing and relaxing effect, which helps to relieve stress. Others may use drugs such as stimulants or hallucinogens in order to get a high that they feel they lack in their life.
In addition to mental illnesses such as depression and anxiety, post-traumatic stress disorder (PTSD) affects college students. It is estimated that approximately 8–9% of students are officially diagnosed with PTSD, though some researchers estimate that the numbers are closer to 15–30% of college students if accounting for those who have PTSD symptoms but do not have an official diagnosis. 11 PTSD is a mental anxiety disorder that occurs after a traumatic event has occurred in someone’s life. This disorder can result in flashbacks and triggers that bring back the traumatic events. Due to this, many people with this disorder look to self-medicate in order to help with their symptoms. While only 8% of Americans have PTSD, 65% of those with PTSD develop a substance abuse problem. 12 The drug of choice for most with PTSD tends to be alcohol, given its numbing and depressive effects. Avoidance is very typical for those with PTSD, causing them to isolate themselves and recall the event over and over, which brings up the pain and trauma again. By self-medicating with drugs, they are able to get brief relief. A blog writer with PTSD who struggled with alcoholism wrote, “I discovered that alcohol lessened my feelings of sadness and anxiety, and allowed me to relate to others without fear and shame. As the years progressed, my PTSD symptoms increased . . . I found that the only way I could shut them off was to drink more and more. Alcohol numbed the feelings and made the flashbacks go away.” 13 However, though alcohol has numbing properties that temporarily halt symptoms of PTSD and other mental illness, the substance wears off and the individual must re-medicate to find the same relief. 14 With time, this constant self-medication can lead to addiction.
Students in universities across the country report the need to escape from the pressures of academics by using drugs, and college students have stated that academic stresses are one of the reasons why they drink alcohol. 15 A common source of stress for many college students is tests and exams. As a result, many students turn to study drugs which make it easier to focus and pay attention. 16 A side effect of study drugs is insomnia, and those that are prescribed this medication are advised to take it in the morning in order to avoid sleepless nights. 17 However, students use these types of drugs when pulling an all-nighter before an exam. Additionally, many college students take these drugs due to the therapeutic effects of increasing focusing and concentration, hoping that they will be able to focus better as they study and take tests. When researching students across the nation, the data showed that around 7% of students were using study drugs to help them focus and stay awake. 18 In comparison, it is estimated that only 5% of college students have been diagnosed with ADHD. 19
These medications are becoming more accessible throughout the country as many more people are diagnosed with ADHD, and as a result, more people are prescribed these medications. Many in the medical field are concerned that there has been over-diagnosing or misdiagnosing of ADHD in recent years; in 1993, there were 600,000 people diagnosed with ADHD. By 2013, this number increased to 3.5 million. 20 Because of this increase in demand for ADHD medication, production of these stimulants has increased by 9 million percent over the last decade alone. Young people in particular are often diagnosed and treated for ADHD, meaning that many more college students have these medications and are able to give them out or sell them to peers. 21 More than half of students that have been prescribed with ADHD medication have been asked to sell it to other students. 22
Many students don’t feel guilty taking stimulants due to the beliefs that these drugs will help them perform better with school, that stimulants aren’t harmful like other drugs, and that these drugs aren’t illegal since they are prescription medication. Due to the fact that these drugs don’t have the same stigma as illegal drugs, they are seen as more acceptable on college campuses than other drugs. 23 In the end, however, using prescription drugs meant for someone else or in an improper way is, in fact, illegal. 24
Not only do students use study drugs to stay awake and perform better, but they also use depressants to help them sleep and feel more relaxed. These drugs are needed and recommended for those that struggle with anxiety or panic attacks and are prescribed these medications by their doctor. 25 However, this use becomes drug misuse when the medication is not used as directed by a physician or if it is used by someone other than who they wrote the prescription for. Many students self-medicate with depressant drugs to help with anxiety and stress that builds up due to schoolwork. 26 Fifty-seven percent of students that misuse drugs have reported misusing depressants, and these drugs are reported to be used primarily to help with sleep and anxiety. 27 This fact is a great concern, since doctors warn that depressants can be particularly addictive; overuse of depressants can lead to adverse health effects, and withdrawals from this medication can lead to an increase of anxiety and possibly seizures. 28 These medications, like stimulants, don’t have the stigma of illegal drugs since they can be prescribed by a doctor. However, selling or giving this medication to others is illegal.
College culture presents a new environment to many new freshmen, as many are living on their own for the first time and are possibly exposed to drugs more often than they would have been before. They may be curious about the new options that are available to them, and this curiosity often leads to trying and experimenting with drugs. 29 This curiosity is compounded with the sudden access to alcohol and drugs that are readily provided at college gatherings. There may even be social pressure to use and experiment with drugs, making new students more likely to participate in order to fit in. Often the drugs will help them feel more confident and have a different perception of how others view them. 30
Drugs and alcohol are considered to be a normal part of college life, and as such are very easily found. Most students don’t even have to look—2 in 3 students will have been offered prescription drugs by their senior year of college. 31 Out of students that had not used marijuana before college, a study found that 74% of them were offered marijuana while at school, and 54% ended up using marijuana. It is estimated that by the time they graduate college, around 36% of students are offered cocaine, and 13% end up using it. 32
Studies indicate that living in a sorority or fraternity can greatly increase the likelihood of substance abuse. 33 This correlation may be due to frequent partying, but could also be attributed to the initiations and hazing that many sororities and fraternities subject their new members to. This peer pressure is why so many students abuse drugs while participating in Greek life. Greek living can put a student at higher risk of becoming addicted to alcohol or other drugs; 4 out of 5 students in Greek life end up binge drinking, compared to only 2 out of 5 students outside of Greek life. 34 The combination of group living and lack of supervision can also lead to experimentation of alcohol with other drugs, as well as the use of illegal drugs. 35 While marijuana was commonly used in both fraternities and sororities, researchers found that students in fraternities used illegal drugs such as LSD and cocaine more often than their peers that were either not involved in Greek life or those in sororities. 36
There has been speculation in the past that perhaps many of these students would use drugs whether or not they were in Greek life and that perhaps they have a predisposition to drugs; however, researchers found that students who left a sorority or fraternity during their college career showed a decrease in substance use the following year. 37
Party culture is another way that many students are exposed to drugs. Drinking games are very popular in college, which can quickly lead to life-threatening issues such as alcohol poisoning. Ecstasy is a particular favorite drug of students when going to parties and raves. 38 Parties also give opportunities to experiment and combine different drugs and alcohol. With more people present, there are more options available to try new things, so experimentation with different drugs may occur.
Students that abuse pain medication, stimulants, and other drugs don’t do as well in school as their peers that don’t abuse substances. 39 Despite the fact that many are taking study drugs, it doesn’t seem to improve their performance, and in fact has been shown to lead to a lower grade point average, lower test scores, skipping classes, and not doing homework. 40 41 These facts continue to disprove the myth that study drugs will help students study better and get better grades.
There are many health side effects that occur when drugs are misused and abused. The numbers of those that have to go to the emergency room due to drug abuse has risen recently. In 2011, there were 5 million drug-related ER visits. 42 The sudden increase of emergency room visits and the emergency care that is needed to address drug-related health emergencies is becoming a concern since more emergency resources are needed to take care of these patients. 43
Many of the organs in the body are affected by alcohol consumption. alcohol affects the neurotransmitters of the brain, slowing them down and causing drowsiness, changes in mood and behavior, memory loss, and possibly seizures. Long-term alcohol abuse can cause the brain to shrink, which changes motor coordination and long-term moods and can also lead to more severe memory loss. 44
Frequent alcohol abuse greatly affects the liver as well. The liver works to get rid of the toxins that are found in alcohol. However, an excess in drinking leads to damage in the liver cells, which can lead to issues such as fatty liver disease, the most common alcohol-related liver disease that leads to an enlarging of the liver, problems in blood clotting, and excessive bleeding. Other liver problems may include fibrosis, which can progress to cirrhosis. 45 The heart is also affected by drinking; too much alcohol can lead to alcoholic cardiomyopathy or arrhythmias. Drinking too much alcohol can also lead to a weakened immune system. White blood cell function decreases, resulting in greater susceptibility to infections and disease, as well as cancer. 46
Drinking too much at one time can lead to alcohol poisoning, which is very life-threatening and must be taken care of very quickly. Symptoms include vomiting, difficulty breathing, seizures, losing consciousness, and going comatose. 47 Every year, more than 1,800 college students die due to alcohol-related problems. 48 Additionally, while many students do not die due to alcohol in college, substance abuse can lead to many of the long-term issues mentioned above, which in turn lead to earlier deaths or expensive medical procedures in the future.
Illegal drugs have severe health consequences as well. Marijuana abuse can lead to impaired body movements, paranoia, breathing problems, and increased heart rate. The frontal lobe controls reasoning skills and can be damaged after long-term substance use, which affects dopamine release. 49 Those that abuse stimulants such as Adderall can have similar arrhythmias and breathing difficulties, but are also more prone to having seizures. 50 cocaine, another powerful stimulants, has similar effects, causing seizures, severe paranoia, possible cardiac arrest, lung damage, and chronic coughs. Those that snort cocaine can damage their sinuses and often get infections. cocaine also greatly affects metabolic processes, which sometimes leads to eating disorders in users. 51 The more substances that are used by an individual, the higher their chances of having long-term medical issues. 52
There is also a tie back to mental health issues when drugs are abused. Drug abuse can increase the risk of mental disorders, and those that have pre-existing mental illnesses will often find that their anxiety or depression becomes more severe with substance abuse. 53 Adderall use, for example, often leads to depression, anxiety, severe mood swings, and even suicidal thoughts. 54 Many who did not have a mental illness before using drugs end up suffering from anxiety and depression, which can become so severe that these abusers become suicidal. Studies have also shown a direct correlation between suicide attempts and alcohol abuse. 55 Additionally, it has been found that “of all non-traffic injury deaths associated with alcohol intoxication, over 20% were suicides.” 56
The abuse of prescription drugs particularly affects the way the healthcare system is functioning. Opiates have become more controlled in past years as the government attempts to combat the current opioid epidemic. After Congress passed the Opioid Crisis Response Act (OCRA) in 2018, more steps are being taken to ensure that doctors don’t over-prescribe opioids. 57 OCRA has put certain restrictions on the way doctors can prescribe opioids in hopes of preventing more patients from becoming addicted. Though the new bill still allows doctors in most states to prescribe a week's worth of opioids to help with acute pain after a broken bone or a surgery, many doctors are afraid to give out too many opioids, especially to those with chronic pain, fearing there will be penalties from the government for over-prescribing opioids. Because of this, they may not prescribe the amount most patients need in order to manage their pain. 58
This dilemma may soon become true with prescription medications for conditions such as ADHD as well. Since the demand and the abuse of ADHD medication has increased so rapidly in recent years, pharmacies and medical personnel are looking to manage the distribution of these medications more closely, and are contemplating creating regulations such as those made for the distribution of opiates. 59
Many students end up having addictions because of substance abuse during their college experience. Because addiction doesn’t require heavy use, anyone that uses drugs could be at risk for addiction. While it depends on the person and their genetic makeup, addictions can develop very quickly; for example, researchers found that 6% of patients that were prescribed just one day’s worth of opioids for pain management were addicted to the drug one year later. For those taking opioids longer than 8 days, there is a 13% chance increase that they will develop a dependence on the drug. 60
Study drugs, particularly Ritalin, are considered gateway drugs, meaning they open the door to other, more intense drugs. These drugs are used at first to help with studying, but then a person may go searching for a greater high in other drugs. 61 Tolerance may also occur when drugs are used too often, and the person may resort to using higher quantities in order to get the same result as before. 62 Since many consider study drugs to be safe, they are sometimes combined with alcohol or other drugs, whether on purpose or on accident, which can be incredibly dangerous and even life-threatening. 63
Many universities across the country are trying to fight against the idea that college is a time of life where alcohol and drug use is acceptable. This movement is done by students forming clubs, universities organizing alcohol-free events, and administrators working to change the norms of universities. Florida State University is an excellent example of this; they have begun implementing many efforts to lower the rate of drinking and drug abuse on their campus. 64 This effort is significant, since researchers found in 2017 that Florida State University students spend the most per month on drugs than any other university’s students, spending around $300 per month buying drugs. 65
The university has a committee called the Committee for Health Advocacy and Wellness (CHAW), whose “goal is to work collaboratively to develop programs, initiatives, and services to reduce the proportion of students engaging in high risk behaviors related to alcohol, tobacco and other drugs.” 66 Rather than trying to teach complete abstinence, this committee and many other committees and groups working at universities are simply striving to educate students on how to drink and use drugs in a more responsible way.
Florida State is not the only school that is working to teach more responsible substance use; the University of Oregon is also implementing ways to prevent abuse. They work to educate students as well, but they also have an on-campus recovery center that is available to all students, a crisis center that any student may use if they are having a mental health crisis, and also workshops for anyone that is looking for help with addiction or substance abuse problems. 67
While many universities are working to promote more responsible use of substances on their campus, there are not many reports on how these programs are helping these universities. Not many publish any records or any numbers regarding how many students take part in workshops or are educated regarding substance abuse. Due to the extensive amount of research it would require to look at every single university in the U.S. and see if they have published anything regarding the decrease of substance abuse in their university due to efforts that have been made, this gap is most likely not true for all universities. However, Florida State has released a few statistics regarding substance abuse in their school. For example, 89% of students at FSU found a designated driver when they had been out drinking, and around 55% of the students report drinking responsibly. 68 There is not any information from previous to compare these numbers with, making it unclear as to whether or not these numbers have improved.
Many universities across the nation are realizing the issue of substance abuse on campuses, working to prevent it happening with new students, and educating other students on being more safe. However, there is not much data on whether their actions are making a difference for college students; this problem may be simply due to the fact that these efforts are a recent initiative, and sufficient research and numbers have not been able to be gathered. However, even if general statistics were available, it would still be difficult to determine impact without research on how these efforts directly affect the number of students with a substance abuse problem.
Programs have been developed specifically to educate campuses and students about drugs and alcohol to help prevent abuse through trainings and workshops. Their goals are usually to help educate students about the effects of substance abuse, how to use them in a safe way if they are legal, and how to help those that may have an addiction. Some begin teaching students about alcohol when they are still in high school. This is again emphasized in many freshman orientations, further educating new students about the importance of using alcohol and drugs safely. 69
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has established the College Alcohol Intervention Matrix (CollegeAIM) to help universities determine which prevention programs are the most effective and will help their university the most. They analyze all these programs, showing whether they are focused more on individuals or changing the environment as a whole, how to find a program that works best with the university’s specific substance abuse problems, the cost of these programs, and how effective they are. This process makes it much easier for campuses to find a resource that can help their campus. 70
One company that is in the CollegeAIM is AlcoholEdu. They focus largely on alcohol abuse, but also have trainings and webinars about prescription drug abuse as well as different programs for freshman and continuing students. They also educate about Greek life culture and work to change the culture of sororities and fraternities who participate in binge drinking and hazing so that there is not as much drug and alcohol abuse in these communities. 71 Their trainings aim to help students in all kinds of situations to understand more about substance abuse; they encourage those that do not drink or use drugs to continue practicing abstinence, help those that are light drinkers to continue to be safe, and then help teach the dangers of substance abuse to those that have addictions and are at risk. They teach about the health effects of substances, hoping to educate those that may not be aware of the health problems that can develop if heavy use continues. 72
From CollegeAIM, we are able to find how these programs affect college campuses and whether or not they are effective. This effectiveness has been researched by addiction professionals over the course of many years, analyzing the different strategies, their effectiveness, and the cost. They have found that the programs that focus on both individual as well as culture change are the most effective in promoting change that lasts 6 months or longer. 73 AlcoholEdu is their highest-rated program and is recommended to help with long-lasting change. 74 This program has been shown to decrease the amount of binge drinking on college campuses the most, and maintain this decreased level for up to a year after the training. AlcoholEdu states that these programs are decreasing the amount of binge drinking and other substance abuse on campuses, but the organization does not provide numbers to support these statements.
There are not many reports from CollegeAIM regarding the impact, the amount of students and campuses that are exposed to these trainings, and how many students continue to have lower levels of substance abuse after a year. This lack of information could be due to the fact that these programs are fairly new, since CollegeAIM started in 2012, and have not been researched very much at this point. However, in order to truly know whether or not these programs really help college campuses and students with substance abuse problems, more research about impact would need to be completed.
With substance abuse becoming such a prevalent problem everywhere, not just with students, treatment centers are popping up across the nation. Some of these treatment centers are residential so that patients may go in and focus entirely on recovery. This practice is particularly helpful for those that use drugs because of outside pressures. In these treatment centers, patients are able to detox while being around counselors and medical professionals that can help them do so effectively. 75 There are also intensive outpatient treatments, which allow patients to continue with their everyday life but still have medical assistance during the detoxing process. This option is better for those that don’t need more consistent medical supervision while overcoming their addiction, as is the case with inpatient treatment. 76 Finally, there is outpatient treatment, which is the most casual of all these treatments. It doesn’t require as many meetings with a healthcare professional, but still gives the patient the sufficient support and help they need to fight their addiction. 77
Another type of treatment available for those with addictions is a Medication Assisted Treatment (MAT). MAT gives the option to patients to use medication to help with their detox and fighting their addiction. Different medications such as Buprenorphine, Naltrexone, and Methadone are used to help patients with their addiction. Patients are also encouraged to go to behavioral therapy while working through their addiction to help with the long-lasting effects. Counselors and medical professionals are still available to help patients recover from their addiction and maintain their sobriety after finishing their treatment. 78
When looking at the effectiveness of treatment centers, it is difficult to determine impact and outcomes due to the lack of outputs provided by the centers. However, we do know that treatment has been implemented with many people; in 2015, the National Survey on Drug Use and Health found that 2.5 million people in the U.S. received treatment to help with an addiction. 79 Regarding MAT treatment, it has been found that opiate-related deaths have dropped in areas where MAT treatment is used. 80 Researchers also found that after a year and a half, half of those that went through the treatment reported to be sober. When following up again 3.5 years later, 61% reported to be abstinent, and only 10% were found to still have an addiction. Overall, doctors feel that this type of treatment is very effective and a safe option for addicts, since the medication itself is not harmful like the abused drugs are and will help them have a less difficult time during withdrawals. 81
It is difficult to have many numbers showing how well treatment is working simply because “success” is difficult to define with regards to addiction; some define it as a completion of the program, others define it as sobriety for a certain period of time after the program ends, while others base it on patient reviews. Additionally, since addiction is a lifelong disease, someone can relapse at any time, making it difficult to define a success. 82 Along with this, since many treatment centers are privately owned, they are not legally required to release specific numbers on whether or not they are effective. Despite this lack of numbers, it is felt that these treatment centers are effective in helping addicts get over their addiction and establish better habits that will aid them in avoiding addiction in the future. 83 However, there is still great room for growth; in 2015 when researchers found that 2.5 million people received treatment, they also found that there were 21.7 million people over the age of 12 that had an addiction, meaning that there were millions of people in the country that went without treatment. 84 This discrepancy could be due to cost, stigma, lack of desire to stop the addiction, or not realizing that the addiction is a problem.
While we can determine that these treatment programs are effective, there isn’t much information on the effect that these treatment programs have had on college students as a specific population. It is also difficult to determine exactly how many people have been treated effectively by these programs since many of the centers do not present any kind of number regarding the success, which is possibly due to the difficulty of defining success.
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