M. Dolores Cimini, Ph.D.
Alcohol and other substance use among young adults in general and college students in particular is a significant public health concern. Alcohol and substance use increase with age, tend to peak in young adulthood (i.e., between 18 and 25 years old) and diminish in later adulthood. Recent national statistics indicate that the prevalence of past month illicit substance use (including marijuana) is about 7.9% for individuals between 12 – 17 years old, sharply increases to 24.2% among 18- 25-year-olds, declines to 19.5% among 26–29-year-olds, and continues to decline within each age group to a low of 3% among adults 65 years old and older (SAMBHSA, 2018). Within the high-risk age group of 18 – 25-year-olds, college students engage in even higher risk substance use than their non-college attending peers.
There are numerous explanations for more prevalent and heavy alcohol use among college students. While some students come to college with experience drinking alcohol, certain aspects of college life, including limited interactions with parents and other adults, availability of alcohol, unstructured time, and inconsistent enforcement of underage drinking laws, appear more likely to be associated with risky alcohol use (NIAAA, 2021). Many students view alcohol use and heavy drinking as an inherent part of the college experience, or a rite of passage (NIAAA, 2021). Factors specific to the college environment have also been linked with heavy and problematic alcohol use, including involvement in fraternity and sorority life and athletics, perceptions of high academic pressure, and peer influences and pressure (NIAAA, 2021). In 2019, the majority of full-time college students ages 18 to 22 (53%) consumed alcohol in the past month and about 33 percent engaged in binge drinking (4/5+ drinks in a two-hour period for women/men) during that same time frame. About 9% of full-time college students met the criteria for past-year alcohol use disorder: AUD (SAMHSA, 2020). Research on college students also indicates that excessive drinking is associated with increased risk for stopping out or dropping out of college, as well as problems transitioning from college to graduate school or to the work force (Arria et al, 2018). With regard to mental health, depression and alcohol use are highly correlated, and excessive alcohol use loads heavily as a factor for increased risk for suicide (Amiri & Behnezhad,2020; Lamis et al., 2010).
While alcohol use is consistently more prevalent among college students as compared to non-college peers, the prevalence of illicit drug use tends to be greater among noncollege attending young adults, with a few exceptions. Data from the Monitoring the Future national survey (Schulenberg et al., 2020) indicate that in 2019, annual prevalence of marijuana use was 43% among both college students and noncollege young adults, the highest level in over three decades (Schulenberg et al., 2020). Cocaine use was also similar (about 5.5%) among both groups. However, prevalence rates of cigarette use (but not vaping nicotine), heroin, methamphetamine, crystal methamphetamine, and sedatives (barbiturates) among noncollege attending young adults was two or more times greater than college student rates. The one illicit drug that college students use at greater rates than noncollege students is amphetamines (e.g., Ritalin, Adderall), as it is often perceived as a “study drug” that enhances wakefulness and focus. In 2019, approximately 8.1% of college students used amphetamines without a doctor’s prescription or in ways other than as prescribed by a doctor, compared to 5.9% of noncollege young adults (Schulenberg et al., 2020).
Despite findings indicating that college student alcohol and other substance use remains a significant problem across institutions of higher education, the support for a strong link between excessive drinking and risk for suicide and other psychiatric comorbidities, and associations between excessive drinking and drug use and stopping out or dropping out of college, there continue to be barriers to the routine, consistent, and timely implementation of evidence-based screening and brief interventions that address substance use within college and university-based clinical service settings. The reasons for such limited uptake include challenges associated with heavy clinical service demands, stigma and a lack of understanding concerning the link between alcohol use and psychiatric symptomology, and scarcity of training, professional development, and funding opportunities specifically aimed at the promotion of evidence-based practices addressing risky and excessive drinking and drug use among college students.
Despite findings indicating that college student alcohol and other substance use remains a significant problem across institutions of higher education, there continue to be barriers to the routine, consistent, and timely implementation of evidence-based screening and brief interventions that address substance use within college and university-based clinical service settings.
Translational research and psychological practice have seen many advances in the assessment of substance use and identification and treatment of substance use disorders (SUDs) as well as an increased focus on prevention of substance use before associated problems can develop. Integral to this proactive focus is a strategy that may be integrated easily into a busy college or university mental health practice in which the practitioner is adding substance use assessment and brief intervention into an existing practice focused primarily on mental health assessment and treatment. Screening, Brief Intervention and Referral to Treatment (SBIRT) is designed to address substance use whenever and wherever a healthcare or social service provider interacts with an individual (Agerwala & McCance-Katz, 2012). SBIRT is a public health approach to the delivery of early intervention and treatment services for individuals at risk of developing substance use disorders as well as those who have already developed these disorders and is comprised of three components:
- Screening quickly assesses the severity of alcohol and other substance use and identifies the appropriate level of treatment.
- Brief intervention focuses on increasing insight and awareness regarding alcohol and other substance use and co-occurring psychiatric conditions and associated motivation toward behavioral change.
- Referral to treatment provides those identified as needing more extensive treatment with access to specialty care.
A skill set that may be applied in many clinical contexts, SBIRT has been adapted for use in hospital emergency departments, primary care centers, office- and clinic-based medical and mental health practices, schools, colleges and universities, and other community settings, providing opportunities for early intervention with at-risk individuals who use substances before more severe consequences occur (Cimini & Martin, 2020). SBIRT always involves a brief screening for substance use and can include the provision of brief treatment for those with risky substance use (i.e., 10 – 50 minutes), prolonged brief intervention for those with less severe SUDs (i.e., multiple visits or sessions), or referral to specialized substance use treatment programs for those with greater severity of disorders. Along with screening and brief interventions for substance use, screening for psychiatric conditions such as depression and anxiety is frequently conducted allowing for early detection and treatment of associated mental health concerns.
Given the preponderance of substance use among college students that does not yet meet criteria for SUDs, early detection and intervention is imperative. The assessment and treatment of substance use therefore warrants attention by clinicians providing mental health care within college and university settings. Integrating screening and intervention for substance use into routine practice allows clinicians to identify potential substance use and substance use disorders that may be linked to depression, anxiety, and other symptom pictures early and address the often-complex role that substance use can play in the development and maintenance of other mental health concerns routinely addressed in treatment settings within institutions of higher education.
M. Dolores Cimini, Ph.D. is the Director of the Center for Behavioral Health Promotion and Applied Research and Senior Research Scientist within the Department of Educational and Counseling Psychology, School of Education at the University at Albany, SUNY. She has been nationally recognized for her translational research work addressing the interface between mental health and substance use among college students.
References
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