Misuse
Note. Lifetime Use sample (n = 262); Past Month Use Sample (n = 166). Participants were given the substance names with examples listed parenthetically as follows: marijuana (pot, hash, hash oil), cocaine (crack, rock, freebase), amphetamines (speed, methamphetamine), hallucinogens (LSD, mushrooms, mescaline), opiates (heroin), inhalants (glue, solvents, gas, nitrates), designer drugs (ecstasy, MDMA, Special K), steroids, PCP= phencyclidine (angel dust, illy), mood/sleep (e.g., Prozac, Celexa, Paxil, Zoloft, Elavil, Nardil), pain (e.g., Codeine, Percodan, Oxycontin, Vicodin), ADHD=attention/hyperactivity (e.g., Ritalin, Adderal, Concerta), anxiety (e.g., Xanax, Valium, Librium, Ativan, Klonopen), respiratory (e.g., cough medicine, allergy medicine, inhalers), and OTC=over-the-counter (e.g., diet pills, analgesics).
A Drug Use Consequences Scale was developed based on items from the Young Adult Alcohol Problem Screening Test (YAAPST; Hurlburt & Sher, 1992 ) and the InDUC ( Tonigan & Miller, 2002 ) and assessed past year (α = .95) and lifetime (α = .92) prevalence of negative consequences due to use/misuse. To insure that students were completing these items with regard to drug or medication misuse, the instructions indicated that they should not consider their alcohol use and most items also included repeated clarification (because, due to, after, while) of “using drugs.” Items were rated on a 10-point ordinal scale reflecting different frequencies (e.g., 0=never, 1=lifetime but not past year, 2=once in past year; 9=40+ times in past year). This scale also provided an estimate of drug abuse and dependence criteria from the Diagnostic and Statistical Manual-IV-TR ( American Psychiatric Association, 2000 ). The note to Table 2 indicates which items from this scale were used to estimate diagnoses for abuse (at least one of the relevant items occurring at least twice in the past year) and dependence (at least three of the relevant items in the past year).
Lifetime and Past Year Prevalence of Negative Consequences Due to Drug Use
Lifetime Consequence (Total Sample; 262) (%) | Past Year Consequences (Current Use Sample; 166) (%) | |
---|---|---|
1. Said or done something embarrassing | 46 | 50 |
2. Felt guilty or ashamed | 45 | 50 |
3. Not done homework, not study for a test, or received lower grade | 44 | 58 |
4. Felt bad physically | 43 | 46 |
5. Spent too much money or lost a lot of money | 39 | 48 |
6. Missed school, work, or activities with friends | 35 | 45 |
7. Done impulsive things you later regretted | 34 | 40 |
8. Spent a significant amount of time thinking about, looking for, or using | 33 | 42 |
9. Taken drugs in larger amounts or over longer period of time than you planned | 28 | 34 |
10. Failed to do what was expected of you | 27 | 31 |
11. Need more drugs to get the same effect or don’t get the same effect with the usual amount | 27 | 33 |
12. Lost interest in activities or hobbies | 25 | 23 |
13. While stoned or high, been physically hurt, burned, or injured | 22 | 27 |
14. While high or stoned, broken or damaged property | 21 | 26 |
15. Gotten into a physical fight | 18 | 22 |
16. Lost a close relationship | 16 | 13 |
17. While high or stoned, injured someone | 15 | 16 |
18. Take more to avoid or reduce withdrawal | 15 | 18 |
19. Gotten into legal trouble or arrested | 13 | 9 |
20. Been suspended or expelled from school | 11 | 10 |
21. Enjoyed using drugs | 65 | 76 |
22. While high or stoned, driven a car | 42 | 48 |
23. Wanted or tried to limit, cut down, or stop. | 41 | 42 |
24. Continued to use despite psychological or physical consequence | 24 | 29 |
Note. Most of the above phrases ended or including a clarification of (because of, when, due to) “using drugs.” Items also were used to estimate diagnostic criteria for substance abuse (6, 10, 15, 16, 19, 20, 22) and dependence (6, 7, 8, 11, 18 23, 24) based on the Diagnostic and Statistical Manual-IV-TR ( American Psychiatric Association, 2000 ).
For each of the nine drug and six medication categories, students rated their level of personal concern with their use/misuse on a Likert scale from 1-5. The concern variable was calculated taking the maximum level of concern endorsed from any drug or medication category.
Participants’ were asked to report their willingness to participate in 11 different intervention/counseling/therapeutic modalities if offered in a variety of on-campus and off-campus locations. The instructions for these items stated: “Hypothetically, if you were a college student concerned about your use of alcohol, street or prescription drugs, please rate how willing you would be to do the following.” Table 4 lists the options which were rated on a 7-point Likert scale: 0 = very unwilling or not interested to 6 = very willing or interested. Students’ highest interest rating was used in the correlational analyses.
To describe our sample and evaluate our predictions regarding the prevalence of marijuana and prescription misuse, we reported the frequencies of drug use/ medication misuse (lifetime; past month), negative consequences (lifetime; past year), current personal concerns, and current intervention interest. Subsequent analyses focused on those reporting current (past month) use/misuse (n=166) and specifically marijuana use as well misuse of any prescription medicine. For further descriptive purposes, we used analysis of covariance (controlling for days of drinking in past month) to compare gender and year in college on past month frequency of marijuana and medication misuse, consequences, concerns, and intervention interest. Partial correlational analyses (again controlling for past month drinking) were then used to test the association between: 1) past month frequency of marijuana use and any medication misuse with past year negative consequences, current personal concerns, and intervention interest; 2) current intervention interest with current concerns and with past year consequences. Analyses were repeated for the subgroup of current users/misusers (n=100) who met our diagnostic criteria for substance abuse or dependence and revealed a similar pattern of results.
Table 1 lists the frequency of drug use and medication misuse among all students who self-reported any lifetime use/misuse as well as the subsample (63%) who also reported use/misuse in the past month. As indicated, marijuana was the most prevalent illicit drug (89% in past month) and pain medication was the most commonly misused (22% in past month). Approximately half (45%) of the sample reported lifetime use/misuse of only one substance, 19% reported two, 10% reported three, 8% reported four, 6% reported five, and 11% reported six or more different substances. Students who reported current marijuana use averaged 12.16 (SD=11.77) days of use in the past month. Students who reported any current medication misuse averaged 4.94 (SD=8.93) days of use in the past month.
Lifetime reports of negative consequences associated with lifetime use/misuse of substances are summarized in Table 2 as are the rates of past year consequences for students reporting past month use/misuse. As shown, students reported a broad range of negative consequences. Intrapersonal consequences were frequent and included doing something embarrassing, feeling guilty or ashamed, or feeling bad physically. Among the subsample (n=166; 63%) who reported past month use, 26% endorsed past year consequences suggestive of a DSM-IV-TR current diagnosis of substance dependence, and an additional 13% endorsed items consistent with a current diagnosis of substance abuse (without dependence).
Students generally conveyed low levels of concern about their lifetime or recent drug use/medication misuse with almost half reporting no level of concern. Although most of the sample used marijuana, only 28% reported being somewhat concerned about their use. Despite this overall low concern about their drug use or medication misuse, 55% reported moderate or greater interest in at least one type of substance use intervention. The top two commonly endorsed interventions were “brief feedback and counseling” and “talk to a trusted teacher, administrator or coach” (See Table 3 ).
Interest in Intervention Modalities by Past Month Use and Past Month Diagnosis Subsamples
Type of Intervention | Past Month Substance Use | Past Month Abuse/Dependence |
---|---|---|
1. Brief feedback/counseling | 39 | 35 |
2. Brief feedback/counseling on campus with someone from student counseling center | 35 | 31 |
3. Brief feedback/counseling with counselor unaffiliated with your college in private office | 38 | 32 |
4. Confidential conversation with counselor on phone | 37 | 33 |
5. Confidential conversation with a counselor via internet | 28 | 24 |
6. Attend Alcoholics Anonymous/Narcotics Anonymous/12 step meeting in community | 17 | 14 |
7. Alcohol or drug treatment from clinic in community | 27 | 21 |
8. Talk to trusted teacher, administrator, or coach | 39 | 37 |
9. Talk with parent or other family member | 37 | 34 |
10. Complete a confidential, self-guided web-based program about drugs and alcohol | 34 | 29 |
11. Daily self- monitoring of substance use using a handheld computing device | 20 | 18 |
Note. n = 166 students reporting Past Month Substance Use, n = 100 for those past month substance using students who reported past year negative consequences consistent with an estimated diagnosis of substance abuse or dependence.
The ANCOVA model (controlling for frequency of past month drinking) for past month marijuana use was significant overall, F(8, 150) =3.51, p<.001, with a significant univariate effect for gender F(1, 150) =10.94, p<.001. Men used marijuana more frequently than women. This gender difference was not found for past month frequency of any medication misuse, and no school year differences were found for either substance frequency measures.
The overall ANCOVA model testing gender and year differences for past year negative consequences was also significant, F(8, 149) =2.54, p<.05, but the only effect was for the alcohol covariate, F(1, 149) =4.34, p<.05. Likewise, past month drinking (covariate), F(1, 150) =10.34, p<.01, was the only significant predictor in the overall ANCOVA, F(8, 150) =2.87, p<.05, for interest in interventions. There were no significant findings for drinking, gender, or school year for the personal concerns measure.
Partial correlations (controlling for past month alcohol frequency) were conducted for students who were past month marijuana or medication misusers. As predicted, significant positive associations were found between days of past month marijuana use and past month medication misuse, r(160)=.16, p<.05, current level of concern, r(160)=.22, p<.01, and number of past year negative consequences, r(160)=.54, p<.001. Past month medication misuse frequency also was correlated with the number of negative consequences, r(160)=.22, p<.01. As predicted, negative consequences were associated with increased personal concerns about drug/medication use, r(160)=.28, p<.001, although contrary to our predictions, greater personal concerns was not associated with greater interest in an intervention, r(160)=.12, p>.05.
This report focused on college students who reported lifetime use of drugs or misuse of medications. Our hypothesis that marijuana use and prescription misuse would be common was supported as 90% reported use of marijuana, and 42% indicated some type of medication misuse. These results supported McCabe et al’s (2005) findings of prevalent use on college campuses. As well, our hypothesis that extensive and recent drug use would be associated with greater negative consequences and concern was supported. Among students who used drugs in the past month, men used marijuana more days of the month and past month drinking effected drug related negative consequences as well as students’ interest in interventions. Use of marijuana in the past month was associated with medication misuse, concern about drug use, and experiencing drug related negative consequences within the past year. Additionally, past month medication misuse was also associated with negative consequences. Overall, these findings are consistent with research by Kilmer et al. (2007) and McCabe and colleagues (2005 ; 2006 ) regarding drug use and students’ report of a wide range of drug related negative consequences. However, the results also highlight students’ level of concern regarding their drug use and interest in interventions which support Larimer and colleagues (2005) recommendation for the development of further assessment, prevention and intervention services specific to drug use.
Our findings suggest the more frequently occurring negative intrapersonal consequences are relatively minor in nature and may not be easily detected without assessment. Almost half of the sample reported feeling embarrassed, receiving a lower grade, or feeling guilty or ashamed by their drug or medication use. In addition, approximately 17-19% of all participants reported experiencing consequences suggestive of more significant problems such as taking drugs in larger amounts over longer period, failing to fulfill role functions, and losing interest in activities. Thus, for some students, marijuana or other drug use appears to be having a substantially adverse impact on their lives and they may benefit from some type of intervention to prevent additional negative effects. This may be particularly relevant given that 13% of the sample of lifetime drug users reported consequences consistent with a current diagnosis of drug abuse and 26% reported symptoms indicative of drug dependence. It is important to note that less than 10% of the students in this sample reported experiencing negative consequences that had come to the attention of school or legal officials. This suggests that a substantial amount of problematic drug/medication misuses is going undetected and may represent a hidden risk factor for compromised academic and future occupational functioning.
We acknowledge several study limitations. First, this was a sample of undergraduate students on a single campus and should not be generalized to all college students. Second, our rates of drug and medication use should not be misinterpreted as prevalence estimates given that our recruitment strategy over-sampled for students with substance-related behaviors. Other possible limitations include the cross sectional nature of this assessment and the exclusive reliance on self-report data. However, the survey was conducted anonymously to increase the probability that students would accurately self-report risky and potentially illegal behavior. Finally, we acknowledge the limitations of using the Drug Use Consequences measure administered in a large group paper-pencil format to estimate students’ endorsements of lifetime drug abuse or dependence criteria. The diagnostic estimates in this report are tentative as this measure has not been validated and does not provide the same level of diagnostic information as a structured clinical interview. However, it is an instrument which can be delivered with ease to a large group of college students to assess drug-related negative consequences while also obtaining an approximate estimate of abuse and dependence criteria.
Consistent with concerns raised by Larimer and colleagues (2005) , our findings suggest that future studies should examine negative consequences and the need for brief or extended intervention for illicit and prescription drug use on college campuses. Many of the consequences reported in this survey may be very important in the lives of students, but not sufficiently severe to lead to detection by campus authorities or law enforcement officials. The development and evaluation of drug-specific interventions poses considerable challenges to researchers and college administrators particularly because current intervention methods for alcohol incorporate a harm reduction model that may conflict with campus zero tolerance policies around illicit drugs. We also emphasize that students who endorse consequences suggestive of a drug abuse/dependence disorder may be most in need of intervention to prevent the development of further problems. This high risk group may need some form of administrative mandate to participate in an intervention for drug use. Innovative approaches also are needed to encourage self-assessment of substance abuse and help-seeking and may include: incorporating drug prevention programming into ongoing campus alcohol prevention efforts; a greater emphasis on policies that would allow a student to receive some type of intervention versus more punitive actions; student counseling centers and clinics attending to seemingly minor negative consequences; and more research aimed at the development and evaluation of campus interventions specific to drug use.
Support for this study was provided by the National Institute on Drug Abuse (P50 DA09241). We thank Kathleen Carroll and staff of the Psychotherapy Development Center at the Yale University School of Medicine for their support of this project. We especially appreciate the facilitative support provided by the Offices of the Dean of Students and Student Development of the University of New Haven. We also thank Jeff Palmer for his assistance with data entry and management for this project.
An abbreviated version of this study was presented at the 68 th Annual Meeting of the College on the Problem of Drug Dependence in June of 2006.
Rebekka S. Palmer, Yale School of Medicine Department of Psychiatry 915 Old Oak Rd. Livermore, CA 94550.
Thomas J. McMahon, Yale School of Medicine Department of Psychiatry and Child Study Center West Haven Mental Health Clinic 270 Center Street West Haven, CT 06516.
Danielle I. Moreggi, University of New Haven 300 Orange Ave West Haven, CT 06516.
Bruce J. Rounsaville, Yale School of Medicine Department of Psychiatry 950 Campbell Avenue – Bldg 35 West Haven, CT 06516.
Samuel A. Ball, Yale School of Medicine The APT Foundation 1 Long Wharf, Suite 321 New Haven, CT 06517.
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