May/June 2016 Issue

Addictions Advisor: Substance Use and Intervention at Colleges and Universities
By Liza Greville, MA, LCSW
Social Work Today
Vol. 16 No. 3 P. 30

For many young adults, "the college experience" entails varying realms of experience with alcohol or other substances, and national statistics show variations over time in categories of use. Colleges and universities continually reinvent and reinvest in strategies to deal with the seemingly intractable problems associated with substance abuse.

Alcohol Use and Intervention
As in the general population, alcohol is the most widely accessible and abused substance among college students. According to the National Institute on Alcohol Abuse and Alcoholism College Drinking fact sheet, almost 60% of college students ages 18 to 22 drank alcohol in the past month, and almost two out of three of them engaged in binge drinking during the same time frame (2015).

Researchers estimate that the following happen each year:
• About 1,825 college students between the ages of 18 and 24 die from alcohol-related unintentional injuries, including motor vehicle crashes.
• About 696,000 students between the ages of 18 and 24 are assaulted by another student who has been drinking.
• About 97,000 students between the ages of 18 and 24 report experiencing alcohol-related sexual assault or acquaintance rape.
• About 1 in 4 college students report academic consequences from drinking, including missing class, falling behind in class, doing poorly on exams or papers, and receiving lower grades overall.

Patrick Gilligan, LISW, director of counseling services at Kenyon College in Gambier, Ohio, notes that "Since research indicates that most students start using alcohol in the first year of college, colleges find themselves in the unique position of helping students with an introduction to responsible alcohol use without sanctioning it" (as the majority of undergraduates are under the legal drinking age of 21).

To that end, he states that Kenyon takes an aggressive approach to delivering education through relationships. Among several programs, Kenyon has 150 students (10% of the student body) who are trained as peer educators and understand the resources for substance use treatment on campus. "Research shows us that students are more likely to divulge their problems to other students," Gilligan says. "Therefore, we work very closely with these groups to convey that issues that affect college students are real, invariable, and can be made better with support."

Michael Durham, LSW, LICDC, substance abuse counselor at Kenyon, explains the college's Good Samaritan policy. This policy allows a student (or peer) to call the campus safety service to respond to and assess a student when there is concern that the student may be at risk of alcohol poisoning, acute intoxication from another substance, or other imminent harm. Students acting under the Good Samaritan policy are not subject to disciplinary action, and Durham meets with any student who uses this service for an individual session. This policy exemplifies the delicate balance of prioritizing safety without condoning dangerous binge drinking, which Durham believes is the most critical challenge facing colleges related to substance abuse.

Other Substance Use
The Monitoring the Future (MTF) survey, conducted by researchers at the University of Michigan with funding from the National Institute on Drug Abuse, has been monitoring trends on college campuses for 30 years. The most recent survey, released in 2014, shows the following (Wadley, 2014):
• Illicit drug use has been rising since 2006, when 34% of college students indicated some illicit drug use in the past year. In 2013, that rate was up to 39%; this is attributable to a rising proportion using marijuana.
• Marijuana is the most widely used illicit drug, with daily or near-daily use (defined as 20 or more occasions of use in the past 30 days) rising from 3.5% in 2007 to 5.1% in 2013.
• Nonmedical use of Adderall ranks second among the illicit drugs being used in college, with 11% of college students indicating some use of Adderall without medical supervision in the prior 12 months.
• The next most frequently used drugs are ecstasy (5.3% in the past 12 months of college in 2013), hallucinogens (5%), and narcotics other than heroin, such as Vicodin and Oxycontin (5.4%).

To put the increase in marijuana use in perspective, Lloyd Johnston, principal investigator of the MTF study, notes, "This is the highest rate of daily use observed among college students since 1981—one-third of a century ago. In other words, one of every 20 college students was smoking pot on a daily or near-daily basis in 2013, including one in every 11 males and one in every 34 females" (Wadley).

Mary-Jeanne Raleigh, PhD, director of counseling and testing services at the University of North Carolina at Pembroke (UNCP) and past president of the American College Counseling Association, sees reflections of the growing cultural acceptance of marijuana in students' perceptions. "Marijuana is so ubiquitous, students often don't consider it a drug, and rather they see it as a medicinal product," she says. Durham adds that it is incumbent on the clinician to be well versed in the current research and literature on marijuana in order to provide accurate education as well as maintain credibility with students.

The Addictions Recovery Model
Depending on the institution, the variety of offenses related to underage drinking and associated behavioral problems, as well as the offenses related to possession of illicit substances, may be handled as violations of a student code of conduct (thus invoking sanctions through an internal judicial affairs process) or alternatively through a legal process. Both are primarily punitive systems.

Raleigh believes colleges have an opportunity to broaden intervention strategies while still holding students accountable for their actions. "Addiction patterns solidify in early adulthood, around ages 18, 19, 20, when students are often away from home for the first time and protective factors in their lives are shifting. Instead of dealing with substance use issues primarily as violations of the student code of conduct or through the legal system, I think colleges would serve students well to incorporate an addictions recovery model into the conduct process."

Research published in Alcoholism: Clinical and Experimental Research supports this approach. In sum, researchers surveyed how campus and local security responded to serious, less serious, and underage alcohol-related incidents both on and off campus. According to an article summarizing the findings, "It was also not typical for these students to be referred to a campus health center to be evaluated for a possible alcohol problem. Rather, students were usually referred for discipline or sanctions to other university officials" (Swartz, 2014).

Raleigh describes the "Be Brave" Recovery Community model at UNCP, which is part of a growing trend at colleges and universities across the country, notably in the University of Texas system. Transforming Youth Recovery, a nonprofit created by the Stacie Mathewson Foundation, accelerates this trend by providing an asset-based model as the basis for building collegiate recovery capacity, as well as grants to institutions to aid in the start-up costs. UNCP is a grantee of Transforming Youth Recovery.

Transforming Youth Recovery
While recovery programming varies across institutions, common components include a licensed alcohol and other drug specialist in the counseling service offering individual and group therapy, peer-facilitated recovery groups, social activities, and housing, as well as an emphasis on service projects. Beyond "substance-free" events, members of recovery communities monitor one another for signs of relapse and mentor each other as they actively confront the challenges of maintaining sobriety in a collegiate environment.

According to Raleigh, "We've spent a lot of money (in higher education) on prevention over the years, and the large-scale efficacy of our prevention work is just not there. Of course, we continue our prevention efforts, but at UNCP, we are not putting all our eggs in the prevention basket. We are expanding our treatment and recovery programs."

Given the complex problems associated with the pervasive use of alcohol, marijuana, and other drugs among young adults, colleges and universities are bound to grapple with best practices in helping students cope with the harmful effects. Multipronged approaches including prevention interventions and treatment resources, as well as effective support for college students in recovery, are integral to a broadening access to a successful college experience for more students.

 — Liza Greville, MA, LCSW, is in full-time clinical practice and a contributor to Social Work Today.

References
National Institute on Alcohol Abuse and Alcoholism, National Institute of Health. (2015). College drinking. Retrieved from http://pubs.niaaa.nih.gov/publications/CollegeFactSheet/CollegeFactSheet.pdf.

Swartz, J. (2014, July 21). Colleges can be doing more to combat drinking culture, study says. USA TODAY College website. Retrieved from http://college.usatoday.com/2014/07/21/colleges-can-be-doing-more-to-combat-drinking-culture-study-says/.

Wadley, J. (2014, September 8). College students' use of marijuana on the rise, some drugs declining. University of Michigan website. Retrieved from http://ns.umich.edu/new/releases/22362-college-students-use-of-marijuana-on-the-rise-some-drugs-declining.