literature review on drug abuse among university students

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• Published: 14 March 2023

Illicit drug use in university students in the UK and Ireland: a PRISMA-guided scoping review

• Maeve Boden 1 &

Substance Abuse Treatment, Prevention, and Policy volume  18 , Article number:  18 ( 2023 ) Cite this article

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Interest in the health and well-being of university students has increased in the UK and Ireland in the past two decades as their numbers have grown. Recent high-profile deaths of students after using illicit drugs have highlighted the importance of the topic for policy makers. This scoping review maps the state of the existing literature evaluating use of illicit drugs in university students in the UK and Ireland. It aims to highlight research gaps and inform policy.

We conducted a systematic search of papers related to psychoactive drug use in university students in the UK and Ireland published before August 2021. The 18 extracted study characteristics included author(s); year of publication; journal; location of data collection; study design; delivery method (e.g., online survey, in-person, postal survey); number of participants; response rate; participant course of study, year of study, degree level (i.e., undergraduate, postgraduate), gender and age; time-period assessed (e.g., lifetime, current use, past 12 months); primary aim; primary outcome; ethical approval; and funding source.

The PRISMA-guided search strategy identified 1583 papers for abstract review; of 110 papers retained for full-text review, 54 studies met criteria for inclusion for this paper. Primary outcomes were coded into five groups: prevalence and patterns of drug use; factors associated with drug use; attitudes and knowledge about, and motivation for, drug use; supply of drugs; consequences of drug use. The results show that there is no coherent body of research in this area. The prevalence of reported drug use has crept up and the range of substances reported has broadened over time, and attitudes to drugs on average have normalised. However, there are significant methodological limitations that limit the utility of these findings. There was little evidence of published work on prevention of, or intervention to reduce, drug-related harms.

The domains identified offer a framework for university administrators, researchers and policy makers to understand the potential response to drug use in university students in the UK and Ireland. Recommendations are made to fill the gaps in the research evidence base.

Illicit drugs are psychoactive substances whose non-medical use has been banned by international drug control treaties as they are believed to pose an unacceptable risk to the health of people that use them [ 1 ]. Prospective cohort studies in high-income countries consistently show that adolescence is the peak period for first illicit drug use, and levels and frequency of use begin to increase in mid-adolescence and peak in early adulthood before slowly declining with age [ 2 , 3 ]. This is consistent with the latest figures available for England and Wales, which relate to trends in drug use for the year ending March 2020 [ 4 ]. Approximately 1 in 5 (21%) young adults aged 16–24 years had taken an illicit drug in the last year (1.3 million people) compared with 1 in 11 (9.4%) adults aged 16–59 years. Furthermore, twice as many young adults had taken a drug more than once a month in the last year. Cannabis was the most common drug used by 16–24 year olds (18.7%).

Illicit drug use in young adults tends to be more experimental and opportunistic than in older age groups, but some young adults start to use drugs more frequently and a small number progress to regular use and dependence. Degenhardt and colleagues have described the epidemiology of illicit drug use in young people (defined as 10–24 years old) around the world, the harms that they cause, and the potential responses available to reduce these harms [ 2 , 5 , 6 ]. Variations in patterns of drug use initiation between countries and cultures suggests that a young person’s entry into illicit drug use may reflect their personal characteristics, illicit drug availability, and social settings that facilitate or deter drug use [ 2 ].

Illicit drug use appears to be a common but infrequent activity amongst university students. In the UK most students start university at the age of 18 or 19, and it was reported in 2017/18 that a record 50.2% of English 17- to 30-year-olds had participated in higher education. This coincides with a period often known as ‘emerging adulthood’, commonly defined as the period between the end of compulsory schooling and the onset of adult commitments such as employment, long-term sexual relationships and parenthood [ 7 ].

During this period most students live away from home for the first time and so become more financially independent and self-reliant as a consequence. New friends are made and old friends from school are left behind, as the individual begins to forge a new adult identity away from parental influence. Peer and romantic interactions become more important, and there is a need to be more self-directed in terms of time management. The university can therefore be seen as a specific ‘risk environment’ [ 8 ], where cultural and environmental factors including distance from parents and the interconnected nature of student life can accelerate trajectories from drug experimentation to more involved drug use [ 9 ]. In this transitional phase, experimentation with drugs may be seen as a normative behaviour by students that helps them to develop new social relationships, enhance new experiences or to boost academic or recreational performance [ 7 , 10 ].

A national survey of 2810 students in the UK in 2018 reported that 56% of respondents had used drugs, and 39% currently used them [ 11 ]. Cannabis was the most frequently taken drug (94% of respondents who said that they had used drugs) and was the most likely to have been used regularly. However, ecstasy, nitrous oxide and cocaine had all been used by most of the drug-using population at some point. Large scale North American surveys show that the annual prevalence of illicit substance use in university student populations has grown gradually from 34% in 2006, to 43% in 2018 [ 12 ]. The US national Monitoring the Future follow-up study reported that the annual prevalence in cannabis use in university students was at a historic high level, with a 5-year trend from 2014–2019 showing a significant 8.6% increase [ 12 ].

The 2017 Government Drug Strategy in England emphasised that Colleges and Universities had an important role to play in supporting the health and welfare of their students [ 13 ] (p9). Likewise, when the Irish Government convened a Rapid Response Group in September 2019 to address illicit drug use in higher education institutions (HEIs) it noted that HEIs “ can assist in addressing the hazards of illicit drug use by implementing actions that have the potential to reduce the number of students who decide to use drugs in the first place, or to reduce the harm experienced by those students who have chosen to use drugs ” [ 14 ]. However, there has been relatively little research on the incidence and prevalence of drug use in UK or Irish university student populations. Previous reviewers have noted methodological shortcomings, including small sample sizes and/or a narrow focus on students from a single university or even a single department [ 15 , 16 ]. It is not clear whether student attitudes to drugs differ from their non-student peers, or whether they have changed over time. There is also a lack of consensus on the extent of drug-related harms and the most effective strategies to reduce them if necessary. In early 2022 Universities UK (UUK) announced that it wished to set out a common approach to reduce harms from drug use and to better tackle supply [ 17 ]. They noted that some universities had the stated aim of a ‘drug-free campus’ whereas others had implemented harm reduction and treatment services.

A coherent body of research into illicit drug use by university students might be expected to explore the epidemiology of use, potential mechanisms of initiation, escalation and reduction in use, prevailing attitudes towards and beliefs about drugs, any potential benefits or harms resulting from use, and methods for detecting, preventing and treating problematic use. The existing evidence base in this area is built on research in North American university populations [ 18 , 19 ], but there are considerable differences between the USA and Europe in terms of the structure and funding of higher education, social and criminal justice systems, and the availability of treatment for substance use disorders. We therefore conducted a PRISMA-guided scoping review of the literature to answer the question ‘what is known from the existing literature about the use of illicit drugs by university students in the UK and Ireland?’. Scoping reviews aim to be comprehensive but with a focus on identifying gaps in the literature to inform policy. As such, they provide an overview of the research in an area of study but without an in-depth consideration of research quality [ 20 ]. The process involves identifying an initial research question, searching for and selecting relevant studies, and collating, charting, summarizing, and reporting the data [ 21 ]. This review is the first attempt to identify gaps in the evidence base to guide future research, policy and practice in identifying and reducing the potential harm of illicit psychoactive drug use in university students in the UK and Ireland.

In line with scoping review guidance, we first considered the concept (what is known about illicit drug use), target population (university students in the UK or Ireland), and. outcomes of interest (including epidemiology, mechanisms of initiation, escalation and reduction in use, attitudes and beliefs about drugs, benefits or harms of use, and methods for detecting, preventing and treating problematic use) to clarify the focus of the scoping study [ 20 , 22 ]. A search strategy was developed in line with our overarching question, and three electronic databases were searched in July 2021 to identify published papers: MEDLINE, PsycINFO and Web of Science. Search terms including ‘United Kingdom’, ‘Ireland’, ‘student’, ‘university’ and drug use’ were used (see Supplementary file 1 for a full list of search strings). The search terms were broad to be as comprehensive as possible. The reference lists of the included papers were searched and experts in the field contacted to identify any further evidence. The electronic databases EThOS and OpenGrey were used to search for unpublished evidence. Following the guidance for a systematic search created by the Canadian Agency for Drugs and Technology in Health [ 23 ], a general Google search was completed and the first 50 results were screened. There were no restrictions imposed on the date of publication, but due to time and cost restraints only English language papers were included.

Study selection

The search produced 1583 potential papers for inclusion. The inclusion and exclusion criteria were formulated as an iterative process once the breadth of the literature was understood. Systematic reviews and literature reviews were excluded but reference lists were searched. Primary studies were not excluded based on their design, and both quantitative and qualitative research was included. Theses and student dissertations were included, but other unpublished literature was assessed separately. Studies that also included non-student participants or non-UK/Ireland-based universities were only included if the results were separated by population and the relevant data could be extracted. Papers discussing drug education in the university curriculum of healthcare professionals were excluded. The full search included papers that focussed on the use of drugs prescribed by a healthcare professional (even if used illicitly e.g. those used as ‘cognitive enhancers’). However, this report focuses on illicit drugs only (see data supplement 2 for excluded papers on the latter topic). If more than one report used duplicate data, the most comprehensive or relevant paper was included.

Two independent reviewers (MB and ED) undertook the study selection process. The titles of the records found in the search were screened and the relevant abstracts independently assessed, with any disagreements between reviewers resolved through discussion. Full-text papers were then obtained and reviewed. The reviewers met frequently to discuss challenges surrounding study selection and to ensure the search strategy was suitable. Papers that assessed any aspect of the use of illicit drugs conducted in the UK or Ireland were included. Figure  1 shows the process of study selection using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework [ 24 ]. The excluded papers are listed in Supplementary file 2 , along with the reasons for exclusion.

Preferred Reporting of Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart

Data extraction

An iterative model was used to determine the study characteristics extracted [ 20 ]. Both researchers independently used a data-charting tool to extract study characteristics from the first five papers included, before meeting to discuss any difficulties and refine the variables to extract. The final characteristics recorded were [ 1 ] author, [ 2 ] year of publication, [ 3 ] journal, [ 4 ] location of data collection, [ 5 ] study design, [ 6 ] delivery method (e.g., online survey, in-person, postal survey), [ 7 ] participant number, [ 8 ] response rate, [ 9 ] participant course of study, [ 10 ] participant year of study, [ 11 ] participant degree level (i.e., undergraduate, postgraduate), [ 12 ] participant gender, [ 13 ] participant age, [ 14 ] time-period assessed (e.g., lifetime, current use, past 12 months), [ 15 ] primary aim [ 16 ] primary outcome (categorized into 6 groups: prevalence and patterns of drug use, risk and protective factors, consequences of drug use, attitudes and knowledge, motivations for drug use, source of drugs), [ 17 ] ethical approval, and [ 18 ] funding source. One researcher (MB) then extracted the 18 study characteristics from each included study and the other researcher independently reviewed the completed data-charting form, with any disputes resolved with discussion. Quality was not formally assessed but ethical approval and funding were used as crude proxies in line with scoping review guidance [ 25 ].

A review of the grey literature found eleven relevant papers, all of which focussed on the prevalence of drug use among university students. One was a survey conducted by the UK National Union of Students and a national charity providing expertise on drugs and the law (Release) [ 11 ], and a second was commissioned by the UK Higher Education Policy Institute from a professional surveying organisation (YouthSight) [ 26 ]. A third reported on a national student survey in Ireland, and the remainder were student newspaper reports. The largest survey was carried out by The Tab, an online magazine covering youth culture and student issues. This had 16,000 responses from students across the UK, but no information was provided on the sampling methodology used. None of these papers reported how they recruited participants or their demographic characteristics, and so these studies are not considered further in this review but are detailed in Supplementary file 2 .

Fifty-four peer-reviewed papers were included representing unique data from 50 separate studies, and 56 papers were excluded at the full-text review stage. These results are summarised in a PRISMA flowchart in Fig.  1 .

Study characteristics

Table 1 summarises the study characteristics. Since the 1980s the number of published papers has increased with each full decade, and almost half of the papers included in this review were published within the last 10 years. All four nations of the UK (England, Wales, Scotland, Northern Ireland) and the Republic of Ireland were represented. Five papers did not report their location within the UK, and only seven papers included universities in more than one country. English (44%) and Irish (19%) universities were the best represented. The majority (63%) of papers recruited participants from just one university, and only 3 (6%) recruited participants from 10 or more universities.

The subject that participants were studying varied, with 16 (30%) papers limiting the sample to a particular course or courses (usually medical, dental or nursing studies). The academic year of study of participants was recorded in 41 (76%) of the papers, and the choice of year group was usually decided pragmatically with no particular focus on students early or late in their course of study. The gender breakdown in the 43 (80%) papers that reported it was between 30 and 89% female. The mean age of the sample was reported in 21 (39%) papers and ranged between 18.8 and 24.9 years.

Study design

A clear majority of the studies had a cross-sectional design, with only 4 reporting data from more than one time point. Forty-seven papers (87%) reported a quantitative analysis, 4 (7%) reported a qualitative analysis and 3 (6%) used mixed methods. In those that employed mixed methods, cross-sectional data was used to inform later semi-structured interviews and open questionnaires. In the 51 papers where numerical data were collected, 36 (67%) used in-person interviews, 9 (17%) on-line data collection, 6 (11%) postal data collection and 1 analysed secondary data.

Ethical approval and funding source

Under half (23, 43%) of the papers reported that they had obtained ethical approval and the remainder did not report whether approval had been sought or not. Twelve of the papers reported funding from various sources including university funds, the British Medical Association, the Wellcome Trust and the Northern Regional Health Authority. The remainder either did not report whether funding was received or specified that there was no external funding for the project.

Drugs assessed

The drugs assessed in the papers were grouped into categories: a broad definition of illicit drugs (sometimes including prescription drugs used in an illicit way) (43, 80% of papers), cannabis only (8, 15%), and ecstasy only (3, 6%). Most papers included questions about drugs alongside alcohol and tobacco. Cannabis was the most reported drug under study, but the range of substances reported increased over time.

Primary and secondary outcome domains

The outcomes of the papers were coded into five categories, with papers that reported more than one outcome coded multiple times. Forty-one of the fifty-four papers (76%) reported the prevalence or pattern of drug use, 28 (52%) factors associated with drug use, 14 (26%) student attitudes towards, knowledge about, and motivations to use drugs, 6 (11%) information about the source and supply of drugs, and 7 (13%) the consequences of drug use. The included papers are categorised by outcome in Table 2 .

Prevalence or patterns of drug use

The 41 papers examining prevalence or patterns of illicit drug use collected data through either an in-person interview (29, 71%), a postal response (4, 10%), an online survey (7, 17%) or both in-person and online methods (1, 2%). The number of participants ranged from 47 to 7855, and 39 of the 46 (85%) samples reported included a percentage response rate ranging from 6 to 100%. The response rate varied by the method used to collect data (in-person 60–100%, postal 33–97%, online 6–33%, in-person and online 41%). In terms of participants recruited the online surveys had the most participants (mean of 3382 compared with mean of 765 in the in-person surveys and 430 in the postal surveys) but the lowest response rates (mean of 15.5% compared with 82.2% in-person and 68.5% postal). A range of time periods of drug use were assessed, including lifetime (35 papers), past year [ 13 ], past 6 months [ 2 ], past 3 months [ 1 ], past 3 months [ 1 ], past 30 days [ 1 ], past month [ 1 ], past 4 weeks [ 1 ], past week [ 3 ], ‘since starting degree’ [ 1 ], ‘current academic year’ [ 1 ] and ‘current’ [ 12 ]. There was a broad trend towards students reporting more experience of a wider range of illicit substances. However, the variability in participant samples, the methods used to collect the data, and the time periods of drug use considered meant that it was not possible to formally assess trends in drug use over time.

Factors associated with drug use

Twenty-eight papers (52%) assessed factors associated with drug use, and these are summarised in Table 3 . Many papers reported more than one associated factor. Twelve papers (22%) explored demographic variables, including age, gender, ethnicity, socioeconomic status, living circumstances and international student status. Eleven (20%) measured personality factors or mental health, including instruments measuring sensation seeking and anxiety. The link between health-related behaviours, including tobacco smoking, alcohol consumption and physical activity, and drug use was assessed in 11 (20%) papers. Other associations included academic course or year of study (8, 15%), attitudes to drug use and health awareness (3, 6%), normative beliefs (2, 4%), academic performance (2, 4%) and religious beliefs (2, 4%). No clear and consistent patterns of association could be drawn from the data.

Attitudes towards, knowledge about, and motivations to use illicit drugs

Fourteen papers assessed student attitudes towards drugs and/or their knowledge about their effects. Issues covered included the morality or ethics of drug use, safety beliefs, the perceived effect of drug use and perceived motivations for use. Early studies noted that attitudes to cannabis were markedly different to those towards tobacco or alcohol [ 27 ]. People that drank alcohol perceived that people that used cannabis were ‘definitely emotionally unstable’ and ‘definitely less able to cope with life’, whereas the latter group perceived that people that used illicit drugs in general were ‘more interested’ and ‘vested with more friends’. This attitudinal separation was hypothesised to be an effective ‘barrier’ to starting cannabis use.

By the late 1990s, papers were reporting that students that regularly used illicit drugs were similar to the general population of students both in their views about the causes of drug use and their personal and social characteristics [ 28 ]. Both students that used drugs and those that did not agreed that youth culture influences and sensation-seeking were the most endorsed reasons for drug taking. The illegality of drugs had little influence on levels of consumption [ 29 ]. Some support was found to support the idea that increasingly liberal views towards drugs would appear across a student’s time at university [ 30 ]. Although attitudes towards tobacco became less positive in year 3 when compared to starting university, there was no such change for illicit drugs. By the 2010s, students were shown to rate tobacco as most harmful to physical health, alcohol most harmful with regard to injuries and social consequences, and cannabis as most harmful with regard to mental health [ 31 ]. As the legal substance alcohol was rated as more harmful than the illegal substance cannabis, the authors hypothesised that young people in the years to come may be less supportive of a traditional drug policy based on criminalization [ 31 ].

By 2018, Patton’s survey found that the top three reasons for drug consumption were for fun or pleasure, for relaxation, and to enhance an activity [ 16 ]. These reasons were thought to fit with the ‘normalization’ hypothesis [ 32 ]. Depictions of drug use in the media were widespread, and 78% felt comfortable consuming media that featured drug use. There was also further evidence of the shift from drug use as a deviant activity into mainstream cultural arrangements (59% of abstainers had one or more close friends who use drugs) [ 16 ]. These results suggest that attitudes towards drugs may have changed over time amongst the student population, but the level of acceptance is not uniform or consistent between different substances in different populations.

The supply of illicit drugs

Six papers were concerned with the supply of drugs. An early study in the 1970s in Ireland found that most students were approached to buy drugs at parties, in pubs or hotels, or at clubs. Roughly half of students obtained their first drugs from friends [ 33 ]. A study in England in the 1990s also found that drugs were usually bought from friends and were most commonly consumed in other people’s rooms or at parties [ 29 ]. The authors contrasted this with alcohol which was consumed in bars or public places. More recently, a larger survey of 7 of the 9 universities in Wales found that half of the students that used drugs obtained them solely from friends and associates, and another 25% used friends and external markets [ 34 ]. In many cases supplying drugs amounted to sharing them or giving them away, but over a third said they had sold drugs. Drugs like nitrous oxide, cannabis, synthetic cannabinoids, ecstasy and magic mushrooms were usually sourced from friends, whereas other drugs (khat, crack, steroids, heroin) more likely to be bought. Male students were more likely to buy from dealers. The authors concluded that methods used by university students to obtain and supply drugs shared features of both ‘social supply’ and ‘traditional drug markets’ [ 34 ].

Moyle and Coomber also considered the nature of the supply of drugs in students. They conducted semi-structured interviews with 60 social suppliers of recreational drugs in two studies involving both a student population ( n  = 30) and a general population sample ( n  = 30) [ 9 , 35 ]. Both samples provided evidence that supplying drugs to, and receiving them from, friends and social contacts had become increasingly normalised and seen as less than ‘real dealing’ and more like gift-giving [ 35 ]. Early experiences of social supply occurred pre-university and usually involved a ‘one off’ act of sharing cannabis. However, once at university this had increased to ‘buying cannabis in bulk and selling excess amounts to friends, and/or purchasing ‘standard’ 3.5 g bags of powders like cocaine and MDMA on behalf of a group and retaining a quantity of the substance as payment’. This behaviour rarely continued when they returned home [ 9 ].

Consequences of drug use

Seven papers reported the consequences of drug use. Two studies surveyed consequences of any illicit drug [ 36 , 37 ], four focussed on cannabis [ 38 , 39 , 40 , 41 ] and one on ecstasy [ 42 ]. Two large online surveys collected data on physical and psychological effects of drugs and drug-related crime, providing a broad overview of a range of issues. In contrast studies utilising in-depth structured interviews with qualitative analysis explored the positive and negative effects of cannabis [ 39 ] and the effects of cannabis on driving [ 41 ]. One lab-based study examined cannabis-related impairments in prospective memory by comparing people that used cannabis and people that did not on both self-reported prospective memory failures and on an objective video-based prospective memory task [ 38 ]. Two studies used objective measures to quantify the consequences of drug use on mental health e.g., the Hospital Anxiety and Depression scale [ 40 , 42 ]. Overall, the positive effects of relaxation, mood elevation and enhanced creativity were balanced by negative effects such as forgetfulness, poor concentration, and reduced productivity. Impaired mental health was a common theme, including paranoia, moodiness, anxiety, irritability, confusion and dependence. Crime-related consequences included driving under the influence, antisocial behaviour and selling drugs [ 36 , 41 ].

This scoping review was conducted at a time when increasing attention was being paid to the issue of drug use in university students, and media reports about drug-related student deaths had prompted a government response in both the UK and Ireland. Universities UK, a body representing 140 Universities across the UK, formed a ‘Task Force’ to explore the issue of drugs on campus in early 2022 [ 17 ], with the stated aim of setting out ‘ a common approach to reduce harms from drug use and to better tackle supply’ . The aim of this scoping review was to map the breadth and depth of research into illicit drug use in university students in the UK and Ireland. In this paper our focus was on illicit drugs, and we excluded a growing body of work on the illicit use of prescribed stimulant medications as aids to studying (to be analysed elsewhere). We made no attempt to assess the quality of studies included, and do not claim to draw conclusions about the findings. However, the gaps in the resulting survey of research covering a period of over 50 years may help to guide policy makers and researchers in the UUK Task Force.

The epidemiology of drug use in university student populations

Monitoring student drug (and alcohol) use over time should be critical to the development of effective evidence-based policy and intervention strategies. High quality estimates can be used to identify trends and patterns, understand the direct and indirect harms of drug use, and guide further research to understand risk and protective factors for student drug use and the effectiveness of policy or treatment interventions. This review found that the prevalence of drug use was the most studied area in terms of number of published papers. However, as has been noted by other researchers [ 16 ], the existing UK/Irish research is methodologically limited. Most published studies reported prevalence of use, but the time window of assessment and the instruments used were variable. Studies including students from more than one university were the exception, and the population under study was often drawn from a single university department. It was rare for a paper to distinguish between single use (e.g., tried once in a lifetime) and regular use (e.g., several days in the past week), and validated clinical diagnoses were never reported. Most of the published papers described cross-sectional studies, with no attempt to follow up participants. One research group based in the north-east of England has repeated studies over time [ 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ], but not used the same methodology or followed through one cohort for significant length of time. Little of the research moved beyond simple descriptions and correlations, and it was rare that any under-pinning theory or conceptual model was described. Finally, there was very little evidence about drug use in specific high-risk populations e.g., LGBTQ or non-white students, or students with co-existing mental health problems.

The Advisory Council on the Misuse of Drugs (ACMD) has noted that prevalence data on young people’s drug use within the UK are ‘generally limited, highly variable and of low quality’ [ 52 ]. They recommend reviewing the scope and detail of the current approaches to monitor prevalence, ensuring that outcome measures used are fit for purpose. Expertise and experience in this area can be drawn from North America, where regular national surveys using sound methodology include university-age students [ 12 ]. The authors of a Canadian report on quality standards for measuring drug use in high schools [ 53 ] noted that surveying students in school is an efficient and cost-effective means of collecting data from young people, and similar reasoning could be applied to universities. However, there is a need for standardised methodology that can be replicated over time in representative samples.

Recommendation : A national survey of student drug use that covers the whole of the UK and Northern Ireland would be helpful, particularly if it was repeated to monitor trends over time. Standardised data collection instruments tailored to young adults must be developed and tested (e.g. see [ 53 ]), and the first step towards this approach has already been taken in Ireland under government direction [ 54 ]. Alternatively, the creation of representative student ‘consumer panels’ may allow researchers to explore patterns and frequencies of drug use in nationally representative samples.

Positive and negative risk factors for drug use

Although several studies described the association of a range of demographic, psychological and social factors with drug use, methodological limitations limited the utility of these findings. Some important areas of potential study were completely absent in our findings. For example, a developing evidence base suggests that there is a positive association between adverse childhood experiences (ACEs) and the development of substance use disorder in adolescence and adulthood [ 55 ]. One potential framework for study is the life course model of substance use [ 56 ], with a focus on the role of illicit drug use in developmental role transitions. Many authors have argued that emerging adulthood (i.e. the traditional university years) is developmentally different from adolescence (school) or full adulthood [ 10 ]. Independence from parents, new social and romantic relationships with peers, increased access to drugs and alcohol, and the need for self-directed study all contribute to a unique social milieu at a developmental stage already characterised by peak levels of risk-taking and high levels of mental health problems [ 57 , 58 , 59 ]. Understanding the factors that increase or decrease substance use at university is important to develop effective responses.

Recommendation: Prospective cohort study designs are needed that include student populations to identify which factors play a role in the initiation, development and cessation of drug use. Risk and protective factors for illicit drug use in young adults may be conceptualised as contextual (e.g. availability of the drug, or social norms that are tolerant of illicit drug use), fixed markers of risk (e.g., sex, parental and sibling substance use, poverty or potential genetic factors), and individual and interpersonal risk factors (e.g., novelty and sensation seeking, conduct disorder in childhood, parenting styles, or poor quality of parent–child interaction) [ 2 , 60 ]. Affiliation with peers that use drugs is one of the strongest predictors of illicit drug use in young adults and of crucial importance in the transitional social milieu of a university campus [ 61 ]. The impact of an increasing awareness of neurodiversity in young adults should also be investigated.

The harms (and benefits) of drug use in the student population

The consequences of illicit drug use were only reported in seven of the papers included in this review, with some limited focus on mental health and criminal justice issues. There were no studies exploring the impact on university-specific outcomes such as completion of a course of study, academic achievement and progression to further study or employment. This is surprising, as these outcomes are important markers of university quality used in national league tables. Understanding the specific harms that relate to university students will help to tailor prevention and treatment responses to this population.

Recommendation : The potential harms of illicit drug use in student populations occur across several domains, including academic performance (attendance and grades), other high-risk behaviours (unprotected sex, violence, driving under the influence), exacerbation of mental health problems, or legal issues (prosecution for possession or dealing) [ 62 ]. These consequences could potentially reshape the entire trajectory of the student’s life course [ 63 ]. Therefore, it would be useful to collect, collate and track standardised data nationally from a range of university departments (e.g., student welfare, registry) as a marker of illicit drug-related harm. Such quantitative data could usefully be supplemented by detailed qualitative studies of each aspect of harm (e.g., academic, physical, mental, social, or legal).

Knowledge about, attitudes and motivation to use drugs

Levels of objective knowledge about drug use were rarely studied, and yet may form the bedrock of a harm reduction approach [ 64 ]. Likewise attitudes and motivations to use drugs were not often reported or studied, despite the existence of potentially useful underpinning theories such as the theory of planned behaviour [ 65 ]. The use of conceptual models to guide findings is important to build an effective evidence base for prevention and intervention. The 2021 UK Government Drug Strategy aims to achieve a ‘generational shift in the demand for drugs’, and one proposed strategy for achieving this is ‘ research and testing messaging through an evidence-based, targeted behaviour change initiative, initially aimed at students in further and higher education’ [ 66 ] (p49). The document further notes that communications campaigns work best when they are tailored and targeted to the audience, and a recent ACMD report on prevention of illicit drug use notes that some activities have been ineffective, such as fear arousal approaches (including ‘scared straight’ approaches) or stand-alone mass media campaigns [ 67 ].

Our results suggest that a national trend towards ‘normalisation’ of recreational drug use has been replicated on university campuses. Furthermore, this has merged with the social supply of drugs, leading to a perception amongst some students that supplying (sometimes) large amounts of drugs is routine [ 35 ]. However, the overall picture is complicated, and not all studies included students who didn’t use drugs and so their voice was often not heard. Survey work using student panels rather than open online questionnaires shows that some students believe that their university should take a tougher stance on drugs [ 26 ]. The ‘social norms’ approach is based on challenging misperceptions individuals hold about their peers. Research at eight Further Education Colleges in the UK reported a perceived norm of frequency of substance use that was higher than the reported norm, and the majority of respondents did not actively approve of tobacco, cannabis or other drug use [ 68 ]. This reflects similar findings in the university system in Canada [ 69 ]. The social norms approach may be a viable method of developing effective methods of behaviour change in UK students.

Recommendation : Studies of knowledge about, and attitudes towards, illicit drugs in representative populations of UK or Irish students would be helpful in designing strategies to educate students about illicit drug use. Theoretically-driven interventions to reduce use and prevent harm may have a significant impact later in life, and comparisons could usefully be drawn with non-student peers.

Prevention and treatment of drug-related harms

Our scoping review found little evidence of published work in UK/Irish universities on prevention of, or intervention to reduce, drug-related harms. Reviews of the North American literature on prevention and treatment have also noted a lack of published studies, but parent-based and in-person brief motivational interventions appear to be promising [ 18 , 70 ]. Our review found no such interventions published in UK or Irish student populations. This may reflect the slow response of universities to consider drug use and tackle its potential harms, and the impact of stigma and illegality on students’ help-seeking attempts. A review of psychological interventions for prevention and treatment of mental health disorders in university students [ 71 ] was also limited by the poor quality of the literature and exclusion of non-published data. It noted considerable uncertainty about the best way to provide interventions for students, and relatively few trials adapted intervention delivery to student-specific concerns. It called for further work to better understand the mechanisms underlying students’ mental health problems, perhaps using transdiagnostic, stepped care approaches. Research on both mental health and drug use should involve students in the design of interventions to increase their acceptability to this population.

The prevention of alcohol-related harm has been well studied in university populations, and several existing interventions for student drinking share theoretical and methodological underpinnings with effective interventions in drug prevention and treatment in other populations (i.e., school-based prevention, adolescent and adult drug treatment) [ 6 , 18 ]. These interventions could be adapted to target drug prevention on university campuses. As is the case in the wider community, a recovery orientated system of care is required, with a full continuum of care encompassing harm reduction through to abstinence [ 72 ]. The development of the first Collegiate Recovery Programs [ 21 ] to support abstinent students at Teesside University and the University of Birmingham [ 73 ] represents the first part of such a continuum. However, despite big strides in the development of campus-based mental health support in the past decade, the issue of addiction to drugs, alcohol or other behaviours has been largely ignored. Tackling this deficit will be important to ensure that students are able to maximise the potential benefits of a university education.

Recommendation : Several commentators have noted that the stigma of psychoactive drug use appears to be particularly prominent in universities in the UK and Ireland, with ‘zero tolerance’ approaches often limiting informed debate [ 64 ]. Working collaboratively across the Higher Education sector may be helpful in supporting universities to provide education and prevent harm whilst respecting the illegality of illicit drug use. There is also a need to develop interventions tailored to the unique needs of students who have developed a drug use disorder, and to evaluate abstinence-based recovery programs on campus.

Conclusions

This review has exposed large gaps in the research evidence base around illicit drug use in university students in the UK and Ireland. The limited evidence reviewed here suggests that more students are coming into contact with illicit drugs and many are experiencing harms. There is therefore a need to unite student unions and universities in exploring the prevalence of drug use and its impact on students, supported by high quality research. A national survey of student drug use that covers the whole of the UK and Northern Ireland would be helpful, particularly if it was repeated to monitor trends over time. Alternatively, the creation of representative student ‘consumer panels’ may allow researchers to understand attitudes of students to the use of psychoactive substances on campus and to explore methods of reducing harm. Little effort has been made to explore the views of those who do not use drugs, or to identify the motivations of university students to decrease or cease drug use. Promising areas of future research on motivations to change in relation to illicit drug use include the social contextual factors, perceptions of effects on social relationships, and actions of friends and family members to prompt contemplation of change [ 74 ]. Trials to evaluate novel theoretically-based prevention and treatment programs that take into account established risk factors for drug use and drug use disorders are also needed [ 18 , 70 ].

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Methylenedioxymethamphetamine

Higher Education Institute

Preferred Reporting of Items for Systematic Reviews and Meta-Analyses

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Papers excluded from the study and reason for exclusion ( n =40).  Table2. Additional papers excluded because the focus was prescribed drugs used as‘cognitive enhancers’ and not illicit drugs ( n =15).  Table3. Grey Literature – all excluded as no detail about methods used.

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Boden, M., Day, E. Illicit drug use in university students in the UK and Ireland: a PRISMA-guided scoping review. Subst Abuse Treat Prev Policy 18 , 18 (2023). https://doi.org/10.1186/s13011-023-00526-1

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Prevalence and factors associated with substance use among university students in South Africa: implications for prevention

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Substance use is an important public health concern in many countries across the globe. Among the general public, institutions of higher learning have developed a reputation for inducing new substance use among students. In addition to socio-demographic factors, substance use and abuse among university students often appear to be related to psychological stressors typically related to the demand to adapt to the new environment and the pressures associated with academia. The purpose of this study was to identify the prevalence of, and factors associated with substance use among university students.

This quantitative study employed convenience sampling to recruit university students who were 18 years and older from a university in the Western Cape. The study made use of self-administered online questionnaires, which participants completed via SurveyMonkey. The sample consisted of 2915 students. Descriptive statistics were used to describe and provide the prevalence and overview of the demographic characteristics of the respondents. Associations between variables were explored using Chi-square and Mann–Whitney U tests.

The main findings revealed a substance use prevalence rate of 62.7%. The most prominent substances used by students were alcohol (80.6%), cannabis (46%), and ecstasy (5.3%). The study further  revealed clear associations between students’ substance use and mental health. Students who reported substance use at university reported higher depression and anxiety scores than those who did not. However, findings reveal no significant association ( p  = 0.233) between being a substance user and a nonsubstance user and students' respective self-perceived stress scores.

Results show the majority of sampled students had started using substances (both alcohol and other substances) only after entering university. The results call into question seminal findings relating to substance use and the university environment. The novel findings of this study could serve as a baseline input to inform policymakers, programme developers, service providers, parents, and other stakeholders who are involved in the design and implementation of more effective awareness, prevention and, needs-based intervention services.

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Substance use is an important public health concern in many countries across the globe. Among the general public, institutions of higher learning have developed a reputation for inducing new substance use among students [ 1 , 2 , 3 ]. In addition to reporting novice use, studies have also found that students who had prior exposure to substance use increased their frequency once exposed to the university environment [ 4 , 5 ]. A growing body of research has also shown that university students reported using a number of substances at a greater rate than their non-student peers [ 1 , 6 , 7 , 8 , 9 ]. Findings of such studies show that the use of alcohol, particularly getting drunk and binge drinking [ 1 , 6 ], marijuana [ 1 ] and non-prescription amphetamine, were considerably higher among university students when compared with their non-university attending peers [ 1 , 7 , 8 , 9 ].

Research suggests that there could exist some conditions within the environment of higher education settings that makes students more susceptible to the use and/or abuse substances [ 4 , 10 , 11 , 12 ]. The term "substance use" refers to the use of alcohol, tobacco, illicit drugs, prescription and over-the-counter medications [ 13 ]. “Substance abuse” refers to the continued misuse of drugs, alcohol, tobacco and other psychoactive drugs even though the individual has knowledge that their usage of these substances may cause several debilitating problems and may eventually lead to some form of addiction [ 14 ].

Although much is known about students’ substance use rates on a global scale, very few representative studies have been conducted in South Africa (see e.g., [ 15 , 16 , 17 , 18 , 19 ]). Among the few studies carried out in South Africa, very high rates of student alcohol use have been reported [ 16 , 17 , 19 ]. For example, Young and De Klerk [ 17 ] found alcohol prevalence rates of almost 50% at Rhodes University. At the same South African university, 2 years later, Young and Mayson [ 19 ] found that 57.9% of the sample reported hazardous alcohol consumption, i.e., four or more drinks at a time on at least three separate days in the previous three months.

Similarly, another South African study carried out by Kyei and Ramagona [ 15 ], at the University of Venda, found that while over 65% of the students surveyed use alcohol, 49% of those students abuse it. A more recent study conducted by Du Preez and colleagues [ 2 ], which focused on the drinking behaviour of students at Stellenbosch University reported that 71% of males and 54% of females reported hazardous drinking patterns. In addition, the study also found that 13% of the sample indicated harmful drinking behaviour.

The concern of such findings lies in the potential short- and long-term adverse effects associated with the use of substances on students’ overall health and well-being. As substance use has been associated with an increased risk of contracting communicable diseases such as HIV/AIDS and TB [ 20 ]; non-communicable diseases such as mental illnesses; maternal and child maternal and child morbidity and mortality [ 21 ]; as well as injury and trauma. The previously noted consequences of substance use and abuse notwithstanding, it has also been recognised to contribute to epidemics of crime and violence, high university dropout rates, unemployment, and high levels of poverty and crime [ 22 ].

Research has shown that to intervene effectively and prevent the negative consequences of substance use, it is important to identify socio-demographic [ 18 , 23 , 24 ], environmental and psychological factors [ 25 , 26 , 27 ] contributing to the use and misuse of substances. According to Becker et al. [ 25 ] and NIDA [ 27 ], mental conditions such as stress, anxiety, and depression are important factors predisposing students to use and subsequently abuse substances [ 25 , 26 ]. The present study, therefore, aimed to establish the prevalence and associated factors of substance use among students at a historically disadvantaged university in the Western Cape, South Africa.

The study attempted to answer the following questions: (1) What is the prevalence rate of substance use amongst students at the University? (2) What types of substances do the students commonly use? (3) What are the factors associated with substance use among university students?

Design and context

This quantitative study employed convenience sampling to recruit university students who were 18 years and older from one of 26 public universities situated in South Africa. The university consists of seven faculties and four schools. Faculties are made up of Arts, Community and Health Sciences, Dentistry, Economic and Management Sciences, Education, Law and Natural Science. The schools include Pharmacy, Government, Nursing and Science and Mathematics. The study was primarily borne out of the realisation that very little was known about the current prevalence and factors associated with substance use and abuse at universities in the Western Cape, even though it is situated in the region where alcohol and drug use is reported to be four times higher than the national average in South Africa [ 28 ].

Procedure and ethics

The study was approved by the university and its ethics committee (BM18/9/1). After receiving a list of all registered students (N = 25,226) from the Registrar of the university, we sent out emails (as well as reminders) to all the student email addresses. The email included the description of the study and the link to the questionnaire. The questionnaire was administered online using SurveyMonkey for a period of two months (31 July to 30 September 2019). A link to the questionnaire was sent to students' university email addresses. Upon accessing the questionnaire, participants were provided with an information sheet and consent form which outlined the purpose, aims and, objectives of this study, the rights and responsibilities of the participants, as well as what it is that would be expected from them should they agree to take part in the research. Through the information sheet and consent forms, participants were also assured that their identity would remain confidential, and their responses used for research purposes only. This was ensured by not requiring any identifiable information from participants, thus maintaining their anonymity. The participants in this study were provided with referral pathways, should the need for counselling services or emergency intervention arise as a result of their participation in this study. Should students have required any additional referrals for social or mental health support, they were provided with telephone and email contact details of possible referrals. The researcher’s contact information was also available should they not have been successful on their own.

Participants

After excluding incomplete and missing data, 2915 questionnaires were deemed valid for analysis (11.6% response rate). Participants with two missing values on either the AUDIT or the DUDIT as well as corresponding missing values for their demographic information, which would have resulted in biased calculations, were removed. See Table 1 for the demographic characteristics of the population under study.

The final sample consisted of 34% men, 64% women and 1.7% who presented as “other” in terms of ‘gender’. Participants’ ages were captured categorically, ranging from 18–24 years to 75 years and older. The majority of the sample fell into the two youngest categories, i.e. [18–24 years (n = 2164 (63.9%)] and 25–34-year-old category (17%) respectively. With reference to the sample’s level of study, a large proportion of the participants were 1st year (28.8%), 2nd year (25.7%) and 3rd year (22.9%), undergraduate students. Most of the sample (34.8%) was from the faculty of Economic and Management Sciences. This statistic was succeeded by the second largest grouping 22% of students in the faculty of Arts and Humanities.

The substance use questionnaire consisted of five different instruments namely, the demographic section (please see Additional file 1 for a copy of the demographic section of this questionnaire), the Alcohol Use Disorders Identification Test [ 29 ], The Drug Use Disorders Identification Test [ 30 ], The Perceived Stress Scale [ 31 ] and The Self-Reporting Questionnaire [ 32 ].

Demographic section

A demographic section was developed in order to ascertain demographic information relevant to the current study’s aims and objectives. Questions regarding the students’ substance use, age, gender, education level, year level, marital status and onset of substance.

The Alcohol Use Disorders Identification Test (AUDIT)

The Alcohol Use Disorders Identification Test (AUDIT) was employed to help screen, categorise and diagnose the incidence of safe, hazardous, harmful and dependent drinking among students. The AUDIT is a brief 10-item, 5-point Linkert scale, self-administered questionnaire, with responses ranging from 0 (never) to 4 (4 + times per week) [ 33 ]. The AUDIT has demonstrated a high degree of internal consistency, yielding a Cronbach’s Alpha score of 0.83, with a range of 0.75–0.97 [ 34 ]. For the current sample, Cronbach’s alpha was 0.82.

The Drug Use Disorders Identification Test (DUDIT)

The DUDIT was employed in order to determine the extent of drug use among students. The DUDIT was developed to assist in the screening, diagnosing and categorising the severity of use of substances other than alcohol [ 30 ]. This self-report questionnaire uses a 5-point Likert scale which categorises individuals into three broad categories of drug use, namely, “no drug related problems”, “harmful use or dependence” and “heavily dependent on drugs”. The DUDIT was found to be a psychometrically sound instrument with high convergent validity (r = 0.85) when compared to 44 similar measures such as the DAST-10 and has a Cronbach's alpha of 0.94 [ 35 ]. For the current sample, the Cronbach’s alpha was 0.88.

The Perceived Stress Scale (PSS-10)

The PSS-10 is one of the most extensively used instruments for measuring self-perceived stress on a scale from 0 (never) to 4 (very often) [ 36 ]. Tallied PSS scores are used to detect three categories of stress. An individual is considered to be experiencing low stress is their respective scores ranges from 0 to 13. Scores ranging from 14–26 suggests moderate stress while scores ranging from 27 to 40 would suggest high perceived stress [ 31 ]. The PSS-10 has shown to have good internal and test–retest reliability (α = 0.84–0.86) and it has demonstrated convergent validity with measures of anxiety, depression, and health, and divergent validity with measures of sensations-seeking, religious faith, and aggression among university students [ 37 , 38 ]. For the current sample, Cronbach’s alpha was 0.58.

The Self-Reporting Questionnaire (SRQ-20)

Developed by the World Health Organization (WHO), this questionnaire is a self-rating scale specifically designed to screen for psychological discomfort among individuals, particularly in developing countries. The SRQ-20 was therefore employed to assess the frequency and severity of 20 symptoms related to depression and anxiety among students. The SRQ has proven to be a valid (Cronbach’s α = 0.85) [ 39 ] and reasonably stable instrument in a several studies in different cultural contexts [ 40 , 41 ]. Both the PSS-10 and SRQ-20 are two of the most widely used instrument to measure perceived stress [ 36 , 37 , 38 ] and psychological distress among populations in several different cultural contexts in and around South Africa [ 40 , 41 ]. For the current sample, Cronbach’s alpha was 0.89.

Data analysis

Data were entered into an Excel spreadsheet, and analysis was conducted using the IBM Statistical Package for Social Sciences Version SPSS 26.0 software. Percentages and frequencies were used to report categorical variables. Descriptive statistics was used to summarise the participants’ socio-demographic characteristics and bivariate analysis to examine the associations between background characteristics and alcohol and drug use. The Chi-square test for independence (using α = 0.05) was used to determine whether there were significant differences between student’s substance use before and after their university enrolment. A chi-square test is commonly used when analysing two categorical variables from a single population [ 42 ]. Because scores were not normally distributed, Mann–Whitney U-tests were used to determine the association between students’ self-reported mental health and their use of substances. A p value of less than 0.05 was determined to be statistically significant.

Prevalence of substance use amongst students

The prevalence rates of substance use among the sampled students are presented in the table below (Table 2 ). The prevalence results presented were based on the results obtained questions in the demographic questionnaire. For students to have been labelled as a “substance user” students had to have responded ‘yes’ to the question, which read, “Are you still using any of the substances mentioned above?”. In order to be considered a “non-substance user”, students had to have indicated ‘no’ substance use with respect to this question. Respondents were labelled “unsure” if they indicated ‘yes’ to this question but had not selected any of the substances listed in the question which followed on the survey.

The findings presented in Table 2 show that the majority of respondents reported using substances after they enrolled at the university (62.7%). In this dataset, chi-square analysis indicated a narrow interval span of 60.89–64.43% can be observed among students with an odds ratio of 0.5, and a 95% confidence level. This is indicative of the chances of using substances after being exposed to the university environment is 50%.

Types of substances used

Table 3 (below) displays a list of the substances reported to have been used by the participants after their enrolment at university. Alcohol was the most used substance among students (80.6%) ( n  = 1472). The second-most used substance reported by respondents is cannabis, which is commonly known in the Western Cape as ‘dagga’ or weed. The percentage of students reporting cannabis use amounts to 46% ( n  = 841) of the sampled respondents. The third largest proportion of students (96 students) indicated that they used ecstasy.

Table 3 further reveals that 8% of the students reported using substances that were not explicitly listed in the questionnaire. These substances were listed by participants as: Ritalin ( n  = 33), Poppers ( n  = 32), Ketamine ( n  = 31), Mescaline ( n  = 30), other over-the-counter-medicine ( n  = 28), Dimethyltryptamine (DMT or N) ( n  = 27), Xanax ( n  = 26), Vape ( n  = 25) Traditional beer ( n  = 24), Pethidine ( n  = 21) Tramadol ( n  = 20), Rock ( n  = 19), Hookah ( n  = 18), Flakka ( n  = 17), CAT ( n  = 16) MD (n = 15), MDMA ( n  = 14), Acid ( n  = 10) LSD ( n  = 12) Mushrooms ( n  = 13) and Cocaine ( n  = 11).

Level of Alcohol and Drug Use among University Students (AUDIT and DUDIT)

The AUDIT and DUDIT were used to determine the amount of alcohol and drug use among the sample of students who stated that they were current substance users in order to supplement the results from the prevalence findings presented above. The results of the Alcohol Use Disorder Identification Test (AUDIT) and the Drug Use Disorder Identification Test (DUDIT) are presented in Table 4 below. In order to determine the extent of substance use by those who identified as using substances, the analysis was conducted on the 1827 participants who reported using substances after enrolling at university.

A total of 1164 (63.7%) of the 1827 students labelled as ‘substance users’ completed the AUDIT. Although the majority of that cohort indicated ‘low-risk drinking’, a total of 349 students indicated ‘hazardous’, ‘harmful’ drinking patterns and ‘alcohol dependence’.

Most respondents (87.2%) who completed the DUDIT reported, what the DUDIT defines as, ‘no drug-related problems’ while 184 students reported ‘harmful/dependence’ and ‘heavily dependent’ use.

Factors associated with substance use

Self-report questionnaire-20.

A cut off score of 7/8 is used to indicate the presence of depression and anxiety [ 41 ] or as Harpham et al. [ 43 ] reports, ‘mental ill health’. Thomas [ 44 ] used a cut-off score of 7/8’s in a study in Durban, South Africa. The table below (Table 5 ) indicates that 32.5% of the total sample, or 45.1% who completed the SRQ-20 presented with a possible case of mental ill health. This indicates the prevalence of mental health distress as reported within this sample.

A Mann–Whitney U Test was conducted in order to test the significance of the association between those who used substances, those who did not and their associated SRQ score. The results are presented in Table 6 below.

The results found in Table 6 and Figs.  1 and 2 reveals a significant association ( p  < 0.01) between being a substance user and non-substance user and students’ respective SRQ scores. The results indicated that students who scored higher in the SRQ-20 (possibly indicating depression and anxiety symptoms) were students who reported substance use at university.

SRQ-25 × Substance Use Histogram

SRQ-25 ×Substance Use Independent-Samples Mann-Whitney U test

A further cross tabulation presented in Table 7 above highlights that those students who reported hazardous, harmful drinking and alcohol dependence also report higher levels of mental health concerns (SRQ-20). Table 8 , below, also indicates that those who report hazardous, harmful drinking and alcohol dependence also report higher levels of perceived stress as compared to those with lower levels of stress. It is interesting to note that all everyone who reported moderate to high perceived stress participated in hazardous or harmful drinking. This speaks to other protective factors which might buffer alcohol use.

Perceived stress scale-10 results

To ascertain the levels of stress students’ experience during their time at university, the PSS-10 was administered and analysed. The PSS-10 measures the level at which respondents appraise life events as being unpredictable, overwhelming, or challenging. Individual scores on the PSS range from 0 to 40, with higher scores indicating higher perceived stress between 0 and 13 are perceived to have low stress. Scores ranging from 14 to 26 would indicate those whose scores are considered as having moderate stress. The final category of scores, i.e. ranging from 27 to 40 would be indicative of individuals having high perceived stress. It is within this context that respondents were scored, and findings were analysed.

Table 9 indicates that substance users have a higher level of perceived stress versus those who do not use substances. The table below indicates whether this difference was significant using a Mann–Whitney U Test (Table  10 ).

The results in Table 8 above and Figs.  3 and 4 below show that there is no significant association ( p  > 0.05) between being a substance user and nonsubstance user post university enrolment and students respective PSS-10 scores. The levels of perceived stress appear to be similar for both cohorts.

PSS-10 × Substance Use Independent-Samples Mann-Whitney U test

PSS-10 × Substance Use Histogram

Table 11 above, is a cross tabulation of the drug use categories according to the DUDIT and the SRQ. According to the table, those who displayed harmful use or are heavily dependent on substances also report the presence of more mental ill health symptoms. Interestingly, 749 of the 1744 students who reported mental ill health challenges did not indicate drug-related problems.

A similar cross tabulation (Table 12 ) was conducted on the DUDIT categories and students’ perceived levels of stress. Although many students indicated a moderate to high level of perceived stress (n = 1608 and 125 respectively), these students did not report problems with drug use. However, a larger number of students reported moderate to high perceived stress who were also using substances in a harmful or dependent manner.

Prevalence of substance use

The aim of this study was to determine the prevalence of, or patterns, of substance abuse among university students as well as mental health factors that may be influencing this use. The term substances refer to both alcohol and drug use. Results from the study show that 62.7% of sampled students indicated, not only that they used substances but that this use (both alcohol and other substances) started after enrolling at the university. The prevalence rates found in this study appear to align with key findings which, similarly, found high substance use rates after students had enrolled at their respective university/college [ 1 , 4 , 10 , 11 , 12 ].

The extent of alcohol and drug use was evaluated using the AUDIT and DUDIT. These results are particularly interesting as it revealed that the majority of students in the sample reported ‘low-risk drinking' (70.4%) and ‘no drug-related problems’ (87.2%). These results are in direct contrast with similar studies in the field which report relatively high prevalence of substance abuse among university students, particularly in South Africa [ 2 , 15 , 19 ]. The substance use rates reported could be due to a variety of reasons, one of which concerns social desirability bias, which refers to the tendency respondents have to present and align themselves and their reality with what they believe to be socially acceptable. However, each questionnaire was self-report and could be completed alone, without the presence of an interviewer or someone known to the student. The majority use notwithstanding, both the AUDIT and DUDIT revealed a number of students who should be considered for either brief or intensive interventions for substance use.

Types of substances used by students

The three most commonly used substances reported were alcohol (80.6%), cannabis (46%) and ecstasy (5.3%) amongst those who used substances after university enrolment. Interestingly, ecstasy use was found to be higher than methamphetamine use among students in the Western Cape, an area well-known for its increased methamphetamine use [ 45 ]. “Other” substances accounted for 8% of the sample, important to note here is that the number of “other” substances evidently surpasses commonly well-known and well-documented substances such as ecstasy (n = 96), methamphetamine (n = 14), buttons (n = 6) and unga (n = 1). This noteworthy and rather unanticipated finding could be indicative of a shift in the types of substances commonly reported/used by university students at this point in time. Although the sample is not representative, this finding is important as it provides an opportunity for researchers and healthcare practitioners to be mindful of the types of substances being used by individuals of a certain age range in the Western Cape.

Mental health of students

The results of this study revealed a significant association ( p  < 0.01) between students’ substance use and their respective SRQ scores. These results appear to be in consensus with much of the available literature which interchangeably associates some aspect of mental health with substance among university students [ 25 , 27 , 46 ]. However, although valuable, the results presented are likewise unable to support or refute the three main hypotheses offered in the literature review which varied from conclusions relating to whether substance use leads to mental health problems [ 47 ]; whether mental health problems cause substance [ 48 ] or whether these concepts are so closely related that it could not be studied in isolation [ 49 ]. It is likewise unfortunate that results were unable to answer the question as to whether students who already present mental health problems prior to attending universities are at an even higher risk of experimenting with substances, as the new environment could exacerbate their already existing symptoms [ 50 ]. What it does however show, is that there appears to be a significant difference between the two groups in terms of their mental health and use of substances, i.e., students who identified as non-users reported fewer symptoms of anxiety and depression (according to the SRQ-20) than students who indicated that they were substances users. Which is indicative of there being some validity to the claims concerning the complex relationship between substance use and mental health, particularly among university students.

This study used the PSS-10 to measure psychological stress among students mainly because it defines stress as an interaction between environmental demands and the individual’s capacity to cope [ 31 ]. Results demonstrate that there is no significant association ( p  > 0.05) between being a substance user and a nonsubstance user post university enrolment and students' respective PSS-10 scores. Figures  1 and 2 furthermore support and expand on the results found in Table 9 by showing how scores cluster around the 19/20 mark in both groups. In terms of students’ level of stress, the results from Figs.  1 and 2 furthermore indicate that the majority of students in both groups fall within the moderate stress levels as per PSS-10. These results found above are in contrast with a body of literature that found significant associations between respondents who suffered from psychological distress and their use of substance use. Substance use was commonly reported as being used by distressed respondents to cope with academic pressures and demands [ 50 , 51 ]. Interestingly, even though we did not account for risk and protective factors, based on the results of the AUDIT/DUDIT category cross tabulation with the SRQ and PSS, protective factors could be moderating or mediating the relationship between stress/mental ill health and students’ either using substances or not. Such factors could account for those with high stress and mental health challenges and not having a substance use problem per se. Considering the scarcity of knowledge about the risk and protective factors of substance abuse among university students, a follow-up study to investigate such factors should be prioritised.

Implications of the study

The insights to be gained from this study could serve several purposes and contribute towards the prevention and reduction of substance use and/or abuse among university students in several ways. In its entirety, the study contributes to the overall scarcity of existing knowledge on substance use and abuse among university students in South Africa. The study sheds light on the current prevalence and the extent to which students’ use and/or abuse substances in a previously underexplored population in the Western Cape. Although it does show that the large majority do not necessarily have harmful or hazardous substance use patterns, it is noteworthy that a minimum of 184 to a maximum of 359 students reported harmful/hazardous/dependent use. Therefore, awareness campaigns and varying degrees of referrals and interventions should be made available to students.

In addition to reporting on the “conventionally” well-documented substances, such as alcohol, marijuana, methamphetamine and heroin in South Africa, this study also provided a platform where students could disclose their use and/or abuse of other types of substance use. This information could prove useful for any future attempts to tailor, inform and/or contextualise research endeavours of a similar nature. The unanticipated findings relating to the assortment of substances could be indicative of a gradual paradigm shift in the types of substances commonly reported/used by students. The novel findings of this study could serve as a baseline input to inform policy makers, programme developers, service providers, parents, and other stakeholders who are involved in the design and implementation of more effective awareness, prevention and needs-based intervention services; and the findings of this study could also serve as a feature map for future research relating to substance use in and around South Africa.

Conclusions

Limitations.

The results produced in this research study, although valuable, reflects a single, purposefully selected university in the Western Cape. Since the prevalence and nature of substance abuse among university students in the Western Cape may vary depending on the environments where the universities are found, the generalisation of the current study’s findings should be done with caution. A general limitation of a correlational study is that it can determine the association between variables but cannot predict causation. Another limitation of inherent is such studies is the ability of respondents to accurately recall past events. In this case, the time intervals for which respondents were asked to report their substance use were not specific, i.e., no reference periods were used to restrict and specify the time intervals for which respondents reported their use of substances. This oversight may have produced unclear assumptions regarding the prevalence of substances among students. In addition, tobacco use was not classified as a problematic substance in this study. This is perhaps something to consider in future studies of this nature.

It is also essential to mention here that the questionnaire was disseminated in only one of the three official languages within the Western Cape, i.e., English. This was done in order to align with the University’s primary medium of teaching and of examination, which is, English. This being said, the official language policy of the Western Cape Government (Western Cape Government 2019) encourages the promotion and use of all of the three official languages of the Western Cape, namely Afrikaans, isiXhosa and English where possible. It is thus recommended that future research carried out in different provinces and or countries consider the official languages of the population under study and strive to provide the respondent with an equal opportunity to interpret and answer questions in their mother tongues.

The social desirability bias, inherent in the self-report measures on substance use, may have resulted in students providing socially acceptable rather than honest answers. Apart from the social desirability bias, it is important to bear in mind that students received the online link via their university student email addresses within a specific timeframe, from 29 July to 27 September 2019. The implications here are that students who were absent, or who did not have access to the necessary resource to complete the questionnaire could have been excluded. Although useful, the cross-sectional design has been criticised for only examining aspects of individual’s beliefs and behaviours without paying concerted consideration to the context in which these beliefs and behaviours occur, which could account for misinterpretation of meanings of the beliefs and/or behaviour recorded. As such, it is necessary to exercise caution when interpreting the results of this study.

Recommendations of the study

Taking the aforesaid findings into consideration, it is hoped that the current study’s results would call upon researchers to further investigate the association of factors in relation to an array of substances other than alcohol. This might be essential in the identification of an increase and/or decrease of many substances, and the identification of newly introduced substances, which is vital for the creatiion of awareness-, and prevention- campaigns as well as intervention strategies aimed at the population under study.

A conclusion of the limitations and recommendations of this study cannot be complete without calling for more comprehensive efforts (multidisciplinary) when investigating the use and abuse amongst individuals in our society. Since this research is observational, experimental research is recommended to identify effective intervention options for mitigating the burden of substance abuse among university students.

Discovering these influencing factors (both risk- and protective) would decrease the probability of an individual using drugs, and would once again pinpoint areas one could focus on with interventions, which would empower those in need of intervention, as opposed to educating only. A determination should also be done on evidence-based “best practices” for primary prevention, as well as the treatment of substance abuse among adolescents in South Africa.

In attempts to promote and adhere to the ethicical principles of avoiding harm, giving respect and protecting participants’ integrity, the author's advocacy plea is to cultivate more inclusivity in future research endeavours, especially in the social sciences. Such efforts could begin by exploring social constructs such as gender on a non-binary spectrum. In addition to this, more culturally sensitive, multi-wave longitudinal research needs to be carried out in order to improve on and expand the understanding of substance use and abuse among young people in South Africa, particularly those transitioning from childhood to adolescence to young adulthood, during which pervasive individual and contextual change is the bedrock of these developmental transitions.

The overall aim of the study was to explore the prevalence and factors associated with substance among university students in South Africa in order to provide baseline information that could inform the development and/or tailoring of any awareness and or prevention campaigns designed to reduce substance use and abuse among students in South Africa. Perhaps more importantly, it is hoped that the results, implications, limitation, and recommendation of the present study invokes increased focus and ignites novel or innovative thinking when undertaking research of similar nature.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Alpha (level of significance)

Equals the size of the population

Equals the sample size

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. Demographic Section. A demographic section was developed in order to ascertain demographic information relevant to the current study’s aims and objectives. Questions regarding the students’ substance use, age, gender, education level, year level, marital status and onset of substance.

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• Substance use
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“College fields of study and substance use”

• Wei-Lin Chen 1 &
• Jen-Hao Chen 2  

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Numerous studies have documented factors that are associated with substance use behaviors among college-aged individuals. However, relatively few studies have considered the heterogeneity of the college experience by field of study (i.e., college major) and how that educational context might affect students’ health behaviors differently. Drawing from theories and prior research, this study investigates whether college majors are associated with different substance use behaviors, both during college and upon graduation.

The study analyzed longitudinal data from the National Longitudinal Survey of Youth 97 ( N  = 1031), specifically data on individuals who obtained a bachelor’s degree, to examine the associations between college fields of study and trajectories of three substance use behaviors: smoking, heavy alcohol use, and marijuana use.

The results indicate that social science and business majors were associated with more substance use behaviors than arts and humanities and STEM majors. However, social science majors were associated with a faster decrease in substance use behaviors over time. Importantly, the differences we found in mean levels of substance use behaviors and trajectories were not explained by demographic characteristics, family SES background, childhood health conditions, and employment experience. Further analysis that examined college major and each substance use behavior individually suggests that the associations were stronger for heavy alcohol use and marijuana use. Moreover, we found the associations were more pronounced in men than women.

Conclusions

The study finds that not all college majors show the same level of engagement in substance use behaviors over time, and that the associations also vary by (1) the specific substance use behavior examined and (2) by gender. These findings suggest it is important to consider that the different learning and educational contexts that college majors provide may also be more or less supportive of certain health behaviors, such as substance use. Practical implications are discussed.

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Introduction

Substance use is an important public health concern in the United States. National surveys consistently show that substance use peaks during emerging adulthood [ 1 ]. Although college students may show less substance use than non-students in the same age range [ 2 ], it remains true that smoking, heavy alcohol use, and illicit drug use are not uncommon [ 3 , 4 , 5 ] among college students and are considered pressing health issues [ 6 ]. O’Mally and Johnston’s [ 7 ] influential study shows a high prevalence of heavy alcohol use and smoking among college students, with only a slight improvement from 1980 to late 1990. Even the most recent national survey data suggest that substance use remains a pressing health concern of the college-age population. The national Monitoring the Future 2018 survey indicates that among full-time college students in the United States, 15.3% have used cigarette, 29% are heavy alcohol users, and 24.7% have used marijuana during the past 30 days [ 4 ].

Moreover, research makes clear that substance use during the college years has significant consequences for learning and health. College students who are heavy alcohol users are more likely to get injured [ 8 ], have lower academic performance and drop out of college at higher rates [ 9 ], and demonstrate poor working memory [ 10 ]. Marijuana can impair neuropsychological functioning and thus affect individuals’ learning and work performance [ 11 ]. Smoking is associated with lower cognitive function among college students, including a lower level of verbal or auditory competence [ 12 ]. Because so many college students use substances and their negative impact on physical health and learning can be significant, it is critical to investigate and understand the factors that relate to students’ substance use behaviors.

There are many prior studies that contribute to our understanding of the risk and protective factors that may promote or deter substance use among college students [ 13 , 14 , 15 , 16 ]. While a full review of the extant studies of substance use among college studies is beyond the scope of this research, it is useful to briefly summarize factors that have been shown to relate to college students’ substance use. Furthermore, studies using large-samples suggest that substance use behaviors (such as heavy alcohol use, smoking, marijuana use) among college students tend to co-occur [ 17 , 18 ], suggesting the need to investigate substance use behaviors simultaneously. Following Ham and Hope’s [ 19 ] approach in their influential systematic review of problematic drinking among college students, we classify previously identified risk and protective factors of substance use at three levels: individual, interpersonal, and contextual. First, substance use varies by individual demographic characteristics and personality factors. For example, studies consistently find that men have a higher likelihood of substance use than women [ 13 , 20 ] and that African American and Hispanic students have lower rates of substance use [ 13 , 20 , 21 ] than white students. Other studies find that certain personality traits appear to be associated with substance use among college students. For example, sensation seeking is related to heavy alcohol use [ 22 , 23 ].

However, individual factors offer little help in prevention and intervention. Therefore, in recent years, research has moved to investigate the role of interpersonal and contextual factors on college students’ substance use. For example, living with parents during college is associated with lower levels of substance use [ 2 ]. In contrast, two systematic literature reviews of problematic drinking and smoking suggest that living on campus appear to correlate with increased alcohol consumption and smoking [ 24 , 25 ]. In contrast, low academic performance, often measured by GPA, is associated with alcohol or illicit drug use. Heavy alcohol or drug use may impact cognitive functioning, which contributes to poorer grades. Evidence also shows that working part-time during college is associated with more substance use [ 26 , 27 ]. Membership in fraternities and sororities is found to be associated with substance use [ 28 , 29 ]. Finally, several studies start to pay attention to the educational context. In a systematic literature review by Carter and colleagues [ 25 ], they conclude that full-time college students, especially for those in 4-year college, display a greater engagement in heavy alcohol use. Cranford and colleagues [ 30 ] analyze a probability sample of students and find that undergraduates are associated with a higher likelihood of heavy alcohol use and marijuana use (but not smoking) than graduate students.

Although prior studies have investigated a wide range of individual, interpersonal, and contextual factors that relate to substance use among college students, the role of college major has received relatively little attention. This is a curious oversight because college education, by nature, is more heterogeneous than secondary education. Even within the same college, majors vary on curricula, expectations, learning environment, and level of professionalization. In addition, majors differ on whether and how much they expect students to learn specialized knowledge, gain hands-on experience, and collaborate on group projects [ 31 , 32 ]. Because a student’s academic experience differs so much by major and is so central to life during the college years, it is reasonable to believe that college major may affect students’ likelihood of engaging in substance use behaviors as they emerge into adulthood. In other words, some of the differences that exist across majors may be more or less protective against, or supportive of, students’ substance use. This study aims to addresses this key, relatively unexplored question: Does a student’s college major predict his/her likelihood of substance use during and after college?

Based on prior studies, there are strong empirical and theoretical reasons to believe that engaging in a health risk behavior, such as substance use, may vary by college major. First, only some majors expose students to knowledge of human health and physiology, which may produce differences in health literacy by major [ 33 ]. Differences in health literacy may, in turn, lead to differences in health behaviors. Second, the undergraduate socialization model conceptualizes college as the primary socialization field for young adults’ development [ 34 , 35 ]. Students are socialized into the norms of their major and participate in activities and social interactions that promote their success in related professional fields. Social learning theory posits that individuals learn from various forms of interaction with peers and colleagues, which highlights the importance of how students’ interactions in their major may affect how they learn health behaviors, such as substance use [ 36 , 37 , 38 ]. For example, health-related majors may be trained to avoid smoking and drug use because they will likely work in smoke-free and drug-free workplaces when they graduate. In contrast, business majors might be socialized to be more tolerant toward smoking and heavy alcohol use because those behaviors occur in the social interactions that graduates have with their clients. In these and other ways, college majors provide a different environment and socialization that may affect health behaviors.

Despite these reasons to believe that a student’s choice of college major may affect their substance use, there is limited empirical evidence on this research question. Of the studies that do exist on the substance use behaviors of college students, many rely on surveys at a single college or university (e.g.), [ 39 , 40 , 41 ]. Even fewer studies exist that consider college major as an influential factor in substance use behaviors over time. Finally, to our knowledge, it appears that no study exists that examines this question with the benefit of a large-scale, national sample with longitudinal data. This study aims to address these limitations by using a large-scale, longitudinal dataset to investigate whether and how engagement in substance use behaviors (i.e., smoking, heavy alcohol use, and marijuana use) varies by college major.

National Longitudinal Survey of youth 1997

This study used data from the National Longitudinal Survey of Youth 1997 (NLSY97), a nationally representative sample of youths who were born between 1980 and 1984. The NLSY97 began by interviewing 8984 respondents who were 12 to 18 years old in 1997–1998 (round 1). Respondents were followed every year until 2013–2014 (round 16). After that, respondents were followed every 2 years [ 42 ]. The NLSY97 aims to understand U.S. youths’ transition from school to work and into adulthood [ 43 ]. The NLSY97’s detailed information on college education, together with the large-scale, longitudinal national sample, provide a rare opportunity to examine college majors and substance use over time.

We used transcript data in the NLSY97 to identify when a respondent started college and when s/he received a college degree. College transcripts provide the most accurate information on when individuals started college and whether they received a bachelor’s degree. We limited the study to respondents who obtained a bachelor’s degree between 2001 and 2011 because no college transcript data was collected after 2011. After excluding any individual whose college major could not be identified or was missing, we were left with a sample of 1099 youths who completed college, obtained their degree between 2001 and 2011, and whose college major was known. A small proportion of youth in our sample had missing values on the variables of interest for health behaviors (i.e., smoking, heavy alcohol use, and marijuana use). For each youth, three rounds of data were used in the analysis: the wave when the respondent entered college, the wave when the respondent finished college, and the wave after college completion. The final sample for longitudinal analysis included 1031 youth.

Classification of college major

In each round of data collection in the NLSY97, respondents who enrolled in college were asked about their major(s); we used this self-reported information to identify the field of the college degree. We chose to rely on self-reports, rather than college transcript data, to identify college majors because the college transcript data from the NLSY97 did not provide raw data on specific majors. Instead, the NLSY97 raw data grouped college majors into categories, such as liberal arts, sciences, general studies, and humanities. Thus, it was unclear what a student’s exact college major was or how the NLSY97 defined its college major categories. Second, we chose to structure our data with self-reported college major rather than NLSY97-defined categories because it would allow future researchers to reclassify majors according to different definitions and research needs. We matched self-reported college major to the college transcript data for the year when respondents received a bachelor’s degree.

We followed the National Science Foundation’s (NSF) classification to group college majors into eight categories [ 44 ]. If a major appeared that was not on the NSF list, we followed the definitions of Liu, Sun, & Winters [ 45 ] because they expanded the NSF classification to include as many majors as possible in their study. If a respondent reported more than one major and the two majors were in the same field, we placed that respondent in the corresponding category (e.g., social sciences or STEM). If a respondent reported more than one major and the two majors were in different fields, we placed the respondent in the “multiple fields” category. Detailed definitions of each group are presented in Table  1 .

Measures of substance use behaviors

The NLSY97 asked respondents to report substance use behaviors during the past month for smoking, healthy alcohol use, and marijuana use. The questions were: “During the past 30 days, on how many days did you smoke a cigarette?”; “On how many days did you have five or more drinks on the same occasion during the past 30 days?”; and “On how many days have you used marijuana in the last 30 days?” We first converted respondents’ answers to binary variables, coding a response ‘one’ if a respondent’s answer indicated his or her engagement of the substance use behavior during the past 30 days, and ‘zero’ if otherwise. Next, because substance use behaviors sometimes cluster together, we generated a new variable for ‘degree of engagement in substance use behaviors.’ For this variable, we summed the three binary indicators to create an indicator of numbers of substance use behaviors (ranging from 0 to 3) in the past month.

The statistical analysis in this study controlled for potential confounders of substance use behaviors. The confounders included race/ethnicity, gender, highest level of parental education, age, childhood health problems (i.e., physical conditions, learning problems, and other chronic conditions), years of degree completion, self-rated general health, number of weeks working at a job during the year, and an income-to-poverty ratio for each year. In the baseline survey, parents were asked if the respondent had the following three childhood health problems that may potentially limit school in early life: (1) a physical condition, (2) a learning problem, and (3) any chronic condition.

Empirical strategy

The first step in the empirical analysis was to use negative binomial regressions to estimate whether receiving a bachelor’s degree was associated with degree of engagement in substance use behaviors in 2011. After completing this cross-sectional analysis, we applied multilevel negative binomial models to estimate the associations between college major and degree of engagement in substance use behaviors over time. We used the multilevel model approach to account for the nested nature of individual longitudinal data because one’s substance use at different time periods is nested within the invariant characteristics of the person [ 46 ]. Specifically, in our statistical model, level 1 represents individual substance use behaviors over time and level 2 represents personal characteristics. Furthermore, we used negative binomial regression in conjunction with the multilevel model approach. The negative binomial regression is widely used to model count data [ 47 ] and has been widely applied in substance use research (e.g.), [ 48 , 49 , 50 ]. More specifically, negative binomial regression can be used for over-dispersed count data, that is when the conditional variance exceeds the conditional mean. As such, it can be considered as a more generalized version of Poisson regression and becomes more efficient than Poisson when the outcome variable is over-dispersed [ 47 ]. In the longitudinal analysis, we also included interaction terms between college major and age to investigate whether substance use behaviors change over time by different majors. All regressions controlled for potential confounders.

For all regressions, we selected arts & humanities majors as the reference group. In addition, we did pair-wise comparisons across college majors using the same model and controlling for the full set of confounders. As such, we were able to fully test whether the association was statistically significant between each major. All analyses were done using Stata 16. This study is exempt from IRB review because it uses a survey dataset that is publicly available.

Table  2 presents sample characteristics for all respondents who obtained a bachelor’s degree between 2001 and 2011, as well as respondents’ substance use behaviors at the time of entering college and at the time of graduation, by college major. At the time of entering college, we observe substantial variations in substance use behavior by college major. For example, students who major in STEM, health sciences, and education showed a lower degree of engagement in substance use behaviors. In contrast, students who major in business, on average, showed a higher degree of engagement in substance use behaviors. A closer look at Table 2 also reveals a trend over time of increased substance use behaviors for individuals in nearly all majors. In other words, for students in nearly all majors, substance use at graduation was more prevalent than it was at college entry.

Table  3 presents the results of regression analyses that examined the association between level of education and substance use behaviors. The first column shows results for the full sample; the second and third columns show results for men and women separately. For the full sample, Model 1 found that individuals with a bachelor’s degree were less likely to engage in substance use behaviors, compared to individuals without a bachelor’s degree. Model 2 found that individuals with a STEM or education major were less likely to engage in substance use behaviors than individuals without a bachelor’s degree. While the coefficients of other majors were in the expected direction, they were not statistically significant. In addition, some gender differences were observed.

Table  4 presents the results from the multilevel negative binomial models that estimated the associations between college major and substance use behaviors over time. Again, the first column shows results for the full sample and the second and third columns show results for men and women separately. Results from the full sample suggest that the main effect of college major showed some variation in substance use behaviors. In addition, interaction terms showed that changes in substance use behaviors with age also differed by major. For example, individuals who majored in social sciences and business (marginally significant) were associated with decreased substance use with age, compared to individuals in arts and humanities majors. Importantly, the results in this table also show that differences between these college majors in substance use and changes over time cannot be explained by the covariates, including demographic characteristics, family SES background, childhood health, and employment. We also performed additional statistical tests that did pair-wise comparisons across majors; these analyses indicated some interesting patterns (results are in the Appendix: Table 6). For example, individuals with a social science major were also less likely to engage in substance use over time than individuals in a STEM major.

Moving to the second and third columns, results from the subsample of men and the subsample of women show remarkable differences. Men who majored in STEM, social sciences, or business were associated with decreased substance use with age, compared to men in arts and humanities majors. However, for women, the rates of changes in substance use behaviors did not vary significantly by majors.

Finally, because it is possible that each substance use behavior may correlate with college major differently, we analyzed each substance use behavior separately (i.e., smoking, heavy alcohol use, and marijuana use). Table  5 shows the regression results from the multilevel models that estimated associations between college majors and each substance use behavior over time. We found that trends in heavy alcohol use and marijuana use were more likely to vary by college major than trends in smoking, which did not vary across college majors. For example, individuals who majored in the social sciences or business were associated with decreased heavy alcohol use with age, compared to individuals in arts and humanities majors. Additionally, individuals in social sciences or health majors were associated with decreased marijuana use as they aged.

We also conducted a number of sensitivity analyses to check the robustness of the results. These analyses included: (1) investigating whether college major is associated with engaging in a substance use behavior in the past year (instead of the past 30 days) and (2) using multiple imputation instead of listwise deletion to recover missing values. The results from both sensitivity analyses were similar to the results in the main analysis. The results of all sensitivity analyses are available upon request.

The college years are a critical point in the life course when individuals build the foundation for a healthy and successful future. Whether college students develop healthy lifestyles and abstain from unhealthy substance use, particularly during the transition to adulthood, is thus a critical issue for public policy and practice. A student’s college experience is strongly shaped by his/her choice of major, with academic and social experiences differing greatly across majors. Nevertheless, the literature that seeks to understand college students’ health behaviors, including substance use, largely overlooks the role of college major. This question has gone unasked: Do all college degrees affect health behaviors in the same way, regardless of the field of study? This study sought to answer to this question by focusing on college major and substance use behaviors. Using longitudinal data from a national sample, the results revealed some interesting patterns between certain aspects of college education and substance use.

Consistent with prior studies, having a college degree was associated with a decreased likelihood of engaging in substance use behaviors (e.g., [ 2 ]). This study found some more specific variations in substance use by college major, particularly in terms of substance use prevalence and trajectories over time. Our analysis found that social science and business majors, on average, show higher rates of substance use than arts and humanities and STEM majors. Yet, social science and business majors also decreased their substance use more quickly over time than other majors did. When examining specific substance use behaviors, we found that college major is a significant predictor of heavy alcohol use and marijuana use, but not smoking. In addition, we observed strong gender differences: The associations we found between college major and substance use were more salient for men than women. Taken together, these findings lend some support to our hypothesis that college majors are heterogeneous and may potentially affect health behaviors, particularly substance use, differently.

The findings from this study are important because they inform the literature on college students’ health and substance use in several key ways. First, studies of substance use have traditionally focused only on the “social” and interpersonal” contexts. Indeed, the literature on adolescent health has long recognized the crucial role that peers and social context play in whether students engage in risky and unhealthy behaviors [ 51 , 52 ], and some recent studies suggest that college students are no exception [ 53 , 54 ]. However, particularly in college when the individual experience differs so much by major, it is also imperative to focus on a student’s ‘educational context’ and how it might relate to substance use and other health behaviors. By focusing on college major and substance use, this study demonstrates that important heterogeneity exists: Not all majors are associated equally with substance use behaviors and the patterns cannot be fully explained by standard social and interpersonal contexts, such as demographics, SES, employment, etc. Future studies can build on this research by digging deeper into college majors to elucidate the mechanisms through which they affect substance use behaviors or other health outcomes.

Second, the findings inform the literature by suggesting that business and social sciences majors may be less ‘healthy’, that is, that students in these majors have a higher likelihood of engaging in substance use behaviors than students in other majors. This finding deserves further discussion and, ultimately, further research. At first glance, the variations in substance use across majors may be assumed to be due to differences in health literacy, i.e., students in health-related majors are more aware of the health implications of their behaviors than other students. However, it is important to note that we found observable differences between students in arts and humanities and other, non-health fields of study; such differences cannot reasonably be explained by differences health literacy. For example, it is difficult to believe that arts and humanities majors would have better health knowledge than social science majors, such as political science, sociology, or pre-law [ 33 , 55 ]. Also, the assumption that the differences are due to what a student’s major teaches about health literacy is of limited explanatory value when one considers that recent, widespread public health campaigns have given all young adults a more similar baseline of health literacy. In fact, a recent study finds no difference in terms of health literacy by college majors [ 56 ]. Unfortunately, the NLSY97 does not include questions about students’ health literacy during the college years, so the aforementioned hypothesis cannot be tested. We argue that the higher likelihood we observe among business and social science majors to engage in substance use behaviors is an empirical finding that must be explained, and that it is likely that factors such as the learning experiences and opportunities in the student’s major may help explain the differences. Lipson, et al. [ 57 ] provides support for this idea, suggesting that a highly competitive environment surrounded by peers and faculty in the arts and humanities may help explain the prevalence of students’ mental health problems. Mental health challenges, in turn, are often associated with an increase in risky and unhealthy behaviors. Future studies that specifically investigate the peer influence and substance use culture for heavy alcohol use, smoking, or marijuana use initiation across learning contexts by college major will yield valuable insights that refine our hypothesis.

Finally, and more broadly, the findings from this study suggest a conceptual reconsideration of the role of education in social epidemiology theory and research. Most social epidemiological research focuses on the health benefits of education, which have been largely understood to mean only educational attainment. Indeed, it has been well documented that college graduates are healthier and exhibit more healthy behaviors than those with less education [ 58 , 59 , 60 , 61 , 62 ]. But, the import of education is not limited to achievement, per se. College graduates differ from non-graduates because they have spent a substantial amount of time in educational settings. Yet, the literature has less to say about what experiences in that educational setting make a difference for later health behaviors. Our understanding of how a college student’s field of study (college major) impacts individual health remains very limited. Findings from this study demonstrate the heterogeneity of college majors with respect to substance use, and in so doing, suggest the need to expand the concept of education in social epidemiology research.

Despite the strength of this study, we recognize a few limitations. First, since students do not randomly select into their major, the results are not causal. There are factors related to students and their lives that affect the choice of major and the choice to engage in risky health behaviors. As such, even though we used longitudinal data and controlled for a wide range of potential confounders, our findings remain associational. In particular, there is some evidence that heavy drinkers appear to gravitate toward business majors, which makes the causal relationship even more complicated [ 63 , 64 ]. Readers should be cautious and refrain from making causal interpretations of the associations reported in this study. Second, because the NLSY97 did not include measures of mental health in every wave of the survey, we could not control for mental health during the college years and thus test whether mental health mediates the associations we found. We hope that future research will shed light on this issue by examining mental health as it relates to college students’ field of study and substance use. Third, the definition of ‘heavy alcohol use’ used in the study differs slightly from the most-up-to-date definition of binge drinking, only because the NLSY97 survey question followed the earlier classification of binge drinking that was used in the National Survey on Drug Use and Health. As such, caution should be used when comparing our results on heavy alcohol use to other studies of binge drinking. Finally, despite the large sample size and detailed information on respondents’ college years, our findings might not be generalizable to current college students. The NLSY97 data is approximately a decade old, and college students today face a different policy context for substance use [ 65 ]. Future research that uses newer data may inform the generalizability of the NLSY97 data.

Limitations notwithstanding, this study demonstrates that even among people who have all completed college, there are significant variations in engaging in substance use, an important health risk behavior. The associations cannot be explained by demographic characteristics, familial SES background, and respondents’ employment and economic well-being. This robust conclusion has three practical implications. First, college health centers need to work with deans and department chairs in fields with a higher risk of substance use (i.e., business, social sciences) to increase awareness of the issue. Going further, our results should encourage deans and department chairs to consider not just the academic preparation of their majors for career success in terms of job placement and salary [ 66 ], but also the preparation of their majors for life success in terms of health behaviors. Our study suggests some majors come with a higher lifelong price, i.e., higher health risk. Increasing awareness of this issue is the very first step. Second, college health centers need to play a more active role in building a healthy culture among faculty members and students in fields that are more vulnerable to substance use. The idea that college major may affect substance use behaviors can be used to promote more collaboration between school health centers and leaders in academic divisions and departments. Finally, our findings call for deans and department chairs to pay greater attention to how the distinct learning and professionalization environment that their major provides might impact future health behaviors. In short, health should become a consideration in future curriculum design.

This study used a large-scale, longitudinal dataset to investigate whether and how engagement in substance use behaviors varies by college major. We find that not all college majors show the same level of engagement in substance use behaviors over time, and that the associations also vary by the specific substance use behavior examined and by gender. These findings suggest it is important to consider that the different learning and educational contexts that college majors provide may also be more or less supportive of substance use behaviors. Going further, our findings should higher education administrators to consider not just the academic preparation of different college majors for career success in terms of job placement and salary, but also the preparation of different majors for life success in terms of health behaviors. Ultimately, findings of this study may promote a more comprehensive understanding of the educational context of college, and how it affects not only students’ learning but also their substance use, will help us better prepare college students for career and life success.

Availability of data and materials

The authors have full access to the NLSY97 public-use dataset. Data can be downloaded from the following link: https://www.nlsinfo.org/investigator . The analytical sample and codes used and/or analyzed during the current study are available from the corresponding author, on reasonable request.

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Substance use and abuse among college students: a review of recent literature

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• 1 UCLA Drug Abuse Research Center.
• PMID: 7814772
• DOI: 10.1080/07448481.1994.9939094

This article reviews the research literature since 1980 on alcohol and other (illicit) drug use among college and university students. The discussion begins with a summary of survey findings on the nature and extent of alcohol and drug use, including prevalence and patterns of use and associated problems. This summary is followed by a discussion of the correlates of substance use and problems, including demographic characteristics, personality factors, year in college and grade point average, college residence, motivation, and attitudes. The most popular substance used by college students is alcohol, used by about 90% of students at least once a year. Heavy alcohol use is also prevalent, and is associated with serious, acute problems. Although alcohol use has decreased somewhat in recent years, much larger declines in use have been recorded for illicit drugs. The major proportion of research on substance use in this population has been devoted to alcohol; more information is needed on the prevalence, patterns, and correlates of illicit drug use. Suggestions for coping with problems of campus alcohol use/abuse are offered.

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Drug and substance abuse among university students

Juliana Mulaa Namada, James Ngari Karimi

This is a preprint; it has not been peer reviewed by a journal.

https://doi.org/ 10.21203/rs.3.rs-966829/v1

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Research objective:

The main objective of the study was to explore drug and substance abuse among university students. Specifically, the study sought to investigate factors influencing drug and substance abuse and find out the effect of drug and substance abuse on university students.

The study adopted mixed method approach. Triangulation was used in data collection both questionnaires and focus group discussions were used to collect data. Multistage sampling was used to get representation from all the five schools within the university. In each school, cluster sampling was while at programme level, simple random sampling was used. Snowball sampling technique was be used to identify the drug and substance abusers who were now targeted for interviews in focus group discussions. Quantitative data was analyzed using descriptive and inferential statistics. Qualitative data was analyzed using common theming method.

The study established three factors which influence drug and substance abuse among university students. The factors in order of significance are peer pressure, student residence and family background of the students. In terms of influence of drugs and substances, they impair student judgement, affect quality of sleep, and lowers the performance of students both in class and outside class.

Conclusions and Recommendations:

The study concluded that the social groupings which generate peer pressure, the type of accommodation for the students and family influence on students need to be considered in student mentoring to effectively manage the menace of drug and substance abuse. The study recommends a turn round strategy by the university in dealing with drug and substance abuse menace to improve performance retention and completion rates. 

Health Policy

Peer Pressure

Substance Abuse

Student Performance

USIU-Africa

Drug and substance abuse is one of the most vexing and pervasive problems that most universities are grappling with in as far as administration and management of universities is concerned. The consequences on the students are disastrous and devastating. This has been aggravated by the rapid social and technology changes which have had a corrupting influence on the students in the university. Drug abuse is a real threat to the students; parents; universities and the economies. Globally countries rely on the valuable youth potential that is being robbed by drugs. Drug and substance abuse is a global problem, whose prevalence has remained unabated amongst youths [ 10]. Substances include pain relievers, stimulants, tranquilizers, sedatives, and all four drug classes combined [ 26 ]. Drugs are substances that is used to prevent, diagnose, treat, or relieve symptoms of a disease or abnormal condition.

Research has consistently reported that drug and substance abuse behaviors among students in higher learning institutions is commonly linked to already perceived norm practices amongst age mates. [ 11 ] identified factors such as peers and media influence, need to release stress, desire to enjoy the drug, accessibility of drugs, desire to experiment, influence from guardians and siblings, poor parenting, having trouble in school are key factors influencing drug and substance abuse. Further, having a problem with the police and unemployment have been reported in most studies to be factors contributing to drug and substance abuse among youth aged between 17 to 28 years old with peer and social media influence being reported as the most influential factor. Colleges and Universities student’s social groups include people of the same age group and similarly minded which cause a strong peer pressure effect. Experts describe age 17 to 28 years old as the age of “window of vulnerability” because most youth are influenced into drug and substance abuse by their peers. The desire of social acceptance and the phobia of being sidelined and rejected by fellow peers has been proved to be a contributing factor to drug and substance abuse among youth [ 30 ]. [ 16 ] found out that drug awareness had helped some of the students involved in this study stop abusing drugs.

Drug and substance abuse has impacted negatively on the academic, social, psychological, economical, and physiological development among the abusers [ 31 ]. It is a matter of grave concern to educational stakeholders, medical practitioners, sociologists, religious leaders, counselors, and parents thus needing urgent attention. Studies have established a high prevalence of drug and substance abuse among the youths. [35] National Campaign Against Drug Abuse (NACADA) have come up with prevention strategies to reduce the prevalence [ 28 , 18 ]. However, the strategies have not reduced the number of taking drugs. It is against this background that this paper seeks to factors influencing drugs and substance abuse and find out the effects which drugs and substance abuse has on university students. In essence, this research contributes to realization of two sustainable development goals of health and wellbeing and quality education.

Literature Review

Factors affecting drug and substance abuse.

Peer pressure is one of the key factors affecting drug and substance abuse. World Drug report indicated that drug users seek approval from their peers to join their habit as a way of seeking acceptance [ 20 ]. Majority of the students in universities and colleges are surrounded by their peers who are experimenting for recreational purposes. This factor is further fueled by the desire to experience something unique. Students in universities are normally in the process of exploring different aspects of their lives in a new environment, it is common for them to dig deep into drug and substance experimentation. Being away from their friends and families creates a need to fit in with majority of them feeling the best way to fit is to be like rest of the students, attend parties organized in school, get drunk and high. The lack of guardian monitoring and supervision provides unlimited freedom to most university students to act or behave as they please, making them vulnerable to try out drugs. [ 24 ] found out that drug and substance abuse was more prevalent among students in third year and fourth year as compared to those in first and second year. This was because majority of the first-year students lacked exposure to freedom and drug and substance abuse and was aware they were in a Christian University environment.

Upbringing plays a major role in drug and substance use and abuse. [ 25 ] noted that the more members of a household who engage in drug and substance abuse, the greater the chances that the younger members of that family students will engage in drug and substance abuse. Parents are not only role models for their children’s behavior, but also older siblings have an impact to their younger siblings by involving them in drug and substance abuse activities such as getting them alcohol, beer or a pack of cigarettes [ 9 ]. According to a study done in a Christian university, majority of the respondents involved in drug use and substance abuse had witnessed their fathers using alcohol and abusing other drugs implying that parents drug use and substance abuse was also a major influential factor to drugs and substance abuse in their children especially as they are experiencing their youth. It also indicated that, parents are neglecting their responsibilities in raising the youth leaving them to influence their characters and behaviors through the media.

[ 27 ] found out that social media and cultural identity in drug and substance use and abuse among African and African American university students to follow musicians and rappers for fan-bases. The Hip-hop genre of music with African American was found to influence the black culture. People abuse drugs and substances with most of the music videos clearly depicting the use of alcohol and cannabis sativa. African American culture therefore is believed to influence the use of drugs and other substances especially through social media in different ways such as the presence of drug and substance abuse on television. Majority of the students perceive these celebrities as role models. Modeling plays an important role in learning of a new behavior hence they tend to copy their attitudes, beliefs, habits, and behaviors including drug use and substance abuse.

Having trouble in school, exams and lack of tuition fees have been proved to cause stress to university and college students. Students believe that the best way to relieve the stress and forget the negative thoughts is to use drugs and substances. University students who try to balance between course workload and part time jobs are most likely rely on drugs as a coping mechanism. Despite the course work overload, part time jobs, attachments, internships, and practicums long hours, it has been noted that majority of the students in the health and science schools have more pessimistic attitudes leading them to be prone and vulnerable to drug and substance abuse [ 8 ]. Anxiety and uncertainties of becoming adults among majority of the students in higher learning institutions was also found to be a leading cause of the youth engaging in drug and substance abuse. This was due to the everyday challenges faced in life and the problems that come with it such as new responsibilities and financial freedom. Loneliness because of abandonment either by a parent, girlfriend, boyfriend or friends brought about drug and substance abuse as a means to escape the constant pain and hurt of being abandoned. Students still dealing with child trauma such as neglect, physical, sexual and emotional abuse are most likely to engage in drug and substance abuse.

The environment surrounding the universities plays a major role in drug and substance abuse. The availability and ease of access of these drugs was also found to be a major influential factor in Drug and substance abuse. [ 24 ] noted that easy access to drugs creates an environment that easily enables the onset of drug and substance abuse and enhances the increased use of these substances. Easy access to drug and other psychoactive substances reduces the barriers to acquiring these substances which in turn lead to potential substance use and abuse. The availability of alcohol outlets such as stores and bars selling liquor, beer, and wine among other drugs has been linked to a higher alcohol consumption rate among college students and adults living within that proximity. [ 19 ] noted that visual exposure to these drugs and other psycho active substances either through advertisements, promotions and marketing are common at different alcohol outlets lead to craving of these substances leading to potential use and abuse. Residing in neighborhoods associated with higher level of alcohol sales and consumption is found to be a stimulating factor in potential alcohol and substance abuse as compared to neighborhoods with ease of access to places of worship, libraries and after school programs.

The residence of the university students was also an influential factor in drug and substance. [ 15 ] established that drug and substance abuse is rampant in many of the students who resided in private hostels outside campus. this group of students confessed to alcohol and substance abuse as compared to those who resided with their parents who came in as the second majority while the students that resided in university hostels reported the lowest levels of engaging in drug and substance abuse [ 22 ]. This was a result of private hostels outside school do not uphold strict rules and regulation on drug and substance abuse within their premises as compared to the university hostels. Landlords avoid the risk of losing their tenants by enforcing strict rules and regulations on them and thus these students are free to exercise their freedom in the use and abuse of drugs and other substances is practiced.

The role of religion was also stated as a significant factor in drug use and substance abuse. Some researchers established in their findings that alcohol was commonly used in religious ceremonies among the orthodox Christians while “khat” was used for prayers among the Muslim religious leaders [ 1 ]. Some of the students saw this as a way in which religious leaders are promoting the use and abuse of these substances. However, evidence-based studies have found out that majority of the students in spiritual universities are less likely to be involved in drug and substance abuse. Faith is believed to protect both young men and women from drug use and substance abuse. A lot of research studies show that faith among young people acts as a powerful obstruction towards drug and substance abuse.

Effect of Drug and Substance Abuse

The use of psychoactive substances among university students is a major global public health problem. The prevalence of substance abuse has been reported to be on the rise in countries throughout the world such as Iran and Brazil and in some African countries such as Nigeria, Ghana and Ethiopia [ 2 ]. Although the substance of choice used by learners may not be similar in all areas, there are some substances that are common at a global scale, and these include alcohol, cigarette, dagga or marijuana or cannabis and cocaine [ 21 ].

Drug abuse is a growing social problem which endangers abuser’s health and productivity. Every abused drug influences the abuser in the short term or long term. A user’s mental abilities such as judgment are severely impaired by use of drugs in addition to exposure of the user to addiction and diseases’ [ 6 ]. Drugs and substance abuse can alter a person's thinking and judgment, leading to health risks, including addiction, drugged driving, and infectious disease.

The high prevalence of substance use is a major concern for public health because it carries significant health risks. It also contributes to social problems such as crime and violence, with students who use substances being more likely to experience violent acts and being involved in criminal activities [ 2 ]. Students who use substances often experience injuries in road accidents and fights, which are sometimes fatal. Substance use is also associated with risky sexual behaviours, scholastic problems like dropping out of school, and physical and mental health problems that include depressive symptoms. Substance use carries significant health risks to learners and increases both morbidity and mortality. Blood-borne infections such as hepatitis C and HIV have been reported to be common amongst people who use injectable drugs [ 30 ]. Substance use also contributes to risky sexual behaviour because sexual inhibition is negatively affected by the effects of the substances used.

Alcohol abuse and addiction can also lead to destructive behavior such as driving under the influence of alcohol and domestic violence. The side effects of alcohol abuse include the hangover, in which headaches, nausea, and vomiting continue after a drinker is no longer actually intoxicated or experiencing the alcohol high. Weight gain and high blood pressure can result from repeated overconsumption of alcohol, and long-term overconsumption of alcohol can raise the risk of depression, liver damage, cancer, depression of the immune system, reduced sexual performance. Alcohol use can also have serious consequences for expecting and breastfeeding mothers and their babies, including fetal alcohol syndrome.

Drugs can disrupt a person’s ability to think and communicate rationally, or even to recognize reality, sometimes resulting in bizarre or dangerous behavior. Hallucinogens and dissociative drugs which have street names like acid, angel dust, and vitamin K, distort the way a user perceives time, motion, colors, sounds and self. Ayahuasca is a hallucinogenic tea made in the Amazon from a DMT-containing plant (Psychotria viridis) along with another vine (Banisteriopsis caapi) that prevents the natural breakdown of DMT in the digestive system, thereby enhancing serotonergic activity. Ayahuasca cause emotions to swing wildly and real-world sensations to appear unreal, sometimes frightening. Dissociative drugs like Phencyclidine (PCP) ketamine, dextromethorphan, and Salvia divinorum may make a user feel out of control and disconnected from their body and environment.

Cocaine is a powerfully addictive stimulant drug made from the leaves of the coca plant native to South America. Its short-term effects include narrowed blood vessels; enlarged pupils; increased body temperature, heart rate, and blood pressure; headache; abdominal pain and nausea; euphoria; increased energy, alertness; insomnia, restlessness; anxiety; erratic and violent behavior, panic attacks, paranoia, psychosis; heart rhythm problems, heart attack; stroke, seizure, coma.

Marijuana is also called weed, herb, pot, grass, bud, ganja and Mary Jane. Marijuana is made from the hemp plant, Cannabis sativa. Marijuana impairs short-term memory and judgment and distorts perception; it can impair performance in school or at work and make it dangerous to drive. It also affects brain systems that are still maturing through young adulthood, so regular use by teens may have negative and long-lasting effects on their cognitive development, putting them at a competitive disadvantage and possibly interfering with their well-being in other ways. Also, contrary to popular belief, marijuana can be addictive, and its use during adolescence may make other forms of addiction more likely. Short-term effects include enhanced sensory perception and euphoria followed by drowsiness/relaxation; slowed reaction time; problems with balance and coordination; increased heart rate and appetite; problems with learning and memory and anxiety.

Substance use tends to peak between the ages of 18 and 25 years with university students being at higher risk for the vice if compared to non-college peers. Alcohol use amongst university students was a major public health disquiet. Substance use among college and university students was likely to interfere with their studies and as result their career development ends in jeopardy. Majority of the studies done on alcohol and drug abuse in low and middle-income countries have.

This has an impact on the students' learning activities. Drug abuse leads to poor class attendance and poor performance that sometimes led to discontinuation from the university. The cases of alcohol abuse were many substances abuse particularly use of marijuana (bhang) had been linked to mental health problems. Participants in this study confirmed witnessing students with mental disorders which after follow-up was established to be associated with the intake of bhang. They gave an example of a student who was rescued after attempted suicide because of the effects of bhang. Rape cases, sodomy and physical assaults were among other effects resulting from drug abuse.

Methodology

Mixed method study design comprising qualitative and quantitative methods was used for the study. The study adopted descriptive survey design which is useful when collecting information about people’s attitudes, opinions, and habits. The study targeted students in all the schools in the university. They were preferred since it was assumed drug and substance abuse at the university has been rampant in the near past. The respondents were sampled from the 5 school of business, school of humanities, school of science and technology, school of pharmacy, school of communication and cinematics. Cluster sampling design was adopted for this study where both day scholars and boarding students were considered in both settings. The clusters were also in terms of part time students and full-time categories of students residing on campus and off campus. The sampling frame comprised of all registered students in Spring Semester 2018. Simple random sampling was used so that every student was targeted for data collection. Snowball technique was used in order to identify the drug and substance abusers who were now targeted for interviews in focus group discussions. Quantitative data was analyzed using descriptive statistics and exploratory factor analysis. The results were presented in tables, graphs, and figures while qualitative data was done using common theming method.

Results And Findings

Response rate.

The study targeted 723 students from all the schools. The total number of the targeted students who returned the questionnaires were 612. Therefore, the response rate for the study was 84.6% which was a good response rate. Alongside the questionnaires, a total of 9 focus group discussions were held from different schools within the university. The highest percentage of students came from the Chandaria School of Business (CSOB) which is the biggest school in the university while the lowest number came form the School of Pharmacy and Health Sciences (SPHS) which was the smallest and had just been created.

The first objective focused on factors which affect drug and substance abuse. The analysis was done using three faced approaches. The first step involved descriptive analysis where mean, standard deviation, KMO and Bartlett’s tests were carried out. The second step involved factor rotation where the factor loadings were established, lastly, extraction of the factors with eigen values above the threshold.

The average mean across all the factors ranged between 3.0 - 3.2 which implies that the respondents seem to agree with different factors affecting the use of drugs and substance abuse. However, in terms of deviation, in terms of previous experience affecting drug and substance abuse the respondents had varying views which deviated from the mean by 2.7. This implies that on this factor ideas from the respondents varied significantly.

The KMO and Bartlett's Test shown above indicates sampling adequacy of .937 against a threshold of .500 which is very good. Test of sphericity is significant at 0 .000. This implies that the sampling of students at in all the schools were adequate for the study. Further the results were significant.

From the Table 3 above, three factors were extracted all with Eigenvalues above 0.7 which is normally the threshold. In total the three factors had 70.077 of the total variances of all the factors. This implies that the three factors which were extracted account for 70% of factors which affect drug and substance abuse among the students.

The scree plot shown indicates that one factor was 6.786 while the other two factors considered in the analysis were 0.875 and 0.749 which were rounded up to a whole number of 1. Therefore, only three factors out of a total number of 12 factors accounted for the considered variance among the factors which affect drug and substance abuse among the students.

The rotated component matrix was able to identify three categories of factors with various components which had loadings greater than 0.5. Factor one had six components which were student’s residence, peer pressure, moral upbringing of the students, the amount of money at the student’s disposal, family background and misplaces priorities on the part of the student. The second factor had four components which included a desire to experience something different, desire to change once’s experiences, physiological intolerance, and peer pressure. The third factor had four components among them previous experience in drugs, the setting for use of drugs, susceptibility of time available and student residence.

Qualitative Data on Factors affecting Drug and Substance Abuse

Peer pressure and upbringing came out strongly from all the focus group discussions as among the key factors affecting drug and substance abuse. In terms of peer pressure, students sought to fit into specific social groups for a sense of belonging and communal. They pointed out that social life, friendship, and companionship were among key considerations of students engaging in illicit behavior. Some added that trends of the moment, curiosity and simply wanting to try something new were among the key drivers. Students who were joining campus from different homes also felt a sense of too much freedom away from home especially those coming from a very sheltered places and those who had been closely monitored by parents and guardians.

Economic status of families and upbringing were mentioned as key catalysts to drug and substance abuse. Some of the students confessed having been brought up by absentee parents who were busy making money and not creating enough time for their children. Such parents to compensate for the absence gave lots of money to the students more than what was required for the campus upkeep. The result is that students used extra money to buy drugs and other illicit substances because affordability was not an issue. The students also had too much time coming in between the classes and the whole weekends. This factor was cited in cases where the students did not engage in extracurricular activities organized on campus instead getting engaged into drug and alcohol abuse.

The surrounding environment around campus was one of the key factors leading to drug and substance abuse. The university is surrounded by many has many entertainment outlets, eateries, service bureaus, formal hotels saloons and barber shops where the illicit products are being sold. The students noted that these places around the university are open early each day. They do both the formal business and the illicit businesses of selling and supplying drugs to the students. The student access these places at their own discretion from morning, evenings, in between classes and during weekends. Bad grades and failure to perform well in class was cited as one of the factors which cause stress and anxiety among the students. The stress makes them use drugs and substances to momentarily forget the problems while on the other hand driving them to addiction.

Effect of Drugs and Substance on Students

The second objective focused on the effect drug and substance abuse on the students. The analysis was done through descriptive statistics where mean, standard deviation and the 5-point Likert scale percentages. The findings were presented in Table 6 as shown.

As per the Table 6 , the descriptive results indicated that there are very clear indications of what the effects of drug have on the students. This can be shown by the means presented on the Table of range 3.12 to 3.28. The most outstanding effect was “impairs performance in school, at work and, make it dangerous to drive” with a mean of 3.286 and “drug abuse potentially harm unborn baby and affect other pregnancy related issues” with a mean of 3.267 respectively. The other questions also raised very fundamental inferences with mean of 3.1 and above.

52. 0% strongly agreed that “Drug abuse potentially harm unborn baby and affect other pregnancy related issues” 51.3% agreed that drugs “Impairs performance in school, at work and, make it dangerous to drive”. 49.0% drugs impair a person’s thinking capabilities. 49.0% drugs have negative and long-lasting effects on their cognitive development of students. 48.6% drugs impair thinking and communication. On the other hand, a small percentage of respondents between 10.7% and 17.5% had neutral observations which is also a worrying trend and shows ignorance of the situation languishing students in the university.

Qualitative Data on effects of Drug and Substance Abuse on Students

From the focus groups, the results reveal that the effects of substance abuse on the student’s touches on affecting their physical, mental, emotional health. Most of the students tend to miss classes, do not submit assignments, and isolate themselves from the universities activities which make them end up in dropping from school. Other effects include low self-esteem, violence, short attention span, hallucination, and low thinking capacity which all this affect their well-being and consequently leads to higher rates of university drop out or take longer to complete.

Discussion Of The Findings

The study established that family background and upbringing are among the main factors which influence drug and substance abuse. These findings were like a study investing the relationship between drug use and substance abuse and quality of sleep among colleges and university students in Yemen and Saudi Arabia [ 5 ]. The researcher found out that cultural factor plays a significant role in drug use and substance abuse. The influence through celebrities and famous people on social media was found to be strong among students in colleges and universities.

This study established that previous experiences including family upbringing and role modelling during initial growth periods influence usage of drugs and substances. A study by [37] found out that parental love, quality time, consistency and role modeling were mentioned in a study as fundamental in defining a youth’s involvement in drug and substance abuse. Children from separated households are more prone to various vices in the society such as drug and substance abuse because majority of them have lacked parental care and supervision from an early age. The study further revealed that lack of maternal support, monitoring and communication have been significantly linked to heavy drinking and drunkenness among adolescents.

This study found that drug and substance abuse lead to impairment in attention, processing speed and sleep quality. The findings resonate with [ 29 ] who observed that that there is a significant evidence of sleep disorders and poor sleep quality among university students. Most of the sleep disorders are mostly linked to tobacco use and poor performance. They further explained that poor sleep quality had a significant effect on the level of drug use and abuse among University students. Students who did not use drugs had a higher quality of sleep compared to students who used drugs who had poor quality of sleep more often. Some students in recent studies have confessed to taking stimulants such as Adderall, Ritalin, Dexedrine, Concerta, and Stratera to enhance their academic performance.

This study established that drug and substance abuse impair performance in school, at work and, makes it dangerous to drive. In agreeing with the findings [ 4 ] noted that drug use and abuse these stimulants medications for both academic and recreational functions. For academic functions students believe that stimulants medication enables them to improve their GPA through helping them study and stay alert for long hours, enhance their concentration, and focus and increase their energy level. For recreational function College and University students it enables them to get rid of fatigue and improve their social awareness

The findings of the research indicate that indeed drug and substance abuse affect students at USIU Africa and from other research done in other regions globally there is a great corroboration of these findings. In this study, the results indicate that drug abuse impairs performance in school, at work and, make it dangerous to drive, there is a great potential for Drug abuse potentially harm unborn baby and affect other pregnancy related issues. These findings are reflected by research conducted by [ 23] who asserts that drug abuse to students is tantamount to poor performance as the objectives of education to students are over run by aggressive behavior, violence and withdrawal. It becomes impossible for such students to concentrate on studies or even interact with fellow students or lecturers

On the other hand, drug and substance abuse increases risk of sexually transmitted infections among the students which end up making them risk their young lives. As well, drug abuse impairs participation and engagement in life, affects person’s ability to think and communicate rationally, recognize reality sometimes resulting in dangerous behavior. These results have a bearing from the research done by [ 3 ] who reported that drug abuse increases the risk of sexually transmitted infections.

Conclusions And Implcations For Practioners

In a nutshell, this study therefore, concludes that peer pressure and the residences of the students were found to be major factors influencing drug and substance abuse among USIU-Africa students. Drug and substance abuse of drug by the students directly affects and impairs academic abilities of the students which limit their academic performance. For most students who use drugs, their maturity is affected and keeps them engaged in deviant peer groups as others move on to more normative groups, thus having a long-term direct effect on educational attainment. The study would recommend multi-approach to curb this vice from the parents, lecturers, peers, counselors to follows preventive interventions aimed at improving academic engagement and broaden their focus beyond drug use in students. Community and family risk factors should also be targets of intervention.

The university needs to come up with mechanisms of dealing with peer pressure amongst students to reduce instances of drug and substance abuse. The university need to partner with parents and accommodation providers around campus to tighten the rules governing student accommodation as a way of reducing the menace. Counseling education should be heightened in campuses to revive those who have already been engaging in the act and the government should strictly enforce its existing laws through NACADA against drug abuse through its regulatory agencies.

ABBREVIATIONS AND ACRONYMS

CSOB - Chandaria School of Business

DMT - A powerful hallucinogenic drug

PCP - Phencyclidine drug

NACADA - National Campaign against Drug Abuse

USIU-Africa - United States international University Africa

SPHS - School of Pharmacy and Health Sciences

Declarations

Ethics approval and consent to participate

• The Proposal for this research work was reviewed and approved by USIU-Africa, Institutional review Board. The certification number is USIU-AFRICA/IRB/ 172-2018
• Ethics review committee is the ethics board of United States International University Institutional-Africa (USIU-Africa) Review Board

Consent to participate in the study

(below is a sample of consent form given to respondents)

TITLE OF THE STUDY: Drug and Substance abuse among University Students: A case of USIU – Africa.

PRINCIPAL INVESTIGATOR

Name: Juliana Mulaa Namada

Department: USIU Chandaria School of Business

Purpose of the Study: 

The main objective of the research will be to analyse the effect of drug and substance abuse on university students at USIU-Africa.

VOLUNTARY PARTICIPATION AND CONFIDENTIALITY

Your participation in this study is voluntary, and your responses to this survey will be anonymous. Please do not write any identifying information on this questionnaire.

I have read and understood the information provided and I wish to participate. I voluntary agree to take part in this study.

Tick the box below about the position you take to participate in the study:

Consent for publication

• Not Applicable

Availability of data and materials

• The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Competing interests

• There are no competing interests from the researchers and the authors of this manuscript.
• This project was funded internally by United States International University-Africa where both the researchers work. 

Authors' contributions

• The authors of this manuscript have contributed equally to the research and the manuscript from the beginning to the level where we are now submitting for publication.

Acknowledgements

The authorship was with the two contributing authors only

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Substance Use Among College Students

• Justine W. Welsh , M.D. ,
• Yujia Shentu , M.S. ,
• Dana B. Sarvey , M.D.

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U.S. college campuses have witnessed a national increase of cannabis, stimulant, and illicit drug use among students over the past decade. Substance use among college students is associated with numerous negative outcomes including lower academic performance, a higher probability of unemployment after graduation, and an increased risk of committing and experiencing sexual assault. Several risk factors for substance use are specific to this population, including an affiliation with Greek life, perception of high academic pressure, and peer pressure. Students with problematic substance use also face unique challenges in planning treatment, including aspects of confidentiality, financial constraints, and potential university oversight and involvement. This article highlights the prevalence of substance use on college campuses and describes some of the specific challenges and approaches to treatment in this population, including screening tests and interventions for specific substances used on college campuses and evidence-based substance use programming for college students.

For many youths, college enrollment is a distinct life event that symbolizes the transition from adolescence to independence and adulthood. It also represents a vulnerable period for increased exposure to a variety of illicit and prescribed substances.

Clinical Context

Substance use on college campuses.

Although attending college has historically been considered a protective factor against the development of substance use disorders, in recent decades substance use has become one of the most widespread health problems on college campuses in the United States ( 1 ). In a study by Caldeira et al. ( 2 ), nearly half of 946 college students who were followed from freshman to junior year met criteria for at least one substance use disorder during that time. Students who regularly use substances are more likely to have lower GPAs, spend fewer hours studying, miss significantly more class time, and fail to graduate or to be unemployed postgraduation ( 3 – 6 ). Substance use is also associated with significant general medical and psychiatric morbidity and mortality for many students ( 7 , 8 ).

One of the most significant challenges with addressing substance use on college campuses is related to its history of integration into the normative tradition and fabric of the college experience. Alcohol use is a prime example. National survey data indicate that over 60% of full-time college students have consumed alcohol, and a staggering 39% report engaging in binge drinking (consuming five or more drinks) over the past month ( 9 ). Surprisingly, both past-month and past-year alcohol use are higher for college attendees than for age-matched cohorts who do not attend college ( 1 ). Binge drinking can lead to dangerously elevated blood alcohol levels and is associated with an increased risk of illicit drug use ( 10 ). The challenges associated with beginning college life, such as separation from family members, participation in new social networks, and more intense academic pressures, may significantly contribute to increased alcohol consumption.

The escalation and normative acceptance of the use of prescription stimulants for cognitive enhancement purposes have also increased on college campuses over the past decade ( 1 ). Annual prevalence of nonmedical dextroamphetamine (Adderall) use among college students is higher (9.9%) than for age-matched youths not enrolled in college (6.2%) ( 1 ). College students often seek out dextroamphetamine prescriptions from mental health practitioners, with the intention of enhancing their ability to focus and study for exams. This presents a unique challenge for prescribers, who must ensure that those who need stimulant medication for a diagnosed condition receive it while not overprescribing to those who may be using it for nontherapeutic purposes.

The use of cocaine among college students presents another challenge to health care providers. According to the 2016 Monitoring the Future survey, 4.0% of full-time college students surveyed used cocaine in the past year, and 1.4% used cocaine in the past month ( 1 ). A longitudinal study of 1,253 college students found that more than 20% were exposed to opportunities for cocaine use in the past year ( 11 ). The substantial presence of stimulants on college campuses warrants the continued attention of clinicians and school administrators.

The percentage of college students using cannabis daily has increased, nearly doubling between 2007 and 2014 ( 1 ). According to the 2016 National Survey on Drug Use and Health, 20% of full-time college students reported using marijuana in the past month ( 12 ). There is considerable evidence of the short-term impact of heavy cannabis use on memory and learning, and it plays a negative role in academic and health outcomes on college campuses ( 4 , 13 ). The likelihood of cannabis use increases during the college years, with some studies demonstrating an escalation in prevalence with each successive year ( 14 ).

Fortunately, tobacco use has been on the decline over the past 20 years across U.S. college campuses. However, campuses have witnessed a relative explosion of electronic cigarette/vaporizer devices, which offer the ability to use more concentrated amounts of nicotine ( 15 ), as well as cannabis oil (sometimes known as “dab pens”). Although college students are still somewhat less likely than noncollege cohorts to use vaporizer devices (6.9% versus 9%), the trend suggests that use of electronic vaporizer devices represents a new and potentially more discrete means of acquiring physiologic nicotine dependence ( 1 ). For example, the Juul is a very small and popular vaporizer device sold online, advertising its compact nature and colorful nicotine pods to youths as fun and convenient (including a charging station that fits onto the side of a laptop computer). One pod contains as much nicotine as a full pack of traditional cigarettes. Relatively short-term use can lead to significant symptoms of nicotine withdrawal. Youths who initiate experimentation with electronic cigarettes are also more likely than those who do not to progress to tobacco products ( 16 ). In some cases, youths are also experimenting with alternative modes of cannabis delivery with vaporizing devices. Cannabis oil cartridge sales have escalated in states where cannabis is legal, such as California, while traditional sales of the cannabis plant product have simultaneously declined ( 17 ).

MDMA, LSD, and other psychedelic drugs are also gaining popularity in the club and rave scenes among college students. The annual prevalence of MDMA use among college students more than doubled from 2004 to 2016 ( 1 ), and the rate of emergency room visits resulting from MDMA use in this age group continues to increase ( 18 ). College students reported taking hallucinogens and MDMA for reasons such as curiosity, a desire to escape or to achieve a novel experience, and social pressures ( 19 , 20 ). In recent years, “microdosing” has also gained popularity among college students. Microdosing describes the act of consuming a small amount of hallucinogen in order to achieve a subtle psychedelic effect but not to fully alter consciousness. Research on the prevalence and potential adverse effects of microdosing is unfortunately scarce ( 21 ).

In the midst of the opioid crisis, college students are particularly vulnerable to opioid misuse. According to the National Survey on Drug Use and Health, young adults ages 18 to 25 report the highest past-year opioid use prevalence of all age groups ( 22 ). The risk for opioid use disorders commonly begins during adolescence and young adulthood ( 23 , 24 ), coinciding with the college years. Results from a recent study suggest that opioid misuse among college students is associated with several factors, such as living off campus and having a low GPA ( 25 ). Unfortunately, individuals in this age group are often reluctant to enter treatment. Even for those who receive treatment, retention rates are lower than for older adults ( 26 – 28 ). Unfortunately, although the American Academy of Pediatrics supports the use of medication-assisted treatment for opioid use disorder, prescribing rates remain relatively low for young adults ( 24 ). Buprenorphine-naloxone is approved for patients ages 16 and older and has been found to be a cost-effective treatment in this age group. Methadone or extended-release injectable naltrexone may also be options; however, some have cautioned about the perceived stigma of methadone in this age group ( 29 ), and to date there is limited data directly supporting extended injectable naltrexone in this population ( 30 , 31 ).

Risk Factors Specific for Substance Use on College Campuses

In addition to general risk factors, such as certain psychiatric conditions and family history of substance use disorders ( 32 , 33 ), there are a number of risk factors for substance use specific to the college campus. Figure 1 summarizes these factors. Peer influence and the perception of harm play a significant role in the decision to engage in substance use on college campuses. This is especially true during the first year of college, with less of an effect in each consecutive year ( 34 ). Students who perceive substance use by their peers to be normative are more likely to be at risk themselves of developing a substance use disorder ( 35 ). This perception is confounded by a general overestimation of peer substance use within the college-age population ( 35 – 37 ). According to the American College Health Association, among 26,139 undergraduate students from 52 schools, 9% had used cigarettes in the past 30 days, yet most believed that about 71% of their counterparts had smoked cigarettes in the past 30 days ( 36 ). The results were also similar for cannabis use. The drastic overestimation of peer use has been found to be present in nearly all categories of substance use.

FIGURE 1. College campus–specific risk factors for substance use

Members of fraternities and sororities have some of the highest rates of substance use on college campuses. Compared with nonmembers, fraternity and sorority members are more likely to use alcohol, cannabis, and other drugs, as well as binge drink more frequently and smoke cigarettes, ( 38 , 39 ). Members also suffer from more negative consequences from substance use compared with nonmembers, including a higher prevalence of driving under the influence, being physically injured, experiencing memory loss, and having unprotected sex ( 40 , 41 ). Males who live in fraternity houses during college not only have a heightened risk of binge drinking but are also at higher risk of an alcohol use disorder later in adulthood (45% reporting symptoms that meet criteria) ( 42 ). Living in a fraternity or sorority house is also associated with a higher prevalence of cigarette smoking ( 38 ). Students who engage in substance use behaviors during high school are more likely to join fraternities and sororities when they enter college ( 43 ). Male students demonstrate a greater increase in alcohol use after pledging into fraternities, compared with nonmembers ( 44 ). Members who are more actively involved or who have taken leadership positions are also more likely to hold positive thoughts about alcohol use, including the facilitation of bonding between brothers, having fun, and enhancing sexual appeal ( 45 ). Not surprisingly, students who later disaffiliate with Greek life demonstrate a decrease in heavy drinking and alcohol-related consequences ( 46 ).

The relative ubiquity of prescription stimulant medication on college campuses places at risk students who are academically underperforming or experiencing significant academic pressure. A recent longitudinal study found that approximately one-third of students were offered stimulants for nonmedical use in the past year. Of those who were offered stimulants, more than one-third misused them ( 47 ). In 2016, approximately one in ten college students reported nonmedical use of dextroamphetamine-amphetamine (Adderall) in the past 12 months ( 1 ). The risk is especially elevated for female college students, who are twice as likely as their noncollege female counterparts to use stimulant medications for nonmedical purposes ( 1 ). The risk is also higher among college students with lower GPAs and those who have skipped more classes ( 14 ). The number of first-time stimulant users typically peaks in April and November, coinciding with college final-exam weeks ( 48 ). Despite popular beliefs by college students that the nonmedical use of stimulants will facilitate earning higher grades ( 49 ), nonmedical use has not been found to be associated with an improvement in academic performance as reflected by GPA ( 50 ).

Substance Use and Sexual Assault

Sexual assault is a significant problem on college campuses. Alcohol and other drug use is a strong predictor of an increased risk of committing and experiencing sexual assault among college students ( 51 ). Unfortunately, being involved in Greek life and binge drinking are added risk factors for experiencing a sexual assault in college ( 52 ). Among a survey of 23,980 college women, 4.7% endorsed having been raped since the beginning of the school year ( 53 ). Three-quarters reported being intoxicated when the perpetration happened. Female students who reported binge drinking (defined by the investigator as having six or more drinks on one occasion) at least monthly were more than twice as likely as those who did not report monthly binge drinking to experience a sexual assault ( 52 ). The amount of alcohol consumed is also linearly correlated with the perpetrator’s aggressiveness ( 54 ). Unfortunately, alcohol consumption by victims can impair their ability to stay alert to the perpetrator’s intent and makes it harder to resist or escape the sexual assault.

Treatment Strategies and Evidence

Each clinical situation requires a specific treatment plan that is tailored to an individual’s current set of circumstances, level of motivation for treatment, and financial and social resources. Table 1 provides a summary of screening tests and treatment recommendations by substance category. Many of these screening tools provide a simple and straightforward way of assessing a college student’s risk of developing a substance use disorder. Additional information to determine the severity of substance use should be obtained by an interview if a student’s screen indicates an elevated risk.

Recommended screening tests and interventions for specific substances used on college campuses

TABLE 1. Recommended screening tests and interventions for specific substances used on college campuses

Prevention and Brief intervention

Multiple prevention and intervention strategies have been implemented for selected at-risk students on college campuses. The Substance Abuse and Mental Health Services Administration has created a national registry of evidence-based programs and practices designed for substance use–related interventions. The database contains several programs tailored to the college student population. One example includes the Brief Alcohol Screening and Intervention for College Students (BASICS) program, which is based on a motivational-interviewing style of interaction that uses cognitive-behavioral therapy skills to reduce alcohol consumption among college students who are at risk of alcohol-related problems ( 55 ). BASICS consists of two 1-hour interviews and an online survey assessment ( 56 ). BASICS aims to motivate students to reduce risky behaviors and has been shown to be effective in reducing alcohol use among heavy-drinking students ( 57 , 58 ). The College Drinker's Check-up (CDCU) is a 90-minute computer-based brief intervention targeted toward college students who are episodic drinkers. The CDCU has demonstrated effectiveness in reducing heavy alcohol use among college students ( 59 ). Additional prevention and intervention programs that target college students are described in Table 2 ( 60 – 84 ).

Evidence-based substance use programming for college students

a Compilation of programs supported by National Registry of Evidence-based Programs and Practices, with additional information derived from studies. All program costs are subject to change.

TABLE 2. Evidence-based substance use programming for college students a

Treatment Considerations

The true confidentiality of patient records can be complicated in this patient population. When treating an adolescent under age 18, a parent or guardian has the right to obtain copies of the medical record without the patient’s consent. For young adults, written consent must be obtained from the identified patient (with special consent required to obtain substance use history and treatment) in order to share any information. Because many students remain under their parent or guardian’s insurance plan at this age, itemized billing statements and summaries of coverage may be disclosed to the subscriber of the insurance plan, placing an additional barrier to completely confidential treatment.

Screening and evaluation of substance use are important, given the relatively low rates of help-seeking behaviors within the transitional youth population (the prevalence of help seeking among those with a substance use disorder is estimated to be only about 8%) ( 2 ). Screening also provides an opportunity for early intervention and education for those who need it, given the low perceived risk of harm from trying substances once or twice and the relative ease of access to substances on the college campus ( 85 ).

Campus Recovery Programs

Students in recovery may feel as though they are missing out on their college experience by needing to avoid high-risk social situations and certain school-related functions, in addition to having to attend treatment. Collegiate Recovery Programs (CRPs) or Collegiate Recovery Communities are college-based drug and alcohol–free programs that provide recovery support to students and an outlet to socialize in safe settings ( 86 ). These supports often include access to substance-free housing, in-person meetings, group activities, support during recovery-related crises, and overall guidance in navigating college life while abstinent. CRPs vary in size, funding capability, and level of supervision from employed staff members ( 87 ), but they share the goals of creating posttreatment communities that help to prevent relapse and promote abstinence. As of 2014, a total of 600 students were enrolled in 33 CRPs across the United States ( 86 ). A national survey of 29 CRPs demonstrated that students enrolled in these programs had a mean age of 26.2. Over a third of these individuals had spent time in jail or prison, and three-quarters had been treated for chronic mental health problems ( 88 ). Students have been found to participate in CRPs for an average of seven semesters, with approximately half already enrolled when they started college ( 64 ). CRPs have also demonstrated encouraging outcomes both in terms of relapse rates and academic performance ( 86 , 89 ). According to Texas Tech University, of the 80 students enrolled in its CRP, 82.5% had a GPA higher than 2.75, and nearly half of the students planned to pursue a professional degree after graduation ( 87 ). Another study found that 87.5% of the CRP alumni had no relapse following graduation ( 90 ). However, more research needs to be conducted to elucidate the ideal characteristics of these programs, compare recovery outcomes of students in these programs versus those not enrolled, and examine longer-term follow up data.

Special Circumstances

There are additional considerations when treating students in a college mental health facility. In certain circumstances, a student may have to agree to allow sharing of protected information between practitioner and the dean of the college in order to maintain good academic standing. Students may understandably be reluctant to share information about their substance use history with a practitioner who works in a health services facility on campus with this type of arrangement, although the same federal laws of confidentiality and consent technically apply in these cases. However, if the college or university already has knowledge of an identified mental health or substance use concern within its student body, it can compel students to receive treatment under the threat of expulsion and may require students to meet contingencies in order to return to school. This may include mandatory urine drug screens, a medical leave of absence, or designated mental health visits in the student mental health center on campus. If the individual is an international student in the United States on a visa, a request for a medical leave of absence can be obtained in most cases (either for treatment within the United States or abroad). Students treated near their college or university may encounter additional challenges over the summer months when school is not in session, especially if they live geographically far from campus.

Questions and Controversy

Two of the most common questions that colleges and universities have faced include how to approach alcohol use on campus and how to control the nonmedical use of prescription stimulants. In an effort to reduce morbidity and mortality, some colleges have banned alcohol consumption for all students on campus, regardless of their age. Colleges with alcohol bans have been found to have higher rates of abstinence, compared with other colleges without such policies (29% versus 16%) ( 91 ). However, students who choose to consume alcohol at colleges with alcohol bans have similar rates of quantity and frequency of alcohol consumption. Implementing alcohol-free fraternity and sorority housing has not been found to be effective in reducing overall alcohol use ( 92 , 93 ). Despite the effort to restrict alcohol use inside fraternity and sorority houses, members will often seek alternative drinking settings off campus ( 92 ).

The focus on preventive measures for the nonmedical use of prescription stimulants on college campuses has been less uniform across the United States. However, certain universities and colleges have implemented policies in their designated mental health facilities in an effort to reduce overprescribing and availability. Some college mental health facilities have stopped offering testing to establish new attention-deficit hyperactivity disorder (ADHD) diagnoses because of the high volume of requests. Others require significant documentation of a current diagnosis in order to provide prescriptions (including prior neuropsychological testing), and the institutions often closely monitor supplies, without permitting early refills ( 94 , 95 ). Many have also started no-prescription policies for controlled stimulant medication, without exception. If patients with a history of substance use require prescription stimulants for a medical indication, clinicians should closely monitor their prescription use and consider providing smaller supplies in an effort to reduce the risk of diversion or personal nonmedical use. Switching to a nonstimulant option (atomoxetine) for treatment of ADHD is another reasonable option for this population.

Although drug testing is not uncommon in other settings in colleges and universities, such as for college athletes and medical and dental school admissions, it is relatively rare for undergraduate universities to require students to take drug tests. The implementation of mandatory universal drug screening has resulted in a class-action lawsuit and a ruling by a federal appeals court that this form of testing is unconstitutional ( 96 ). In addition, mandatory drug testing can be viewed as an invasion of privacy and consumes a significant portion of school resources. One can argue that college students over age 18 should be allowed to make decisions for themselves, even if such decisions might result in severe consequences. Conversely, drug testing allows schools to identify at-risk students and intervene at an early stage to protect them from unnecessary risks, such as alcohol-related accidents and overdose. Whether colleges and universities should be allowed to implement mandatory drug testing remains controversial. However, urine drug screening should be a routine part of any clinical mental health assessment when working with this higher-risk population. Urine drug screening is often most beneficial when used as part of daily practice and not ordered only following suspicion of substance use or a known substance-related incident.

Recommendations

Even though problematic substance use has a marked presence on college campuses, many struggling students continue to go unrecognized. Treatment of this population presents specific challenges, but it can also be highly rewarding. Summary recommendations are provided below for psychiatrists working with the college-age youths both on and off college campuses.

Recommendation 1: Be Clear About Confidentiality Limitations

Offer a clear explanation of confidentiality limitations, especially as they apply to college students who are still under their parents’ insurance plans. This is the best way to begin to foster trust and to strategize with the patient about how to best protect his or her health information moving forward. Consider referral to an off-campus provider if the student understands the confidentiality protections but is still concerned about disclosing information to an on-campus provider. Because most college students presenting for a mental health evaluation will not express concern about a primary substance use disorder, it is important to carefully screen for co-occurring substance use (both concurrent and past use).

Recommendation 2: Screen for Past Sexual Assault and Violence

Screening for past sexual assault and violence is important when assessing a student who has a history of any substance use, particularly alcohol. Although most young adults will not typically volunteer information about prior sexual encounters during a general interview, sensitive but direct questioning about potential past assault (“Have you ever been taken advantage of when under the influence?”) increases the probability that the individual will report this information. Those who report past sexual assault and violence should be offered the option of further medical screening for sexually transmitted diseases, as well as a thorough safety assessment and assistance with law/campus enforcement, when appropriate.

Recommendation 3: Consider the Student’s Time Constraints in Treatment Planning

Treatment planning should take into consideration whether a student is willing or able to take time off from his or her education to pursue more intensive options. For example, an intensive outpatient program, in conjunction with a 12-step program in the evenings, might be more feasible than a medical leave of absence for some students. Universities and colleges often require that a student taking a medical leave of absence take off more than a single semester of study, which can delay graduation and thereby incur additional financial burden.

Recommendation 4: Formalize the Procedure for Planning a Medical Leave of Absence

If medical leave is being considered for longer-term treatment, it is important to have a clear plan (i.e., referral to a designated residential treatment facility and stipulation of what the treatment goals are while on leave). A written request by the treating clinician can be submitted to the academic department within the school to allow the student to suspend his or her enrollment for a designated period. Some schools may allow a treatment re-entry plan that can reduce the required time of medical leave (i.e., one versus two semesters).

Recommendation 5: Specify Treatment Site for International Students Taking Medical Leave

To request a medical leave of absence for international students, the clinician must specify where the treatment is to occur. The request should be communicated to the designated office of international services or student affairs, as well as to the student’s specific academic department.

Recommendation 6: Plan Ahead for Treatment Occurring Outside the Academic Year

Clinicians should plan ahead for alternative treatment arrangements over the summer months if the student lives out of state, as well as create a plan for handling any crises that may arise outside of the academic year. If a student is receiving a controlled substance, consider a required local check-in with an out-of-state provider, as well as review of any available Prescription Drug Monitoring System (PDMP). Many states are now linking viewable access to out-of-state prescription fills.

Recommendation 7: Discuss Tuition Insurance With Families

Families have the option of purchasing tuition insurance if there is concern that a chronic illness may interrupt the process of completing the semester at school and inflict additional financial cost. Substance use disorders are no exception, and a recommendation to purchase tuition insurance should be considered for identified at-risk students.

Future Directions

Colleges are facing continued challenges around students’ high rates of binge drinking, nonmedical use of stimulants for performance enhancement, and nicotine use. Psychiatrists have the opportunity to influence their local colleges and universities to integrate evidence-based practices. Although promising prevention and treatment programs are available, more research is needed to better inform university administrators about the effectiveness of various programs targeted to college students.

There is a need to develop prevention programming targeted toward specific high-risk subgroups, such as fraternity and sorority members. These members play a pivotal role in influencing the substance use culture on campus. Colleges and universities should communicate and collaborate with the National Panhellenic Conference and the North-American Interfraternity Conference when enforcing substance use policies. The National Panhellenic Conferences has a strict policy on the ban of alcohol use in sorority houses.

Campus recovery programs are increasing and are a way to provide support to students who have a history of problematic substance use. The Association of Recovery in Higher Education has compiled a list of participating CRC universities ( https://collegiaterecovery.org/collegiate-recovery-programs ), and clinicians can work with the association to create a CRC program at their institution.

The Drug Enforcement Administration also provides resources, such as the Campus Drug Prevention ( https://www.campusdrugprevention.gov ), to universities and colleges. The resources include information on how to identify illicit substances and a list of federal, state, and law enforcement resources.

Clinicians should closely monitor new drug-related trends that are increasing in popularity in this age group, such as vaping and microdosing. Despite lack of conclusive long-term data about the impact of these substances on health and psychological well-being, patients should still be cautioned about potential risks of addiction and associated medical complications. These complications may include respiratory damage and physiologic nicotine dependence with vaping, and neurotoxicity with LSD microdosing. Clinicians can commit to continuing medical education on this topic and contribute to the solution by creating new prevention and intervention programs for college campuses or by providing scientific support to existing programs.

Preparation of this article was financially supported by grant R21 DA046738 from the National Institute on Drug Abuse.

Dr. Welsh reports receipt of consulting fees from GW Pharmaceuticals and training fees from Chestnut Health Systems. The other authors report no financial relationships with commercial interests.

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• Joji Suzuki , M.D.

• college students

• Open access
• Published: 26 June 2024

Evaluation of nurses’ attitudes and behaviors regarding narcotic drug safety and addiction: a descriptive cross-sectional study

• Ayten Kaya   ORCID: orcid.org/0000-0002-7684-3675 1 ,
• Zila Özlem Kirbaş   ORCID: orcid.org/0000-0003-4030-5442 2 &
• Suhule Tepe Medin   ORCID: orcid.org/0000-0002-1980-1612 3  

BMC Nursing volume  23 , Article number:  435 ( 2024 ) Cite this article

98 Accesses

Metrics details

By evaluating nurses’ attitudes and behaviors regarding narcotic drug safety and addiction, effective strategies need to be developed for combating addiction in healthcare institutions. This study, aimed at providing an insight into patient and staff safety issues through the formulation of health policies, aimed to evaluate nurses’ attitudes and behaviors regarding narcotic drug safety and addiction.

The study was conducted in a descriptive cross-sectional design. It was carried out with 191 nurses in a public hospital between March 2023 and August 2023. Data were collected through face-to-face interviews, gathering socio-demographic information and utilizing the Addictive Substance Attitude Scale. The data were analyzed using independent sample t-tests, one-way ANOVA tests, and regression analysis ( P  < .001 and p  < .05).

The average age of the participants was determined to be 36.58 ± 8.40. It was reported by 85.3% of nurses that narcotic drug follow-ups in their units were conducted according to procedures. In the study, it was found that 63.9% of nurses did not know the procedure to be followed towards a healthcare professional identified as a narcotic substance addict. The total mean score of the Addictive Substance Attitude Scale of nurses participating in the study was 74.27 ± 14.70. A significant difference was found between the total scores of the scale and the level of education of nurses, the follow-up status of the drugs in the unit where they work, their status of receiving narcotic drug addiction training, and their routine use of the half-dose drug disposal form ( p  < .05).

Conclusions

The findings of this study underscore the importance of evaluating nurses’ attitudes and behaviors regarding narcotic drug safety and addiction. These results indicate the need for nursing administrators, particularly in terms of patient and staff safety, to adopt more effective policies and strategies.

Peer Review reports

Addiction is the continued use of a substance despite the fact that it causes mental, physical or social problems, the inability to quit despite the desire to quit, and the inability to stop the desire to take the substance [ 1 ]. There are many factors that affect the addiction process. The person’s genetic structure, gender, existing mental illnesses, personality traits such as impulsivity and novelty-seeking, the environment in which one lives, chaotic home environment, substance use by parents in the family, lack of appropriate parental supervision, negative experiences in childhood, influence of friends, starting to use substances at an early age, and the properties of the substance itself affect the development of addiction. In addition to these, the workload of healthcare professionals, sleep patterns disorders, long working hours, and mobbing to which they are exposed on the job are also factors that affect the addiction process [ 2 ].

Healthcare institutions are places where opioid-type painkillers or anesthetic substances are concentrated. The presence of drugs that cause addiction in health institutions and the easy access of nurses to drugs pose a risk of substance use among nurses. In addition to intense work stress, changing working conditions, and addiction to these drugs can develop after any trauma or surgery. Although it is known that there are employees who use addictive drugs in health institutions, official statistics for this situation are not yet available. Healthcare professionals can hide this addiction for reasons such as fear of losing their job, fear of loss of prestige, or self-treatment [ 3 ]. Similarly, corporate managers can ignore such situations in order to prevent the loss of prestige of their institutions. Nurses and other healthcare professionals may prefer to adopt an attitude as if it does not happen at all, especially in cases of anesthetic and opioid-type drug addiction. There are no official data on how common anesthetic substance addiction is among healthcare professionals in Türkiye. In addition to studies showing that the incidence of substance addiction in healthcare professionals is the same as in society, there is also data showing that healthcare professionals are more prone to addiction to anesthetic and narcotic drugs, especially in clinical settings [ 4 , 5 ]. Studies conducted around the world show that healthcare professionals are more prone to substance addiction. In the USA, 62% of residency program directors reported that at least one trainee had a substance abuse problem and an alarming increase in the incidence was noted [ 6 , 7 ].

Healthcare institutions are places where opioid-type pain relievers or anesthetic substances are concentrated. The presence of drugs that can lead to addiction in healthcare institutions and nurses’ easy access to these drugs pose a risk for substance use among nurses. Intense work stress, along with changing working conditions following any trauma or surgery, can lead to addiction to these drugs. While it is known that there are employees in healthcare institutions who use addictive substances, official statistics regarding this issue are not yet available. Healthcare workers may conceal this addiction due to fear of losing their job, fear of losing prestige, or self-treatment. Similarly, institutional managers may turn a blind eye to such situations in order to prevent prestige loss for their institutions. Nurses and other healthcare workers may prefer to adopt an attitude as if nothing is happening, especially in cases of anesthesia and opioid-type substance addiction. In Türkiye, there is no official data available on the prevalence of anesthetic substance addiction among healthcare workers. In addition to studies indicating that the frequency of substance addiction among healthcare workers is similar to that in the general population, there is also data suggesting that healthcare workers, especially in clinical settings, are more prone to anesthesia and narcotic drug addiction. Research conducted worldwide indicates that healthcare workers are more susceptible to substance addiction. In the United States, 62% of residency program directors reported at least one trainee experiencing substance addiction issues, with a concerning increase in cases noted [ 6 , 7 ].

Nursing is a professional occupation aimed at protecting and promoting the health of individuals, families, and communities, as well as restoring their physical, mental, and social integrity in case of disruption, and ensuring their return to their former state [ 8 ]. Nurses play important roles in combating addiction by taking preventive measures, providing support to patients, and managing treatment processes. Within these roles, they conduct activities such as patient education, management of support groups, assessment of addiction-related risk factors, and planning appropriate interventions. Nurses working collaboratively with the healthcare team in the prevention and treatment process of substance addiction may encounter excessive presence of narcotic drugs in their work environments and may come across addicted colleagues due to heavy work conditions or social reasons. While data on substance use among nurses are insufficient, research suggests that substance use among nurses is similar to the general population [ 9 , 10 ].

Professional occupations are responsible for ensuring that their professions are delivered in accordance with ethical standards. Particularly, nurses are obligated to adhere to ethical principles while providing care, to protect public health, and to maintain the image of nursing. Recognizing their colleagues’ substance use, and protecting patients and the professional image are professional responsibilities. Hospital administrators’ failure to address or intervene to protect addicted employees can lead to worse outcomes.

Nurses have easier access to opioid analgesics and anesthetic substances compared to other members of society. This access can be facilitated by diverting medication intended for patients for personal use, taking leftover doses, or directly obtaining drugs from areas where narcotic substances are stored. In this regard, narcotic drug addiction not only impacts the health of the addicted nurses themselves but also compromises the health of the patients under their care [ 11 ]. To combat drug abuse, the Ministry of Health of the Republic of Türkiye has mandated the standardization of narcotic drug management within the framework of Health Quality Standards (HCS) [ 12 ]. Accordingly, all hospitals have been directed to regulate the administration of narcotic drugs and have implemented these regulations in their units. These comprehensive guidelines outline the procedures for ordering narcotics, obtaining them from the pharmacy, administering them to patients, recording the process, and storing the drugs in locked cabinets. Despite all these precautions, narcotic addiction and deaths resulting from it can still be encountered in hospitals. The easy access to narcotic drugs poses a risk of substance abuse among nurses. This issue, often overlooked and ignored in healthcare institutions, is of paramount importance for nursing due to its adverse effects on patient safety, public trust in healthcare services, and the nursing profession’s image. The attitudes of nurses towards addicted colleagues are of paramount importance in early detection, reporting, and intervention to protect patients from harm and to assist colleagues in their recovery. The attitude of colleagues is crucial in identifying nurses suspected of addiction, guiding them towards medical assistance, and supporting them during treatment and rehabilitation stages. Research examining nurses’ attitudes towards individuals who use substances has revealed that nurses exhibit similar negative attitudes and reactions towards addicted individuals as seen in society [ 13 , 14 ].

Ford et al. (2008) demonstrated that as nurses’ biases against individuals using substances increased, their therapeutic behaviors decreased [ 15 ]. Stigmatization and exclusion of individuals identified as addicted by their colleagues erode trust between them and negatively impact the self-esteem of the addicted nurse [ 16 ]. Nurses’ attitudes towards their substance-addicted colleagues may not only hinder the individual’s access to treatment but also detrimentally affect their social and professional life. An individual feeling stigmatized by coworkers may gravitate towards a circle of fellow substance users where they don’t feel ostracized. Nurses’ negative attitudes towards their colleagues they suspect are addicted can exacerbate the individual consequences of addiction [ 17 , 18 ].

When nurses suspect drug addiction or a personality disorder, it should be clarified promptly to prevent stigmatization. If left untreated, the individual may exploit tolerance and goodwill, leading to a gradual decline in their work performance. Delayed detection of substance use can exacerbate problems [ 10 ]. It is the responsibility of nurses and hospital managers to identify employees with substance use early, refer them to treatment, ensure compliance with treatment, and develop institutional policies on this issue [ 3 ].

In the literature, numerous studies have been conducted examining nurses’ attitudes towards patients with substance use disorders [ 19 , 20 , 21 ]. Despite substance use rates among nurses being significant compared to the general population [ 22 ], there is a lack of sufficient research on colleagues’ attitudes towards narcotic drug addiction among nurses. This study is important in revealing colleagues’ perspectives on narcotic drug addiction among healthcare professionals. The study aimed to determine errors, omissions, and nurses’ attitudes and behaviors towards addicted colleagues in processes related to narcotic drug safety in hospitals. Additionally, the perceptions of nurses working with addicted colleagues were evaluated.

Procedure and samples

This study was conducted as a descriptive-cross-sectional model with nurses employed at a State Hospital located in a province in the northeastern part of Türkiye. The hospital provides services to adult patients, including outpatient services as well as internal medicine and surgical clinics, with intensive care units. It has a total of 460 beds, employing 550 nurses and 1300 staff members. Since 2005, the hospital has been managed according to patient and staff safety procedures, including narcotic drug safety, as part of the QHS standards adopted nationwide in Türkiye.

The population of the research consisted of 378 nurses working in the hospital between March 2023 and August 2023. However, due to the possibility that some of these nurses were on leave or refused to participate in the research, the sample calculation method was used. The sample of the research consisted of 191 nurses determined using the known sample calculation method (95% confidence interval, 5% margin of error). The sample of the qualitative part of the research; Among the nurses participating in the study, 39 nurses who had previous experience working with addicted healthcare workers were determined by the Analogous sampling method used in qualitative research designs. Out of the nurses who participated in the study, 39 responded to open-ended questions cotic drug safety, as part of the QHS adopted nationwide in Türkiye.

In this research, a mixed method consisting of quantitative and open-ended questions was used. The qualitative part of the study was based on descriptive phenomenology theory , with the aim of understanding in depth the experiences of nurses who had experience working with addicted healthcare professionals, among the participants who answered predetermined questions. Open-ended questioning technique was used within the scope of unstructured interviews , which is one of the qualitative research data collection techniques. This open-ended question, added to the end of the data collection form containing quantitative questions, was conducted immediately after the quantitative part.

With the data collection form containing quantitative data, the demographic information of nurses working in areas where narcotic drugs are used and their behaviors regarding narcotic drug safety management processes were determined. Nurses’ attitudes towards their addicted colleagues were evaluated with the Addictive Substance Attitude Scale. In the study, open-ended questions were added to the last section of the data collection form in order to determine the experiences of nurses working with addicted individuals and their opinions and feelings regarding these processes.

The data breakdown phase was carried out by writing down 39 answers obtained from open-ended questions. Common themes among similar expressions were identified. These common themes were identified as statements about trust, help and support offered to an addicted colleague, a normal working relationship, and acceptance of addiction. The expressions given according to these common concepts obtained are classified under 2 headings. The responses were grouped under the headings of trust-based attitudes towards addicted colleagues and behaviors towards addicted colleagues.

Prior to commencing the study, approval was obtained from the ethics committee of Ordu University Clinical Research Ethics Committee (2023 / Decision no. 68), and institutional permission was obtained from the Provincial Health Directorate. Participants were informed about the study in accordance with the Declaration of Helsinki, and their consent was obtained through the Informed Consent Form. Participation in the study was voluntary. Volunteers who wished to participate were required to complete a volunteer consent form, which outlined the purpose and methodology of the study as well as the rights of the volunteers regarding participation. The Personal Information Form and the Addictive Substance Attitude Scale were administered face-to-face to nurses by the researcher, and their data were collected. The completion of the forms took an average of 30–40 min.

The research sought answers to the following questions.

What are the problems experienced in carrying out narcotic drug safety processes in hospitals?

What is the attitude of nurses towards their addicted colleagues?

What are nurses’ opinions about their experiences with addicted colleagues?

Data collection tools

Personal Information Form: It questioned nurses’ socio-demographic characteristics such as age, education, years of work, and number of children. Also, this form includes questions prepared to determine the management processes of narcotic drugs used in clinics, the problems experienced in these processes, and the attitudes and behaviors towards teammates who are addicted to these drugs.

Addictive Substance Attitude Scale (ASAS): The scale, whose validity and reliability analyzes were conducted by Kaylı et al. (2020) [ 23 ]. Measures attitudes towards people who use addictive substances, with a 5-point Likert scale (“I completely agree” = 1, “I somewhat agree” = 2, “I am undecided” = 3, “I disagree.” = 4, “I strongly disagree” = 5). An increase in the total score on the scale means having a more negative attitude towards individuals who use substances. Therefore, while calculating the total score, the scores of items other than items 7, 11, 12, 15, 19 and 20, that is, items with negative expressions, were reversed (this reversal process yields 1 = 5, 2 = 4, 3 = 3, 4 = 2, in the format 5 = 1).

Permission was obtained from the responsible researcher for the use of the scale. An increase in the total score on the scale means having a more negative attitude toward people who use addictive substances. The Cronbach Alpha coefficient of the scale was found to be 0.923. In the current study, the Cronbach’s Alpha value of the scale was found to be 0.872.

Data analyses

The quantitative data analysis of the study was done in the Statistical Package for the Social Sciences (SPSS) 26.0 for Windows (SPSS, Chicago, Il, USA) package program. Whether the data was distributed normally or not was evaluated by the Skewness and Kurtosis coefficients being in the range of (-1) - (+ 1) [ 24 ]. Numbers, percentages and mean values and standard deviation (SD) were used for descriptive statistics. Independent Samples Test and the One- Way ANOVA test were used to compare the descriptive characteristics of the nurses and their scale scores. The relationship between some nurses’ variables and the total scale scores was examined with a multiple linear regression model. P  < .001 and p  < .05 were taken as levels of statistical significance.

Nurses who had previously worked with addicted individuals were asked an open-ended question about their attitudes and behaviors towards addicted colleagues. The data breakdown phase was carried out by writing down 39 answers obtained from open-ended questions. Common themes among similar expressions were identified. These common themes were identified as statements about trust, help and support offered to an addicted colleague , a normal working relationship, and acceptance of addiction. The expressions given according to these common concepts obtained are classified under two headings. The responses were grouped under the headings of trust-based attitudes towards addicted colleagues and behaviors towards addicted colleagues.

When examining the characteristics of the nurses participating in the study, it was observed that their average age was 36.58 ± 8.40, 89.0% were women, 85.3% had undergraduate or graduate education, 74.9% were married, and 72.3% had children. Additionally, 46.6% of the nurses worked in intensive care wards, 80.1% worked as clinical nurses, and 67.0% had ten or more years of work experience. Regarding drug usage, 69.6% of the nurses stated that they did not use drugs. Moreover, 85.3% reported that drug monitoring was conducted in the units they worked in, while 52.3% were unsure if there was an institutional policy regarding substance addiction. Furthermore, 55.5% mentioned receiving training on narcotic drug addiction, and 97.9% confirmed being on duty, with 96.3% stating that a post-seizure medication count was performed.

In terms of procedures related to missing drugs, 44.5% of the nurses notified the nurse in charge when detecting a missing drug in the count before the shift. Additionally, 69.1% sent half-used narcotic drugs to the pharmacy, and 72.8% routinely used the half-dose drug disposal form. Regarding awareness of procedures for healthcare workers addicted to narcotic drugs, 63.9% of the nurses stated they were not aware of such procedures. Furthermore, 61.3% indicated they would suggest their addicted friend to see a psychiatrist, and 79.6% had not worked with a drug addict before (Table  1 ).

The Addictive Substance Attitude Scale (ASAS) total score average of the nurses participating in the study was found to be 74.27 ± 14.70. Table  2 shows the comparison of some characteristics of nurses with their total scale scores. A significant difference was found between the total scores on the scale and the level of education of the nurses, the follow-up status of the drugs in the unit where they work, the status of receiving narcotic drug addiction training, and the routine use of the half-dose drug disposal form ( p  < .05). In the study, when the total score averages of the scale were compared with their educational status, it was determined that those who had a bachelor’s degree or higher had a higher scale score than those who graduated from high school. It was determined that the scale scores of nurses who reported that medication monitoring was not done in the unit in which they worked were higher than those who reported that medication monitoring was done. Additionally, the average score of nurses who received narcotic drug addiction training was found to be higher than those who did not receive training (Table  2 ).

In line with the literature, the relationship between some nurses’ variables and total scale scores was examined with a multiple linear regression model (Table  3 ). In the analysis of some nurses variables, it was seen that there was a significant model in the evaluation of model goodness of fit (F/p) regression coefficients (R/R 2 ) ( p  < .01). 11.3% of the variance in the dependent variable of the Addictive Substance Attitude Scale was explained by the independent variables (R 2 adjusted = 0.113). It was determined that the educational status of the nurses and their routine use of the half-dose drug disposal form were statistically significant predictors in a positive direction, and the status of nurses receiving narcotic drug addiction training was a statistically significant predictor in the negative direction ( p  < .01, Table  3 ).

In the study, 39 nurses responded affirmatively to the semi-structured question “Have you ever worked with a healthcare professional who you know is addicted?” When asked to summarize their approaches and experiences in a few sentences, the following responses were obtained:

Nurses’ attitudes towards addicted colleagues:

Nurses reported that when working with a healthcare professional addicted to drugs, they initially attempted to assist their addicted colleagues individually. Subsequently, they distanced themselves from the environment and exercised extra caution. They mentioned that they secured the narcotic medicine cabinet in the presence of the addicted colleague at the workplace to prevent access to drugs.

Nurses’ attitudes and behaviors towards addicted colleagues:

They indicated that they endeavored to support their colleagues known to be addicted by encouraging them to seek treatment, recommending professional help, maintaining communication, providing ongoing support throughout the process, documenting incidents to inform management, and continuing their friendships as long as it did not compromise their own well-being.

In clinics, the management of narcotic drugs is carried out according to a prescribed procedure determined by QHS standards. This procedure encompasses the prescription of the drug, its request from the pharmacy, stages of transportation, labeling, storage, administration, effects on the patient, and disposal of excess doses. These processes are carried out primarily by nurses. Continuous in-service training and on-the-job training must be repeated to ensure smooth progression of the process. To identify situations where drug safety is compromised, safety reporting systems have been established. However, due to the neglect that comes from the constant repetition of the same tasks or a busy work pace, some steps in this process may occasionally be overlooked.

In the hospital where the research was conducted, drug management has been carried out under quality standards since 2005. After the narcotic drugs are prescribed by the physician, they are personally received by the nurse on behalf of the patient and kept in a locked cabinet. Drugs are counted at every shift change, and the drugs used are recorded under the patient’s name. The remaining doses of drugs requested in half doses are destroyed with the assistance of a pharmacist using a half-dose drug disposal form.”

The majority of participating nurses (85.3%) indicated that drug tracking is performed in their units. Almost all of them (97.7%) reported counting and delivering narcotic drugs before and after their shifts. From this perspective, it can be said that nurses adhere to protocols in the management of narcotic drugs within the framework of healthcare quality standards. However, the disposal of remaining doses after drug administration is also an important part of this process. In the study, 6. 8% of nurses mentioned storing the remaining dose for use on another patient or the same patient. While storing the remaining doses with good intentions may seem logical, it poses a risk of misuse for individuals with addiction. Especially, these remaining doses left unnoticed during shift changes can be used for unintended purposes. To control the disposal of remaining doses, a half-dose disposal form has been developed within the framework of quality standards. In the study, 27. 2% of nurses stated that they did not fill out the half-dose disposal form. This form is used to control the remaining doses of narcotic drugs given to patients. In the study, 24. 1% of nurses mentioned throwing away the remaining drugs.

In Dadak et al.‘s study [ 25 ], it was observed that anesthesia specialists (87%) and psychiatry workers (72%), who work in areas where narcotic drugs are more frequently used, had the highest rates of addiction among healthcare personnel. A study conducted on the regulation of narcotic drugs in a university hospital revealed that narcotic drugs are prepared before procedures, especially in operating theater units, and excess products are obtained from the pharmacy [ 26 ]. While these are well-intentioned initiatives aimed at expediting medical procedures by stockpiling drugs before their definitive use, they may inadvertently facilitate access to and misuse of drugs by individuals struggling with addiction [ 25 ].

According to QSH standards, unused doses of narcotics should be disposed of with a written report under the supervision of the responsible personnel responsible for narcotic drug monitoring. When looking at the literature, there are not many studies related to the safety of narcotic drugs. However in a study conducted in Canada, 70 reports related to narcotic drug safety were observed in a 442-bed healthcare institution [ 27 ]. All employees in the participating hospital in our study reported counting medications during shift turnovers. Of the nurses participating in the study, 44. 5% reported informing the responsible nurse when they detected missing drugs, 17. 8% documented the incident and 37. 7% investigated and attempted to find the missing drug. However during the period of the study, no drug safety reports were found in the institution. In terms of drug safety, the activation of the safety reporting system, conducting root cause analysis and initiating corrective actions through the creation of official statistics are important. The disposal of unused medications may not have been documented on the safety reporting form, as it may have been perceived not to pose a threat to patient safety. In their examination of approximately two years of retrospective safety reporting records at a public hospital, İncesu and Orhan (2018) found no data related to medication safety [ 28 ]. Written reporting during the provision of healthcare services contributes to the establishment of a reporting culture within the institution, enabling the identification of the root cause of errors and guiding improvements in the necessary direction [ 29 ]. Therefore, it is crucial to design patient and employee safety reporting systems in a way that is understandable to all employees, adapt them to the system, and provide training to employees on reporting systems [ 28 ].

The disposal of unused medications may have been overlooked, assuming it did not pose a threat to patient safety, thus resulting in the security reporting form not being filled out. However, considering the potential risk for employees and other individuals with substance dependence, the disposal of unused medications should be assessed as a preventive measure. When İncesu and Orhan (2018) examined approximately two years of retrospective security reporting records in a public hospital, they found no data regarding medication safety [ 28 ].

In the country where the study was conducted, there is no official data on narcotic drug use among healthcare professionals. According to a presentation by the Emergency Medicine Specialists Association (ATUDER) on “Substance Use and Suicide Risk in Emergency Service Employees,” 50 healthcare professionals were found dead in their rooms due to drug overdose over a 10-year period [ 30 ]. Moreover, a media search conducted by the BBC between October and June 2022 found that at least 6 healthcare professionals in the anesthesia, emergency services, or intensive care branches suspiciously lost their lives [ 31 , 32 ]. These professionals may have obtained drugs from the hospital, wards, or leftover doses given to patients.

Addiction to narcotic drugs is also a workplace safety issue. The treatment processes of nurses identified as addicted to opioid or anesthetic substances include acceptance and initiation of treatment, providing social and psychological support to the individual, and rehabilitation. The attitudes and behaviors of nursing colleagues are crucial at all stages. Early recognition of addicted individuals, providing support during treatment, and effectively managing the process during rehabilitation are important for reintegrating the addicted individual into society. In this study, while a percentage of nurses received training on the safety of narcotic drugs, 55. 5% did not receive education on substance addiction. The research revealed a significant difference in ASAS scores between nurses who received training on drug addiction and those who did not. Trained nurses exhibited more negative attitudes. This situation may be attributed to the fact that the content of the training only focused on narcotic drug safety.

A study conducted until 2020, which analyzed the meta-analysis of medication safety training conducted under pharmacist supervision, revealed that the training provided covered the stages of procurement, preparation, and administration of medications, but did not specifically include training on narcotic drug management [ 33 ]. Additionally, within the scope of these trainings, healthcare professionals should be provided with awareness on the misuse and addiction of narcotic drugs [ 34 ].

Supporting individuals with addiction socially fosters their sense of belonging to a community and helps them believe that they are valued, protected, accepted, and respected in an environment where they feel loved. In a study conducted with cocaine-dependent individuals, it was found that perceived social support positively impacted psychological well-being and reduced anxiety levels [ 35 ]. During the addiction process, individuals who receive help from friends or colleagues do not struggle with accepting their identity and self-concept. Social support enables individuals to cope more effectively with feelings of helplessness and seek new solutions [ 36 ]. Therefore, the attitude of colleagues towards a nurse suspected of addiction plays a significant role in their acceptance of treatment and recovery.

In the study, the ASAS scale was used to measure nurses’ attitudes towards addicted colleagues. The total ASAS score average in the research was determined as 74.27 ± 14.70. Comparing this result with a study by Kayli et al. with individuals in the community ( n  = 222), where the average ASAS score was 92.15 [ 23 ], the average ASAS score of nurses in our study is lower. An increase in the total score on the scale indicates a more negative attitude towards individuals who use substances. It can be said that the attitudes of the nurses in the study are more positive compared to the results obtained in the study by Kayli et al. [ 23 ]. Another study investigating the attitudes of emergency nurses towards addicted individuals found that they exhibited negative attitudes towards maintaining social distance from addicted individuals. The attitude scale scores identified in the study by Pilge and B. Arabacı (2016) (Mean: 49.43 ± 19.59) indicate that emergency nurses have a more negative attitude compared to the results of the current study [ 37 ].

This difference may be due to demographic variations. It can be said that nurses are less biased toward addicted individuals compared to the general population [ 21 ]. Some research in the literature supports the results of our study by showing that the attitudes of healthcare professionals toward addicted individuals are more positive [ 38 , 39 , 40 ]. Broadu and Evans identified factors such as gender, age, education, religious beliefs, and history of addiction treatment as influencing attitudes toward addicted individuals [ 41 ]. In this study, gender, age, years of experience, and history of addiction did not affect the ASAS score.

In the literature, it has been observed that age and gender do not affect attitudes both in society and among healthcare professionals similar to the results of the study [ 42 , 43 , 44 ]. Only individuals with a bachelor’s degree or higher exhibited a higher ASAS score. It was noted that individuals with higher levels of education demonstrated elevated ASAS scores. It is hypothesized that exposure to education regarding drug addiction during their academic pursuits may amplify biases. Incorporating addiction-related subjects into school curricula or educational settings often relies on oversimplified and historical perspectives. A comprehensive health education should encompass the significance of social determinants of health, recognizing that addiction entails complex biopsychosocial processes that cannot be adequately addressed in isolation [ 45 , 46 ]. Consequently, educational interventions solely focusing on depicting addiction’s consequences and passing judgment may exacerbate bias against individuals struggling with addiction. The investigation revealed no significant disparities in scale scores between those who had prior experience working with individuals with addiction and those who had not.

In the study nurses, when asked open-ended questions about their experiences working with individuals struggling with addiction, expressed that they continued their work as if “such a situation did not exist.” This sentiment is supported by Bettinardi & Bologeorges’ (2011) study, where 57% of nurses stated that they would not report suspicions of substance use among their colleagues [ 47 ]. Dependent healthcare workers are still not adequately assessed and continue to receive insufficient treatment for addiction and substance dependency [ 4 ].

Managers who do not establish procedures for detecting and monitoring narcotic drug addiction in their institutions, along with employees who fail to implement these procedures, may overlook the presence of an addicted employee. Fear of damaging the institution’s reputation, causing harm to the employee, termination of employment, or protecting colleagues may prevent reporting regarding the addicted individual. During this process, the addiction of an individual who fails to recognize the need for help may worsen. Early detection and initiation of treatment are crucial as addiction tends to become more chronic over time. Even if the job performance of the addicted nurse has not yet deteriorated, directing them towards treatment, with a focus on alcohol and substance addiction, is imperative [ 10 ]. Acceptance and engagement in treatment represent significant steps in combating addiction. The attitudes of those around addicted individuals influence both the acceptance phase and the rehabilitation process [ 48 ]. Negative societal attitudes towards addicted individuals can lead to their isolation [ 49 ]. In the study, 18.8% of nurses stated they would not socialize with addicted individuals, while 12.6% expressed willingness to improve communication and offer support for their treatment. Early detection and referral to treatment for a nurse suspected of addiction are critical for fostering self-confidence, overcoming denial, and encouraging initiation and continuation of treatment [ 49 , 50 ]. American Nurses Association (ANA) is calling on professional nurses to support their addicted colleagues, ensure access to appropriate treatment, and advocate for fair treatment in institutional practices [ 51 ].

In response to open-ended questions, some nurses in the research mentioned experiencing trust issues with the addicted individuals they worked with. Approaching addicted individuals with bias, behaving as if drug theft could occur at any moment, not only impacts the self-confidence of addicted individuals but also contributes to their social exclusion. Individuals who feel alienated from society and isolated may seek solace among other addicted individuals who have encountered similar discrimination, thereby reinforcing each other’s behaviors and potentially normalizing addiction. Consequently, the individual may be less inclined to seek help.

In another study examining the perspectives of healthcare professionals on substance addiction, it was revealed that they preferred not to be in the same social environments as patients using substances. A systematic review by Van Boekel et al. highlighted that negative attitudes among healthcare professionals toward patients with substance use disorders were widespread and had implications for treatment outcomes. Interestingly, in the study mentioned, there were no significant differences in scale scores between those who had prior experience working with an addict and those who had not [ 14 ].

Theoretical implications

One significant aspect that sets nurses apart from other hospital staff is their easier access to narcotic drugs. Obtaining a narcotic drug, creating addiction with this drug, or sustaining this addiction can be easier. Nurses’ attitudes and behaviors towards their colleagues who are addicted to narcotic drugs demonstrate their efforts to support addicted individuals and their willingness to direct them towards treatment. These attitudes are important for the early detection of addiction and for supporting addicted individuals during the rehabilitation process. Nurses play a crucial role in combating addiction by encouraging their addicted colleagues to seek treatment, recommending professional help, maintaining communication, and providing support at every stage of the process.

Managerial implications

In the tracking of narcotic drug management processes, drug safety reporting systems are crucial. During the study period, it was found that the institution where the research was conducted did not have drug safety reports, including those related to narcotic drug management processes. For drug safety, it is important to activate the safety reporting system, conduct root cause analyses, and take corrective actions based on official statistics. Considering the potential risks to employees and other individuals with substance dependence, the disposal of unused drugs or identifying missing drugs can be evaluated as preventive measures. Therefore, careful execution of narcotic drug tracking processes is vital for the early detection of addicted individuals, prevention of overdose deaths among healthcare workers, and ensuring safe patient care. Comprehensive training related to narcotic drug management should include legal regulations, safe storage and distribution measures, proper dosage and administration, as well as the use and intervention of narcotic drugs in emergencies. Additionally, these trainings should cover the causes of drug addiction, symptoms observed in addicted individuals, approaches to dealing with addicted individuals, and even case studies.

Limitations

This study had some limitations. First, this study used self-report measurement instruments, which can introduce some form of response bias. Secondly, since this study was conducted in a province located in the northeastern part of Türkiye the results cannot be generalized. Third, since the study was cross-sectional, causality could not be determined. Therefore, caution is recommended when interpreting the study results. Despite these limitations, the study had its strengths. This study is valuable in terms of evaluating the attitudes and behaviors of nurses, a very special group with a large majority in the healthcare system, toward individuals with narcotic drug and substance addiction in many aspects and raising awareness among nurses about this issue. Future research could enhance the generalizability of the findings by including larger sample groups and participants from diverse geographical regions and cultures to assess nurses’ perspectives. Additionally, future studies should aim to improve the accuracy of results by utilizing objective measurement methods alongside subjective measurement tools. However, considering the limitations of the cross-sectional design, future research is recommended to prefer longitudinal or experimental designs to better understand causal relationships. Consequently, the limitations of this study should be taken into account for future research, employing more comprehensive methods and increasing the generalizability of results.

This study addresses the attitudes of colleagues towards addicted nurses, which is a significant aspect of the narcotic drug management processes in healthcare institutions, aimed at ensuring the safe and effective management of narcotic drugs. The findings indicate that protocols established for the correct and safe use of narcotic drugs are generally followed. However, deficiencies in the disposal of remaining doses of drugs after administration may potentially increase the risk of misuse. Additionally, it has been emphasized that addiction related to the use of narcotic drugs among healthcare workers and its consequences constitute a serious issue. In this context, the education and awareness-raising of healthcare workers are of critical importance in ensuring the safety of narcotic drugs and preventing addiction. The findings also reveal that some nurses experience distrust when working with addicted colleagues, while others continue their work as if such a situation does not exist. These attitudes may jeopardize patient safety, lead to the neglect of health issues among addicted individuals, and hinder their access to effective treatment. Therefore, increasing awareness of addiction among healthcare workers and adopting a sensitive attitude towards this issue are important. Furthermore, as highlighted by the study, existing policies and practices in this regard need to be strengthened. This can enhance the effective management of narcotic drugs while improving patient and staff safety and support.

Data availability

He datasets used and/or analysed during the current study are available from the corresponding author on easonable request.

Abbreviations

United States of America

Addictive Substance Attitude Scale

Association of Emergency Medicine Specialists

British Broadcasting Corporation

Health Quality Standards

American Nurses Association

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We would like to thank all the nurses who participated in our study and filled out our survey.

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AK, ZK, and STM started the project. AK drafted the initial manuscript. AK, STM secured the data and ZK, AK conducted the analyzes. All authors participated in interpreting the results, contributed to the writing of the manuscript, provided critical feedback to the manuscript, and approved the final draft of the manuscript for submission.

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Kaya, A., Kirbaş, Z.Ö. & Medin, S. Evaluation of nurses’ attitudes and behaviors regarding narcotic drug safety and addiction: a descriptive cross-sectional study. BMC Nurs 23 , 435 (2024). https://doi.org/10.1186/s12912-024-02109-2

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Received : 20 February 2024

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DOI : https://doi.org/10.1186/s12912-024-02109-2

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• v.5(Suppl 2); 2014 Dec

A Review Study of Substance Abuse Status in High School Students, Isfahan, Iran

Mah monir nahvizadeh.

Provincial Health Center, Isfahan University of Medical Sciences, Isfahan, Iran

Shohreh Akhavan

1 Vice-chancellery for Research, Isfahan University of Medical Sciences, Isfahan, Iran

Leila Qaraat

Nahid geramian, ziba farajzadegan.

2 Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran

Kamal Heidari

3 Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Background:

As the first experience of substance abuse often starts in adolescence, and studies have shown that drug use is mainly related to cigarette and alcohol consumption, an initial exploration of substance abuse prevalence, including cigarette and alcohol, seems to be the first step in preventing and controlling drug consumption. This study aimed to explore studies on drug use among high school students by investigating articles published in the past decade in Iran.

In this study, the databases inside the country were used to access articles related to substance abuse by students during 2001–2011, among which 7 articles on 14–19 years old high school students were studied.

The seven studied articles showed that the highest drug use prevalence pertained to cigarette and hookah, followed by alcohol, opium, ecstasy, hashish and heroin. Opium and heroin use in Kerman city were, respectively, about 4 and 5 times of their use in other studied cities.

Conclusions:

Drug use is relatively high in the adolescent and effective group of the society, which requires particular attention and prompt and immediate intervention.

INTRODUCTION

Substance abuse is a common phenomenon in the world and has invaded the human society as the most important social damage.[ 1 , 2 ] Substance abuse is a nonadaptive model of drug use, which results in adverse problems and consequences, and includes a set of cognitive, behavioral, and psychological symptoms.[ 3 ]

Iran also, due to its specific human and geographic features, has a relatively high degree of contamination.[ 4 ] The World Health Organization's report in 2005 shows that there are about 200 million opiate addicts in the world, reporting the highest prevalence in Iran and the most frequency in the 25–35 year-age group.[ 5 ] The onset of drug use is often rooted in adolescence, and studies show that substance abuse is often related to cigarette and alcohol consumption in adolescence.[ 6 ] Results of studies indicate that age, being male, high-risk behavirs, and the existence of a cigarette smoker in the family or among friends, the experience of substance abuse, inclination and positive thoughts about smoking have relationship with adolescent cigarette smoking.[ 7 ] Studies also confirm that the chance of becoming a cigarette smoker among males and females is almost equal (11.2%); however, the prevalence of regular alcohol consumption in males (22.4%) is slightly higher than in females (19.3%).[ 8 ]

Few studies have been conducted in Iran on adolescents’ patterns of substance abuse, producing various data on the prevalence and the type of consumed drugs, but there is currently no known specific pattern of substance abuse in this age group; therefore, this review study has studied drug consumption prevalence in the student population of the country by collecting various data.

This article is a narrative review focusing on studies conducted in Iran. In this research, all articles related to substance abuse and its patterns among high school students, which were conducted in Iran and published in domestic and international journals, were investigated. The articles were acquired from academic medical journals, research periodicals and the Scholar Google, Magiran, Irandoc, and Medlib. The search keywords included prevalence, substance abuse, Iranian student, and addiction.

This study explored articles in the past 10 years (2001–2011) about Iranian high school students. The full texts of the articles were often accessible in the scientific information database and magiran websites, but the full text of the article about Gilan Province was obtained after contacting the journal's office. Correspondence was made with the author of the article about Mahriz city to obtain the article as it was not published in the Toloee Behdasht journal.

These articles provide information about the consumed drug type, its prevalence in terms of the sex and age, and the experience of at-least-once consumption in the adolescent's life. Some articles had only pointed to drug consumption, which was also included in this research. Some had attended to substance abuse in general terms without distinguishing different kinds of drugs, and in some articles only psychoactive drug use, was mentioned.

The cases, in which the sample volume was not sufficient, or were not in the studied age groups, were excluded from the study. Due to different categorizations in these articles regarding the long-term prevalence of substance abuse or the experience of at-least-once consumption, in this study the shared aspect of these articles, that is, the experience of at-least-once use was adopted. Some articles had addressed the students’ predisposing factors for drug abuse, in addition to drug use prevalence, which were not included in this study for being scattered.

An initial search into the data bases yielded 11 articles, two of which were related to years before the study time frame (1997 and 1998). Furthermore, two articles were ignored, one because of its different age group (a lower age) and the other because it had addressed a particular district in Tehran with a small sample size. These results are based on 7 articles. All studies were about the 14–19 years old group, and only three studies had distinguished between the sexes. All 7 studies considered in this article were cross-sectional.

The prevalence of drug consumption in the studied cities

A study was conducted in 2003 on 500 students, from 142 high schools and vocational schools in Zahedan City, using a multi-stage cluster sampling method. In total, from the total of 259 females and 216 males who completed the questionnaire, the following results were obtained. 0.4% of the females and 2.3% of the males would usually smoke cigarette. The first experience of smoking was most often seen at the age of 14 (26.2%). The prevalence of other drugs was not studied in this research.[ 9 ] A study was conducted in 2009 on 610 students of Kerman's Male Pre-university Centers, in which the prevalence of each drug was reported, but the total consumption prevalence was not mentioned.[ 10 ]

A study in Gilan Province in 2004–2009 on 1927 high school students, including 46% females and 54% males, showed that the percentage of at-least-once use, including and excluding cigarette, was 23.7 and 12.8, respectively.[ 11 ]

A study in Karaj city in 2009–2010 on 447 high school students, including 239 females and 208 males, showed that 57% had at-least-once experience of drug use, including cigarette, of this number 56.1% were male and 43.9% were female.[ 12 ]

A study in Nazarabad city in 2007 on 400 3 rd year high school students, including 204 females and 196 males with the mean age of 17.3, showed that drug use prevalence, including and excluding cigarette, was 24.5% and 11.1%, respectively.[ 13 ] A study was performed in Lahijan city in 2004 on 2328 high school students, including 42.2% females and 57.8% males.[ 14 ] A descriptive study was conducted in 2008 on a 285-member sample of male high school students.[ 15 ]

The consumption prevalence for each drug type in different cities

A research on Kerman's Male Pre-university students yielded the following results. The consumption prevalence of hookah was 15.5%, sedatives (without medical prescription) 40.7%, alcohol 37.7%, cigarette 34.6%, strong analgesics 10.2%, nas 9.7%, opium 8.7%, hashish 6.7%, ecstasy 6.6%, and heroin 4.9%.

Consumption prevalence for each drug type in Gilan: The prevalence was 20% for cigarette, 10.5% for alcohol, 2.4% for opium, 1.2% for ecstasy, 2% for hashish, and 0.3% for heroin. In Karaj city, the consumption prevalence was 53% for hookah, 24.8% for cigarette, 13.6% for alcohol, 2% for ecstasy, 2% for opium, 1.1% for hashish, 0.4% for crystal, and 0.2% for heroin.

In Nazarabad City, the consumption prevalence was found to be 23.1% for cigarette, 2% for opium, 1% for amphetamines and ecstasy, 0.5% for heroin, 0.3% for hashish and cocaine. The male and female drug consumption was 69.7% and 36.2%, respectively, representing a significant statistical difference ( P < 0.05).

A study in Lahijan City showed that the consumption prevalence was 14.9% for cigarette, 2.4% for ecstasy, 4.1% for other drug types (with the highest rate of consumption for opium and hashish). In the Mahriz city of Yazd, the consumption prevalence among the male 3 rd year high school students in 2008 was reported 6.8% for alcohol and 3% for psychoactive substances [ Table 1 ].

The comparison of the prevalence of at-least-once drug use for each drug type in each studied region[ 9 , 10 , 11 , 12 , 13 , 14 , 15 ]

Drug consumption prevalence for each sex

A study in Zahedan also reported that at-least-once drug use prevalence was 1.6% and 8%, respectively, among females and males; and at-least-once cigarette smoking prevalence was 7.8% and 25.2%, respectively, for females with the mean age of 15.8 and males with the mean age of 16.

In Gilan, drug use, excluding cigarette, was reported 19.1% and 5.3%, respectively, for males and females, representing a significant statistical difference ( P < 0.05). Furthermore, cigarette and drug use prevalence was 31.3% and 14.8% in males and females, respectively, showing that this rate was significantly higher in males ( P < 0.05). Cigarette use prevalence was 25.9% and 3%, respectively, for male and female students. Alcohol consumption was 16.6% and 3.4% for males and females, respectively. Opium consumption was 3.3% and 1.5% among males and females, respectively, which was a significant statistical difference (…). Drug consumption, excluding cigarette, was 19.1% and 5.3%, respectively, for males and females, pointing to a statistically significant difference ( P < 0.05). Ecstasy use prevalence was reported 3% and 1.1%, respectively, for males and females, pointing to a statistically significant difference ( P < 0.00081); 0.5% of males and 0.1% of females were heroin consumers, lacking any significant statistical difference ( P > 0.05). In Karaj city, drug consumption prevalence was studied for each sex and drug type [ Table 2 ].

The comparison of the prevalence of at-least-once drug consumption for each sex in each studied region

Drug consumption prevalence based on the age distribution in the studied populations

As the study conducted on students with the mean age of 16 in Zahedan showed that the highest incidence of the first experience of cigarette smoking belonged to the age of 14. A study in Kerman on students with the mean age of 17.9 about the age at the first experience yielded the following results for each drug type: 14 for cigarette, 14.6 for alcohol, 13.9 for hookah, 13.1 for sedatives, 15.3 for analgesics, 17 for ecstasy, 16.7 for hashish, 16.7 for heroin, 16.7 for opium, and 15.3 for naswar.

A study in Gilan indicated that drug and cigarette consumption had significantly increased in males aged 19 and above (88.9% of males aged 19 and above) ( P < 0.05). According to a study in Nazarabad, the highest drug use onset was at the age of 15–16. The students’ mean age in the Karaj study was 16.9.

Exploring the MFT performed in the USA on the 10 th graders showed that drug use had increased from 11% to 34% during 1992–1996. In 1998, 12.10% of the 8 th year and 12.5% of the 10 th graders and 25.611 th % had experienced illegal drug use in the previous month.[ 16 ] It was shown that hashish, followed by opium and alcohol, is the most commonly used illicit drug.[ 17 ] The immediate necessity of planning for reducing the consumption of these drugs among students, and consequently among university students, has become increasingly important.

Investigating addictive drugs prevalence among university students showed the prevalence in the following order: Hookah (74.5%), cigarette (67.5%), opium (6.1%), alcohol (13.5%), psychoactive pills (5.26%), hashish and heroin. Entertainment constitutes the tendency for drug consumption in most cases (47.4%).[ 18 ] Results of a meta-analysis showed that 7% of Iranian adolescents regularly smoke, and 27% had experienced smoking. The increased cigarette use prevalence among Iranian adolescents is a major public health concern.[ 19 ] Paying attention to healthy recreations for adolescents and the youth has become increasingly important and needs planning for discouraging drug use. The cross-sectional prevalence of drug use in 1997 among American 12–17 years old adolescents was reported 11.4%, which was close to drug use prevalence, excluding cigarette.[ 16 ]

Another study showed that 56% of male and 42% of female university students were drug users, which accords with the present research with regard to the higher number of the males.[ 20 ] Since, the addiction problem is an old problem in other countries, it might be better to use the solutions practiced by them to speed up our reaction in cases which adhere to our culture and customs.

At-least-once alcohol use prevalence among the 8 th year American students in 2005 and 2006 was 27% and 20%, respectively, increasing to 88% among the 12 th year students.[ 20 ] The history of hashish consumption among the 8 th , the 10 th , and the 12 th year students was 10%, 23%, and 36%, respectively, representing a remarkable difference with our country's students.[ 20 ] About 0.5% of the 8 th year and 10% of the 12 th year students consumed cocaine, and the consumption of amphetamines by the 12 th year students was 1.5%,[ 20 ] being almost close to the consumption rate of Iranian students. The open consumption of hashish is common in France by almost one-third of the population (nearly 30%), compared with the average rate of 19% in European countries; also the consumption of ecstasy and cocaine has increased over 2000–2005, although it is 4% but yet remarkable.[ 21 ]

A study on students’ knowledge of narcotics in Rafsanjan and Yazd cities showed that 5.6% of Yazdian and 10% of Rafsanjanian students had at least one addicted person in their families. Also, 2.23% of the Yazdian and 7% of the Rafsanjanian students held that narcotics could also be useful.[ 22 ] The important issue here is the existence of an addicted relative and his or her leadership role in this regard; therefore, this point suggests the further importance of the sensitivity of this age group with regard to their dependence on narcotics.

It is noteworthy that Kerman City, compared to other studied cities, has received higher rates of drug use, such that opium and heroin consumption in this city has been, respectively, almost 4 and 5 times that of other cities. These statistics also hold true clearly with regard to ecstasy and alcohol consumption, each being almost 3 times that of Karaj and Gilan. Hashish consumption in the pre-university stage in this city is also higher than in other cities, which might be related to easier drug access in Kerman.

In the cities, in which sex-distinct studies were conducted, drug consumption by males had been, with no exception, far higher than by the females, which is, almost 4 times except for hookah and then cigarette. Of course, it is not possible to judge firmly about drug use general prevalence as a result of the few studies in this field; however, the important point is the relatively high drug use among the adolescent and effective group of the society, which deserves particular attention for education and intervention in this group. It has been observed that adolescent and young crystal users, compared to nonusers, show clinical symptoms, have less control and affection in their families, with excitable, aggressive and anxious personalities, and low accountability;[ 23 ] on the other hand, behavioral problems and friend influence are among the strongest risk factors of drug consumption among adolescent consumers.

Nevertheless, it is not clear to what extent the adolescent can manage the effect of behavioral problems and peer group interaction for refusing invitations for drug consumption.[ 24 ] It has been stated that using software programs would assist in the prevention and increasing the youth's skills for reducing drug use.[ 25 ] It has been shown that adolescent inclination to and consumption of drugs decrease significantly in the 1 st year of educational intervention.[ 26 ] On the other hand, studies indicate that there is a relationship between the borderline personality disorder and the extent of drug abuse.[ 27 ]

Therefore, prevention programs for harm reduction, treatment and consultation as the main objective of the intervention structure should apply to consumers.[ 28 ] Also, emphasis should be laid upon the relationship between schools and parental care as important protective factors for adolescents’ health.[ 29 ] Adolescence is a growth period which is associated with a relatively high rate of drug use and its related disorders. Accordingly, recent progress in evaluating drug abuse among adolescents would continue for information sharing in the field of clinical and research services.[ 30 ] Therefore, attention to this group through coherent planning for damage prevention would still remain in priority.

CONCLUSIONS

Source of Support: Nil

Conflict of Interest: None declared.

Fall 2024 Semester

Undergraduate courses.

Composition courses that offer many sections (ENGL 101, 201, 277 and 379) are not listed on this schedule unless they are tailored to specific thematic content or particularly appropriate for specific programs and majors.

• 100-200 level

ENGL 151.S01: Introduction to English Studies

Tuesday and Thursday, 11 a.m.-12:15 p.m.

Sharon Smith

ENGL 151 serves as an introduction to both the English major and the discipline of English studies. In this class, you will develop the thinking, reading, writing and research practices that define both the major and the discipline. Much of the semester will be devoted to honing your literary analysis skills, and we will study and discuss texts from several different genres—poetry, short fiction, the novel, drama and film—as well as some literary criticism. As we do so, we will explore the language of the discipline, and you will learn a variety of key literary terms and concepts. In addition, you will develop your skills as both a writer and researcher within the discipline of English.

ENGL 201.ST1 Composition II: The Mind/Body Connection

In this section of English 201, students will use research and writing to learn more about problems that are important to them and articulate ways to address those problems. The course will focus specifically on issues related to the mind, the body and the relationship between them. The topics we will discuss during the course will include the correlation between social media and body image; the efficacy of sex education programs; the degree to which beliefs about race and gender influence school dress codes; and the unique mental and physical challenges faced by college students today. In this course, you will be learning about different approaches to argumentation, analyzing the arguments of others and constructing your own arguments. At the same time, you will be honing your skills as a researcher and developing your abilities as a persuasive and effective writer.

ENGL 201.S10 Composition II: Environmental Writing   

Monday/Wednesday/Friday 1-1:50 p.m.

Gwen Horsley

English 201 will help students develop the ability to think critically and analytically and to write effectively for other university courses and careers. This course will provide opportunities to develop analytical skills that will help students become critical readers and effective writers. Specifically, in this class, students will:

• Focus on the relationships between world environments, land, animals and humankind.
• Read various essays by environmental, conservational and regional authors.
• Produce student writings. 

Students will improve their writing skills by reading essays and applying techniques they witness in others’ work and those learned in class. This class is also a course in logical and creative thought. Students will write about humankind’s place in the world and our influence on the land and animals, places that hold special meaning to them or have influenced their lives and stories of their own families and their places and passions in the world. Students will practice writing in an informed and persuasive manner, in language that engages and enlivens readers by using vivid verbs and avoiding unnecessary passives, nominalizations and expletive constructions.

Students will prepare writing assignments based on readings and discussions of essays included in "Literature and the Environment " and other sources. They may use "The St. Martin’s Handbook," as well as other sources, to review grammar, punctuation, mechanics and usage as needed.

ENGL 201.13 Composition II: Writing the Environment

Tuesday and Thursday 9:30-10:45 a.m.

Paul Baggett

For generations, environmentalists have relied on the power of prose to change the minds and habits of their contemporaries. In the wake of fires, floods, storms and droughts, environmental writing has gained a new sense of urgency, with authors joining activists in their efforts to educate the public about the grim realities of climate change. But do they make a difference? Have reports of present and future disasters so saturated our airwaves that we no longer hear them? How do writers make us care about the planet amidst all the noise? In this course, students will examine the various rhetorical strategies employed by some of today’s leading environmental writers and filmmakers. And while analyzing their different arguments, students also will strengthen their own strategies of argumentation as they research and develop essays that explore a range of environmental concerns.

ENGL 201 Composition II: Food Writing

S17 Tuesday and Thursday 12:30-1:45 p.m.

S18 Tuesday and Thursday 2-3:15 p.m.

Jodi Andrews

In this composition class, students will critically analyze essays about food, food systems and environments, food cultures, the intersections of personal choice, market forces and policy and the values underneath these forces. Students will learn to better read like writers, noting authors’ purpose, audience organizational moves, sentence-level punctuation and diction. We will read a variety of essays including research-intensive arguments and personal narratives which intersect with one of our most primal needs as humans: food consumption. Students will rhetorically analyze texts, conduct advanced research, reflect on the writing process and write essays utilizing intentional rhetorical strategies. Through doing this work, students will practice the writing moves valued in every discipline: argument, evidence, concision, engaging prose and the essential research skills for the 21st century.

ENGL 221.S01 British Literature I

Michael S. Nagy

English 221 is a survey of early British literature from its inception in the Old English period with works such as "Beowulf" and the “Battle of Maldon,” through the Middle Ages and the incomparable writings of Geoffrey Chaucer and the Gawain - poet, to the Renaissance and beyond. Students will explore the historical and cultural contexts in which all assigned reading materials were written, and they will bring that information to bear on class discussion. Likely themes that this class will cover include heroism, humor, honor, religion, heresy and moral relativity. Students will write one research paper in this class and sit for two formal exams: a midterm covering everything up to that point in the semester, and a comprehensive final. Probable texts include the following:

• The Norton Anthology of English Literature: The Middle Ages. Ed. Alfred David, M. H. Abrams, and Stephen Greenblatt. 9th ed. New York: W. W. Norton & Company, 2012.
• The Norton Anthology of English Literature: The Sixteenth Century and Early Seventeenth Century. Ed. George M. Logan, Stephen Greenblatt, Barbara K Lewalski, and M. H. Abrams. 9th ed. New York: W. W. Norton & Company, 2012.
• The Norton Anthology of English Literature: The Restoration and the Eighteenth Century. Ed. George M. Logan, Stephen Greenblatt, Barbara K Lewalski, and M. H. Abrams. 9th ed. New York: W. W. Norton & Company, 2012.
• Gibaldi, Joseph. The MLA Handbook for Writers of Research Papers. 6th ed. New York: The Modern Language Association of America, 2003.
• Any Standard College Dictionary.

ENGL 240.S01 Juvenile Literature Elementary-5th Grade

Monday, Wednesday and Friday noon-12:50 p.m.

April Myrick

A survey of the history of literature written for children and adolescents, and a consideration of the various types of juvenile literature. Text selection will focus on the themes of imagination and breaking boundaries.

ENGL 240.ST1 Juvenile Literature Elementary-5th Grade

Randi Anderson

In English 240 students will develop the skills to interpret and evaluate various genres of literature for juvenile readers. This particular section will focus on various works of literature at approximately the K-5 grade level. We will read a large range of works that fall into this category, as well as information on the history, development and genre of juvenile literature.

Readings for this course include classical works such as "Hatchet," "Little Women", "The Lion, the Witch and the Wardrobe" and "Brown Girl Dreaming," as well as newer works like "Storm in the Barn," "Anne Frank’s Diary: A Graphic Adaptation," "Lumberjanes," and a variety of picture books. These readings will be paired with chapters from "Reading Children’s Literature: A Critical Introduction " to help develop understanding of various genres, themes and concepts that are both related to juvenile literature and also present in our readings.

In addition to exposing students to various genres of writing (poetry, historical fiction, non-fiction, fantasy, picture books, graphic novels, etc.) this course will also allow students to engage in a discussion of larger themes present in these works such as censorship, race and gender. Students’ understanding of these works and concepts will be developed through readings, research, discussion posts, exams and writing assignments designed to get students to practice analyzing poetry, picture books, informational books and transitional/easy readers.

ENGL 241.S01: American Literature I

Tuesday and Thursday 12:30-1:45 p.m.

This course provides a broad, historical survey of American literature from the early colonial period to the Civil War. Ranging across historical periods and literary genres—including early accounts of contact and discovery, narratives of captivity and slavery, poetry of revolution, essays on gender equality and stories of industrial exploitation—this class examines how subjects such as colonialism, nationhood, religion, slavery, westward expansion, race, gender and democracy continue to influence how Americans see themselves and their society.

Required Texts

• The Norton Anthology of American Literature: Package 1, Volumes A and B Beginnings to 1865, Ninth Edition. (ISBN 978-0-393-26454-8)

ENGL 283.S01 Introduction to Creative Writing

Steven Wingate

Students will explore the various forms of creative writing (fiction, nonfiction and poetry) not one at a time in a survey format—as if there were decisive walls of separation between then—but as intensely related genres that share much of their creative DNA. Through close reading and work on personal texts, students will address the decisions that writers in any genre must face on voice, rhetorical position, relationship to audience, etc. Students will produce and revise portfolios of original creative work developed from prompts and research. This course fulfills the same SGR #2 requirements ENGL 201; note that the course will involve a research project. Successful completion of ENGL 101 (including by test or dual credit) is a prerequisite.

ENGL 283.S02 Introduction to Creative Writing

Jodilyn Andrews

This course introduces students to the craft of writing, with readings and practice in at least two genres (including fiction, poetry and drama).

ENGL 283.ST1 Introduction to Creative Writing

Amber Jensen, M.A., M.F.A.

This course explores creative writing as a way of encountering the world, research as a component of the creative writing process, elements of craft and their rhetorical effect and drafting, workshop and revision as integral parts of writing polished literary creative work. Student writers will engage in the research practices that inform the writing of literature and in the composing strategies and writing process writers use to create literary texts. Through their reading and writing of fiction, poetry and creative nonfiction, students will learn about craft elements, find examples of those craft elements in published works and apply these elements in their own creative work, developed through weekly writing activities, small group and large group workshop and conferences with the instructor. Work will be submitted, along with a learning reflection and revision plan in each genre and will then be revised and submitted as a final portfolio at the end of the semester to demonstrate continued growth in the creation of polished literary writing.

• 300-400 level

ENGL 424.S01 Language Arts Methods grades 7-12  

Tuesday 6-8:50 p.m.

Danielle Harms

Techniques, materials and resources for teaching English language and literature to middle and secondary school students. Required of students in the English education option.

AIS/ENGL 447.S01: American Indian Literature of the Present 

Thursdays 3-6 p.m.

This course introduces students to contemporary works by authors from various Indigenous nations. Students examine these works to enhance their historical understanding of Indigenous peoples, discover the variety of literary forms used by those who identify as Indigenous writers, and consider the cultural and political significance of these varieties of expression. Topics and questions to be explored include:

• Genre: What makes Indigenous literature indigenous?
• Political and Cultural Sovereignty: Why have an emphasis on tribal specificity and calls for “literary separatism” emerged in recent decades, and what are some of the critical conversations surrounding such particularized perspectives?
• Gender and Sexuality: What are the intersecting concerns of Indigenous Studies and Women, Gender and Sexuality Studies, and how might these research fields inform one another?
• Trans-Indigeneity: What might we learn by comparing works across different Indigenous traditions, and what challenges do such comparisons present?
• Aesthetics: How do Indigenous writers understand the dynamics between tradition and creativity?
• Visual Forms: What questions or concerns do visual representations (television and film) by or about Indigenous peoples present?

Possible Texts

• Akiwenzie-Damm, Kateri and Josie Douglas (eds), Skins: Contemporary Indigenous Writing. IAD Press, 2000. (978-1864650327)
• Erdrich, Louise, The Sentence. Harper, 2021 (978-0062671127)
• Harjo, Joy, Poet Warrior: A Memoir. Norton, 2021 (978-0393248524)
• Harjo, Sterlin and Taika Waititi, Reservation Dogs (selected episodes)
• Talty, Morgan. Night of the Living Rez, 2022, Tin House (978-1953534187)
• Wall Kimmerer, Robin. Braiding Sweet Grass, Milkweed Editions (978-1571313560)
• Wilson, Diane. The Seed Keeper: A Novel. Milkweed Editions (978-1571311375)
• Critical essays by Alexie, Allen, Cohen, Cox, King, Kroeber, Ortiz, Piatote, Ross and Sexton, Smith, Taylor, Teuton, Treuer, Vizenor, and Womack.

ENGL 472.S01: Film Criticism

Tuesdays 2-4:50 p.m.

Jason McEntee

Do you have an appreciation for, and enjoy watching, movies? Do you want to study movies in a genre-oriented format (such as those we typically call the Western, the screwball comedy, the science fiction or the crime/gangster, to name a few)? Do you want to explore the different critical approaches for talking and writing about movies (such as auteur, feminist, genre or reception)?

In this class, you will examine movies through viewing and defining different genres while, at the same time, studying and utilizing different styles of film criticism. You will share your discoveries in both class discussions and short writings. The final project will be a formal written piece of film criticism based on our work throughout the semester. The course satisfies requirements and electives for all English majors and minors, including both the Film Studies and Professional Writing minors. (Note: Viewing of movies outside of class required and may require rental and/or streaming service fees.)

ENGL 476.ST1: Fiction

In this workshop-based creative writing course, students will develop original fiction based on strong attention to the fundamentals of literary storytelling: full-bodied characters, robust story lines, palpable environments and unique voices. We will pay particular attention to process awareness, to the integrity of the sentence, and to authors' commitments to their characters and the places in which their stories unfold. Some workshop experience is helpful, as student peer critique will be an important element of the class.

ENGL 479.01 Capstone: The Gothic

Wednesday 3-5:50 p.m.

With the publication of Horace Walpole’s "The Castle of Otranto " in 1764, the Gothic officially came into being. Dark tales of physical violence and psychological terror, the Gothic incorporates elements such as distressed heroes and heroines pursued by tyrannical villains; gloomy estates with dark corridors, secret passageways and mysterious chambers; haunting dreams, troubling prophecies and disturbing premonitions; abduction, imprisonment and murder; and a varied assortment of corpses, apparitions and “monsters.” In this course, we will trace the development of Gothic literature—and some film—from the eighteenth-century to the present time. As we do so, we will consider how the Gothic engages philosophical beliefs about the beautiful and sublime; shapes psychological understandings of human beings’ encounters with horror, terror, the fantastic and the uncanny; and intervenes in the social and historical contexts in which it was written. We’ll consider, for example, how the Gothic undermines ideals related to domesticity and marriage through representations of domestic abuse, toxicity and gaslighting. In addition, we’ll discuss Gothic texts that center the injustices of slavery and racism. As many Gothic texts suggest, the true horrors of human existence often have less to do with inexplicable supernatural phenomena than with the realities of the world in which we live. 

ENGL 485.S01: Undergraduate Writing Center Learning Assistants 

Flexible Scheduling

Nathan Serfling

Since their beginnings in the 1920s and 30s, writing centers have come to serve numerous functions: as hubs for writing across the curriculum initiatives, sites to develop and deliver workshops and resource centers for faculty as well as students, among other functions. But the primary function of writing centers has necessarily and rightfully remained the tutoring of student writers. This course will immerse you in that function in two parts. During the first four weeks, you will explore writing center praxis—that is, the dialogic interplay of theory and practice related to writing center work. This part of the course will orient you to writing center history, key theoretical tenets and practical aspects of writing center tutoring. Once we have developed and practiced this foundation, you will begin work in the writing center as a tutor, responsible for assisting a wide variety of student clients with numerous writing tasks. Through this work, you will learn to actively engage with student clients in the revision of a text, respond to different student needs and abilities, work with a variety of writing tasks and rhetorical situations, and develop a richer sense of writing as a complex and negotiated social process.

Graduate Courses

Engl 572.s01: film criticism, engl 576.st1 fiction.

In this workshop-based creative writing course, students will develop original fiction based on strong attention to the fundamentals of literary storytelling: full-bodied characters, robust story lines, palpable environments and unique voices. We will pay particular attention to process awareness, to the integrity of the sentence and to authors' commitments to their characters and the places in which their stories unfold. Some workshop experience is helpful, as student peer critique will be an important element of the class.

ENGL 605.S01 Seminar in Teaching Composition

Thursdays 1-3:50 p.m.

This course will provide you with a foundation in the pedagogies and theories (and their attendant histories) of writing instruction, a foundation that will prepare you to teach your own writing courses at SDSU and elsewhere. As you will discover through our course, though, writing instruction does not come with any prescribed set of “best” practices. Rather, writing pedagogies stem from and continue to evolve because of various and largely unsettled conversations about what constitutes effective writing and effective writing instruction. Part of becoming a practicing writing instructor, then, is studying these conversations to develop a sense of what “good writing” and “effective writing instruction” might mean for you in our particular program and how you might adapt that understanding to different programs and contexts.

As we read about, discuss and research writing instruction, we will address a variety of practical and theoretical topics. The practical focus will allow us to attend to topics relevant to your immediate classroom practices: designing a curriculum and various types of assignments, delivering the course content and assessing student work, among others. Our theoretical topics will begin to reveal the underpinnings of these various practical matters, including their historical, rhetorical, social and political contexts. In other words, we will investigate the praxis—the dialogic interaction of practice and theory—of writing pedagogy. As a result, this course aims to prepare you not only as a writing teacher but also as a nascent writing studies/writing pedagogy scholar.

At the end of this course, you should be able to engage effectively in the classroom practices described above and participate in academic conversations about writing pedagogy, both orally and in writing. Assessment of these outcomes will be based primarily on the various writing assignments you submit and to a smaller degree on your participation in class discussions and activities.

ENGL 726.S01: The New Woman, 1880–1900s 

Thursdays 3–5:50 p.m.

Katherine Malone

This course explores the rise of the New Woman at the end of the nineteenth century. The label New Woman referred to independent women who rebelled against social conventions. Often depicted riding bicycles, smoking cigarettes and wearing masculine clothing, these early feminists challenged gender roles and sought broader opportunities for women’s employment and self-determination. We will read provocative fiction and nonfiction by New Women writers and their critics, including authors such as Sarah Grand, Mona Caird, George Egerton, Amy Levy, Ella Hepworth Dixon, Grant Allen and George Gissing. We will analyze these exciting texts through a range of critical lenses and within the historical context of imperialism, scientific and technological innovation, the growth of the periodical press and discourse about race, class and gender. In addition to writing an argumentative seminar paper, students will complete short research assignments and lead discussion.

ENGL 792.ST1 Women in War: Female Authors and Characters in Contemporary War Lit

In this course, we will explore the voices of female authors and characters in contemporary literature of war. Drawing from various literary theories, our readings and discussion will explore the contributions of these voices to the evolving literature of war through archetypal and feminist criticism. We will read a variety of short works (both theoretical and creative) and complete works such as (selections subject to change): "Eyes Right" by Tracy Crow, "Plenty of Time When We Get Home" by Kayla Williams, "You Know When the Men are Gone" by Siobhan Fallon, "Still, Come Home" by Katie Schultz and "The Fine Art of Camouflage" by Lauren Johnson.