Addressing College Drinking and Drug Use Executive Summary
“Please take a moment to reflect on the bright futures that end in alcohol or drug-related illness, injury, or deaths at colleges and universities. Over the last decade, they have numbered in the thousands. College drinking and drug abuse are issues of extreme urgency. And you, as a trustee, have the power—and the fiduciary duty—to make the campus safer. The transition from high school to college is a time of vulnerability for many students. For most, it is their first time away from home for an extended period, and they are thrust into an environment where everyday interactions are almost entirely with their peers. Throw alcohol and drugs into the mix and you can have a lethal combination.”
—American Council of Trustees and Alumni, 2012
In February 2012, the American Council of Trustees and Alumni (ACTA) released a short guide to help trustees and administrators understand the growing problem of substance use on campus. Unfortunately, the statistics remain grim. While the newest statistics might not be surprising, the prevalence of drug and alcohol abuse on campus has a tragic human face.
This guide seeks to provide the latest data on substance use among college students, reframe prevention efforts around the university’s academic mission, and help trustees and university leadership change their campus cultures through evidence-based practices. Lastly, to help trustees and administrators see these recommendations at work, this guide offers examples of successful programs that have implemented effective strategies on campus.
Although the specific effects of alcohol, cannabis, and prescription medication misuse on student health and success differ, they share in common the reality that they all can have a harmful impact on academic achievement and impair mental and/or physical well-being.
About one-third of full-time undergraduate college students in the United States drink excessively, which includes heavy drinking and binge drinking (as defined by four or more drinks on a single occasion for females and five or more for males).1 Annually, more than 1,500 students die from alcohol-related consequences, and hundreds of thousands experience alcohol poisoning and/or non-fatal injuries.2 Harm to others in the form of assaults,3 impaired driving,4 and damage to community property5 are highly prevalent as well.
Increasing cannabis use by college students is a warning bell calling campus leaders to address substance use. The growing body of evidence on cannabis use reveals that cannabis can have significant negative effects on the cognitive development and health of young adults. And the 21st century is bringing an array of new challenges, including higher levels of THC in cannabis, synthetic cannabinoids, and new modes of drug administration including edible products and vaping. The impression that cannabis is a relatively harmless substance has proven faulty and dangerous— cannabis-impaired driving, cannabis-associated mental health problems, decreases in academic engagement, and links to opioid use all show the very real risks of failing to address cannabis use.
Prescription drug misuse, which has been called the fastest-growing drug problem in the United States, is also cause for concern, with many college students using drugs like Adderall® and Ritalin® without a prescription purportedly to improve their academic performance. Unfortunately, this form of drug use is typically a symptom of broader substance use problems and academic difficulties.6
Only 60% of college students will graduate within six years.7 Leaders in higher education increasingly recognize the contribution of substance use issues to academic disengagement and dropout rates. Not only have multiple studies demonstrated that substance use during college can compromise health and safety,8 there is ample evidence that it strongly correlates with diminished cognitive ability,9 critical thinking,10 academic performance,11 and with limited likelihood of employment post-college.12
To address these problems, the standard approach that colleges take is to educate students about risks. However, educating students about the risks of excessive drinking does not change their behavior.13 The National Institutes of Health CollegeAIM framework recommends both environmental and individual-level interventions to address substance use.14 Federal agencies also endorse multi-level, multi-component approaches. Environmental interventions (e.g., enforcement of underage drinking laws,15 social host laws,16 responsible beverage service,17 and use of campus and local media to promote awareness and enforcement of these laws18) are effective in reducing college student drinking. Campus policy enforcement is also essential, but the sanctions for violating policies must be sensible and geared toward getting high-risk students the help they need to change their behavior. At the individual level, widespread screening to identify students at high risk for developing problematic substance use patterns and clinical interventions for unhealthy alcohol use and substance use are feasible and effective.19 Unfortunately, colleges seldom use this set of comprehensive strategies.20
Policies that work to strengthen the academic mission, re-norm the campus culture, improve screening, deploy evidence-based clinical interventions, and provide alternatives to consumption are all important components of a comprehensive strategy that campuses will need to reverse the dangerous trajectories of substance abuse. Many concerned university leaders and personnel across the country have led efforts to discern which prevention policies actually work. Institutions must craft and enact policies that address their particular student body and culture, as well as the nature and prevalence of substance abuse on the particular campus. To be successful, cost-effective approaches require coordination at various university levels, full support from the president and trustees, and collaboration with the community, other universities, and state government. Campus leaders must also publicly communicate to students what the policies actually are and why they have been chosen, consistently enforce these policies, and work to shape students’ perceptions in a positive and data-driven manner.
- Rachel Lipari and Beda Jean-Francois, “A Day in the Life of College Students Aged 18 to 22: Substance Use Facts,” The CBHSQ Short Report, Substance Abuse and Mental Health Services Administration (SAMHSA), May 26, 2016, https://www.samhsa.gov/data/sites/default/files/report_2361/ShortReport-2361.html.
- Ralph Hingson, Wenxing Zha, and Daniel Smyth, “Magnitude and Trends in Heavy Episodic Drinking, Alcohol- Impaired Driving, and Alcohol-Related Mortality and Overdose Hospitalizations Among Emerging Adults of College Ages 18–24 in the United States, 1998–2014,” Journal of Studies on Alcohol and Drugs 78, no. 4 (2017): 540–548, https://www.ncbi.nlm.nih.gov/pubmed/28728636.
- Ralph Hingson, Wenxing Zha, and Elissa Weitzman, “Magnitude of and Trends in Alcohol-Related Mortality and Morbidity Among U.S. College Students Ages 18–24, 1998–2005,” Journal of Studies on Alcohol and Drugs Supplement 16 (2009): 12–20, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2701090/.
- “Magnitude and Trends, 1998–2014.”
- Henry Wechsler, et al., “Secondhand effects of student alcohol use reported by neighbors of colleges: the role of alcohol outlets,” Social Science & Medicine 55 (2002): 425–35, http://archive.sph.harvard.edu/cas/Documents/ secondhand/secondhandarticle.pdf.
- Amelia M. Arria, et al., “Dispelling the myth of ‘smart drugs’: cannabis and alcohol use problems predict nonmedical use of prescription stimulants for studying,” Addictive Behaviors 38, no. 3 (2013): 1643–50, https:// http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3558594/.
- National Center for Education Statistics, “Fast Facts,” Institute of Education Sciences, https://nces.ed.gov/ fastfacts/display.asp?id=40.
- Amelia M. Arria, et al., “Substance-related traffic-risk behaviors among college students,” Drug and Alcohol Dependence 188, no. 2-3 (2011): 306–12, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3161136/; “Magnitude and Trends, 1998–2014”; and “Magnitude of and Trends, 1998–2005.”
- Marta Zamroziewicz, et al., “Effects of drinking patterns on prospective memory performance in college students,” Neuropsychology 31, no. 2 (2017): 191–199, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5280574/; Alecia D. Dager, et al., “Relationship between fMRI response during a nonverbal memory task and cannabis use in college students,” Drug and Alcohol Dependence 188 (2018): 71–78, https://www.ncbi.nlm.nih.gov/ pubmed/29754029; Dustin Hammers and Julie Suhr, “Neuropsychological, impulsive personality, and cerebral oxygenation correlates of undergraduate polysubstance use,” Journal of Clinical and Experimental Neuropsychology 32, no. 6 (2010): 599–609; and Shashwath Meda, et al., “Longitudinal effects of alcohol consumption on the hippocampus and parahippocampus in college students,” Biological Psychiatry: Cognitive Neuroscience and Neuroimaging 3, no. 7 (2018): 610–617, https://www.ncbi.nlm.nih.gov/pubmed/29680476.
- Teniell Trolian, Brian An, and Ernest Pascarella, “Are There Cognitive Consequences of Binge Drinking During College?” Journal of College Student Development 57, no. 8 (2016): 1009–1026.
- Amelia M. Arria, et al., “The Academic Consequences of Cannabis Use during College,” Psychology of Addictive Behaviors 29, no. 3 (2015): 564–575, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4586361/; Amelia M. Arria, et al., “Dispelling the myth of ‘smart drugs’: cannabis and alcohol use problems predict nonmedical use of prescription stimulants for studying”; Amelia M. Arria, et al., “Drug Use Patterns and Continuous Enrollment in College: Results from a Longitudinal Study,” Journal of Studies on Alcohol and Drugs 74, no. 1 (2013): 71–83, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3517265/; and Riane Bolin, Margaret Pate, and Jenna McClintock, “The impact of alcohol and cannabis use on academic achievement among college students,” The Social Science Journal 54, no. 4 (2017): 430–437.
- Amelia M. Arria, et al., “Drug use patterns in young adulthood and post-college employment,” Drug and Alcohol Dependence 127, no. 2-3 (2013): 23–30, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3463732/; and Peter Bamberger, et al., “Does college alcohol consumption impact employment upon graduation? Findings from a prospective study,” Journal of Applied Psychology 103, no. 1 (2018): 111–121, https://www.ncbi.nlm.nih.gov/ pubmed/28836800.
- Thomas F. Babor, et al., Alcohol: No Ordinary Commodity: Research and Public Policy (Oxford: Oxford University Press, 2010).
- National Institutes of Health: National Institute on Alcohol Abuse and Alcoholism, CollegeAIM: Alcohol Intervention Matrix, https://www.collegedrinkingprevention.gov/collegeaim/. CollegeAIM is a resource for colleges and universities to help address student drinking through 60 different individual- and environmental-level interventions.
- Robert Flewelling, et al., “Reducing youth access to alcohol: Findings from a community-based randomized trial,” American Journal of Community Psychology 51, no. 1-2 (2013): 264–277, https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC3790581/.
- Robert Saltz, et al., “Alcohol risk management in college settings: the safer California universities randomized trial,” American Journal of Preventative Medicine 39, no. 6 (2010): 491–499, https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC3085398/.
- Kent Johnsson and Mats Berglund, “Education of key personnel in student pubs leads to a decrease in alcohol consumption among the patrons: a randomized trial,” Addiction 98, no. 5 (2003): 627–633, https://www.ncbi. nlm.nih.gov/pubmed/12751980.
- “Alcohol risk management in college settings: the safer California universities randomized trial.”
- Virginia Moyer on behalf of the U.S. Preventive Services Task Force, “Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse: U.S. Preventive Services Task Force Recommendation Statement,” Annals of Internal Medicine 159, no. 3 (2013): 210–218, https://www.ncbi.nlm.nih.gov/ pubmed/2369879.
- Ken Winters, et al., “Screening for alcohol problems among 4-year colleges and universities,” Journal of American College Health 59, no. 5 (2011): 350–357, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3086775/; Toben Nelson, et al., “Implementation of NIAAA College Drinking Task Force recommendations: how are colleges doing 6 years later?” Alcoholism: Clinical and Experimental Research 34, no. 10 (2010) 1687–93; and Jeff Foote, et al., “National survey of alcohol screening and referral in college health centers,” Journal of American College Health 52, no. 4 (2004): 149–157.