You’ve seen the headlines and heard the news reports: Drug and alcohol abuse continues to threaten college students’ safety, health, and social and academic functioning. To change this trend, as a society we must acknowledge the breadth and depth of substance abuse among college students, recognize its negative impact, and develop and implement solutions to this problem.
As a nurse, you need to be able to recognize and intervene for substance abuse among college students seeking health care—particularly for mental and physical health problems linked to such abuse. Nurses have the opportunity to help students connect the dots between their substance use and the negative outcomes that result. Using evidence-based practices, we must support changes that prevent students’ further decline into substance abuse and encourage those with identified substance-abuse problems to seek appropriate treatment.
Understanding the scope of the problem
College students—especially those between ages 18 and 24 who are enrolled in 4-year colleges and universities—are at greater risk for engaging in high-risk drinking and other drug use than their non-college peers. As a group, persons ages 18 to 24 tend to drink and use drugs more excessively than other age-groups, whether or not they attend college. Generally, this tendency stems from the following:
- developmental factors of late adolescence and young adulthood, including continuing brain development through the early 20s and the move toward greater independence and autonomy
- cultural and social norms of college life that support heavy alcohol use.
Individual factors, such as family history, also may play a part in the development of high-risk alcohol and drug use. (For statistics on substance use in college students, see the box below.)
Students who abuse alcohol experience more physical and mental health problems than those who don’t drink or who drink at low-risk levels. They report lower rates of overall health and experience higher rates of depression, anxiety, and personality disturbances. What’s more, binge drinking, marijuana use, tobacco use, and use of other substances are linked to increased rates of suicidal ideation.
Heavy alcohol use—both occasionally and over time—is bound to put young adults at risk. Those who start drinking before age 21 are more likely to have alcohol-related problems later in life, if not during college.
Alcohol abuse affects females differently than males. Young women experience the physical negative effects of alcohol much more quickly than young men. Unwanted, unintended, and unprotected sexual activity increases sexual problems for women, who may seek treatment related to these problems.
Rat experiments suggest adolescents who drink may experience less motor impairment and sedation than adults. This finding suggests adolescents lack the physical cues necessary to signal them to stop drinking. When drinking to intoxication, they reach high blood-alcohol levels and possible alcohol poisoning that can result in death.
Differentiating no risk, low-risk, and high-risk drinking
Some college students remain at no risk by choosing not to drink. Others drink in low-risk ways, staying within the recommended guideline of four drinks per occasion or 14 drinks per week for men and 3 drinks per occasion or 7 drinks per week for women. (See the box below for the official definition of a drink.)
Still others engage in binge drinking (five or more drinks on an occasion) or heavy drinking (five or more drinks on five or more occasions within a month). This high-risk alcohol use leads to many emotional, health, social, safety, academic, and legal problems.
According to a 2009 study commissioned by the National Institute on Alcohol Abuse and Alcoholism Task Force on College Drinking, drinking by college students ages 18 to 24 contributes to an estimated 1,825 student deaths (up 27% from 2005), 599,000 injuries, and 97,000 cases of sexual assault or date rape each year. College students who binge-drink may suffer serious consequences; those who are heavy drinkers fall behind in school work, miss classes, and have lower grade-point averages than nonabusing peers.
Despite greater attention to the dangers of drinking and driving, increased enforcement of drinking and driving laws, and encouragement of designated-driver and safe-ride programs, 3.3 million college students acknowledged driving under the influence of alcohol. What’s more, 40% of binge-drinking college students admitted to driving drunk.
Recognizing that these problems are linked to drug and alcohol abuse enhances your ability to identify and screen students whose physical and mental health–related problems may be associated with substance use—and can help them make a change. Nurses working in emergency departments, urgent-care settings, women’s health and sexual health clinics, primary care, and college student health and mental health clinics are especially likely to encounter college students seeking treatment for illnesses and injuries stemming from substance use. Such opportunities give you the chance to promote healthy, low-risk choices among college students.
Know what you can do
Nurses have a unique opportunity to respond to substance abuse among college students. We can use current science to collaborate with other healthcare professionals toward reducing substance abuse among college students.
Examine your own attitudes and actions
First and foremost, act as a role model for responsible behavior. In your community or on your campus, promote a cultural and climate shift that supports enforcement of underage drinking laws and other alcohol- and drug-use laws. Reduce tolerance for heavy or high-risk alcohol use in your own social circle and community. And address the stigma associated with seeking help for substance-abuse problems.
Support screening and intervention
Ensure adequate resources for screening and early intervention for students who may have substance- abuse problems. The Substance Abuse and Mental Health Services (SAMHA) initiative called SBIRT (Screening, Brief Intervention, Referral and Treatment) provides clear guidance for this process. Substance-abusing students commonly present to the healthcare system with illnesses or injuries related to substance use, including injury, trauma, sexual concerns, and mental health problems (such as suicidal ideation, depression, or anxiety).
Screening for alcohol and drug problems should be done during routine assessment for all patients. It involves two parts—biomarkers (such as positive alcohol and drug screens) and self-report use instruments.
- AUDIT (Alcohol Use Disorder Identification Test), developed by the World Health Organization, has proven effective in screening for alcohol problems in college students. This easily administered and scored 10-item instrument using a 5-point Likert scale includes questions on quantity and frequency of use, signs and symptoms of alcohol dependency, and problems caused by alcohol use. (See http://whqlibdoc.who.int/hq/2001/who_msd_msb_01.6a.pdf.)
- DAST (Drug Abuse Screening Test) is a 20-item, yes-no screening tool with general questions about drug use, dependency indications, and problems caused by use. Interventions or next steps are based on the student’s score on these tools. They range from education to referral to specialty substance-abuse treatment. (See the box below.)
Patient education should include expressing concern for high-risk use, teaching about low-risk alcohol-use limits (including standard drink sizes), and stressing the importance of avoiding high-risk situations (such as drinking during pregnancy or while operating hazardous equipment). Be sure to assess for past use and problems to determine if the student needs support for continued recovery and to identify whether past use may predispose the student to future problems.
Brief intervention includes four steps:
Step 1: Ask. Ask the patient about the quantity and frequency of substance use.
Step 2: Assess. Evaluate the student’s academic, social, behavioral, and medical status. Be sure to link the student’s physical or mental health problems with alcohol or drug use as indicated.
Step 3: Advise. Provide appropriate education and advice about cutting down or not using substances at all. For students with moderate alcohol problems, brief interventions of 5 to 10 minutes based on concern for the student and motivational interviewing can decrease alcohol use and its negative consequences.
Step 4: Support and follow-up care. Provide support and follow-up with a referral to a substance-abuse specialist if the patient is substance dependent. (For details on brief interventions, see http://www.collegedrinkingprevention.gov/niaaacollegematerials/trainingmanual/module_3.aspx.)
Brief Alcohol Screening and Intervention for College Students (BASICS) is a brief two-session, evidence-based practice designed specifically to prompt changes in drinking patterns among college students who drink heavily and experience such problems as poor class attendance, accidents, and violence. This program may be available though the student’s college health and/or counseling services. (See http://nrepp.samhsa.gov/ViewIntervention.aspx?id=124.)
Refer patients with severe substance-abuse problems for treatment. This may include additional motivational sessions, intensive inpatient and/or outpatient interventions, and a 12-step program. Make sure you’re familiar with local treatment facilities and Alcoholics Anonymous groups so you can make appropriate referrals. Also give students information about when, how, and where to seek help for fellow students.
Collaborate with others
Join with others in your community to form coalitions seeking to create safe, positive environments on campuses and in the community. The best practices focus on environmental strategies, including those that reduce alcohol access for underage persons and cheap alcohol sales around campuses, as well as offer alternative activities that don’t include alcohol or drug use (such as community service activities). Strive to ensure adequate resources for various levels of treatment easily accessible to college students.
Be a constant and consistent source of accurate information about substance abuse among college students. Support the message that underage alcohol use, binge drinking, tobacco use, and illegal drug use are unsafe, unhealthy and, for the most part, illegal. Help young people understand the importance of risk factors, including family history of substance abuse.
Help make the future brighter
As nurses, parents, and concerned citizens, we want the best for our college students. Sharing our knowledge, advocating for safe and healthy environments, and providing evidence-based care for students with substance-abuse problems can promote a brighter future for us all. Become familiar with available resources that offer a more comprehensive discussion of the problem and its solution. (See the box below for online educational resources.) Participate with others in your community to change the atmosphere of acceptance of these high-risk behaviors and push for policies that reduce the likelihood of these behaviors.
Web resources on substance abuse
Armstrong M, Feigenbaum J, Savage CL, et al, eds. Addictions Nursing, Core Curriculum. 2nd ed. Raleigh, NC: International Nurses Society on Addiction; 2006.
Cha YL, Li Q, Wilson W, et al. Sedative and GABAergic effects of ethanol on male and female rats. Alcohol Clin Exp Res. 2006;30(1):113-8.
Hingson RW, Zha W, Weitzman ER. Magnitude of and trends in alcohol-related mortality and morbidity among U.S. college students ages 18-24, 1998-2005. J Stud Alcohol Drugs. 2009 July(suppl 16): 12-20.
Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE. Monitoring the Future: National Results on Adolescent Drug Use. Overview of Key Findings, 2010. Ann Arbor, MI: Institute for Social Research, University of Michigan; 2011.
Ruth Staten is an advanced practice registered nurse in the Department of Behavioral Health at Ireland Army Community Hospital, Ft. Knox, Department of the Army, and an Associate Professor Emeritus at the University of Kentucky College of Nursing in Lexington.