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Clinical Implications of Substance Abuse in Young Adults

Clinical Implications of Substance Abuse in Young Adults

AUDIT-C is a 3-item screening test that can be used in college studentsFigure 1. AUDIT-C is a 3-item screening test that can be used in colle...
DAST-10 is a modified version of the DAST developed by Harvey A. SkinnerFigure 2. DAST-10 is a modified version of the DAST developed by Harve...

The transition from high school to college often sparks excitement and fear in the new high school graduate. There are many things to consider as he or she plans for this transition, and these considerations are influenced by the experiences of parents and older siblings and friends; advice from teachers and guidance counselors; and—last but not least—popular media, including movies, television, and music.

These sources play a major role in shaping the idea of what college might be like. Some nights will be spent in the library writing term papers, while others may be spent socializing at fraternity parties playing beer pong and drinking a mysterious “jungle juice.” Along with the sense of newfound freedom from the “hall pass,” high school truancy laws, and the umbrella of parental oversight comes increased access to alcohol, illicit substances, and pharmaceutical drugs.

As clinicians, we may find it difficult to address this developmental period. We understand how important it is for youth to develop an individualized sense of self outside the context of previous constraints, but we also want to limit risk to young persons and to the community, which makes it difficult to determine when and how to intervene.


Alcohol use among college students far exceeds that of any other psychoactive substance. The most recent data from the Monitoring the Future National Survey estimate that 63% of college students in 2014 consumed alcohol within the past 30 days and 35% had occasions of heavy drinking (5 or more drinks in a row) in the past 2 weeks.1 In addition, 43% reported being drunk in the past 30 days; 13% reported having 10 or more drinks in a row in the past 2 weeks, and 5% reported having 15 or more in a row. With the exception of the latter 2 rates of extreme binge drinking, these estimates range between 6% and 9% higher in college students. While in high school, the college-bound students were less likely to consume alcohol; thus, these rates indicate a substantial increase in alcohol consumption in the transition between high school and college.

In contrast, the annual prevalence of illicit drug use was lower among college students compared with their noncollege peers: at 39% and 44%, respectively. In the college population, the highest annual prevalence was for marijuana use (34%), followed by medically unsupervised amphetamines (10%), medically unsupervised sedatives/tranquilizers (6.6%), and ecstasy/3,4-methylenedioxymethamphetamine (5%). Prescription opioid narcotics, cocaine, and hallucinogen misuse was slightly under 5%, while use of inhalants, gamma hydroxybutyrate, ketamine, and heroin was much rarer. It is worth noting that, like alcohol use, past-year amphetamine salts misuse was higher among college students compared with their noncollege peers. Annual prevalence of marijuana use was 5% greater in college men than in women, and amphetamine misuse was 2.5% greater in men.

While these rates may seem trivial, the consequences are clear. Excessive college drinking has a profound effect on the individual and the community, with yearly estimates of 1825 deaths; 599,000 injuries; 696,000 assaults; and 97,000 sexual © DenisNata/shutterstock.com© DenisNata/shutterstock.com
assaults or date rapes.2 More than 80% of all apprehensions by campus police involve alcohol. And a quarter of students report academic problems related to alcohol consumption.3 It is abundantly clear that college substance abuse poses a significant community health risk. Furthermore, the increased risk to the individual may be long-lasting and have lifelong consequences.

Neurobiology of substance use and development

At the biological level, various regions of the brain continue to develop and mature at different intervals throughout young adulthood. These active processes make the individual more likely to engage in novelty-seeking behaviors while simultaneously making the brain more susceptible to neurotoxic processes that can result from substance use. For substance abusers, increased neuroplasticity during development comes with a cost.

Imaging studies have confirmed various neural structural and physiological changes associated with adolescent and young adult alcohol use.4,5 These changes include reduced hippocampal volumes and accelerated gray matter reduction in the frontal and temporal cortices with attenuated white matter growth in the corpus callosum and pons. These effects translate into problems with executive function, learning and memory, impulse control, and affective regulation. In addition, neurobiological changes alter cognition and increase the risk of substance use disorders and other neuropsychiatric processes.

Impact on psychopathology

Drug use among college students puts them at increased risk for adverse health, behavioral, and social consequences. Among adults aged 18 or older with serious mental illness in 2014, the percentage of those who had past-year substance use disorder was highest among 18- to 25-year-olds (35%), followed by 26- to 49-year-olds (25%).6[PDF]  Evidence suggests that heavy drinking during adolescence and young adulthood is associated with poor neurocognitive functioning and is particularly associated with poor visuospatial skills and attention.7

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