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
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
Dr Blevins and Dr Khanna are third-year psychiatry residents in the department of psychiatry and neurobehavioral sciences at the University of Virginia Medical School in Charlottesville, VA. The authors report no conflicts of interest concerning the subject matter of this article.
1. Johnston LD, O’Malley PM, Bachman JG, et al. Monitoring the Future National Survey Results on Drug Use, 1975-2014: Volume II, College Students and Adults Ages 19-55. Ann Arbor, MI: Institute for Social Research, The University of Michigan; 2015.
2. Hingson RW, Wenxing Z, Weitzman ER. Magnitude of alcohol-related mortality and morbidity among U.S. college students ages 18-24, 1998-2005. J Stud Alcohol Drugs. 2009;16:12-20.
3. Presley CA, Meilman PW, Lyerla R, Cashin JR. Alcohol and Drugs on American College Campuses. Use, Consequences, and Perceptions of the Campus Environment. Volume I: 1989-1991; 1996. http://eric.ed.gov/?id=ED358766. Accessed December 1, 2015.
4. De Bellis MD, Clark DB, Beers SR, et al. Hippocampal volume in adolescent-onset alcohol use disorders. Am J Psychiatry. 2000;157:737-744.
5. Squeglia LM, Tapert SF, Sullivan EV, et al. Brain development in heavy-drinking adolescents. Am J Psychiatry. 2015;172:531-542.
6. Center for Behavioral Health Statistics and Quality. Behavioral health trends in the United States: results from the 2014 National Health Survey on Drug Use and Health; 2015. http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf. Accessed December 1, 2015.
7. Tapert SF, Caldwell L, Burke C. Alcohol and the adolescent brain: human studies. Alcohol Res Health. 2004;28:205-212.
8. Caldeira KM, O’Grady KE, Vincent KB, et al. Marijuana use trajectories during the post-college transition: health outcomes in young adulthood. Drug Alcohol Depend. 2012;125:267-275.
9. Cranford JA, Eisenberg D, Serras AM. Substance use behaviors, mental health problems, and use of mental health services in a probability sample of college students. Addict Behav. 2009;34:134-145.
10. American College Health Association. ACHA—National Health Assessment II: Undergraduate Students Reference Group Data Report, Spring 2015. Hanover, MD: American College Health Association; 2015.
11. Hingson R, Heeren T, Winter M, Wechsler H. Magnitude of alcohol-related mortality and morbidity among US college students ages 18-24: changes from 1998 to 2001. Annu Rev Public Health. 2005;26:259-279.
12. National Institute on Alcohol Abuse and Alcoholism. What colleges need to know now: an update on college drinking research; 2007. http://www.collegedrinkingprevention.gov/1college_bulletin-508_361C4E.pdf. Accessed December 1, 2015.
13. Walters ST, Neighbors C. Feedback interventions for college alcohol misuse: what, why and for whom? Addict Behav. 2005;30:1168-1182.
14. Kokotailo PK, Gangnon R, Brown D, et al. Validity of the alcohol use disorders identification test in college students. Alcohol Clin Exp Res. 2004;28: 914-920.
15. DeMartini KS, Carey KB. Optimizing the use of the AUDIT for alcohol screening in college students. Psychol Assess. 2012;24:954-963.
16. Skinner HA. The Drug Abuse Screening Test. Addict Behav. 1982;7:363-371.
17. McCabe SE, Boyd CJ, Cranford JA, et al. A modified version of the Drug Abuse Screening Test among undergraduate students. J Subst Abuse Treat. 2006;31:297-303.
18. Johnson BA. Medication treatment of different types of alcoholism. Am J Psychiatry. 2010;167: 630-639.
19. Borsari B, Carey KB. Descriptive and injunctive norms in college drinking: a meta-analytic integration. J Stud Alcohol. 2003;64:331-341.
20. Baer JS, Kivlahan DR, Blume AW, et al. Brief intervention for heavy-drinking college students: 4-year follow-up and natural history. Am J Public Health. 2001;91:1310-1316.
21. Amaro HA, Reed E, Rowe E, et al. Brief screening and intervention for alcohol and drug use in a college student health clinic: feasibility, implementation, and outcomes. J Am Coll Health. 2010;58: 357-364.
22. Tanner-Smith EE, Wilson SJ, Lipsey MW. A comparative effectiveness of outpatient treatment for adolescent substance abuse: a meta-analysis. J Subst Abuse Treat. 2013;44:145-158.