College students are vulnerable to addiction: Can we do anything to help?

Editor's Note: This editorial was written by Ryan J. Martin, Ph.D.  Dr. Martin is an assistant professor in the Department of Health Education and Promotion at East Carolina University. This editorial is part of September's Special Series on Addiction and College Students.

Movies and television shows often portray college students as heavy partiers who use and abuse a variety of substances, including alcohol and other drugs.  However, we know that stereotypes are not always consistent with reality.  This BASIS editorial explores the important addiction-related risks that college students actually experience and considers the implications for those with an interest in the health of this population.

College is a time for many young people to explore their independence and discover their passions.  While adjusting to living independently is healthy, the college years also can be fraught with challenges that can lead to unhealthy behaviors.  For example, during college, students must deal with being away from the social controls of family, navigating a time of stressful developmental transition, and managing new kinds of peer pressure.

At risk for addiction
Research indicates that young people, especially college students, are one of the highest risk groups for engaging in and having problems associated with various expressions of addiction, including alcohol (Hingson, Zha, & Weitzman, 2009) and illicit drugs (Mohler-Kuo, Lee, & Wechsler, 2003). Gambling is a recent addition to this list of recognized risky behaviors in this population, and researchers have found that the college student population is more likely than the general population to experience gambling-related problems (Barnes, Welte, Hoffman, & Tidwell, 2010; Blinn-Pike, Lokken Worthy, & Jonkman, 2007).

At risk for mental health problems
In addition to higher rates of addictive behaviors, college students also evidence higher rates of mental health problems, including anxiety and depression (American College Health Association, 2009; Eisenberg, Gollust, Golberstein, & Hefner, 2007).  Researchers have confirmed an increase in college students with psychological problems in recent years (Kadison & DiGeronimo, 2004). One possible reason for this increase is the dramatic advance in psychotropic drug treatment during the past 30 years that has enabled more students with depression, anxiety, and other psychiatric disorders to attend college (Gallagher, 2004).  Another possibility is that improved identification and assessment of psychiatric and addictive disorders have increased awareness of these problems (Emerson et al., 2009).

Co-morbidity
It also is important to note that co-morbidity (i.e., experiencing multiple psychiatric disorders) is prevalent with expressions of addiction both in the general population (Kessler et al., 2008; Petry, Stinson, & Grant, 2005) and in the college population (Martin, Usdan, Cremeens, & Vail-Smith, 2014).  In other words, those individuals experiencing one expression of addiction or mental health disorder are at much higher risk for experiencing additional addictions and mental health issues.  For instance, excessive gambling and gambling-related problems are highly correlated with other expressions of addictions and mental health disorders in the college student population, including driving under the influence, binge drinking, alcohol problems, illicit drug use, and depression (Engwall, Hunter, & Steinberg, 2004; LaBrie, Shaffer, LaPlante, & Wechsler, 2003; Martin et al., 2014).

What can be done?
Although many college students “grow out” of these behaviors during or soon after their college years, others continue to deal with difficult issues in the decades after college. To help college students avoid experiencing these difficulties during and after college, researchers, college administrators, health professionals, and others must confront a difficult and complex set of behaviors during a sometimes-tumultuous time of life.

It is important that colleges and universities intervene to address addiction and mental health issues in their student body.  The National Institute on Alcohol Abuse and Alcoholism (NIAAA) Task Force on College Drinking conducted comprehensive reviews of intervention/prevention strategies among college students and have provided empirically based recommendations for university alcohol policy and prevention strategies (National Institute on Alcohol Abuse and Alcoholism, 2005).  The NIAAA Task Force found that the following strategies are the most effective at preventing and reducing college drinking.

1. Combinations of cognitive-behavioral skills training, including clarifying about alcohol use, and motivational enhancement interventions.
2. Brief motivational enhancement interventions.
3. Interventions challenging students’ expectations about their alcohol use.

Although these strategies have been tested most rigorously with alcohol use and misuse, they have evidenced success with other expressions of addiction, including gambling.  Consequently, I encourage college health professionals to consider implementing these strategies and to explore other scientifically sound strategies that might evidence success with college students struggling with addiction.  

One final note concerning treatment: because we know that individuals who experience one addiction or mental health disorder are at increased risk of experiencing co-occurring disorders, college mental health professionals should consider screening and intervening for co-occurring disorders and tailoring treatment/interventions accordingly.  In other words, it is imperative to treat the addiction syndrome (Shaffer et al., 2004; Shaffer, LaPlante, & Nelson, 2012; Shaffer, LaPlante, & Nelson, 2012) and not just one expression of the syndrome.
  
References

American College Health Association. (2009). American College Health Association-National College Health Assessment II: Reference Group Executive Summary Fall 2009. In American College Health Association (Ed.). Linthicum, MD: American College Health Association.

Barnes, G., Welte, J., Hoffman, J., & Tidwell, M. (2010). Comparisons of gambling and alcohol use among college students and noncollege young people in the United States. Journal of American College Health, 58(5), 443-452.

Blinn-Pike, L., Lokken Worthy, S., & Jonkman, J. (2007). Disordered gambling among college students: a meta-analytic synthesis. Journal of Gambling Studies, 23, 175-183.

Eisenberg, D., Gollust, S., Golberstein, E., & Hefner, J. (2007). Prevalence and correlates of depression, anxiety, and suicidality among university students. American Journal of Orthopsychiatry, 77(4), 534-542.

Emerson, P., Andes, S., Bailey, E., Bernhard, B., Buhrow, W., Dittick-Nathan, K., . . . Wanner, K. (2009). A call to action. Addressing college gambling and recovery from addiction: Recommendations for science-based policies. An executive summary of the report of the Task Force on College Gambling Policies. Boston, MA: Division on Addictions and the National Council on Responsible Gaming.

Engwall, D., Hunter, R., & Steinberg, M. (2004). Gambling and other risk behaviors on university campuses. Journal of American College Health, 52(6), 245-255.

Gallagher, R. (2004). National survey of counseling center directors. Alexandria, VA: International Association of Counseling Services, Inc.

Hingson, R., Zha, W., & Weitzman, E. (2009). Magnitude of and trends in alcohol-related mortality and morbidity among US college students ages 18-24, 1998, 2005. Journal of Studies on Alcohol and Drugs, Supplement no. 16, 12-20.

Kadison, R., & DiGeronimo, T. F. (2004). College of the overwhelmed: The campus mental health crisis and what to do about it. San Francisco: Jossey-Bass.

Kessler, R. C., Hwang, I., LaBrie, R. A., Petukhova, M., Sampson, N., Winters, K., & Shaffer, H. J. (2008). DSM-IV pathological gambling in the National Comorbidity Survey Replication. Psychological Medicine, 38, 1351-1360.

LaBrie, R. A., Shaffer, H. J., LaPlante, D. A., & Wechsler, H. (2003). Correlates of college student gambling in the United States. Journal of American College Health, 52(2), 53-62.

Martin, R. J., Usdan, S., Cremeens, J., & Vail-Smith, K. (2014). Disordered gambling and co-morbidity of psychiatric disorders among college students: An examination of problem drinking, anxiety and depression Journal of Gambling Studies, 30, 321-333.

Mohler-Kuo, M., Lee, J., & Wechsler, H. (2003). Trends in marijuana and other illicit drug use among college students: results from 4 Harvard School of Public Health College Alcohol Study Surveys: 1993-2001. J Am Coll Health, 52(1), 17-24.

National Institute on Alcohol Abuse and Alcoholism. (2005). A call to action: Recommended strategies.   Retrieved October 10, 2008, from http://www.collegedrinkingprevention.gov/NIAAACollegeMaterials/TaskForce/TaskForce_TOC.aspx

Petry, N. M., Stinson, F. S., & Grant, B. F. (2005). Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 66(5), 564-574.

Shaffer, H., LaPlante, D., LaBrie, R., Kidman, R., Donato, A., & Stanton, M. (2004). Toward a syndrome model of addiction: Multiple expressions, common etiology. Harvard Review of Psychiatry, 12, 367-374.

Shaffer, H., LaPlante, D., & Nelson, S. (2012). The APA Addiction Syndrome Handbook (Vol. 1. Foundations, Influences, and Expressions of Addiction). Washington DC: American Psychological Association Press.

Shaffer, H., LaPlante, D., & Nelson, S. (2012). The APA Addiction Syndrome Handbook (Vol. 2. Recovery, Prevention, and Other Issues). Washington DC: American Psychological Association Press.