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Early alcohol use predicts college students’ polysubstance use

Findings support individualized approach to intervention programs for college students

A study recently published in the Journal of American College Health found college students who were introduced to alcohol before the age of 14 were more likely to use multiple substances—such as alcohol, cannabis, opioids, stimulants or other illicit drugs—at the same time. Texas A&M University School of Public Health’s Benjamin Montemayor, PhD, and Adam Barry, PhD, co-authored the study.

College students and their peers between 18-22 years of age use substances at some of the highest rates of all populations—and polysubstance use, which involves using multiple substances such as alcohol and stimulants at the same time, can be especially dangerous due to their oppositional effects. Depending on the substances taken in unison, drugs used recreationally do not usually cancel each other out but rather amplify the other substances effects. Alcohol, a central nervous system depressant, mixed with a stimulant, a substance that increases activity in central nervous system, can cause some to drink more than they normally would.

“You’re asking your body to adapt to not just alcohol, but alcohol and another psychoactive substance, such as a stimulant or narcotic,” said Montemayor, a visiting assistant professor in the Department of Health Behavior. “By using stimulants, you bypass functions in the body that naturally let your body know it’s time to slow down because that stimulant may be telling your body that you can continue to drink.”

Predictors of polysubstance use

The Texas A&M researchers worked with Melody Noland, PhD, of the University of Kentucky to analyze data from 822 students who violated their university’s alcohol policy between October 2019 and July 2021. This study was designed as a baseline assessment to facilitate better understanding of alcohol, drug and polysubstance use before developing appropriate intervention programs.

The researchers initially looked at predictors of these college students’ alcohol use and found that a top predictor was age-of-onset, which is the age at which the student first consumed alcohol. The study also identified four additional predictors of a student’s alcohol use: being male, being white, being affiliated with a Greek organization on campus, and having an inflated perception that more people are using alcohol than really are.

The researchers then analyzed the data for polysubstance use. They found that among this group of college students, those who had early onset alcohol use were twice as likely to engage in polysubstance use, while those who had a Greek affiliation were one-and-a-half times more likely. Students registered in their second year and beyond, as well as students who had inflated norms about others’ alcohol use, were also more likely to engage in polysubstance abuse.

Revising intervention programs

Most universities have a zero-tolerance policy for alcohol and cannabis use, particularly for underage students. However, Montemayor noted that cannabis, stimulant and narcotic misuse is harder to notice due to medical prescriptions and the covert way in which they are used. However, colleges frown on use of these drugs without a prescription, and policies nationwide regarding cannabis use are mixed.

Violations of campus alcohol and drug policies are the most frequent reason that students receive disciplinary referrals. These infractions happen in a variety of ways, including drinking at a tailgate, getting drunk at a party and then coming back to their residence hall, or being drunk and getting caught somewhere on campus.

Because of limited funding or staffing, some colleges and universities take a one-size-fits-all approach where all students are required to attend the same intervention program. However, Montemayor believes this approach doesn’t benefit students, especially those who need more individualized approaches.

Instead, he is advocating for a stepped care and tailored approach. “Ultimately, what I want to do is create a stepped approach to intervention programming for college students,” he said. “Essentially, if you violate a university substance use policy but you’re at a potentially low risk level of being diagnosed with a substance use disorder and it’s a one-off event, you might benefit from an online program that focuses on education and changing your actions. However, that’s not the case for everyone. There may be a case that those who are moderate or intense users could benefit from a stepped approach that includes transitions to group-based or one-on-one counseling services.”

He also believes developing a screening tool of evidence-based risk factors will help administrators select the best level of support for each individual student. For example, knowing that a student began drinking before the age of 14 and may be more susceptible to polysubstance use, administrators and college health and wellness professionals can try a personalized approach to intervention programming and screen to see if the student has underlying tendencies indicative of a substance use disorder.

The researchers also are conducting additional studies that look at topics such as binge drinking as well as cultural and social characteristics of alcohol use—such as family’s alcohol usage, and football tailgating or other sociocultural norms—that may predict substance or polysubstance misuse. Montemayor recently received a grant from Texas A&M Health to assess the scope of substance use and those who meet the criteria for a substance use disorder among students at Texas A&M University.

“We may be able to look at some of these predictor factors and see how we can create intervention programs that help mitigate the risk associated with binge drinking, polysubstance use, cannabis use, or having inflated perceived norms and assumptions that some substances are less risky than others,” Montemayor said. “The implications here are not just theoretical; they’re practical where we want to implement intervention programs that can help these students.”

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