Colleges

The non-medical use of prescription drugs among U.S. college students has increased significantly during the past decade.^x Many students progress from ingesting energy drinks to taking stimulants such as Adderall® or Ritalin® to respond to the stress of exams and to keep them alert and awake for longer periods. Studies show that from 5 to 35 percent of college students misuse stimulants to cope with stressful academics.^xi With the pressures of performance mounting, college students are turning to academic doping which is perceived to be safe in an effort to keep them ahead of their peers.

Colleges and Universities can play an important role in preventing prescription drug misuse by being included in community-based efforts to fight this national problem. Prevention efforts are most effective when they change students' beliefs about the prevalence and acceptability of prescription drug use among their peers. Whatever your role in the educational field - administrator, faculty, student advisor, residence hall advisor, health educator, student wellness center employee, athletic coach, or student - you can play an important part in preventing prescription drug misuse by promoting prevention efforts and anti-use norms at your school.

Assess student prescription drug abuse and misuse to determine the extent of the problem.

The University of California at Los Angeles (UCLA) has been a part of the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Screening and Brief Intervention (SBI) grant. UCLA’s Access to Care program utilizes a screening tool called Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), which was adopted by the World Health Organization in 1997, to quickly assess the severity of substance use and identifies appropriate treatment.

For more information about screening and brief intervention, see the Health Professionals section.

The National Center on Addiction and Substance Abuse at Columbia University and Harvard University School of Public Health both have helpful surveys. The Harvard School of Public Health College Alcohol Study (CAS) is an ongoing survey of over 14,000 students at 120 four-year colleges in 40 states. The CAS study examines high-risk behaviors among college students, such as heavy episodic or binge drinking, smoking, illicit drug use, gun possession, violence, and other behavioral, social, and health problems confronting today's American college students.

Offer students feedback about use rates and correct misperceptions.

Schools can teach students actual prescription drug misuse rates, substance use policies and enforcement, and signs and symptoms of substance abuse through educational programs.

Roger F. Jadosz, R.N. with the Health Services/Education Department at The University of Rhode Island (URI) developed a comprehensive outreach program called the "Designer Drug Awareness Project" (DDAP). It includes a fast paced, 90-minute presentation involving a lecture, dialogue, Q&A, PowerPoint, videos, photos, and other visual aids that raise awareness of popular drugs including ecstasy, GHB, ketamine, rohypnol, energy drinks, prescription medication, and supplements. DDAP is presented in dormitories and classrooms, and to fraternities, sororities, and athletic teams on campus.

Western Washington University (WWU) created a Welling Collaborative involving three campus groups, Alcohol and Drug Counseling Assessment, Prevention Services (ADCAPS), Student Recreation Center (SRC) and Center for Civic Engagement. They have launched a social norms marketing campaign called Set the Trend – Do you know POP culture? Prescribed does not mean safe – don’t share, use correctly, store securely and dispose responsibly. On January 22, 2009, a webinar on an innovative approach targeting prescription drug misuse in college students was hosted by WWU. Students were surveyed to understand the impact of the Pop Culture campaign. The following results were reported:

• 28.3% agreed with the statement: "I am more likely to have someone watch out for me and my prescription drug use while partying."
• 36.6% agreed with the statement "I am more cautious when using prescription drugs."
• Almost 50% agreed with the statement: "I am more likely to watch out for my friends and their prescription drug use while partying."^xiii

More information can be found at www.setthetrend.wsu.edu.

Factors that may be contributing to prescription drug abuse or misuse in your school or community

Academic Doping

Those who abuse these drugs to keep up with the rigorous academic and time demands of college tend to believe that using the drugs for these purposes is more socially acceptable than using them to party or get high. Some students think that it is "cool" to use these drugs while others think of prescription stimulants as the "new caffeine," in terms of their ubiquity, popularity and growing acceptability as a study aid. Students who provide prescription stimulants to other students are seen more as trying to help their peers excel in school than as drug dealers.

A common notion among stimulant abusers is that if they do not take advantage of the medication like everyone else, they will fall behind their peers academically. Those who do not abuse these drugs often feel that it is unfair that their colleagues are gaining an academic advantage essentially by cheating.⁷ College students will use Adderall® and Ritalin® to stay up days at a time, to help them write more pages, complete assignments faster, and read for longer stretches, and to help them cram and retain last-minute information for exams - it’s the next turbo-charged step up from caffeine and energy drinks. Adderall®, a blend of four different amphetamines, is frighteningly easy to get addicted to, and it can prove especially irresistible to the most ambitious, hardest-working students, as journalist Joshua Foer reveals in his piece for Slate.com about his self-experiment with Adderall ("The Adderall Me: My Romance With ADHD Meds," May 10, 2005). Adderall® is like "a cognitive steroid," writes Foer. "[G]ym rats have steroids, and overachievers have Adderall®."^xiv

Enforcement

Colleges and universities may contribute to student substance use through lax enforcement of the schools’ substance-use control policies, permitting easy access to prescription drugs or offering limited prevention and intervention services.⁷ Research and best practices indicate that the most effective programs are campus-wide efforts that involve as many parts of the college as possible, including administrators, staff, faculty, and students. Building coalitions with local community leaders is also critical.

Steps being taken within your school system to help kids become aware of the negative consequences of prescription drug misuse and abuse

Focus on positive social behavior and correct misperceptions

The website of the Social Norms Center (www.socialnorm.org) presents data from colleges and universities documenting substantial reductions in health risk behaviors within one or two years of initiating a social norms marketing campaign. Some of the marketing methods include newspaper ads, posters, flyers, mailers, community presentations, print and visual advertising, radio and television, and promotional items like key chains or stress balls. Eliciting student input and employing visual media where the students recognize the environment can improve the likeness for success by bringing credibility to the marketing materials.

Form coalitions with student and Greek organizations

The challenges of addressing alcohol and other drug abuse and violence problems on campus should not be taken on by any one person in isolation. Successful prevention requires building and nurturing relationships to gain the assistance and partnership of key stakeholders so that the resulting prevention efforts are well received and championed by others. Building a coalition of capable and knowledgeable allies also strengthens the prevention program, bringing to bear a greater breadth and depth of skills and perspectives than any one person can possess. Colleges and universities can assign an effective campus prevention coordinator to mobilize and organize the campus and community and be a catalyst for change.

Research finds that fraternity and sorority members are twice as likely as non-members to abuse prescription stimulants such as Adderall®, Ritalin® and Dexedrine®. Education programs involving sorority and fraternity leadership can change the perception and culture of these social organizations. Utilizing an environmental management approach, the Higher Education Center has identified five areas of strategic intervention that are effective in altering AOD environment that can be adapted to include non-medical prescription drug use:^xv

1. Offer substance-free social, extracurricular, and public service options.
2. Create a health-promoting normative environment.
3. Restrict the marketing and promotion of alcohol and other drugs both on and off campus.
4. Limit availability of alcohol and other drugs.
5. Develop and enforce campus policies and enforce laws to address high-risk and illegal alcohol and other drug abuse and violence.

Adopt practices to prevent students from selling or giving their prescription drugs to their peers

Universities should engage their student health center to offer a program for the safe disposal of expired prescription drug medication.

What your school can do to educate parents about prescription drug misuse and abuse

Provide specific signals so parents can detect PDM.

Collegians with PDM can exhibit excessive energy or excessive drowsiness. They may have an inability to concentrate and lowered inhibitions with increased secrecy. Some youth will have dramatic and compelling but vague complaints about life. Physical symptoms may include some of the following: constricted or dilated pupils, flushed face and neck, slowed breathing, lower blood pressure and sensory alteration.¹¹

Encourage staff to use screening tools and brief intervention

• Administrators can establish a strategy to combat prescription drug abuse and misuse by providing screening tools and intervention tactics.
• Create a system for routine screenings for all students at your university’s health care center and work with local hospitals to mandate screening for alcohol and drugs a routine of every emergency room visit.
• Educate faculty and residence hall advisors about the signals and symptoms of prescription drug abuse and misuse and how to respond.