Staying Sober in College


College is often a place where young people experiment with drugs and alcohol and is often the time where young people first engage in substance use.1 In fact, many view this experimentation as part of the college experience, but it can also lead to regular abuse and even addiction. Some of the most common substances of abuse that are used among the college crowd include alcohol, marijuana, amphetamines, cocaine, and MDMA (ecstasy and Molly).

Some students, however, opt to stay away from drugs and alcohol while in college. Whether they have struggled with substance abuse in the past or simply choose to avoid trying these substances in the first place, staying sober in college is an option that some students choose.

Alcohol and Binge Drinking

In 2018, 59.6% of college students report using alcohol in the last 30 days.2 In a 2017 report to Congress, the U.S. Substance Abuse and Mental Health Services Administration reported that alcohol is the most widely used substance among America’s youth, more than tobacco, marijuana, or other drugs.3

College students also engage in binge drinking at alarmingly high rates. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines binge drinking as the equivalent of roughly 5 alcoholic beverages in two hours. According to the 2018 Monitoring the Future survey sponsored by the National Institute of Drug Abuse, a whopping 28% of college students reported drinking more than 5 drinks in a row on at least one occasion in the past two weeks prior to the survey.2 Extreme binge drinking of 10 or more drinks in a row on 1 or more occasion in the prior 2 weeks was reported by 5% (1 in 20) of college students, and 3% (1 in 33) engaged in binge drinking of 15 or more drink

About 25% of college students who frequently binge drink report academic consequences, including missing class, falling behind in class, doing poorly on tests and experiencing a drop in grades.4 Binge drinking has also been tied to an increased risk of dying in a motor vehicle crash or suffering fatal unintentional poisoning (from alcohol as well as from mixing alcohol with other drugs).

The consequences extend beyond the drinker’s academic performance and health, however, as binge drinking is associated with motor vehicle crashes, unsafe sexual practices and sexual violence and victimization.3

For college students who don’t wish to abstain from alcohol entirely, it’s crucial to have the knowledge and skills to safely moderate their consumption of alcohol. The Rethinking Drinking website from the NIAAA provides guidance, education and resources that will help reduce problem drinking and consume alcohol safely. Some tips that may help college students drink more responsibly includes:

  • Set goals by deciding how many drinks you will have and stay under that goal.
  • Keep track of drinks (e.g., marking a card or using a phone app).
  • Drink wisely. Drink less than one alcoholic drink per hour, and alternate alcoholic drinks with something that doesn’t contain alcohol, such as soda, juice or water.
  • Don’t drink on an empty stomach. Doing so can cause alcohol to be absorbed more readily.
  • Avoid triggers and situations in which heavy drinking is likely.
  • Learn how to say “no” if you don’t want to drink (e.g., have a nonalcoholic drink in your hands at all times may help cut down on drink offers).

The NIAAA has also put together a guide to help parents discuss the risks and consequences of college drinking.

Marijuana

Marijuana is the most commonly used illicit drug in the country, according to the National Institute on Drug Abuse.7 In 2018, nearly 43% of college students used marijuana in the last 30 days.2 Some college students—5.8% in 2018—report using marijuana on a daily basis.

Although several states have legalized the use of the recreational and/or medicinal use of marijuana, the U.S. Drug Enforcement Agency (DEA) still considers marijuana a Schedule 1 substance, and it’s illegal at the federal level.8

Marijuana is commonly smoked, eaten, drunk, and vaped.  The trend toward legalization of marijuana in individual states means that the drug is more widely and easily available. Also, levels of concentration of THC, the active ingredient responsible for the drug’s intoxicating “high,” increased threefold from 1995 to 2014.9

In addition to producing marijuana’s euphoric high, THC is also responsible for some of the undesirable side effects of marijuana: loss of balance, impaired coordination, altered senses, anxiety, paranoia, and sometimes even psychosis.

Regular use of marijuana with high THC concentrations is also associated with cannabinoid hyperemesis syndrome, a condition of uncontrollable cyclic vomiting over a 24-48-hour period that’s associated with chronic marijuana use.10,11

Recent research has demonstrated that marijuana may alter brain functioning in adolescents and young adults in a way that leads to impaired decision-making and memory as well as impulsivity.12 Use of marijuana in conjunction with alcohol has also been shown to adversely affect critical skill development of complex attention, memory, processing speed and the ability to visually perceive space and distance in adolescents.12

Frequent use of marijuana can lead to dependence, which is even more likely when used in higher doses. When a person whose body is dependent on marijuana stops using, they will experience unpleasant withdrawal symptoms with the first week of quitting and lasting up to 14 days: irritability, insomnia, restlessness, cravings and physical discomfort.13

Adderall and ‘Study Drugs’

Another common drug often encountered by college students is Adderall, a stimulant medication that’s prescribed for the management of attention deficit hyperactivity disorder (ADHD).14 Adderall is a combination of dextroamphetamine and amphetamine and helps those with ADHD improve their ability to focus and concentrate.14

Stimulants like Adderall and other amphetamine products that are used to manage ADHD are often referred to as “study drugs” by high school and college students.15 When surveyed about prescription drug use, college students cite academic motivations at rates of 50-89% as the primary reason for their non-medical use of Adderall and similar prescription stimulants.16

Adderall and prescription stimulants have seen an increase in use by college students over the last few years. In 2018, approximately 11% of college students report having used Adderall in the past 30 days.2 Interestingly, research indicates that the drug actually has little impact on neurocognitive performance in college students who do not have ADHD.17

In a survey of college students taking prescription medication, 27% of respondents indicated they had been approached to sell, trade, or give away their medications.18 And those who took prescription stimulants for ADHD were 54% more likely to be approached.18

Regular use of Adderall can cause dependence and carries with it a risk of sudden death in addition to other side effects and potential adverse effects. Furthermore, rmisuse of prescription stimulants by college students is—despite their reputation as a “study drug”—actually associated with a lower GPA, indicating that it actually hinders academic performance.19

Prescription painkillers (i.e., opioids) and benzodiazepines (e.g., Valium and Xanax) are much less likely to be misused by college students, although  their use is not insignificant and should be noted. Prescription painkillers are as addictive as heroin and can lead to serious health consequences, including addiction.

Sedatives such as benzodiazepines may be used by students looking to reduce stress or cope with social anxiety. Benzodiazepines are dangerous, particularly when used in conjunction with alcohol.

Cocaine and Heroin

Other drugs with abuse potential are less frequently used by college students but are still worth noting. In 2018, 5.2% of college students used cocaine in the past 30 days.2

Cocaine is often used in conjunction with alcohol.20 As with all poly-substance abuse, the risks of both alcohol and cocaine are magnified when both substances are used together.21

Heroin is an illicit opioid similar to prescription painkillers like morphine, OxyContin, Vicodin, codeine, etc.22 It can be administered by injection, insufflation (i.e., “snorting”) or smoking.22 Like all opioids, heroin has a high potential for abuse and addiction.22

Overdoses and fatal overdoses from heroin as well as other opioids have been increasing over the last several years.22 An overdose will cause a person to stop breathing and is a medical emergency. Naloxone is a drug that’s used to revive someone who has overdosed on opioids. It’s been made increasingly available over recent years.23

On-Campus Resources to Help Students Stay Sober

Although it may feel like the majority of college students are partying, drinking, and doing drugs, many choose to stay sober. And they don’t have to do that alone. There are many resources available to help students stay sober in college.

Collegiate Recovery Programs (CRPs) have become popular and widely used university-based initiatives for helping college students who are battling drug and alcohol issues or who have already been diagnosed with a substance use disorder and are in recovery. A directory of CRPs is available on the website of the Association of Recovery in Higher Education.

Students attending college where a recovery program isn’t available on campus should connect with their school’s counseling center or student health center to inquire about local and/or campus resources that may be helpful. Options that may be available include mutual-help groups (i.e., 12-step recovery programs like Narcotics Anonymous or Alcoholics Anonymous, or similar programs like SMART recovery) or sober living residences (e.g., on or off campus dormitories that help promote or sustain sobriety), sober activities)

For students wishing to find a mutual-help group, meeting finders are available on both the Alcoholics Anonymous and SMART Recovery websites.

Additional Tips for Sobriety

To maintain sobriety, surround yourself with others who wish to stay sober. Rather than socializing at high-risk places like bars, clubs, and frat parties, opt instead to meet with friends at coffee shops or other alcohol-free venues.

Fill your schedule with fun—and sober—extracurricular activities. Most college campuses are home to a bevy of clubs dedicated to specific interests, such as music, art, films, literature, and sports; join a club that interests you most and learn to have fun without drugs or alcohol.

For some students, living off campus may be a better option. If you live with others who don’t drink or use drugs—or who are at least supportive of your sobriety—peer pressure to abuse substances will be substantially reduced.

References

  1. Substance Abuse and Mental Health Services Administration. (2016). A Day in the Life of College Students Aged 18 to 22: Substance Use Facts.
  2. National Institute on Drug Abuse (2019). Monitoring the Future 2018, Volume 2: College Students & Adults Ages 19–60. Ann Arbor: Institute for Social Research, The University of Michigan.
  3. Substance Abuse and Mental Health Services Administration. (2017). Report to Congress on the Prevention and Reduction of Underage Drinking.
  4. White, A., & Hingson, R. (2014). The Burden of Alcohol Use: Excessive alcohol consumption and related consequences among college students. Alcohol Research: Current Reviews, 35(2), 201–218.
  5. Hingson, R., Zha, W., & Smyth, D. (2017). Magnitude and Trends in Heavy Episodic Drinking, Alcohol-Impaired Driving, and Alcohol-Related Mortality and Overdose Hospitalizations Among Emerging Adults of College Ages 18-24 in the United States, 1998-2014. Journal of Studies on Alcohol and Drugs, 78(4), 540–548.
  6. National Institute on Alcohol Abuse and Alcoholism. (2016). Rethinking Drinking: Thinking About a Change: Tips to Try.
  7. National Institute on Drug Abuse. (2019). Drug Facts: Marijuana.
  8. S. Drug Enforcement Agency. (2019). Drug Scheduling.
  9. Elsohly, M. A., Mehmedic, Z., Foster, S. (2016). Changes in Cannabis Potency Over the Last 2 Decades (1995-2014): Analysis of Current Data in the United States. Biological Psychiatry, 79(7), 613-619.
  10. Galli, J. A., Sawaya, R. A., & Friedenberg, F. K. (2011). Cannabinoid hyperemesis syndrome. Current Drug Abuse Reviews, 4(4), 241–249.
  11. Monte, A. A., Shelton, S. K., Mills, E., Saben, J., Hopkinson, A., Sonn, B., … Abbott, D. (2019). Acute Illness Associated With Cannabis Use, by Route of Exposure: An Observational Study. Annals of Internal Medicine, 170(8), 531–537.
  12. Meda, S. A., Gueorguieva, R. V., Pittman, B., Rosen, R. R., Aslanzadeh, F., Tennen, H., … Pearlson, G. D. (2017). Longitudinal influence of alcohol and marijuana use on academic performance in college students. PLoS One, 12(3), e0172213.
  13. National Institute on Drug Abuse. (2019). Marijuana Research Report: Is marijuana addictive?
  14. National Institute on Drug Abuse. (2018). Prescription Stimulants.
  15. U.S. National Library of Medicine. (2012). Prescription stimulants in individuals with and without attention deficit hyperactivity disorder: misuse, cognitive impact, and adverse effects.
  16. Faraone, S. V., Rostain, A. L., Montano, C. B., Mason, O., Antshel, K. M., & Newcorn, J. H. (2019). Systematic Review: Nonmedical Use of Prescription Stimulants: Risk Factors, Outcomes, and Risk Reduction StrategiesJournal of the American Academy of Child & Adolescent Psychiatry, Aug. 26, 2019, [ePub ahead of print].
  17. Weyandt, L. L., White, T. L., Gudmundsdottir, B. G., Nitenson, A. Z., Rathkey, E. S., De Leon, K. A., & Bjorn, S. A. (2018). Neurocognitive, Autonomic, and Mood Effects of Adderall: A Pilot Study of Healthy College StudentsPharmacy (Basel, Switzerland), 6(3), 58.
  18. Garnier, L. M., Arria, A. M., Caldeira, K. M., Vincent, K. B., O’Grady, K. E., & Wish, E. D. (2010). Sharing and selling of prescription medications in a college student sampleThe Journal of Clinical Psychiatry71(3), 262–269.
  19. Weyandt, L. L., Oster, D. R., Marraccini, M. E., Gudmundsdottir, B. G., Munro, B. A., Rathkey, E. S., & Mccallum, A. (2016). Prescription stimulant medication misuse: Where are we and where do we go from here?Experimental and Clinical Psychopharmacology, 24(5), 400–414.
  20. Liu, Y., Williamson, V., Setlow, B., Cottler, L. B., & Knackstedt, L. A. (2018). The importance of considering polysubstance use: Lessons from cocaine research. Drug and Alcohol Dependence, 192, 16–28.
  21. Wilson, F. A., Stimpson, J. P., & Pagán, J. A. (2014). Fatal crashes from drivers testing positive for drugs in the U.S., 1993-2010. Public Health Reports (Washington, D.C. : 1974), 129(4), 342–350.
  22. National Institute on Drug Abuse. (2019). Drug Facts: Heroin.
  23. National Institute on Drug Abuse. (2019). Medications to Treat Opioid Use Disorder: Is naloxone accessible?


About The Contributor

Ryan Kelley, NREMT
Ryan Kelley, NREMT

Medical Editor, American Addiction Centers

Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series... Read More


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