Jade Pearson

Specialty 2d/e/f
Addiction Prevention in Higher Education

Research Outline for CACREP Specialty Standard 2f: signs and symptoms of substance
abuse in individuals in higher education settings

● Research Questions:
○ (1) What are the risk factors of substance misuse and abuse in college students?
○ (2) What are effective intervention strategies for working with individuals with
substance use disorders?
● Thesis:
○ Substance abuse is a major and prevalent public health concern among university
students. Tobacco smoking, risky alcohol behavior, and illegal drug consumption
may lead to health problems and behavioral and academic issues (Delgado-Lobete
et al., 2020). There are prevalent risk factors of substance abuse in the college
student population. Intervention strategies range from early intervention,
collaboration among student affairs professionals utilizing a multidisciplinary
approach, student-led initiatives, and structured exercise programs.
● Risk Factors
○ Alcohol use disorder (Delgado-Lobete et al., 2020)
○ Being male (Delgado-Lobete et al., 2020)
○ Living with other students (Delgado-Lobete et al., 2020)
○ Combined substance consumption (Delgado-Lobete et al., 2020)
○ Early exposure to cigarette smoking and alcohol use leads to later use of
marijuana, cocaine, non-medical use of prescription drugs, and other illegal drugs
in humans (Myers et al., 2013)
○ “Gateway Sequence” of drug usage (Kandel & Kandel, 2015)
■ Describes how use of legal and easily accessible drugs (typically tobacco
or alcohol) precedes use of harder and more addictive drugs, such as
marijuana, cocaine and other illegal drugs
○ Fear of being left out because “everyone is doing it”
○ Alcohol and drugs are readily available
○ They’ve never tried it before
○ It’s a way to self-medicate and relax
○ Students think they are more fun when they are intoxicated
○ Mental illness and psychosis may not be a cause of substance use, but can be
co-occurring with substance abuse
● Symptoms
○ Dysphoric mood states
○ Decrease in memory and attention
○ Neglecting of appearance and hygiene
○ Disturbances in sleep
Jade Pearson
Specialty 2d/e/f
Addiction Prevention in Higher Education
○ Social withdrawal

● Intervention Strategies
○ Intervention at the earliest point in a student’s college career is essential
(Eikenberry, 2016).
■ There is a significant increase in substance abuse between students in their
freshman year and their senior year. (Eikenberry, 2016)
○ Prevention programs aimed to decrease the prevalence of tobacco smoking,
alcohol misuse or illegal drug consumption in university students should
especially focus on students who are in a more vulnerable situation
(Delgado-Lobete et al., 2020)
○ A multidisciplinary approach should be used; it is necessary for health
professionals and academic institutions to design collaborative prevention and
intervention strategies (Delgado-Lobete et al., 2020)
○ Emphasis on non-birth family support systems for transgender individuals
(Flentje, Heck, & Sorensen, 2014)
○ The use of structured exercise can be used as an alternative intervention for
substance use disorders (Rawson et al., 2015)
○ Student-led initiatives with the goal of promoting a college-wide drug-free
environment are recommended. Involving parents and guardians in education and
support for substance abuse related offenses provides opportunities for
partnerships between the institution and one of its most important stakeholders
(Eikenberry, 2016)

Research
● Delgado-Lobete et al. (2020)
○ Key Points
■ The purposes of this study were to evaluate the association of individual
and environmental factors and substance use, and to analyze the
relationship between tobacco smoking, alcohol abuse, and drug
consumption, considering alcohol abuse as a possible mediator.
○ Methodology
■ A total of 550 Spanish undergraduate and postgraduate students completed
several questionnaires regarding their smoking status, alcohol use, and
drug consumption during the last six months. Bivariate and multivariate
analyses were conducted to explore associations between factors. Direct,
indirect, and mediating effects were tested using a partial least squares
approach.
○ Results
Jade Pearson
Specialty 2d/e/f
Addiction Prevention in Higher Education
■ Substance abuse is associated with being male, living with other students,
and combined substance consumption.
● Men are more likely to simultaneously co-use cannabis with
alcohol and tobacco as well. The well-explored association
between impulsivity traits and substance consumption could
contribute to explain why male students use drugs more than
women, as impulsivity disorders are more prevalent among men
■ This study showed a significant effect of tobacco smoking and alcohol
abuse on drug consumption.
■ Alcohol abuse plays a mediating role in the relationship between tobacco
smoking and drug use.
■ Prevalence of substance use in the sample is high, especially considering
that up to 22.5% of the participants reported alcohol abuse and that almost
half of the students had used cannabis at least once in their life;
■ Tobacco smoking and risky alcohol behavior were associated with illegal
drug consumption, both in the bivariate and the multivariate analyses
■ Family proximity plays a protective role in substance abuse among
adolescents and higher education students. This protective factor could
contribute to explaining why students who live away from the family
home are more likely to engage in risky alcohol behaviors and illicit drug
use
● The fear of being socially alienated and excluded is one of the
factors that relate the most with alcohol abuse in this population
○ Intervention Strategies
■ Prevention programs aimed to decrease the prevalence of tobacco
smoking, alcohol misuse or illegal drug consumption in university
students should especially focus on students who are in a more vulnerable
situation
● Due to the complex interrelation between the individual and
environmental factors that altogether contribute to substance abuse,
a multidisciplinary approach should be used. It is necessary for
health professionals and academic institutions to design
collaborative prevention and intervention strategies.
○ Limitations & Future Research
■ Future studies should explore the longitudinal effects of living away from
the family home on risky alcohol behavior among university students.
■ Studies regarding other illegal drugs apart from cannabis use are scarce, as
most of them solely explore cannabis consumption. However, hard drugs
have pervasive and negative effects on mental health, behavior, and further
Jade Pearson
Specialty 2d/e/f
Addiction Prevention in Higher Education
drug use problems and therefore should be further addressed as they seem
to be prevalent in this population
■ Data collection relied exclusively on self-reported questionnaires, which
may introduce bias. The frequency of illegal drug use (i.e., monthly,
weekly or daily) was not established, and should be comprehensively
explored in future studies.
■ All participants came from one university in Northwest Spain and
participation rate was low. It may be possible that those students with
higher illicit drug consumption may have been less likely to respond as by
doing so, they would be disclosing illegal behavior.
■ Cross-sectional studies cannot establish causality between individual and
environmental factors and substance consumption.
● Flentje, Heck, & Sorensen (2014)
○ Key Points
■ Comparison of transgender and cisgender individuals in substance abuse
treatment.
■ Transgender individuals reported more health problems.
■ Transgender individuals evidenced psychosocial differences.
■ Transgender individuals evidence strengths and challenges to inform
treatment
○ Methodology
■ Transgender (n=199) and non-transgender (cisgender, n=13,440)
individuals were compared on psychosocial factors related to treatment,
health risk behaviors, medical and mental health status and utilization, and
substance use behaviors within a database that documented individuals
entering substance abuse treatment in San Francisco, CA from 2007 to
2009 using logistic and linear regression analyses (run separately by
identified gender).
○ Results
■ Transgender men (assigned birth sex of female) differed from cisgender
men across many psychosocial factors, including having more recent
employment, less legal system involvement, greater incidence of living
with a substance abuser, and greater family conflict
■ Transgender women (assigned birth sex of male) were less likely to have
minor children than cisgender women. Transgender women reported
greater needle use, and HIV testing rates were greater among transgender
women.
■ Transgender men and women reported higher rates of physical health
problems, mental health diagnoses, and psychiatric medications, but there
were no differences in service utilization.
Jade Pearson
Specialty 2d/e/f
Addiction Prevention in Higher Education
■ There were no differences in substance use behaviors except that
transgender women were more likely to endorse primary
methamphetamine use.
■ Transgender men were, however, more than 5 times as likely as cisgender
men to have been living with a substance abuser
■ Transgender individuals evidence unique strengths and challenges that
could inform targeted services in substance abuse treatment.
○ Intervention Strategies
■ Transgender men were more than 5 times as likely as cisgender men to
have been living with a substance abuser. This implies that transgender
men may require additional support while in outpatient treatment,or when
leaving residential treatment, as previous research has suggested poorer
treatment outcomes for individuals in a cohabitating relationship with a
substance abuser
■ The power of non-birth family relationships should be considered in
treatment settings; this is because transgender individuals reported higher
levels of family conflict.
■ Existing research with transgender individuals does suggest that
psychological distress is predictive of nonmedical use of prescription
medication, which is in turn associated with illicit drug use (Benotsch et
al., 2013).
● the findings of increased physical health problems, mental health
diagnoses, and mental health medications indicate that substance
abuse programs need to be prepared to link transgender clients to
care for both physical and mental health
○ Limitations & Future Research
■ Transgender men presenting for substance abuse treatment were
considerably younger to a degree that is likely to be of clinical
significance (the mid-20s for transgender men versus mid-30s for
transgender women and cisgender individuals).
■ It is possible that this was a cohort trend within the San Francisco area,
meaning that there were more young transgender men in this geographical
area at this time,
● trans-gender men were experiencing an earlier onset of substance
abuse problems
● or that this particular cohort was willing to identify as transgender
at a younger age
■ Future research is needed to elucidate the needle use practices of
transgender women and identify the specific substances for which needles
are used and/or shared.
Jade Pearson
Specialty 2d/e/f
Addiction Prevention in Higher Education
■ Transgender women were also more likely to have been tested for HIV.
● These findings suggest that while transgender women are engaging
in higher rates of needle use, they may be more likely to engage in
proactive health behaviors (e.g., HIV testing).
● Future targeted research is necessary to clarify this relationship.
■ Additional research to elucidate the role of minority stress in health
outcomes for transgender individuals is needed
■ This study took place in the urban area of San Francisco, and thus the
results reported here are not necessarily generalizable to other areas of the
country.
■ There may also be sources of resilience among transgender people and
minority communities, such as “community cohesiveness”(Meyer, 2003,
p. 677), which may reduce minority stressors. This suggests that while
transgender individuals may experience increased stress, they may also
have unique sources of strength and resilience.

● Rawson et al. (2015)

○ Key Points
■ This paper reports data from a study designed to determine the impact of
an 8-week exercise program on depression and anxiety symptoms among
newly abstinent methamphetamine (MA)-dependent individuals in
residential treatment.
■ Exercise has a significant effect on reducing depression and anxiety
symptoms among methamphetamine-dependent individuals who are newly
abstinent.
■ A significant dose interaction effect was also found between session
attendance and exercise on reducing depression and anxiety symptoms
over time.
■ Results support the role of a structured exercise program as an effective
intervention for improving symptoms of depression and anxiety associated
with methamphetamine abstinence.
● Methodology
○ One hundred thirty-five MA-dependent individuals, newly enrolled in residential
treatment, were randomly assigned to receive either a 3-times-per-week,
60-minute structured exercise program for 8weeks (24 sessions) or an equivalent
number of health education sessions. Using mixed-modeling repeated-measures
regression, we examined changes in weekly total depression and anxiety scores as
measured by the Beck Depression Inventory and Beck Anxiety Inventory over the
8-week study period.
● Results
Jade Pearson
Specialty 2d/e/f
Addiction Prevention in Higher Education
○ Mean age of participants was 31.7 (SD=6.9); 70.4% were male and 48% Latino.
Analyses indicate a significant effect of exercise on reducing depression
(β=−0.63, P=0.001) and anxiety (β=−0.95, P=0.001) symptoms over the 8-week
period compared to a health education control group.
○ A significant dose interaction effect between session attendance and exercise was
found as well on reducing depression (β=−0.61, P<0.001) and anxiety symptoms
(β=−0.22, P=0.009) over time compared to the control group.
○ Results support the role of a structured exercise program as an effective
intervention for improving symptoms of depression and anxiety associated with
MA abstinence.
○ findings in this study provide valuable information with regard to the potential
benefits of exercise within a treatment population who experience dysphoric
mood states.
● Intervention Strategies
○ \the use of structured exercise can be used as an alternative intervention for
substance use disorders, including promoting smoking cessation (Zschucke,
Heinz, & Ströhle, 2012), reducing cannabis craving (Buchowski et al., 2011), and
promoting sustained recovery among those in recovery (Palmer, Palmer, Michiels,
& Thigpen, 1995).
○ Exercise interventions (ranging from 8 to 12 weeks) have been embraced in
healthcare as a promising approach for populations suffering from an array of
health issues

● Limitations & Future Research

○ Findings may not be generalizable to MA-dependent individuals in other
treatment settings or to those who are not seeking treatment.
○ Participants in the health education session were exposed to sessions around
general health topics, including stress. This may be limiting to the outcomes of
this study since stress education may have an impact on anxiety symptoms.
○ The study sample was predominately male (70%), which reduces the
generalizability of the results to both sexes
Jade Pearson
Specialty 2d/e/f
Addiction Prevention in Higher Education

Annesa Flentje, Nicholas C. Heck, James L. Sorensen, Characteristics of transgender individuals

entering substance abuse treatment, Addictive Behaviors, Volume 39, Issue 5, 2014,
Pages 969-975, ISSN 0306-4603, https://doi.org/10.1016/j.addbeh.2014.01.011

Delgado-Lobete, L., Montes-Montes, R., Vila-Paz, A., Cruz-Valiño, J.-M., Gándara-Gafo, B.,
Talavera-Valverde, M.-Á., & Santos-del-Riego, S. (2020). Individual and Environmental
Factors Associated with Tobacco Smoking, Alcohol Abuse and Illegal Drug
Consumption in University Students: A Mediating Analysis. International Journal of
Environmental Research and Public Health, 17(9), 3019. MDPI AG. Retrieved from
http://dx.doi.org/10.3390/ijerph17093019

E. Zschucke, A. Heinz, A. Ströhle. Exercise and physical activity in the therapy of substance use
disorders. Scientific World Journal, 2012 (2012), p. 901741

Eikenberry, R. (2016). Emotional intelligence and substance abuse in college students (Order No.
10107114). Available from ProQuest Dissertations & Theses Global: The Humanities and
Social Sciences Collection. (1791486139). Retrieved from
https://libproxy.csun.edu/login?url=https://www-proquest-com.libproxy.csun.edu/disserta
tions-th
eses/emotional-intelligence-substance-abuse-college/docview/1791486139/se-2?accounti
d=7285

J.A. Palmer, L.K. Palmer, K. Michiels, B. Thigpen. Effects of type of exercise on depression in
recovering substance abusers. Perceptual and Motor Skills, 80 (1995), pp. 523-530

Kandel, D.; Kandel, E. The Gateway Hypothesis of substance abuse: Developmental, biological
and societal perspectives. Acta Paediatr. 2015, 104, 130–137.

Richard A. Rawson, Joy Chudzynski, Rachel Gonzales, Larissa Mooney, Daniel Dickerson,
Alfonso Ang, Brett Dolezal, Christopher B. Cooper, The Impact of Exercise On
Depression and Anxiety Symptoms Among Abstinent Methamphetamine-Dependent
Individuals in A Residential Treatment Setting. Journal of Substance Abuse Treatment,
Volume 57, 2015, Pages 36-40, ISSN. 0740-5472,
https://doi.org/10.1016/j.jsat.2015.04.007.
Jade Pearson
Specialty 2d/e/f
Addiction Prevention in Higher Education
M.S. Buchowski, N.N. Meade, E. Charboneau, S. Park, M.S. Dietrich, R.L. Cowan, et al.
Aerobic exercise training reduces cannabis craving and use in non-treatment seeking
cannabis-dependent adults PloS One, 6 (2011), p. E17465

Myers, M.G.; Doran, N.M.; Edland, S.D.; Schweizer, C.A.; Wall, T.L. Cigarette smoking
initiation during college predicts future alcohol involvement: A matched-samples study.
J. Stud. Alcohol Drugs 2013, 74, 909–916.