Objective Examine trends in nonmedical use of prescription stimulants (NPS), including motives, routes of administration, sources, cost, and risk factors. Participants 1,253 college students. Methods Data were collected annually during academic years 2004–5 through 2008–9. Generalized estimating equations analyses evaluated longitudinal trends. Logistic regression models evaluated stability of associations between risk factors and NPS over time. Results Almost two-thirds (61.8%wt) were offered prescription stimulants for nonmedical use by Year 4, and 31.0%wt used. Studying was the predominant motive (73.8 to 91.5% annually), intranasal administration was modest (<17% annually), and the most common source was a friend with a prescription (≥73.9% annually). Significant changes over time included: decreasing curiosity motives, increasing overuse of one’s own prescription, and increasing proportion paying $5+ per pill. Lower GPA and alcohol/cannabis use disorders were consistently associated with NPS, holding constant other factors. Conclusions Prevention opportunities exist for parents, physicians, and college administrators to reduce NPS.

This study tested the hypothesis that college students’ substance use problems would predict increases in skipping classes and declining academic performance, and that nonmedical use of prescription stimulants (NPS) for studying would occur in association with this decline. A cohort of 984 students in the College Life Study at a large public university in the US participated in a longitudinal prospective study. Interviewers assessed NPS; Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) cannabis and alcohol use disorders; and frequency of skipping class. Semester grade point average (GPA) was obtained from the university. Control variables were race, sex, family income, high school GPA, and self-reported attention deficit hyperactivity disorder diagnosis. Longitudinal growth curve modeling of four annual data waves estimated the associations among the rates of change of cannabis use disorder, percentage of classes skipped, and semester GPA. The associations between these trajectories with NPS for studying was then evaluated. A second structural model substituted alcohol use disorder for cannabis use disorder. More than one-third (38%) reported NPS for studying at least once by Year 4. Increases in skipping class were associated with both alcohol and cannabis use disorder, which were associated with declining GPA. The hypothesized relationships between these trajectories and NPS for studying were confirmed. These longitudinal findings suggest that escalation of substance use problems during college is related to increases in skipping class and to declining academic performance. NPS for studying is associated with academic difficulties. Although additional research is needed to investigate causal pathways, these results suggest that nonmedical users of prescription stimulants could benefit from a comprehensive drug and alcohol assessment to possibly mitigate future academic declines.

Marijuana is the most prevalent illicit drug used by adolescents and young adults, yet marijuana initiation is rarely studied past adolescence. The present study sought to advance our understanding of parent and peer influences on marijuana exposure opportunity and incident use during college. A sample of 1,253 students was assessed annually for four years starting with the summer prior to college entry. More than one-third (38%wt) of students had already used marijuana at least once prior to college entry; another 25%wt initiated use after starting college. Of the 360 students who did not use marijuana prior to college, 74% were offered marijuana during college; of these individuals, 54% initiated marijuana use. Both low levels of parental monitoring during the last year of high school and a high percentage of marijuana-using peers independently predicted marijuana exposure opportunity during college, holding constant demographics and other factors (AOR=0.92, 95% CI=0.88-0.96, p<.001 and AOR=1.11, 95% CI=1.08-1.14, p<.001, respectively). Among individuals with exposure opportunity, peer marijuana use (AOR=1.04, 95% CI=1.03-1.05, p<.001), but not parental monitoring, was associated with marijuana initiation. Results underscore that peer influences operate well into late adolescence and young adulthood and thus suggest the need for innovative peer-focused prevention strategies. Parental monitoring during high school appears to influence exposure opportunity in college; thus parents should be encouraged to sustain rule-setting and communication about adolescent activities and friend selection throughout high school.

ABSTRACT. Objective: Few longitudinal studies have examined the relationship between illicit drug use and academic outcomes among college students. This study characterized drug use patterns of a cohort of young adults who were originally enrolled as fi rst-time, fi rst-year college students in a longitudinal study. It evaluated the association between these drug use patterns and continuous enrollment during college, holding constant demographic characteristics, high school grade point average, fraternity/sorority involvement, personality/temperament characteristics, nicotine dependence, and alcohol use disorder. Method: Participants (n = 1,133; 47% male) were purposively selected from one university and interviewed annually for 4 years, beginning with their fi rst year of college, regardless of continued college attendance. Enrollment data were culled from administrative records. Group-based trajectory analyses characterized 4-year longitudinal drug use patterns. Two grouping variables were derived based on (a) marijuana use frequency and (b) number of illicit drugs used other than marijuana. Seventy-one percent of the sample was continuously enrolled in the home institution during the fi rst 4 years of study. Results: Multivariable logistic regression models demonstrated that infrequent, increasing, and chronic/heavy marijuana use patterns were signifi cantly associated with discontinuous enrollment (adjusted odds ratio = 1.66, 1.74, and 1.99, respectively), compared with minimal use, holding constant covariates. In separate models, drug use other than marijuana also was signifi cantly associated with discontinuous enrollment. Conclusions: Marijuana use and other illicit drug use are both associated with a decreased likelihood of continuous enrollment in college, independent of several other possible risk factors. These fi ndings highlight the need for early intervention with illicit drug users to mitigate possible negative academic consequences. (J. Stud. Alcohol Drugs, 74, 71-83, 2013)

Objective-This study describes help-seeking among college students with a lifetime history of suicide ideation.Methods-Life-history interviews assessed psychological distress episodes, formal treatment, and informal help-seeking among 158 college students with lifetime suicide ideation history.Results-The first distress episode typically occurred in adolescence (62%; n=94); 52% (n=78) had episodes in both adolescence and young adulthood. Overall, 87% (n=131) received informal help, 73% (n=110) received treatment, and 61% (n=92) received both. Depression, anxiety, more lifetime episodes, and earlier onset were positively associated with obtaining treatment. Leading sources of help were family (65%), friends (54%), psychiatrists (38%), and psychologists (33%). Treatment barriers reflected ambivalence about treatment need/effectiveness, stigma, and financial concerns.Conclusions-Most students had some contact with treatment, but family and friends might be important gatekeepers for facilitating treatment access. Parents of college-bound children should consider continuing mental health care over time.Keywords college students; service delivery; suicide; suicidal behavior; treatment utilization Suicide remains a leading cause of death among U.S. young adults (1) and college students in particular, among whom one in ten contemplated suicide during the previous year, and 1-2% made an attempt (2,3). Suicide ideation is sometimes regarded as a transitory (4), yet epidemiologic evidence indicates that adolescent suicide ideation often recurs in adulthood (5). Campus counseling center directors have observed recent increases in the number of college students exhibiting severe mental health problems (6), including suicidality (7).Unfortunately, among U.S. adolescents, only 28% of suicide ideators received counseling in the past year (8). Help-seeking rates are similarly low among college students with suicide ideation (3,9), with typically cited barriers including a preference to manage the problem on one's own, fears about what others might think (10), negative attitudes and beliefs about mental health services, and stigma (11).Help-seeking can include both formal professional treatment and informal help (e.g., friends, parents, and informational resources). Few studies have explored informal help-seeking in young adults. Australian researchers asked youth about recent problems that caused them "considerable distress" and found that students sought help more readily from informal sources than professionals (12).The current study focused on an understudied population-namely, college students with a lifetime history of suicide ideation-and used a novel life history interview method to capture a broad range of help-seeking behaviors. The study aimed to: describe help-seeking behaviors; explore the degree of continuity between pre-college and college experiences with psychological distress and/or help-seeking; examine the sociodemographic correlates of service utilization; and describe barriers among students with an...