The present study found that approximately 1 in every 10 undergraduate students reported three or more DAST-10 items in the past year from using a substance other than alcohol. However, less than 6% of undergraduate students who reported three or more DAST-10 items had ever used treatment services for substance abuse. These findings suggest that institutions of higher education may need to provide opportunities for screening to detect students at risk for drug abuse. More importantly, additional efforts are needed to ensure that adequate assessment, monitoring, and treatment options are available for those individuals at risk for drug abuse.
The findings of this study revealed some important gender differences. Although the 12-month prevalence of any illicit use of drugs other than alcohol did not differ as a function of gender, undergraduate men were significantly more likely than women to report DAST-10 items. Previous studies have found that DAST results are not correlated with gender (
Martino, Grilo, & Fehon, 2000;
Skinner & Goldberg, 1986;
Staley & El-Guebaly, 1990). However, gender differences in illicit drug use behaviors among college students suggest the need to examine possible gender differences in drug abuse (e.g.,
Johnston et al., 2004;
McCabe, Knight, et al., 2005;
McCabe, Schulenberg, et al., 2005).
We found that 9% of the overall sample and 23% of illicit drug users reported using more than one drug at a time in the past 12 months. These prevalence rates are alarming in light of the consequences associated with polydrug use. For example, more than half (54%) of drug-related emergency department visits in 2002 involved two or more substances, providing evidence for the increased risk associated with polydrug use (
SAMHSA, 2004). The simultaneous use of substances may conceal the effects of an individual drug due to drug interactions, failing to signal high levels of intoxication or potential overdose to the user (
Earleywine & Newcomb, 1997). The present study also found that past year polydrug users reported significantly higher mean scores on the DAST-10, which adds to a growing body of evidence for a positive relationship between polydrug use and drug abuse (
Stephens, Roffman, & Simpson, 1993).
As expected, results showed that the past 12-month frequency of illicit drug use—particularly marijuana use—was positively associated with DAST-10 scores. Positive associations between the frequency of use of psychedelics, cocaine, and ecstasy and DAST-10 scores were also observed. Findings also showed that earlier age of onset of marijuana and psychedelic use was predictive of DAST-10 scores for male and female students, whereas early-onset cocaine use among women was associated with the DAST-10. These findings indicate that college students using these substances at an earlier age are at increased risk for subsequent development of drug abuse. These results mirror those from studies of early-onset alcohol and drug use (e.g.,
Grant & Dawson, 1997,
1998;
Grant, Stinson, & Harford, 2001;
Muthen & Muthen, 2000) and highlight the importance of early drug prevention efforts.
4.1. Implications for practice
The finding that 1 in every 10 undergraduate students surveyed reported three or more DAST-10 items in the past 12 months clearly demonstrates a need for increased substance abuse assessment and treatment among undergraduate college students. This need is further supported by the fact that, among those individuals who reported three or more DAST-10 items in the past 12 months, fewer than 6% had ever used treatment services for substance abuse. Thus, the challenge in this population lies in identifying those students who may be in need of services and in assessing the severity of the problem (given early-onset indicators) to recommend the appropriate level of treatment. The burden of assessment and referral rests on those who have contact with students in environments most likely to have the desired outcome (i.e., acceptance of a referral); typically, this will be health care or health-care-related settings such as counseling centers, health centers, hospitals, and other clinics that see college students. However, others on campus could be in positions to identify those in need of services, including hidden populations less likely to be detected, such as minorities and women. Furthermore, additional opportunities for substance abuse detection are often presented to those managing and monitoring academic and nonacademic discipline cases, sports teams, social fraternities and sororities, and campus residence halls. With limited effort, all of these settings include personnel who could be trained in detection and referral strategies. Interestingly, the second most frequently cited DAST-10 item in this study was “feeling bad or guilty about drug use”—a factor that could potentially serve to heighten referral acceptance and treatment motivation.
Although some college health centers currently screen for alcohol abuse, the findings of this study suggest that colleges and universities should also provide screenings for abuse of drugs other than alcohol. The DAST-10 may be a useful initial screening instrument for the detection of potential problematic illicit drug use among college students. For example, brief drug screening using the DAST-10 (or similar instruments) could be administered by health professionals during face-to-face visits. Furthermore, such brief screening instruments can be made available online for self-administration, and problematic scores can be referred for a more in-depth assessment.
4.2. Strengths and limitations, and future research
The present study has several strengths that build upon past research examining drug use among college students. First, the study featured a brief screening instrument that has proven reliability and validity in clinical and nonclinical populations. Second, this study focused on a wide range of drugs other than alcohol, which represents an understudied topic among college students. Finally, there were an adequate number of undergraduate women and men for the assessment of gender differences.
The current study also has some limitations that should be taken into account while considering the implications of the findings. The cross-sectional nature of the data precludes determination of the mechanisms underlying the observed associations. There is a great deal of variation between rates of illicit drug use across U.S. college campuses (e.g.,
Gledhill-Hoyt et al., 2000;
McCabe, Knight, et al., 2005); thus, caution should be exercised when generalizing our findings to a larger population of college students. However, despite this limitation, our findings provide strong evidence that studies with college-age samples should include measures to assess drug use and abuse for substances other than alcohol. Colleges and universities with traditional-age students are advised to add such measures because college students and young adults between 18 and 29 years appear to be more likely than other age groups to meet criteria for
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (
DSM-IV) alcohol abuse or dependence diagnoses, and marijuana abuse or dependence (e.g.,
Compton et al., 2004;
Dawson, Grant, Stinson, & Chou, 2004;
Knight et al., 2002). Finally, the DAST-10 does not cover all of the problems that are known to be related to drug use, including some
DSM-IV criteria. Although the DAST-10 has been used in clinical and nonclinical settings, it has not been used widely in college populations. Despite the limitations, the DAST-10 is a promising screening instrument for detecting possible drug abuse among college students. Further validation of the DAST-10 using survey research and standard clinical interviews is needed to confirm optimal cutpoints for sensitivity and specificity among college students. Related research needs to compare rates of
DSM-IV drug use disorders between young adults in college and those not attending college because the rates of alcohol dependence have been shown to be higher for college students (e.g.,
Dawson et al., 2004).
Past college-based longitudinal studies have shown that many forms of drug use tend to increase during the transition from high school to college and then decline as students graduate and assume postcollege responsibilities (e.g.,
Johnston et al., 2004;
Schulenberg et al. 2001;
Sher & Gotham, 1999). However, more prospective longitudinal studies are needed to examine whether these findings also apply to the course of drug use disorders among college students. Such longitudinal efforts would help advance theory regarding the epidemiology of drug abuse during the transition from adolescence through young adulthood and would shed light on the long-term implications of drug abuse in college.
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