Research has demonstrated that campus-wide prevention campaigns focusing on information or awareness tend to have minimal effect on actual alcohol or drug use behaviors². Several studies have even demonstrated an increase in maladaptive drug-related attitudes and/or drug use with non- classroom prevention programming. This is more often the case for didactic, informational, or general skills-based programs using abstinence-oriented approaches with high-risk (i.e., currently drug using) populations ^2–6. While it is hoped that academic health courses (e.g., drug use, nutrition and exercise, sexuality, etc.) increase knowledge, awareness, and interest in these topics among undergraduates, little research has been conducted to examine the effects of academic substance use courses on college student attitudes and actual health behaviors.

In a review of the literature, we located one study that found reduced alcohol use after an undergraduate nursing course; however, campus-wide prevention efforts occurred simultaneously⁷. A second study reported reduced drug use and related negative consequences after a semester-long course based on abnormal and health psychology among students who had violated campus drug regulations⁸. A general health awareness course at the American University of Beirut found improvements in stage of change for several areas including smoking, fruit and vegetable intake, and exercise ⁹. Another study saw improvements in cancer prevention attitudes and behaviors in a course called “The Nature of Cancer”¹⁰. No other studies evaluating general academic drug education courses were located in our review of the literature. However, Norton and colleagues found that introductory psychology students reported more positive attitudes toward smoking than a general sample of college students¹¹.

The rationale for the current exploratory study was to determine the effects (positive, negative, or neutral) of an academic drug education course on drug-related attitudes and behaviors among college students. Such courses could provide a valuable opportunity to inform and supplement drug prevention programming. It is important to first identify existing effects of drug and alcohol course curricula on student attitudes and behaviors given the possibility that such courses may increase knowledge while also encouraging maladaptive attitudes and harmful drug use behaviors. To examine the effects of drug course content on attitudes and behaviors, the current study utilized a quasi-experimental design comparing pre-post drug and alcohol knowledge, attitudes, and behaviors among students in a drugs and behaviors course and two other psychology courses.

The current study focused on several hypotheses:

The current research was a quasi-experimental study following students in three academic courses across a semester. Students in all three classes were equally emotionally and physically healthy at baseline. Across the entire sample, students reported a decrease in emotional well-being throughout the semester, as might be expected due to academic pressures. Additional assistance for students in coping with academic pressures could help maintain emotional well-being and potentially stave off increases in substance use across the semester²⁴. Males in abnormal psychology experienced greater increases in emotional role limitations than females over the course of the semester. It is possible that exposure to the abnormal psychology course made men more aware of emotional issues than they would have been otherwise. Exposure to such courses could be helpful in funneling distressed men into psychological counseling, since they are typically less likely to enroll in counseling than women²⁵. Additionally, drugs and behavior students and drug users were more likely than others to have had risky sex during the semester. Risk behaviors tend to cluster together²⁶; thus, preventing substance use could reduce risky sex and sexual assault among college students. Combined prevention programming could be beneficial among this population.

As hypothesized, students in the drugs and behavior class reported slightly higher levels of substance use at baseline than did other students, perhaps reflecting the attraction to such courses among more high risk individuals. While drugs and behavior students did not know more about substances than students in other courses at the start of the semester, they did learn more about them over the duration of the class, suggesting that substance use courses could be viable opportunities for prevention efforts, given appropriate course content.

Gender was also a clear determinant of self-reported substance use. Men reported greater levels of substance use at baseline than did women in the drugs and behavior class. Across the entire sample, there was a trend toward higher levels of alcohol use at baseline among men than women, as would be expected from the literature²⁷. Thus, college men are in greater need of substance prevention and treatment efforts than women. An academic substance use course may be a non-threatening outlet for substance use programming among this population.

Perceived prevalence of alcohol use was higher at baseline among students in the drugs and behavior course and became slightly more accurate over time than the estimates of students in the other classes. In this particular regard, students in the drugs and behavior class were more knowledgeable than other students, and course material on substance use prevalence appeared to increase their knowledge somewhat regarding alcohol use prevalence. Perceived norms is one of the best predictors of college alcohol consumption²⁸. Several studies have found normative reeducation to be effective for alcohol prevention among college students². One study also found that normative perceptions of protective behavioral strategies for alcohol consumption were related to actual use of these protective strategies²⁹. In addition to campus-wide efforts at normative reeducation, the college classroom could be another venue for such interventions.

Perceived vulnerability to the consequences of hypothetical regular substance use did not vary across class, gender, or time-point, however. On average, students in this study reported a moderate level of concern about negative consequences from using drugs or alcohol. In several prior studies, young adults have reported that they are less likely to experience negative health consequences than are their peers^{30, 31}. Realistic consequences of substance use could easily be incorporated into course content, hopefully resulting in an increase in perceived vulnerability. However, even when perceived vulnerability increases among young people, this increase may not always be associated with a decrease in risky behaviors such as drinking and smoking³². For example, one study found that negative perceptions of and motives for alcohol consumption predicted alcohol-related problems but not alcohol consumption per se²⁸. More research on perceived vulnerability, its relationship to substance use behaviors, and strategies for designing interventions accordingly is needed in order to inform course content.

Across the entire sample, marijuana expectancies became less favorable over time. While positive expectancies for marijuana remained stable for males in the drugs and behavior class, they tended to decrease for males in the other classes. It is possible that this difference is accounted for by the fact that students in the drugs and behavior class were exposed in some depth to several other classes of drugs (e.g., heroin) that were perceived to be more harmful than marijuana. Alcohol expectancies did not vary across class, gender, or time-point, however. Prior studies have found alcohol expectancies to be predictive of college alcohol use and night clubbing^{26, 33}. Studies have also found alcohol expectancy challenges to reduce alcohol use even among heavy drinking college students³⁴. Alcohol expectancy challenges involve demonstrating pseudo-intoxication after being given placebo alcohol, thus demonstrating some of the psychosocial and contextual factors involved in alcohol use. Some form of an alcohol expectancy challenge (or even a video of an expectancy experiment) may be able to be utilized effectively in the college classroom. The differences in expectancies between marijuana and alcohol may partially be a function of familiarity and personal experience – as reported earlier, over 95% of all participants had used alcohol recently. In contrast, 40% had ever used marijuana, and 33% had used marijuana within the last month at post-test.

Across the entire sample, there was a trend toward an increase in the perceived similarity of oneself to the prototypical drug user, particularly among females. However, students’ positive perceptions of the prototypical drug user decreased among those not in the drugs and behavior class. It is possible that as students become increasingly exposed to substance use throughout their college experience, they become more aware of the negative consequences of drug use. Interventions targeting drug user prototypes among young people may be helpful in reducing actual substance use ^{16, 35, 36}. If college students develop a negative perception of drug users as a result of their experiences in and out of the classroom, they might be motivated to reduce their own drug use.

Men reported greater expectation of using substances than did women at pre-test, and women’s expectations decreased over time but were low at both time points. However, male students’ self-reported behavior throughout the semester varied by type of substance. Across the entire sample, self-reported alcohol use decreased throughout the semester, with this decrease being statistically significant among male but not female students. There was a trend toward an increase in tobacco use across the semester, particularly among men. Binge drinking is common among college students, particularly men³⁷, yet the novelty of this behavior may wear off over the course of a semester. However, nicotine is highly addictive, so tobacco users may become more tolerant of its effects, thus tending to increase its use over the same timeframe. Furthermore, the post-test assessment coincided with the end of the semester – a potentially stressful time. It is conceivable that male tobacco users increased their smoking in response to this stress whereas female smokers employed other stress-reducing strategies. This is entirely speculative, however; motives for substance use were not assessed.

The CASA study found prevalence rates of 33% for marijuana and 6% for cocaine use in 2005 ¹. In the current study, 39.5% of students self-reported marijuana use, and 7.5% reported using stimulants, including cocaine, at pre-test. Thus the overall rates of use in this study are similar to those in other studies, However, whereas the proportion of males who reported using marijuana was roughly equal to the proportion of females (44% vs. 38%), males were almost four times more likely to report using stimulants than were females, 16% compared to 4.7%. Although males (non-significantly) increased their tobacco use during the semester, suggesting a potential target for intervention, it is encouraging that males decreased their alcohol consumption and that drug use among both genders did not increase. Moreover, females did not increase their alcohol consumption or smoking, and their expectancies for using substances decreased. Almost all college students have used alcohol, and at least a third of our sample had used other drugs. The characteristics of students who have and have not used drugs other than alcohol likely differ from one another. This suggests the potential benefit of using different intervention approaches for these groups. For example, harm reduction would be more appropriate than abstinence-only programs for those who have already used drugs³⁸.

Strengths of this research include the use of a pre-post design, the inclusion of students from three different courses which varied greatly in content, and the measurement of many different variables and constructs related to health, substance use, attitudes, and behavioral precursors such as behavioral intention and willingness. Results suggest that exposure to the substance use curriculum did not increase use. It did result in increased knowledge and more accurate normative perceptions of the prevalence of alcohol use. Normative reeducation is one of the approaches that has demonstrated some success in substance use prevention programming². Limitations include the quasi-experimental design, reliance on self-report, and limited diversity of the sample, including the unequal proportions by gender.

While the primary goal of an academic drug education course may not be drug use prevention per se, it may be worthwhile to consider how course content can overlap with broader, empirically-validated prevention efforts on campus, or be feasibly incorporated into such efforts. This is especially important given that some studies have demonstrated harmful effects on substance-related attitudes and behaviors among high risk populations with the use of certain approaches (e.g., didactic, informational, or general skills-based programs using abstinence-oriented approaches) that are employed currently in college classrooms^2–6. To further examine the potential synergistic influence of blending substance use-related course content with drug prevention efforts, future researchers should use prospective, experimental methods prior to implementation in the classroom, perhaps using randomization to compare the impact of isolated vs. blended prevention components on operationally-defined behaviors among groups of students. For example, further examination of how substance-related attitudes influence behaviors should be conducted in controlled settings before testing components in the classroom. Also, using well-defined theoretical frameworks (e.g., The Prototype/Willingness Model¹⁵) to guide experimental studies could facilitate understanding of how best to implement and interpret effects of blending drug prevention education in the classroom with broader prevention efforts.