SUBSTANCE USE HARM REDUCTION IN RESIDENCE HALLS Jordan Salinsky Graduate Supervisor for Residential Programs and Services - Indiana University Bloomington
Introduction
Housing and residential life practitioners often observe substance use in the residence halls through reading incident reports, responding to duty calls, and in conduct hearings with students. Out of 6,211 Indiana college students between the ages of 18-25 surveyed as part of the 2019 Indiana College Substance Use Survey, 60.8% of students reported consuming alcohol in the month before the survey; 25.5% reported using electronic cigarettes and other vapors; 20.7% reported using marijuana; 10% reported smoking cigarettes; and 3.7% of students reported using stimulants not prescribed to them (King & Jun, 2019, p. 6). 33.3% percent of students, regardless of being over 21, reported binge drinking in the previous two weeks, which can be defined as consuming four or more drinks for females and five or more drinks for males (King & Jun, 2019, p.10). Alcohol is the most common substance to be consumed. College students consume alcohol for social camaraderie, to improve moods, and to reduce tensions that accompany being a student (Labrie et. al, 2007, p. 395). While alcohol consumption can cause people to relax and reduce anxieties, alcohol consumption and intoxication is also a factor in many violent crimes, from battery to sexual assault (Advokat et. al, 2019, pp. 346-348). In residence halls and campus housing, prevention and reduction of substance use and abuse is critical
to ensuring community safety. As alcohol and drug use is often aggregated for college students, prevention approaches may overlap. There are multiple effective approaches for substance use. Student Codes of Conduct and Substance Use Prevention
Institutions often have policies for alcohol and drug use and position in residence halls and on campus property. At Indiana University Bloomington, Residential Programs and Services’, policies are described in the Code of Student Rights, Responsibilities, and Conduct. The code includes prohibition of “public intoxication, use, or possession of alcoholic beverages on university property” and states that students may be disciplined for, “unauthorized possession, manufacture, sale, distribution, or use of illegal drugs, any controlled substance, or drug paraphernalia. Being under the influence of illegal drugs or unauthorized controlled substances” (The Trustees of Indiana University, 2021a). Implementing a blanket “dry campus” policy is not an effective environmental-level strategy to reduce students’ alcohol use on campus. Such policies are rated low on the College Alcohol Intervention Matrix and may stigmatize substance use as inherently wrong (National Institute on Alcohol Abuse and Alcoholism, 2021; Students for Sensible Drug Policy, 2021). Subsequently, relying solely on policy as a prevention or deterrent method is
motivational interviews can be used to...[give] students the agency to change.
ineffective, as students may seek solutions to avoid policy violations such as moving to an offcampus location to engage in risky substance use (Larimer et. al, 2005, p. 444). Student affairs practitioners often learn about student substance misuse through policy violations. It is important to move beyond punitive sanctions to educational sanctions that can assist with reducing substance use on campus. Promising Prevention Approaches
As an abstinence-focused approach towards substance use on campus is ineffective, colleges and universities should shift prevention and reduction strategies to a harm reduction approach, which moves from merely mitigating risk to changing students’ behaviors related to substance use. Motivational Interviewing
Motivational interviewing is a technique where therapists and other clinicians offer feedback about willingness to change behaviors, using reflective listening in a way where clients come to their own conclusions about change (Larimer et. al, 2005, pp. 440-441). In relation to alcohol and drug use amongst college students, motivational interviews can be used to facilitate conversations about reducing substance use while giving students the agency to change. A study conducted by McCambridge and Strang (2004) demonstrated significant reduction in drug, tobacco, and alcohol use for student participants after hour-long peer motivational interviews, thus suggesting that motivational interviewing is an effective method of preventing substance use for this population (Larimer et. al, 2005, p. 437). While implementing peer-led motivational interviews may not be feasible in residential life, incorporating brief motivational interventions (BMIs) as educational approaches can successfully reduce both alcohol and drug use.
Residential life departments can partner with campus counselling and/or substance use reduction prevention centers to incorporate the following: The Brief Alcohol Screening and Intervention for College Students (BASICS) uses motivational feedback about students’ alcohol consumption, perception about other students’ consumption, and education about blood alcohol content and risk factors. While BASICS is specific to alcohol use, addressing risk factors that can cross use of multiple substances has demonstrated to reduce self-reported alcohol, marijuana, and cocaine use (Dennhardt & Murphy, 2013, p. 2613). There is potential for incorporating BMIs for cannabis use. Dennhardt & Murphy (2013) reported that an in-person cannabis and stimulant BMI containing an exercise about decision making, a discussion about potential consequences of drug use, and a conversation about drug use and students’ goals decreased subjects’ substance use on average from 15.7 times per week to 5.4 times per week (p. 2613). Limitations to the motivational methods as the primary prevention approach regards the availability of resources and for students to access services. Adopting structured motivational interviews requires trained counselors and/or student affairs practitioners and peer facilitators to conduct motivational interviews, which may not be reasonable given the scale of students using alcohol and drugs riskily and the capacity of counselling centers and prevention offices. Online Motivational Practices
The College Alcohol Intervention Matrix rates individual-level strategies that may reduce college students’ alcohol use and lists a multi-
component education focused program (MCEFP), in the form of the two-part program as a higher effectiveness approach (National Institute on Alcohol Abuse and Alcoholism, 2021). As an educational approach, housing and residential life practitioners can incorporate: AlcoholEdu is a two-to-three-hour long course with various modules taken by incoming firstyear students that is often mandated by universities. The modules provide feedback about misperceptions around alcohol use and risky drinking on campus, include interactive exercises, and incorporate strategies about reducing binge drinking and consequences (Paschall et. al, 2011). The second component, which occurs during the first semester of undergraduate studies, reviews material from the first course, introduces brief new content, and has students take a followup survey (Paschall et. al, 2011). Paschall et. al (2011) found that students participating in the AlcoholEdu intervention had significantly lower risks of alcohol programs than at schools not participating in the program as well as had lower risks for problems related to social and sexual violence victimization impacts. As AlcoholEdu uses student responses to customize the feedback and content shown as students progress through the modules, this approach may be seen as more relevant for students to engage in. At this time, there is not an online program adapted for marijuana and other drugs including cocaine and stimulants; however, this is a potential area for growth as a mandatory harm reduction approach for all students living in residence halls. Stress Reduction and Substance Use Prevention
Students may consume alcohol and other substances as a coping mechanism for stressors
associated with being in college (Labrie et. al, 2007, p. 393). In the 2019 Indiana College Substance Use Survey, 55.6% of respondents consumed alcohol as a means to relax, and 14.9% of respondents consumed alcohol as a means to escape their problems (King & Jun, 2019, p. 15). McHugh et. al (2020) confirmed that high levels of stress were common for men and women in substance use disorder treatment and that comorbidity rates of major depressive disorder were 65.7% over the lifetime (p. 2). However, providing interventions in the form of individual and group counseling served to reduce self-reported stress levels and substance use over a period of nine months (p. 4). This implies that treating underlying conditions, like stress and depression symptoms, for college students may be an effective mechanism of reducing substance use. An overview of 24 studies about stress reduction amongst college students found that cognitive, behavioral, and mindfulness-based interventions were most effective for reducing symptoms of stressinduced anxiety (Regehr et. al, 2013, p. 7). Housing and residential life practitioners can promote stress reduction for students in the residence halls by incorporating the following approaches: Encouraging students to use online resources that assist with stress reduction. At Indiana University Bloomington, all students have free access to WellTrack, which is a mobile application utilizing cognitive behavioral aspects through assessments and tools to help students “identify, understand, and address issues like stress, resiliency, anxiety, and/or depression” (The Trustees of Indiana University, 2021b). Partnering with campus offices to offer stress reduction programs for students. At Indiana University Purdue University Indianapolis, Counselling and Psychological Services offers
free weekly guided meditation workshops for students (The Trustees of Indiana University, 2021c). Other suggestions include hosting yoga or other relaxation-focused classes in residence halls and encouraging student staff members to utilize passive strategies like bulletin boards to share stress reduction tips and relevant campus resources. Which is the most effective prevention approach?
Dick and Hancock (2015) write that “effectively addressing substance use requires a coordinated approach across the university and its academic and administrative units.” Thus, substance use prevention and reduction is not the sole responsibility of one department and must involve multiple stakeholders to better reach students living and learning on campus. Ultimately, there is not a substance abuse prevention or reduction approach for college students that is universally most effective, as student body characteristics and institutional cultures influence what might work best at a particular institution. For example, at a liberal arts college boasting a close-knit peer culture, a hall-based social norms prevention approach for cannabis use may be more effective than at a large, public institution due to student investment in the sense of a campus community. There are opportunities to develop strategies beyond individual-level approaches and for harm reduction strategies specifically targeting commonly abused non-alcohol substances like marijuana, prescription pills, and other illicit drugs, as institutional approaches have long prioritized alcohol prevention and reduction. Engaging students in stress-reduction interventions in residence halls can contribute to bettering the mental health of college students and improving coping skills for stress, which can reduce the desire to consume substances as a coping mechanism.
References Advokat, C.D., Comaty, J.E., & Julien, R.M. (2019). Julien's primer of drug action: A comprehensive guide to the actions, uses, and side effects of psychoactive drugs. Worth Publishers. Dennhardt, A.A., & Murphy, J.G. (2013). Prevention and treatment of college student drug use: A review of the literature. Addictive Behaviors, 38(10), 2607-2618. https://doi.org/10.1016/j.addbeh.2013.06.006 Dick, D.M., & Hancock, L.C. (2015). Integrating basic research with prevention/intervention to reduce risky substance use among college students. Frontiers in Psychology, 6(54). https://www.frontiersin.org/articles/10.3389/fpsyg.2015.00544/full King, R., & Jun, Y. (2019). Results of the Indiana college substance use survey 2019. Indiana University Institute for Research on Addictive Behavior. https://iprc.iu.edu/publications/icsus/ICSUS_Survey_2019.pdf Labrie, J.W., Hummer, J.F., & Pederson, E.R. (2007). Reasons for drinking in the college student context: The differential role and risk of the social motivator. Journal of Studies on Alcohol and Drugs, 68(3), 393-398. https://www.jsad.com/doi/pdf/10.15288/jsad.2007.68.393 Larimer, M.E., Kilmer, J.R., & Lee, C.M. (2005). College student drug prevention: A review of individually-oriented prevention strategies. Journal of Drug Issues, 35(2), 431-456. McHugh, R. K., Sugarman, D. E., Meyer, L., Fitzmaurice, G. M., & Greenfield, S. F. (2020). The relationship between perceived stress and depression in substance use disorder treatment. Drug and Alcohol Dependence, 207(107819), p. 1-4. National Institute on Alcohol Abuse and Alcoholism. (2021). Environmental level strategies. College Alcohol Intervention Matrix. https://www.collegedrinkingprevention.gov/CollegeAIM/EnvironmentalStra tegies/defaul t.aspx National Institute on Alcohol Abuse and Alcoholism. (2021). Individual-level strategies. College Alcohol Intervention Matrix. https://www.collegedrinkingprevention.gov/CollegeAIM/IndividualStrate gies/default.aspx#close Paschall, M.J., Antin,T., Ringwalt, C.L., & Saltz, R.F. (2011). Effects of AlcoholEdu for college on alcohol-related problems among freshmen: A randomized multicampus trial. Journal of Studies on Alcohol and Drugs, 72(4), 642-650. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3125887/ Regehr, C., Glancy, D., & Pitts, A. (2013). Interventions to reduce stress in university students: A review and meta-analysis. Journal of Affective Disorders, 148(1), 1-11. Students for Sensible Drug Policy. (2021). Introduction. https://ssdp.org/campus-policy-gradebook/ The Trustees of Indiana University. (2021a). H. Be responsible for their behavior, and respect the rights and dignity of others both within and outside of the university community. Code of Student Rights, Responsibilities, & Conduct. https://studentcode.iu.edu/responsibilities/on-campus-personal.html The Trustees of Indiana University. (2021b). Meet WellTrack, a new mobile app to support your mental health. Student Health Center. https://healthcenter.indiana.edu/counseling/well-track.html The Trustees of Indiana University. (2021c). Mindfulness meditation. Division of Student Affairs. https://studentaffairs.iupui.edu/health/wellnessprograms/resources/mindfulness-meditation.html