Heavy Drinking and Non-Medical Use of Prescription Drugs among University Students: A 9-Year Follow-Up

Nonmedical Use of Controlled Medications by Adolescents and Young Adults: Clinical Report

Nonmedical prescription drug use (NMPDU), the use of controlled prescription medications for purposes other than initially intended by the prescriber, is common among adolescents and young adults (AYAs). Prescription stimulants, sedatives, and opioid medications are the 3 main categories of controlled medications nonmedically used by AYAs. The intent of this clinical report is to provide an overview of the epidemiology, motives, sources, and risk factors of NMPDU among AYAs. This report also describes acute and long-term morbidity and mortality associated with NMPDU and discusses the importance of primary and secondary prevention to reduce the burden of NMPDU among AYAs. This report concludes with a series of recommendations on how pediatricians can address NMPDU with patients and their families.

Drug use among medical students in São Paulo, Brazil: a cross-sectional study during the coronavirus disease 2019 pandemic

BACKGROUND

Medical students demonstrate higher rates of substance use than other university students and the general population. The challenges imposed by the coronavirus disease 2019 (COVID-19) pandemic raised significant concerns about mental health and substance use.

OBJECTIVES

Assess the current prevalence of substance use among medical students at the University of São Paulo and evaluate the impact of the COVID-19 pandemic on drug consumption.

DESIGN AND SETTING

A cross-sectional study was conducted on 275 medical students from the University of São Paulo Medical School (São Paulo, Brazil) in August 2020.

METHODS

Substance use (lifetime, previous 12 months, and frequency of use before and during the COVID-19 pandemic) and socioeconomic data were assessed using an online self-administered questionnaire. Symptoms of depression were assessed using the Patient Health Questionnaire-9.

RESULTS

Alcohol was the most consumed substance in their lifetime (95.6%), followed by illicit drugs (61.1%), marijuana (60%), and tobacco (57.5%). The most commonly consumed substances in the previous year were alcohol (82.9%), illicit drugs (44.7%), marijuana (42.5%), and tobacco (36%). Students in the first two academic years consumed fewer substances than those from higher years. There was a decreasing trend in the prevalence of most substances used after the COVID-19 pandemic among sporadic users. However, frequent users maintained their drug use patterns.

CONCLUSION

The prevalence of substance use was high in this population and increased from the basic to the clinical cycle. The COVID-19 pandemic may have affected the frequency of drug use and prevalence estimates.

A 2-year follow-up of the effects of combined binge drinking and cannabis consumption on academic performance and adjustment in Spanish third-year university students

Introduction

The study was based on 2-year follow-up of the effects of binge drinking and cannabis co-consumption on academic performance and adjustment in Spanish Third-Year University Students and to further explore the impact of academic adjustment on this relationship.

Methods

A total of 144 students (aged 19-20 years) enrolled in the third year of university completed the study. The students were recruited during in first academic year (T1) via a survey that included items regarding the use of alcohol (AUDIT-C), cannabis and other drugs and demographic variables. Then, participants meeting the study criteria were then selected and invited by e-mail to a clinical (face-to face) structured interview. The participants completed a calendar of alcohol consumption during the 6 months prior to the interview (Alcohol Timeline Follow back), and recorded cannabis consumption in 3 months prior to the interview. To examine the effects of alcohol and cannabis co-consumption on the outcome variables, we categorized participants into three consumption groups (i.e., control, BD, and BDCA) based on the number of BD days and cannabis unit scores.

Results

Binge drinking and cannabis co-consumption in first-year students was significantly associated with poor academic performance and adjustment after 2 years of undergraduate study. Relative to controls, co-consumers (BDCA) reported significantly lower academic and personal-emotional adjustment to university as well as poorer performance. Mediation analysis showed that academic adjustment explains the mechanism by which BDCAs perform less well, mediating the relationship between co-consumption and academic performance, with an indirect effect representing 64.61% of the total effect. Furthermore, the mediating effect of academic adjustment was maintained after controlling for academic adjustment and baseline grade point average (T1).

Conclusion

This prospective follow-up study helps to further our knowledge of how combined binge drinking and cannabis consumption may affect university adjustment and academic success in Spanish university students Overall, the study results should encourage health professionals, educational psychologists and academic institutions to take ownership of the need for support and involvement in prevention, as well as for provision of guidelines for implementing appropriate intervention strategies.

Severity of behavioral addiction symptoms among young adults using non-prescribed sedatives/hypnotics

Introduction

Young adulthood is considered a critical period in terms of non-medical use of sedatives/hypnotics (NMUSH) as well as different types of behavioral addictions (BAs). However, the relationship between these behaviors has received scarce attention among young adult samples. Therefore, the aim of the present study was to investigate the association between NMUSH and symptoms of distinct BAs among young adults.

Materials and methods

Analyses were conducted based on the data of two large sample studies (including a representative sample) carried out with young adult samples. The following BAs were assessed: problematic internet use, problematic video gaming, problematic social media use, problem gambling, exercise addiction, eating disorders, compulsive buying behavior, problematic mobile phone use, work addiction, and hair pulling. Symptoms of distinct BAs were analyzed in three groups formed based on the NMUSH: non-users, lifetime users, and current users.

Results

The symptoms of problematic internet use, problematic social media use, problem gambling, exercise addiction, eating disorders, compulsive buying behavior and work addiction were significantly more severe among lifetime and/or current non-medical sedative and hypnotic users, compared to the non-user participants. The symptoms of problematic mobile phone use were the most severe in the non-user group.

Conclusions

The results suggest co-occurrence between NMUSH and distinct BAs among young adults. These findings draw attention to the need for preventive interventions for this high-risk population.

Alcohol Consumption among Freshman College Students in Spain: Individual and Pooled Analyses of Three Cross-Sectional Surveys (2005, 2012 and 2016)

Objective: We aimed to evaluate changes in the prevalence of Heavy Episodic Drinking (HED) and Risky Consumption (RC) in freshman college students between 2005, 2012 and 2016; and to identify the explanatory variables of these patterns of consumption using individual and pooled analyses. Methods: A cross-sectional study involving 5260 students was carried out in Spain in 2005, 2012 and 2016. HED and RC were determined using the Alcohol Use Disorders Identification Test. Another questionnaire was used to measure parental education level and alcohol use, alcohol-related problems, age of onset of alcohol use and alcohol-related expectancies. Adjusted Odds Ratios (ORs) of RC and HED and their 95% Confidence Intervals were estimated using logistic regression. Results: An increase in the prevalence rates of HED and RC was observed among women during the three-study periods, nonetheless there was no statistically significant difference in the prevalence rates among men. High maternal educational level, living away from parental home, initiating drinking before the age of 15 and having positive expectancies about drinking are associated with higher prevalence of RC in both genders. High positive expectancies and early onset of alcohol use are associated with higher rates of HED among men and women. Students recruited in 2012 and 2016 are protected against RC in comparison to those recruited in 2005. Conclusions: The age of alcohol consumption onset is the most influencing factor on HED and RC for both genders in the three-study periods. Alcohol prevention campaigns targeting youth at early ages can reduce risky drinking behaviors.

The Prevalence of Substance Misuse and its Effects among Omani College Students: A Cross-sectional Study

Objectives

Many studies have confirmed that the use of alcohol, tobacco, and cannabis is prevalent among university students. This study aimed to assess the prevalence of substance misuse among college students in Oman, identifying the most commonly used substances, and reviewing the effect of substance misuse on the students’ performance.

Methods

This cross-sectional study was conducted in a higher learning institution in an urban setting in Oman from April 2018 to December 2018. A descriptive, self-administered online questionnaire, the Alcohol, Smoking, and Substance Involvement Screening Test, version 3.0 (Arabic version), adapted from the World Health Organization was sent to 12 000 students at the college. The sample size was calculated using online software (Raosoft), with a margin of error of 5% and a confidence level of 95%.

Results

A total of 375 students responded (response rate = 3.1%). The overall lifetime prevalence for any substance misuse (including tobacco and alcohol) among the participants was 41.3%, with the overall prevalence without tobacco or alcohol at 29.9%. Tobacco was the most common substance used, with a prevalence of around 23.5%, followed by alcohol at 10.7%. Male students had a significantly higher rate of substance abuse, for any substance, compared to female students (p < 0.001). There was a significant correlation between tobacco use, alcohol misuse, and misuse of other substances. Most of the adverse effects attributed to substance misuse reported by the respondents in this study were social (27.7%) and health-related (25.8%) problems. The impact of substance abuse on their performance was also high (23.8%). Furthermore, 15.4% of the respondents had financial problems, and 4.7%% were struggling with legal issues. Notably, only 49.1% of the respondents perceived that substance misuse was a serious problem.

Conclusions

Although college students are expected to be more aware of the negative impacts of substance misuse, this study found a high prevalence of smoking, alcohol, and other substance misuses among the group of Omani college students. Further research in this field is essential, and the results of this study have shed light on a critical problem among Omani college students. It is hoped that the findings of this study will be used and built on in future research to recognize students at risk of substance misuse from early school life, leading to early intervention, and potentially preventing the possible negative consequences.

Real-time associations between young adults' momentary pain and prescription opioid misuse intentions in daily life

Managing pain has been identified (mainly through retrospective reports) as a robust motivator for individuals engaging in prescription opioid misuse. However, surprisingly little work has directly examined whether momentary pain experiences are associated with prescription opioid misuse in daily life. Participants included 297 young-adult college students recruited on the basis of recent prescription drug misuse. Ecological momentary assessment over a 28-day period was utilized to collect participants' pain experiences and prescription opioid misuse intention and behavior. Hierarchical generalized linear modeling and binary logistic regression tested hypotheses. Findings revealed that higher in-the-moment pain was positively associated with intentions to engage in prescription opioid misuse, accounting for report timing and participant sex and background substance use. Also, the between-person result indicated that participants who reported higher levels of pain across the reporting period were more likely to intend to misuse prescription opioids in daily life. There was a similar reliable association between higher pain ratings across the reporting period and greater likelihood of engaging in misuse behavior, although actual misuse frequency was low. Reliable moderation was observed: As hypothesized, the within-person association between momentary pain and misuse intentions was stronger for females compared with males. Also, the within-person link between pain and misuse intentions was stronger for those who reported lower (vs. higher) levels of problematic alcohol use; this was not consistent with the hypothesized direction. Understanding the role of college students' pain in their intentions to engage in prescription opioid misuse is important for informing future research and prevention efforts. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Acute effects of alcohol on cardiac electrophysiology and arrhythmogenesis: Insights from multiscale in silico analyses

Acute excessive ethyl alcohol (ethanol) consumption alters cardiac electrophysiology and can evoke cardiac arrhythmias, e.g., in 'holiday heart syndrome'. Ethanol acutely modulates numerous targets in cardiomyocytes, including ion channels, Ca²⁺-handling proteins and gap junctions. However, the mechanisms underlying ethanol-induced arrhythmogenesis remain incompletely understood and difficult to study experimentally due to the multiple electrophysiological targets involved and their potential interactions with preexisting electrophysiological or structural substrates. Here, we employed cellular- and tissue-level in-silico analyses to characterize the acute effects of ethanol on cardiac electrophysiology and arrhythmogenesis. Acute electrophysiological effects of ethanol were incorporated into human atrial and ventricular cardiomyocyte computer models: reduced I_Na, I_Ca,L, I_to, I_Kr and I_Kur, dual effects on I_K1 and I_K,ACh (inhibition at low and augmentation at high concentrations), and increased I_NCX and SR Ca²⁺ leak. Multiscale simulations in the absence or presence of preexistent atrial fibrillation or heart-failure-related remodeling demonstrated that low ethanol concentrations prolonged atrial action-potential duration (APD) without effects on ventricular APD. Conversely, high ethanol concentrations abbreviated atrial APD and prolonged ventricular APD. High ethanol concentrations promoted reentry in tissue simulations, but the extent of reentry promotion was dependent on the presence of altered intercellular coupling, and the degree, type, and pattern of fibrosis. Taken together, these data provide novel mechanistic insight into the potential proarrhythmic interactions between a preexisting substrate and acute changes in cardiac electrophysiology. In particular, acute ethanol exposure has concentration-dependent electrophysiological effects that differ between atria and ventricles, and between healthy and diseased hearts. Low concentrations of ethanol can have anti-fibrillatory effects in atria, whereas high concentrations promote the inducibility and maintenance of reentrant atrial and ventricular arrhythmias, supporting a role for limiting alcohol intake as part of cardiac arrhythmia management.

Individual and Environmental Factors Associated with Tobacco Smoking, Alcohol Abuse and Illegal Drug Consumption in University Students: A Mediating Analysis

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. Several individual and environmental factors associate with substance abuse in this population, and the mediating effect of alcohol abuse in the relationship between tobacco smoking and drug consumption is yet to be explored. 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. 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 (PLS-SEM). The results indicated that substance abuse is associated with being male, living with other students, and combined substance consumption. PLS-SEM 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.

We Need to Delay the Age of Onset of Alcohol Consumption

In recent years, new consumption patterns, such as binge drinking, have increased among young people and have not always been recognized as problematic either by health personnel or by society in general, as they are intensive episodes, interspersed with no consumption periods. Although the prevalence of alcohol use disorders in the adult population continues to be higher in men than in women, these gender differences in relation to alcohol consumption are barely observed in adolescents between 14 and 18. Therefore, we are witnessing a change in the pattern of consumption, from regular to episodic, and an attenuation of gender differences. New patterns of alcohol consumption have not only been associated with an increased risk of alcohol use disorders in adult life, but also with neurocognitive involvement in youth. Understanding the risk and resilience factors of alcoholism or problematic drinking patterns will not only allow us to identify the most vulnerable group, but also to guide prevention programs towards protective factors; the skills that contribute to the natural abandonment of the pattern. Knowing the variables involved in the trajectories of abandonment and dependency would contribute to personalizing the interventions and increasing their efficacy and success—a lower relapse rate—, reducing the economic and socio-sanitary costs associated with alcohol dependency, as well as improving the health and well-being, family relations, work and social status of alcohol-dependent people.

The Use of Non-Prescribed Prescription Drugs and Substance Use Among College Students: A 9-Year Follow-Up Cohort Study

The use of non-prescribed prescription drugs (NPPD) is common in post-modern societies and a significant proportion of youth consume NPPD concomitantly to other drugs. We studied the prevalence of this consumption among university students in Spain, and its relationship to different patterns of alcohol, tobacco, and cannabis use. A cohort study among university students (n=1,380) (2005-2015) was carried out. Students completed self-administered questionnaires at initial (n=1,363, 98.7%), at 2 years (n=875, 75%) and 9 years of follow-up (n=415, 30.5%). Consumption of medicines (last 15 days), risky alcohol consumption (RC), heavy episodic drinking (HED), and tobacco and cannabis use were measured. Multilevel logistic regressions for repeated measures were generated using consumption of medicines with or without medical prescription as dependent variables. Prevalence of RC, HED, tobacco and cannabis had significant reductions during the follow-up. The use of NPPD increased over time, from 35.5% and 33.3% at 18 and 22 years old, respectively, to 49.6% at 27 years old. The highest rates were found among cannabis, tobacco, RC and HED users. For females, cannabis and RC constitute signitifant risk factors for use of NPPD. Conversely, for males, tobacco and cannabis were risk factors for such use of medicines. Later onset of alcohol consumption constitutes a protective factor for females. Our results reveal high prevalence of NPDD among university students. Those who consume NPPD are -at the same time- more likely to be alcohol, tobacco, and cannabis users than those who take medication under prescription. Preventive strategies should be reinforced and focused on this target population to decrease these high levels of poly-consumption.

Prescription Drug Misuse in "Clubbers" and Disco Goers in Ibiza

Background: Prescription drug misuse and its related risks are considered a worldwide public health issue. Current trends show that the extent of such phenomenon may not be limited to subjects with psychiatric disorders, as it also spreads to dance party and nightclub attendees, who often consume prescription drugs in combination with alcohol and psychoactive substances. This study aims to report the sociodemographic data and the psychiatric and clinical features of a sample of clubbers reporting prescription drugs use. Methods: Patients admitted to the psychiatry ward of the Can Misses Hospital in Ibiza were recruited for the study during a span of four consecutive years (2015-2018). The inclusion criteria were age 18-75 years old and the intake of psychoactive substances or more than five alcohol units during the previous 24 h. Substance use habits, psychopathological features, and use of unprescribed pharmaceuticals were investigated. Urine samples were collected and analyzed using gas chromatography/mass spectrometry. Results: A total of 110 subjects with psychoactive substance intoxication were recruited for the study. Among these, 37 (40%) disclosed the use of prescription drugs without medical supervision. The most common compounds were benzodiazepines (66%), antiepileptic drugs (8%), antidepressants (6%), opioids (6%), antipsychotics (6%), stimulants (6%), and non-steroidal anti-inflammatory drugs (NSAIDs, 2%). Prescription drug misuse was negatively associated with the use of psychodysleptics (two-tailed Fisher's exact test p = 0.018, ρ = -0.262). Conclusions: The use of prescription drugs is also common among clubbers, usually characterized by low propensity to be prescribed benzodiazepines, antipsychotics, or antidepressants. Prescription drugs may be an alternative to classic and novel psychoactive compounds or may be used to tamper and self-medicate the effects determined by the use of substances. Party goers should be adequately informed about possible risks of co-intake of psychoactive substances and prescription drugs to prevent serious medical and psychiatric consequences.

Perceived Social Support from Significant Others among Binge Drinking and Polyconsuming Spanish University Students

Sense of acceptance is conceived as a central component of perceived social support and is thought to be a key resilience factor for adjustment during transition to university. The current study examines how a binge drinking pattern of alcohol consumption and the co-consumption of binge drinking and cannabis in first-year university students are related to perceived acceptance from family, mother, father, and friends. The study sample consisted of 268 women and 216 men, of average age 18.25 years (SE = 0.01), enrolled in the first year of different degree courses at the University of Santiago de Compostela. Participants were classified in three groups (control, binge drinking, polyconsuming) on the basis of the Timeline Followback for alcohol and cannabis. Perceived sense of acceptance was measured using the Perceived Acceptance Scale. Analysis of the data revealed that perceived acceptance was lower in polyconsuming students than in the binge drinking and control groups (p < 0.05; with η2 ranging between 0.009 and 0.020). A curvilinear relationship between binge drinking and perceived acceptance from friends was identified. Social support should be considered in future investigations and interventions as a vulnerability marker for detrimental consequences of substance use and risk of consumption disorders, as well as adolescent maladjustment.