SUBSTANCE ABUSE AND ANXIETY IN AMERICAN COLLEGE STUDENTS
DENNIS RAMIREZ
JESSENIA BALBUENA
WINTRESS JOHNSON
BADELIN ALVAREZ
INTRO
Have you ever felt so worried about a situation that you couldn’t focus on anything else? Imagine being that worried your entire life, with a voice in the back of your head telling you that all is NOT going to be ok. Well, that feeling has a medical name, “anxiety,” and it’s a psychological disorder that makes you extremely worried about what can happen, to a point that might make simple tasks very difficult. Not coming out of the house and not asking for help are some of the more common situations that might be caused by anxiety. Imagine having a brain that always thinks of the worst possible outcome. You may ask “why is this important?” Well, turns out a lot of people live with this condition. Anxiety currently affects about 300 million people worldwide (Intentional Misuse of Over-the-Counter Medications, Mental Health, and Polysubstance Use in Young Adults, 2013). A survey found that about 41% of college students have anxiety, and about 51% are likely to get it. That said, as college students we have a high tendency of getting anxiety. Not only that, college students tend to get creative when it comes to dealing with personal problems. This paper will focus on several studies about the coping mechanisms American college students use to deal with psychological disorders. Specifically, study how substance abuse and anxiety are correlated in American college students. The search terms “substance abuse vs anxiety”, “college students”, and “United States” and a filter from 2010-2019 were used to find this research.
There are many studies correlating substance abuse and mental illness, but most of them find that most substances are not directly responsible for mental illness. Although substances can indirectly influence the development of some psychological disorders we see how people enjoy the occasional drink or other substances, from time to time. Why do people turn to substances when feeling down (symptoms of depression) or even stress (symptoms of anxiety)? The articles to be discussed in this paper are going to give you a clear picture on the relationship between substances, mental illness (focusing on anxiety), and college students in the US.
INTRO OF BODY
“Intentional misuse of Over-the-Counter (OTC) medication, mental health, and polysubstance Use in Young adults” was conducted by Eric G. Benotsch in December 2013. This article focuses on the reasons why young adults (18-25) use OTC medications for recreational purposes. According to the article, the drastic increase in visits to the emergency room (ER) for misuse of OTC within the last 10 years motivated the authors to find the problem. This article does focus more on substance abuse than anxiety but it does correlates them, and even mentions anxiety as one of the problems.
Another article is “College binge drinking and its Association with Depression and anxiety…” by R Nourse, P Adamshick, J Stoltzfus (2016). This article focuses on the relationship between binge drinking (BD) and anxiety, and the consequences of BD on college students. According to the article, the national rate for BD in college campuses is approximately 39 to 44%, and some schools even convey higher BD rates. This has been a problem for over decades now, that according to the article usually leads to mental health problems like anxiety, depression, and in serious cases, suicide.
The article “Everyone else is doing it: examining the role of peer influence on the relationship between social anxiety and alcohol use behaviours” states that college students are socially influenced by their peers. This peer influence situation pressures the increase of alcohol consumption and related problems. The article states that, “almost 50% of students have engaged in heavy drinking at least once within the past two weeks” (U.S. Department of Health and Human Services, National Institute on Alcohol Abuse and Alcoholism [NIAAA], 2012)(Margo Villarosa1, Saarah Kison1, Michael Madson1, and Virgil Zeigler-Hill 2015). There is a high rate of alcohol consumption among college students with “nearly 2000 deaths and an estimated 97,000 alcohol- related sexual assaults and rapes”, (NIAAA, 2012)(Margo Villarosa1, Saarah Kison1, Michael Madson1, and Virgil Zeigler-Hill 2015). College students drink to fit in, to increase social relationships and interaction with others. Resistance to peer influences is subject to less anxiety and more aware of the consequences influenced by alcohol.
The next article would be “Social anxiety and alcohol use: The role of alcohol expectancies about social outcomes”, and the main purpose is to understand the mechanism in determining the alcohol consumption or alcohol related problems that associates with social anxiety and college students. Researchers believe they can track those who are socially anxious with their behavior experiences with alcohol. Anxiety disorder and alcohol usage are common factors in college student life. Therefore, the researchers will be able to examine whether alcohol outcome expectancies play a role in leading to unsafe and extreme drinking issues. A student that has higher levels of anxiety will feel more discomfort and will drink up to feel comfortable. But on the contrary, college students with high levels of anxiety can reject social life but still suffer from drinking related problems or extreme alcohol use.
Other studies like “ The role of mindfulness skills in terms of anxiety-related cognitive risk factors among college students with problematic alcohol use”, and “Social anxiety and drinking refusal self-efficiency moderate the relationship between drinking game participation and alcohol-related consequences” focus on the interactions and consequences college students have with drinking games, and how anxiety can become a potential consequence from this games.
“Self-medication” is defined as the reasoning behind socially anxious people having drinking problems (Strahan, E. Y., Panayiotou, G., Clements, R., & Scott, J, 2010). Self-medication suggests that people “are attempting to medicate themselves for a range of psychological disorders and painful emotional states.” Alcohol has typically been used as a stress reliever, and individuals will use it to reduce their shy and awkward feelings. Between 19% – 22% of college undergraduate students meet the criteria for social anxiety. Those with social anxiety are 2.2-3.5 times more likely to develop alcohol dependence. 36.4% of men and 20.5% of women will meet the criteria for alcohol abuse/dependence at some point in their life (Strahan et al. 2010).
College is also a time in which levels of alcohol and marijuana use peak. Social anxiety makes an individual more vulnerable to substance use disorders. Villarosa et al. (2019) define social anxiety as “elevated psychological distress” in social situations due to the threat of negative evaluation and embarrassment. College students with higher levels of social anxiety also tend to show support to substance disorders, regardless of how much substances they personally use. Previous literature, which has examined the effects of college student’s social anxiety on their alcohol and marijuana use has done so separately. It is unclear whether students have different reasons for using each substance, but individuals with social anxiety tend to use substances more with both positive and negative motives.
The studies all aim to sample substance use within the college-student population. They effectively introduce the relevance and importance of the work to be presented, and why studying particularly college students is so important. Among all the studies analyzed, a range of information regarding social anxiety, substance use, and the college-student population is established.
METHODS
The study conducted by Villarosa et al. recruited 7,307 college students from 10 universities across 10 different U.S. states to participate in an online survey. They were compensated with research participation credit from their school’s Psychology Department. The study does not explain how the locations of these universities were chosen, but does specify the exclusion criteria of only selecting students who had endorsed concurrent marijuana and alcohol use in the past 30 days. The total sample for this study was cut down to 2,034 participants with this exclusion criteria. The study used various established scales to measure social anxiety, alcohol and marijuana use motives, levels of alcohol and marijuana use, and alcohol and marijuana related problems. These established scales were clearly defined with examples.
Another study by Strahan et. al also used self-report measures to assess social anxiety and alcohol use. This study recruited 824 college students from two college campuses in the United States and one university in Cyprus. Both campuses in the United States were from schools in the Midwest with one being medium sized and one a small liberal arts college. This larger campus recruited their subject pool from an Introductory Psychology class and given extra credit for their participation in the study. The larger US campus contained 319 females and 216 males in its sample and the smaller college contained 82 females and 80 males. The Cyprus campus had an overrepresentation of female students in their sample. The students were then given questionnaires to measure their social anxiety and use of alcohol.
For “Intentional misuse of Over-the-Counter (OTC) medication, mental health, and polysubstance Use in Young adults” conducted by Eric G. Benotsch in 2013, the researchers believed that a self-administered anonymous survey would capture the honesty of college students. Because of this, they went to a mid-size university in the rocky mountain region. But, the researchers didn’t only make one survey, they gave out two surveys, the first was brief and went directly to the point, and the second one was a little more elaborated and was administered online. The inclusion criteria for the first survey was 500 students taking psychology classes. They had to be between the ages 18-25. The students were told that the survey contained questions about drug use. The second survey had the same criteria as the first survey, but this one correlated mental health issues with the substance abuse and students were rewarded class credit for completing the survey. Now the methods of survey have really come in handy when it comes to psychological related issues. But the survey we are interested in (the second one) gives the student an incentive to complete the survey, so yes, a lot of students are going to do it. However, it is not guaranteed that they will be telling the truth, which can tilt the results. And let’s not forget it was self-administered.
Another study in 2016, “College binge drinking and its Association with Depression and anxiety…” conducted a Questionnaire and scales (survey), to give them a little more insight on why college students binge drink. The inclusion criteria for this study states that the questionnaire was filled by 201 students at a small private college. With a mean standard deviation age of 21.1 +-3.8 years. It’s important to point out that this questionnaire wasn’t anonymous. Some students also receive a reward of one extra credit point, and all students received 25$ give cards. This contributed to the number of students that completed the questionnaire. In the study, they used what’s called “The alcohol Use Disorders Identification Test (AUDIT)”, which is a questionnaire that identifies problematic alcohol consumption. The “Young Adult Alcohol Consequences Questionnaire (YAACQ)” is also used, which according to the article is “designed to assess the broad range of consequences of heavy drinking.”
In “Social anxiety and alcohol use: The role of alcohol expectancies about social outcomes,” there were a total of 718 undergraduate volunteers ages 18-25. Students were recruited from the Psychology department at Midwestern University. There were no exclusion criteria. All procedures that were made were approved by principles investigator’s Institutional Review Board. Students were compensated for volunteering and a credit was established for their participation. Students ethnicity was shown as: 85% White (non-Hispanic), 2% Hispanic/Latino, 4% Black, 1% American Indian, 3% Asian, 4% other and 1% ethnicity was not reported. Questionnaires were given to students. Questionnaires range from [1 Not at all -5 Extreme likely scale.] Such as, “The Social Expectancies of Alcohol Scale (SEAS) is a 30-item measure (15-item. ‘‘I would feel at ease in social situations.’’) (15-items; e.g. ‘‘I would make a fool out of myself”). Other measures such as (Drinking Expectancy Questionnaire and Comprehensive Effects of Alcohol Scale) were evaluated to help view the correlation between social anxiety and hazardous alcohol use and alcohol consumption.
For the study, “Everyone else is doing it: examining the role of peer influence on the relationship between social anxiety and alcohol use behaviors” there were about 562 college student participants from a university in the southern region of the United States. The participants were between ages 18 through 25 [ 150 men, 412 women]. Participants must have consumed alcohol within 30 days to be eligible. “The racial/ethnic composition of our sample was 58% White non-Hispanic, 37% African American and 5% Other. All students participated in return for partial fulfillment of a research participation requirement. Participants were recruited via an online data management system (i.e. SONA) during the 2012- 2013 academic year and directed to a secure website (Qualtrics), where they completed a University Institutional Review Board-approved informed consent followed by measures of resistance to peer influence, social anxiety, harmful drinking, alcohol-related negative consequences and PBS use”(Margo Villarosa1, Saarah Kison1, Michael Madson1, and Virgil Zeigler-Hill 2015). Participants were given the 20- item Social Interaction Anxiety Scale and the Social Phobia Scale. The scale range from being [0 not at all -4 extremely]. Some questions included were ‘‘I have difficulty making eye-contact with others’’ and ‘‘I get nervous that people are staring at me as I walk down the street’’ to indicate the levels of anxiety each participant. The results would show those who scored higher, it indicated the anxiety levels they had. Other questionnaires were given such as [10-item Resistance to Peer Influence, Scale 0- item Alcohol Use Disorders and Identification Test, The 18-item Protective Behavioral Strategies Scale- revised, The 23-item brief version of the Rutgers Alcohol Problem Index, Daily Drinking Questionnaire], examen further issues to conduct the correlation between each other.
“ The role of mindfulness skills in terms of anxiety-related cognitive risk factors among college students with problematic alcohol use” aimed to find any associations with anxiety and alcohol use. This study consisted of 202 college students, 69% of them being male. These participants self-reported which could raise the question of how authentic the study could be because they could be as honest or as secretive as possible.
The final study analyzed, “Social anxiety and drinking refusal self-efficiency moderate the relationship between drinking game participation and alcohol-related consequences” had a much bigger pool of samples, totaling at 6,000 undergraduate students from two different universities. The study was an open invitation like the first one, meaning both are susceptible to the question of how authentic it is.
The methods of many of these studies are not reproducible and are not necessarily generalizable. Firstly, they do not give a breakdown of the locations of universities and colleges they used and how these selections were made. Because of this, they may not have been choosing school samples to study that are representative of all college-students. Almost all the studies further recruit students their Psychology Departments, with credits and other incentives only being rewarding for these students. This may mean that the studies aren’t even generalizable for the universities at which they are conducted. The sample sizes range from 200 to 2000 students which might also be due to differences in schools selected. Larger universities might have a larger pool of students to recruit from but the social dynamics at these schools may be different from the ones present in smaller colleges. The studies who do breakdowns of gender tend to have higher majorities of female students, but one study, “The role of mindfulness skills in terms of anxiety-related cognitive risk factors among college students with problematic alcohol use” has a large overrepresentation of male participants. These inconsistencies of gender may also affect the results of the studies.
RESULTS
The first study “The role of mindfulness skills in terms of anxiety-related cognitive risk factors among college students with problematic alcohol use” aimed to find any associations with anxiety and alcohol use. The results “indicated that after controlling for the effects of gender, smoking status, marijuana use status and negative affectivity, greater use of the mindfulness skill of observing was associated with higher anxiety sensitivity (AS), greater describing was associated with lower AS and higher DT (distress tolerance), greater non-judgement was associated with lower AS and higher DT, and greater non-reactivity was associated with increased DT.
The study “Social anxiety and drinking refusal self-efficiency moderate the relationship between drinking game participation and alcohol-related consequences” found that “After controlling for sex, age, and typical drinking, higher levels of social anxiety, lower levels of DRSE, and playing drinking games predicted greater alcohol-related consequences. Moreover, two-way interactions (Social AnxietyDrinking Games, DRSEDrinking Games) demonstrated that social anxiety and DRSE (Drug-Related Side Effects) each moderated the relationship between drinking game participation and alcohol-related consequences.” This opposes the common idea that most people believe: drinking games would help you to loosen up around others. But this research was initiated to bring awareness to the topic and show how powerful the presence of alcohol is. With the results found, one of the key points that were made, to help bring change into the drinking game culture is accessibility to professionals, and screening at risk students who would possibly attend harm reduction interventions.
In The Relationship Between Social Anxiety and Alcohol and Marijuana Use Outcomes Among Concurrent Users study participants consumed more alcohol than marijuana in the past 30 days, and reported more social motives behind their alcohol use than their marijuana use (Villarosa et al). Marijuana was used more than alcohol with motives of enhancement. After breaking gown the important means and standard deviations into one paragraph, the results section is further divided up. These paragraphs discuss the effects of marijuana and alcohol use both separately and together. There are two tables provided, Table 1 gives the relationship between all the study variables and is difficult to understand. Table 2 breaks down the motives for alcohol use and marijuana use separately and is much easier to understand. It also directly correlates to the researcher’s hypothesis.
In the Beer, wine, and social anxiety study, students tended to endorse more negative alcohol expectancies when they had social anxiety. For men, those with the highest level of social anxiety were found to drink the least. For women, no relationship was found between social anxiety and alcohol use.
According to the BD study 36.3% of students said that they had anxiety problems before drinking alcohol, 13.4% after they drank. Where in the OTC medication study 12.39% of students reported that they used OTC medication to relieve anxiety symptoms. As predicted the results show that both positive and negative social alcohol outcome expectancies were associated with greater alcohol usage. Social anxiety is one of the key factors that could develop alcohol use. The observation that was found “The total effect of social anxiety on alcohol consumption was non-significant. The indirect effects of positive [B 1⁄4 0.03 (95% CI 1⁄4 0.016, 0.036); p50.001] and negative [B 1⁄4 0.02 (95% CI 1⁄4 0.025, 0.01); p50.001] social Alcohol Outcome Expectancies in the association between social anxiety and alcohol consumption were significant” (Lindsay S. Ham, Amy K. Bacon, Maureen H. Carrigan, Byron L. Zamboanga, and Hilary G. Casner 2015). Their observations were not what they predicted, but instead the studies did not acknowledge gender in their study. And the results show how social anxiety mechanism operates different between the two genders. In their observations woman are higher positively associated with social anxiety and alcohol consumption more than men.
DISCUSSION
The BD study found that it was difficult to associate dangerous alcohol consumption with depression or anxiety meaning they did not found the correlation. This states that you won’t develop anxiety from BD, but it doesn’t cover the fact that college students are using it as a coping mechanism for said disorder. Peer influence and pressure is a major factor in which college students are engaged with alcohol usage and problems stemming from alcohol use (Margo Villarosa1, Saarah Kison1, Michael Madson1, and Virgil Zeigler-Hill, 2015). The study also found that “students believe that alcohol can reduce their emotional discomfort in the form of anxiety…”, but the results from the study suggest that mood regulation is far from being the main reason why college student BD. This means that a couple of students might use alcohol as a coping mechanism for anxiety, while most them use substances irresponsibly, leading to the decaying of mental health and later needing more alcohol to cope with that. So, it sounds like students are using “feelings” of anxiety as an excuse to drink alcohol. This varies in each individual student.
College students who possess higher levels of AS are more likely to drink so that they don’t experience rejection from their peers. It’s more of an indirect form of peer pressure that leads them to become anxious in social settings. The OTC study found data very similar, where 11% of students used OTC drugs to deal with anxiety like symptoms. The main reason for students abusing substance is for recreational purposes.
Being exposed to alcohol varies differently among each college student. Regardless of being socially anxious or not a college student can develop drinking habits. The outcome of alcohol is what keeps college students coming back for more and helps cope with social life and peers.
One research study had to re-do their studies and acknowledge gender. Social anxiety differs differently in sexes. Data showed where women are social anxious then men. This will be inaccurate results because studies didn’t incorporate gender from the start. To prove that women are aiming towards alcohol use and show where women stand with anxiety; gender and size amount would have to be measured equally. Reliable questionnaires are necessary to prove or ensure that a college student is diagnosed with anxiety or not.
These studies were initiated to bring awareness to the topic and show how powerful the presence of alcohol is. With the results found, one of the key points that were made, to help bring change into the drinking game culture is accessibility to professionals, and screening at risk students who would possibly attend harm reduction interventions. This research study demonstrate how protective strategies can be also helpful although college students with lower levels of anxiety tend to use this strategy more than the ones with higher levels of anxiety. The article can be very helpful to students on campus who feel pressured to drink and socialize.
The researchers do discuss the limitations of the study. The sample is not representative of all college students due to their method of recruitment. The study uses volunteers, the majority are compensated through their Psychology Department. Some universities offer credits for their participation and some would not benefit from this research at all. The study further does not discuss the reliability of the self-report measures that it utilizes. The sample sizes were unbalanced in few of the studies. Some samples were overbalanced with female students than men. For some studies, the sample size wasn’t large enough. Some studies did not address ethnicity, but one demonstrated the substance use of Caucasians was more predominant. Also, the anxiety most of the students were experiencing wasn’t clinically diagnosed and was instead self-reported. They performed a self-report survey which is not that reliable in all cases. The studies did have a considerable number of participants they took students from different universities, meaning different environments. While all of the studies provide insightful and interesting information that contribute to the significance of the problem, their reliability is still questionable.
