The Impact of Mental Health Substance Abuse on Student Success

1. The Impact of Mental Health Substance Abuse on Student Success Mental Health on Campus: We all Play a Part! Ohio Program for Campus Safety and Mental Health Conference May 20, 2014 Columbus State Community College Conference Center Amelia M. Arria, Ph.D.Associate ProfessorDirector, Center on Young Adult Health and DevelopmentDepartment of Behavioral and Community HealthUniversity of Maryland School of Public Healthaarria@umd.edu

2. Today’s Overview PART 1: Substance Use and Mental Health Problems among College Students PART 2: Impact of Substance Use and Mental Health on Academic Achievement a. Academic Behaviors b. GPA and Discontinuous Enrollment c. Goal Diffusion and Attenuation d. Dropout PART 3: Innovative Strategies and Solutions to Maximize Student Potential a. Addressing “Hardware” Issues b. Addressing “Software” Issues c. Addressing Connectivity Issues

3. PART 1: Substance Use and Mental Health

4. Post College Year 3 Summer Orientation First Year Sophomore Year Junior Year Senior Year Post College Year 1 Post College Year 2 Post College Year 4 Baseline Interview (n=1,253) 24 Months: Interview (n=1,101) 88% 48 Months: Interview (n=1,019) 81% 72 Months: Interview (n=982) 78% Screening (n=3,401) 60 Months: Interview (n=1,001) 80% 84 Months: Interview (n=951) 76% 36 Months: Interview (n=1,097) 88% 12 Months: Interview (n=1,142) 91%

5. Major Domains Measured in the College Life Study Demographics Family Composition Gender Race/Ethnicity Socioeconomic Status Parental Education Alcohol and Other Drugs DSM-IV Disorders Quantity/Frequency Consequences Nonmedical Prescription Drug Use Sharing & Selling Prescription Drugs Perceived Harmfulness Individual Characteristics Personality/Temperament Religiosity Sensation-seeking Physical Health Academic Achievement Personal Goals Employment Quality of Life Stress & Social Support Mental Health Major Depression Bipolar Disorder Anxiety Disorder ADHD Suicidal Behaviors Peer Relations Peer Drug Use Parent Influences Parental Monitoring Relationship Quality Communication Parental Authority Style Family History Health Services

8. Mental health and substance use • Excessive drinking, drug use, and mental health problems tend to cluster among the same students, but their effects on academic outcomes do not overlap completely. • The effects of mental health and substance use on academic outcomes are separate and additive. • Academic consequences of drinking (e.g., falling behind on work, missing class) can be more pronounced when the drinker also has mental health problems.

9. Marijuana use and Mental Health • Some studies have demonstrated an association between marijuana use and bipolar, major depression and mania (Henquet, 2006). • Clear evidence has accumulated showing that marijuana is a contributory factor for the development of schizophrenia (DiForti, 2009; Bossong, 2010; Arseneault, 2004).

10. National Data: Past-month alcohol and other drug use among 18-22 year olds by college enrollment % of students *“Binge use” defined as “Five or more drinks on the same occasion at least once in the past 30 days.” **“Heavy use” defined as “Five or more drinks on the same occasion on each of 5 or more days in the past 30 days.” ***Among persons aged 18 and older. Source: Substance Abuse and Mental Health Services Administration, Results from the 2011 National Survey on Drug Use and Health: Detailed Tables, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012.

11. National Data: Past-month alcohol and other drug use among 18-22 year old college students by sex % of students *“Binge use” defined as “Five or more drinks on the same occasion at least once in the past 30 days.” **“Heavy use” defined as “Five or more drinks on the same occasion on each of 5 or more days in the past 30 days.” Source: Substance Abuse and Mental Health Services Administration, Results from the 2011 National Survey on Drug Use and Health: Detailed Tables, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012.

12. National Data: Past-month alcohol and other drug use among 18-22 year old college students by race/ethnicity % of students Source: Substance Abuse and Mental Health Services Administration, Results from the 2011 National Survey on Drug Use and Health: Detailed Tables, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012.

13. National Data: Past-month drug use among 18-22 year old college students by race/ethnicity % of students Source: Substance Abuse and Mental Health Services Administration, Results from the 2011 National Survey on Drug Use and Health: Detailed Tables, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012.

14. Alcohol, tobacco, and illicit drug use by educational level among persons aged 26 and older *“Binge use” defined as “Five or more drinks on the same occasion at least once in the past 30 days.” **“Heavy use” defined as “Five or more drinks on the same occasion on each of 5 or more days in the past 30 days.” ***Among persons aged 18 and older. Source: Substance Abuse and Mental Health Services Administration, Results from the 2011 National Survey on Drug Use and Health: Detailed Tables, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012.

15. Estimated probabilities of developing alcohol dependence based on drinking level at college entry Drinking level at college entry: High-risk Drinkers:26% (6+ drinks/day) Estimated probability of developing alcohol dependence Medium Risk Drinkers: 40% (3-5 drinks/day) Low-risk Drinkers: 22% (1-2 drinks/day) Non-drinkers: 12% Year of College

16. Source: College Life Study. Not to be shown or redistributed without written permission from Amelia M. Arria, PI

17. Illicit and nonmedical drug use in the first four years of college 70.0 63% Year 4 60.0 Year 3 Year 2 50.0 Year 1 40.0 Weighted percent of students who used drug at least once in lifetime Pre- College 30% 30.0 23% 16% 20.0 13% 13% 8% 7% 10.0 3% 1% 0.0 Marijuana Prescription Prescription Hallucinogens Inhalants Prescription Ecstasy Amphetamines Cocaine Heroin Analgesics Stimulants Tranquilizers Data weighted to adjust for both sampling bias and attrition.

18. 12-Month prevalence of psychiatric disorders among college students

19. How many college students screen positive for current mental health problems? *During the past 4 weeks

20. PART 2: Impact on Academic Achievement

21. Overall, only 3 in 8 first-time traditional-age students receive a degree within 4 years

22. %

25. Results Five-Year STEM Completion Rates by Race

28. “Low college completion rates—as with the declining rates of high school completion—are depriving the nation of college-educated and trained workers need to keep the American workforce competitive globally.” Impact on Global Competitiveness

29. Interlocking Dimensions of Student Success • Motivated • Cognitively Strong • Supported

30. Mechanisms Excessive drinking and drug use Academic performance ? • “Hijacking” brain reward pathways • Peer affiliation • Brain development • Decreased sleep

31. Neurobiological Consequences of Alcohol use In adolescents, heavy alcohol use is associated with: • Structural and function changes in the brain • Differences in sleep patterns • Poor planning • Impaired executive functioning • Spatial deficits • Attention deficits

32. Neurobiological Consequences of marijuana use Acutely, marijuana use is associated with: • Attention and concentration difficulties • Decreased working memory • Decreased information processing • Decreased decision response speed Longer-term… • Impaired planning, organizing, and problem solving • Deficits to allocation of attentional resources and filtering out irrelevant material • Retrieval and immediate verbal memory deficits

33. Neurobiological Consequences of Marijuana Use • Deficits are more likely when marijuana use is initiated earlier in life and when use is more frequent. • Early chronic marijuana use is associated with declines in IQ of up to 8 points. (Corresponds to a drop from the 50th to 30th percentile)

35. Conceptual Model Long-Term Outcomes Short-Term Manifestations Intermediary Processes • Delayed Graduation • Failure to Graduate • Attenuation of Goals • Lack of Readiness for Employment • Underemployment • Skipping Class • Studying Less • Decreased Motivation • Poor Quality/Less Sleep • Cognitive Problems • Declining GPA • Dropping Classes • Lost Opportunities (internships, work, special studies)

36. PART 2: Impact on Academic Achievementa. Academic Behaviorsb. GPA and Discontinuous Enrollment c. Goal Diffusion and Attenuationd. Dropout

37. Excessive Drinking and Academic Performance • Alcohol, sleepiness, and GPA (Singleton and Wolfson, 2009) • Excessive drinking and fewer interactions with faculty (Porter and Prior, 2007) • Alcohol use and decreases in GPA (Pascarella, 2007)

38. High-intensity drinkers were individuals in the top gender-specific quartiles for both quantity and frequency of alcohol use. High-intensity drinkers were significantly different from all others regardless of year (p<.001). Source: College Life Study. Not to be shown or redistributed without written permission from Amelia M. Arria, PI

39. Overall drug use frequency inclusive of marijuana, hallucinogens, cocaine, amphetamines, ecstasy, heroin, and nonmedical use of prescription stimulants, analgesics, and tranquilizers. Non-users were significantly different from both drug-using groups, and the “50 or more” users were significantly different from the “1-49” users (all p<.001). Source: College Life Study. Not to be shown or redistributed without written permission from Amelia M. Arria, PI

40. Misperceptions about nonmedical prescription stimulant use “It doesn't seem to be causing too much trouble since most [students] use the drugs not to get high but to function better…. When exams are over, they go back to normal and stop abusing the drugs.” —Prominent university psychiatrist quoted in U.S. News & World Report, March 3, 2008

41. Research shows that nonmedical stimulant users spend less time studying, skip classes more often, and earn lower grades.

42. Marijuana Dependence Marijuana Use Academic Performance Skipping Class Time Nonmedical Use of Prescription Stimulants for Studying

43. How many college students screen positive for current mental health problems? *During the past 4 weeks

44. Seven commonly-cite threats to a student’s ability to persist • Delayed enrollment • Part-time enrollment • Being a single parent • Having children under 18 • Being financially independent of one’s parents • Working full-time • Lacking a high school diploma

45. PART 2: Impact on Academic Achievementa. Academic Behaviors b. GPA and Discontinuous Enrollment c. Goal Diffusion and Attenuationd. Dropout

46. Marijuana and alcohol use: relationships to discontinuous enrollment First year alcohol use (typical number of drinks/day) and frequency of marijuana use was related to late discontinuity, even after controlling for demographics, psychiatric symptoms and diagnosis, and high school GPA. “Late discontinuity”: Years 3-4 (n=233) 20% Continuously enrolled Years 1-4 (n=805) 70% • (n=107) • 9% “Early discontinuity” Years 1-2 • Arria et al. (in press) Discontinuous enrollment during college: Associations with substance use and mental health. Psychiatric Services.

47. Marijuana use trajectories: relationship to “discontinuous” enrollment Chronic/Heavymarijuana users were 2.0 times as likely as “minimal users” to have discontinuous enrollment……even after controlling for demographics, personality, and high school GPA. 40.8% stop-out 36.1% stop-out 30.5% stop-out 36.1% stop-out 24.9% stop-out Arria, A.M., Garnier-Dykstra, L.M., Caldeira, K.M., Vincent, K.B., Winick, E.R., O'Grady, K.E. (under review). Drug use patterns and continuous enrollment in college: Results from a longitudinal study. Journal of Studies on Alcohol and Drugs.

48. Drugs other than marijuana: relationship to “discontinuous” enrollment “High-level” drug users were 2.0 times as likely as “minimal users” to have discontinuous enrollment… even after controlling for demographics, personality, and high school GPA. 41.0% stop-out 34.9% stop-out 24.2% stop-out Arria, A.M., Garnier-Dykstra, L.M., Caldeira, K.M., Vincent, K.B., Winick, E.R., O'Grady, K.E. (under review). Drug use patterns and continuous enrollment in college: Results from a longitudinal study. Journal of Studies on Alcohol and Drugs.

49. Mental Health and Discontinuous Enrollment in College • Nearly half of students say that their mental health affected their academic performance in the past month. • The presence of a psychiatric disorder makes a student significant less likely to complete a college degree, especially when the disorder is diagnosed during college.

50. Mental Health Problems Related to discontinuous Enrollment During College Individuals who were diagnosed with depression during college were three times more likely to experience early discontinuity, even after controlling for demographics, drug and alcohol use, and high school GPA. “Late discontinuity”: Years 3-4 (n=233) 20% Continuously enrolled Years 1-4 (n=805) 70% (n=107) 9% “Early discontinuity” Years 1-2 Arria et al. (in press) Discontinuous enrollment during college: Associations with substance use and mental health. Psychiatric Services.