The Development of the Substance Use Wellness Tool on University Campuses

PURPOSE: Substance misuse and associated problems in postsecondary educational settings are prevalent. Increasing awareness of substance use patterns and potential consequences depends on developing a way of thinking and talking about this issue that resonates with young people. As part of a larger study focusing on substance use and mental health, the purpose of this study is to develop and validate the Substance Use Wellness Tool, developed by occupational therapists, that serves as a tool to raise awareness and early detection of student substance misuse issues on university campuses.

DESIGN: This study used a mixed-method design involving a participatory research process for tool construction and a quantitative survey for empirical validation. In Phase 1, a participatory research process was used to cocreate the wellness tool with campus stakeholders. A series of focus groups were held with students and parents of students to dialogue about their perceptions of how substance misuse is expressed among students. All focus group data were transcribed verbatim. The qualitative analysis focused on describing specific thoughts, feelings, opinions, activities, experiences, and language related to substance use in the context of the campus culture.

After initial construction of the tool, iterative validation of the content was conducted through consultation with experts in the substance research field. In Phase 2, to empirically validate the tool, a survey was sent to undergraduate students on two university campuses that included the Substance Use Wellness Tool and two standardized screening instruments—the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Abuse Screening Test (DAST)—to demonstrate associations among these tools.

RESULTS: The Substance Use Wellness Tool identifies substance use patterns according to the degree of disruption in a continuum across 13 dimensions (control, amount and frequency, coping, peer pressure, patterns of use, peer use, motivation, relationship, activity, academic, physical, financial, and behavioral) of daily student life from no disruption (green), mild disruption (yellow), and moderate disruption (orange) to severe disruption (red). Among 3,652 completed responses, 80.2% of male and 85.5% of female participants described their substance use as green, 15.0% of male and 11.0% of female participants as yellow, 3.7% of male and 3.0% of female participants as orange, and 1.1% of male and 0.4% of female participants as red. In particular, 16.9% of students reported excessive use of substances at least once a week, and 18.3% of students used substances in social situations as a response to peer pressure. Significant correlations between the tool and the AUDIT (r = .73, p < .01) and DAST (r = .59, p < .01) were found.

CONCLUSION: Using a risk-based color spectrum from green to red, the Substance Use Wellness Tool allows students to place themselves on the spectrum using characteristics described in the continuum as a way to self-monitor their mental health status and substance use behaviors. This study revealed substance misuse issues among university students. The findings indicate good concurrent validity with the AUDIT and DAST. The Substance Use Wellness Tool provides an excellent structure for early intervention to reduce substance misuse and promote mental health of young people on campuses. It raises awareness of the link between occupation, substance use, and mental health. It could be a helpful resource for occupational therapists working to enable health and well-being of adolescents and young adults in the student role.

References

O’Malley, P. M., & Johnston, L. D. (2002). Epidemiology of alcohol and other drug use among American college students. Journal of Studies on Alcohol (Suppl. 14), 23–39. https://doi.org/10.15288/jsas.2002.s14.23

Perkins, H. W. (2002). Surveying the damage: A review of research on consequences of alcohol misuse in college populations. Journal of Studies on Alcohol (Suppl. 14), 91–100. https://doi.org/10.15288/jsas.2002.s14.91

Saunders, J. B., Aasland, O. G., Babor, T. F., De La Fuente, J. R., & Grant, M. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons With Harmful Alcohol Consumption–II. Addiction, 88, 791–804. https://doi.org/10.1111/j.1360-0443.1993.tb02093.x

Skinner, H. A. (1982). The Drug Abuse Screening Test. Addictive Behaviors, 7, 363–371.

Sullivan, M., & Wodarski, J. (2004). Rating college students’ substance abuse: A systematic literature review. Brief Treatment and Crisis Intervention, 4, 71–91. https://doi.org/10.1093/brief-treatment/mhh006