Predictors of Collegiate Substance Use and Misuse: A Quantitative Analysis of Romantic Relationships, Alcohol and Prescription Stimulant Use, and Social Support Kaia Bjorlie, Nikolaus Rasmus, Beth Reynolds, Kathryn Sorenson, Andrew Wilson Department of Sociology/ Anthropology, St. Olaf College, Northfield MN, 55057

Abstract. Substance use is a widespread and culturally-sanctioned aspect of the college experience. In this study we investigate the correlation between nonmedical prescription stimulant use and alcohol consumption by undergraduate students and their involvement in intimate relationships. We administered an online survey questionnaire to students at a small, private, liberal arts college in the Midwest to measure frequency of stimulant and alcohol use, relationship status, and self-reported social support levels. Building from previous research on social support, we focus on intimacy and relationships as a form of social support and test the hypothesis that students in intimate relationships have lower rates of non-medical prescription stimulant use, and alcohol consumption. In addition, students who report more social support overall have lower rates of substance (prescription stimulant and alcohol) use. We discovered no correlations between stimulant or alcohol use and relationship status. However, we found that men were more likely to use stimulants illicitly than women were.

Introduction Social support is a multi-dimensional concept with influences on mental and physical health. Social support has been defined by Hale, Hannum, and Espelage (2005) as including four domains: tangible support, sense of belonging, disclosure of personal information, and social intimacy. These four domains of social support have been linked to important aspects of physical, social, and mental well-being. Romantic relationships constitute many elements of social support and have been investigated for their role in influencing behavior, including substance abuse. Elements and Sources of Social Support

A large body of social science literature has examined various sources

and consequences of social support, such as religious involvement, sociallyinfluenced eating behaviors, and more recently, online social networks. Academic success is an influence upon successful integration of students into their social academic communities. Many studies have linked academic success to time spent working at a job, socializing with peers, studying, and consuming alcohol. One study found that the more hours students spent in employed work, the less likely they were to rely on peers for support (Royal 1996). Other studies of group membership and social support have examined involvement in organized activities in relation to depressive symptoms (Randall 2009). Randall collected social support data through three domains: sense of belonging and social acceptance, academic motivation, and integration into the larger social fabric (2009). Prescription Stimulant Abuse: a Growing Trend

In the United States substance use has been closely associated with the college experience, alcohol historically being the most prevalent and widely available substance. More recently there has been an exponential rise in the use and misuse of prescription drugs, especially at colleges and universities. Prescription stimulants are one type of the most commonly reported prescription drugs used non-medically by college students (Arria, OGrady, Calderia, Vincent, Wish 2008). From 1993 to 2001, the production of amphetamines alone increased by 5,767% (Hall, Irwin, Bowman, Frankenberger, and Jewett 2005) and 2.5 million children between the ages of four and seventeen in America have been prescribed medication to treat Attention Deficit/ Hyperactivity Disorder (ADHD) (DeSantis, Webb and Noar 2008). The increase in diagnoses and production of stimulants has facilitated an increase in the accessibility and availability of prescription stimulants on college campuses. Often, prescription stimulants are sold and given away by students who have a prescription to other students who do not. In one study, more than half of the college students diagnosed with ADHD or other disorders with stimulants as prescriptions had been approached to trade, sell, or give away their medication to other students (McCabe, Knight, Teter, and Wechsler 2004). Advokat, Guidry and Martino (2008) discovered that 84% of diagnosed students reported being approached to give away their medication to a nondiagnosed student. Prior research indicates many different motivations for both the licit and illicit uses of prescription stimulants. In many studies, the primary motivation for illicit use of prescription stimulants was associated with academic performance (Advokat et al. 2008). Interestingly, several studies have suggested that the misuse of prescription stimulants lacks many of the negative

values that are often associated with other types of drug use. Students also reported a general lack of guilt when using prescription stimulants illicitly. A majority of students surveyed by DeSantis, Webb and Noar (2008) who used stimulants illicitly viewed it as physically and psychologically harmless, as well as morally acceptable and stigma-free. Past studies of stimulant and alcohol use indicate relationships between substance use and gender, relationship status of the user, and membership in Greek organizations. Students belonging to a fraternity or sorority reported higher rates of Ritalin use than non-members; members were almost six times more likely than non-members to report Ritalin use in the past month. Additionally, both men and women affiliated with fraternities and sororities drank alcohol more heavily than non-organization members (Harrington et al. 1997). Members of fraternities and sororities also reported more negative consequences associated with their drinking experiences than did nonmembers (Larimer, Anderson, Baer and Marlatt 2000). Reasons for stimulant use and the way in which it is used vary across gender. Men use prescription stimulants illicitly more frequently than women. Women, however, are more pressured by time commitments, which according to Hall et al. (2005) may serve to increase women’s illicit use of stimulants in the future. Contrary to research by Hall et al., Wu and Schlenger (2003) discovered that females were more likely to use and become dependant upon stimulant medications than men. These contradictions in the literature make it difficult to generalize gender specific patterns of use and misuse (White, Becker-Blease, and Grace-Bishop 2006). Relationships and Substance Use

College students in a committed relationship were half as likely to report past month and year Ritalin and Adderall use (Shillington et al. 2006). Shillington et al. did not determine whether the relationship itself lowers stimulant use, or if the people who are likely to be in relationships are simply less prone to use alcohol and prescription stimulants illicitly. Lange (2009) suggested that those involved in a committed romantic relationship may simply participate less in risky behavior than those not in a relationship. Likewise, men in relationships consumed alcohol less than single men did. Differences between single and involved individuals may be due to a change in behavior which is a consequence of intimate relationships. Engels and Knibbe (2000) mentioned that partners tend to go out less often, instead seeking each other’s company in private and inherently less risky settings. Alcohol consumption was more than twice as likely to be part of an encounter between those students not in a relationship than those in a relationship (Brown and Vanable 2007).

Limitations of Previous Studies

Studies examining correlates between social support, substance use, and romantic relationships shared some similar limitations. First, definitions of relationship status varied across studies and undoubtedly among respondents, making it difficult to compare conclusions from different studies. A common limitation was shared by studies that discovered an association between relationship status and substance abuse but were unable to account for how relationships in fact influenced alcohol and stimulant use. Most studies we came across varied in their methodology, usually sampling substance users of very different age groups. For example, Engels and Knibbe (2000) examined adolescents between the ages of 14 and 18, whereas Hall et al. (2005) surveyed students between the ages of 18 and 25. This limited our ability to apply research to our investigation. Relevance to Our Research

Research on substance use and relationship status among college students provides strong evidence that relationships and social support are important in determining the extent to which students use stimulants and alcohol, chiefly that students in committed relationships use fewer stimulants than single individuals (Shillington et al. 2006). We are interested to what extent relationships provide social support and consequently influence substance use behavior. Our study will contribute to this body of knowledge by investigating relationship status, social support, and alcohol and stimulant use.

Methods We conducted our investigation via an analysis of results from an online survey questionnaire administered in fall 2009. We hypothesized first that students in committed, romantic relationships would be less likely to use non-prescribed prescription stimulants. Secondly, we hypothesized that individuals in committed, romantic relationships consume less alcohol. Thirdly, individuals with a higher sense of perceived social support will use stimulants less frequently. Lastly, those with a higher sense of perceived social support will also consume less alcohol. We suggest that social support provided by such relationships accounts for reduced stimulant and alcohol misuse. To increase our familiarity and to refine our conceptual definitions of social support, romantic relationships, and stimulant and alcohol use, we facilitated a six-person focus group of St. Olaf students and gathered information on students’ perceptions of stimulants, alcohol, and romantic relationships on campus. Our primary independent variable was active involvement in a relationship. We

defined a relationship as being both committed and romantic in nature. We measured relationship status by asking whether or not (Yes/No) the respondent was currently in a relationship, and if so, how long (open-ended question). Our primary dependent variables included illicit use of prescription stimulants and the consumption of alcohol. We defined stimulants as including medications commonly used to treat Attention Deficit /Hyper Activity Disorder (ADHD): Ritalin, Adderall, Vyvanse, Cylert, Dexedrine, Concerta, Metadate, Methylphenidate and Desoxyn. Respondents were asked to report the frequency of their use of any of these medications within the past month, regardless of whether they were prescribed the medication. We then asked about respondents’ illicit use (anything without or contrary to a doctor’s prescription) of these stimulants. We measured the frequency of alcohol use by the number of occasions (situations where the student had consumed one or more drinks) in which respondents had consumed one or more alcoholic drinks in the past month. Several Likert-type questions measured perceived social support, an additional independent variable. Participants were asked to respond to specific statements that measured elements of social support which were modeled after four domains of social support defined in previous research (Hale et. al. 2005): a sense of belonging, a sense of intimacy, disclosure, and tangible support. We strived to obtain three types of validity: face, criterion, and content. Face validity is achieved when there is consensus among the scientific community and qualified others that an indicator adequately measures a construct (Neuman 2007: 118). Our survey measurements and conceptual constructs were reviewed and verified by our professor as well as our classmates. Content validity is established through an exhaustive specification of a conceptual construct. This requires that measures fully capture all elements of a thoroughly defined construct (Neuman 2007: 118). We achieved this by fully defining the elements of social support, stimulant and alcohol use, and relationship status and then establishing indicators that fully encapsulated these definitions. Social support definitions and indicators were modeled from four forms of social support: tangible, intimacy, self-disclosure and belonging (Hale et. al. 2005). Respondents replied to a scale of agreement with thirteen individual statements, creating a comprehensive social support index. Criterion validity is found when a construct’s indicator is validated by a similar indicator (Neuman 2007: 118). We approached concurrent validity by modeling our indicators from established and authoritative measurements, by consulting Hale’s four dimensions of social support and Shillington’s past research methods for stimulant and alcohol use among college students. Reliability indicates the reproducibility and dependability of empirical data and is aided by fully conceptualized concepts, precise measurement levels, multiple

indicators, and pilot tests (Neuman 2007: 116). The use of a focus group was helpful in fine-tuning conceptual definitions and developing survey questions that addressed issues of greatest relevance to our concepts. By using multiple indicators of a variable, we were able to augment the level of specificity our Likert-type questions measured. For example, we asked respondents to rank levels of social support they received from a range of groups and individuals. We also asked respondents to indicate a category that most closely represented their frequency of alcohol consumption and stimulant use. Both allowed for greater understanding of our conceptual definitions regarding social support, stimulant use and alcohol consumption. We surveyed a population of undergraduate students from a small liberal arts college in the upper Midwest. The target population of our study was college students over the age of 18. The accessible population was St. Olaf’s 3,099 students. We first eliminated from the initial accessible population were those under 18, students studying off-campus, participants in our earlier focus groups, both sections of Sociology/ Anthropology 371, and non full-time students. We used a simple random sample of our population, which consisted of 703 students, 333 of which responded, giving us a response rate of 47.3%. Within our samples, class years were represented fairly evenly: 28% freshmen, 23% sophomores, 22% juniors, 26% seniors, and 0.6% other. Respondents were 32.3% male, 67.3% female, and 0.6% other, which gave us an unequal representation of gender at St. Olaf, which states gender demographics of 45% male, and 55% female for Fall 2009. Respondents’ ages ranged from 18 to 23. We faced several ethical considerations during our survey including guaranteeing informed consent, safeguarding special populations, protecting respondents from psychological harm, and ensuring privacy. Many of our questions addressed sensitive and personal issues. Anonymity was extremely important in conducting this research and was achieved by using an online random sample of our student population. Susan Canon, director of the St. Olaf Institutional Research, provided the random computer-generated list of 703 students whom we then asked to participate in our survey. Informed consent was achieved through a cover letter preceding the survey that communicated the intent, understanding, and implications of a participant’s response. Participants were informed that participation was voluntary and that they could opt out of any question at any time. No person under the age of 18 was allowed to participate because of their minor status. In order to protect respondents from potential psychological harm, we strived to structure our questions in the most sensitive manner possible. Finally, we submitted our survey to the Institutional Review Board of St. Olaf College for its approval. Final intermediate IRB approval was given by Professor Charles Huff, Chair of the Social Sciences

section of the Human Subjects Review Committee. Once the Board approved our survey, we sent it via email to the random list of students.

Results Not only did the results of this survey provide information on the prevalence of stimulant and alcohol use among respondents, but it allowed us to compare this data with students’ social support levels according to our hypotheses. Slightly less than half (41.9%) of respondents were in a relationship and the average relationship length was 18 months. Only 6.5% of respondents reported using stimulants illicitly (n=21), and 82.7% of students reported consuming alcohol on one or more occasions in the past month. Gender accounted for some of the differences in alcohol use (Fig. 1), stimulant use and social support among respondents. Out of our entire student sample, more women (77.8%) consumed alcohol than men (67.3%) (T=.013, p=.045). More men misused stimulants (10.6%) than women (4.7%) (T=.013,p=.046). WomenMen Significance Stimulant Users (%) 4.7 10.6 p=.046 Alcohol Consumers (%)77.8 67.3 p=.045 Social Support Index 167.06 132.67p=.002

Figure 1 Figure 2 shows how gender also predicted differences in social support: women reported more social support than did men (U= 8217, p=.002).

Figure 2 Of students who consumed alcohol, the majority (33%) reported consuming alcohol on two to three occasions in the last month, as Figure 3 illustrates.

Figure 3 Most respondents reported high social support with a median social support index of 35. Our first hypothesis stated that students in committed, romantic relationships are less likely to use prescription stimulants than those not in a relationship. Findings indicated that relationship status did not significantly predict stimulant use, as determined by a Goodman and Kruskal tau test (T=.005, p>.05). As is evident in Figure 4, students in relationships actually used stimulants slightly more than those not in relationships (8.2% and 4.8%, respectively).

Figure 4 Secondly, we assumed that students in committed, romantic relationships are less likely to consume alcohol than those not in a relationship. Using a Goodman and Kruskal tau test, we found no significant difference between relationship status and alcohol use (T=.002, p>.05). We presumed in our third hypothesis that students with higher social support (according to Hale’s four dimensions: tangible, intimacy, disclosure and belonging) are less likely to use stimulants illicitly than students with lower social support. A Mann-Whitney U test was used to examine the nonparametric data for social support among stimulant users and nonusers. No significant differences in social support and illicit stimulant use were found (U=2311,p>.05). Our fourth and final hypothesis stated that students with higher social support (Hale’s four dimensions) were less likely to consume alcohol than those with lower support. A weak but significant correlation was found

between these variables with a Spearman’s rho test (ρ=.121, p=.031). Discussion The results of our first hypothesis found that there was no significant indication that students in committed, romantic relationships were less likely to use prescription stimulants than those not in a relationship. In our sample, associations between relationship status and illicit prescription stimulant use were weak and largely due to chance. Due to the relatively small number of respondents who reported illicit stimulant use, we found that it was slightly more common for illicit users to be in relationships than not in relationships. This result is a stark contrast to the Shillington et al. (2006) findings that report relationship status to be an influential factor in the nonillicit use of stimulants. This difference can be attributed to the inability to generalize findings that are generated by such a small number (n=21) of students reporting illicit stimulant use on this campus. Our second hypothesis, that students in romantic relationships consume less alcohol was not supported by our data. Among respondents at St. Olaf College, more males consumed alcohol if they were in a relationship than males who were not in a relationship. Conversely, slightly more females consumed alcohol who were not in a relationship than females in a relationship. This supports the findings of Engels and Knibbe (2000) that males consumed more alcohol when in a relationship than if not in a relationship. Engels and Knibbe (2000) suggest that different environments characterize relationships. People in relationships may spend more time alone in private with their partner than people not in relationships who may spend more time in the public sphere. Our third hypothesis stated that students with higher social support were less likely to use stimulants than those with lower social support. We found no previous research that investigated levels of social support among those who use prescription stimulants illicitly. However, Shillington et al. (2006) reported that Greek organization members, an institution providing social support, exhibited higher rates of stimulant use. Since these institutions do not exist at St. Olaf College, and most respondents reported high levels of social support, we could speculate that our institutions unique social environment may influence stimulant use. In our final hypothesis, results confirmed that students with higher social support were less likely to consume alcohol than those with lower social support. Our findings mirror the findings of Hale et al. (2005) in which women reported higher social support than men. Their research states that women engage in social relationships and social intimacy more than men do.

Conclusion Our study explored social support, relationship status, and their relationship to substance use on the St. Olaf campus. According to our results, students at St. Olaf College use illicit stimulants less frequently than students at other institutions where similar studies have been conducted. We found that relationship status does not predict stimulant or alcohol use. Students who reported a higher level of social support consume alcohol less frequently than those who reported lower levels of social support. This study contributes to a relatively small body of literature on stimulant misuse among college students. Additionally, it provides information on the relationship between illicit stimulant and alcohol use and their relationship to students’ perceived levels of social support. Our study examines rates of alcohol and illicit stimulant use on a private Liberal Arts campus in the Midwest. This study can be used to compare potential similar patterns of use at similar institutions. These results are useful for college administrators and college student support services that determine health information pertinent to students. It can assist counseling centers in raising awareness of commonly misused substances on campuses and in students’ lives. Alcohol use receives a large amount of public attention as the most widely used substance on college campuses, yet stimulants are increasing in use and general acceptability. Due to the increasing availability and use of prescription stimulants, it is necessary that the use and misuse of such substances receive adequate attention concerning the implications of increasing use. These results are limited by errors in self-reporting, primarily social desirability bias. Future studies could explore character traits that explain substance use and differences between people in romantic relationships and those who are not. Since Greek organizations reported higher rates of stimulant use, further research could explore the differences between campuses with Greek organizations and those without such organizations.

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