Analysis: drug use by students is under-researched, and doesn't consider the unique context in which students live, work and study

Student healthcare and student counselling services are seeing increasing numbers of students who are experiencing negative consequences associated with drug use. There is an increasing prevalence of college students who report occasional or frequent drug use, and a greater range of drug type, including marijuana, cocaine, ecstasy, ketamine and 'synthetic drugs' often bought online

For some students, college life is associated with beginning or increasing drug use. This change in drug use is likely related to the unique combination of developmental, social, and environmental factors associated with college life, combined with misperceptions about social norms and harms of drug use.

Drug use by college students is under-researched, and much of the research focuses on addiction, or other age groups, or doesn’t consider the unique context in which college students live, work and study. Students are unlikely to perceive their own drug use as problematic, and so may not be motivated to change their behaviour, and even when experiencing negative consequences they rarely seek help. There are some intriguing inconsistencies: although the majority of college students who use drugs say they aren’t concerned about their drug use, almost 80% reported an interest in interventions to help them stop using drugs.

Students have voiced concerns related to health, stigma, legal consequences and negative consequences of using drugs

Our research shows students use drugs to be part of the group, meeting their needs of social belonging, thrill-seeking and excitement. For some, drugs are used for the management of emotions such as anxiety or fear. So if drug use meets some need, why would students want to stop using drugs? Students place great value on their psychological, physical and social health, as well as academic progress. However, these are the very aspects of life that are negatively affected by drug use. 

Students have also voiced multiple concerns related to their health, stigma, legal consequences and negative intrapersonal consequences of using drugs. Despite these concerns, students often don’t believe they can identify or pursue alternatives to drugs that would serve their needs, which hints towards the need for personalised approaches.

The prevalence of student drug use presents a challenge of both specificity and scale: how do you address the specific needs of students, and how to do so for thousands of them? Preventing people from beginning drug use is a necessary part of health care, but programmes for students who are already using drugs is also needed. 

Behaviour change

Behaviour change interventions must have strong theoretical foundations and be evidence-based, but their effect is enhanced by incorporating the perspectives of the students themselves. Their involvement in designing a programme directly contributes to the acceptance, quality and effectiveness of any such intervention.

In the My Understanding of Substance-use Experiences project, we’ve been developing a tailorable, scalable, online intervention for, and with, college students. The first phase, completed in 2018, reviewed the motivations students have to reduce or stop using drugs, and the efficacy of digital interventions for drug use and other health behaviours. In addition, qualitative and participatory research with students, and a large survey on student experiences, capabilities and motivations to change their drug use behaviour formed an evidence base to guide the development of the specific content and structure of MyUSE. 

The online format enables students to engage at any time, can serve large numbers of students and mitigates the limited capacity of student health services for delivering face-to-face interventions to the numbers of students in need. Even before the Covid-19 pandemic, we had begun to develop virtual student supports, with services which met students where they were most likely to engage with services, and receive personalised, responsive care.

Using multi-disciplinary and person-centred design approaches, we have accumulated evidence to describe the knowledge, skills and motivations students need to change their drug use behaviour. Based on this, we have identified the activities that would guide students to increase their awareness of their reasons for using drugs, reflect upon the life they desire, identify their personal life and academic goals, as well as prioritise their mental wellbeing. 

Strategies

Our research identified several strategies as most likely to be effective in preventing or reducing harms associated with drug use. These include increasing the person's awareness of their values and goals related to college life, reflective activities, behavioural awareness and the correction of inaccurate perceptions about student drug use in general.  

Currently, we use multiple behaviour change techniques that function via training, incentivisation, persuasion and education. It begins with the student completing measures that provide feedback on their use, moving through tailored activities to identify and practice strategies that the student uses to align their behaviours (related to drug use and non-use) to their values and goals. Crucially, the design has been centred around the student to ensure that the complexity of the algorithm and intervention itself is experienced as a smooth, personalised and engaging experience. 

This design approach draws upon the expertise of business information systems and human computer interaction research, and we developed a clinical algorithm to stream students toward personalized components, based on their self-reported behaviours and experiences. This is now entering a testing phase, focused on examining the programme usability, feasibility, and effectiveness.

We have accumulated evidence to describe the knowledge, skills and motivations students need to change their drug use behaviour

In order to meet the specific physical and mental health care needs of college students, services must be readily accessible and tailored to the unique social and cultural context of higher education settings. The combination of digital delivery techniques and developmentally-informed behavioural science enables higher education institutions to meet the needs of their students, in a way that is scalable, tailorable and contextually-sensitive.

The MyUSE Programme has been developed by researchers from UCC Student Health, School of Public Health, Business Information Systems and Applied Psychology. It was funded by UCC SCFF and conducted in collaboration with the Students Union and a Student Advisory Group. In collaboration with the Department of Education and Skills and research partners across Ireland, the MyUSE Project team will undertake the Drug Use in Higher Education in Ireland Survey, a comprehensive examination of recreational and habitual drug use by students in higher education, with results expected in 2021. 


The views expressed here are those of the author and do not represent or reflect the views of RTÉ. If you have been affected by issues raised in this article, support information is available online


<esi:include src="<p><span style="font-size:10pt"><span style="font-family:Calibri, sans-serif"><w:sdt showingplchdr="t" sdttag="goog_rdk_408" id="-1903829102"> </w:sdt><b><span lang="EN-GB" style="font-size:12.0pt">How can universities work to reduce the harms associated with students' drug use</span>?</b></span></span></p><p><span style="font-size:11pt"><span style="background:white"><span style="vertical-align:baseline"><span style="line-height:115%"><span style="font-family:Calibri, sans-serif"></span></span></span></span></span></p><p><span style="font-size:11pt"><span style="background:white"><span style="vertical-align:baseline"><span style="line-height:115%"><span style="font-family:Calibri, sans-serif">By Samantha Dockray, UCC</span></span></span></span></span></p><p><span style="font-size:11pt"><span style="background:white"><span style="vertical-align:baseline"><span style="line-height:115%"><span style="font-family:Calibri, sans-serif"></span></span></span></span></span></p><p><span style="font-size:11pt"><span style="background:white"><span style="vertical-align:baseline"><span style="line-height:115%"><span style="font-family:Calibri, sans-serif"><span style="color:black">Student healthcare and student counselling services are seeing increasing numbers of students who are experiencing negative consequences associated with drug use.  T</span>here is an <span style="color:black">increasing prevalence of college students who report occasional or frequent drug use, and a </span><a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7583-6" style="color:blue; text-decoration:underline">greater range of drug type</a>, including marijuana, cocaine, ecstasy, ketamine and 'synthetic drugs' often <a href="https://www.rte.ie/brainstorm/2020/0901/1162507-drug-dealing-consumption-ireland-recession-coronavirus/" style="color:blue; text-decoration:underline">bought <w:sdt sdttag="goog_rdk_15" id="-544525896"></w:sdt><w:sdt sdttag="goog_rdk_36" id="-1062401467"></w:sdt><w:sdt sdttag="goog_rdk_59" id="1302203378"></w:sdt><w:sdt sdttag="goog_rdk_83" id="-1970191717"></w:sdt><w:sdt sdttag="goog_rdk_108" id="-1752340885"></w:sdt><w:sdt sdttag="goog_rdk_134" id="1793402442"></w:sdt><w:sdt sdttag="goog_rdk_161" id="965630583"></w:sdt><w:sdt sdttag="goog_rdk_189" id="-284041416"></w:sdt><w:sdt sdttag="goog_rdk_218" id="-671029566"></w:sdt><w:sdt sdttag="goog_rdk_234" id="-46611763"></w:sdt><w:sdt sdttag="goog_rdk_265" id="-2006202226"></w:sdt><w:sdt sdttag="goog_rdk_296" id="1533916323"></w:sdt><w:sdt sdttag="goog_rdk_328" id="792796308"></w:sdt><w:sdt sdttag="goog_rdk_361" id="-1452705038"></w:sdt><w:sdt sdttag="goog_rdk_396" id="-334070316"></w:sdt><w:sdt sdttag="goog_rdk_432" id="-2012512656"></w:sdt>online</a>.  <span style="color:black">For some students, college life is associated with beginning or increasing drug use and t</span>his change in drug use is likely related to the unique combination of developmental, social, and environmental factors associated with college <w:sdt sdttag="goog_rdk_0" id="2026132630"></w:sdt><w:sdt sdttag="goog_rdk_21" id="1634439934"></w:sdt><w:sdt sdttag="goog_rdk_43" id="1762728468"></w:sdt><w:sdt sdttag="goog_rdk_66" id="-1053459031"></w:sdt><w:sdt sdttag="goog_rdk_90" id="699139021"></w:sdt><w:sdt sdttag="goog_rdk_115" id="577797278"></w:sdt><w:sdt sdttag="goog_rdk_141" id="678468232"></w:sdt><w:sdt sdttag="goog_rdk_168" id="-1196611596"></w:sdt><w:sdt sdttag="goog_rdk_196" id="-41298193"></w:sdt><w:sdt sdttag="goog_rdk_223" id="-165172674"></w:sdt><w:sdt sdttag="goog_rdk_253" id="2047787140"></w:sdt><w:sdt sdttag="goog_rdk_284" id="-499737566"></w:sdt><w:sdt sdttag="goog_rdk_316" id="907579098"></w:sdt><w:sdt sdttag="goog_rdk_349" id="-1522468530"></w:sdt><w:sdt sdttag="goog_rdk_383" id="-1818486357"></w:sdt><w:sdt sdttag="goog_rdk_418" id="-246500978"></w:sdt>life, combined with misperceptions about social norms and harms of drug use. Drug use by college students is under-researched, and much of the research focuses on addiction, or other age groups, or doesn't consider the <a href="https://psyarxiv.com/5u7bs/" style="color:blue; text-decoration:underline">unique context</a> in which college students live, work and study.  Students are unlikely to perceive their own drug use as problematic, and so may not be motivated to change their behaviour, and even when experiencing negative consequences they rarely seek help. There are some intriguing inconsistencies though, for example <w:sdt sdttag="goog_rdk_262" id="-1677494447"></w:sdt><w:sdt sdttag="goog_rdk_293" id="-901823731"></w:sdt><w:sdt sdttag="goog_rdk_325" id="-1522465480"></w:sdt><w:sdt sdttag="goog_rdk_358" id="1819532004"></w:sdt><w:sdt sdttag="goog_rdk_393" id="-1270090621"></w:sdt>although the majority of college students who use drugs say they aren't concerned about their drug use, almost 80% reported an interest in <w:sdt sdttag="goog_rdk_42" id="-416246807"></w:sdt><w:sdt sdttag="goog_rdk_65" id="-1469661241"></w:sdt><w:sdt sdttag="goog_rdk_89" id="-1795975579"></w:sdt><w:sdt sdttag="goog_rdk_114" id="169233247"></w:sdt><w:sdt sdttag="goog_rdk_140" id="-1048609556"></w:sdt><w:sdt sdttag="goog_rdk_167" id="-768235253"></w:sdt><w:sdt sdttag="goog_rdk_195" id="1742594952"></w:sdt><w:sdt sdttag="goog_rdk_239" id="1094138299"></w:sdt><w:sdt sdttag="goog_rdk_270" id="-88705085"></w:sdt><w:sdt sdttag="goog_rdk_302" id="-596791032"></w:sdt><w:sdt sdttag="goog_rdk_335" id="-351498801"></w:sdt><w:sdt sdttag="goog_rdk_368" id="-1915150789"></w:sdt><w:sdt sdttag="goog_rdk_403" id="-7519850"></w:sdt><w:sdt sdttag="goog_rdk_439" id="1532222613"></w:sdt>interventions to help them stop using drugs.</span></span></span></span></span></p><p><span style="font-size:11pt"><span style="background:white"><span style="vertical-align:baseline"><span style="line-height:115%"><span style="font-family:Calibri, sans-serif"><span style="color:black"></span></span></span></span></span></span></p><p><span style="font-size:11pt"><span style="background:white"><span style="vertical-align:baseline"><span style="line-height:115%"><span style="font-family:Calibri, sans-serif">Our <w:sdt sdttag="goog_rdk_49" id="233133670"></w:sdt><w:sdt sdttag="goog_rdk_73" id="-450546074"></w:sdt><w:sdt sdttag="goog_rdk_97" id="1234894222"></w:sdt><w:sdt sdttag="goog_rdk_122" id="-1864196805"></w:sdt><w:sdt sdttag="goog_rdk_149" id="935414350"></w:sdt><w:sdt sdttag="goog_rdk_176" id="-396205459"></w:sdt><w:sdt sdttag="goog_rdk_205" id="1059823788"></w:sdt><w:sdt sdttag="goog_rdk_227" id="961460924"></w:sdt><w:sdt sdttag="goog_rdk_257" id="320244839"></w:sdt><w:sdt sdttag="goog_rdk_288" id="-1338225106"></w:sdt><w:sdt sdttag="goog_rdk_320" id="-1986857332"></w:sdt><w:sdt sdttag="goog_rdk_353" id="-815731571"></w:sdt><w:sdt sdttag="goog_rdk_387" id="1352537538"></w:sdt><w:sdt sdttag="goog_rdk_423" id="165610641"></w:sdt>research shows students use drugs to be part of the group,  meeting <a href="https://scholarspace.manoa.hawaii.edu/bitstream/10125/64157/0335.pdf" style="color:blue; text-decoration:underline">their needs of social belonging, of thrill-seeking and excitement,</a> and for some, the management of emotions such as anxiety or fear.  So if drug use meets some need, why would students want to stop using drugs? Students place great value on their psychological, physical and social, as well as academic progress, however these are the very aspects of life that are negatively affected by drug use.  Students have also voiced multiple concerns related to their health, stigma, legal consequences, and negative intrapersonal consequences of using drugs.  Despite these concerns, students often don't <w:sdt sdttag="goog_rdk_297" id="-2096546222"></w:sdt><w:sdt sdttag="goog_rdk_329" id="856169183"></w:sdt><w:sdt sdttag="goog_rdk_362" id="929083559"></w:sdt><w:sdt sdttag="goog_rdk_397" id="1569072892"></w:sdt><w:sdt sdttag="goog_rdk_433" id="-646672134"></w:sdt>believe they can identify or pursue alternatives to drugs that would serve their needs, which hints toward what kind of intervention might be effective and <a href="http://ecis2018.eu/wp-content/uploads/2018/09/2129-doc.pdf" style="color:blue; text-decoration:underline">the need for personalised approaches</a>. </span></span></span></span></span></p><p><span style="font-size:11pt"><span style="background:white"><span style="vertical-align:baseline"><span style="line-height:115%"><span style="font-family:Calibri, sans-serif"> </span></span></span></span></span></p><p><span style="font-size:11pt"><span style="background:white"><span style="vertical-align:baseline"><span style="line-height:115%"><span style="font-family:Calibri, sans-serif"></span></span></span></span></span></p><p><span style="font-size:11pt"><span style="background:white"><span style="vertical-align:baseline"><span style="line-height:115%"><span style="font-family:Calibri, sans-serif"><span style="color:black">The prevalence of student drug use presents a challenge of both specificity and scale – how to address the specific needs of students, and how to do so for thousands of students? Preventing people from beginning drug use is a necessary part of health care, but interventions </span>for students who are already using drugs is also needed.  Behaviour change interventions must have strong theoretical foundations and be evidence-based, but their effect is enhanced by incorporating the perspectives of the target populations themselves, that is, college students. The participatory <w:sdt sdttag="goog_rdk_330" id="-1341155139"></w:sdt><w:sdt sdttag="goog_rdk_363" id="-592628134"></w:sdt><w:sdt sdttag="goog_rdk_398" id="1510326947"></w:sdt><w:sdt sdttag="goog_rdk_434" id="1102377990"></w:sdt>involvement of students in designing the features of an intervention directly to contributes to the acceptance of an intervention, as well as its quality and effectiveness. In the <i>My Understanding of Substance-use Experiences </i>(MyUSE) Project at UCC we've been <a href="https://www.researchprotocols.org/2020/8/e17829/" style="color:blue; text-decoration:underline">developing a tailorable, scalable, online intervention</a> for, and with, college students.  The first phase, </span></span></span></span></span></p><p><span style="font-size:11pt"><span style="background:white"><span style="vertical-align:baseline"><span style="line-height:115%"><span style="font-family:Calibri, sans-serif">completed in 2018, systematically reviewed the motivations students have to reduce or stop using drugs, and the efficacy of digital interventions for drug use and other health behaviours. In addition qualitative and participatory research with students, and a large survey on student experiences,  capabilities and motivations to change their drug use behaviour formed an evidence base to guide the development of the specific content and structure of MyUSE.  The online format of the intervention enables students to engage at any time, can serve large numbers of students, and mitigates the limited capacity of student health services for delivering face-to-face interventions to the numbers of students in need. Even before the Covid-19 pandemic, we had begun to develop virtual student supports, with services which meeting students where they may be likely to engage with services, and receive personalised, responsive care.</span></span></span></span></span></p><p><span style="font-size:11pt"><span style="background:white"><span style="vertical-align:baseline"><span style="line-height:115%"><span style="font-family:Calibri, sans-serif"></span></span></span></span></span></p><p><span style="font-size:11pt"><span style="background:white"><span style="vertical-align:baseline"><span style="line-height:115%"><span style="font-family:Calibri, sans-serif"><w:sdt sdttag="goog_rdk_125" id="-465499988"></w:sdt><w:sdt sdttag="goog_rdk_152" id="-94167527"></w:sdt><w:sdt sdttag="goog_rdk_179" id="-254059135"></w:sdt><w:sdt sdttag="goog_rdk_208" id="1859853640"></w:sdt><w:sdt sdttag="goog_rdk_247" id="-1315572939"></w:sdt><w:sdt sdttag="goog_rdk_278" id="-1788741390"></w:sdt><w:sdt sdttag="goog_rdk_310" id="-927570379"></w:sdt><w:sdt sdttag="goog_rdk_343" id="1616945485"></w:sdt><w:sdt sdttag="goog_rdk_377" id="1845204364"></w:sdt><w:sdt sdttag="goog_rdk_412" id="1798490377"></w:sdt>Using multi-disciplinary and  person-centred design approaches, we have accumulated evidence to describe the knowledge, skills and motivations students need to change their drug use behaviour. Based on this, we identified that powerful components of our intervention would be activities that guide students to increase their awareness of their reasons for using drugs, reflect upon the life they desire, identify their personal life and academic goals, as well as prioritise their mental wellbeing.  Our research identified several strategies as most likely to be effective <a href="https://assets.researchsquare.com/files/rs-86503/v1/cd3e7ef1-2616-467b-abc3-6691ef8bc0c9.pdf" style="color:blue; text-decoration:underline">in preventing or reducing harms</a> associated with drug use, including <w:sdt sdttag="goog_rdk_17" id="-157617574"></w:sdt><w:sdt sdttag="goog_rdk_38" id="-481080795"></w:sdt><w:sdt sdttag="goog_rdk_61" id="-1318724101"></w:sdt><w:sdt sdttag="goog_rdk_85" id="1323003960"></w:sdt><w:sdt sdttag="goog_rdk_110" id="1992902487"></w:sdt><w:sdt sdttag="goog_rdk_136" id="368348383"></w:sdt><w:sdt sdttag="goog_rdk_163" id="-1768146210"></w:sdt><w:sdt sdttag="goog_rdk_191" id="-1489247283"></w:sdt><w:sdt sdttag="goog_rdk_220" id="-1942834841"></w:sdt><w:sdt sdttag="goog_rdk_235" id="783625820"></w:sdt><w:sdt sdttag="goog_rdk_266" id="-742720521"></w:sdt><w:sdt sdttag="goog_rdk_298" id="-1421402950"></w:sdt><w:sdt sdttag="goog_rdk_331" id="1542315001"></w:sdt><w:sdt sdttag="goog_rdk_364" id="1144620981"></w:sdt><w:sdt sdttag="goog_rdk_399" id="-1778475073"></w:sdt><w:sdt sdttag="goog_rdk_435" id="-948227125"></w:sdt>increasing the persons awareness of their values and goals related to college life, reflective activities, behavioural awareness and the correction of inaccurate perceptions about student drug use in general.  Currently the intervention uses multiple behaviour change techniques that function via <span style="color:black">training, incentivisation, persuasion and education.  It begins with the student completing measures that provide feedback on their use, moving through tailored activities to identify and practice strategies that the student uses to align their behaviours (related to drug use and non-use) to their values and goals.  </span>Crucially, the design has been centred around the student to ensure that the complexity of the algorithm and intervention itself is experienced as a smooth, personalised and engaging experience.  <w:sdt sdttag="goog_rdk_11" id="51434778"></w:sdt><w:sdt sdttag="goog_rdk_32" id="-1491318537"></w:sdt><w:sdt sdttag="goog_rdk_55" id="2094821836"></w:sdt><w:sdt sdttag="goog_rdk_79" id="-39062348"></w:sdt><w:sdt sdttag="goog_rdk_104" id="338356835"></w:sdt><w:sdt sdttag="goog_rdk_130" id="867951244"></w:sdt><w:sdt sdttag="goog_rdk_157" id="1909107207"></w:sdt><w:sdt sdttag="goog_rdk_185" id="1091048667"></w:sdt><w:sdt sdttag="goog_rdk_214" id="1685169009"></w:sdt><w:sdt sdttag="goog_rdk_231" id="-1874522795"></w:sdt><w:sdt sdttag="goog_rdk_261" id="-1358581291"></w:sdt><w:sdt sdttag="goog_rdk_292" id="-1563247920"></w:sdt><w:sdt sdttag="goog_rdk_324" id="362331409"></w:sdt><w:sdt sdttag="goog_rdk_357" id="-1628302466"></w:sdt><w:sdt sdttag="goog_rdk_392" id="90365362"></w:sdt><w:sdt sdttag="goog_rdk_428" id="1675914653"></w:sdt><span style="color:black">This design approach draws upon the expertise of business information systems and human computer interaction research, and we developed a</span><span lang="EN-US" style="background:white"><span style="color:black"> clinical algorithm to stream students toward personalized intervention components, based on their self-reported behaviours and experiences.  The digital intervention is now entering a testing phase, focused on examining the programme usability, feasibility, and effectiveness. </span></span> </span></span></span></span></span></p><p><span style="font-size:11pt"><span style="background:white"><span style="vertical-align:baseline"><span style="line-height:115%"><span style="font-family:Calibri, sans-serif"><span lang="EN-GB" style="background:white"><span style="color:black"></span></span></span></span></span></span></span></p><p><span style="font-size:11pt"><span style="background:white"><span style="vertical-align:baseline"><span style="line-height:115%"><span style="font-family:Calibri, sans-serif"><span lang="EN-GB" style="background:white"><span style="color:black">In order to meet the specific physical and mental health care needs of college students, services must be readily accessible and tailored to the unique social and cultural context of higher education settings.  The combination of digital delivery techniques and developmentally-informed behavioural science enables higher education institutions to meet the needs of their students, in a way that is scalable, tailorable and contextually-sensitive.</span></span></span></span></span></span></span></p><p><span style="font-size:11pt"><span style="background:white"><span style="vertical-align:baseline"><span style="line-height:115%"><span style="font-family:Calibri, sans-serif"> </span></span></span></span></span></p><p><span style="font-size:11pt"><span style="background:white"><span style="vertical-align:baseline"><span style="line-height:115%"><span style="font-family:Calibri, sans-serif"><span style="background:yellow"><span style="color:black"></span></span></span></span></span></span></span></p><p><span style="font-size:11pt"><span style="background:white"><span style="vertical-align:baseline"><span style="line-height:115%"><span style="font-family:Calibri, sans-serif"><span style="color:black">=======</span></span></span></span></span></span></p><p><span style="font-size:11pt"><span style="background:white"><span style="vertical-align:baseline"><span style="line-height:115%"><span style="font-family:Calibri, sans-serif"><span style="color:black">The MyUSE Programme has been developed by a multidisciplinary team of researchers from UCC Student Health, School of Public Health, Business Information Systems and Applied Psychology. The research programme was funded by UCC SCFF and conducted in collaboration with the Students Union and a Student Advisory Group.  In collaboration with </span>The Department of Education and Skills<span style="color:black">  and research partners across Ireland, the MyUSE Project team will undertake the </span><a href="http://www.sin.ie/2020/03/19/nationwide-survey-aims-to-review-drug-use-among-students/" style="color:blue; text-decoration:underline"><b><span style="border:none windowtext 1.0pt; font-size:10.0pt; padding:0cm"><span style="background:white"><span style="font-family:"inherit",serif">Drug Use in Higher Education in Ireland Survey</span></span></span></b></a><b><span lang="EN-GB" style="border:none windowtext 1.0pt; font-size:10.0pt; padding:0cm"><span style="background:white"><span style="font-family:"inherit",serif"><span style="color:#323130">,</span></span></span></span></b><span style="color:black">a comprehensive examination of recreational and habitual drug use by students in higher education</span><w:sdt sdttag="goog_rdk_35" id="-1224592826"></w:sdt><w:sdt sdttag="goog_rdk_52" id="-91395380"></w:sdt><w:sdt sdttag="goog_rdk_58" id="1959911884"></w:sdt><w:sdt sdttag="goog_rdk_76" id="-853033604"></w:sdt><w:sdt sdttag="goog_rdk_82" id="-1618216186"></w:sdt><w:sdt sdttag="goog_rdk_100" id="2131811702"></w:sdt><w:sdt sdttag="goog_rdk_107" id="1934393417"></w:sdt><w:sdt sdttag="goog_rdk_126" id="-797145552"></w:sdt><w:sdt sdttag="goog_rdk_133" id="1035474055"></w:sdt><w:sdt sdttag="goog_rdk_153" id="-720442426"></w:sdt><w:sdt sdttag="goog_rdk_160" id="1824154127"></w:sdt><w:sdt sdttag="goog_rdk_180" id="1068459579"></w:sdt><w:sdt sdttag="goog_rdk_188" id="1029373243"></w:sdt><w:sdt sdttag="goog_rdk_209" id="825863210"></w:sdt><w:sdt sdttag="goog_rdk_217" id="443267322"></w:sdt><w:sdt sdttag="goog_rdk_248" id="-1140564968"></w:sdt><w:sdt sdttag="goog_rdk_251" id="1394930079"></w:sdt><w:sdt sdttag="goog_rdk_279" id="-930893634"></w:sdt><w:sdt sdttag="goog_rdk_282" id="-744720157"></w:sdt><w:sdt sdttag="goog_rdk_311" id="102083853"></w:sdt><w:sdt sdttag="goog_rdk_314" id="648643177"></w:sdt><w:sdt sdttag="goog_rdk_344" id="1121273997"></w:sdt><w:sdt sdttag="goog_rdk_347" id="-1841535042"></w:sdt><w:sdt sdttag="goog_rdk_378" id="1274753968"></w:sdt><w:sdt sdttag="goog_rdk_381" id="1030770529"></w:sdt><w:sdt sdttag="goog_rdk_413" id="-2029553878"></w:sdt><span style="color:black">, with results </span><w:sdt sdttag="goog_rdk_419" id="201366455"></w:sdt><span style="color:black">expected in 2021.  </span></span></span></span></span></span></p>" />