MIAMI – Some general principles of substance abuse prevention are suitable for targeting college students who misuse stimulants to enhance performance, Dr. Theodore V. Parran Jr. said at the annual conference of the American Society of Addiction Medicine.
Changing environmental factors and providing consistent prevention messages are likely the most effective strategies. In contrast, increasing individual resiliency and delaying nonmedical stimulant use as long as possible are potentially less effective, said Dr. Parran, director of the addiction medicine fellowship program at Case Western Reserve University in Cleveland.
Misuse is defined as the use of prescription stimulants to enhance performance by an individual for whom they were not prescribed. Prevention efforts are intended to lessen the risk, pain and suffering, and number of deaths associated with the use of “performance-enhancing drugs” in a community, he said. Prevention efforts are particularly challenging in the college community because a lot of stimulant misuse is within peer-group norms.
Alteration of environmental factors could help with prevention. “Ease of access, price, and social norms and values are important in encouraging or discouraging performance-enhancing substance misuse,” Dr. Parran said. Limitation of controlled, prescribed medications on a college campus is a very important strategy that is “often not paid attention to,” he noted.
Prevention messages must be consistent. They must be longitudinal and multiple and involve several different venues, such as family, school, religious institutions, and academic leaders. “That tends to work regarding misuse,” he said.
Identification of risk and resiliency factors, another general principle for substance abuse prevention, is somewhat applicable to stimulant misuse. “There are probably resiliency factors, factors in an individual that decrease the odds of misuse and abuse of prescription drugs,” but their existence has not yet been proven, he said. If they do exist, “the job of the family and community is to build protective factors and limit risk factors.”
A strategy to delay experimentation might not be applicable to stimulant misuse. Most beliefs and practices about substance use and misuse are established by the time an individual is in college.
A combination of primary, secondary, and tertiary prevention efforts can be effective in this population of college students. Primary prevention efforts, which target an entire community regardless of individual risk, might be more challenging for clinicians.
“Physicians tend to think about patients and not communities,” Dr. Parran said. Secondary prevention targets high-risk subgroups of substance users and abusers. Tertiary prevention involves treatment of an individual, such as in a drug detoxification unit.