Ali Safawi: A call to action on substance use

Monday, September 10, 2018 - 5:36pm

Substance misuse on campus

Substance misuse on campus Buy this photo
Roseanne Chao/The Michigan Daily

According to a story published in The Michigan Daily last spring, 25 percent of students at the University use Adderall and related drugs, despite only 9 percent of them having a prescription.

Substance use has been something I have become increasingly interested in, as I spent the summer interning at an addiction treatment startup in Ann Arbor. So, I decided to look at what my own university was doing to address substance use on campus. My verdict: not enough.

Substance use disorder, an umbrella term for the harmful use of psychoactive substances, is increasingly being recognized as a chronic brain disease. Therefore, I use the term “substance use” as opposed to “substance abuse” or “addiction” because I do not want to pass judgment on anyone’s behaviors nor do I want to use words with the weight of stigma attached. Substance use rewires the brain’s natural reward response, causing the cravings so often associated with these conditions. Despite this new framework, Alcoholics/Narcotics Anonymous persists in promoting the old dogma — that substance use is a moral failing.

But, is the use of psychoactive substances at the University of Michigan a problem worth addressing? I think so. The Daily’s survey on Adderall brought the misuse and trafficking of prescription drugs on campus into the limelight for many people. Putting aside the legal implications of the Adderall trade on campus — it is a federal crime to divert a controlled substance to people without a prescription — there are also serious health risks associated with these behaviors. Stimulants like Adderall (as well as illicit ones like cocaine and methamphetamine) can be deadly to students with heart conditions, and conditions that they might not even know they have until it is too late. Adderall, despite student beliefs, is highly addictive and can cause psychosis that can lead to suicide, as in the tragic case of a Vanderbilt University student in 2010.

Writing this column to my own standards of evidence is proving difficult because, well, we do not have good data on substance use at the University. Most of my evidence is, admittedly, anecdotal. I have heard from several sources that cocaine is a frequent feature of Greek life and co-op parties, as is the mixing of prescription drugs Adderall and Xanax with alcohol — a potentially lethal combination.

Yes, there was the aforementioned Adderall survey and several others focused on marijuana and alcohol. However, what about other substances like opioids — you know, the drugs that killed more Americans in one year than the Vietnam War or the HIV/AIDS epidemic during its peak? A large, eight-year cohort study out of the University of Maryland found that prescription analgesics — which includes opioids — are the third most misused drug by college students, following marijuana and prescription stimulants (alcohol and tobacco were not considered in this study). According to that study, 35 percent of college students have used prescription stimulants non-medically at least once. The stereotype of an opioid user is someone of the working class in downtrodden areas in states like Michigan and Ohio. However, it only takes a prescription for Norco or Oxycontin after a sports injury or surgery for something to go wrong. Anyone, including high-achieving University students, is at risk for opioid addiction.

Some university communities, such as the University of Texas at Austin, have acted on opioid use on their campus. A student group at the university has been educating students and faculty there and at two other Texas universities on how to administer Narcan, the opioid overdose reversal drug. To my knowledge, nothing like this exists at the University of Michigan.

While interning within the realm of addiction treatment, I learned a lot about treatment options for substance use disorder. There are effective therapies, either psychological or medical, to help people break an addiction to psychoactive substances. While the University does a good job of educating students on the risk of the three most abused substances among our age group — tobacco, alcohol and marijuana — not much else is being done.

If you take a look at the “Alcohol and Other Drugs” page of the University Health Service website, you can see their many educational programs. This is all well and good, however, educational programs only help prevent people from getting addicted in the first place. There are many tools and programs for alcohol listed on that page, such as the “Stay in the Blue” app and the “Alcohol e-CHECKUP TO GO.” None of these programs help students break an addiction to alcohol. Is the University even offering treatment for alcohol use disorder, such as cognitive behavioral therapy and the anti-cravings drug naltrexone to students through CAPS and UHS? If so, they need to do a better job of advertising these services. I would like to see a new UHS page or a new website made by the University dedicated to presenting comprehensive information on substance use, including screening and treatment options.

I urge the University administration to take a serious look at substance use on campus. We need a comprehensive survey looking at all psychoactive substances to have good data to act on. Furthermore, we need dedicated divisions of UHS and CAPS focused on addiction treatment that offers evidence-based counseling and medication-assisted treatment for students. The University community should look to the University of Texas at Austin as an example of how to proactively address student substance use. We cannot be reactive and wait until one of our students dies from an overdose because that would be a completely avoidable tragedy.

Ali Safawi can be reached at asafawi@umich.edu.