This is the focus:Behavior Analysis (previously known as behaviorism) SEE articles are attached below

ORIGINAL ARTICLE

If Everyone Is Doing It, It Must Be Safe: College Students’ Development of Attitudes toward Poly-Substance Use

Erin Willisa , Robyn Adamsb, and Justin Keeneb

aAdvertising, Public Relations & Media Design, University of Colorado Boulder, Boulder, Colorado, USA; bCreative Media Industries, College of Media and Communication, Texas Tech University, Lubbock, Texas, USA

ABSTRACT Background: While binge drinking on college campuses has been a topic of concern for dec- ades, especially among fraternity and sorority members, recreational drug use is on the rise and mixing alcohol and drugs is now more of a concern than ever. Objective: Social learning theory was used as a framework for understanding how students develop attitudes regard- ing the possible risks and rewards of various behaviors such as binge drinking and drug use. Method: This research reports the results of 13 focus group discussions with 63 college students. A thematic approach was used and revealed several themes: participating in col- lege culture, experimenting is expected, ignoring risk-taking, and resisting peer pressure. Findings: Participants felt as if it was expected that college students would experiment with alcohol and drugs, and that it was just “part of going away to college.” Students reported ignoring the known risks of mixing alcohol and drugs use despite prior education efforts. Conclusions: The findings of this study suggest that alcohol and drug use on college cam- puses is, at least in part, driven by a perception of college culture and a poor balancing of the risks and rewards associated with these behaviors.

KEYWORDS Binge drinking; social learning theory; focus groups; non-medical use of prescription medication; risky behavior

Over one-third of full-time college students (18–22) engaged in binge drinking in the past month; about one in five used an illicit drug in the past month (Center for Behavioral Health Statistics & Quality, 2015). The Centers for Disease Control and Prevention (2017) characterize substance use as the foremost public health hazard facing college students. Substance use creates negative health, social, and eco- nomic consequences for students, their families, and their communities (National Institute on Drug Abuse, 2017; Substance Abuse and Mental Health Services, 2006). While binge drinking on college campuses has been a topic of concern for decades (Hahm, Kolaczyk, Jang, Swenson, & Bhindarwala, 2012; Wechsler, Lee, Kuo, & Lee, 2000; White & Hingson, 2013), recre- ational drug use is on the rise and poly-substance use (mixing alcohol and drugs) is now more of a concern than ever (CDC, 2017). In addition, much of this poly-substance use involves prescription medication in lieu of more illicit drugs (e.g., cocaine, marijuana). Young people who engage in the non-medical use of prescription medications have an increased risk of using other drugs (e.g., alcohol, marijuana), suffering from health issues (e.g., weight gain, mental health

problems), and engaging in risky behaviors (e.g., unprotected sex, criminal activity) (Ford & Arrastia, 2008).

Exposure and access to prescription medication is high on college campuses with 61% of college students being offered these medications at least once, and 31% using them non-medically (Garnier-Dykstra, Caldeira, Vincent, O’Grady, & Arria, 2012). In addition, stu- dents often overestimate the risky behaviors of their peers; they overestimate stimulant use by 12.2% and pain medication use by 8.8%, whereas marijuana use by only 2.9% (McCabe, 2008). Such an overestimation of risky behavior likely influences students’ percep- tions of the risks associated with particular behaviors and shifts their likelihood of partaking in such behav- ior in the future.

Many universities and colleges now require stu- dents to complete alcohol education programs prior to arriving on campus (Croom et al., 2009). Previous research notes that these brief alcohol interventions yield only modest results, and that education alone is not effective (Carey, Scott-Sheldon, Garey, Elliott, & Carey, 2016; Tanner-Smith & Lipsey, 2015). Thus, this study has two goals: (1) to better understand the role

CONTACT Erin Willis [email protected] University of Colorado Boulder, 1511 University Ave, Boulder, CO, 478 UCB, 80309, USA. � 2019 Taylor & Francis Group, LLC

SUBSTANCE USE & MISUSE 2019, VOL. 54, NO. 11, 1886–1893 https://doi.org/10.1080/10826084.2019.1618334

of social influence and peer behavior on the creation and maintenance of attitudes toward various sub- stance use behaviors, like mixing alcohol and drugs; (2) to better understand how these attitudes interact with perceptions of rewarding outcomes and risky consequences to influence planned behavior. The goals of this study add to our understanding of college stu- dents’ decision-making processes, and better inform health education and promotion targeted at new and incoming students. We employed qualitative method- ology to gain insight into college students’ perspec- tives specific to the social learning theory. The results are discussed within the context of this theory with particular emphasis on the practical outcomes associ- ated with cessation efforts on college campuses related to education and intervention.

Social learning theory

Social learning theory provides a theoretical frame- work for understanding risk-taking behaviors among college students. The theory posits that people can learn by observing and modeling others’ behaviors (Bandura, 1977). Deviant behavior is learned and pri- mary groups, such as peer groups, play a central role in this learning. One place where the influence of peers is prevalent is college campuses. Indeed, collegi- ate peer use of alcohol often determines individual use, and peer norms predict binge drinking (Bandura, 1977; Crawford & Novak, 2010; Read, Wood, Kahler, Maddock, & Palfai, 2003; Sher, Bartholow, & Nanda, 2001; Tyler, Schmitz, Ray, Adams, & Gordon Simons, 2017). Previous research also notes that many college students have positive attitudes toward alcohol use (Peralta & Steele, 2010; Schultz, Nolan, Cialdini, Goldstein, & Griskevicius, 2007; Wechsler et al., 2003), have well-defined reasons for drinking, for instance, mood enhancement or reducing stress (O’Connor & Colder, 2005; O’Hara, Armeli, & Tennen, 2015).

In addition, the perceived benefits (e.g., social interaction, fun/enjoyment) of drinking are significant predictors of alcohol use (Brooks-Russel, Simons- Morton, Haynie, Farhat, & Wang, 2014). Prior work has demonstrated that first-year students are highly susceptible to modeling the behavior of their older peers, and are at the highest risk for the negative con- sequences of alcohol use (Armeli, Conner, Cullum, & Tennen, 2010; Maggs, Williams, & Lee, 2011). Students with the highest likelihood of engaging in multiple health-risk behaviors reported poorer mental health, particularly related to stress and anxiety (Martinez, Klanecky, & McChargue, 2018). Perceived

norms influence college students’ level of drinking through the observation and comparison of their peers’ drinking levels (Fournier, Hall, Ricke, & Storey, 2013; Stappenbeck, Quinn, Wetherill, & Fromme, 2010). The prediction here is that risky substance use on college campuses is, at least in part, a product of social learning processes that lead to attitudes regard- ing specific substances and situations.

Differential association and reinforcement

There are several key elements to the learning process, including differential association and differential reinforcement (Akers, 2011). Differential association is the association with individuals who engage in certain types of conduct, as well as the exposure to different sets of values and norms as a consequence of such associations (Akers, 2011). For example, over 70% of students nationwide overestimated the quantity of alcohol consumed by their peers; further, the percep- tion of campus drinking norms was by far the stron- gest predictor of personal consumption, stronger even than the actual campus drinking norm (Wesley Perkins, Haines, & Rice, 2005).

Differential reinforcement is “the balance of antici- pated and actual rewards and punishments that follow or are consequences of behavior” (Akers, 2000, p. 78). Within the context of alcohol use, this could take the form of several different outcomes (e.g., hangovers, Driving While Impaired (DWIs), alcohol poisoning). However, as Durkin, Wolfe, and Clark (2005) demon- strated, college-aged binge drinkers reported that alco- hol consumption has more rewarding outcomes than negative consequences.

In addition to the prediction related to the role of social learning processes in risky behaviors, the cur- rent study also seeks to understand how these social learning processes interact with prior knowledge regarding the risky nature of certain behaviors. By concentrating on the differential associations and rein- forcements regarding binge drinking and drug use among college students, this study explores how atti- tudes are formed and how behaviors are reinforced by perceptions of normative behavior within peer groups. This research fills a gap in the literature related to the qualitative exploration of college students’ perceptions of poly-substance use and risk-taking behaviors.

Method

This study used focus groups drawn from a larger stu- dent population at a southwestern university. Focus

SUBSTANCE USE & MISUSE 1887

groups provide insights into a target audience’s per- ceptions and motivations (Krueger & Casey, 2015), and can capture the complexities of attitude and behavioral intentions (Kitzinger, 1994). Enrollment at the southwestern university was approximately 37,000 students. The college students were recruited from general media and communication studies courses via an online recruitment system, and they received extra course credit for their participation. This research study was approved by the southwestern university’s institutional review board. The key ethical considera- tions reviewed for this study relate to informed con- sent, confidentiality, and the right to withdraw. Participants had to be at least 18 years old to register for the study and be enrolled at the southwestern uni- versity. The recruitment procedures, discussion guide, transcription process, and data analysis were approved by the IRB. Age and university enrollment were the only exclusion criterion; participants were not excluded based on substance use history.

Thirteen group discussions were held in October 2017 with a total of 63 college students (27 men, 36 women; 3–8 per group) who were between 18 and 25 years old. Prior to the focus group discussions, a trained moderator reviewed the goals of the study, consent forms, and the right to withdraw with the participants. One author, who had received training in conducting focus group discussions, moderated each semi-structured focus group discussion. The duration of the focus groups ranged from 45 to 80 min. A dis- cussion guide was developed to probe participants’ per- ceptions of the college “party scene” and substance use on campus. Open-ended questions helped minimize researchers’ bias and allow participants to respond. Following open-ended questions, probing questions focused on participants’ feedback. Sample questions included: What role does alcohol play in college for you and your friends? When drinking alcohol, are there times when drugs are around? In your experience, is it common for your peers to do drugs? What social pres- sures do you feel regarding drinking/drug use?

The focus groups were audio-recorded, transcribed verbatim by an online transcription service, and then analyzed using a thematic approach (Miles & Huberman, 1994). Thematic analysis identifies themes that emerge as being important to the description of a phenomenon; it is a form of pattern recognition within the data, while emerging themes become cate- gories for analysis (Miles & Huberman, 1994). The theoretical proposition that led this study – social learning theory, specifically differential associations and reinforcements – was used to assist in the

development of themes. This research used Miles and Huberman’s data-analysis procedures. The first author reviewed all transcripts and derived a set of themes from the discussions, and the second and third authors independently reviewed all transcripts and the appro- priateness of the themes derived by the first author. Disagreements on themes were resolved through dis- cussion. The first author then coded all of the tran- scripts by categorizing relevant statements in the transcripts under themes (Stappenbeck et al., 2010). The second and third authors then reviewed the coded statements, and disagreements on the codes were resolved. This rigorous analysis by multiple researchers enhanced the reliability of the themes (Miles & Huberman, 1994). The number of focus groups needed was determined by saturation, or the point where no new themes emerged (Krueger & Casey, 2015).

Findings

The current study used the social learning theory as the analytical framework for identifying themes. Focusing on differential associations and differential reinforcements related to “partying” and substance use, the following themes emerged: participating in college culture, experimenting is expected, ignoring risk-taking, and resisting peer pressure, and are described below.

Participating in college culture

The majority of participants felt that alcohol and drug use is part of attending college, and that most college students engage in this type of behavior as part of socializing. Five participants reported not drinking due to various factors including religion, addiction, or hiatus. Several participants mentioned that there was “nothing else to do” or that drinking “is just – you don’t think about it, it’s what you do.” The partici- pants felt as if “partying” was expected of them since they were in college, “that’s what college students do.”

I mean in general I feel like when you want to do something, it’s always like centered around drinking. Like it’s kind of like the social thing to do. I think it’s just sort of the college thing. (Female, 19, Group #5)

You feel more inclined to drink since everybody, or a lot of people, are doing it in this demographic area. (Male, 21, Group #1)

I just can’t imagine being here without alcohol. (Female, 22, Group #2)

Some participants even chose to attend this particu- lar university because of its “party school” reputation.

1888 E. WILLIS ET AL.

Many participants reported binge drinking more while underage than after they turned age 21 due to several factors, including being new to alcohol and not know- ing their limits or lack of access. However, many par- ticipants reported “having a drink at dinner” and “just staying home on the weekends and drinking” rather than frequenting bars after they were legally allowed to drink.

I mean, I’m not 21 anymore. I don’t go out and get lit every weekend. Yeah, we might drink at home, but it’s not like going to the bars. (Female, 22, Group #6)

We will just kick back and chill sometimes at the house … might have a few people stop by, but it’s very chill. (Male, 22, Group #10)

All of the participants mentioned football games and tailgating specifically as times where “drinking is taken to the next level,” meaning that people are drinking heavily (some reported “up to 22 drinks on game day”). “Pre-gaming,” by student definition is where five to eight drinks are consumed before going out, was commonly reported. While out at the bar, participants reported drinking more alcohol and sometimes using drugs such as cocaine, Molly, or Xanax. Participants reported keeping a running list of what types of alcohol mixed best with specific types of available drugs. While many reported experimenting with alcohol and drugs prior to college, that experi- mentation drastically increased while in college.

Yeah, you get here and you see everyone drinking. Eventually, you start drinking as much as everyone else. (Female, 21, Group #9)

Participants reported having more opportunities to binge drink in college, and because alcohol seemed to be at most social functions, drinking (and often, binge drinking) was expected behavior.

Experimenting is expected

Participants felt experimentation with combining drugs and alcohol was normal, and most agreed that marijuana use was very common among college stu- dents. All of the focus group participants reported seeing or using marijuana while at college. Six partici- pants reported being regular users of marijuana.

I smoke weed every single day. I do everything high and I have great grades. (Female, 19, Group #8)

Other drugs were reported to be popular among some crowds or in “bathrooms everywhere in the bars.” For example, half of participants reported being offered cocaine at a party.

I was at a party. We’ve had [fraternity] events where a couple of my friends, they’d just be like, “hey, you want a bump or something? I’d be like, ‘yeah, why not’, it’s free, it’s nothing I would pay for because it’s not worth it to me. (Male, 21, Group #7)

It was just at a gathering and some girl just had some cocaine and she was like, ‘who wants a free line?’ And I was like, ‘why not?’. (Female, 20, Group #10)

Being in a social environment and having the opportunity to try the drug facilitated participants’ willingness to act. “It’s like since so many others are doing it, I just can’t see the harm, I guess.” The majority of participants reported seeing others mix drugs and alcohol. The participants who reported common drug use also reported having prior desires and positive attitudes toward such risky behavior.

Ten of the participants reported actively using drugs recreationally, sometimes in combination with alcohol. For example, many participants reported using Xanax prior to drinking or cocaine after a long night “to sober you up.” Half of the participants reported experimenting with drugs once or twice, but then after the experience, refraining from future drug use because “it just isn’t my thing.” The remaining participants had never used drugs, but felt like it was okay for others who wanted to experiment.

Ignoring risk-taking

All of the participants discussed “blacking out from alcohol,” either having personal experience or hearing first-hand from friends. Participants reported “blacking out” because they either did not yet know their limits or as a planned behavior.

Usually I feel like alcohol plays the biggest part in blacking out. I think people do plan to black out, because I have so many friends that are like, ‘Oh, my God, I had four tests this week. I just want to go out tonight and not remember anything’. They completely black out. I’ve blacked out before. Personally, I don’t really like it because I don’t like not remembering anything, because I feel like I did something stupid and you just don’t remember it … (Female, 21, Group #5)

In terms of drug use, one participant noted that ‘everyone is medicated’ and that ‘prescription pills are everywhere’. Many reported the use of prescription pills specifically. For example, some reported friends ‘stockpiling’ prescription Xanax to use recreationally, or purchasing Adderall from friends with prescrip- tions to use while studying or ‘partying’. Participants reported prescription drugs as being ‘very accessible around here’.

SUBSTANCE USE & MISUSE 1889

Most of the participants reported not associating marijuana with any risk, ‘probably because it’s legal in most states’. Other drugs were thought of as being dangerous, including cocaine and prescription medica- tions such as Adderall, Ambien, and Xanax, when taken with alcohol. Additionally, when asked to rank substances by most dangerous to least dangerous, most participants agreed that alcohol was the most dangerous drug, followed by prescription pills and cocaine.

I probably would just say that alcohol is one of the worst because you don’t see it as a drug, but it really is because people get addicted to it every day. (Female, 24, Group #11)

I’d say I think alcohol is worse [than prescription drugs]. So I would really say … of course the cocaine, most definitely, and then alcohol after that, you know what I’m saying? Not because of the long- term effects or whatever. You got to drink a whole lot to actually mess your kidneys, but just the fact that people get messed up on it, drive and stuff like that. (Male, 19, Group #2)

The majority of participants reported engaging in binge drinking and/or drug use, but did not discuss the risks with friends due to several factors men- tioned, including “we learned about that in high school” and “that’s her life, whatever.” Participants reported drug users as not wanting to think about the risks, or “they’re not going to be proactive with it. You’ve got to ask them.” Five participants reported knowing friends who passed away from drug overdose but still reported engaging in drinking and drug use, just “in moderation.” In addition, most agreed that they would not warn strangers of the risks of sub- stance use. Participants felt as if strangers would not heed their warning, and, therefore, agreed that they would not try to dissuade a stranger from using drugs in combination with alcohol, despite the obvious risks.

Resisting peer pressure

The participants agreed that they felt social pressure to drink but not to do drugs.

I’ve never been pressured to take any drugs. I’ve been asked, but they weren’t really as persistent as with alcohol, because I think they know that drugs is a little more than just alcohol. (Female, 20, Group #12)

No one’s like, ‘Shove this [drink] down or you’re not part of the [name of school] family!’ I don’t think it’s like that, it’s just we all do it [binge drink]. (Female, 19, Group #4)

There’s no pressure to do drugs … it’s just, it’s just if you want it. (Male, 18, Group #10)

If participants were offered drugs and they did not want to partake, many felt as if it would be easy to decline the offer. Additionally, participants noted that drugs were common among ‘certain crowds’ and that peer pressure was about choice.

I think there’s always going to be that social pressure. The kind of friend they’re going to be like, ‘Oh, smoke this, smoke this, smoke this’. But it’s really like at the end of the day, it’s your own decision to make. (Male, 23, Group #7)

I feel that it’s like a lot who you surround yourself with and like who your friends are, and like who you choose to be around and stuff. (Female, 20, Group #11)

Although it would seem drugs are commonly offered with no pressure, alcohol carries a greater social influence, “I mean, it’s hard because everyone is doing it.” The majority of participants reported drink- ing frequently, and when opting not to drink – did not mention being pressured by their peers. Most reported that their friends did not pressure them to do anything they didn’t already want to do.

Well, I guess you are on Snapchat and you see all your friends out, you’re like, oh, crap. I want to go out drinking with them. I don’t want to be stuck at home. (Female, 19, Group #8)

Participants reported fearing missing out on the social scene if they were not out drinking with their friends. Specifically, seeing friends having fun on social media platforms created a desire for participants to engage in the same activities. However, educational duties often dictated when participants engaged in heavy drinking, and most agreed that “drinking shouldn’t get in the way of why I’m here.”

For those participants who did not drink at the time of the focus groups, all reported not having any difficulty resisting peer pressure in social settings whether related to drugs and alcohol. After “pre- gaming,” many participants reported drinking two to four drinks while out at the bar unless “someone buys me a drink, and yeah, I’ll drink it.” One participant said: “I’ve never seen anyone be pressured to start drinking, but I have seen people pressured to keep drinking.”

Discussion

This study had two goals: (1) to understand how both social influence and peer behavior influences attitudes toward various substance use behaviors, and (2) to understand how perceptions of rewarding outcomes and risky consequences interact with these attitudes to

1890 E. WILLIS ET AL.

influence planned behavior. Focus groups were used to discuss binge drinking and substance use with col- lege students to understand their perceptions of these risky behaviors; specifically, the differential associa- tions and differential reinforcements that students perceive of these behaviors was probed with direct questioning. Although previous research has demon- strated that experimentation with drugs and alcohol is common and increasing among college students (Behavioral Health Coordinating Committee: Prescription Drug Abuse Subcommittee, Department of Health & Human Services, 2013), this study revealed how perceptions of peer norms and the bal- ancing of risk with reward influence behavior.

Four themes were identified within the data: partic- ipating in college culture, experimenting is expected, ignoring risk-taking, and resisting peer pressure. Students believed they were expected to experiment with alcohol and drugs, and that sometimes included use. In every focus group, it was said at least once, “everybody’s doing it” in regard to drinking. Students also noted that their university had a “party school” reputation and that was attractive during recruitment.

Marijuana was considered “normal” amongst stu- dents because it was often reported as “always being around.” Interestingly, however, students reported feeling pressure to partake in alcohol but not drugs. Both illicit and prescription drugs were common and available to students, and some reported accepting while others declined. Regardless of the type, drug use was highest in conjunction with alcohol. Although students reported knowing the risks of combining alcohol with prescription medications and illicit drugs, these risks did not outweigh the perceived rewards. Few students reported avoiding discussing the risks with their friends because “it’s their life, you know?.”

Theoretical implications

Theoretically, the findings from this study offer insight into the differential associations and reinforce- ments among college students related to alcohol and drug use. About half of the participants reported abstaining from drug use, while only five reported not drinking alcohol. The reported variance in drinking behavior was evidence of different peer groups at this university and how these associations influence the perception of norms. Several students reported seeing “hard drugs” at parties and making the decision to leave because they did not feel comfortable around illicit drug use. However, when it came to drinking, excessive consumption was permitted because “that’s

what everyone else is doing.” Students reported “pre- gaming” as a common behavior prior to drinking more while out at a bar where drug use might also occur. Many students perceive alcohol and drug use as part of the college experience and thus, they per- ceive this to be the norm. Because of their desire to be part of the “in-group,” they report more reward than risk due to their perception that “everybody’s doing it.” Additionally, participants also mentioned seeing “partying” on social media applications – sometimes from peers at their same university, some- times from peers at different universities – contribu- ting to students’ perceptions that indeed, “everybody’s doing it.”

In terms of differential reinforcement, students reported learning their limits “the hard way,” for example, drinking until sick, “blacking out,” and then adjusting their behavior as to avoid negative conse- quences in the future. Most of the students reported socialization and “having fun” as benefits to engaging in risk-taking behaviors, but they also acknowledge the negative consequences, for example, hangovers, sexual assault. Akers notes that differential reinforce- ment is the “balance” of rewards and consequences of engaging in a particular behavior (Akers, 2000; Maggs et al., 2011). It is clear that over time, students find a balance in the rewards and consequences of particu- larly risky behavior that is common to their perceived college experience. Interestingly, students’ evaluations of their risk-taking behaviors are determined by their performance in classes. If drinking or drug use was interfering with attendance or their personal (or par- ental) definition of success, then it was perceived as a problem. However, health issues were not cited as a reason for the cessation of the risky behavior.

Public health implications

The findings from this study inform public health interventions targeted at high school and college stu- dents specifically. Although the current study focused on college students, many said they used drugs and/or alcohol prior to attending college. Therefore, predis- positions to alcohol and drugs start prior to college, as does students’ perception of college culture; thus attempts to prevent or cessate must start earlier and grow as college progresses. More health education should be targeted to this age group to help them form an understanding of the risks of substance use, especially mixing alcohol and drugs. Realistic, targeted health messaging could help set this population’s expectations of college “partying” and demonstrate the

SUBSTANCE USE & MISUSE 1891

consequences of risky behaviors. Findings from this study might be used by college university’s health cen- ters to design messages that highlight the consequen- ces of substance abuse. Additionally, many universities require students to complete alcohol education prior to their first year on campus. Often, university educa- tion includes bystander training which focuses mainly on sexual misconduct, but perhaps should also include lessons for students on substance use and discourag- ing peers (not just friends!) from mixing drugs and alcohol. Our research offers insight into substance abuse topics that is informed by students and should be considered when designing health messages to this audience. This research demonstrates that students are likely ignoring the negative consequences to risky behaviors in order to be accepted by their peer group and to achieve the perceived benefits of alcohol and drug use. Future public health messaging related to the use of drugs and alcohol concurrently should con- centrate on accentuating the rewards of avoiding such behavior rather than simply focusing on the risks as these risks seem to be easily dismissed by this age group.

Limitations

This study used a qualitative approach; focus groups cannot be generalized to a general population of col- lege students. The lack of independent coding by more than one author is a limitation. In addition, the students in the sample are from one university and, thus, future work should include other campuses across the country. Additionally, the university’s IRB limited the demographic and behavioral information that could be collected from students. Future work should attempt to probe the relationships between these differential associations and reinforcements through quantitative measures such as large-scale sur- veys or experimental designs intended to present mes- sages that might appeal to one or both of the social learning processes.

Taken together, the findings of this study suggest that poly-substance use on college campuses is, at least in part, driven by a perception of college culture and a poor balancing of the risks and rewards associ- ated with these behaviors.

Declaration of interest

The authors declare that they have no conflict of interest. The authors alone are responsible for the content and writ- ing of the article.

ORCID

Erin Willis http://orcid.org/0000-0002-1582-0867 Justin Keene http://orcid.org/0000-0002-1404-0025

References

Akers, R. L. (2000). Criminological theories: Introduction, evaluation, and application (pp. 17–21). Los Angeles, CA: Roxbury.

Akers, R. L. (2011). Social learning and social structure: A general theory of crime and deviance (pp. 34–38). Piscataway, NJ: Rutgers.

Armeli, S., Conner, T. S., Cullum, J., & Tennen, H. (2010). A longitudinal analysis of drinking motives moderating the negative affect-drinking association among college students. Psychology of Addictive Behaviors, 24(1), 38–47. doi:10.1037/a0017530

Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychology Review, 84(2), 191–215. doi:10.1037/0033-295X.84.2.191

Behavioral Health Coordinating Committee: Prescription Drug Abuse Subcommittee, Department of Health and Human Services. (2013). Addressing prescription drug abuse in the United States: Current activities and future opportunities. Retrieved Jan 8, 2018 from http://www.cdc. gov/HomeandRecreationalSafety/pdf/HHS_Prescription_ Drug_Abuse_Report_09.2013.pdf.

Brooks-Russel, A., Simons-Morton, B., Haynie, D., Farhat, T., & Wang, J. (2014). Longitudinal relationship between drinking with peers, descriptive norms, and adolescent alcohol use. Prevention Science, 15, 497–505. doi:10.1007/ s11121-013-0391-9

Carey, K. B., Scott-Sheldon, L. A. J., Garey, L., Elliott, J. C., & Carey, M. P. (2016). Alcohol interventions for man- dated college students: A meta-analytic review. Journal of Consulting and Clinical Psychology, 84(7), 619–632. doi: 10.1037/a0040275

Center for Behavioral Health Statistics and Quality. (2015). Results from the 2014 national survey on drug use and health: Detailed tables (pp. 6–12). Rockville, MD: Substance Abuse and Mental Health Services Administration.

Centers for Disease Control and Prevention. (2017). Fact sheets – Binge drinking. Retrieved Dec 15, 2017 from https://www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm.

Crawford, L. A., & Novak, K. B. (2010). Beliefs about alco- hol and the college experience as moderators of the effects of perceived drinking norms on student alcohol use. Journal of Alcohol and Drug Education, 54, 69–86.

Croom, K., Lewis, D., Marchell, T., Lesser, M. L., Reyna, V. F., Kubicki-Bedford, L., … Staiano-Coico, L. (2009). Impact of an online alcohol education course on behavior and harm for incoming first-year college students: Short- term evaluation of a randomized trial. Journal of American College Health, 57(4), 445–454. doi:10.3200/ JACH.57.4.445-454

Durkin, K. F., Wolfe, T. W., & Clark, G. A. (2005). College students and binge drinking: An evaluation of the social learning theory. Sociological Spectrum, 25(3), 255–272. doi:10.1080/027321790518681

1892 E. WILLIS ET AL.

Ford, J. A., & Arrastia, M. C. (2008). Pill-poppers and dop- ers: A comparison of non-medical prescription drug use and illicit/street drug use among college students. Addictive Behaviors, 33(7), 934–941. doi:10.1016/ j.addbeh.2008.02.016

Fournier, A. K., Hall, E., Ricke, P., & Storey, B. (2013). Alcohol and the social network: Online social networking sites and college students’ perceived drinking norms. Psychology of Popular Media Culture, 2(2), 86–95. doi: 10.1037/a0032097

Garnier-Dykstra, L. M., Caldeira, K. M., Vincent, K. B., O’Grady, K. E., & Arria, A. M. (2012). Nonmedical use of prescription stimulants during college: Four-year trends in exposure opportunity, use, motives, and sour- ces. Journal of American College Health, 60(3), 226–236. doi:10.1080/07448481.2011.589876

Hahm, H. C., Kolaczyk, E., Jang, J., Swenson, T., & Bhindarwala, A. M. (2012). Binge drinking trajectories from adolescence to young adulthood: The effects of peer social network. Substance Use & Misuse, 47, 745–756. doi:10.3109/10826084.2012.666313

Kitzinger, J. (1994). The methodology of focus groups: The importance of interaction between research participants. Sociology of Health and Illness, 16, 103–121. doi:10.1111/ 1467-9566.ep11347023

Krueger, R. A., & Casey, M. A. (2015). Focus groups: A practical guide for applied research (5th ed.; pp. 18–23). Thousand Oaks, CA: Sage Publications, Inc.

Maggs, J. L., Williams, L. R., & Lee, C. M. (2011). Ups and downs of alcohol use among first-year college students: Numbers of drinks, heavy drinking, and stumble and pass out drinking days. Addictive Behaviors, 36(3), 197–202. doi:10.1016/j.addbeh.2010.10.005

Martinez, H. S., Klanecky, A. K., & McChargue, D. E. (2018). Problem drinking among at-risk college students: The examination of Greek involvement, freshmen status, and history of mental health problems. Journal of American College Health. doi:10.1080/07448481.2018. 1432625

McCabe, S. E. (2008). Misperceptions of non-medical pre- scription drug use: A web survey of college students. Addictive Behaviors, 33(5), 713–724. doi:10.1016/ j.addbeh.2007.12.008

Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis: An expanded sourcebook (pp. 98–101). Thousand Oaks, CA: Sage Publications, Inc.

National Institute on Drug Abuse. (2017). Medical conse- quences of drug abuse. Retreived Dec 6, 2017 from http://www.drugabuse.gov/related-topics/medical-conse- quences-drug-abuse.

O’Connor, R. M., & Colder, C. R. (2005). Predicting alcohol patterns in first-year college students through motiv- ational systems and reasons for drinking. Psychology of Addictive Behaviors, 19, 10–20. doi:10.1037/0893- 164X.19.1.10

O’Hara, R. E., Armeli, S., & Tennen, H. (2015). College stu- dents’ drinking motives and social-contextual factors: Comparing associations across levels of analysis. Psychology of Addictive Behaviors, 29, 420–429. doi: 10.1037/adb0000046

Peralta, R. L., & Steele, J. L. (2010). Nonmedical prescrip- tion drug use among US college students at a midwest university: A partial test of social learning theory. Substance Use & Misuse, 45, 865–887. doi:10.3109/ 10826080903443610

Read, J. P., Wood, M. D., Kahler, C. W., Maddock, J. E., & Palfai, T. P. (2003). Examining the role of drinking motives in college student alcohol use and problems. Psychology of Addictive Behaviors, 17(1), 13–23. doi: 10.1037/0893-164X.17.1.13

Schultz, P. W., Nolan, J. M., Cialdini, R. B., Goldstein, N. J., & Griskevicius, V. (2007). The constructive, destructive, and reconstructive power of social norms. Psychological Science, 18(5), 429–434. doi:10.1111/j.1467- 9280.2007.01917.x

Sher, K. J., Bartholow, B. D., & Nanda, S. (2001). Short- and long-term effects of fraternity and sorority member- ship on heavy drinking: A social norms perspective. Psychology of Addictive Behaviors, 15(1), 42–51. doi: 10.1037//0893-164X.15.1.42

Stappenbeck, C. A., Quinn, P. D., Wetherill, R. R., & Fromme, K. (2010). Perceived norms for drinking in the transition from high school to college and beyond. Journal of Studies on Alcohol and Drugs, 71(6), 895–903.

Substance Abuse and Mental Health Services Administration. (2006). A comprehensive plan for pre- venting and reducing underage drinking. Retrieved Dec 29, 2017 from: http://www.stopalcoholabuse.gov/media/ pdf/underagerpttocongress.pdf.

Tanner-Smith, E. E., & Lipsey, M. W. (2015). Brief alcohol interventions for adolescents and young adults: A system- atic review and meta-analysis. Journal of Substance Abuse Treatment, 51, 1–18. doi:10.1016/j.jsat.2014.09.001

Tyler, K. A., Schmitz, R. M., Ray, C. M., Adams, S. A., & Gordon Simons, L. (2017). The role of protective behav- ioral strategies, social environment, and housing type on heavy drinking among college students. Substance Use and Misuse. doi:10.1080/10826084.2017.1363235

Wechsler, H., Lee, J. E., Kuo, M., & Lee, H. (2000). College binge drinking in the 1990s: A continuing problem results of the Harvard School of Public Health 1999 College Alcohol Study. Journal of American College Health, 48(5), 199–210. doi:10.1080/07448480009599305

Wechsler, H., Nelson, T. E., Lee, J. E., Seibring, M., Lewis, C., & Keeling, R. P. (2003). Perception and reality: A national evaluation of social norms and marketing inter- ventions to reduce college students’ heavy alcohol use. Journal of Studies on Alcohol, 64(4), 484–494. doi: 10.15288/jsa.2003.64.484

Wesley Perkins, H., Haines, M. P., & Rice, R. (2005). Misperceiving the college drinking norm and related problems: A nationwide study of exposure to prevention information, perceived norms and student alcohol mis- use. Journal of Studies on Alcohol, 66(4), 470–478. doi: 10.15288/jsa.2005.66.470

White, A., & Hingson, R. (2013). The burden of alcohol use: Excessive alcohol consumption and related conse- quences among college students. Alcohol Research: Current Reviews, 35, 201–218.

SUBSTANCE USE & MISUSE 1893

Copyright of Substance Use & Misuse is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.