The developmental stage spanning from mid-adolescence to early adulthood is critical in setting one’s life course in general, and this also applies to the onset of substance use disorders (SUDs): SUD rates triple from 7 percent in adolescents to 20 percent in young adults (SAMHSA, 2011). There are effective treatments for SUD-affected young people, but as with adults, relapse risks remain relatively high, especially early on. The chronic nature of SUDs for many makes recovery support critical to remaining substance free and leading a healthy life. This is especially true of young people because this life stage is a time when the influence of peers is at its peak and also, one when key life decisions are made. One such decision is whether or not to pursue a higher education.
For young people in SUD recovery, the already stressful decision of whether and where to attend college is further complicated by the high rates of substance use on campuses that may jeopardize recovery. Many college-bound youths consider attending institutions away from home, leaving behind their established sober network; that may increase vulnerability to the influence of substance using college peers. Therefore the prospect of college attendance is fraught with difficulty for any young person in recovery.
What are Collegiate Recovery Programs?
The need to provide support for students in recovery was first recognized by a handful of academic institutions in the 1980s. They developed informational seminars about addiction and established sober housing, providing students with ready-made access to peers in recovery. This model is consistent with continuing care and with the critical role peer support plays in recovery maintenance. The programs were started organically by interested faculty or other university staff and went largely unnoticed until the early 2000s. At that time, the increasing recognition of the chronic nature of addiction and an emerging emphasis on recovery in the addiction field, combined to fuel interest in what was to become known as collegiate recovery programs (CRPs). CRPs strive to create a campus-based, “recovery friendly” space and a supportive sober social community to enhance educational opportunities while supporting students’ recovery and emotional growth. SAMHSA and the US Department of Education cofunded the development of a “how-to” curriculum to start a CRP (Harris, Baker, & Thompson, 2005), and national CRP conferences started being held annually in 2009; they brought together leaders from existing CRPs, some of their students, and representatives of institutions seeking information about the model or considering starting their own CRP. As a result, the number of CRPs grew exponentially from four in 2000 to thirteen in 2010 and fifty at this writing, with three to five new programs starting annually (Laudet, Harris, Kimball, Winters, & Moberg, 2014). This trend is likely to increase with the recent formation of the national Association for Recovery in Higher Education (ARHE).
In spite of this impressive growth, the model has been neglected by researchers. The lack of empirical knowledge about CRPs and the students they serve has been frequently cited by university staff interested in starting a program and meeting difficulties in securing institutional support. Note that information about young people in SUD recovery is also important to collect independently of their CRP participation. We know little about individuals who successfully sustain recovery at a relatively young age since the bulk of research bears on treatment-involved individuals who are often in their thirties or older following up to two decades of active addiction. Therefore, to begin filling these knowledge gaps, we secured federal funding to conduct a nationwide survey of the CRPs in existence as of 2012, when the project started. The project was conducted in two stages. We first surveyed the program directors to gather information about each program’s history, funding sources, menu of services, staffing, theoretical model (if any), enrollment and participation rules and policy, students served, and site-level outcomes (Laudet, Harris, Winters, Moberg, & Kimball, 2013). Because CRPs have historically started organically with no formalized model or set of elements, individual programs can vary significantly in the type and breadths of supports and services they provide—often due to their budget and to how long they have been operating. Next, we surveyed the students enrolled in these programs. Our findings for this arm of the project were reported in details elsewhere and are summarized here following an overview of the project’s methodology.
Conducting the Survey
Before starting the project, we had reached out to all CRPs we knew of from the annual conferences and related interactions, as well as to individuals or institutions who had requested information in view of starting a CRP to determine whether they were enrolling students. This yielded a list of twenty-nine CRPs representing nineteen US states: 44 percent in the south, 22 percent in the Midwest, 19 percent in the Northeast, and 15 percent on the west coast. These CRPs completed the program survey then were recontacted in late 2012 to recruit their enrollees for the student survey; CRPs were the recruiting agents, rather than the research team, to maximize students’ confidentiality. Site directors were provided with information sheets about the survey and asked to announce the survey to students in CRP meetings and seminars, and through posting on their bulletin board and internal websites.
Topics covered in the student survey included sociodemographic background, academics, general physical and mental health questions, substance use and behavioral addiction history, current recovery status from these addictions, and utilization of treatment and other recovery resources (e.g., Twelve Step fellowships, medication). The decision to collect information about behavioral addictions—disordered eating, compulsive sex, gambling, shopping, and self-harm—was based on reports from CRP staff that some students were experiencing these issues. We could not locate scientific studies examining both substance use and multiple behavioral addiction patterns and wanted to begin documenting their prevalence.
Where possible, we used psychometrically validated standardized scales and instruments. Data were collected from February 2013 through the spring, summer, and fall semesters of that year to acquire as large a sample as possible, since students may join a CRP at any time during the academic year. The survey, administered online via Survey Monkey, began with an informed consent page, and required about one hour for which students received a $40 Amazon e-gift card. A total of 486 unduplicated surveys were completed. Based on an estimated pool of six hundred participants enrolled in CRPs over the data collection period, this represents an estimated 81 percent participation rate.
What We Found
CRP students are somewhat older than traditional college age, averaging twenty-six years of age (mean); this is not surprising given their addiction history. They represented all academic ranks, reported a 3.2 (mean) grade point average, and had participated in their CRP for seven semesters on average. Although most considered themselves in good physical health, a quarter had been to the emergency department for a medical problem or injury in the past year; we did not collect information on the specific reasons for these ER visits. Most alarming, 40 percent smoke. Reports of mental health problems were highly prevalent, with three quarter having been diagnosed with a mental health disorder, chiefly depression, anxiety disorders, and bipolar disorder, and two thirds currently receiving mental health treatment. However, most students rated their mental health as “good” or “very good.”
In terms of addiction history, the primary lifetime problem was drugs for over half the sample, and alcohol for four out of ten. A very distant third primary problem was disordered eating (5.5 percent); however it was also cited among secondary problems by one out of ten students, as was sex and love addiction. In fact, a higher than expected percentage of students reported considering themselves in recovery from a behavioral addiction—independently of their substance use recovery status—the top three being disordered eating (15.6 percent), self-harm (10.5 percent), and sex and love addiction (9.5 percent). Although alcohol- and drug-free for an average of three years, some 12 percent reported recently engaging in one or more behavioral addiction in the past ninety days.
CRP students’ substance use history, albeit relatively short (seven years) compared to the bulk of addiction studies that are typically conducted among treatment enrolled persons, was extensive in scope and included numerous substances. “Regular” substance use—that is, once a week or more often for a year or longer—started on average at age fifteen with marijuana and alcohol. The latter was cited most as the primary individual substance (i.e., drug of choice; 41 percent) followed by heroin, cocaine or crack, and pain relievers, about one out of ten for each substance.
Dependence to these substances had been severe as measured by a standardized scale, and was perceived as such by students themselves as they reported high levels of “considerable harm” from past substance use and similarly high benefits for sustained sobriety. Further evidence for having had a severe addiction history, a third of students had experienced a period of homelessness, and reports of past involvement with the criminal justice system were frequent: over half had been arrested and charged, and over a third had been incarcerated. However, most students had no current involvement with the criminal justice system.
Also consistent with a severe addiction history and with findings from other studies of persons in recovery (Laudet & Hill, 2015), most CRP students had received substance abuse treatment (82 percent). However, unlike other samples who typically do not initiate treatment until their mid-thirties, CRP students entered treatment at age twenty-one (mean). Several other forms of recovery support were reported in addition to treatment; they include individual counseling and prescribed medication as well as participation in self-help groups, chiefly Twelve Step fellowships, reported by 93 percent.
A note of caution: this is an important study because it represents a first step in finding how about students who join CRPs and more broadly, about young persons in stable recovery. However the study has limitations that must be considered when interpreting our findings. Key among these is the cross-sectional design: the study is limited to describing students’ past and current status. As such, it relies on retrospective reports—anything that we asked about the past—that may be subject to biased recall, and of course, it cannot speak of the effectiveness of CRPs over time as that requires a longitudinal design with repeated measurements.
Implications for Clinicians
The many costs of active addiction to individuals and to the nation are well documented, and they are astronomical. Emerging evidence suggests that stable recovery is beneficial to both the individual and to society (Laudet, 2013). However, many opportunities are either lost or significantly delayed because recovery typically does not begin until midlife. Educational attainment is one area that may be especially curtailed by addiction, as SUDs often develop during the period when critical decisions are made about college attendance and future career plans. Therefore it stands to reason that fostering stable recovery early on, rather than letting an SUD progress for a decade or longer as is too often the case, can have significant benefits. CRPs appear to be successful at their mission of engaging recovering students who are able to sustain their recovery status while staying in college, an environment that has been described as “abstinence hostile.” Our study findings underline several critical points that are of relevance to clinicians and clinical services developers.
First, stable recovery—a minimum of three years substance-free—is attainable at a relatively young age, even among individuals who have experienced a severe dependence and related consequences such as homelessness. That is, the course of addiction can be curtailed, sparing the individual up to another decade of active substance use followed by a cycle of relapse and recovery (Dennis, Foss, & Scott, 2007). Multiple recovery resources are typically used to initiate and sustain recovery among CRP students, consistent with findings of studies conducted among middle-aged samples. Additional research is needed to identify the contextual, psychosocial elements that foster seeking treatment and recovery in early adulthood. For example, we did not collect information on students’ socioeconomic background— note that 91 percent are Caucasian—or on the circumstances surrounding seeking treatment such as family intervention or criminal justice involvement.
Second, our findings show that some CRP students, while sober, continue to engage in several unhealthy behaviors, including smoking and disordered eating. The prevalence of smoking in this sample is more than twice the national rate, even when considering only the age group with the highest smoking prevalence, adults aged twenty-five to forty-four years, as reported by the Centers for Disease Control and Prevention (CDC, 2014). While this finding is not unique in addiction studies, it is concerning and should sensitize health care providers working with young people, as well as CRPs themselves, to the need for smoking cessation efforts in this population. While few studies have examined SUDs and behavioral addictions simultaneously, our findings will likely not be unexpected among clinicians though not previously documented in the scientific literature.
The concern here is of course that a full-blown addiction develops, be it to food, self-harm, sex/love or other compulsive unhealthy behaviors, and/or that continuing a compulsive behavior pattern, even to a nonsubstance, may increase the risk of returning to substance use (i.e., relapse). We lack research on the dynamic interaction (if any) between substance use disorders and behavioral addiction over time, and we also lack knowledge about how engaging in one of these patterns may threaten recovery from another addiction. At minimum, our findings suggest that clinicians ought to screen for disordered behavior patterns—eating, sex/love, and self-harm among young people—in addition to screening for alcohol, drug, and tobacco use. Any and all of these patterns can jeopardize overall healthy functioning and need to be addressed as early as possible, lest they become established and more challenging to alter later in life.
Finally, students reported an extensive history of past and current mental health issues, the latter being evidenced by high rates of current engagement in mental health services. Again, this finding is not unique to our sample as numerous studies of young people and adults have documented a high prevalence of co-occurring mental health issues among substance-involved persons and vice versa. Perhaps what makes this finding noteworthy is that CRP students are now sober, high functioning (i.e., in college with a better than a B average GPA), but continue to require mental health services. For counselors working with adolescents and young adults, the implication of this finding is that it is critical to screen young people for both substance use and mental health issues, and to do so regularly as problems and behaviors change over time as a function of contextual influences (e.g., academic challenges, new peer group).
Overall, consistent with the extant addiction knowledge base obtained among mostly middle-aged adults, our results document multiple unhealthy behavioral health patterns among in this sample of college students in recovery, both in the past and currently: substance use of course but also smoking, behavioral addictions, and mental health problems. This emphasizes the need for behavioral health services in general to move to an integrated approach where all unhealthy patterns can be detected and addressed simultaneously, rather than treated according to the siloed model that currently prevails. Note that until some twenty years ago, substance use and mental health, while frequently co-occurring, were treated separately by professionals working in different agencies and trained with vastly different ideologies and practices. Research and practice have since documented the superiority of an integrated approach for persons dually diagnosed with both substance use and mental health disorders (Drake et al., 2001). The scope of such integrated models may benefit from expanding to behavioral addictions, especially among young persons.
In sum, it is possible to derail the progressive course of addiction—that is, to promote stable recovery among young persons. Doing so maximizes the likelihood that they lead healthy lives and pursue educational goals that will make them competitive in the job market of the future. Young people in stable recovery report past and current issues in multiple behavioral health areas. While we do not know how representative our sample is of other young persons in recovery, especially those not enrolled in CRPs, our findings are largely consistent with prior studies from several independent lines of research, suggesting that present reports may characterize numerous young persons in addiction recovery. We urge clinicians working with this population to be vigilant about undetected co-occurring behavioral health issues, as left unaddressed they may compromise recovery and overall health.
Acknowledgements: The author gratefully acknowledges the support of research grant R21DA033448 from the National Institute on Drug Abuse (NIDA). The opinions expressed here are those of the author and do not represent the official position of NIDA.
Center for Disease Control and Prevention (CDC). (2014). Current cigarette smoking among adults—United States, 2005–2012. Morbidity and Mortality Weekly Report, 63(2), 29–34.
Dennis, M. L., Foss, M. A., & Scott, C. K. (2007). An eight-year perspective on the relationship between the duration of abstinence and other aspects of recovery. Evaluation Review, 31(6), 585–612.
Drake, R. E., Essock, S. M., Shaner, A., Carey, K. B., Minkoff, K., Kola, L., . . . Rickards, L. (2001). Implementing dual diagnosis services for clients with severe mental illness. Psychiatric Services, 52(4), 469–76.
Harris, K., Baker, A., & Thompson, A. (Eds.). (2005). Making an opportunity on your campus: A comprehensive curriculum for designing collegiate recovery communities. Lubbock, TX: Center for the Study of Addiction and Recovery, Texas Tech University.
Laudet, A. (2013). Life in recovery survey. Retrieved from http://www.facesandvoicesofrecovery.org/resources/life-recovery-survey
Laudet, A., Harris, K., Kimball, T., Winters, K. C., & Moberg, D. P. (2014). Collegiate recovery communities programs: What do we know and what do we need to know? Journal of Social Work Practice in the Addictions, 14(1), 84–100.
Laudet, A., Harris, K., Winters, K., Moberg, D. P., & Kimball, T. (2013). Nationwide survey of collegiate recovery programs: Is there a single model? Paper presented at the 75th Annual Meeting of the College on Problems of Drug Dependence, San Diego, CA.
Laudet, A., & Hill, C. (2015). Life experiences in active addiction and in recovery among treated and untreated persons: A national study. Journal of Addictive Diseases, 34(1), 18–35.
Substance Abuse and Mental Health Services Administration (SAMHSA). (2011). Results from the 2010 National Survey on Drug Use and Health: Volume I. Summary of national findings. Retrieved from http://www.samhsa.gov/data/sites/default/files/NSDUHNationalFindingsResults2010-web/2k10ResultsRev/NSDUHresultsRev2010.pdf
Editor’s Note: This article was adapted from an article by the same authors previously published in the Journal of Substance Abuse Treatment (JSAT). This article has been adapted as part of Counselor’s memorandum of agreement with JSAT. The following citation provides the original source of the article:
Laudet, A., Harris, K., Kimball, T., Winters, K. C., & Moberg, D. P. (2015). Characteristics of students participating in Collegiate Recovery Programs: A national survey. Journal of Substance Abuse Treatment, 51(1), 38–46.