Academic Impairment From Sleep Difficulties: The Role of Substance Use, Psychological Distress, and Loneliness in U.S. College Students

Sleep-related academic impairment is a common issue among college students and may be influenced by psychological and behavioral health factors. This study used data from the Spring 2021 American College Health Association-National College Health Assessment III (ACHA-NCHA III) to examine whether psychological distress, loneliness, and substance use were associated with academic impairment due to sleep difficulties among U.S. college students aged 18–24 (N = 798). Logistic regression showed that psychological distress, loneliness, and elevated risk scores for alcohol and cannabis use were significantly associated with sleep-related academic impairment. Tobacco use was marginally associated.Demographic factors did not show significant associations. These findings suggest that mental health and substance use are important, intersecting contributors to academic impairment caused by sleep problems. Interventions that address mental health, reduce substance use risk, and promote healthy sleep may be particularly beneficial in improving academic outcomes and overall student well-being on college campuses.

The Evidence for SBIRT in Adolescents

This study examines how tobacco, alcohol, and cannabis use predict Serious Mental Illness (SMI) among college students while considering demographic and lifestyle factors. Using secondary data from the American College Health Association-National College Health Assessment III (2019–2023), we analyzed responses from 69,131 students (ages 18–24) across 129 U.S. institutions. Logistic regression models assessed the relationships between substance use risk levels and SMI prevalence, controlling for confounders. SMI was measured using the Kessler 6 (K6) scale, while substance use risk was categorized as low, moderate, or high based on Substance Specific Involvement Scores (SSIS). High-risk use of tobacco, alcohol, and cannabis significantly increased the likelihood of SMI, with odds ratios of 2.67, 3.38, and 3.33, respectively. Protective factors included sufficient sleep (OR: 0.46) and sports participation (OR: 0.80). Additionally, transgender and gender non-conforming students faced a significantly higher risk of SMI (OR: 2.26). The findings highlight the critical role of substance use in shaping mental health outcomes among college students. Interventions should integrate substance use prevention while promoting protective behaviors like adequate sleep and regular physical activity to enhance student well-being.

Mental health symptoms are overrepresented among college students worldwide. The current research investigates the associations among substance use, family functionality, and mental health (depression, anxiety, and stress) among college students in Spain. A total of 828 (59.2% female and 40.8% male) college students from two public universities completed a self-reported online survey that included items on demographic information, substance use (alcohol, tobacco, cannabis, cocaine, prescription sedatives, and recreational sedatives), mental health symptoms (using the DASS-21 questionnaire) and family functionality (using the APGAR questionnaire). College students reporting substance use (especially recreational sedatives) and family dysfunctionality were more likely to exhibit symptoms of depression, anxiety and stress. These findings provide support for the underlying role of substance use and family functionality on mental health symptoms. Treatments targeting depression, anxiety, and stress among college students in Spain should aim to reduce substance use by and increase family support of students.

This study estimated how patterns of substance use are related to work status, public program use, and well-being among a sample of female caregivers and children. This study assessed work, public program use, and well-being measures as a function of substance use among 1,623 female caregivers of children aged zero to four or ten to 14 who participated in the Welfare of Children and Families study and lived in low- and moderate-income neighborhoods in Boston, Chicago, and San Antonio. Data were analyzed from baseline interviews that were conducted from March through December 1999 and from follow-up interviews that were conducted 11 to 26 months after baseline (average of 16 months). Substance use patterns were placed into three categories: light or no substance use reported in both interviews, moderate or heavy substance use (that is, moderate or heavy use in both interviews or increased substance use during the study period), and reduced substance use during the study period. Among caregivers who reduced their substance use, measures of work status, receipt of income assistance, mental health symptoms, and reports of child behavior problems were not significantly different at follow-up from those of caregivers with light or no substance use. At follow-up, compared with caregivers with light or no substance use, those with moderate or heavy substance use were significantly less likely to experience improvements in mental health symptoms and to see improvements in their children's behavioral problems. Caregivers with moderate or heavy substance use were more likely to be "detached" (p=.051)--that is, neither working nor collecting income assistance--although this difference was only marginally significant. Caregivers with increased substance use fared poorly on measures of well-being and work. Policies that promote, rather than impede, reductions in substance use are more likely to promote self-sufficiency and well-being.

Cyber dating abuse (CDA) is prevalent on college campuses, with 43% of college students experiencing CDA each year. Yet, the potential impacts of CDA victimization on college students' health outcomes remain poorly understood. Informed by the self-medication hypothesis and longitudinal data linking dating abuse to substance use outcomes, the present study tested the hypothesis that CDA victimization positively associates with college students' next-day alcohol use (number of drinks consumed, odds of any drinking) and odds of cannabis use (yes/no). We also explored whether CDA's association with next-day substance use varied as a function of gender. Daily data on alcohol use, cannabis use, and CDA victimization were collected across 60 consecutive days from 236 undergraduates who were in dating relationships (73.73% cisgender women). Multilevel modeling revealed gender differences. Among men, CDA victimization predicted next-day cannabis use (aOR = 7.34, p < .001), but negatively related to the number of drinks consumed the following day (B = -2.63, p < .001). Among women, CDA victimization did not relate to next-day cannabis or alcohol use. Regardless of gender, CDA victimization was unrelated to the odds of any drinking. College men are more likely to use cannabis the day after experiencing CDA victimization relative to other days. Targeting CDA and related aftermath may benefit college-based substance use intervention. This is the first study to identify that cannabis use occurs subsequent to CDA victimization, which can inform college-based CDA and cannabis use prevention programming.

Schizophrenia and Co-Occurring Substance Use Disorder

BackgroundCannabis is the most frequently used illicit substance in the United States resulting in high rates of cannabis use disorders. Current treatments for cannabis use are often met with high rates of lapse/relapse, tied to (1) behavioral health factors that impact cannabis use such as poor sleep, and (2) access, stigma, supply, and cost of receiving a substance use intervention.ObjectiveThis pilot study examined the feasibility, usability, and changes in cannabis use and sleep difficulties following mobile phone–delivered Cognitive Behavioral Therapy for Insomnia (CBT-I) in the context of a cannabis cessation attempt.MethodsFour male veterans with DSM-5 cannabis use disorder and sleep problems were randomized to receive a 2-week intervention: CBT-I Coach mobile app (n=2) or a placebo control (mood-tracking app) (n=2). Cannabis and sleep measures were assessed pre- and post-treatment. Participants also reported use and helpfulness of each app. Changes in sleep and cannabis use were evaluated for each participant individually.ResultsBoth participants receiving CBT-I used the app daily over 2 weeks and found the app user-friendly, helpful, and would use it in the future. In addition, they reported decreased cannabis use and improved sleep efficiency; one also reported increased sleep quality. In contrast, one participant in the control group dropped out of the study, and the other used the app minimally and reported increased sleep quality but also increased cannabis use. The mood app was rated as not helpful, and there was low likelihood of future participation.ConclusionsThis pilot study examined the feasibility and initial patient acceptance of mobile phone delivery of CBT-I for cannabis dependence. Positive ratings of the app and preliminary reports of reductions in cannabis use and improvements in sleep are both encouraging and support additional evaluation of this intervention.

Psychological distress has been inconsistently associated with sexual risk behavior in youth, suggesting additional factors, such as substance use, may explain this relationship. The mediating or moderating role of substance use on the relationship between psychological distress and sexual risk behaviors was prospectively examined over the four high school years in a sample of urban youth (N = 850; 80% African American; 50% female). Growth curve modeling was used to estimate changes in sexual risk across adolescence and to test its association to psychological distress symptoms and frequency of substance use. Substance use was associated with psychological distress. Greater psychological distress was associated with increased sexual intercourse frequency, decreased condom use, and increased number of partners. Substance use fully mediated the relationship between psychological distress and intercourse frequency and condom use, and partially mediated the relationship between psychological distress and number of partners. We found no differences in mediation by sex or race/ethnicity and no evidence to support moderation of psychological distress and substance use on sexual risk. Findings suggest that psychological distress is associated with sexual risk because youth with greater psychological distress are also more likely to use substances. Practical implications for adolescent HIV/STI prevention are discussed.

AimsSuicide and substance use all contribute significantly to the global burden of mortality and morbidity. While existing evidence establishes the association between substance use and suicidal behaviour in Lower- and Middle-Income Countries (LMICs), only a few studies illustrate how substance use affected deceased people's lifestyles and suicide attempts. The study addresses this gap by exploring the role of substance use (particularly, alcohol and drug use) in overall lifestyles and suicides of deceased with substance use in Pakistan – an underexplored and under-researched country regarding suicide and substance use.MethodsWe conducted in-depth qualitative interviews (N = 11) with close relatives and friends of those who died by suicide and have a history of substance use. The topic guide was comprised of a narrative part exploring the circumstances that surrounded the suicidal death of the deceased and a problem-focused part collecting comprehensive details about the deceased's personal, family, psychological, and social context and the role of substance use in the lifestyles and the suicide of the deceased.ResultsThe content analysis of interviews revealed five key themes: 1) Reasons for suicide, 2) Personality traits, 3) Psychological distress, 4) Initiation of substance use, and 5) Suicidal tendencies. Most of the participants reported the reason for their loved one's suicide was either an overdose of drugs or alcohol, family dynamics, or societal attitudes such as difficulty in building trust and finding acceptance within the family or society. Deceased individuals were perceived as impulsive with low control over their emotional states. Participants highlighted the underlying psychological distress in the deceased, emphasising the complexity of mental health and substance use problems. Participants reported that the deceased initiated drugs at an early age; had suicidal ideations; and overdosed themselves as a means of suicide.ConclusionThis study provides valuable insights into the role of substance use in suicide. The findings highlight the need for a holistic approach to understanding the multifaceted factors that may influence suicidal behaviours in individuals with substance use. Understanding these factors can help develop targeted suicide prevention and intervention strategies, particularly in low-resource settings such as Pakistan.

Screening and brief intervention (SBI) programs in schools have the potential to provide substance use prevention messages to large numbers of adolescents. This study evaluated the association between exposure to a school-based SBI program and reductions in substance use among youths after enactment of a law that required Massachusetts schools to provide SBI to all students. To estimate the association between exposure to a school-based SBI program and changes in substance use among youths. In this mixed-method quality improvement study using an effectiveness-implementation hybrid design, stakeholder interviews were conducted to describe the operations, timing, and impressions of SBI implementation at 14 intervention schools in Massachusetts. Repeated cross-sectional surveys of youths in intervention and comparison groups were administered between December 19, 2017, and May 22, 2019, to assess substance use and associated measures of perceived risk, knowledge, and adult support before and approximately 3 months after SBI implementation among exposed groups. A difference-in-differences framework was used to estimate substance use outcomes associated with SBI exposure among students in middle school (grades 7 and 8) and high school (grades 9 and 10) using adjusted overlap-weighted generalized models to account for covariate imbalance between exposed and unexposed school grades. In addition, 14 school staff members were interviewed about implementation. Exposure vs nonexposure to a school-based SBI program. Frequency of alcohol, cannabis, and e-cigarette use (measured in days) and any binge drinking in the past 3 months. Between December 2017 and May 2019, 8771 survey responses were collected from 4587 students in grades 7 through 10 who were attending one of 23 participating school districts. The median (IQR) age was 13 (13-14) years (range, 12-17 years); 2226 students self-identified as female (48.5%), 2206 (48.1%) as male, and 155 (3.4%) as transgender or preferred not to answer. Overall, 163 students (3.6%) identified their race as Asian, 146 (3.2%) as Black or African American, 2952 (64.4%) as White, and 910 (19.8%) as mixed or other race (including American Indian or Alaska Native and Native Hawaiian or Pacific Islander); 416 students (9.1%) preferred not to answer or were missing data on race. A total of 625 students (13.6%) identified their ethnicity as Hispanic and 3962 (86.4%) as non-Hispanic. Cannabis use increased over time in both the SBI group (middle school: marginal estimated probability, 0.73 [95% CI, 0.21-2.51] at baseline vs 2.01 [95% CI, 0.60-6.70] at follow-up; high school: marginal estimated probability, 2.86 [95% CI, 0.56-14.56] at baseline vs 3.10 [95% CI, 0.57-16.96] at follow-up) and the control group (middle school: marginal estimated probability, 0.24 [95% CI, 0.05-1.03] at baseline vs 3.38 [95% CI, 0.81-14.18] at follow-up; high school: marginal estimated probability, 1.30 [95% CI, 0.27-6.29] at baseline vs 1.72 [95% CI, 0.34-8.66] at follow-up). e-cigarette use also increased over time in both the SBI group (middle school: marginal estimated probability, 0.81 [95% CI, 0.22-3.01] at baseline vs 1.94 [95% CI, 0.53-7.02] at follow-up; high school: marginal estimated probability, 3.82 [95% CI, 0.72-20.42] at baseline vs 3.51 [95% CI, 0.55-22.59] at follow-up) and the control group (middle school: marginal estimated probability, 0.51 [95% CI, 0.12-2.30] at baseline vs 3.40 [95% CI, 0.72-16.08] at follow-up; high school: marginal estimated probability, 2.29 [95% CI, 0.41-12.65] at baseline vs 3.53 [95% CI, 0.62-20.16] at follow-up). Exposure to SBI was associated with a significantly smaller increase in the rate of cannabis use among middle school students (adjusted rate ratio [aRR], 0.19; 95% CI, 0.04-0.86) and significantly smaller increases in the rates of cannabis and e-cigarette use among all female students (cannabis use: aRR, 0.17 [95% CI, 0.03-0.96]; e-cigarette use: aRR, 0.16 [95% CI, 0.03-0.82]) compared with nonexposure. No other significant differences were observed among students in grades 7 and 8, and no differences were found in any comparison between groups in grades 9 and 10. In this quality improvement study, exposure to a school-based SBI program was associated with a significantly smaller increase in the rate of cannabis use among middle school students and significantly smaller increases in the rates of cannabis and e-cigarette use among all female students. These findings suggest that implementation of SBI programs in schools may help to reduce substance use among middle school and female students, and further study of these programs is warranted.

Associations among discrimination, psychological functioning, and substance use among US Black adults aged 18–28: Moderation by racial attribution and sex

Telehealth has considerable potential to overcome many of the barriers to accessing care for substance use problems, thereby increasing the opportunity for earlier intervention. The Ready2Change program is a multiple-session outbound telephone-delivered cognitive and behavioural intervention for mild-to-moderate substance use disorders, embedded within a long-established 24/7 alcohol and drug helpline. We sought to analyse routinely collected program data in a preliminary study to examine the effectiveness of Ready2Change in reducing substance use problem severity and psychological distress. A retrospective analysis of program data from December 2013 to June 2018 was performed. Analysed cases were 249 clients living in Victoria, Australia with alcohol (n=191), methamphetamine (n=40) or cannabis (n=18) as their primary drug of concern. A within-subjects design was used to examine pre- and post-intervention substance use problem severity and psychological distress. For alcohol cases, there was a statistically significant decrease in alcohol problem severity [AUDIT, mean difference=-12.7, 95% confidence interval (CI) -14.0, -11.5]. Statistically significant reductions in drug problem severity (DUDIT) were observed for methamphetamine (mean difference=-17.3, 95% CI -20.9, -13.7) and cannabis (mean difference=-15.9, 95% CI -22.3, -9.6) cases. All groups showed reductions in problem severity for other substances used (P < 0.05) and psychological distress (P < 0.001). Results suggest Ready2Change benefits clients with alcohol, methamphetamine and cannabis use problems, with the potential to improve treatment access for health inequity groups including those living in remote areas. These findings warrant further investigation into the effectiveness of this program.

Background. Mindfulness, a state of awareness that results from intentionally attending to the present moment without judgment, has been associated with improved health. In substance use treatment, mindfulness-based interventions (MBIs) improve mood and emotional regulation, possibly through increased positive affect and effective coping with negative affect. MBIs may also decrease substance cravings and use. Because affect, substance desire, and mindfulness vary moment-to-moment in daily life contexts, examining their associations may improve understanding of how MBIs reduce substance use. Momentary effects of mindfulness also have implications for ecological momentary assessment (EMA) and interventions (EMIs) for substance use. EMA samples momentary experience and EMIs administer treatment in real-time, real-life contexts. In bringing attention to thoughts and feelings at the time of the report, EMA can raise self-awareness. EMIs can provide content tailored to time or situation. EMA studies have shown that increased momentary negative affect predicts momentary cannabis desire and use events. If mindfulness decreases momentary negative affect, then EMA to raise awareness of momentary states and EMIs to prompt mindfulness practice in daily life may be effective cannabis use treatment. We examined whether momentary mindfulness changed after cannabis use interventions that included EMA, and explored associations with momentary negative affect, positive affect, and cannabis desire. Methods. Hospital clinic outpatients 15-24 years using cannabis ≥3 times per week were randomized to one of three interventions to reduce cannabis use. All interventions included two weekly 1-hour motivational enhancement therapy (MET) sessions. In two interventions, participants also received two weeks of EMA with or without supportive messages following report of contexts personally triggering for cannabis use. We used EMA to measure cannabis-related momentary states, contexts, and behavior 4-6x/day for one week at baseline and three months post-intervention. Of 70 participants enrolled, 68 (MET+EMA, n=40; MET-Only, n=28) contributed momentary data (N=1,971 reports) to these analyses. We calculated individual-level mean scores for the continuous momentary variables and normalized them using z-score or Blom transformation, as appropriate. Using generalized linear mixed effects models, we examined momentary mindfulness trends from baseline to 3-month follow-up, and whether changes differed by study group (MET+EMA vs. MET-Only) via phase-by-group interaction. We then examined associations of momentary mindfulness with negative affect, positive affect, and cannabis desire in separate models. We ran models unadjusted and adjusted for momentary contexts, group, phase, and mean reports/day in phase. Results. Mean momentary mindfulness was significantly higher at follow-up, compared to baseline (adjusted βdifference=0.146, SE=0.034, p&lt;.0005). Momentary mindfulness increased from baseline to follow-up in the MET+EMA group, but did not change significantly in the MET-Only group (βEMA_difference=0.237, SE=0.045, p&lt;.0005; βMET-Only_difference=0.055, SE=0.050, p=0.269; βphase_x_group =0.182, SE=0.066, p=.006). Higher momentary mindfulness was associated with lower negative affect (adjusted βmindfulness=-0.526, SE=0.045, p&lt;.0005) and with lower cannabis desire (adjusted βmindfulness=-0.521, SE=0.044, p&lt;.0005). Momentary mindfulness was not significantly associated with momentary positive affect (adjusted βmindfulness =0.013, SE=0.035, p=.712). Conclusions. Among youth using cannabis frequently, momentary mindfulness increased following interventions with EMA after counseling, and was inversely associated with negative affect and cannabis desire. Mindfulness may be a useful target for momentary intervention.

Objectives Multiracial (alternatively, mixed-race or biracial) college students report higher rates of alcohol/substance use than their monoracial peers, yet factors associated with this disparity remain understudied. Guided by minority stress and tension-reduction frameworks, associations of general and Multiracial discrimination experiences with psychological distress and substance use were investigated. Methods Cross-sectional data obtained from a convenience sample of 193 Multiracial college students (Mage =20.34 [SD = 1.32], 30% Male, 31% fraternity/sorority affiliation) were used. Multiracial college students reported their lifetime discriminatory experiences (general and Multiracial-specific), psychological distress (i.e., depressive and anxiety symptoms), and past-year alcohol/substance (alcohol, cannabis, and tobacco) use frequencies. Fully saturated structural regression models were used to test relations of general discrimination and a latent Multiracial-specific factor with a latent substance use factor with and without psychological distress in the model. Results Without psychological distress in the model, Multiracial-specific (but not general) discrimination experiences were positively associated with substance use (β = 0.29, 95% CI [0.02, 0.57], p = 0.04). With psychological distress in the model, however, neither Multiracial-specific nor general discrimination were directly associated with substance use. Instead, Multiracial (but not general) discrimination predicted psychological distress (β = 0.26, 95% CI [0.06, 0.46], p = 0.01), and psychological distress and substance use were positively associated with each other (β = 0.39 [95% CI [0.05, 0.59], p = 0.003). Ancillary analyses further indicated the mediating role of psychological distress in the discrimination-substance use association. Conclusions The novel findings suggest roles of Multiracial-specific discrimination by peers and family members and psychological distress in heightened substance use among Multiracial college students. Leveraging prospective methodologies is critical to determine temporal order.