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Article Excerpt
NATIONAL SURVEILLANCE DATA and several anecdotal case reports document the potential severe consequences that can occur as a result of simultaneous use of alcohol and prescription drugs (e.g., Barrett and Pihl, 2002; Cone et al., 2003; Koski et al., 2002; Substance Abuse and Mental Health Services Administration [SAMHSA], 2004a,b; Watson et al., 2004). For instance, data from the Drug Abuse Warning Network indicate that the majority of prescription benzodiazepines, opioids, and related emergency department visits also involved the use of another substance, most frequently alcohol (SAMHSA, 2004a,b). Furthermore, of the deaths attributed to oxycodone between August 1999 and January 2002 in 23 states in the United States, only 3.3% (n = 30) reported oxycodone as the single causal agent; alcohol and benzodiazepines were the most prevalent drugs involved in oxycodone-related deaths (Cone et al., 2003). Finally, popular press reports have documented several deaths of undergraduate college students as a result of co-ingestion of alcohol and prescription drugs (e.g., Ensslin, 2004; Leinwand, 2005; Petrillo and Cantlupe, 2005). Despite the potential tragedies associated with coingestion of alcohol and prescription drugs, there is a paucity of epidemiological research examining the prevalence, correlates, and consequences associated with this drug-use behavior.
Several recent studies suggest that the nonmedical use of prescription drugs is associated with heavy drinking behavior among adolescents and young adults in the United States (e.g., Inciardi et al., 2004; McCabe et al., 2004, 2005a,b; SAMHSA, 2004a,b). In a national study of U.S. college students, nonmedical users of prescription stimulants were over six times more likely to report frequent heavy drinking than their peers who did not report nonmedical use of prescription stimulants (McCabe et al., 2005a). In another national study of U.S. college students, nonmedical users of prescription opioids were over four times more likely to report frequent heavy drinking than their peers who did not report nonmedical use of either of these prescription opioids (McCabe et al., 2005b). Finally, a third study surveyed 8th- and 11th-grade students in the Delaware Public Schools and found that the majority of 8th-grade nonmedical users of pain medication (71%) and almost all of the 11th-grade nonmedical users of pain medication (92%) also misused alcohol (Inciardi et al., 2004). Although the nonmedical use of prescription drugs seems to be strongly associated with heavy drinking behavior, little is known about the extent to which this drug-use behavior is concurrent versus simultaneous, and very little research has examined the prevalence, correlates, and consequences associated with these two types of polydrug use.
To date, many studies have not differentiated between concurrent and simultaneous polydrug use (see Schensul et al., 2005). Concurrent polydrug use refers to the use of more than one drug in the same time period (e.g., 12 months) but not necessarily at the same time (Martin et al., 1992, 1993). Simultaneous polydrug use refers to the coingestion of different drugs at the same time (e.g., Collins et al., 1998; Earleywine and Newcomb, 1997; Martin et al., 1992). Thus, simultaneous polydrug use is a subset of concurrent polydrug use. Although marijuana and alcohol are the most common drugs used simultaneously, adolescents and young adults have particularly high rates of other types of simultaneous polydrug use (e.g., Collins et al., 1998; Earleywine and Newcomb, 1997).
Because of the possible risks associated with simultaneous polydrug use, more research is needed to examine the extent of simultaneous polydrug use as well as the factors and consequences associated with this drug-use behavior. To fill this gap in the literature, the present study reports results from a large Web-based survey of 4,580 college students and focuses on distinguishing concurrent and simultaneous polydrug use in terms of prevalence, correlates, and consequences. Although there are many possible combinations of polydrug use, this study examines the concurrent and simultaneous use of alcohol and prescription drugs.
Method
This study was conducted during a 2-month period in January and February 2005, drawing on a total undergraduate population of 20,138 full-time students (10,339 women and 9,799 men). After receiving institutional review board approval, a random sample of 5,389 full-time undergraduate students was drawn from the registrar's office. Additionally, 652 Hispanic, 634 black, and 244 Asian undergraduate students were oversampled. A Web-based survey method was used; similar methods have been shown to be feasible and effective for research on alcohol and other drug use in college student samples (e.g., Kypri et al., 2004; McCabe et al., 2002). The entire sample population was mailed $2 and a notification letter describing the study and inviting them to self-administer the confidential Student Life Survey by typing a link and using a unique password to access the Web survey. The Web survey was maintained on an Internet site running under the secure socket layer protocol to ensure security, and respondents gave informed consent online. Nonrespondents were sent an invitation email and up to four reminder emails. By participating in the survey, students became eligible for a sweepstakes that included cash prizes, travel vouchers, field passes to athletic events, and iPods. The final response rate was 66.2%, which exceeded the average response rate for national college-based alcohol and other drug studies (Wechsler et al., 2002). Furthermore, of those students who started the Web survey, the proportion of respondents who completed the entire survey (completion rate) was 97.4%.
Measures
The Student Life Survey included questions on a wide range of topics, including demographic information (e.g., gender, race/ethnicity, living arrangement, social fraternity/ sorority membership, and family income), alcohol and other drug use, gambling behavior, and mental health. Herein, we describe the measures used in the present study.
Past-year alcohol use was assessed with the following question: "On how many occasions (if any) have you had alcohol to drink (more than just a few sips) during the past 12 months?" The response scale was 1 = no occasions, 2 = 1-2 occasions, 3 = 3-5 occasions, 4 = 6-9 occasions, 5 = 10-19 occasions, 6 = 20-39 occasions, and 7 = 40 or more occasions.
Age of drinking onset was assessed with the following question: "What grade were you in when you first started drinking alcohol (more than just a few sips)?" The response scale was 1 = kindergarten-Grade 4, 2 = Grades 5-6, 3 = Grades 7-8, 4 = Grades 9-10, 5 = Grades 11-12, and 6 = college. Because of the skewed distribution of responses, kindergarten-Grade 4, Grades 5-6, and Grades 7-8 were collapsed into one...
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