Prevention Profiles: Take Five - Dr. Amelia M. Arria (University of Maryland)

Rich Lucey:
 
Hi this is Rich Lucey with the Drug Enforcement Administration's Community Outreach and Prevention Support Section, and welcome to this episode of our webcast series, “Prevention Profiles: Take Five.”
 
Today's guest is Amelia Arria and let me tell you a little bit about Dr. Arria before we get into the interview.
 
Dr. Amelia Arria is director of the Center on Young Adult Health and Development and the Office of Planning and Evaluation at the University of Maryland School of Public Health and an associate professor with the Department of Behavioral and Community Health.
 
Currently she is the principal investigator on the College Life Study – a longitudinal prospective study of health risk behaviors among college students.
 
Her research focuses on risk and resiliency factors associated with the development of mental health and substance use among adolescents and young adults as well as the consequences of untreated mental health conditions and substance use.
 
With that, Amelia welcome to the podcast.
 
Dr. Amelia Arria:

Great to be here.
 
Lucey:
We're really excited to talk with you. I know you and I have been at different conferences and events together and have heard each other speak and I've always been interested in the research and the cutting edge information that you have for people to help support them in their work.
 
So I'm really excited about today's interview.
 
So as you know, the format for our podcast series is based around five questions and I'm going to jump right into the first one and we'll go with our conversation from there.
 
So we know that many college students engage in the non-medical use of prescription
stimulants because they believe it provides academic benefits.
 
What is the research telling us about this? And what should be the primary message that prevention practitioners promote to students?
 
Dr. Arria:
Well, first I think it's really important to separate, or draw a distinction between, therapeutic use of prescription stimulants and prescription misuse.
So, therapeutic use can be effective to help students who've been diagnosed with ADHD to function better. So it's important to point that out.
 
But some people think that if it's going to help students with ADHD then it will help them even though they don't have ADHD, and that's where we run into problems.
 
An analogy that I like - that I didn't make up - but is to having prescription lenses to correct eyesight.
 
And so the glasses that I wear to correct my vision won't help you see better than you already do. And I think that's useful.
 
Lucey:
… Very interesting analogy, I like that.
 
Dr. Arria:
…But the research shows that about 10% of students use these drugs on their own without having a prescription. And that colleges vary widely with respect to that prevalence estimate.
 
Interestingly, students actually don't use them regularly or frequently like a person with ADHD would – who would take it almost every day.
 
So intermittent use is a more typical pattern and that gets to your part of your question about academic benefits.
 
So it is true that one common motive is the perceived improvements in concentration or that the drug will help someone stay up longer to study or complete an assignment.
 
That might be true in the short term, but what we have found in the research is that there's no improvement in GPA associated with non-medical use.
 
In fact, students who engage in non-medical use have lower grades and that's been found across the board in several cross-sectional studies.
 
So we dove into that a little bit more deeply with our longitudinal data and found that when you peel things back, the decline in academic performance that decrease in GPA is related to an increase in skipping classes which in turn is associated with drinking and
other drug use including marijuana.
 
So what you see, putting it all together, is that the non-medical use of prescription stimulants appears to be a last-ditch attempt to compensate for the declining academic performance that's associated with other drug use and drinking.
 
So the key message here is that the underlying causes need to be addressed – which might include drinking and marijuana use those underlying causes of poor academic performance.
 
Lucey:
 
Hmm .. I'm making some notes for myself because … in every interview and every workshop I go to, I try to come away with something new that I've learned. And to hear you say it is kind of the AHA thing I've learned today.
 
We always know that you need to address the root causes. But to hear you say that typically the root causes of lower grades skipping school, missing classes, exams is due to maybe other drug use -- whether it's alcohol, marijuana use, what-have-you –and that maybe they've turned because of that they've turned to the non-medical use of prescription stimulants because, as you've said, ‘well I know my friend who has a prescription for it and needs to take it for their diagnosis well then then it should help me and my grades are failing so maybe I should pop some Ritalin or whatever.’
 
Arria:
Right.
 
Lucey:
So I love that thought that you know it's based on perhaps other drug use that's caused
them to then turn to the misuse of this particular class of drugs.
 
Arria:
Right. And what we did was we looked because some people have said to us well maybe their grades would have been even worse if they didn't take the drug.
 
And so what we looked at was 2 years’ worth of data and said what about the people who continued to take them, and the people who stopped taking them? Did the people who stopped experience a decline in their grades?
 
And actually we found that the people who stopped or never started had actually higher grades than the people who continued to use.
 
Lucey:
So it sounds like I'm trying to parcel out two different types of that messaging need to be promoted here. And one is the message that we want to promote to our colleagues and the prevention practitioners that are working on these issues which, like you've just said, they also need to be looking at the underlying causes.
 
But if we were to also then promote the message to students, is it the fact that, you know, we need to counter your essentially you're our misbelief here?
 
Arria:
Yes, and I also think that the whole term, the terminology and the language is so important because I don't like it when people call them smart drugs or brain steroids.
 
Because even if they're joking, it's not true for students without ADHD.
 
Lucey:
And, in fact, I think that's … well terminology in our field in general is so critically important but you know you've mentioned ‘smart drugs.’ I think even some of the national or maybe statewide surveys have even changed their language to say ‘study drugs’ because that's how students, you know, refer to them and that's what students will understand.
 
But I think it's critically important that we call them genuinely what they are.
 
Arria:
Right and then correcting the misperception that people, a lot more people, are using them than they actually are. When we talk about ten percent of students using them, people are very surprised. They think that it's much much more common and, as you know, correcting misperceptions is a prevention strategy.
 
Lucey:
Absolutely.
 
I'm gonna move on to our next question. The phrase that I use in the question – I say you've coined it, I'll give you that credit – but it's this issue of your research you you've taken a look at the relationship between using various drugs and what you've called ‘stopping out’ or what's traditionally we'd hear of dropping out of college.
 
I guess before I ask the question, could you briefly explain what the concept is of stopping out of colleges?
 
Arria:
Sure. And just to be sure, I didn't make up that term. It's a term that's used in the educational literature, where people stop out or have periods of what they call discontinuous enrollment. And it places someone at risk for dropping out. And it also just represents a hiccup in their academic trajectory where they might have to drop out for a semester and they might go back and they might go back to a different school but
it's an at-risk period.
 
Lucey:
And so it probably isn't as this cut and dried but it seems that maybe ‘stopping out’ could be perceived as something that might be temporary…
 
Aria:
Yes.

Lucey:
Whereas dropping out seems like there's a little bit more permanence to it, or maybe even harder to get back on track.
 
Arria:
Yes, that’s true.
 
Lucey:
So based on that research that you've done, that looks at various drugs and stopping out or dropping out of college, what suggestions do you have with regard to targeting prevention efforts and linking those efforts to supporting the campuses larger mission, which is likely student retention?
 
Arria:
Well, I think one of the important things is that you're, more and more, you're seeing academic performance in the list of possible consequences of excessive drinking and other substance use during college. And that's really a step in the right direction.
 
Students, college health professionals, higher education administrators, prevention specialists, can really use that evidence to say that by preventing substance use you are promoting academic achievement. And that message is different than, ‘you shouldn't use drugs because they're bad for you.’
 
The message is tweaked to say, ‘if you can prevent substance use, you're actually increasing the likelihood that you'll fulfill your potential as a student. And that it'll promote career development and productivity and that sort of thing.
 
On the other hand, what the information does is that it it's useful in that it tells us that students who are academically struggling might be at risk for substance use.
 
So students whose grades are low or who drop precipitously, or who stop out of college temporarily, might be one of those target populations for our prevention activities and they might benefit from an assessment, a comprehensive assessment, of all the things that might be getting in the way of their achievement which might include mental health issues and substance use.
 
So I think those are the two ways that you can use that information.
 
Lucey:
That’s great and what you just said … I did a mental loop back to our conversation around the first question. So if you're looking at, you know, lower grades, the possibility of having to stop out or drop out, doesn't that then lead us right back to underlying causes?
 
Arria:
 Yes, yes.

Lucey:
…and you need to address those?
 
Arria:
Right, right.
 
Lucey:
Yeah absolutely the other issue here as long as I've been in this field we know that as prevention practitioners, one of the things we need to have in our toolbox is to know how to communicate and what to communicate with a whole different variety of audiences.
 
With senior administrators and college presidents especially time and time again the academic mission student retention is right near at the top if not at the top and so that's how we need to be able to talk to them or about this issue and say look if we're not… if
we don't put our resources behind preventing substance misuse it's gonna have a significant impact on our retention.
 
Arria:
Mm-hmm and just academic engagement in general.
 
Lucey:
Right, right yeah.
 
This is such a … and I'm hoping our listeners took away your very clear takeaway message that I hear and wrote down is that preventing substance abuse does help to achieve academic retention.
 
There's a link there and so there's the messaging that our listeners can take back to their senior administrators and to their presidents so thank you for pointing that out for them.
 
I'm gonna move on to our third question and I'm fascinated by this question.
 
It actually came from one of our colleagues as I recruited some questions from our peers in the field and I think the question came up because you've recently started speaking about this or have at other conferences and it's about parents.
 
We spend a lot of time thinking about how the generations of college students have
changed over time – Gen X, Y, Z, Millennials –  and perhaps adjusting our prevention strategies accordingly.
 
Do you think we also should be looking at how the parents of college students have changed over time and how that might have an effect on our prevention approaches and working with parents?
 
Arria:
It's a great question. And there are two possible things that come to mind: first, I think parents might be more permissive these days about marijuana use and we don't have a hard data on that.
 
I do have a lot of anecdotal data on that because I'm deluged all the time with requests by parents about the risks of marijuana use. And we do wonder if parents are having challenges communicating the risk of marijuana use. And those messages that
parents impart are very influential. And thus it's important that parents expressed disapproval to prevent marijuana use because their words really matter.
 
So that's one way that things have changed for our parents.
 
On the other hand, it's interesting that you bring up this issue because I was recently asked to give a presentation at the American College Health Association on
“overparenting,” which is I'm not sure how related it is to our field and substance use prevention but it is changing.
 
Frequency of contact with parents is on the rise and this idea of overparenting is on the rise. And over parenting means doing things for children rather than letting them do things for themselves. And it's very well intentioned.
 
Parents think that their children might benefit from them clearing the obstacles, or making sure that they don't experience something unpleasant, that they avoid unpleasant situations.
 
But what the research shows is that supporting autonomy builds resilience.
 
Experiencing setbacks, learning how to manage, practicing active coping strategies, when things don't go your way are really critical. And you have to have the practice in doing this.
 
So it's tricky because we want parents to be vigilant about signs of substance use no health problems step in when those issues occur. But that's probably very different than getting involved when your student needs a replacement ID or has a problem with their roommate.
 
It's really important to promote those autonomy supportive behaviors and build resilience so that the end result is a successful transition to adulthood.
 
Lucey:
 
Right. Two concepts coming out of what I just heard you say: one is that parents have more influence than they think they do.
 
Arria:
 
That’s true
 
Lucey:
I you know my former role at CSAP, where I worked in the Center for Substance Abuse
Prevention and was the special assistant to director Fran Harding. You know we have and I know SAMHSA still continues to have the “Talk, they hear you” campaign around preventing underage drinking.
 
And that whole campaign is based on the fact that children really do listen to their parents. I mean it may not seem like it, and there are plenty of times that, you
Know, as a non parent myself I see it in my sisters and my friends who have kids,
that you know they think that their kids just aren't listening to them. But they truly are.
 
 
And as parents, as you know, you're being a role model whether or not you think you are.
 
Arria:
They really are.
 
Lucey:
And that goes either way right? Bad or good.
 
But there's that thought.
 
But, you know, when you just said overparenting it to me was the second concept I thought of is that then different than you know we've heard the term of “helicopter parents” you know that they are more or less the hoverers, if you will.  They're always looking over their kids’ shoulders, if you will.
 
But this is more …this seems more involved. Like that like you just said they're doing things for their kids more than just looking over the shoulder.
 
Arria:
Right in having to prepare for that talk at ACHA, I looked into all the terminology that's being used  - helicopter parenting, lawn mower parenting (which is more even more involved) – and I came down on the side of the labels really don't help anyone.
 
Just like stereotypes don't help. And that if we move away from telling parents what
they shouldn't do (like, ‘you shouldn't be a lawnmower parent and you shouldn't be a helicopter parent) and rather tell parents what they should do in supporting the autonomy of their child, I think we're gonna get farther along so that that way colleges and parents don't come to a head and argue with each other.
 
But they're really in support of student independence and autonomy.
 
Lucey:
 
Absolutely and it's very important, as you've just said it, the whole idea of labeling really
does not help anybody really.
 
Again we'll go back to it's the underlying causes, the underlying issue, that we should be addressing. So that's a really important concept and I'm glad that we were able to talk a little bit about it during this interview.
 
I want to move on to our fourth question and this gets to how do we tell our story.
 
So you know I've been in the prevention field now for more than 25 years at both state level and federal level. And it goes back to how we communicate with various audiences, and one of the things we need to continue to learn how to do is to communicate our successes in the prevention field which has always been a challenge in prevention field.
 
Unlike say the treatment field which has quantitative numbers in terms of intake and outpatient and beds served and all that kind of thing.
 
You know prevention I can count the number of students who come to a workshop but that doesn't necessarily translate to a change in behavior down the road.
 
And so what are your thoughts on how the prevention field can best leverage the research that you're conducting to better tell our story especially with senior leaders on campus?
 
Arria:
 
Well one thing that I do want to say in response to what you just said is that we can tell our story of progress in the prevention field by showing the increases dramatic increases in the proportion of young people who are not using tobacco alcohol and marijuana starting in eighth grade.
 
There are definitely so we are making huge strides in creating a very resilient youth population today. That are going to have their challenges and we see it when they turn 18 and they enter into high-risk environments and where marijuana is available we might see increases in marijuana use among that group because of the environmental pressures, but it is important to tell the prevention story of drug abstinence all through adolescence.
 
And it's very very dramatic Bob DuPont has a great article on that. But what I think also you're alluding to is the need for individuals in the substance use prevention field to be very explicit that they share a common goal with all of those other audiences and that is we all care about student success. Not just academic achievement, but personal achievement of their goals.
 
And really that's the bottom line that we are all working toward that same goal. And recently I saw that you promoted our new report which is great
 
Thank you for doing that. The one that we worked with the American Council of trustees and alumni on and that report is sort of an attempt to discuss this issue. And to say that, ironically enough, if they do what they are supposed to do in strengthening the academic mission of their college or university they are helping us out because one of the most powerful counterweights to substance use and one of the most powerful prevention strategies is to provide students with those challenging and rewarding experiences that a college education can provide.
 
So, if students become very engaged and passionate and rewarded by something that is challenging, they might not have the time to be distracted by something like substance use that can take them off their path.
 
And the other thing is that we really need to describe the approaches that we use to prevent substance use - that has to go far beyond educating students about consequences.
 
You've been in this field for a very long time like me and we're still … we seem to have that as our go-to strategy and we need to move ahead and say that we have to tackle these issues by reducing availability, intervening effectively with students at risk using evidence-based approaches.
 
And I think that's where we tried to do that in our report as well.
 
Lucey:
 
Yeah so you touched on, you know, one of the cornerstones. And I learned this from Fran. She's my mentor she knows that I've worked with her for so long that's in my entire career. But you know it's looking at access availability and norms are really the three kinds of touch tones in our field. But you know – I loved what, and I wrote it down for myself to use--- that we're working in disparate campuses, communities, agencies and such and we all have different agendas and our demographics are all different but the one thing that's common is we're all working toward the same goal and that is student success.
 
And so that's what brings us together right? I mean we go to conferences and all these different people come together and yet we are all working toward that one goal, same goal, student success.

So I'm glad that you brought that up and it goes back to, I think, what we were talking about with student retention.

It's kind of flipping it around and saying to the senior leaders on campus by you supporting us you're helping us in our goal - which is a win-win, if you will, for the campus and the community. 

In fact, and you mentioned the report that you did, and we're looking to have the president of ACTA, the Association of Trustees and Alumni, write a ‘View from the Field’ for campusdrugprevention.gov in the coming months.

I think it's a different audience that sometimes gets overlooked in the
whole issue of preventing drug abuse on college campuses. And so that's one of
the reasons we would like to bring them into the fold. if you will . 

So we were very happy to help promote the report and the work that you did with them and looking forward to hear more from them in the coming months.
 
So I'm gonna move on to our fifth and final question.

And it's not a question I've asked of any of the other guests that we've had in about a year and a half into the  podcast series but one of our colleagues suggested it and I said you know what it's pretty interesting.  Let's go with it and ask Amelia what she has to say.

So basically it's pretty simple. The question is, maybe not the answer. But what was the biggest challenge that you faced professionally and how did you overcome it?
 
Arria:
Well, first, I can't think of just one challenge but from sort of a philosophical point of view I think I handle challenges in the same way. 

I've really learned the value of patience. I'm extremely optimistic. I have a very positive attitude. I try to stay calm.

But I think that listening is something that is really really important. When I've had the chance to work in the Maryland collaborative now for seven or eight years and when I interact with higher education administrators, it's been really a learning experience for me to understand their viewpoint and what they value because we've had multiple
challenges with that project because we deal with so many different kinds of the institutions. But I think it's really really important to listen and to try to figure out how researchers can be of value to the people in the field. 

And I think we've succeeded by taking that approach. 

The other challenge is with parents. 

I think you and I both know that we live in a society where we're always doing things a little bit too late and with parents it's really hard for them to see the value of prevention and to seek help at earlier stages rather than waiting until things spin out of control. So it's hard to engage them and we've had several challenges related to this where we try to provide information to parents to get them to monitor whereabouts, activities and look at signs for substance use, and intervene at the earliest stage possible and that's really really difficult.

We haven't overcome that challenge.

But I think this academic achievement finding is important because they care a lot about academic achievement and so that's a way in to parent’s values.
 
Lucey:
Yeah what you just mentioned about parents, and I, again over my long career, talked to many people about this that one of the typical challenges – without, you know, the risk of painting a broad stroke of parenting – you know, many times they kind of, you know, brush off their hands and basically say at age 18, ‘I'm done.’ And, ‘I've sent my kid off to college and hope all good things happen.’ And we continue to try to promote whether we even knew we were doing it to say, ‘you know your job really isn't done yet.’ And of course say it in the nicest way possible. In the most even nurturing way possible.

But it goes back to parents, even at that age, are still a pretty big influence on their children whether they know it or not.

Arria:
Oh, huge, huge. Yeah.

Lucey:
So continuing to try to engage parents … and I think that that's been a movement
that's happened actually more over the last decade to 15 years. Is that college
campuses more and more now parent orientations, which didn't happen when I
was in college. I mean it was, you know, and I went to a local school. I didn't go away. But, you know, I got dropped off at the campus and I went to my Student
Orientation and parents weren't engaged. My mom and dad weren't engaged – it
wasn't offered, ok. I would like to think, and I'm pretty sure, my parents being the way they were they would have been engaged if it had been offered. 

But I think more often, and I see now my nieces and nephews are going to college, parents are significantly more involved in the orientation process than it was when I was in school .

Arria:
Right, right.

And this does get back to our earlier conversation about being overly involved in the things that they might not need to be involved with.

Lucey:
Yeah, yeah. Well, Amelia I thank you so much for being our guest on today's episode of the podcast. I went into it thinking we were going to get some really rich and great information out of it and you did not disappoint. I think that you've got some great message points and it's never easy.

We work in a complex field. Very rewarding, and also very challenging, but I think that you've given some folks some really concrete things to work with.

So I really want to thank you for joining us.

Arria:
Well, thank you.

Lucey:
And to our listeners I hope you've enjoyed this episode of “Prevention Profiles: Take Five.”

And with that I will say thanks for listening and have a great day.