Universities Require a Sustainable Structure and Evaluation Plan to Address Substance Misuse on Campus

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Universities Require a Sustainable Structure and Evaluation Plan to Address Substance Misuse on Campus

-Julie Edwards, Ed.D.

Julie Edwards

Substance misuse continues to be a priority on college campuses. According to ACHA’s fall 2022 National College Health Assessment, 70% of students have used alcoholic beverages and 38% have used cannabis. These rates are comparable to the data from ACHA’s fall 2021 NCHA report. While the numbers haven’t increased drastically, substance misuse remains a consistent concern among college administrators. Universities continue to grapple with high-risk alcohol use, including students experiencing negative consequences from their drinking behaviors. It is critical to include substance misuse prevention work in the overall context of campus well-being by using a systems and settings approach to address this issue.

Creating Sustainable Structures

I have seen positions posted with titles such as substance misuse coordinator, BASICS/CASICS health educator, and well-being educator for AOD. While it makes sense to clearly identify the role an individual will serve in an institution of higher education, I argue that it is everyone’s responsibility to address substance misuse. A way to encourage all campus stakeholders to collaborate on prevention efforts is to consider creating sustainable structures and evaluation plans where stakeholders can see the role they play in stemming the tide of substance misuse and how the strategies being used are making a difference.

In my community health work with counties across the state of Illinois, we created communities of practice to serve as the sustainable structures for a wide range of health priorities, from mental health and access to healthcare to substance misuse. These communities of practices were comprised of diverse, multidisciplinary individuals and organizations who came together to brainstorm strategies and work collaboratively to solve these complex issues. Wenger et al. (2002) describes a community of practice as “a group of people who share a concern, a set of problems, or a passion about a topic, and who deepen their knowledge and expertise by interacting on an ongoing basis.” These structures can be incredibly helpful to broaden the lens of this work, identify root causes and social determinants, implement strategies to address the issue, and evaluate overall outcomes on a consistent basis.

There are three components of a community of practice that are helpful when creating such a structure:

  • Domain (what we care about): Creates common ground, inspires members to participate, guides learning, and gives meaning to actions.
  • Community (who cares about it): Enables collective learning, fosters interaction, and encourages a willingness to share ideas.
  • Practice (what we do about it): Provides focus on ways to address the problem identified.

Another important factor to consider when creating sustainable structures is to look at the work already being done, including initiatives that are working well as well as areas of opportunity. Key questions to ask yourself are:

  • Is there a strong foundation that already exists?
    • If so, can you expand upon the existing substance misuse prevention efforts?
    • If not, how can you develop a structure that sustains itself into the future?
  • How will existing initiatives fit into the newly established structure?
  • Who are key campus stakeholders needed within the structure?
    • Consider decision makers, individuals with access to financial resources to fund recommended strategies, prevention experts, research analysts, community agencies, and students to name a few.

Some suggested categories to consider in a community of practice include the following:

  • Policies and practices: Identify the policies currently in place to prevent substance misuse and determine if there are gaps that need to be addressed.
  • Services and resources: Inventory the existing campus-wide services available to support students dealing with substance misuse, from early intervention to recovery.
  • Campus and community stakeholder engagement: Confirm the existing ways key stakeholders are engaged in substance misuse prevention and identify if there are opportunities to include students in the development of prevention efforts.
  • Research and evaluation: Determine what data are currently being collected to evaluate substance use prevention efforts and what other evaluative methods are needed to monitor progress over time.

Developing an Evaluation Plan

If exploring whole-system action as described above, universities should consider a comprehensive plan to evaluate the outcomes of campus-wide culture change around substance misuse prevention. The Social Ecological Model portrays the exchange among individual, interpersonal, community, policy, and environmental risk and protective factors that affect holistic well-being. This model illustrates that while individual students collectively influence and shape campus culture, in turn, campus culture also influences and shapes individuals. For these reasons, universities must intervene across multiple levels to address substance misuse, creating an evaluation plan that maps onto the various spheres of influence within higher education settings.

Below is one example we are using at Cornell for our Health Promoting Campus efforts that may also be applied to substance misuse specifically:

  • Level 1: Evaluation of Program and Intervention Effects. The purpose of this level is to evaluate the effect of theory-informed programs and interventions in improving well-being outcomes among participants.
  • Level 2: Evaluation of Policy Changes and Interventions. This level’s purpose is to evaluate the impact of policy changes on students’ academic and well-being outcomes.
  • Level 3: Evaluation of Campus Environment and Culture. The purpose of Level 3 is to evaluate, research, and monitor student well-being at the environmental level over time.

Using a comprehensive, population-level approach to prevent substance misuse on campuses is critical to stem the tide of this important issue. As mentioned above, I encourage universities to create a sustainable structure that engages all campus stakeholders in prevention efforts to move the needle and change the culture around substance use. The only way we will know if these prevention efforts are making a difference is by evaluating outcomes using a multi-faceted approach, monitoring individual, policy, and environmental changes over time. It is important to recognize the role we all play in this important work and to encourage others to do the same.

Julie Edwards is Director of the Skorton Center for Health Initiatives where she and her team advance campus well-being through institutional leadership, education, research, and public engagement. Prior to Cornell, Julie served as the Director of Health Promotion at the University of Chicago where she led campus well-being initiatives. Julie also served as the Director of Community Health Strategy for Presence Health and has extensive experience working with counties to conduct community health needs assessments, identify community priorities, develop systems-wide strategies, and evaluate the effectiveness of those initiatives. Julie currently serves as Secretary of the U.S. Health Promoting Campuses Network, Co-Chair of ACHA’s Campus COVID-19 Vaccination and Mitigation Initiative Steering Committee, member of ACHA’s Healthy Campus Leadership Team, member of ACHA’s COVID-19 Task Force, Immediate Past Co-Chair of NASPA’s Well-being and Health Promotion Leadership Planning Committee, and Past Chair of the Health Promotion Section for ACHA.