TABLE 1.

Recommended screening tests and interventions for specific substances used on college campuses

Substance	High-risk population	Screening	Brief interventions	Treatment recommendations
Alcohol	Fraternity and sorority membership, students who used heavily in high school	CRAFFT (for adolescents; car, relax, alone, forget, friends, trouble), CAGE Questionnaire (cut down, annoyed, guilty, eye opener), AUDIT (Alcohol Use Disorders Identification Test), TAPS Tool (tobacco, alcohol, prescription medication and other substance use), NM ASSIST (NIDA-Modified Alcohol, Smoking and Substance Involvement Screening Test)	BASICS Program; College Drinker's Check-up (CDCU); motivational interviewing to address discrepancy between problematic use and values and to assess readiness for change	Detoxification when withdrawal symptoms are present; referral for individual therapy, self-help groups, or pharmacotherapy (i.e., naltrexone or acamprosate) for alcohol use disorders; close monitoring around academic performance and necessary accommodations
Tobacco, nicotine	Fraternity and sorority membership, existing mental health difficulties	NM ASSIST	Motivational interviewing to address discrepancy between problematic use and values and to assess readiness for change	Nicotine replacement therapy; no evidence that vaporizing devices lead to reduced risk of relapse (may escalate use); behavioral therapy referral
Stimulants	Academic difficulties, preexisting ADHD, midterms	DAST (Drug Abuse Screening Test), TAPS Tool, NM ASSIST	Motivational interviewing to address discrepancy between problematic use and values and to assess readiness for change; warn of risk of using cocaine with alcohol.	No evidenced-based pharmacological intervention at this time; balance risk of prescribing stimulants with need, if indicated; cognitive-behavioral therapy and 12-step programming may be helpful; close monitoring of academic performance and necessary accommodations
Opioids	Withdrawal from social interactions, poor academic performance, existing mental health difficulties	DAST, TAPS Tool, NM ASSIST	Motivational interviewing not advised; thoroughly assess for signs of withdrawal and acute safety concerns	Significant risk of overdose; consider detoxification setting or residential treatment setting for regular use; buprenorphine-naloxone and long-acting injectable naltrexone are considered first-line treatment; close monitoring of academic performance and necessary accommodations
Marijuana, cannabis	Low perception of harm of marijuana use, peers who use, poor academic performance, existing mental health concerns	World Health Organization ASSIST (Alcohol, Smoking and Substance Involvement Screening Test), how many times have you used marijuana in the past 90 days, TAPS Tool, NM ASSIST	Motivational interviewing to address discrepancy between problematic use and values and to assess readiness for change; marijuana eCHECKUP TO GO	N-acetylcysteine 1,200 mg twice daily may reduce cravings and risk of relapse among motivated individuals up to age 21 in addition to contingency management; behavioral therapy referral; close monitoring of academic performance and necessary accommodations
Hallucinogens	Frequent attendance at “rave parties” or club settings	DAST, TAPS Tool, NM ASSIST	Motivational interviewing to address discrepancy between problematic use and values and to assess readiness for change; provide information about potential risks of “microdosing” (21)	Inform of risk of tolerance formation after only one use, as well as flashbacks; develop a plan for abstinence or reduction; referral for individual therapy
Benzodiazepines	Existing mental health difficulties, combining benzodiazepines and alcohol in party setting	DAST, TAPS Tool, NM ASSIST	Motivational interviewing to address discrepancy between problematic use and values and to assess readiness for change; provide psychoeducation about dangers of using benzodiazepines in combination with alcohol and other substances	Assess for withdrawal symptoms and consider detoxification if present, followed by residential treatment or long-term program; outpatient management is not recommended unless use is infrequent
Inhalants	Existing mental health difficulties, expressed need for escape and dissociation	DAST, NM ASSIST	Provide psychoeducation about the acute and long-term dangers of use	Significant health concerns and risk with acute intoxication; long-term use can lead to depression and brain damage; consider higher level of care, such as inpatient or partial program.
Over-the-counter medications (dextromethorphan, antihistamines)	Existing mental health difficulties, expressed need for escape and dissociation	DAST	Motivational interviewing to address discrepancy between problematic use and values and to assess readiness for change	Risk of significant impairment from acute intoxication; inpatient hospitalization for any accompanying suicidality, paranoia, or persistent hallucinations.