Service Utilization and Screening Among U.S. College Students with Substance Use Disorder

Background and Purpose:
An estimated 24% of U.S. college students meet criteria for a substance use disorder (SUD), with alcohol use disorder (AUD) being most prevalent, followed by cannabis use disorder (CUD). Yet fewer than 5% of students with SUDs receive treatment. Healthcare settings (e.g., primary care or emergency departments) offer opportunities for substance use screening and brief intervention, but factors influencing both treatment and healthcare utilization among college students with SUDs remain understudied. Evidence from general population studies suggests that service use may vary by SUD type and race/ethnicity, but these associations have not been thoroughly examined in college populations. This study examined associations between SUD type and race/ethnicity with three outcomes among a nationally representative sample of college students with a past-year SUD: (1) treatment receipt, (2) healthcare utilization, and (3) receipt of a substance use screening from a healthcare provider.

Methods:
Data came from the 2021–2023 National Survey on Drug Use and Health. The analytic sample included college students aged 18–22 who screened positive for a past-year SUD (N = 1,494). Analyses of screening receipt were limited to students who accessed healthcare services in the past year (N = 1,230). Outcome variables included past-year SUD treatment receipt, healthcare utilization, and receipt of a substance use screening (i.e., alcohol or illicit drug use screen). Key predictors were SUD type (AUD-only, CUD-only, other illicit SUD-only, or multiple SUDs) and race/ethnicity (Black, Hispanic, Other, or White). Study analyses included weighted descriptive statistics and chi-squares tests of independence. Multivariable logistic regression was used to test for associations of SUD-type and race/ethnicity with service utilization outcomes after adjusting for covariates. Results are presented as adjusted odds ratios (AOR) with 95% confidence intervals.

Results:
Among college students with a SUD, 11% reported receiving treatment in the past year. Over 83% utilized healthcare services, and among these, 79% received a substance use screening. Compared to students with AUD-only, those with other illicit SUD-only (AOR = 3.27, 95% CI = 1.36–7.89) and multiple SUDs (AOR = 2.38, 95% CI = 1.08–5.27) had greater odds of receiving treatment when adjusting for covariates. Healthcare utilization did not significantly differ by SUD type or race/ethnicity. Among those who accessed healthcare, Black students had lower odds of receiving a screening compared to White students (AOR = 0.33, 95% CI = 0.15–0.75), while screening receipt did not significantly differ by SUD type.

Conclusions and Implications:
Findings indicate that college students with SUDs underutilize treatment services. SUD type appears to influence treatment-seeking among college students, as other illicit SUDs and multiple SUDs were positively associated with treatment receipt compared to AUD, whereas CUD did not significantly differ from AUD. Greater social acceptance of alcohol and cannabis use, despite their health risks, may impede help-seeking behavior. Findings also have important implications for healthcare providers. The lower screening likelihood among Black college students demonstrates the need to improve the reach and delivery of substance use screening services across campus and community healthcare settings.