Underestimation of Drug Use: A Perennial Problem with Implications for Policy


by Olivia Maynard

In a paper recently published in the journal Addiction, Hannah Charles and colleagues suggest that the prevalence of illicit drug use among 23-25 year olds in a Bristol-based birth cohort (ALSPAC) is over twice that reported in the Crime Survey for England and Wales (CSEW). The team propose that these figures reflect under-reporting in the CSEW, although they note that they may reflect higher levels of illicit drug use in Bristol. Here I present some preliminary data supporting their view that the CSEW underestimates illicit drug use.

In March 2020, I recruited 683 UK university students to participate in a short survey on drug use via the online survey platform Prolific which has been shown to produce reliable data. I recruited only students aged 18 to 24 years who reported using alcohol in the past 30 days, and participants reported whether they had used any of MDMA/ecstasy, cocaine or cannabis in the past two years.

Table 1. Prevalence of self-reported illicit drug use across three surveys of young people in the UK

University
students
via Prolific

Aged 18-24

Bristol, ALSPAC

 

Aged 23-25

CSEW

 

Aged 23-25

2 years 1 year Lifetime 1 year Lifetime
Any illicit drug usea 52.7 (360) 36.7 62.8 16.4 40.6
Cannabis 50.2 (343) 29.2 60.5 13.8 37.3
MDMA/ecstasy/amphetaminesb 23.3 (159) 17.0 32.9 3.6 11.1
Cocaine 21.1 (144) 19.6 30.8 4.8 13.9

Notes: Values represent percentage of participants (number of participants). Percentages for CSEW and ALSPAC are taken from Charles et al (1) and are weighted percentages.
a ‘Any illicit drug use’ refers only to the illicit drugs assessed in the respective surveys (only cannabis, MDMA and cocaine in our survey), more drugs in ALSPAC and CSEW – see Charles et al (1).
b Our Prolific survey asked about ‘MDMA / ecstasy’ use, ALSPAC categorised ecstasy/MDMA use along with other ‘amphetamine’ use and CSEW asked about ‘ecstasy’ use.

Over half of my sample reported using at least one of cannabis, cocaine or MDMA in the past two years (Table 1). This is markedly higher than the CSEW’s estimates of either past year or lifetime use, and more in line with those reported in ALSPAC. Comparing across drugs, past two-year use of the three drugs is higher in my survey than either past year or lifetime use in the CSEW, and higher than past year, but lower than lifetime use in ALSPAC. Perhaps of more interest than ever use of the drugs over the past two years, I also examined the combinations of drugs students in my survey were using (Table 2). I find that the majority of students who report using illicit drugs have only used cannabis in the past two years (25% of all students), although the second largest group (15%) have used all three of cannabis, MDMA and cocaine.

Table 2. Prevalence of self-reported illicit drug among UK university students

Qualtrics survey of university students (past two years)
All
(n=683)
Female
(n=336)
Male
(n=312)
Other
(n=35)
Illicit drug use 
Cannabis 50.2 (343) 48.5 (163) 53.5 (167) 37.1 (13)
MDMA / ecstasy 23.3 (159) 19.3 (65) 29.2 (91) 8.6 (3)
Cocaine 21.1 (144) 17.6 (59) 26 (81) 11.4 (4)
Illicit drug use profiles
Alcohol only (no illicit drug use) 47.3 (323) 48.2 (162) 44.6 (139) 62.9 (22)
Any illicit drug usea 52.7 (360) 51.8 (174) 55.4 (173) 37.1 (13)
Cannabis only 24.5 (167) 27.4 (92) 21.5 (67) 22.9 (8)
Cannabis + Cocaine + MDMA 15.4 (105) 11.3 (38) 20.8 (65) 5.7 (2)
Cannabis + MDMA 6.3 (43) 6 (20) 7.1 (22) 2.9 (1)
Cannabis + Cocaine 4.1 (28) 3.9 (13) 4.2 (13) 5.7 (2)
Cocaine only 0.9 (6) 1.2 (4) 0.6 (2) 0 (0)
MDMA only 0.9 (6) 0.9 (3) 1 (3) 0 (0)
Cocaine + MDMA 0.7 (5) 1.2 (4) 0.3 (1) 0 (0)

Notes: Values represent percentage of participants (number of participants).
‘Illicit drug use’ refers to participants reporting any use of the three drugs in the past two years.
‘Illicit drug use profiles’ refers to the combinations of drugs participants report using in the past two years.
a ‘Any illicit drug use’ refers only to use of cannabis, MDMA and cocaine.

There are some important differences between my sample and both the CSEW and ALSPAC samples. Some differences may mean that my figures are overestimates, including sampling university students who are more affluent than the general population (although drug use is not necessarily higher among students than non-students) and only including those who reported drinking alcohol (although according to the study authors, over 95% of the ALSPAC participants report past year drinking). Other differences may mean my figures are underestimates, including only asking about use of three drugs (thereby underestimating ‘any illicit drug use’), and the younger average age of my sample. I also report on past two-year use, rather than either lifetime or past year use as per CSEW and ALSPAC. Given these differences, I would like to run a larger, more representative sample on the Prolific platform (Prolific allows researchers to recruit a sample which is representative of the general population), to get an estimate of illicit drug use which is more comparable to ALSPAC and CSEW.

Despite these differences, my data support those reported by Charles and colleagues. Indeed, I find it unsurprising that illicit drug use is under-reported in the Home Office’s CSEW. The validity of self-reports for sensitive issues has long been a concern. Over-reporting of illicit drug use is not considered to be a concern and numerous methods have been developed for preventing under-reporting (see a 1997 NIDA report on this issue, as well as more recent techniques for estimating prevalence of use such as the crosswise method). It is important to consider the context in which surveys are administered, including participants’ perception of who is asking the questions and for what reason. It seems that if drug use is asked about in a research context, (e.g., with a clear research objective, informed consent and no possibility of repercussions), the validity of responses may be higher than when questions are asked by organisations that are perceived to be involved in the punishment of people who use drugs (e.g., governments, universities).

While the CSEW recognises that it does not reliably measure problematic drug use, my data and that of Charles and colleagues provide evidence that CSEW’s claim that it is a ‘good measure of recreational drug use’ may be wrong. Although it may be convenient to believe that only a small subset of the population uses illicit drugs, accurate information may galvanise policy makers (both nationally and locally, including at universities) into developing drugs policies that reflect reality and which support, rather than criminalise, the large proportion of the population who choose to use drugs. Indeed, this is what we’re doing at the University of Bristol, where it has been accepted that drug use is relatively common among our students and we’re providing support and education to those students who need it.

TARG’s top tips for wellbeing and productivity

Working from home can present huge challenges both to our work productivity and overall wellbeing. These challenges will vary in type and intensity from one person to another, and may also wax and wane at different times of the year.

Things we in TARG have been struggling with include:

  • No separate workspace versus home space; blurring of boundaries between home and work
  • Lack of motivation due to general stress or anxiety about the state of the world
  • Material problems e.g. caring responsibilities, things in life disrupted by the pandemic
  • The social aspect of not seeing people
  • Difficulties in communicating and getting things done when we can’t be together in person

Although it is important to note that “it’s ok not to be ok”, there are things we can do that may help us feel better and/or be more productive in our work during these times.

With this in mind, and wanting to support each other as best we can, our group got together to share tips for coping with working from home.

Here is the TARG list of top tips for wellbeing and productivity:

Working Environment

  • Set a designated working area and go to a separate space for breaks.
  • Or, rotate your working area around different spaces for a change of scene.
  • Keep your working environment tidy.
  • It helps if you keep your home tidy too – it doesn’t have to be spotless though! Just things like making the bed and opening the curtains each morning helps.
  • Have one day every week or fortnight when you tidy up your files and emails.
  • If it helps you concentrate, listen to music or nature sounds or have the radio on. You could turn it off when you’re on a break, then restart it when you want to continue working. Spotify has lots of focus music playlists, or try YouTube.
  • Try using earplugs or noise-cancelling headphones if you want a quieter environment.
  • If you have to work from a laptop, try attaching a computer monitor and separate keyboard and mouse. The extra monitor extends your screen space making working easier, and also gives the feeling of using a separate ‘work computer’ helping to differentiate your personal laptop use from work time.
  • Download a second web browser and use it only for work tasks. Keep only work bookmarks on your work web browser.

Emails

  • Only check your emails two to three times a day at specific times.
  • Add a message to your email signature such as “I check my email at 10am and 3pm every day so you will only hear from me at these times”. We don’t have to be constantly available.
  • Don’t leave your email inbox open. Turn off notification sounds and popups.
  • Work for an hour in the morning before checking emails.
  • Glance at an email to see if it’s important but then ignore it until later.
  • Flag emails and then answer them all in a block of time later.

Phone

  • Only check your phone two to three times a day at specific times.
  • Leave your phone out of sight e.g. in a drawer that’s out of reach.
  • Turn off notification sounds.
  • Remove work email apps from your phone.

Daily Routine

  • Tailor your work schedule to your personal preferences – there’s no need to stick to 9 to 5.
  • Whatever your preferred working schedule is, do have one, and stick to it.
  • Schedule tea breaks at certain times of the day.
  • Get ready and dress in the morning as if you were going to work.
  • Go for a quick walk before you start work to simulate a commute.
  • Have a proper lunch break, away from your working area if you can.

Task Scheduling

  • ‘Eat the frog’: do the most difficult task of the day first.
  • Block out a particular day for particular tasks.
  • Schedule tasks that require more concentration to quieter times of the day.
  • Set your tasks for the day each morning. Make them specific goals. Prioritise the tasks you need to do; don’t try to do everything.
  • Or, schedule tasks per week rather than per day. Whatever works for you.
  • If you’re struggling to start try to do just one task. Often once you start it’s easier to continue.
  • Break up big tasks into smaller chunks and schedule them through the week.
  • Make your day task-based rather than hours-based. E.g., “I will complete three tasks today” rather than “I will work seven hours today.” If you finish early, have the rest of the day off!

To Do and Done Lists

  • Keep a ‘Done’ list to remind yourself of what you’ve achieved each day.
  • If you start a task but haven’t finished it, have a symbol you can mark next to it so you can still see your progress.
  • Have a symbol/colour to mark tasks that you’re waiting to hear back from others on before you can proceed.
  • Colour code your to do list depending on task urgency.
  • Break down tasks into micro-steps.
  • Make your to do list visually appealing.
  • Use Trello to make a to do list.

Motivation/Rewards

  • Schedule time for activities you enjoy.
  • Write a list of things you enjoy and use it as motivation.
  • Gamify work: time spent working unlocks points that you can spend on fun/relaxing activities or treats. You could make a motivation board with stickers to record your points.

Meetings

  • During meetings which are mostly just listening, do household chores that don’t take mental capacity (so you can still concentrate on listening) to have extra free time later.
  • Attend a meeting from outside by using your phone. Sit in the garden, or go for a walk.

Maintain Clarity and Perspective

  • Avoid foods at lunchtime that spike your blood sugar leading to lethargy in the afternoon.
  • If things pop into your head (e.g. things to do, worries) note them down and set them aside for later.
  • If you’re struggling to focus, take a break. E.g. go for a walk, have a nap or relax with a book. Set a timer for going back to work.
  • Take a break every 10 minutes or use the Pomodoro Technique.
  • Set a time limit for tasks and then move on (unless it’s urgent that you finish it).
  • If you’re struggling to get anything done, sometimes it’s much better to just do the minimum amount and then stop, or allow yourself the day off and try again tomorrow. That’s ok!
  • If you have a non-productive day, don’t be hard on yourself. Try speaking to yourself as you would a dear friend.
  • We are all trying to just be as reasonably productive and motivated as we can in these circumstances – don’t expect as much from yourself as you would in normal times, and know that you are most definitely not alone in struggling.

Take Care of your Wellbeing

  • Looking after your wellbeing is important in and of itself but also benefits productivity.
  • There are lots of things we can do to improve our wellbeing, but we don’t want to turn those things into yet more ‘tasks to get done’. Rather than setting wellbeing goals, you could try simply recording what you do each day for your wellbeing, without judgment or expectation. By just recording these things, you may find you automatically start doing them more.
  • Move: go for a walk, do some stretches, get up to make a cup of tea, walk around the garden.
  • Sleep: try to get plenty of sleep, instead of working late ask yourself “can this task be finished tomorrow?”
  • Rest: set aside a bit of time each day to rest and relax with whatever feels restful to you.
  • Play: find time to do things you enjoy, having fun is important for adults as well as children!
  • Gratitude: take a moment to think about something you are grateful for in your life.
  • Nature: notice the nature all around us, even in urban environments there is plenty to see and hear.
  • Pets: cuddling a pet releases endorphins!
  • Laugh: listen to a funny podcast or watch a comedy show.
  • Connect: share how you really feel with a trusted person. Resist the urge to pretend everything’s ok if it’s not. (But if you don’t feel like sharing, that’s ok too.)

Group Strategies

  • Daily morning check-ins that anyone can pop in to.
  • Socials (socially distanced outside when permitted by rules, otherwise online).
  • Online coffee breaks and lunch breaks on Slack/Zoom.
  • Continuing the schedule of regular meetings that we had before the pandemic, but online.
  • Sharing our successes AND failures, it’s especially good if we can laugh about it!
  • Using Slack for quick messages and to stay in touch socially with a dedicated social channel.
  • One-to-one catch ups.
  • Sharing goals for the day with each other and checking in at the end of the day/an hour later.
  • Online writing retreats.

Incorporating new things into your daily routine can feel odd or an uphill struggle at first, but we humans are very good at building habits, so stick with it for a few days and it might become second nature. You could try picking one or two things from the list that resonate with you, and see how you go.

Thanks to the whole group for their contributions and especially to Jackie Thompson for holding the group meeting and co-ordinating responses.

We will be posting these tips on Twitter; if you’d like to see these regular reminders in your Twitter feed follow @BristolTARG or head to the #TARGWellbeing hashtag.

Take care everyone!

Reflections on a crisis – opportunities for a teaching overhaul

Written by Angela Attwood and Olivia Maynard, with reflections from Marcus Munafò

Beyond the immediate impact on people’s lives and livelihoods, the SARS-CoV-2 pandemic has caused a great deal of disruption in how we work. The burden on academics, particularly with respect to teaching, has been considerable. But are there positives that we can take from this situation?

Academia can be surprisingly conservative – we have ways of working that we are reluctant to change. While undergraduate courses may have been tweaked in response to student feedback, they remain largely unchanged from the courses available in the 1990s. Yet over this same period the ways that young people digest knowledge has changed radically. Today’s undergraduates are digital natives, used to receiving content in very different (and more flexible) ways.

Once we knew the pandemic would force us to move to online teaching, and that we’d be delivering our third-year optional psychology unit on ‘Drug Use and Addiction’ online, we knew we had to take the opportunity to completely overhaul our course and update our pedagogy.

We started by identifying key principles that would inform the redesign of the course. As we outline below, we aimed to: ensure clarity, maximise engagement, facilitate presence, tackle the “valuable but missable” problem of live sessions, and be flexible.

Our redesigned course followed a flipped lecture format, whereby asynchronous material was delivered ahead of an online live (synchronous) session. This flipped approach is known to have pedagogical benefits over traditional didactic lectures. This was a substantial structural change to our course, but throughout we tried to avoid reinventing the wheel! Rather we wanted to create a course that was pedagogically sound, based on current evidence, and shaped by our key principles.

The feedback so far from students has been overwhelmingly positive (perhaps even more so than in previous years!) and we strongly believe our principles have been key to the success of the course. We therefore want to expand on each principle and share what we have learned so far, in case this is helpful for others also faced with the daunting task of complete course redesign.

Principle 1: Ensuring clarity

More than anything else, it was essential that students understood what they needed to do and why they need to do it.

What we did:

  • Created a consistent structure. We had folders for each sub-unit (previously lectures, but “sub-unit” better captures the granular nature of the content). Released weekly, these contained all teaching material (e.g., pre-recorded mini “lectures”, reading, etc.) for that week.
  • Ensured requirements were clear. Each sub-unit started with a “roadmap”, including a summary of the sub-unit, intended learning outcomes, and an ordered list of tasks for completion, with an estimate of the time required for each.
  • Clarified the importance of each task. We labelled these as either as CORE or RECOMMENDED. This allowed students flexibility, as they could choose to leave or return to RECOMMENDED items.
  • Provided guidance notes for all academic reading (i.e., journal articles, book chapters). This included an overview (why it was chosen), any focussed reading (particularly useful for long review articles), and key “take home” messages *.

* This was an unexpected “win” as our discussion board inbox was significantly quieter this year. Many questions in previous years asked how to make notes on or read journal articles in the context of the course. The number of these questions received at the point of writing is zero!

Example sub-unit structure from one of the “roadmaps”

Student feedback

“The structure for the sub-units is SO helpful, really like how it tells you how much time each activity is going to take.”

“The pre-recordings are a very good length, and the little summary of everything we are doing for the sub-unit with the timings is incredibly helpful.”

Principle 2: Maximising engagement

Students are spending more time working at home, due to local or national restrictions, or limits on campus study space. This means that as well as material needing to be high quality, it also needs to be interesting and engaging. We focussed on material that was digestible, offered various methods of delivery, and gave students flexibility in how they structured their own learning.

What we did:

  • Lectures recorded into bitesize chunks (ideally of no more than 20 minutes each). This reduced the burden associated with listening to each lecture and provided students with more flexibility when it came to organising their learning.
  • Academic reading was supplemented with additional materials (e.g., videos, podcasts, websites). This allowed students to explore areas of personal interest more deeply if they wished to.
  • Student-led activities (e.g., interview their friends, own literature searches, evaluate websites, mini-experiments). This provided opportunities for students to again explore areas of personal interest more deeply, in a range of different ways.
  • Student choice (e.g., choosing a drug they were interested in, and activities that could be aligned to build a “portfolio” of materials specific to their drug of choice). This fed through to assessment where they could answer the question on any drug they wanted.

Student feedback

“I really like the sub-unit structure. As someone who doesn’t learn best unless there is a range of different learning stimuli in combination (e.g., lecture content, reading, visual cues like videos/stats graphs etc.) I find the subunits are so interesting and they help me to focus my energy onto the task at hand and stops me getting distracted.”

“I really enjoyed the variety and the fact it wasn’t just hours and hours of straight lectures which can get really dull! :)”

Principle 3: Facilitating presence

Working through material posted on a website can be isolating. It’s important to create a sense of community in online settings.

What we did:

  • Used software that enabled student interaction and reflection throughout the week (e.g., Padlet, Mentimeter). We made sure at least one of these was present in each sub-unit, and encouraged students to communicate with each other as well as ourselves.
  • Recorded “reflection” lectures between ourselves (lecturers) or invited guests. This ensured that students saw our faces during the week, as well as a range of different contributions from the wider academic community.
  • Held weekly live sessions on Zoom to reflect on the week’s teaching. Although not strictly necessary, we both attended all live sessions to maximise our interaction with the students, and encouraged students to have their webcams on during these sessions (about half did).
  • Held weekly live drop-in sessions (in addition to core live sessions) to answer questions and chat. This provided further opportunities to interact directly with ourselves and other students in real time.
  • Used Zoom functions in live sessions – including breakout rooms – to give students a chance to talk to each other. We also used Zoom polling to ensure that all students had an opportunity to contribute, even if they didn’t feel like talking.
  • Emailed the cohort regularly with additional opportunities, talks etc. relevant to the course. This created a sense of the wider academic community that they are part of, and the ongoing research activity relevant to the course.

Student feedback

“I really enjoyed the smaller rooms when on Zoom to talk to others in small groups of 5. Found it a lot easier to talk in these smaller groups than larger ones. I also liked the multiple-choice questions that you can present on the screen to see how everyone else is doing in terms of the sub units and the current work.”

Principle 4: Tackling the “valuable but missable” problem for live sessions

One of the biggest risks to any live session are technical issues. This created a “valuable but missable” paradox – we didn’t want to deliver core material during live sessions (so they could be missable if a student had Internet issues), but the sessions also had to be seen as valuable (or students might not attend!)

What we did:

  • Constructed live sessions to be “skill building” (e.g., essay planning, argument building, debating skills, evidence synthesis and critique). These were designed to be valuable across the course as a whole, but any one could be missed with limited impact on assessment.
  • Created different formats for the live sessions to make sure these were seen as valuable, but also interesting and engaging (e.g., discussion on how to answer a mock essay question, multiple choice quiz, hot topic debates).

Student feedback

“I really liked the quiz session last time, it made me think about the information I absorbed in the subunits, but equally I loved the debate. Practice essay questions are also very useful because I am struggling with planning my essays in general.”

“I think the live sessions have been very beneficial in a number of ways related to our essays, overall course understanding and guiding areas for reading.”

Principle 5: Being flexible (we are learning too!)

Co-design with end-users is vital for the best end-product. We allowed time to ask for student feedback, and space to respond to it.

What we did:

  • Created polls that allowed students to vote on upcoming content (e.g., what question would be discussed in live sessions; what format of live sessions they find most helpful).
  • Kept aspects of the course only partially developed (e.g., live session format) so that we had scope to be responsive to feedback.
  • Continually asked for student feedback, via short polls and surveys on specific questions (e.g. ‘What should the format of the live sessions be?’, ‘How long should we stay in breakout groups for’) as well as asking for stop-start-continue feedback on the course as a whole, via an online survey that students could complete at any point during the course.

So, what does the future hold?

While we all hope ‘normal’ life will resume soon, the reality is that the world will not be quite the same post-pandemic. Much like many businesses that are planning to retain positive elements of home working, we should be open to retaining elements of our new ways of teaching. The crisis of the pandemic has created an opportunity to fundamentally overhaul and modernise the way that we teach that would have been unthinkable in a ‘normal’ year. And it seems to have worked – to quote a student, “It’s better than face to face teaching” (emphasis added).

We agree that these new ways of teaching are better – not just for students but for academics too. The recorded asynchronous material will stay current for 2 or 3 years (and perhaps longer for more introductory courses), meaning that if we retain this overall structure, our workload will be less next year. At the same time, many of the various synchronous elements can return to a face-to-face format, ensuring we spend more time in small groups, doing interactive work which both students and academics (certainly ourselves) find more engaging and fulfilling.

While our model is certainly not perfect – it had to be developed rapidly under considerable pressure – it’s a start, and offers a glimpse of the future.