A Student Walks into Class … Vignettes to Identify Substance Use Disorder Models of Illness among College Students

Abstract

Introduction

Illness models, including illness recognition, perceived severity, and perceived nature can affect treatment-seeking behaviors. Vignettes are a leading approach to examine models of illness but are understudied for substance use disorders (SUDs). We created vignettes for multiple common DSM-5 SUDs and assessed SUD illness models among college students.

Methods

Seven vignettes in which the protagonist meets DSM-5 diagnostic criteria for SUDs involving tobacco, alcohol, cannabis, Adderall, cocaine, Vicodin, and heroin were pilot tested and randomly assigned to 216 college students who completed measures related to illness recognition, perceived severity, and perceived nature. MANOVAs with Scheffe post-hoc tests were conducted to examine vignette group differences on models of illness.

Results

Vignettes met acceptable levels of clarity and plausibility. Participants characterized the protagonist’s substance use as a problem, a SUD, or an addiction most frequently with Vicodin, heroin, and cocaine and least frequently with tobacco and cannabis. Participants assigned to the Vicodin, heroin, and cocaine vignettes were the most likely to view the protagonist’s situation as serious and life-threatening, whereas those assigned to the cannabis vignette were the least likely. Numerically more participants characterized the pattern of substance use as a problem (91%) or an addiction (90%) than a SUD (76%), while only 15% characterized it as a chronic medical condition.

Conclusions

Illness recognition and perceived severity varied across substances and were lowest for cannabis. Few participants conceptualized SUDs as chronic medical conditions. College students may benefit from psychoeducation regarding cannabis use disorder and the chronic medical condition model of SUDs.

Keywords:

• Substance use disorders
• narrative medicine
• vignette
• attitudes
• illness models

Acknowledgements

While the research team did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors to conduct this research, the write-up of this research was supported in part by grants from the NIH to Dr. Barry [Blinded] (MPI; U01 HL150596-01 and RM1 DA055310).

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of NIH or the affiliated institutions.

Declaration of interest

The authors declare that they have no conflict of interest. The authors alone are responsible for the content and writing of the article.

Notes

1 For example, SUDs are categorized as psychiatric disorders in different iterations of the DSM, one of the main diagnostic systems used to classify SUDs in the U.S.

2 The text for the other vignettes can be requested from the corresponding author.

3 Ratings for the Likert-type scale were as follows: 1 = strongly disagree; 2 = disagree; 3 = somewhat disagree; 4 = don’t agree or disagree; 5 = agree somewhat; 6 = agree; 7 = strongly agree

4 https://www.census.gov/quickfacts/fact/table/US/PST045219

Additional information

Funding

The write-up of this research was supported in part by a grant from the NIH/NHLBI to Dr. Barry (MPI; U01 HL150596-01).]