Low Academic Achievement in High School Tied to Long-Term Drug Abuse Risk

Poor academic achievement as a teen can increase risk for drug abuse and its criminal and medical repercussions over the long term, according to a study posted September 5 in JAMA Psychiatry. The study suggests that interventions to help youth improve their schoolwork may be a cost-effective solution for substance use prevention.

The study involved more than 900,000 ninth graders in Sweden who were followed on average 19 years. Researchers aimed to determine whether poor academic achievement as a teen is merely associated with drug abuse, as many studies have already shown, or whether it actually causes it.

Previous studies showed that various individual and school-based interventions that improved academic achievement also lowered drug use, but the studies were short, making it hard to draw conclusions about long-term effects, explained Kenneth Kendler, M.D., director of Virginia Commonwealth University’s Institute for Psychiatric and Behavioral Genetics, and colleagues. The results are of particular importance as the nation grapples to find cost-effective ways of preventing and treating people with substance use disorder in light of steadily increasing drug overdoses: 72,000 deaths last year, a nearly 10 percent increase.

The study involved two separate analyses, each relying on differing statistical methods and both tapping into Swedish population data. For the first study, researchers obtained the date of birth and grade point average for all ninth graders (mostly 16-year-olds) across the entire population of Sweden for four consecutive years and converted their grades to a scale from 1 to 5 (with 5 indicating the highest achievement). A separate, complementary analysis involved nearly 400,000 closely related Swedish ninth graders who were cousins, siblings, or identical twins.

Participants were followed for an average of 19 years, with researchers searching for a “registration” of what they termed drug abuse, either prescription or illicit, in Swedish medical/mortality records or criminal justice/traffic records. (Researchers did not examine alcohol or nicotine use and tallied only drug use that resulted in criminal or medical problems.) Researchers found that 3.6 percent of participants were registered for drug abuse within an average of five years.

Although the two analyses used very different approaches, they produced similar results: that boosting academic achievement at 16 years old by 1 standard deviation cuts long-term risk of drug abuse by 45 percent. This suggests that a substantial proportion of the observed association between low academic achievement and subsequent risk of drug abuse may be causal, Kendler told Psychiatric News.

Furthermore, individuals with lower academic achievement at age 16 were more than twice as likely to later be registered as drug abusers over the next 20 years. The results support the idea that providing services to students to improve their academic achievement is an effective means of preventing drug abuse, the researcher wrote. The idea is that students who succeed academically will tend to develop strong positive attachments to school and their teachers and other authority figures, facilitating their commitment to “pro-social” lifestyles, which in turn reduce their risk of drug abuse and other “deviant” behaviors.

“Most of these programs are now designed for younger children, primarily elementary and middle schoolers, and our results suggest that interventions should be developed and tested for high school students, too,” Kendler said. Programs such as chess clubs, debate clubs, and after-school homework assistance can be helpful as well, he said. “Whenever students’ emotional involvement to school goes up, their grades go up, their attachment to teachers and the community improves, and their risk of drug abuse goes down.”

“Schools are an optimal setting for delivering such programs, given their natural focus on academic achievement and their ability to reach most adolescents,” the authors concluded. “Such interventions may target individual students with academic services or may be comprehensive interventions that change school policies, organization, or climate to provide a more positive learning environment, thereby increasing the student-school emotional bond.”

“We are pursuing several additional projects with the assistance of Swedish researchers to further understand a range of risk factors for the development of drug abuse,” Kendler said. “None of this work would have been possible without my Swedish colleagues, Jan Sundquist, M.D., Ph.D., Kristina Sundquist, M.D., Ph.D., and Henrik Ohlsson, Ph.D. This project has been collaborative international science at its best.”

The study was funded by the National Institute on Drug Abuse, the Swedish Research Council, and Medical Training and Research Agreement funding from Region Skane. ■

“Academic Achievement and Drug Abuse Risk Assessed Using Instrumental Variable Analysis and Co-relative Designs” can be accessed here.