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Self-Esteem and Non-Medical Use of Prescription Drugs among College Students: Coping as a Mediator

Non-medical use of prescription drugs (NMUPD) is an issue among young adults and is associated with negative outcomes such as college dropout, poor academics, poor employment, and adverse health behaviors. Previous research has shown self-esteem and coping may be a psychological determinant of substance use. Due to the lack of research on these determinants and NMUPD, the current study looks at the association between self-esteem, coping strategies, and past three month NMUPD among college students.

The final sample size for this study included 1000 undergraduate students between the ages of 18 and 25 years. Measures included non-medical use of prescription drugs, self-esteem, and coping strategies. NMUPD was assessed by asking students about use of opioids, sedatives, anxiolytics, and stimulants. Self-esteem was assessed using a scale with 10 items about attitude toward themselves. Finally, coping strategies were assessed using 28 item scale with 14 domains of coping strategies.  These domains included self-distraction, active coping, denial, substance use, use of emotional support, etc.

Overall, 24% of participants reported past three month NMUPD with the most used being stimulants and least used being sedatives. Two factors of coping strategies were determined to mediate the relationship between self-esteem and NMUPD. The first factor was adaptive coping which included planning, active coping, positive reframing, and acceptance. The second was maladaptive coping which included behavioral disengagement, denial, and self-blame. The study showed self-esteem did show to be a protective factor for NMUPD in college students during this study. These findings suggest students with low self-esteem may benefit from services that help them to develop adaptive coping strategies to lower this risk of non-medical use of prescription drugs.

Take Away: Non-medical use of prescriptions drugs (NMUPD) continues to be an issue among young adult college students. The current study looks at the association between self-esteem, coping strategies, and past three month NMUPD among college students. students. The final sample size included 1000 undergraduate students with measures including non-medical use of prescription drugs, self-esteem, and coping strategies. Overall, 24% of participants reported past three month NMUPD and two factors of coping strategies were determined to mediate the relationship between self-esteem and NMUPD. These factors were adaptive coping and maladaptive coping. Self-esteem was found to be a protective factor for NMUPD. These findings suggest students with low self-esteem may benefit from services to help develop self-esteem and adaptive coping strategies.


Tam, C. C., Benotsch, E. G., & Li, X. (2020). Self-Esteem and Non-Medical Use of Prescription Drugs among College Students: Coping as a Mediator. Substance Use & Misuse, 55(8), 1309-1319. doi:10.1080/10826084.2020.1735441

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