A Public Health Review of Socioecological Determinants and Behavioral Patterns of Substance Use in Tertiary Education Populations

Review Article

Abstract

Substance use among university students represents an escalating global public health challenge characterized by high prevalence rates, severe morbidity, and profound academic and social disruptions. The transition into tertiary education coincides with a critical neurodevelopmental window marked by heightened sensitivity to rewards and incomplete prefrontal regulatory control. This developmental vulnerability interacts with unique environmental pressures, including financial precarity, academic stress, peer normative influences, and widespread physical and digital access to psychoactive agents. By organizing these diverse risk factors within Bronfenbrenner's ecological systems theory, a clear hierarchy emerges, ranging from national policies and regional socioeconomic disparities down to localized peer dynamics and individual genetic or psychopathological susceptibilities. Upstream economic pressures, such as escalating tuition debt and post-graduation employment insecurity, serve as chronic stressors that trigger physiological allostatic loads, often driving maladaptive self-medication strategies. Simultaneously, micro-level factors, such as peer group norms and social media exposure, systematically normalize hazardous consumption patterns, particularly binge drinking and the non-medical misuse of prescription stimulants. These determinants operate not in isolation, but synergistically, creating dual-diagnosis states where substance use and psychiatric comorbidities, such as depression and anxiety, mutually reinforce one another. Mitigating this burden requires a shift from punitive, individual-centric behavioral interventions toward integrated, multi-sectoral public health strategies. Such approaches must incorporate universal screening, accessible mental healthcare, institutional environmental reforms, and national regulatory measures, with particular urgency in resource-constrained regions experiencing rapid urbanization and expanding illicit substance markets