J. DRUG EDUCATION, Vol. 43(2) 97-120, 2013

PERCEPTION VS. REALITY: AN INVESTIGATION OF THE MISPERCEPTIONS CONCERNING THE EXTENT OF PEER NOVEL DRUG USE* AMBER SANDERS JOHN M. STOGNER, PH.D. University of North Carolina at Charlotte BRYAN LEE MILLER, PH.D. Georgia Southern University

ABSTRACT

Misperceptions of peer substance use have previously been implicated as significant influences on individual use of both alcohol and illicit drugs. However, research on perceived social norms and related interventions are typically limited to binge drinking and marijuana and no empirical studies have explored misperceptions related to “novel drugs.” The present study explored the extent of use and perceptions of use among a college sample (N = 2,349) for three categories of novel drugs: synthetic cannabinoids (Spice, K2, Mr. Miyagi, Pot-Pourri, etc.), synthetic cathinones (commonly known as “bath salts”), and Salvia divinorum. Results indicate that overall perceived use was significantly higher than actual reported use. The frequency of overestimation of peer use was particularly large for the emerging drugs when compared to alcohol and marijuana. This finding is concerning as these misperceptions have the potential to influence students toward experimentation with these substances and suggests that a possible target for intervention is misperceptions of emerging novel substances.

*This study was supported in part by funds from the Office of the Vice President for Research and the Jack N. Averitt College of Graduate Studies at Georgia Southern University. The office and college had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication. 97 Ó 2013, Baywood Publishing Co., Inc. doi: http://dx.doi.org/10.2190/DE.43.2.a http://baywood.com

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INTRODUCTION Both the etiology and perception of normative behaviors are essential to our understanding of social order and variations in human behavior (Campbell, 1964; Durkheim, 1951). The behavior of peers and norms in society each play a central role in driving both positive and negative behaviors (Warr, 2002). In fact, these influences are argued to have a greater impact on individuals’ behavior than biological, personality, familial, religious, and cultural factors (Berkowitz & Perkins, 1986; Borsari & Carey, 2001; Kandel, 1985). Peers are typically the strongest influence on personal behaviors such as alcohol and substance use and their influence is especially strong during late adolescence and early adulthood (Kandel, 1980, 1985). However, peer influences may be based more on what individuals think others believe and do (the “perceived norm”) as opposed to others’ true beliefs and actions (the “actual norm”). This gap between the perceived and actual, referred to as a misperception, has been shown to have an effect on substance use behaviors (Berkowitz, 2004), which has provided justification for numerous “social norms” interventions. Social Norms Adolescents and young adults often behave in ways corresponding with the perceived norm of their respective peer group, even if that perception is not a true representation of the actual norm (Borsari & Carey, 2001). They are potentially influenced more by what they think their friends do as opposed to what those friends actually do. This relationship may arise from a youth’s desire to avoid standing out (Carey, Borsari, Carey, & Maisto, 2006), to be a more attractive peer to their friends (Dijkstra, Cillessen, Lindenberg, & Veenstra, 2010), to gain acceptance, or simply due to the idea that the behavior is normal. Regardless of their origins, it appears that misperceptions can strongly alter an individual’s personal behavior. Young and Weerman (2013) recently noted that overestimation did affect self-reported delinquency above and beyond peers’ actual delinquency in a sample of Dutch adolescents. Their work revealed that overestimation of peer deviance was particularly influential among less popular students, ones that experienced intense peer pressure and students that most strongly valued social approval. Some research suggests that perceptions of what others would do, and have done, are particularly influential in situations that include greater uncertainty (Cialdini & Trost, 1998); drug use would most certainly fit this criteria. This may explain why misperceptions are frequently considered influences of alcohol use among students (Clapp & McDonnell, 2000; Page, Scanlan, & Gilbert, 1999; Perkins, 1997, 2002; Wood, Nagoshi, & Dennis, 1992). A student may rely on popular media or observe the alcohol use of a limited group and make the presumption that heavy drinking is the normative behavior. That student may in turn alter their behavior to match what they perceive to be the norm, potentially

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resulting in heavier alcohol use and further perpetuation of this misperception (Perkins, 1997). While alcohol and marijuana use are likely influenced by misperceptions, Cialdini and Trost’s (1998) research suggest that misperceptions may be more important for less frequent behaviors such as novel drugs or uncommon forms of delinquency. Perkins and Berkowitz (1986) were among the first to evaluate misperceptions of social norms related to substance use. In their seminal study, they noted that the majority of college students believed a person should never drink alcohol to the point of intoxication or that intoxication was acceptable only in limited circumstances. However, almost two-thirds of these same students thought their peers believed frequent intoxication or intoxication that interfered with academics and other responsibilities was acceptable. Additional surveys conducted over several years consistently demonstrated misperceptions of similar magnitude (Berkowitz & Perkins, 1986; Haines & Spear, 1996; Perkins, 1994; Perkins, Haines, & Rice, 2005). One large-scale study, which examined the relationship between misperceptions of norms regarding drug use and actual drug consumption at 100 college campuses, found that peer norms were generally inflated for many substances, including tobacco, marijuana, cocaine, and designer drugs (Perkins, Meilman, Leichliter, Cashin, & Presley, 1999). Misperception of social norms research has even been extended beyond the realm of substance use to include issues such as sexual assault and violence, eating disorders, and homophobic prejudice (Bowen & Bourgeois, 2001; Bruce, 2002; Carter, Stewart, Dunn, & Fairburn, 1997; Fabiano, Perkins, Berkowitz, Linkenbach, & Stark, 2003; Kilmartin, Conway, Friedberg, McQuoid, Tschan, & Norbet, 1999; Mann, Nolen-Hoeksema, Huang, Burgard, Wright, & Hanson, 1997). As noted previously, the overestimation of peer substance use has been hypothesized to increase the likelihood that an individual will initiate or continue excessive substance use (Perkins et al., 1999). Indeed, recent studies have indicated that a person’s perceptions of others’ behavior influence their own behaviors significantly more than others’ actual behavior (Borsari & Carey, 2001; Perkins et al., 2005). In an attempt to correct misperceptions based on peer norms, and as a result potentially reduce the likelihood of substance abuse, intervention and prevention measures have attempted to present young adults with accurate information about peer group norms. The goal of these efforts is to reduce perceptions of the perceived norm to a more accurate level known as the actual norm (Perkins, 2002). These programs, known as social norms interventions, have been implemented at many colleges and universities to combat inflated social peer norms regarding alcohol (Borsari & Carey, 2001; Perkins et al., 1999, 2005), and have also been extended to include tobacco and marijuana use (ArbourNicitopoulos, Kwan, Lowe, Taman, & Faulkner, 2010; Neighbors, Geisner, & Lee, 2008). These programs typically attempt to alter misperceptions so that they are more consistent with the actual behaviors of a group (Berkowitz, 2003). For example, at the University of North Carolina at Chapel Hill first year students

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are exposed to the marketing campaign promoting that “whether it’s Thursday, Friday, or Saturday night, 2 out of 3 UNC students return home with a .00 blood alcohol concentration” (Foss, Deikkman, Bartley, & Goodman, 2003, p. 3). This particular campaign addresses both what misperceptions exist and what are the typical behaviors of the general student body. To address the concern of whether social norms interventions are effective, Haines and Spear (1996) and Glider, Midyerr, Mills-Novoa, Johannson, and Collins (2001) evaluated drinking behaviors in response to social norms interventions each at a single university and reported a decrease in drinking rates following implementation of a social norms campaign. Similarly, Gomberg, Schneider, and Dejong (2001) found a decrease of perceptions regarding alcohol use, alcohol use behavior, and alcohol-related harms following implementation of a social norms campaign, but could not attribute the results completely to the intervention due to other campus efforts to curb drinking behaviors. However, Gorman and others (Brown, 2004; Fernández, Nebot, & Jané, 2002; Gorman, 1998, 2003; Gorman & Conde, 2010) have challenged that numerous past school-based interventions have gathered false and inappropriate support. They challenge that the research supporting many programs is simply “irrelevant of evidence.” That is, the apparent reductions in substance use credited to school-based programs may have little to do with the programs themselves. The reductions noted may be the result of underlying drug declines or, worse, invalid findings created through lowered standards and other questionable practices driven by financial incentives, publication motives, and political pressure. As research suggests that school-based programmatic interventions may not have had the utility that initial reports implied (Brown, 2004; Fernández, Nebot, & Jané, 2002), policymakers should carefully assess the evaluation research lauding extant programs prior to implementing them in their own areas. Recently Martens et al. (2006) extended social norms research beyond alcohol, tobacco, and marijuana use by exploring misperceptions related to a wider variety of illicit drugs including cocaine, amphetamines, and Rohypnol/GHB/Liquid X, as well as sexual behavior. Martens et al. (2006) found that college students had significant misperceptions of the social norms for all studied behaviors and that the vast majority of students overestimated normative behaviors for alcohol use, drug use, and sexual behavior. Martens et al. (2006) did not implement or evaluate an intervention, but their work is important in that they demonstrate that misperceptions may exist for a diverse array of deviant behaviors as opposed to just frequently used substances such as alcohol and marijuana. Martens et al. (2006) assert that their findings suggest the scope of social norms interventions may be expanded beyond commonly used substances. Future research will be required to determine if social norms interventions for stimulant and club drug use can match the apparent efficacy (e.g., Glider et al., 2001) of alcohol norm interventions.

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Novel or Emerging Drugs Since 2008 certain novel drugs, also referred to as emerging or designer drugs, have risen in popularity (Corazza, Assi, Simonato, Corkery, Bersani, Demetrovics, et al., 2013; Miller, Boman, & Stogner, 2013). These substances are often synthetic compounds that contain modified molecular structures similar to those of illegal or controlled substances, but can also be existing substances whose recreational use becomes a brief popular culture phenomenon (Griffin, Miller, & Khey, 2008; Loeffler, Hurst, Penn, & Yung, 2012). Two classes of designer drugs that have recently reached national status include synthetic cannabinoids and synthetic cathinones (Loeffler et al., 2012). The name of a popular cannabinoid product, Spice, has become the namesake of any designer drug with effects similar to cannabis. Drugs of this type consist of psychoactively static dry plant material that has been sprayed with synthetic cannabinoid receptor agonists (Dresen, Ferreirós, Pütz, Westphal, Zimmermann & Auwärter, 2010). Effects of spice inhalation resemble that of cannabis intoxication: an altered consciousness, disinhibition, feelings of euphoria, and a state of “being energized” (Schifano, Corazzaa, Delucab, Daveyc, DiFuriad, Farree, et al., 2009). Synthetic cathinones are a family of structurally related sympathomimetic designer drugs similar to amphetamine which are marketed and known as “bath salts.” “Bath salts” may also include methylenedioxypyrovalerone (MDPV), a synthetic stimulant chemically and pharmacologically similar to the cathinones but not technically a member of that classification; for the purpose of this study MDPV is grouped with the synthetic cathinones. Effects of “bath salts” are similar to that of stimulants such as cocaine and methamphetamines (Loeffler et al., 2012). Another novel substance of concern, which started to gain popularity in the late 1990s, is Salvia divinorum, a plant from the mint family whose active ingredient, salvinorin A, creates a short but intense dissociative state for the user (Grundmann, Phipps, Zadezensksy, & Butterweck, 2007; Prisinzano, 2005). Salvia has a long history of use in the Oaxaca, Mexico region either through chewing of leaves or the grinding of leaves into an ingested tea, but modern recreational users smoke a modified leaf product out of a pipe (Dennehy, Tsourounis, & Miller, 2005; Halpern & Pope, 2001). The use of novel drugs and their popularity has increased for many reasons. First, until recently they were legal, inexpensive, and readily available in retail outlets like “head” shops, gas stations, and online (Loeffler et al., 2012); some remain legal in many states today (see Stogner, Khey, Griffin, Miller, & Boman, 2012). Second, they were not initially detected in standard urine drug screens which made them more desirable for some demographics, such as the military, athletes, and probationers (European Monitoring Centre for Drugs and Drug Addiction, 2009; Loeffler et al., 2012). Additionally, they have been covered by the media at alarming rates and promoted on numerous websites (Vardakou, Pistos, & Spiliopoulou, 2010). Finally, they are often advertised as “herbal” and “natural” which may have led potential users to believe that they are safer

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alternatives to other substances (Loeffler et al., 2012; Saha, Deanne Wilson, & Adger, 2012). Use of novel drugs does appear to be concentrated in young adult populations. Monitoring the Future added synthetic marijuana to their survey in 2011 and found that 11.4% of high school seniors reported using a synthetic cannabinoid within 12 months. This number remained stable in 2012 at 11.3%. In 2012, grades 8 and 10 were asked about their synthetic marijuana use for the first time and reported annual prevalence rates of 4.4% and 8.8%, respectively. Until May of 2011, synthetic marijuana was not scheduled by the Drug Enforcement Administration (DEA), so common brands such as Spice and K2 were readily available. The 2012 rates for synthetic marijuana idyllically reflect changes due to the DEA scheduling. The stable rate of use among 12th graders indicates that either compliance to the scheduling has been limited or that those manufacturing these products have continued to modify their chemical formulas to evade using the scheduled ingredients (Johnston, O’Malley, Bachman, & Schulenberg, 2013). “Bath salts” were added to the survey for the first time in 2012 and reported annual prevalence rates of 0.8%, 0.6%, and 1.3% for grades 8, 10, and 12 respectively (Johnston et al., 2013). While salvia was added in 2009, the 2012 annual prevalence rates were 1.4%, 2.5%, and 4.4% for grades 8, 10, and 12, respectively (Johnston et al., 2013). These substances are also prevalent at universities with studies estimating their use at 4.4% to 6.7% for salvia (Khey, Miller, & Griffin, 2008; Lange, Reed, Ketchie Croff, & Clapp, 2008), around 8% for synthetic cannabinoids (Hu, Primack, Barnett & Cook, 2011). While data on prevalence of synthetic cathinones is limited, the American Association of Poison Control Centers has reported many calls related to bath salts: 304 in 2010, 6,038 in 2011, and 2,654 in 2012 (American Association of Poison Control Centers, 2013). With the escalation of novel drug use, it is increasingly important to understand their presence among populations particularly vulnerable to substance misperceptions and subsequent use. Peer influence represents such a strong force in shaping personal behavior that misperceptions and exaggerations of the norms of peers are particularly worrisome (Carey et al., 2006; Perkins, 2002, 2003). Misperceptions of social norms may even be greater than those of alcohol and marijuana. Though referring to perceptions of best-friend behavior rather than overall peer group behavior, Miller, Boman, and Stogner (2013, p. 65) argue: Perceptions of novel peer drug use may be more problematic than perceptions of other behaviors because novel drugs are used very infrequently, meaning that inaccuracies in the measure of perceptual peer substance use may be amplified because there is little opportunity for a respondent to notice that a peer is using the substance.

This study seeks to examine the extent of use and perceptions of use for three categories of novel drugs among a collegiate population: synthetic cannabinoids

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(Spice, K2, Mr. Miyagi, Pot-Pourri), synthetic cathinones (commonly known as “bath salts”), and Salvia divinorum. More specifically, we seek to explore whether misperceptions about peer novel drug use exist, whether they are greater than those associated with alcohol and marijuana use, what traits are linked to inaccurate perceptions, and whether users are more likely to hold inaccurate beliefs about others’ behaviors. This study may indicate a need for colleges and universities to design and implement novel substance social norms intervention measures similar to those typically addressing alcohol. We offer the following hypotheses: H1: Students perceive that novel drug use is more common among their peers than it is in reality. H2: Misperceptions of novel drug use are more common than misperceptions related to more frequently occurring behaviors such as alcohol and marijuana use. H3: Users of novel drugs will overestimate use among their peer group to a greater degree than nonusers. METHODOLOGY Data In the spring semester of 2012, a print survey was administered to students enrolled in 40 randomly selected undergraduate classes at a large university in the Southeastern United States. Courses were selected from two strata—15 classes with more than 100 students enrolled were randomly selected and 25 classes with 30 to 99 students enrolled were similarly selected. Online, distance, physical education, and laboratory classes were removed from the sampling frame. In the event an instructor denied the research team access to their class, that course was replaced by another randomly selected course from that strata. Of those enrolled in the courses, approximately 80.4% were in attendance at the time of the survey. Students were asked not to complete the survey again if they had previously participated in another course. Data collection in the 40 courses yielded a final sample of 2,349 students that was largely representative of the university’s general student population. The sample was 51.6% female, 68.9% White, 24.4% Black, and 2.8% Hispanic, with 4.0% falling into other categories. The general student population is 51.5% female, 65.5% White, 25.0% Black, and 3.8% Hispanic. Similar to the general student body, 15.7% of the sample was in Greek organizations and 5.3% were student athletes. Within the sample, the median family income category was $75,000 to $99,999, the mean age was 20.06, and 2.8% self-identified as lesbian, gay, bisexual, or transgender.

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Measurement As the focus of the present analysis lies in potential misperceptions of the normative behaviors of a group, it is critical to quantify both the actual behavior of the group and the perceptions of the group’s behavior. Actual behavior was assessed through items that instructed the respondents to “Please check the appropriate box for the number of days that you have used each of the following substances recreationally in the last 30 days” and offered the following options: none, 1 to 2 days, 3 to 5 days, 6 to 9 days, 10 to 19 days, or 20 or more days. Similar ordinal drug use frequency items have been used in major datasets such as the National Youth Survey and the National Longitudinal Study of Adolescent Health. Students were asked about their use of alcohol, marijuana, Salvia divinorum, synthetic cathinones or “bath salts,” and two categories of synthetic cannabinoids/synthetic marijuana: those packaged as K2 and Spice and those packaged as “Mr. Miyagi” or “Pot-Pourri.” The state’s regulation of the former but not the latter group of synthetic cannabinoids in March of 2011 led to the separation of these compounds. The latter products (“Mr. Miyagi” and “Pot-Pourri”) remained on store shelves in the state until several months after the survey was completed. Consistent with the novel drug definitions provided by Miller et al. (2013) and Corazza et al. (2013), the four latter drug types were chosen due to being those that were rarely if at all used recreationally 10 years previously, but that were finding some traction as a recreational drug in the sample (more than 1% use). Responses were aggregated to represent actual group behaviors for each substance. As the sample of 2,349 respondents represents over 10% of the student population, this aggregation serves as a viable estimate for actual university behavior and norms. Perceptions of normative behavior was assessed through items that asked the respondents “How often do you think the average [university name] student has used the following in the last 30 days?” (emphasis in original). Participants were asked about the same substances and offered the same possible responses as they were to the self-reported use items. Participants also reported their gender, age, race/ethnicity, family income, grade-point average, sexual orientation, whether they were a member of a Greek organization, and whether they were a student athlete. Analytic Strategy We initially explored whether as a whole the student sample overestimated use of the university population in two ways. To first examine prevalence of use, we utilized t-tests to compare the proportion of students that perceived that the normative behavior of any use for each substance in a month with the proportion that actually reported any use. Second, we explored differences between the ordinal self-reported frequencies of use measures and the perceptions of frequency of use measures with Wilcoxon signed-rank tests. Findings

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for emerging drugs were then compared to those associated with alcohol and marijuana use. Additionally, we examined the degree of overestimation for each substance to determine if the magnitude of overestimation was different for emerging drugs than it was for alcohol and marijuana. More specifically, we attempted to determine whether extreme overestimation of normative behaviors were more common for novel drugs or alcohol and marijuana. The relationship between individuals’ substance use and their estimation of normative behaviors were then evaluated for each substance. Finally, we explored demographic characteristics associated with misperceptions of university norms in an attempt to offer recommendations for targeted programmatic interventions. RESULTS Table 1 displays both the proportion of students that reported using each substance in the last month and the proportion that perceived that the average student had used each substance. Self-reported alcohol (74.7%) and marijuana use (33.3%) were quite common, but the perception that the average student used these substances was almost universal (98.4% and 95.7%). Last month novel drug use was somewhat rare in the sample with only 1.3% reporting salvia use, 0.5% reporting synthetic cathinone use, 1.5% reporting use of K2 or Spice, and 2.7% reporting use of Mr. Miyagi or Pot-Pourri. However, approximately half of the sample reported believing that the typical student at the university used each of these substances. K2 and Spice had the highest percentage reported perceived use (55.8%), but even the most rarely used substance, synthetic cathinones, was viewed as normative by over a third of the sample (38.4%). For each substance the proportion that perceived normative use was significantly higher than the proportion that reported use. Also displayed in Table 1 are median values for the actual and perceived frequency of use measures. For both alcohol and marijuana, students reported believing that use occurs significantly more frequently than it is self-reported to be. Similarly, the distributions of the perceptions of the frequency of use for each of the emerging drugs are shifted toward more frequent use when compared to those distributions of reported use. Figure 1 presents the average perceptions of use graphically with actual use superimposed. It clearly demonstrates that students believe use is more common and frequent than it actually is for each substance. Despite being relatively rarely used, the novel drugs are perceived to be commonly used by a number of those in the sample. These results all suggest support for Hypothesis 1; that students perceive use of novel drugs to be more common and frequent than it is in reality. The percentages of students who underestimate, near accurately estimate, overestimate, and extremely overestimate the frequency that each substance is used by members of the student population are displayed in Table 2. Respondents

< .001 < .001 < .001 < .001 < .001 < .001

6 to 9 days 6 to 9 days 1 to 2 days Not once 1 to 2 days Not once

3 to 5 days Not once Not once Not once Not once Not once

< .001 < .001 < .001 < .001 < .001 < .001

98.4% 95.7% 53.5% 38.4% 55.8% 41.6%

74.7% 33.3% 1.3% 0.5% 1.5% 2.7%

Alcohol

Marijuana

Salvia divinorum

Synthetic cathinones

K2, Spice

Mr. Miyagi, Pot-Pourri

Substance

Wilcoxon SignedRank Test p value

Perceived last month frequency (median)

Reported last month frequency (median)

Proportions t-test p value

Percent perceiving normative last month use

Percent reporting last month use

Table 1. Actual and Perceived Incidences and Frequencies of Drug Use

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Figure 1. Perceptions of student substance use and self-reported student substance use.

Table 2. Percentage of Students that Underestimate, Accurately Estimate, and Overestimate Substance Use Underestimation

Near Accurate Estimate

Overestimation

Extreme Overestimation

Alcohol

1.6%

27.0%

52.0%

19.4%

Marijuana

4.3%

37.0%

41.2%

17.6%

Salvia divinorum

—

77.0%

15.9%

7.1%

Synthetic cathinones

—

85.7%

8.8%

5.6%

K2, Spice

—

71.6%

19.1%

9.3%

Mr. Miyagi, Pot-Pourri

—

83.4%

10.3%

6.3%

Substance

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who selected an option for the perceptual measure which matched, was one option above, or was one option below the mean value for the corresponding selfreported use variable were classified as “near accurate” estimators. Respondents reporting perceptions two or three options above or below the mean for that substance were classified as overestimating and underestimating use, respectively. Those perceptions four or more options above the mean were labeled “extreme overestimation.” As seen in the Table’s rightmost two columns, overestimation of the frequency of use, and extreme overestimation does occur for each substance. However, in contrast with Hypothesis 2, overestimation (and extreme overestimation) is far more common for alcohol and marijuana. For each of the novel drugs, over 70% of respondents’ perceptions matched or came close to matching the actual reported use. This suggests that while, as a group, students overestimate novel drug use, they are not grossly incorrect in their perceptions. In fact, they are far more often extremely inaccurate with their perceptions of alcohol (19.4%) and marijuana use (17.6%) than they are with perceptions of salvia (7.1%), synthetic cathinones (5.6%), K2/Spice (9.3%), and Mr. Miyagi/Pot-Pourri (6.3%). These distinctions are even more pronounced in the “overestimation” classification than in the “extreme overestimation” classification. To allow for the examination of Hypothesis 3, the percentages of lifetime users for each of the six substances that overestimate actual use of each of the six substances are displayed in Table 3. For the purpose of this analysis, those committing “overestimation” and “extreme overestimation” were collapsed into a single category and are simply referred to as “overestimators.” Users of alcohol were more often overestimators of alcohol (72.5%) and marijuana use (60.9%), but no more likely than nonusers to overestimate use of the novel drugs. In fact, they actually overestimated synthetic cathinone use (13.4%) less often than users. Marijuana users were more often overestimators of marijuana use (64.4%) and K2/Spice use (31.8%). K2 and Spice users were more often overestimators of use of those products than nonusers (44.3%). Similarly, Mr. Miyagi/ Pot-Pourri users were more often overestimators of both K2/Spice (38.5%) and Mr. Miyagi/Pot-Pourri use (33.0%). Interestingly, salvia users were no different in the perceptions of university salvia use than non-users and synthetic cathinone users did not misperceive the use of cathinones more often than non-users. Thus, support for Hypothesis 3 is mixed. It appears that a trend exists with novel drug users more often overestimating synthetic cannabinoid use than non-users, but not overestimating synthetic cathinone use more than non-users. Care should be taken not to infer that misperceptions increase the likelihood of use and similarly not to infer that use increases misperceptions. As the data are cross-sectional, directionality of this relationship cannot be determined. Finally, Table 4 presents overestimation of university substance use across several demographic characteristics in an attempt to clarify which students are most frequently incorrect in their beliefs about peer norms. For categorical

Mr. Miyagi, Pot-Pourri users 68.5% 60.0% 16.7% 8.9% 38.5% (+) 33.0% (+)

K2, Spice users 72.9% 66.7% (+) 17.4% (–) 7.4% (–) 44.3% (+) 16.4%

Synthetic cathinone users 45.5% (–) 47.6% 13.6% 21.7% 21.7% 21.7%

Salvia divinorum users 70.9% 68.9% (+) 24.3% 8.6% (–) 36.2% (+) 17.2%

Marijuana users 72.7% 64.4% (+) 22.0% 12.3% (–) 31.8% (+) 16.0%

72.5% (+) 60.9% (+) 22.7% 13.4% (–) 28.8% 16.2%

Alcohol

Marijuana

K2, Spice

Mr. Miyagi, Pot-Pourri

Notes: Values represent the percentage of users of the substance listed in the column that overestimated university-wide use of the substance listed in the row. (+) or (-) indicates that the proportion of users of the substance that overestimate university use of the indicated substance is significantly different (p < .05) than that of non-substance users. (+) indicates that the proportion of users that overestimates use is higher than that of non-users with (–) indicating that a smaller proportion of users than nonusers overestimates use.

Synthetic cathinones

Salvia divinorum

Substance use estimated

Alcohol users

Table 3. Overestimation of University Norms Among Substance Users

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1136 (48.4%) 1210 (51.6%)

557 (24.4%) 20 (0.9%) 64 (2.8%) 1574 (68.9%) 70 (3.1%)

1978 (84.3%) 369 (15.7%)

2254 (97.2%) 64 (2.8%)

Gender Male Female

Race/Ethnicity African American Asian Hispanic White Native Amer./Other

Fraternity/Sorority No Yes

Sexual Orientation Heterosexual Homosexual/Bisexual

Categorical characteristics

Characteristics

Sample N (%)

72.0%* 57.1%*

71.2% 72.6%

37.3% 66.7% 60.3% 73.7%* 67.2%

69.6%† 73.1%†

Alcohol % overest.

58.8% 56.6%

59.0% 57.4%

62.8% 55.6% 63.5% 57.1% 58.2%

57.2% 60.3%

Marijuana % overest.

23.1% 27.6%

23.4% 21.2%

24.1% 47.1% 18.0% 22.7% 23.9%

23.1% 22.9%

Salvia divinorum % overest.

14.3% 20.7%

14.9% 11.8%

16.9% 22.2% 10.2% 13.5% 14.9%

13.7% 14.9%

Synthetic cathinones % overest.

28.1%* 42.1%*

29.4%* 23.2%*

30.4% 33.3% 27.9% 28.2% 29.2%

29.1% 27.8%

K2, Spice % overest.

Table 4. Substance Use Overestimation Across Various Demographic Groups

16.6% 19.3%

17.0% 14.4%

18.5% 22.2% 13.3% 15.8% 21.2%

16.7% 16.4%

Mr. Miyagi, Pot-Pourri % overest.

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3.03 (.59) 2.99 (.64)

5.22 (2.10)* 4.95 (2.03)*

3.01 (.60)

5.15 (2.09)

GPA Overestimators Non-overestimators

Family income Overestimators Non-overestimators 5.14 (2.06) 5.15 (2.13)

3.00 (.59)† 3.05 (.62)†

20.01 (2.76) 20.01 (3.12)

M (SD)

5.22 (2.17) 5.16 (2.07)

3.01 (.60) 3.02 (.61)

20.13 (2.55) 19.92 (2.79)

M (SD)

5.05 (2.14) 5.19 (2.80)

3.00 (.60) 3.03 (.60)

20.16 (2.88) 19.92 (2.70)

M (SD)

*Indicates that p < .05, †indicates p < .10; African American serves as the reference group for race.

20.02 (2.92) 20.02 (2.89)

20.02 (2.91)

M (SD)

Age Overestimators Non-overestimators

Ordered characteristics

M (SD)

5.17 (2.10) 5.15 (2.10)

3.00 (.60) 3.03 (.60)

19.97 (2.50) 19.95 (2.80)

M (SD)

5.18 (2.14) 5.17 (2.08)

3.00 (.61) 3.03 (.60)

20.19 (2.81)† 19.92 (2.71)†

M (SD)

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variables, differences between groups were assessed with c2 tests. The lower portion of the table compares mean scores of overestimators and nonoverestimators of the continuous variables such as age and GPA using t-tests. Very few significant differences emerged. For alcohol, Whites (73.7%) and heterosexuals (72.0%) were more often overestimators than African Americans (37.3%) and sexual minorities (57.1%). K2/Spice use was overestimated by fewer of those in Greek organizations (23.2%) than those non-members (29.4%) and overestimates were more common among sexual minorities (42.1%) than heterosexuals (28.1%). Overall, it appears that substance use overestimation is not concentrated in any one group or portion of the student body. DISCUSSIONS AND CONCLUSIONS The purposes of this study were: 1. to indicate whether students perceive that novel drug use is more common among their peers than it is in reality; 2. to compare misperceptions of novel drug use to more frequently occurring behaviors such as alcohol and marijuana use; and 3. to determine whether users of novel drugs overestimate use among their peer group to a greater degree than nonusers. We found support for our first hypothesis; students perceive use of novel drugs to be more common and frequent than their peers report actual use. While over a third of students consider use of each novel drug normative in the population, none of the novel drugs looked at in the study were used by more than 3% of the sample in the last month. It also was hypothesized that misperceptions of novel drug use would surpass misperceptions for more commonly used substances. This was not supported by the results. Rather, students were far more often extremely inaccurate with their perceptions of alcohol (19.4%) and marijuana use (17.6%) than with perceptions of novel substance use (ranging 5.6% to 9.3%). It seems that although participants were inaccurate in their perceptions of novel drug use, their misperceptions were small in magnitude compared to alcohol and marijuana. Our last hypothesis, that users of novel drugs will overestimate use among their peer group to a greater degree than nonusers, only gathered mixed support. Compared to nonusers, novel drug users were more likely to overestimate synthetic cannabinoid use, but less likely to overestimate synthetic cathinone use. This suggests that novel drug users may be more aware of which novel drugs are actually being used, but overestimating use of the more commonly used novel drugs (synthetic cannabinoids) and underestimating the very rarely used ones (synthetic cathinones). We found that substance use overestimation was not concentrated in any one group or portion of the student body. Few significant differences emerged

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when exploring characteristics of an “overestimator.” For alcohol, Whites and heterosexuals were more often overestimators than African Americans and sexual minorities. K2/Spice use was overestimated by fewer of those in Greek organizations than those non-members and overestimates were more common among sexual minorities than heterosexuals, but no significant differences were observed for marijuana, synthetic cathinones, Salvia divinorum, or Mr. Miyagi/ Pot-Pourri. Thus, the findings seem to indicate that there is no single profile for an overestimator of peer substance use and that interventions cannot be targeted toward any specific portion of the population. Within social norms theory, the term “misperception” has been used to describe the gap between actual attitudes or behaviors and what people think is true about others’ attitudes or behaviors. More simply, a misperception is an overestimation or underestimation of the prevalence of attitudes or behaviors in a group (Berkowitz, 2004). The formation of misperceptions like those noted in this study can be attributed to pluralistic ignorance, the false consensus effect, and false uniqueness. Pluralistic ignorance refers to a person’s false belief that their peers think or act differently from them when in fact their attitudes or behaviors are rather similar (Miller & McFarland, 1987, 1991; Prentice & Miller, 1996). Previous research suggests that most college aged moderate drinkers are victims of pluralistic ignorance, believing that their peers drink more than they do in reality (Berkowitz, 2004). False consensus is the belief that others are like one’s self but in reality they are not. This misperception maintains an individual’s denial that his or her attitudes or behaviors are problematic or unusual (Ross, Greene, & House, 1977). False uniqueness is the phenomenon of when individuals who are in the minority presume that the difference between them and others is greater than is actually is (Suls & Wan, 1987). This is primarily the case for those who abstain from substances, as they often see themselves as more of a minority in a substance prevalent environment. It is likely that misperceptions of novel drug use are driven by either false uniqueness or pluralistic ignorance, though the present research cannot make this distinction. Social norms interventions aim to address and correct misperceptions regardless of their origins. Social norms interventions often attempt to rectify pluralistic ignorance by informing the majority that their behavior is actually more normative than they believe. This allows a person to realign their behavior more closely with personal attitudes and subsequently remove anxiety associated with acting in ways incongruent with their own desires (Berkowitz, 2004). Similarly, the interventions address the denial associated with false consensus and present a more truthful norm to those who are heavily abusing substances (DeJong, 2003; Dunnagan, Hayes, Linkenbach, & Shatwell, 2003). Social norms interventions also affect those who perceive false uniqueness by providing information about the actual number of abstainers and responsible drinkers (Berkowitz, 2004). To date, some social norms interventions have been found effective in altering alcohol use behavior of the moderate user majority via pluralistic ignorance,

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confronting and changing the behavior of the heavy using minority via false consensus and maintaining, or increasing the number of those who abstain or use infrequently via false uniqueness (Foss et al., 2003; Glider et al., 2001; Haines & Spear, 1996; Perkins, 2002). While many studies on student misperceptions look at alcohol, tobacco and marijuana (Arbour-Nicitopoulos et al., 2010; Borsari & Carey, 2001; Neighbors, Geisner, & Lee, 2008; Perkins et al., 1999, 2005), few have extended the principle to other substances and behaviors. In an attempt to expand the spectrum, Martens et al. (2006) found that college students had significant misperceptions of the social norms for a wider variety of illicit drugs including cocaine, amphetamines, and Rohypnol/GHB/Liquid X, as well as sexual behavior. Our study similarly explores a previously unexamined misperception. Much like Martens et al. (2006), our work identifies key misperceptions that may influence behavior but stops short of designing and evaluating an intervention. With most current social norms intervention programs typically targeting alcohol use among college students (Borsari & Carey, 2001; Perkins et al., 1999, 2005), key misperceptions may be currently overlooked. Our results do indicate that alcohol is still the most misperceived substance, but misperception rates for novel drugs are also alarming. With these obvious misperceptions of normative peer behavior at play, pilot testing of intervention material extended to include novel drugs seems both natural and warranted. Our results suggest that there may be impetus to redesign social norms interventions so as to target novel drug misperceptions along with alcohol and other substances. Although our research cannot speak to the potential efficacy of these changes, well-designed and implemented programs may have the ability to reduce misperceptions regarding novel drug use. Such programs have the potential to combat these misperceptions and reach the apparent success seen with previous intervention efforts targeting alcohol and marijuana (Glider et al., 2001; Gomberg et al., 2001; Haines & Spears, 1996), but care must be taken to produce an accurate and unbiased quantitative evaluation (Gorman, 1998). In sum, this work suggests that it may be beneficial to expand the current scope for social norms research and policy, but future research is tasked with assessing the utility of program modifications. With the legality of many of these substances often being unknown to students (Singleton, Stogner, & Miller, 2013), it is increasingly important to educate students on the legal status of novel drugs. Corazza and colleagues (2013) note that the label of a “legal high” often applied soon after initial production may deceive potential users to believe a substance is currently legal. This is particularly true given the constant legislation changes and the resulting development of new chemical configurations by manufacturers attempting to bypass prohibitions. Unfortunately, the “legal high” label seems to persist after a ban and substances marketed as such often contain illicit compounds (Ayres & Bond, 2012). The misperception that a banned substance is legal might increase

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misperceptions of safety and exacerbate misperceptions of peer use. Therefore, social norms interventions attempting to minimize overestimation of peer novel drug use would likely benefit from including information about actual legality to similarly correct those misperceptions. The efficacy of including accurate legal information about novel drugs in social marketing campaigns should also be assessed through pilot studies. Overall, it may be necessary to begin inclusion of novel substances in adolescent and young adult health and drug education efforts. Earlier education efforts which incorporate evolving substance trends may keep perceptions, particularly those of less common drugs, closer to the normative level. Such efforts have been implemented by the military. In August 2011, Vice Admiral Adam M. Robinson Jr., Surgeon General of the Navy and Marine Corps and Chief of the Navy Bureau of Medicine and Surgery, issued a report to Navy and Marine Corps personnel about the legal consequences and adverse health effects of Spice and other synthetic drugs. He also encouraged “Commanding Officers and others in positions of leadership to be fully engaged in their command’s implementation plan to continually communicate and educate all hands as to the Navy’s zero tolerance policy on Spice and other synthetic designer drugs” (Robinson, 2011). The current study presents a few limitations. The results described here are from a single university; thus, these results may not generalize to other institutions and their unique patterns of substance use. Data were self-reported making it difficult to determine if students’ answers were affected by a social desirability bias. Legality of substances possibly proves to be the biggest limitation to the present study. At the time of data collection, three of the studied novel substances were illegal in Georgia. As states do not consistently regulate all of these substances (see Stogner et al., 2012), a replication of this study in a state with alternative policies would help clarify how legality, or illegality, affects perceptions of novel drug norms. The primary focus of this study was to explore the extent of novel drug use and related perceptions within a population. These findings pave the way for consideration of emerging novel substances as a possible target of social norms intervention programs. This study demonstrates the significant potential for addressing perceived social norms in prevention efforts to reduce use of substances other than alcohol and marijuana. Future research should implement and explore the outcome of social norm interventions programs that include novel drugs. Most importantly, future research must keep up with the evolving legality and trends of novel substances. REFERENCES American Association of Poison Control Centers. (2013). Bath salts. Retrieved January 20, 2013, from http://www.aapcc.org

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