The Influence of Opioid Misuse on Academic Achievement of Veteran Students

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Introduction

The number of veteran students I growing fast. Since 2020, the number of veteran student in the US has nearly doubled (McGuffin, 2017). Thus, policy-makers and scholars are becoming increasingly interested in the problems veterans face during their studies in higher education institutions. It commonly known that opioid use is prevalent among veterans, as up to 35% of veterans received pain treatment with opioids at some point.

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Prolonged treatment with opioids is associated with increased risk of developing addictions, which can cause significant cognitive and social problems. However, there are no studies that discuss how opioid misuse affects the academic achievement of veteran students. The proposed research aims at closing the gap in existing literature by studying the influence of opioid misuse on academic achievement of veteran students.

Literature Review

Factors Affecting Academic Achievements of Veteran Students

Academic achievement of veteran students has been a matter of interest for researchers for more than half a century. After World War II, early researchers viewed veterans superior to civilians in terms of academic achievement (Gowan, 1947; Owens & Owens, 1949). However, the researchers realized that there were different factors contributing to the academic achievement of veteran students. Gowan (1947) stated that there were at least seven factors that affect academic achievement, including social group participation, presence of educational goals, attitude towards grades, time spent in study, attitude toward courses and instructions, attitude towards individual attention and instruction, and attitude towards class attendance.

Owens and Owens (1949) also believed that age, aptitude score test results, and the number of years in service were also indicative of academic achievement. However, the results Pearson’s correlation tests revealed that the number of years in service had a small negative impact on grade point average (Owens & Owens, 1949).

Currently, veteran students are a distinct population with their unique characteristics. A systematic review conducted by Barry et al. (2014) concluded that veteran students are different in comparison with their civilian counterparts. Veteran students have a lower GPA, an increased chance of engaging in risky behavior, lower social support, and different drinking motivations (Barry et al., 2014). Additionally, veterans usually have lower confidence levels and adaptation to academic life (Barry et al., 2014). These unique characteristics of the population often put veterans at a disadvantage while receiving higher education.

Low GPAs of veteran students can be explained by a wide variety of reasons that partially contribute to the matter. Psychological well-being is one of the factors that can contribute to the decreased academic performance of veteran students. In particular, posttraumatic stress disorder (PTSD) and depression often lead to reduced ability and motivation to perform the tasks needed to achieve high grades (Bryan et al., 2014; Clark & Walker, 2020).

However, the effect of PTSD and depression are moderated by the demographic characteristics of veteran students. Elliott et al. (2011) suggested that combat experience and associated PTSD can cause alienation of veteran students. Quantitative analysis revealed that alienation could cause decreased academic achievement of veteran students (Elliot et al., 2011). Eakman et al. (2019) also mentioned the importance of academic self-efficacy. In short, there is a wide variety of internal factors that can influence the academic achievement of students.

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At the same time, there are many environmental factors that may contribute to the decreased academic achievement of veteran students. The majority of the environmental factors were discussed by Semer and Harmening (2015). The researchers mentioned that environmental factors included receiving oral feedback from faculty members, engagement in some types of co-curricular activities, physical exercise, attending events on campus, and time spent committing to class (Semer & Harmening, 2015).

Additionally, Clark and Walker (2020) mention the importance of seating on the academic performance of students. Eakman et al. (2019) emphasize the importance of support from the instructors. In summary, factors that affect the academic achievement of students is a widely discussed matter among scholars both historically and recently.

Opioid Use among Veterans

The problem of opioid misuse among veterans is a subject of heated discussion in current scholarly literature. According to Hudson et al. (2017), between 23% and 35% of veterans received pain treatment using opioids. There are various dangers associated with the prolonged use of opioids for pain treatment. In particular, opioid use for treatment can cause dependency, which is associated with significant problems in social and academic life, such as financial problems and alienation (Wilder et al., 2015).

Any type of opioid administration is associated with a considerable risk of death from overdose. The central reason for overdose is decreased awareness about the contributing risk factors (Wilder et al., 2015). However, the problem of overdose is mostly discussed in terms of the general veteran population, and there is not enough information about the risk of opioid overdose among veteran students.

Another problem associated with opioid use is the danger of heroin initiation. Veterans and other patients treated for pain initiate heroin due to its increased availability from illegal sources (Banerjee et al., 2016). Heroin addiction is associated with increased risk of death from different matters, including unknown purity, injection-associated infection, overdose, and vascular diseases (Banerjee et al., 2016). Additionally, heroin addiction can cause severe mental health conditions that further aggravate illicit drug abuse (Banerjee et al., 2016). Thus, opioid administration for pain treatment can cause severe complications that need to be prevented.

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Prolonged opioid use can be associated with cognitive and socio-cognitive functioning problems. A study by Kroll et al. (2018) confirmed that opioid use negatively affects cognitive domains of attention, declarative memory, and global cognitive empathy. These effects were found to be dose-dependent (Kroll et al., 2018). Such cognitive changes may negatively affect the academic achievement of students.

While opioid use among veterans is widely discussed by various researchers, there is a lack of studies discussing the effect of opioids on the academic achievement of veteran students. In particular, it is unclear if a history of pain treatment with opioids can lead to the decreased academic performance of veteran students.

At the same time, severe pain in veteran students is a common condition acknowledged by current research. According to Boccieri et al. (2019), 22.2% of veteran students have severe pain, which implies that they are 4.3 times more likely to the condition in comparison with the general student population. Moreover, approximately 25% of veteran students reported that their ability to perform daily tasks was limited by pain (Boccieri et al., 2019). Thus, severe pain is a significant bother among veteran students.

Theoretical Frameworks

There are several theories that explain the academic achievement of students that can be used to answer the research question in the present paper. First, self-determination theory can give significant insights into the matter. This theory focuses on how external factors affect a sense of volition and initiative to perform certain tasks. A recent study confirmed that the theory could predict the academic achievements of students and their dropout intentions (Jeno et al., 2018).

Another theory that can be used is the neurocognitive theory of intelligence proposed by Das, Naglieri, and Kirby (Georgiou et al., 2020). The theory is called the PASS intelligence theory, which stands for planning, attention, simultaneous, and successive processing (Georgiou et al., 2020). The theory was found to successfully explain the ability to gain knowledge and improve academic achievement (Georgiou et al., 2020). These two theories will be synthesized to answer the research question proposed in the present paper.

Synthesis and Analysis

Veteran students are a distinct population, as they have common characteristics distinguishing them from their civilian counterparts. Historically, veterans were believed to have higher academic achievements due to increased experience and maturity level. However, recent research demonstrates that veteran students are disadvantaged due to a wide variety of internal and external factors that affect the academic achievement of veteran students.

These factors include increased chances of depression, PTSD, pain, alienation, exposure to combat, and low self-efficacy. At the same time, there some factors that can positively influence the academic achievement of veteran students, including participation in some co-curricular activities, oral feedback from instructors, general support of the instructors, and sitting preferences.

The review of the literature revealed that factors affecting the academic achievement of veteran students is a topic widely discussed both currently and historically. At the same time, the problem of opioid use among veterans is a relatively recent subject that emerged during the past two decades. The problem of the opioid epidemic among veterans is crucial, as many veterans are treated for pain using opioids. Such treatment may cause addiction, overdose, heroin initiation, cognitive impairment, and the development of mental conditions.

The literature review revealed two considerable gaps in the current body of knowledge. On the one hand, there are no reliable studies that provide the proportion of veteran students that have a history of opioid treatment. Thus, it is difficult to estimate how dangerous the opioid epidemic is for veteran students. On the other hand, it is unclear if having a history of opioid use is a significant predictor of academic achievement of veteran students.

In other words, the current body of knowledge cannot answer the question if current or past use of opioids for any purpose can influence the academic performance of veteran students. The analysis of literature can explain these phenomena by the fact that the problem of opioid use among veterans is only an emerging topic, which implies that many areas of uncertainty remain.

The analysis of literature can help to make hypotheses concerning two identified gaps. First, considering the fact that prolonged opioid use is associated with significant co-morbidities, including social and financial problems, the prevalence of opioid misuse among veteran students should be lower than that of the general veteran population. Thus, it can also be supposed that fewer veteran students have a history of opioid use of treating pain in comparison general veteran population.

Second, considering the fact that approximately a quarter of students report that they have difficulty performing everyday tasks, they must be undergoing pain treatment. As opioids are the second line of pain treatment, it can be assumed that 22.2% of veteran students that reported severe pain were treated with opioids. This implies that the problem of opioid use is a significant problem that needs to be addressed. Third, considering the fact that opioids may lead to cognitive impairment, a history of opioid use for any purpose may affect the academic achievements of students.

The analysis of literature has significant implications for future research. It is recommended that future studies focus on closing the gaps in knowledge identified in the present paper. In particular, it is crucial to estimate the prevalence of veteran students that have a history of opioid misuse. Moreover, it is crucial to confirm that the opioid epidemic is a significant bother for the veteran student population. Finally, it imperative to evaluate the effect of opioid use on the academic achievement of veteran students.

Methods

The primary purpose of the study is to determine if opioid misuse has a significant impact on the academic achievement of veteran students. Recent studies demonstrate that opioid misuse may have an impact on the academic achievement of veteran students (Hudson et al., 2017). This study aims to determine the association between university performance and opioid misuse in veteran students.

Additionally, it investigates how demographic differences, including age, gender, ethnicity, and income level moderate the effect of opioid misuse on academic performance. The hypothesis developed for the study anticipates that veteran students’ opioid misuse will have a significant impact on their grades. Descriptive statistics, multiple linear regression and t-test analysis will be used to test the hypothesis.

Sampling

The population under analysis is veteran students at the University of Hawai’i at Mānoa. A sample of randomly selected university students with experience in military service will be recruited at the University of Hawai’i at Mānoa. The inclusion criteria were the fact of being a student of the University of Hawai’i at Mānoa and a history of engagement in the military. The absence of opioid use history will not be an exclusion criterion.

The sample for the current research includes students at different years of study from the first year to graduate masters and doctoral students. Thus, the present research will use simple random sampling as the sampling method. According to Mellinger and Hanson (2016), simple random sampling is free from sampling biases, as each person in the population has an equal chance of being selected.

Instruments

The first primary construct will be the academic achievement of students will be operationalized as the current average GPA. It will be a continuous variable that will range between 0 and 5. GPA has been commonly used to measure academic achievement in all student populations, including veteran students, both currently and historically (Barry et al., 2014; Clark & Walker, 2020; Eakman et al., 2019). Academic achievement will be a dependent variable, as it is affected by a myriad of factors. It will be measured by asking “What is your cumulative grade point average?”

Academic achievement can be measured both qualitatively and quantitatively. The most frequently used measure for academic achievement in quantitative studies is the current GPA of students. In fact, even if the studies use other measures to quantify academic achievement (Bryan et al., 2014; Clark et al., 2020; Fonteyne et al., 2017; Novikova & Vorobyeva, 2017). However, there are other measures that were used in various studies to attend to the associated flaws of the measure. For instance, Bryan et al. (2014) used the concept of academic problems to assess students’ achievement.

The variable was measured by asking how frequently the students had late assignments, low grades, failed exams, and skipped classes. Even though this measure is applicable, the authors do not provide validation of the questionnaire assessing the variable. Fonteyne et al. (2017) also use a binary variable that demonstrates if the students passed the previous semester.

However, the use of this measure is questionable when assessing the academic achievement of those students who have already graduated. In summary, even though there are other measures of academic achievement, GPA is the most consistent and validated method among the substitutes. However, supplementary measured for operationalizing academic achievement can be considered to improve the reliability of findings.

The second primary construct will be the opioid misuse, which will be measured using Current Opioid Misuse Measure (COMM). It is a commonly used instrument to measure opioid misuse in all populations. It is an instrument consisting of 17 items. Even though it is a self-reported questionnaire, it has been validated for screening purposes by numerous research (Butler et al., 2007; Butler et al., 2010). The instrument is recommended by both SAMHSA (2012) and CDC (2020).

The relationship between the two matters is expected to be moderated by demographic variables (Owens & Owens, 1949; Chan, 2018). The demographic variables will be measured by a self-made questionnaire that will include three questions:

  • What is your age?
  • What is your biological gender?
  • What is your ethnicity?
  • What is your income per household member?

Procedures

The proposed research is a correlational quantitative study. The study will measure GPA of two groups: veteran students who had a history of opioid misuse and veteran students who did not have the history of opioid misuse. Thus, the study has cross-sectional design. The recruitment will be conducted using emails that were asked to participate in the study. The recruited individuals will sign informed consent forms to validate their agreement for participation.

The emails will give short background information on the study, including its purpose, variables, hypothesis, and expected outcomes. The emails will also emphasize the significance of the study and its possible implications for scholars and policymakers. The emails will instruct the participants on the procedures and the tasks they will be expected to complete. The survey will be carried out using Qualtrics Surveys software.

Data Analysis

R software will be used to analyze the effect of (R Core Team, 2017). The data will be analyzed by means of descriptive statistics, t-tests, and multiple regression analyses to understand the influence of the independent variable on the academic achievement of student veterans. Answers to each question will be combined and visualized using appropriate tools. First, a two-sample t-test will be used to understand if there was a difference between the mean GPA scores of veteran students who use opioids for any purpose and those who do not use opioids.

Second, multiples regression analysis will be used to understand how the control variables moderated the effect on GPA. The selected methods allow understanding of the variety of interconnections between all the variables and test the influence of independent and control variables on the dependent variable (Mellinger & Hanson, 2016). The proposed data analysis process is relevant and consistent with the study goals.

References

Barry, A. E., Whiteman, S. D., & MacDermid Wadsworth, S. (2014). Student Service Members/Veterans in Higher Education: A Systematic Review. Journal of Student Affairs Research and Practice, 51(1), 30–42.

Banerjee, G., Edelman, E., Barry, D., Becker, W., Cerdá, M., & Crystal, S. (2016). Non-medical use of prescription opioids is associated with heroin initiation among US veterans: A prospective cohort study. Addiction, 111(11), 2021-2031.

Boccieri, B. J., Gazdik, K. W., Kerns, L., Williams, P. L., Landgraff, N. C., & Ge, W. (2019). Severe pain in veteran students. Journal of Allied Health, 48(3), 172-182.

Bryan, C. J., Bryan, A. O., Hinkson Jr, K., Bichrest, M., & Ahern, D. A. (2014). Depression, posttraumatic stress disorder, and grade point average among student servicemembers and veterans. Journal of Rehabilitation Research & Development, 51(7), 1035-1045.

Butler, S. F., Budman, S. H., Fernandez, K. C., Houle, B., Benoit, C., Katz, N., & Jamison, R. N. (2007). Development and validation of the current opioid misuse measure. Pain, 130(1-2), 144-156.

Butler, S. F., Budman, S. H., Fanciullo, G. J., & Jamison, R. N. (2010). Cross validation of the Current Opioid Misuse Measure (COMM) to monitor chronic pain patients on opioid therapy. The Clinical journal of pain, 26(9), 770.

CDC. (2020). Improve opioid prescribing. Web.

Clark, D. A., & Walker, K. (2020). Veterans in classrooms: Post traumatic stress, seating preferences, and achievement. Journal of Veterans Studies, 6(1). Web.

Eakman, A. M., Kinney, A. R., Schierl, M. L., & Henry, K. L. (2019). Academic performance in student service members/veterans: Effects of instructor autonomy support, academic self-efficacy and academic problems. Educational Psychology, 39(8), 1005-1026.

Elliott, M., Gonzalez, C., & Larsen, B. (2011). US military veterans transition to college: Combat, PTSD, and alienation on campus. Journal of Student Affairs Research and Practice, 48(3), 279-296.

Gowan, A. M. (1947). Unique characteristics of freshman veterans at the Iowa State College, with administrative implications [Doctoral dissertation]. Iowa State College.

Fonteyne, L., Duyck, W., & De Fruyt, F. (2017). Program-specific prediction of academic achievement on the basis of cognitive and non-cognitive factors. Learning and Individual Differences, 56, 34-48.

Hudson, T. J., Painter, J. T., Martin, B. C., Austen, M. A., Williams, J. S., Fortney, J. C.,… & Edlund, M. J. (2017). Pharmacoepidemiologic analyses of opioid use among OEF/OIF/OND veterans. Pain, 158(6), 1039-1045.

Jeno, L. M., Danielsen, A. G., & Raaheim, A. (2018). A prospective investigation of students’ academic achievement and dropout in higher education: A Self-Determination Theory approach. Educational Psychology, 38(9), 1163-1184.

Kroll, S. L., Nikolic, E., Bieri, F., Soyka, M., Baumgartner, M. R., & Quednow, B. B. (2018). Cognitive and socio-cognitive functioning of chronic non-medical prescription opioid users. Psychopharmacology, 235(12), 3451-3464.

Mellinger, C. D., & Hanson, T. A. (2016). Quantitative research methods in translation and interpreting studies. Taylor & Francis.

Novikova, I. A., & Vorobyeva, A. A. (2017). Big Five Factors and academic achievement in Russian students. Psychology in Russia, 10(4), 95.

Owens, W. A., & Owens Jr, W. A. (1949). Some factors in the academic superiority of veteran students. Journal of Educational Psychology, 40(8), 285-288.

R Core Team (2017). R: A language and environment for statistical computing. R Foundation or Statistical Computing. Vienna, Austria. Web.

SAMHSA. (2012). Managing chronic pain in adults with or in recovery from substance use disorders. Web.

Semer, C., & Harmening, D. S. (2015). Exploring significant factors that impact the academic success of student veterans in higher education. Journal of Higher Education Theory & Practice, 15(7), 31-43.

Wilder, C., Miller, S., Tiffany, E., Winhusen, T., Winstanley, E., & Stein, M. (2015). Risk factors for opioid overdose and awareness of overdose risk among veterans prescribed chronic opioids for addiction or pain. Journal of Addictive Diseases, 35(1), 42-51.

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