The relationship between spiritual meaning and purpose and drug and alcohol use among college students.

Abstract: While spirituality is one of the primary constructs of health, little research has studied the relationship between spirituality and health related behavior. This investigation examined the relationship between spiritual meaning and purpose and the use of alcohol and drugs. A sample of 606 undergraduate students were surveyed using an amended version of the National College Health Risk Behavior Survey and Pargament's Spiritual Meaning Scale. Results of this study show negative correlations between spiritual meaning and purpose scores and the use of alcohol and drugs. Students with a higher Spiritual Meaning score were significantly less likely to use marijuana, drink alcohol, and participate in binge drinking. An individual's spiritual beliefs appear to have a buffering effect on alcohol and drug use. Results of this study suggest that health education programming that provides students opportunities for spiritual growth and exploration may be a useful tool in the prevention of drug and alcohol use by college students.

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Spiritual health has long been considered an integral component of holistic health and wellness. Spirituality and its impact on health and health behavior have become of interest during the last twenty years (Banks, Poehler, & Russell, 1984; Bensley, 1991; Boland, 1998; Cavendish et al., 2000; Dennis, Muller, Miller, & Panerjee, 2004; Doswell, Kouyate, & Taylor, 2003; Holder et al., 2000). Little research has explored the relationship between an individual's spiritual beliefs and his/her drug and/or alcohol use behavior. Drug and alcohol use continues to be a major concern across college campuses (Douglas et al., 1997, Wechsler & Kuo, 2000). The American College Health Association (2005) reported that 37% of college students reported regretting their actions after drinking, 28% had impaired memory, and 16% engaged in unprotected sex. In addition, 8% of college students indicated their alcohol use has been a major impediment to their academic performance.

Alcohol use has been identified as a contributing factor in two-thirds of suicides, 90% of rapes, and 95% of violent crimes among college students. In addition, alcohol and drug use can have a significant impact on college class attendance and performance (Douglas et al., 1997, Wechsler & Kuo, 2000).

SPIRITUALITY

While the terms "spirituality" and "spiritual health" are frequently used, no commonly accepted definition exists for these terms (Jose &Taylor, 1986; Perrin & McDermott, 1997). In general, spirituality has been defined as connectedness with self, fellow human beings, nature, or a higher power (Banks et al., 1984; Bellingham, Cohen, & Jones, 1989; Bensley, 1991; Perrin & McDermott, 1997, Doswell et al, 2003), the ability to transcend daily life and struggle (Berggren-Thomas & Griggs, 1995; Burkhardt, 1989; O'Brien, 1982, Doswell et al, 2003), and a search for meaning and purpose in life (Banks et al., 1984; Bazan & Dyer, 1998; Benjamin & Looby, 1998; Doswell et al. 2003).

Despite the identification of spirituality as a component of health, few research studies have explored the impact of one's spiritual beliefs on health-related behavior. Most of the existing studies examining the role of spirituality and health have focused on terminally ill and/or chronically ill individuals; these studies reported individuals who expressed strong spiritual beliefs indicated they had a higher quality of life, and adapted better to their illness or disability (Gioella, Berkman, & Roninson, 1998; Fryback & Reinert, 1999; Kaczorowiski, 1988; Gall, 2000; Do Rozario, 1997; Rowe, Michelle, & Ricahrd, 2004). Carson, Soeken, Shanty, and Terry (1990) found that spiritual well-being was related to hope in individuals with chronic disease. With regard to drug and alcohol abuse, Green, Thompson, and Fullilove (1998) found that having a spiritual awakening can lead to sustained abstinence in alcohol and drug users. In addition, Holder and colleagues (2000) found that a high level of spiritual interconnectedness was associated with a lower level of voluntary sexual activity among adolescents.

Most recently, Stewart (2001) surveyed 337 college students using the CORE Alcohol and Drug Survey and several supplemental questions focusing on spiritual beliefs. A student's spirituality beliefs were found to have a moderate buffering effect on the decision to use alcohol and binge drink among college students. In a similar study, Hammermeister and Peterson (2001) surveyed 462 college students using the Spiritual Wellbeing Scale and selected questions about drug and alcohol use. The results of this study revealed the students who had a higher level of spiritual well-being were less likely to report using drugs and alcohol. These studies suggest that ones spiritual beliefs have an influence on their health-related behaviors. However more research is needed to examine such relationships. The purpose of this study was to explore the relationship between spiritual meaning and purpose and alcohol and drug use behaviors among undergraduate students. Results of this study may be useful to health educators who are developing interventions focused on college student drinking behaviors.

METHODS

PARTICIPANTS AND SETTING

A sample of 606 undergraduate students attending a regional comprehensive university in the southern US was utilized for this study. Initially, instructors teaching large undergraduate courses drawing multiple majors were contacted and asked for permission to survey their classes. Once permission was granted, student volunteers were sought during class meetings. Students were informed that they could elect not to participate in the study, and were assured of anonymity. Students completed the survey in approximately 15 minutes. The sample represented 4.7% of the undergraduate population of the university during the semester during which data were collected. Most participants (92.7%) were between 18 and 28 years of age (mean = 21.42, SD = 4.37 years). Demographic characteristics of the sample paralleled those of the university (see Table 1).

INSTRUMENTS

The National College Health Risk Behavior Survey (NCHRBS) was adapted from the high school Youth Risk Behavior Survey (YRBS) by the Centers for Disease Control and Prevention to measure six high-risk behaviors among college students. These behaviors include: tobacco use, alcohol and other drug use, behaviors that contribute to unintentional and intentional injuries, sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases, unhealthy dietary behaviors, and physical inactivity. The YRBS was previously shown to have content validity and test-retest reliability (Bremer, Collins, Kann, & Warren, 1995; CDC, 1990).

Drug and alcohol items of the NCHRBS were utilized for this study. This portion of the survey consists of 29 questions that address the use of tobacco, alcohol, and other illicit drugs including cocaine and hallucinogens. In addition, the researchers added 4 questions focusing on the use of MDMA (ecstasy) and GHB, these being contemporary drugs not addressed in the NCHRBS items. Survey questions focused on the age of first use of substances, frequency of lifetime use, as well use during the last 30 days. Alcohol use items also inquired about binge drinking (5 or more drinks in one sitting), drinking and driving, and frequency of riding with a driver who had been drinking.

Spirituality was assessed using Pargament's (1999) Meaning Scale (PMS) available from the Fetzer Institute. This scale consists of 20 statements focusing on religious and spiritual meaning (see Table 2). The survey attempts to measure the theoretical concept of meaning and purpose growing from the work of psychiatrist Viktor Frankl. The responses follow a 5-point Likert format, indicating the extent to which the participant agrees or disagrees with each statement.

DATA ANALYSIS AND RESULTS DESCRIPTIVE STATISTICS OF SUBSTANCE USE BEHAVIORS

Descriptive statistics of selected substance use behaviors were calculated for the sample, and these compared to national averages from the 1995 NCHRBS data (Douglas et al., 1997). The percent of participants in this study who engaged in substance use behaviors was slightly higher than from the national data. Of the participants in the study, 38% smoked cigarettes in the last 30 days, compared to 29% from the 1995 NCHRBS data. Seventy-two percent consumed alcohol in the last 30 days, compared to 68% nationally. Twenty-one percent of participants in this study smoked marijuana in the last 30 days; 14% nationally reported doing so. Eighteen percent of the participants in this study indicated using cocaine at least once in their lifetime; 14% did so nationally. Finally, 27% of this study's participants indicated using MDMA at least once in their lifetime, 9% in the last 30 days; and 14% indicated using GHB at least once in their lifetime, 3% in the last 30 days. No national comparison data are available for these two substances as the NCYRBS does not include items addressing them.

CALCULATION OF SPIRITUALITY SCORE

Responses to the PMS were subjected to a principal components factor analysis that revealed only one factor with an eigenvalue greater than 1.0 (actual eigenvalue = 12.88), accounting for 64% of the total variance in responses. Factor loadings indicated 19 of the 20 items loaded on this single factor; the criterion of .40 was used as the threshold level for factor loading. The internal consistency of the scale (Cronbach's alpha = .97) indicated strong reliability. Items from the PMS, and their associated factor loadings are provided in Table 1. A spiritual meaning score was calculated for each participant by averaging his/her responses to these 19 items. Spirituality Scores had a possible range of 1 to 5. The mean (SD) Spirituality Score for the sample was 3.83 (0.79).

RELATIONSHIP BETWEEN SPIRITUALITY AND SUBSTANCE USE BEHAVIORS

To examine the relationship between spirituality and substance use behaviors, Pearson Product Moment Correlation coefficients were computed between individual's Spirituality Score and numerical responses to survey items indicating lifetime engagement in substance use behaviors and that during the last 30 days (see Table 3). All of the resultant correlations were negative, indicating participants with higher Spirituality Scores engaged in these substance use behaviors less often, and most were significant. The strongest relationships were observed between spirituality and lifetime marijuana use, and alcohol consumption and binge drinking in the last 30 days. While most relationships were statistically significant, all were small to moderate in size, and accounted for less than 10% of the variance among scores. The relatively modest relationships were due, in part, to distributions skewed in the direction of lower engagement in these behaviors. That is, more participants indicated engaging in these substance use behaviors less often, and fewer participants indicated frequent engagement. In addition, the categorical nature of responses to survey items may have tended to reduce sensitivity.

We considered it logical to suggest that individuals with stronger spirituality beliefs would refrain from ever using certain substances, particularly those that are illegal. If this suggestion were true, then a difference would be observed when comparing the Spirituality Scores of individuals who had never engaged in illegal substance use behaviors during their lifetime to those who had used a substance at least once. To examine this prediction, we divided participants accordingly relative to the use of marijuana, cocaine, MDMA, and GHB. These groups' Spirituality Scores were then compared using independent t-tests. To control for the inflation of experiment-wise Type I error, the alpha level typically used when making group comparisons (.05) was divided by the number of comparisons conducted (4), and a conservative p-value of .01 used as the criterion for statistical significance.

As shown in Table 4, for each illegal substance investigated in this study, the average Spirituality Score of individuals who had never used it was significantly higher than those who had used it even once during their lifetime. Effect size (ES) was calculated for each comparison as an indicator of the size of the difference (see Table 4). These were moderate in size, indicating Spirituality Scores of non-users was one-third to one-half of one standard deviation unit higher than that of individuals who had used an illegal substance.

DISCUSSION

Spirituality is considered one of the primary constructs of health. However health research seldom examines the spiritual dimension. The limited evidence that exists suggests that spirituality may play an influential role in health related behavioral choices and beliefs. This study focused on the role between spirituality and alcohol and drug use among college students.

Existing evidence has reported that religion or spirituality may be protective factors against alcohol and drug use (Green et al., 1998; Hammermeister & Peterson, 2001; Stewart, 2001; Templin & Martin, 1999; Turner & Willis, 1979). The results of this study are consistent with previous findings exploring the impact of spiritual beliefs on alcohol and drug use. In this study, negative correlations were found between scores reflecting ones level of spiritual meaning and purpose in life, and the use of alcohol and drugs. In addition, students who reported no use of illegal drugs in their lifetime had a higher spirituality score than those who had engaged in such. These results suggest an individual's spiritual beliefs appear to have a buffering effect on alcohol and drug use.

Spirituality and religiosity are typically thought to be separate concepts. Interestingly, while Pargament's scale was designed to discern between religiosity and spiritual beliefs, the results of a factor analysis suggested respondents in our study did not identify a difference between their spirituality beliefs and their religious practices. This result maybe attributable to the data collection location of this study, the southern region of the United States, whose people in general have been reported to have more conservative values and higher regard for religion (Stewart, 2001).

The results of the association between spiritual meaning and purpose and drug and alcohol use raise some interesting questions for further study. Is regular drug and alcohol use a barrier to spiritual meaning and purpose in life, does spirituality serve as a protective factor against drug and alcohol use, or does perceived lack of meaning and purpose in life lead to higher rate of drug and alcohol use?

LIMITATIONS OF THIS STUDY

While our findings indicate that college students who have a higher level of spiritual meaning and purpose in life are significantly less likely to use alcohol or drugs, readers should be careful not to assume a causal relationship between these factors, as the design of this study was correlational. However, the direction of this relationship appears to be a fruitful area of further research. In addition, further research needs to be conducted to validate Pargament's Meaning Scale (PMS); the results of this study indicate that the scale was not able to differentiate between students' spiritual beliefs and students' religious beliefs, which may actually reflect two separate constructs. In addition, the sample was drawn from one university in southern region of the country, which may not reflect the beliefs of all college students.

CONCLUSIONS AND RECOMMENDATIONS FOR PROGRAMMING

The results of this study suggest that health education programming that provides students opportunities for spiritual growth and exploration may be a useful tool in the prevention of drug and alcohol use by college students. Current approaches to collegiate drug and alcohol prevention have included normative programming, policy change, and the identification of factors that put college students at-risk for alcohol or drug use, as well as protective factors that buffer or protect against the use of alcohol or drugs.

Based on the results of this study, health educators should design programming that assists students to identify and develop spiritual meaning and purpose in life.

Specifically, health educators can:

1. design strategies that assist students identify relationships in their life that provide a sense of connectedness and spiritual meaning,

2. encourage and assist students to transcend life struggles, and

3. encourage students to search for meaning and purpose in life through the use of values clarification exercises and self-exploration exercises (Banks et al., 1984; Benjamin, & Looby, 1998; Berggren-Thomas & Griggs, 1995; Burkhardt, 1989).

Wood and Hollander (2002) suggested that teaching strategies should provide student opportunities to develop a personal definition of spirituality, explore factors that contribute to discovering ones meaning and purpose and life, and identify if current health behaviors serve as a barriers or catalysts to spiritual health. Hammermeister and Peterson (2002) suggested that college students might be more open to a discussion of the core elements of spiritual well-being, than those of religion. Specifically, students might have an easier time accepting the importance of developing a sense of connectedness and meaning and purpose in life in relation to over-all wellness.

In addition, Dennis and Dennis (2002) suggested that universities could integrate spiritual education into existent free-standing classes. Such classes might include philosophy, religion, sociology, psychology and health classes.

This exploratory study of the impact on spiritual meaning and purpose in life on drug and alcohol use behaviors among college students indicates that spiritual meaning and purpose in life may serve as a protective factor. While these findings should be taken with a degree of caution, the exploration of spiritual domain of health offers yet another avenue to improve the quality of health for all individuals. In 1995, Glen Richardson predicted that spiritual health would be a major focus for educators for the 21st century. For this prediction to become a reality, further study is needed into the impact of spirituality and spiritual health on health behaviors, as well as the effectiveness of programming that addresses the spiritual health domain.

CHES AREA

Responsibility I--Assessing Individual and Community Needs for Health Education

Competency A: Obtain health related data about social and cultural environments, growth and development factors, needs, and interests.

Competency B: Distinguish between behaviors that foster and those that hinder well-being.

Responsibility VII--Communicating Health and Health Education Needs, Concerns, and Resources

Competency A: Interpret concepts, purposes, and theories of health education.

Competency B: Predict the impact of societal value systems on health education programs.

REFERENCES

American College Health Association (2005). National College Health Assessment Web Summary. Updated September 2005. Available at http://www.acha.org/projects_programs/ncha_sampledata.cfm

Banks, R. L., Poehler, D. L., & Russell, R. D. (1984). Spirit and human-spiritual interaction as a factor in health and in health education. Health Education, 15(5), 16-19.

Bazan, W. J., & Dwyer, D. (1998). Assessing spirituality. Health Progress, 79(2), 20-24.

Bensley, R.J. (1991). Defining spiritual health: A review of the literature. Journal of Health Education, 22(5), 287-290.

Bellingham, R., Cohen, B., Jones, T., & Spaniol, L. (1989). Connectedness: Some skills for spiritual health. American Journal of Health Promotion, 4(1), 18-24.

Benjamin, P., & Looby, J. (1998). Defining the nature of spirituality in the context of Maslow's and Roger's theories. Counseling and Values, 42(2), 92-99.

Berggren-Thomas, F., & Griggs, M. J. (1995). Spirituality in aging: Spiritual need of spiritual journey? Journal of Gerontological Nursing, 21(3), 5-10.

Bremmer, N. D, Collins, J. L., Kann, L, & Warren, C. W. (1995). Reliability of the youth risk behavior survey questionnaire. American Journal of Epidemiology, 141, 574-580.

Boland, C. S. (1998). Addressing the significance of social support and spirituality for sustained health-promoting behaviors in the elderly. Journal of Holistic Nursing, 16(3), 355-368.

Burkhardt, M. A. (1989). Spirituality: An analysis of the concept. Holistic Nursing Practice, 3(3), 69-77.

Carson, V., Soeken, D. L., Shanty, J., & Terry, L. (1990). Hope and spiritual well-being: Essentials for living with aids. Perspectives in Psychiatric Care, 26(2), 28-34.

Cavendish, R., Luise, B. J., Horne, K., Bauer, M., Medefindt, J., Gallo, M., et al. (2000). Opportunities for enhanced spirituality relevant to well adults. Nursing Diagnosis, 11(1), 151-167.

Centers for Disease Control and Prevention (1990). Youth risk behavior surveillance system. Washington, DC: Department of Health and Human Services, US Public Health Service.

Dennis, D. L., & Dennis, B. G. (2002). Mental health: A case for spiritual education in public schools. The Health Educator, 34(1), 17-22.

Dennis, D. L., Muller, S. M., Miller, K., & Panerjee, P. (2004). Spirituality among a college student cohort: A quantitative assessment. American Journal of Health Education, 35(4), 220-227.

Do Rozario, L. (1997). Spirituality in the lives of people with disability and chronic illness: A creative paradigm of wholeness and reconstitution. Journal of Disability and Rehabilitation, 19(10), 427-434.

Doswell, W. M., Kouyate, M., & Taylor, J. (2003). The role of spirituality preventing early sexual behavior. American Journal of Health Studies, 18(4), 195-202.

Douglas, K. A., Collins, J. L., Warren, C., Kann, L., Gold, R., Clayton, S., et al. (1997). Results from the 1995 national college health risk behavior survey. Journal of American College Health, 46, 55-66.

Fryback, P., & Reinert, B. R. (1999). Spirituality and people with potentially fatal diagnoses. Nursing Forum, 34(1), 13-22.

Gall, T. G. (2000). Integrating religious resources within a general model of stress and coping: Long-term adjustment to breast cancer. Journal of Religion and Health, 99(2), 167-182.

Gioiella, M. F. (1998) Spirituality and quality of life in gynecologic oncology patients. Cancer Practice, 6(6), 333-338

Green, L. L., Fullilove, T. F., & Fullilove, R. E. (1997). Stories of spiritual awakening. The nature of spirituality in recovery. Journal of Substance Abuse Treatment, 15(4), 325-331.

Hammermeister, J., & Peterson, M. (2001). Does spirituality make a difference? Psychosocial and health-related characteristics of spiritual well-being. American Journal of Health Education, 32(5), 293-297.

Holder, D. W., Durant, R. H., Harris, T. L., Daniel, J. H., Oveidallah, D., & Goodman, E. (2000). The association between adolescent spirituality and voluntary sexual activity. Journal of Adolescent Health, 26(4), 295-302.

Jose, N. L., & Taylor, E. L. (1986). Spiritual health: A look at barriers to its inclusion in the health education curriculum. The Eta Sigma Gamman, 18(2), 16-19

Kaczorowski, J. M. (1989). Spiritual well-being and anxiety in adult diagnosed with cancer. The Hospice Journal, 5(3/4,), 105-116.

O'Brien, M. (1982). The need for spiritual integrity. In H. Yura & M. Walsh (Eds.), Human Needs 2 and the Nursing Process. Norwalk, CT: Appleton-Centiry-Crofts.

Pargament, K. I. (1999). Multidimensional Measurements of Religiousness/Spirituality for Use in Health Research. Kalamazoo, MI: Fetzer Institute.

Perrin, K. M., & McDermott, R. J. (1997). The spiritual dimension of health: A review. American Journal of Health Studies, 13(2), 90-99.

Richardson, G. E. (1995). Graduate programs in the year 2020. The Eta Sigma Gamma Monograph Series, 13(2), 142-164.

Rowe, M., Michelle, A., & Ricahrd, G. (2004). Spirituality as a means of coping with chronic illness. American Journal of Health Studies, 19(1), 62-67.

Stewart, C. (2001). The influence of spirituality on substance use of college students. Journal of Drug Education, 31(4), 343-351.

Templin, D., & Martin, M. (1999). The relationship between religious orientation, gender, and drinking patterns among catholic college students. College Students Journal, 33(4), 488-497.

Turner, C., & Willis, R. (1979). The relationship between self-reported religiosity and drug use by college students. Journal of Drug Education, 9(1), 67-78.

Wechsler, H., & Kuo, M. (2000). College students define binge drinking and estimate its prevalence: Results from a national survey. Journal of American College Health, 49, 57-64.

Wood, R. J., & Hollander, D. (2002). In search of spirit: Strategies for the development of wholeness, health and spirit. American Journal of Health Education, 33(3), 186-188.

Ralph J. Wood, PhD, CHES

Edward Hebert, PhD

Ralph J. Wood, PhD, CHES is an Associate Professor of Health Studies and Edward Hebert, PhD is an Associate Professor of Kinesiology in the Department of Kinesiology and Health Studies at Southeastern Louisiana University. Address all correspondence to Ralph J. Wood, SLU 10845, Hammond, LA 70402; PHONE: [phone]; FAX: [phone]; E-MAIL: [e-mail].

Table 1. Demographic Characteristics of the Sample and
University Undergraduate Population

                               Sample

                                         University
                                         Population
Demographic Characteristic    n     %        %

Gender
  Female                     414   68%      63%
  Male                       192   32%      37%
Race
  Caucasian                  486   77%      82%
  African American           111   18%      14%
  Other                      27    4%       4%
Classification
  Freshman                   219   36%      37%
  Sophomore                  171   28%      22%
  Junior                     109   18%      17%
  Senior                     107   18%      24%
Marital Status
  Single                     419   69%
  Married                    64    11%
  Separated/Divorced         22    4%

Table 2. Items from Pargament's Meaning Scale and Factor Loadings

Survey Item                                                    Factor
                                                               Loading

My spiritual beliefs give meaning to my life's joys and          .77
  sorrows.
The goals of my life grow out of my understanding of God.        .62
Without a sense of spirituality, my daily life would be          .81
  meaningless.
* The meaning in my life comes from feeling connected to         .31
  other living things.
My religious beliefs help me find a purpose in even the most     .84
  painful and confusing events in my life.
When I lose touch with God I have a harder time feeling that     .77
  there is purpose and meaning in life.
My spiritual beliefs give my life a sense of significance        .88
  and purpose.
My mission in life and guided/shaped by my faith in God.         .89
When I am disconnected from the spiritual dimension of my        .74
  life, I lose my sense of purpose.
My relationship with God helps me find meaning in the ups        .88
  and downs of life.
My life is significant because I am part of God's plan.          .85
What I try to do in my day-to-day life is important to me        .79
  from a spiritual point of view.
I am trying to fulfill my God-given purpose in life.             .84
Knowing that I am part of something greater than myself          .81
  gives meaning to my life.
Looking at the most troubling or confusing events from a         .83
  spiritual perspective adds meaning to my life.
My purpose in life reflects what I believe God wants for me.     .87
Without my religious foundation, my life would be                .79
  meaningless.
My feelings of spirituality add meaning to the events in my      .86
  life.
God plays a role in how I choose my path in life.                .85
My spirituality helps define the goals I set for myself.         .85

* This item was not used in calculating the Spirituality Score.

Table 3. Correlation between Spirituality Score and Self-Reported
Substance Use Behaviors

                           Lifetime frequency    Frequency in
                                                 last 30 days

Substance Use Behavior        r      [r.sup.2]   r         [r.sup.2]

Cigarette smoking                                -.23 **      .05
Alcohol consumption                              -.29 **      .08
Binge drinking                                   -.28 **      .07
Driving after consuming                          -.20 **      .04
  alcohol
Being a passenger in a                           -.16 **      .03
  vehicle driven by
  someone who had
  been consuming alcohol
Smoking marijuana          -.30 **      .09      -.20 **      .04
Cocaine use                -.15 **      .02      -.04         .00
MDMA                       -.18 **      .03      -.14 **      .02
GHB                        -.09 *       .O1      -.06         .00
Alcohol plus illegal                             -.17 **      .03
  substance

Correlation significant (p < .05)

** Correlation significant (p <.O 1)

Table 4. Mean (SD) Spirituality Scores of Groups Differentiated by
Engaging in or Refraining from Using Illegal Substances During
Lifetime

Substance use     Engaged in          Never engaged
behavior          behavior at          in behavior
                  least once         during lifetime
                during lifetime

                 n     Mean (SD)     n     Mean (SD)    t-value    ES

Marijuana       336   3.64 (0.79)   265   4.06 (0.72)   6.72 *    0.55
Cocaine         110   3.53 (0.80)   493   3.90 (0.77)   4.50 *    0.48
MDMA            160   3.62 (0.70)   439   3.91 (0.80)   4.07 *    0.37
GHB             81    3.64 (0.63)   515   3.87 (0.80)   2.41 *    0.30
Alcohol plus    120   3.58 (0.77)   455   3.92 (0.78)   4.22 *    0.43
  illegal
  substance

* Groups significantly different (p < .01)