Capturing the context of drug use for college students: A contextual behavioural science informed qualitative analysis of harm reduction practices using network feedback loops simulation modelling

Drug use during college can have substantial harm on students' lives and impacts the institutions' functioning and local communities. Yet existing interventions for drug use at college poorly address the concurrent dynamic influences of the experiences in earlier developmental periods of young adults and the proximal contextual triggers of college life; both risk factors that can contribute to drug use. To address this, we leveraged system dynamic methods and contextual-behavioural science (CBS) approaches to support the development of interventions focusing at addressin these risk factors. Using Causal Loop Diagram methods (Vensim PLE), we collected qualitative data from college students to generate Network Feedback Loops (NFLs) (n = 24, Maged 22 years old), during the development phase of the MyUse: a contextual behavioural change intervention for harm reduction practices at college students. The findings underscored central nodes (determinants within an intervention) that support our previous identified three CBS-harm-reduction practices for college students (targeted edges: mindful drug-use decision making, value-based activities, context-sensitive personalized plan of harm reduction). Analyses revealed 4 NFLs for students with previous drug use, consisting of 13 edges (4 positive, 2 negative, and 4 balancing reinforcing relationships) and 3 NFLs for students with no previous drug use, consisting of 4 positives, one negative, and one balancing relationship. All the NFLs were nested with the three CBS-related targeted outcomes. College students who use drugs need drug-related knowledge about the unpredictable and adverse effects of drugs, presented in a compassionate way and distributed from credible resources (e.g., students’ unions/club). Students with no previous drug use need education about the effects of drugs and awareness of how drugs can devaluate value-based activities (e.g. sports, friendships, social life). These should be delivered via proxy cue reminders and mobile-text approaches conveying messages about drug use susceptibility, distributed in real-time. Idiosyncratic, dynamic, and contextual-bound factors of lapse risks or preventive practices should account for each person-specific vulnerabilities via personalized harm reduction plans.