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The College Balancing Act: From a Durkheimien Perspective
Kumiko Sasa
Colorado Mesa University
Dr. Wilhelm
Word Count:4631

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Young adults face many challenges over their life course, one of which can be the
balance between social life, college and work. Through these trials some are shaped into
moments of excellence, dreams, a sense of belonging, and hope. Others however, may find
themselves in a state of depression, severe stress and to the point of harming themselves or
others. The latter of these is important to understand as patterns of harmful behaviors, such as
drug/alcohol abuse, cutting and suicide attempts may indicate a lack of social order. From a
Durkheimian perspective, a lack, as well as a surplus, of social integration and moral regulation
in the lives of young adults in college can explain these patterns of harmful behavior.
To begin, one of the primary concerns for those ages 15 to 25 is this ideology of suicide.
Suicide is one of three forms of self-directed violence (Center for Disease Control and
Prevention 2014). Suicide is the first form referring to “death caused by self-directed injurious
behavior with the intent to die as a result of the behavior.” The second is suicide attempt, “a non-
fatal self-directed potentially injurious behavior with any intent to die as a result of the behavior.
A suicide attempt may or may not result in injury.” Then finally, the third is suicidal ideation
which is “thinking about, considering, or planning for suicide.” Statistics for the overall age
group show that for individual’s ages15 to 25 suicide is the third leading cause of death (Cerel,
Bolin and Moore 2013). Deaths by unintentional injury and homicide are the first two (Center for
Disease Control and Prevention 2013). Now in the United States specifically, suicide takes the
life an individual between this age range every 2hrs and 7minutes (McIntosh and Drapeau 2014).
Even though the rates are declining, there is still a call for understanding of the overall patterns
for suicide rates amongst this age group. Currently there appears to be a decline in suicides
among those ages 10 to 24. The Center for Disease Control (2014) indicates that from 1991 to
2009 the suicides within this age group has declined from 9.24 suicides per 100,000 to 7.21

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suicides per 100,000. Even with this apparent decline an argument can be made that this rate of
suicide is still too high.
This pattern of high but declining rates can also be seen among college students, and their
suicidal thoughts or actions. In 2005, Westerfeld and colleagues, in their study of 1,800 students
from four universities, found that 24% of college students had seriously thought of committing
suicide at one point in their life. 5% had actually attempted or made a plan to commit suicide
during college. In comparison, data from a more recent study in 2010, indicates that only 12% of
college students had thought about committing suicide and only .9% had actually attempted or
planned to during college (Wilcox et al., 2010).
Furthermore, the rates of suicide vary on gender. In comparison to the general U.S.
population, a study spanning 2004-2005 through 2008-2009 found that “the relative risk of
suicide for male students of .53 and for female students of .84 when compared to the general
U.S. population. In other words male, students were far less likely to commit suicide than same-
age males in the general population, while female students were only somewhat less likely to
commit suicide than females in the general population” (Schwartz 2013:345). In the same study
Schwartz (2006:356) also argues that for students at a four-year college the suicide rate is half
that of the matched group in the U.S. Population; instead of 13 suicides per 100,000 it is at 6.5
suicides. In short, the rates of suicide or self-directed violence appear to be in decline, and
college students are less likely to commit suicide than those of the same age in the general
population.
In addition to recognizing this declining rate of suicide, it is of equal importance to
understand the potential forces that may drive individuals to actually become one of the
statistics. Lamis and Jahn (2012) provide a variety of reasons as well as potential risk factors that

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help to explain the variation among students who may contemplate suicide; some of which
include “establishing autonomy, managing time and money, living independently, coping with
increased difficulty of academic, work, and changing social contacts or support. Parent–child
conflict… broad familial difficulties (eg, poor relationships with parents, conflict between
parents)…depressive and anxious symptoms.” Under such circumstances of social or
environmental change, stress, and conflict, individuals are at an increased risk for suicide.
From a Durkheimien perspective, these factors might be considered as they relate to
social integration and moral regulation. In 1897, looking particularly at high rates of suicide
within modern and industrial societies, Durkheim takes what is considered this individualized act
and reveals rather it is a social issue. The two main concepts he uses to describe this issue are
social integration and moral regulation. Social integration refers to an individual’s incorporation
into the social group, and moral regulation refers to an individual’s internalized moral code
(Edles and Applerouth 2012:100). He argued that an imbalance of both social integration and
moral regulation creates these patterns of social disorder and further disrupts social solidarity.
Abnormally high levels of social integration leave no room for individualism. The individual has
overly strong ties to society and no sense of I. With abnormally low levels of social integration
there is little to no sense of connection with society. The individual’s ties to society are weak and
they have too much individualism. Abnormally high levels of moral regulation places too many
rules on the individual, and little room for passions. This is similar to high levels of social
integration, there is little room for an individual to be creative. Now, with abnormally low levels
of moral regulation an individual has a weak internalized moral code. Few limits are placed on
the individuals passions. Overall, given these extremes, Durkheim’s argument is that society

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needs both moral regulation and social integration. In other words, too much or not enough of
either is problematic.
In this primary example of suicide, given the small statistical decline in suicide rates
among the overall population ages 15 to 25, and the rates of suicide among university students, it
can be argued that from a Durkheimien perspective that perhaps the levels of social integration
and moral regulation is higher among the student versus non-student population. Given their
environment at school, university students may find themselves more involved in various group
projects, clubs, school sporting events and fundraisers. As a result, their levels of social
integration and social support may be higher than those of the non-student population, as more
opportunities are available for students to be involved and belong to a particular social group. As
for their higher levels of moral regulation, it can be argued that college students are given more
room to be creative than non-students, yet at the same time also given a set of regulations for
their college career. For instance, their program sheets provide a set number of required classes
they are to take in order to graduate. Thou at the same time, they are allowed to take electives
that spark an interest that will also count towards their credits for graduation. This selection
process, and choice provides a balance of moral regulation for students. In contrast, the non-
student population may be given little room for individuality, passions and creativity, as their
jobs may require them to complete a task in the same manner each time. Once again, from a
Durkheimien point of view, too many of these restrictions on individual passions can create
problems and push people towards harmful behaviors, such as suicide.
Other Harmful Behaviors
Equally, it is also important to understand that young adults engage in harmful behaviors
that fall short of suicide. In further analysis of those ages 15 to 25, these principles of social

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integration and moral regulation may also be used to explain other patterns of harmful behaviors,
such as substance abuse and deliberate self-harm (DSH). Substance abuse can be defined as “the
excessive use of a substance, especially alcohol or a drug” (MedicineNet.com 2014). In relation
to the overall age group, Haddad and collegues (2010) report an overall global increase in drug
availability, consumption and vulnerability of those between 15 and 25 years old. The National
Center on Addiction and Substance Abuse (CASA) at Columbia University (2007:i) reports that
almost half of all full-time students (ages 18-22) binge drink, abuse prescription drugs or illegal
drugs every month. Almost 25% percent of these individuals will met the DSM-IV criteria for
substance abuse. Then in relation to the general population this is almost triple (8.5%).
Substance Abuse
As mentioned above, the two increasing patterns of harmful behavior among college
students are the rates of frequent binge drinking and the percentage of students abusing
prescription drugs. First, binge drinking refers to “five or more drinks on any one drinking
occasion in the past two weeks.” (CASA 2007:3). From 1993 to 2005, the National Center on
Addiction and Substance Abuse found that:
The proportion of students reporting frequent binge drinking increased 15.7 percent (from
19.7 percent to 22.8 percent). Other indicators of increased risky drinking showed even
greater increases over that period: a 24.9 percent increase in drinking on 10 or more
occasions in the past month (18.1 percent to 22.6 percent); a 25.6 percent increase in
being intoxicated three or more times in the past month (23.4 percent to 29.4 percent);
and a 20.8 percent increase in drinking for the purpose of getting drunk in the past month
(39.9 percent to 48.2 percent). (CASA 2007:3)

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In the same study a significant increase in the percentage of students abusing prescription drugs
is also observed. Over the span of 10 years, results showed “a 93.3 percent increase in those
abusing prescription stimulants like Ritalin and Adderall (1.5 percent to 2.9 percent,
approximately 225,000 students); a 450 percent increase in those abusing prescription
tranquilizers like Xanax and Valium (0.4 percent to 2.2 percent, approximately 170,000
students)” (CASA 2007:3). Together, these patterns demonstrate that a large portion of college
students partake in substance abuse and binge drinking.
Factors that drive college students towards substance abuse and binge drinking include
social influences and expectations of positive effect. In regards to social influences, students may
feel compelled to engage in these behaviors to fit it; examples include pressures to maintain a
certain weight or appear a certain way (Nebhinani, Misra, and Grewal 2013). Of female seniors
in college, 43.8 percent report trying to lose weight. In relation to substance abuse, the National
Center on Addiction and Substance Abuse explains that “as girls get older, they are significantly
likelier to engage in weight control behaviors, some of which are quite unhealthy” (2003:42).
The overall pressure of weight management and appearance may lead to feelings of depression,
anxiety, and low self-esteem which are also links to substance abuse. Not surprisingly, female
college students who report having a drinking problem are approximately four times more likely
to report feeling worthless (CASA 2003:41). Durkheim describes these feelings as the “instinct
of imitation”; in other words, there is an “impulse which drives us to seek harmony with the
society to which we belong, and, with this purpose, to adopt the ways of thought or action which
surround us” (Durkheim 1951:124). This is contributed to the level of one’s social integration,
and under these factors of social pressure the desire to be integrated to the likeness of others

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explains why numerous university students may binge drinking or abuse drugs. A quote from
Durkheim states:
We actually see the individual in all these cases seek to strip himself of his personal
being in order to be engulfed in something which he regards as his true essence. The
name he gives it is unimportant; he feels that he exists in it and in it alone, and strives so
violently to blend himself with it in order to have being. He must therefore consider that
he has no life of his own. (Durkheim 1951:225)
University students with abnormally high levels of social integration have such strong social ties
to society that they have little room to be themselves. They strip themselves of who they truly are
to conform to the society around them.
In addition to this element of too much integration, a pattern of too little regulation can
also be seen in students’ abuse of alcohol and drugs. Besides these feelings of meeting social
expectations, other common reasons students gave for either drinking, smoking or using drugs
was to reduce stress, relax and forget their problems. This gets at the expectations of positive
effect. Some students felt that prescription stimulants would help their concentration and
alertness. Durkheim makes an important statement describing the reasoning for this type of
action:
No living being can be happy or even exist unless his needs are sufficiently proportioned
to his means. In other words, if his needs require more than can be granted, or even
merely something of a different sort, they will be under continual friction and can only
function painfully. (Durkheim 1951: 246).

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Over the course of students’ lives stress accumulates quickly from tests, social pressures, and
possibly even work. Their needs for sleep, time and energy become increasingly necessary, yet
often unobtainable. As a result, if nothing external can restrain them from the use of substances
to subdue their pain through stress then that may be the path they choose. Along with these
increasing mindsets and patterns of harmful behaviors, comes a rise in disruptive and harmful
consequences. One of the more predominate consequences is the rate of drinking and driving. In
comparison to 22 other countries, some of which are Colombia, England, France, Germany, and
Spain, U.S. students “have the highest rate of drinking and driving (50% of male drinkers and
35% of female drinkers)” (CASA 2007:5). Another consequence related to obsessive drinking is
the increased rate of sexual activity in between students and someone they just met, or alcohol
related unplanned sexual activity (CASA 2007). In addition to these, other costs of substance
abuse include a lower academic performance, suspension, missed classes, drug or alcohol law
violations leading to compromised career opportunities.
From a Durkheimien perspective, these overall consequences can be explained as an
imbalance of moral regulation; in short, there is too little regulation to place limits on individual
passions resulting in the use of alcohol and drugs to suppress one’s feelings of stress. However,
in the act of using these substances, various consequences result such as drunk driving,
unplanned sexual activity and lower academic performance. As sad as it is “to achieve any other
result, the passions first must be limited. Men would never consent to restrict their desires if they
felt justified in passing the assigned limit…[therefore] they must receive it from an authority
which they respect, to which they yield spontaneously” (Durkheim 1951:248). In some cases,
this may include intervention from legal authority, parental figures, and/or school administration.

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Yet, in spite of these patterns, there are two protective factors that can decrease a
student’s risk of substance abuse. Religion or spirituality is the first one. The greater the level of
religiosity and involvement the less likely the student is to smoke, use illicit drugs or drink.
Elements of Durkheim’s study on suicide rates among Protestants and Catholics can be used to
explain this particular pattern. When looking at the religious ideologies of both religions, he
found that each prohibits “suicide with equal emphasis; not only do they penalize it morally with
great severity, but both teach that a new life begins beyond the tomb where men are punished for
their evil actions, and Protestantism just as well as Catholicism numbers suicide among them”
(Durkheim 1951:157). This prohibition of suicide is seen as divine and given by God himself,
whom they hold in high authority. Given these similarities, Durkheim explores why then is it that
Catholics kill themselves “only one third as often as the Protestants” (Durkheim 1951:156). One
of his major findings was that Protestantism has a freer inquiry. In other words, individuals have
more freedom to shape their own actions. As he puts it “the Protestant is far more the author of
his faith,” which results in a less integrated and morally regulated lifestyle (Durkheim 1951:158).
In contrast to Protestantism, the Catholic faith holds strongly to their faith and social
cohesiveness. Overall, he concludes that:
The more numerous the manners of action and thought of a religious character are, which
are accordingly removed from free inquiry, the more the idea of God presents itself in all
details of existence, and makes individual wills converge to one identical goal. Inversely,
the greater concessions a confessional group makes to individual judgment, the less it
dominates lives, the less cohesion and vitality. (Durkheim 1951:159)
This signifies that an increased sense of belonging and adherence to strong religious ideologies
can have a positive impact on reducing rates of suicide. In the same way, Durkheim’s argument

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may be a potential explanation for the decreasing rates of substance abuse among students
involved in a particular religious group. They may find a balance in social integration and moral
regulation. That is, they may feel like they belong with a particular group, and believe that they
should align their behaviors with the morals as stated by the religion. These morals may include
the prohibition and condemnation for use or overindulgence of particular substances, such as
alcohol, smoking or using drugs. Hence the protective factor that guides the behavior of
university students to refrain from usage.
In support of this argument, Gomes and colleagues, in 2011, found a similar correlation
between religious involvements as a protective factor for substance abuse (2013). Their sample
size consisted of 12,595 university students from Brazil, and in this study 85% reported some
religious affiliation. The makeup of this group consisted of 50.1% Catholicism and 17.5%
Evangelicalism/ Protestantism (Gomes et. al. 2013:32). Of both of these groups, evangelical
students tended to be the most frequent of observers of their religion, and frequent attendants of
religious services. In order to understand the correlation of religious involvement and substance
usage, a multivariate logistic regression was set up “for the use of alcohol, tobacco, marijuana
and at least on illicit drug (marijuana included) in the last 30 days” (Gomes et. al. 2013:31).
Results indicate that drug use was higher among those who were non-frequent attenders than
those who frequently attended religious services. However, they emphasize that some religions
may be more of a protective factor than others. In their study, Protestants tended to have
significantly lower alcohol usage than those of other religious affiliations; “moreover, Protestants
were not likely to be excessive drinkers, suggesting that more conservative religions are more
protective against alcohol use” (Gomes 2013:35). Furthermore, they found that students who
were frequent attenders were also more likely to volunteer. In comparison to Durkheim, they

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suggest that “religiosity may induce healthy and pro-social values and behaviors, protecting
students from health-jeopardizing behaviors (including drug use) and improving the quality of
life” (Gomes et. al. 2013:35). This leads to the second protective factor against substance abuse
which is high levels of engagement.
The National Center on Addiction and Substance Abuse asserts that:
Students who report spending six or more hours in a typical week engaged in non-
required campus or community service activities, such as tutoring, counseling or
volunteering are significantly less likely than those who spend five or fewer hours to be
binge drinkers (26.3 percent vs. 36.1 percent), frequent drinkers (19.0 percent vs. 26.1
percent) and to have ever used marijuana (27.4 percent vs. 35.2 percent) or abused
prescription drugs (7.3 percent vs. 13.8 percent). (CASA 2007:8)
Volunteering in positive extracurricular activities possibly limits the extra time outside of school
for students to engage in harmful behaviors, such as substance abuse. From a Durkheimien
perspective this may be linked to an individual’s sense of social integration. The more involved
they are, and through feelings of belonging the less likely university students may partake in
substance abuse. In addition to this perspective, Walsh and Eggert (2007) look at elements of
self-efficacy as part of social integration, and how it is a protective factor especially against
suicide. Included in their definition of self-efficacy is how an individual views themselves in
control of oneself and their self-esteem level. Given this definition, various research studies
indicate that those who felt more in control over their life and who had a high self-esteem were
less likely to commit suicide (Walsh and Eggert 2007:352). Now in a similar manner, Richard
Muench (1981), explains self-efficacy as rather the personality of the individual. He states that
“through the interpenetration of individual desires and social expectations something new is

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born: the personality” (1981:361). Essentially, the community with which an individual belongs
to becomes an integral part of them. This refers back to Durkheim and the balance of
individuals’ integration in society. Given these perspectives, within these positive extracurricular
activities individuals may feel a strong sense of control over their involvement and feel a sense
of belonging. As a result, their social integration restrains them from using substances.
Deliberate Self-Harm
Finally, yet equally important to these patterns of suicide and substance abuse, is the rates
of deliberate self-harm (DSH) among this particular age range. Before doing so it’s necessary to
understand what constitutes as deliberate self-harm. In reality there is no definite definition;
however, most commonly it includes “skin cutting, scratching, and burning, but may also include
carving the skin, preventing wounds from healing, and placing oneself in situations where the
risk of injury is high” (Goldstein, Flett, Wekerle, and Wall 2009:241). The majority of
individuals acting in these manners of self-harm fall in between 11 and 25 years (Mental Health
Foundation 2014). However, looking at the rates of self-harm among college students it tends to
vary across studies. In one study completed by Gratz, Conrad, and Roemer (2002), 38% of
undergraduate participates reported having engaged in at least one act of DSH. In comparison,
Whitlock and colleagues (2006) state that 17% of students reported having engaged in at least
one act of DSH. From a more recent study in 2009, Goldstein, Flett, Wekerle, and Wall found
that of their 320 university student participants DSH was a relatively common practice. 29.4%
had engaged in at least one type of DSH and 78.7% “endorsed fewer than five self-harm acts”
(Goldstein, Flett, Wekerle, and Wall 2009:246). With these forms of self-harm, data further
indicates that women are more likely to cut, whereas men are more likely to put themselves in
risky situations.

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Once again, in order to understand these particular forms of harmful behavior, it is
important to address the factors driving college students towards self-harm. Given the
information in the studies above, many significant correlations to DSH among university
students have been made; such as “depressive symptoms, physical neglect, emotional abuse,
openness, sensation seeking and past year illicit drug use” (Goldstein, Flett, Wekerle, and Wall
2009:246). Other common reasons for an individual to DSH include reducing stress or tension,
self-punishment, and interpersonal stress (Bifuko et. al. 2014). Furthermore, “evidence from
young people themselves suggests that social isolation – and believing that they are the only one
that has self-harmed – can be a key factor in self-harm for some” (The Mental Health Foundation
2014). Essentially, actions of self-harm for college students can be seen as a correlation to
feelings of stress, isolation and other emotions.
In summary, there are increasing rates or patterns of substance abuse and DSH, and
declining rates or patterns of suicide among university students. Each of these patterns include
various risk factors like stress, conflict and change that place a student at an increased risk to
partake in these behaviors. It is important to understand how these may push a student one way
or the other. Within these patterns it is also imperative to recognize the protective factors that
may inhibit students from these harmful behaviors. Durkheim’s concepts of social integration
and moral regulation are useful for understanding this overall argument. Overall, he describe this
necessary balance between both.

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REFERENCES
Bifulco, Antonia, Adriano Schimmenti, Patricia Moran, Catherine Jacobs, Amanda Bunn, and
Adina Carmen Rusu.2014. “Problem Parental Care and Teenage Deliberate Self-Harm In
Young Community Adults.” Bulletin of the Menninger Clinic 78(2):95-114.
Center for Disease Control and Prevention.2013. “Youth Violence: National Statistics on
Leading Causes of Death.” Atlanta, GA: USA.gov. Retrieved October 18, 2014
(http://www.cdc.gov/ViolencePrevention/youthviolence/stats_at-a_glance/lcd_119.html).
Center for Disease Control and Prevention.2014. “National Suicide Statistics at a Glance: Trends
in Suicide Rates among Both Sexes, by Age Group, United States, 1991-2009.” Atlanta,
GA: USA.gov. Retrieved October 18, 2014
(http://www.cdc.gov/violenceprevention/suicide/statistics/trends02.html).
Cereal, Julie, Mary Chandler Bolin, and Melinda M. Moore.2013. “Suicide Exposure,
Awareness, and Attitudes In College Students.” Advances in Mental Health 12(1):46-53.
Durkheim, Emile. 1951. Suicide. Translated by J. Spaulding and G. Simpson. New York: Free
Press.
Edles, Laura Desfor and Scott Appelrouth. 2012. Classical and Contemporary Sociological
Theory: Text and Readings, 2nd edition. Pine Forge Press.
Goldstein, Abby L., Gordon L. Flett, Christine Wekerle, and Anne-Marie Wall. 2009.
“Personality, Child Maltreatment, and Substance Use: Examining Correlates of
Deliberate Self-Harm Among University Students.” Canadian Journal of Behavioral
Sciences 41(4):241-251.

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Gomes, Fernanda C., Arthur Guerra de Andrade, Rafael Izbicki, Alexander, Moreira-Almeida,
and Lucio Garcia de Oliveira. 2013. “Religion As a Protective Factor Against Drug Use
Among Brazillian University Students: A National Survey.” Revista Brasileira de
Psiquiatria 35(1):29-37.
Gratz, Kim L., Sheree Dukes Conrad, and Lizabeth Roemer. 2002. “Risk Factors for Deliberate
Self-Harm Among College Students.” American Journal of Orthopsychiatry 72(1):128
140.
Haddad, Linda, Ali Shotar, Mary Umlauf, and Sukaina Al-Zyoud.2010. “Knowledge of
Substance Abuse Among High School Students in Jordan.” Journal of Transcultural
Nursing 21(1): 143-150.
Lamis, Dorian A. and Danielle R. Jahn. 2012. “Parent-Child Conflict and Suicide Rumination in
College Students: The Mediating Roles of Depressive Symptoms and Anxiety
Sensitivity.” Journal of American College Health 61(2): 106-113.
McIntosh, John L. and Christopher W. Drapeau.2014 “U.S.A. Suicide 2010: Official Final
Data.” Washington, DC: American Association of Suicidology. Retrieved October 20,
2014 (http://prevention.mt.gov/suicideprevention/USSuicideData.pdf).
MedicineNet.com. 2014. “Definition of Substance Abuse.” Retrieved October 19, 2014
(http://www.medicinenet.com/script/main/art.asp?articlekey=24405).
Mental Health Foundation. 2014. “Self-Harm.” Ireland, UK: The Mental Health Foundation.
Retrieved October 18, 2014
(http://mentalhealth.org.uk/help-information/mental-healtha-z/S/self-harm/).

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Muench, Richard. 1981. “Socialization and Personality Development from the Point of View of
Action Theory, The Legacy of Emile Durkheim.” Sociological Inquiry 51(3/4):311-354.
National Center on Addiction and Substance Abuse (CASA). 2007. “Wasting the Best and the
Brightest: Substance Abuse at America’s Colleges and Universities.” The National
Center on Addiction and Substance Abuse. Retrieved October 19, 2014
(http://www.casacolumbia.org/addiction-research/reports/wasting-best-brightes substance
abuse-americas-colleges-universitys).
National Center on Addiction and Substance Abuse (CASA). 2003. “The Formative Years:
Pathways to Substance Abuse Among Girls and Young Women Ages 8-22.” The
National Center on Addiction and Substance Abuse. Retrieved October 19, 2014
(http://www.casacolumbia.org/addiction-research/reports/formative-years-pathways
substance-abuse-among-girls-and-young-women-ages).
Nebhanani, Naresh, Mamta Nebhinani, Arun Kuman Misra, and Seema Grewal.2013.
“Substance-Related Knowledge and Attitude in School and College Students.” German
Journal of Psychiatry pp.16-19.
Schwartz, Allan J.2006. “College Student Suicide in the United States: 1990-1991 through
2003-2004.” Journal of American College Health 54(6):341-352.
Schwartz, Allan J.2013. “Comparing the Risk of Suicide of College Students with Nonstudents.”
Journal of College Student Psychotherapy 27(1):120-137.
Walsh, Elaine, and Leona L. Eggert. 2007. “Suicide Risk and Protective Factors among Youth
Experiencing School Difficulties.” International Journal of Mental Health Nursing
16(1):349-359.

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Westefeld, John S., Beeta Homaifar, Jennifer Spotts, Susan Furr, Lilian Range, and James L.
Werth. 2005. “Perceptions Concerning College Student Suicide: Data from Four
Universities.”Suicide Life Threat Behavior 35(6): 640–645.
Wilcox, Holly C., Amelia Arria, Kimberly M. Caldeira, Kathryn B. Vincent, Gillian
Pinchevsky, and Kevin E. O’Grady.2010. “Prevalence and Predictors of Persistent
Suicide Ideation, Plans, and Attempts during College.” Journal of Affective Disorders
127(1): 287-294.