Disability and substance use risk in higher education: Findings from a national survey of college students

Background Students with disabilities represent an underserved population in public-health and higher education, yet little is known about their risk for substance use. Objective To examine the relationship between disability status and substance use severity among a national sample of U.S. college students. Methods Data were drawn from the American College Health Association’s National College Health Assessment (ACHA-NCHA) III surveys administered between Fall 2019 and Spring 2025 (n = 640,806). The primary exposure was self-reported disability type. The primary outcome was high-risk substance-specific involvement score (SSIS), calculated using the ASSIST tool. Multivariable logistic regression models were used to estimate adjusted odds of high SSIS by disability type, number of disabilities, and multiple disability categories. Models adjusted for demographic and health-related covariates including psychological distress. Results Most disabilities were associated with significantly increased odds of high SSIS. ADHD (aOR = 1.85), speech/language disorders (aOR = 1.56), learning disabilities (aOR = 1.32), and sensory disabilities (aOR = 1.31) were among the strongest predictors. Autism showed a protective association overall (aOR = 0.85), with lower odds of high-risk tobacco use, and no significant differences for alcohol or cannabis. Odds increased with the number of disabilities reported. Several disability combinations, such as sensory disabilities combined with speech/language disorders, were associated with especially high SSIS (aOR = 2.59). Conclusions Disability status, particularly ADHD, speech/language disorders, sensory impairments, and multiple disability categories, is associated with elevated high-risk substance use among students. This highlights the need for inclusive, disability-informed prevention and intervention strategies in campus health programs.