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Meta-Analysis
. 2025 Jul 1;25(1):959.
doi: 10.1186/s12909-025-07530-y.

Substance use and academic performance among university students: systematic review and meta-analysis

Giampiera Bulfone #  1   2 , Fabio Ingravalle  3 , Francesco Scerbo #  4   5 , Rocco Mazzotta  6 , Ilaria Simonelli  3 , Alessandra Pancaldi  4 , Stefano Ungaro  4 , Michela Cocco  3 , Ercole Vellone  4   7 , Rosaria Alvaro  4 , Antonio Vinci  3 , Massimo Maurici  8
Affiliations
Meta-Analysis

Substance use and academic performance among university students: systematic review and meta-analysis

Giampiera Bulfone et al. BMC Med Educ. .

Abstract

Background: Substance use is a widespread concern among young adults and is particularly significant among college students. Substance use in this population is associated with several academic, physical, mental, and social difficulties. This systematic review and metanalysis explores whether there is an effect of the legal and illegal substance and alcohol consumption behaviors on academic achievement among university students.

Methods: The databases searched were MEDLINE, CINHAL, Scopus, ERIC, and PROSPERO, updated in January 2025. The risk of bias was assessed using the Edwards score. We used a random-effects model. The protocol of this review was registered in the Open Science Framework.

Results: The systematic review included 21 studies, while the meta-analysis included four studies. In a sample of 1,219 subjects in the control group and 350 legal and illegal substances consumers, there is a negative and significant association of substances consumption on academic achievement [SMD = - 0.61 (95% CI - 0.84 to - 0.38; p = 0.008). In a subgroup analysis, a sample of 2,479 subjects in the control group and 7,134 alcohol consumers, there is a non-statistically significative association of alcohol consumption on academic achievement [SMD = - 0.24 (95% CI -0.51 to 0.04; p = 0.073).

Conclusions: Despite the limitations of this study, this systematic review provides quantitative evidence on the relationship between legal and illegal use of substances among university students and academic achievement. Specifically, we found a significant medium association of substance use in general and a small effect for alcohol consumption on academic achievement.

Clinical trial number: Not applicable.

Keywords: Academic achievement; Alcohol drinking; Substances use disorders; University student.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of preferred reporting items for systematic reviews and meta-analyses (PRISMA) study selection. Create using PRISMA Flow Diagram Tool [45]
Fig. 2
Fig. 2
Forest plot of meta-analysis on the consumption of legal and illegal substances and academic achievement
Fig. 3
Fig. 3
Funnel plot for consumption of legal and illegal substances and academic achievement meta-analysis
Fig. 4
Fig. 4
Forest plot of the meta-analysis on alcohol consumption and academic achievement
Fig. 5
Fig. 5
Funnel plot for alcohol consumption and academic achievement meta-analysis
Fig. 6
Fig. 6
Funnel plot for consumption of substances and Odds Ratios of High academic performance
See this image and copyright information in PMC

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