Mental Health Issues and the University Student

7. Non-alcohol Substance Abuse on Campus

Do any of your counseling centers/health centers currently provide buprenorphine treatment to students? We’re unfortunately seeing more and more students with opioid dependence at our college, and are starting to think about providing this at some point within the next year or so. This query recently appeared on a list-serve of college psychiatrists to which I belong, and it generated a flurry of responses. The specialized training and legal requirements that govern treating narcotic dependence would have been considered beyond the scope of care of college counseling centers in the recent past, but clearly that is changing. Opioids are by no means the most commonly encountered drugs of abuse on campus, but this query highlights one end of the spectrum of substances that become problematic for college students. Although alcohol continues to be the most widely used substance, students also experiment with everything from illegal drugs, including marijuana, cocaine, hallucinogens, and heroin, to nonmedicinal use of legal drugs, including narcotics and stimulants. For a sizeable minority, these experiments cause significant mental health problems. Chapter 7 Non-alcohol Substance Abuse on Campus Non-alcohol Substance Abuse on Campus  55 Marijuana After alcohol, marijuana continues to be the most commonly used drug on campus. According to the 2012 National College Health Assessment, 17% of students had used marijuana in the past 30 days. The Monitoring the Future Study, which reported that annual use in college students had slightly declined in 2010 to about 33%, also cautioned that the downtrend might be about to reverse, since in 2010 marijuana use in grades 8, 10, and 12 increased. Students who are frequent users consider it less harmful than alcohol and are skeptical that it affects their academic performance or contributes to other problems. The evidence shows otherwise. Marijuana users have lower GPAs than non­ users, and frequency of use correlates with GPA, with more frequent users having lower GPAs than periodic users.1 Regardless of frequency of use, marijuana users report more psychiatric problems, including depression, anxiety, hostility, interpersonal sensitivity, and paranoia, than their peers who abstain. In a large prospective study of more than 1,000 people followed from birth to age 38, those who used cannabis four or more days a week showed a decline in IQ, impaired neuropsychological functioning, and observable attention and memory deficits as described by those who knew them best.2 The IQ decline was greater for adolescent-onset users than for adult-onset users, and in the adolescent-onset users quitting didn’t fully restore their functioning within the subsequent year. Legalization initiatives may mean that we see growing numbers of students using marijuana. Rosa is a 23-year-old African American first-year law student, referred to the psychiatrist for a medication evaluation. She’d come in to the counseling center after panicking on exams at the end of first semester, and she’d performed poorly compared with her previous high performance in college. She reported having a hard time in law school, noting decreased focus, trouble remembering the vast amounts of material she was expected to memorize, nervousness, and significantly lowered self-esteem. She felt hopeless about improving. She wondered if she’d chosen the wrong career or perhaps too demanding a program. In the course of her intake with the counselor, she’d admitted that she was smoking a joint every night to get to sleep. She spoke of this in a quiet voice, with downcast eyes. She admitted that she’d tried quitting at the start of law school, knowing it might affect her future career, but found she felt even more restless and irritable. Smoking pot 56  Clinical Challenges was the only time she felt relaxed, and the only way she could get to sleep at night. She’d smoked some in college, but sporadically. Her usage increased after a summer internship abroad in South Africa. Students almost never present to counseling centers requesting treatment for marijuana dependence. It’s a problem that’s generally uncovered during the substance abuse assessment portion of the intake. Many have heard that cannabis is not addicting in the way other drugs are, and most believe they can stop using any time they wish. Cannabis withdrawal was not included in the DSM-IV. However, the marijuana that is currently available is more potent than that of a generation ago—sometimes 25 times as potent!—and in general, rates of dependence and...