Guide to Abuse and Mental Health in College


Perhaps more than any other time in history, college students face relentless amounts of pressure to make their undergraduate years the best years of their lives, while simultaneously learning their trade and preparing for the job market, all the while growing and maturing into responsible adults. Therefore, it comes as little surprise that substance abuse and mental health issues on college campuses are serious enough for schools to address the matters publicly, and to offer counseling and rehabilitative services to stressed and scared students.


The Other Side of the College Experience

College is supposed to be an era of self-discovery, of unbridled potential complemented by lifelong friendships, independence, and experiencing what the world has to offer. But for tens of thousands of students, the weight of unforgiving expectations placed on them by their parents, teachers, and other students is made worse by having to adopt a facade of being a young go-getter with the world in the palm of their hands. They are pulled in different directions – to study, to party, to travel, to plan for the future, to enjoy their college years – while their brains and concepts of themselves and their place in the world are still in relative infancy.

All these factors coming together can create a perfect storm of anxiety and depression – and temptation. Alcohol flows quite freely on college campuses, but drugs (both recreational and prescription, both legal and illegal) are exchanged in dorm rooms and classrooms, either as a way to escape from all the stress, or to boost academic performance (at the risk of developing an addiction).

studying in college

‘Penn Face’

For some students, it becomes too much to handle. The depression, the expectations, and the peer pressure become a blur from which there is no way out. Suicide.org writes that students taking their own lives is the second leading cause of death on college campuses. Following from that, the leading cause of suicide for these students is depression that goes unreported and untreated.[1] The 2014 edition of the National Survey of College Counseling Centers reported that more than half the students seen by college counseling centers across the country have significant mental health concerns.[2]


As the suicide rate has increased among people between the ages of 15 and 24 (9.6 deaths per 100,000 in 2007, to 11.1 per 100,000 in 2013), the Center for Collegiate Mental Health at Pennsylvania State University confirms that the two most common mental health diagnoses given to college students are anxiety and depression.[3], [4] college students and suicide rates

But at the University of Pennsylvania, which has produced a dozens heads of state, one President of the United States, and a number of Supreme Court judges, the administration has actively sought to dismantle what has become known as the “Penn Face,” which is something The New York Times calls “a potentially life-threatening aspect of campus culture” – the idea of hiding feelings of stress or anxiety behind a mask of happiness and self-assuredness at attending one of the most prestigious universities in the country. The phenomenon is known as known as “Duck Syndrome” at Stanford University, because of the way a duck appears to glide gracefully on the surface, but is frantically and relentlessly paddling underneath.[5]


Social Media and Societal Pressure

The problem, says the Times and University of Pennsylvania, is that struggling students too often compare themselves to the high-achieving, successful, and popular upperclassmen – the ones who stand out. The problem is exacerbated by social media, which only shows carefully selected highlights (good grades, a boyfriend or a girlfriend, exotic travel locations, etc.), and not the moments of doubt and uncertainty that are much more common – albeit unspoken – as part of a natural college life.

A student who is unsure of their place on campus, or in life, being forced to adopt the Penn Face, will feel overwhelmed, insecure, and isolated. Hundreds of miles away from family – or, alternately, pressured even further by always-present helicopter parents – and being suffocated by the belief that they should not express their dissatisfaction, there is a legitimate danger that such students believe that they are left with no other option but to take their own lives.

Such was the case of a UPenn freshman in 2014, who, despite being a “star athlete, bright student and beloved friend,” jumped off the roof of a nine-story parking garage. She was 19 years old.[6] She was the third of six students to commit suicide in a 13-month span, prompting the University of Pennsylvania to take a close look at the culture that bred such a result.

One result of their examinations was the holding of a panel to dispel the notion of the “Penn Face,” specifically to help struggling students see that all members of the UPenn student body face similar problems. Upperclassmen would be asked to share some of their experiences, and information and resources about mental health counseling on campus (such as increasing the hours of the counseling center and designating a special phone line) would be made available, with the goal of changing how students perceived life at the university.[7], [8]


Female Students and ‘Effortlessly Perfect’

The pressure to be perfect on college campuses may be skewed by gender as well. In 2010, the Southern Communication Journal published a report describing experiences shared by female college students: a need to be “effortlessly perfect,” both in terms of academic and professional achievements, but also balancing an expectation to be feminine, respond to sexual overtures appropriately and safely, prepare for family life, and simultaneously embark on a career.[9] According to the 2015 National College Health Assessment published by the American College Health Association, 90.3 percent of female students said they felt overwhelmed by everything they had to do as a student.[10]

female students overwhelmed in college

The term “effortlessly perfect” was first used in 2003, by a study conducted by Duke University’s Women’s Initiative, which found that female students resort to eating disorders and self-harm if they fall short of the ideal of attaining perfection with no visible effort.[11]

It led to a writer for The Odyssey relating that she heard a student opine that “Duke [University] is not a good place to be,” because of the obsession with female students having to conform to standards of having perfect makeup, hair and clothes at all times, even as they pull all-night study sessions, take extra credit courses, maintain an active social life, and intern at their dream job. With social media, and its endless parade of selfies showing happy, beautiful, and successful people, female students who have negative impressions of their abilities or their bodies are induced to compare themselves to their fellow classmates, and, in the words of a student talking to The Odyssey, feel jealous or self-conscious.[12]

As ESPN put it, social media offers filtered insight into the lives of college students, those who feel on top of the world, and those who feel crushed by the weight of the world; real life offers no such screen.[13]


Social Comparison Theory and Achievement Culture

The curse of effortless perfection is not just a simple case of jealousy. In 1954, social psychologist Leon Festinger called it the social comparison theory, which posits that people determine their self-worth by comparing themselves to others. The result of this is that various factors, such as physical attractiveness, wealth, intelligence, happiness, etc., are constantly evaluated on the basis of how others are doing.[14] Generally speaking, adults have the maturity and experience to understand the flaws in social comparison, even if they are prone to it; college students, on the other hand, do not yet have fully mature brains. In the first year of college, many students are confronted with challenges that test their cognition, their emotions, and their social skills. A study conducted by Dartmouth College showed that college freshmen had brains that were “very different” from the brains of older adults.[15]

It may be tempting to brush off the pressure felt by college students as par for the course, but in creating what The Huffington Post calls “The Dark Side of

America’s Achievement Culture,” suicides across schools (both high schools and higher education institutions) have cast a shadow over the endless drive for grades, popularity, and prospects.[16] The squeeze is felt even more among elite colleges, since students are rarely granted leaves of absence to take a break from the grind and recover their mental health. Readmission is not always guaranteed, which was a tragic factor in the suicide of a 20-year-old Yale student, who wrote as much in her suicide note; in response, Yale altered its policies, giving students more leeway to temporarily withdraw from the school for medical or personal reasons.[17]

The University of Pennsylvania now offers peer-to-peer counseling services, where overwhelmed students can converse with fellow students trained in therapeutic services from the school’s Counseling and Psychological Services. The Daily Pennsylvanian specifically mentioned “several student deaths” and an increased examination of mental health issues on the University of Pennsylvania campus, as the reason behind the efforts.[18]


Study Drugs

One way students are dealing with the enormous pressure to excel academically is to indulge what are sometimes known as “study drugs,” pills and tablets that boost alertness and mental activity for hours at a time. Such drugs are especially popular when students pull all-nighters, either with deadlines looming or during finals week.[19]

However, these drugs are not specially crafted substances to help students study better. They are prescription medications like Adderall and Ritalin, explicitly meant to be taken for the treatment of certain medical conditions (such as attention deficit hyper disorder and narcolepsy), and not meant to be consumed without a doctor’s supervision. For a generation of stressed, overworked, and impulsive college students, however, the disclaimers are secondary to the results.

ABC News writes of how these medications give students “almost superhuman focus and concentration,” with the head of psychiatry for health services at the University of Wisconsin comparing them to steroids that athletes abuse for physical performance.[20]

Students report feeling like they can study forever, thanks to the powerful effect those drugs have on their central nervous systems. On many college campuses, there exists an open culture of talking about the drugs, taking them, and even selling them. Prices tend to go up for finals week, as much as $10 for a pill.

Obtaining the drugs is relatively easy. They can be procured from friends (74 percent of students got their Adderall from friends who had prescriptions, according to the Journal of American College Health), bought from other students, or obtained by filling out a true-false questionnaire as part of a brief consultation at a doctor’s office.[21]

adderall from friends

Adderall for All

It may seem strange for prescribed and regulated drugs to be so easily abused, but students often point to the acceptance of the substances – unlike heroin or cocaine, Adderall and Ritalin are not illegal to own and do not have the same stigma surrounding their use – and prescriptions for the medications have been so astronomical over the past few years (a trend that has led to “The United States of Adderall,” in the words of The Huffington Post), that the drugs have become accessible and familiar.[22] ABC News writes of how television shows depict adult characters using prescription medication (with household name status, like Adderall and Ritalin) for comedic effect and results, with little thought given to the message that such behavior sends out.

One of the (many) problems is that some students do not even think of Adderall as a controlled substance. In 2010, the Substance Use and Misuse journal reported that the majority of sampled students at a “large, urban research university” were convinced that Adderall was “definitely not a drug,” and that there was nothing medically or ethically amiss about using it to boost mental acuity.[23] As it’s “America’s favorite amphetamine,” students may even feel empowered to openly ask for (or buy) Adderall, feeling that it gives them a competitive advantage in an environment where pressure and stress are taken for granted.[24]


adderall
Abusing Adderall is incredibly popular on college campuses. The Center on Young Adult Health and Development writes that almost 33 percent of college students had taken stimulant prescription drugs, without prescriptions, at least once during their enrollment.[25]

However, students put themselves at incredible danger when they abuse prescription drugs in this way. The Substance Abuse and Mental Health Services Administration writes that from 2005 to 2010, emergency rooms saw 17,865 more cases as a result of Adderall and Ritalin being used improperly.[26]


The Amphetamines behind Adderall

How could it be that such a dangerous drug is so widely abused in places of learning and education? In addition to the combination of stress and relative naiveté of the college years, one reason is that the names Adderall and Ritalin mask the true nature of the substances. Adderall, for example, is the brand name of the combination of two drugs: amphetamine and dextroamphetamine.[27] While the choice of the name Adderall is not meant to conceal the ingredients, the innocuous nature of the name has contributed to Adderall and Ritalin abuse becoming normalized among college students (especially since amphetamines are often discussed in the same context as cocaine and methamphetamines, substances renowned for their dangers and associated stigma).[28], [29]

But despite erroneous perceptions of Adderall, the combination of amphetamine and dextroamphetamine places it on the U.S. Drug Enforcement Administration list of Schedule II drugs, sharing space with methadone, oxycodone, and fentanyl. As a Schedule II drug, Adderall’s medical applications are accepted in the United States, but since the drug can cause severe physical and psychological dependence, and it has a high likelihood of being abused, there are strict rules its distribution. One of those rules is that the drug cannot be legally obtained without a prescription, rendering the sale of Adderall and Ritalin by college students and the subsequent consumption of those drugs as crimes.

Indeed, Emerald Coast Magazine uses the term “black market” when talking about the prevalence of stimulant drugs on college campuses.[30]

Naturally, the risks of abusing Adderall go far beyond legal concerns. The burst of energy created by the drug hitting the brain, often necessary for narcoleptics and people with ADHD, can be instantly addictive to people who abuse Adderall with no regard for its proper administration. A person who does not medically need Adderall, but takes it anyway, is in danger of:

  • Mood swings
  • Episodes of anxiety and depression
  • Sleep disorders
  • Uncontrollable trembling
  • Loss of sexual desire or function
  • Stomach pain, nausea, and vomiting.[31]

Binge Drinking

Of course, study drugs like Adderall aren’t the only chemical substances being abused in college, whether on- or off-campus. The yearly spring break tradition, where male students tend to drink an average of 18 drinks a day (and female students consume 10 drinks a day), and 25 percent of students aged 18-20 leave campus to drink and take drugs like marijuana and MDMA, is often thought of as a rite of passage. [32], [33] Perhaps the greatest danger facing these students is binge drinking, a psychiatrist and addiction specialist tells Forbes magazine.[34]


binge drinking threshold

The definition of binge drinking is simple: consuming too much alcohol in too short a period of time. How much alcohol is too much, and how short a period of time is too short, depends on sex. For men, the binge drinking threshold is having five or more drinks in a two-hour span. For women, the limit is four or more drinks within two hours.


Why the difference? Women tend to be physically smaller than men, so less alcohol is required to produce a high blood alcohol level in women. Also, alcohol breaks down much more slowly in women than it does in men.


Binge Drinking on College Campuses

Why would people drink so much, so quickly? College has long been thought of as a time when young adults, freed from the supervision of their parents, give in to indulgence and peer pressure (although more and more students are getting an introduction to alcohol in their adolescent years, sometimes from family members at social gatherings as much as from their peers).[35] Students drink to break the ice, to have fun, to bond with same-sex peers, bond with opposite-sex peers (with the dynamic of facilitating sexual liaisons as an added possibility), and to feel better about themselves.

binge drinking in college

For young adults who are away from home for the first time; homesick; straining under the pressure to get good grades, to find good internships, to find a boyfriend or girlfriend, to get over the end of a relationship; and struggling with money or any other factor that causes feelings of anxiety or depression during the college years, getting drunk – and getting really drunk hard and often – can seem like a very good idea.

But there is a big difference between social drinking, getting drunk infrequently, and binge drinking. Psychology Today writes that moderate alcohol consumption has health and social benefits, but Forbes points out that every year, 1,825 college students aged 18-24 die as a result of binge drinking. The primary cause of death is alcohol poisoning, where even the automatic breathing functions of the body become impaired due to high levels of alcohol in the blood. Similarly, excessive levels of alcohol can impair the gag reflex, leading to the possibility of a person drowning in their own vomit.[36]


Party Drugs and Greek Life

While alcohol has a place on college campuses for its use as a social lubricant, other substances, ostensibly employed with the same goal in mind, are much less medically and legally tolerable. A New York University grad student told the New York Daily News that drug use on campus is less about the experimentation that characterized the hippie movement of the 1960s and 1970s; today, “it’s more practical, part of going to school.” A senior at Pace University tells of parties where bags of cocaine are openly offered, so much so that some students are becoming skilled drug dealers of everything from marijuana to LSD to cocaine.[37]


cocaine
A study by the Southern Medical Journal in 1991 identified “frequent heavy drinkers” as the students most likely to use cocaine, especially if the students in question were members of fraternal organizations.[38]

Such Greek-letter clubs are infamous for their peer pressure, hazing rituals, and impulsive, risky behavior. In 1995, the Harvard School of Public Health reported that membership in such a fraternity or sorority was the biggest predictor (“by far”) of binge drinking tendencies in college. More recently, in 2008, 96 people – 75 of them students – were arrested for running a drug smuggling ring at San Diego State University. Marijuana plants were grown in frat houses, and authorities were tipped off when a 19-year-old sorority sister was discovered to have died from a cocaine overdose, and not alcohol poisoning, as was initially suspected. Police and federal agents seized marijuana, cocaine, ecstasy, methamphetamine, prescription drugs, firearms, and $60,000 in cash during the raid. Some of the contraband belonged to a student majoring in criminal justice; another asked if his arrest and incarceration would hamper his chances of becoming a federal law enforcement officer.[39], [40]


How Are Colleges Working to Help Students?

Naturally, universities are taking a very serious look at the conditions that can foster harmful effects on mental health on their campuses, and how this translates to students abusing drugs – whether to escape feelings of depression or unhappiness, or as an unhealthy celebration of college life. Some colleges, for example, provide information about prescription drug abuse on their websites, in the same way that information about safe sex practices is offered as part of student wellness programs.[41] Similarly, the offering of free testing for sexually transmitted diseases is mirrored in students receiving free counseling, like the outreach adopted by the University of Pennsylvania.[42]

Yet more schools are getting creative with how they can

improve the mental health culture on their campuses. Caldwell University in New Jersey, for example, offers bracelet beading, massages, dancing, and puppy therapy during finals week. Caldwell’s Director of Counseling Services told Forbes that stress and anxiety levels have increased over the years – and with them, the temptation to abuse prescription meds, buy a bag of coke, or hit the bottle hard has risen as well.

Instead, dozens of schools have jumped at the thought of de-stigmatizing mental health, doing something free and fun for their student body, and fostering a culture of happiness and innocence on their campuses, especially at a time of the year most associated with stress and anxiety.[43]


On- and Off-Campus Treatment Options for Students

For students who are worried that their mental health, alcohol consumption, or drug use is getting out of hand, talking to their campus health services department is the first step toward getting help. Additional information can be obtained via the college’s website, or by looking up the online portals of the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism.

If students’ alcohol or drug abuse is so severe to the point of genuinely endangering their lives, emergency medical treatment is required, either at a hospital with detox services, or at a specialized treatment center. It could take up to a week (or two weeks) to fully purge students of the physical craving to persist with their drug or alcohol abuse, after which a therapist will work with them to address the psychological damage caused by the abuse. This stage of treatment will also prepare students to rejoin their college (or, at least, rejoin the outside world) while having a better idea of how to resist the temptation to drink or take drugs again.

treatment options

Addiction and mental health issues are so widespread that some student bodies are taking it upon themselves to create clean and healthy cultures for recovering and teetotaling students to enjoy campus life, without the pressure to drink (or be vigilant against drinking). Every year, for example, students from the University of Michigan host the St. Patrick’s Day Sober Skate Party, part of the larger Students for Recovery Organization, to provide a place for people to enjoy the festivities of the traditionally alcohol-friendly St. Patrick’s Day, without the alcohol. A 23-year-old former addict told USA Today that “Priority number one is fun” at such events.[44]

Similarly, Minneapolis’s Augsburg College’s StepUP program offers recovering students the chance to engage in team-building and socializing exercises, with the caveat that the students avoid nightclubs, bars, and casinos for the first semester of their program. StepUP gives these students fun experiences where they can meet new friends and get the best out of their college life, but in a way that is healthy, structured, and positive.[45] The University of Missouri’s Sober in College program provides a safe space where recovering students can talk about the challenges and frustrations of having to be abstinent in typically drinking-friendly areas, while hosting events that allow these students to enjoy being young adults with the world in the palms of their hands.[46]

Citations

  1. College Student Suicide.” (n.d.). Suicide.org. Accessed February 5, 2016.
  2. National Survey of College Counseling Centers.” (2014). The International Association of Counseling Services, Inc. Accessed February 5, 2016.
  3. 2014 Annual Report.” (2014). Center for Collegiate Mental Health. Accessed February 5, 2016.
  4. Death Rates for Suicide, by Sex, Race, Hispanic Origin, and Age: United States, Selected Years 1950-2013. (2013). Centers for Disease Control and Prevention. Accessed February 5, 2016.
  5. Suicide on Campus and the Pressure of Perfection.” (July 2015). New York Times. Accessed February 5, 2016.
  6. Kate Fagan: Split Image — The Tragic Story of Madison Holleran.” (May 2015). Universal Journal Review. Accessed February 5, 2016.
  7. Deconstructing the Penn Face.” (n.d.) University of Pennsylvania. Accessed February 5, 2016.
  8. Penn Launches Mental Health Hotline.” (December 2014). The Daily Pennsylvanian. Accessed February 5, 2016.
  9. Pressure to be Perfect: Influences on College Students’ Body Esteem.” (July-August 2010). Southern Communication Journal. Accessed February 5, 2016.
  10. Spring 2015 Reference Group Executive Summary.” (2015). American College Health Association. Accessed February 6, 2016.
  11. Abolishing “Effortless Perfection”.” (n.d.) National Education Association. Accessed February 5, 2016.
  12. Duke Is Not a Good Place to Be, It Is Just a Good Place to Be From.” (November 2015). The Odyssey. Accessed February 5, 2016.
  13. Instagram Account of University of Pennsylvania Runner Showed Only Part of Story.” (May 2015). ESPN. Accessed February 5, 2016.
  14. Social Comparison Theory.” (n.d.) Psychology Today. Accessed February 5, 2016.
  15. Brains of Young Adults Not Fully Mature.” (February 2006). Livescience. Accessed February 5, 2016.
  16. The Dark Side of America’s Achievement Culture.” (February 2015). The Huffington Post. Accessed February 6, 2016.
  17. Yale Alters Leave Policy Amid Protest Over Student Suicide.” (April 2015). The Wall Street Journal. Accessed February 6, 2016.
  18. Penn Benjamins Will Offer Student-to-Student Counseling.” (February 2015). The Daily Pennsylvanian. Accessed February 6, 2016.
  19. Just Say Yes? The Rise of “Study Drugs” in College.” (April 2014). CNN. Accessed February 7, 2016.
  20. Illicit “Study Drugs” Tempting More Students.” (n.d.) ABC News. Accessed February 6, 2016.
  21. Nonmedical Use of Prescription Stimulants During College: Four-Year Trends in Exposure Opportunity, Use, Motives and Sources.” (2012). Journal of American College Health. Accessed February 6, 2016.
  22. The United States of Adderall.” (September 2011). The Huffington Post. Accessed February 6, 2016.
  23. ”Adderall Is Definitely Not a Drug: Justifications for the Illegal Use of ADHD Stimulants.”” (2010) Substance Use and Misuse. Accessed February 6, 2016.
  24. Adderall: America’s Favorite Amphetamine.” (October 2013). The Huffington Post. Accessed February 6, 2016.
  25. Nonmedical Use of Prescription Stimulants.” (n.d.). Center on Young Adult Health and Development. Accessed February 6, 2016.
  26. Emergency Department Visits Involving Attention Deficit/Hyperactivity Disorder Stimulant Medications.” (January 2013). Substance Abuse and Mental Health Services Administration. Accessed February 6, 2016.
  27. What is Adderall?” (n.d.) Everyday Health. Accessed February 6, 2016.
  28. New Survey: Misuse and Abuse of Prescription Stimulants Becoming Normalized Behavior Among College Students, Young Adults.” (November 2014). Partnership for Drug Free Kids. Accessed February 6, 2016.
  29. The Fast and Furious: Cocaine, Amphetamines and Harm Reduction.” (n.d.) Council of Europe. Accessed February 6, 2016.
  30. Amphetamine Black Market Feeds College Students’ Need for Speed.” (n.d.) Emerald Coast Magazine. Accessed February 6, 2016.
  31. Adderall: Uses, Abuses and Side Effects.” (November 2013). Livescience. Accessed February 6, 2016.
  32. Spring Break’s Greatest Danger.” (March 2014). Forbes. Accessed February 6, 2016.
  33. DrugFacts: Nationwide Trends.” (January 2014). National Institute of Drug Abuse. Accessed February 6, 2016.
  34. Spring Break’s Greatest Danger.” (March 2014). Forbes. Accessed February 6, 2016.
  35. Why Students Drink.” (November 2013). University of Minnesota. Accessed February 7, 2016.
  36. Binge Drinking in Young Adults and Older People.” (March 2012). Psychology Today. Accessed February 7, 2016.
  37. Drugs Rampant on Campuses: “We Have People at Parties Holding Up Bags of Coke,” College Student Says.” (December 2010). New York Daily News. Accessed February 7, 2016.
  38. Alcohol and Cocaine Use Among First-Year College Students.” (January 1991). Southern Medical Journal. Accessed February 7, 2016.
  39. Study Ties Binge Drinking to Fraternity House Life.” (December 1995). New York Times. Accessed February 7, 2016.
  40. Yearlong Probe Results in 96 Arrests on SDSU Campus.” (May 2008). San Diego Union Tribune. Accessed February 7, 2016.
  41. Colleges Combat Drug Use During Finals.” (July 2013). University Business. Accessed February 7, 2016.
  42. Sexual Health on College Campuses.” (n.d.) Sperling’s Best Places. Accessed February 7, 2016.
  43. Pet Therapy Is A Nearly Cost-Free Anxiety Reducer On College Campuses.” (July 2015). Forbes. Accessed February 7, 2016.
  44. Students Organize Sober St. Patrick’s Day Events, Combat Binge Drinking.” (March 2014). USA Today. Accessed February 7, 2016.
  45. At Augsburg, Some Students Mix Studies and Sobriety.” (September 2012). MPR News. Accessed February 7, 2016.
  46. Clean & Sober.” (December 2014). University of Missouri. Accessed February 7, 2016.

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