A CALL TO ACTION: ADDRESSING THE
MENTAL HEALTH AND SUBSTANCE
ABUSE CRISIS ON CAMPUS
MARISA A. GIGGIE, MD, MPAFF
ADAM B. DOWNS, PH.D, LMFT
BLAKE SCHNEIDER
OVERVIEW
•Statement of Need (Giggie)
•Current Services (Downs)
•Student Perspective
(Schneider)
GOALS
• Review of substance use problem on college
campuses
• Review psychiatric problems common in emerging
adults
• Discuss co-morbidity between substance use and
psychiatric illness
• Discuss importance of addressing BOTH substance
use and other psychiatric disorders
OVERVIEW OF PROBLEM
“Amanda”
20 year old
sophomore who
overdosed on heroin
found dead by
sorority sister in her
apartment
OVERVIEW OF PROBLEM
“Michael”
19 year old freshman
admitted to local
hospital for alcohol
poisoning after
fraternity party
RITE OF PASSAGE
SUBSTANCE USE IN COLLEGE
• 18-25 y.o. – enrolled
in college more likely
to drink ETOH, binge
& drink heavily
• 2011 – 70% drank
ETOH, 14% drank
heavily, 22% use illicit
drugs (SAMSA)
• 50% full-time students
18-22 y.o. binged or
abused drugs
monthly
SUBSTANCE USE DISORDERS IN
EMERGING ADULTS
• 30% met criteria for substance use d/o (2011 –
SAMSA)
• 23% of full-time college students have SUD vs 8.5% in
general population
• In 2011, 13.2 million high school students in US. 1.6
million have SUD
• Only 6% receive treatment for addiction
• Thousands of substance abuse prevention &
treatment programs exist in US.
• Only handful exist for collegiate students
CONSEQUENCES OF SUBSTANCE USE
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Legal Offenses
Health Problems
Academic Problems
Unintentional Injury or Death
Intentional Injury or Death
• Co-occur with psychological
disorders
CO-OCCURRENCE OF SUBSTANCE USE
AND OTHER PSYCHIATRIC DISORDERS
• Selfmedication
hypothesis
• High-risk
hypothesis
• Both
REWARD PATHWAY
• Mesolimbic Pathway
• Ventral Tegmental
Area (VTA) → Nucleus
Accumbens
(NAcc)→Dopamine
(DA)
• Stimulants stimulate
NAcc directly
• Nicotine & ETOH
stimulate VTA
• Opiates & THC work at
VTA & some effects on
NAcc
PATHWAYS
ADDICTION & THE REST OF
PSYCHIATRIC ILLNESS
• DA release in the NAcc “highjacks” the reward
pathway
• Is this separate or related to other psychiatric
illnesses?
• Addiction is BOTH separate and related to OTHER
psychiatric illness
RATES OF MENTAL ILLNESS IN
EMERGING ADULTS IN COLLEGE
• 2011, 17.5 million students
• More than 1,100 suicides
• 2012, ACHA survey, 45% hopeless, 85% overwhelmed, 80%exhausted, 30%depressed, 7%-suicidal
thoughts, 6%-SIB, 1.2%attempted suicide
• 24% of students seen by
counselors – get rx
MENTAL ILLNESS IN COLLEGE
STUDENTS
• 88% - counseling center directors report more
severe psychological problems
• In 2012, directors report an increased % of:
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Emergency Crises (73%)
Psychiatric Medication Issues (67%)
Illicit Drug Use Problems (48%)
ODS Issues (59%)
Sexual Abuse Issues (30%)
Eating Disorders (26%)
SIB (40%)
Severe Psychological Problems (39%)
MENTAL ILLNESS IN EMERGING
ADULTS IN COLLEGE
• Problems are diverse & complex
• Developmental issues (identity formation,
separation crises, transition problems)
• Trauma & violence
• Onset of severe mental illness occurs in young
adulthood – Schizophrenia, Bipolar Disorder, MDD
• Stressor of college can trigger
psychotic/manic/depressive episode
CO-MORBIDITY
• SUD co-occur with psychological disorders
• 18-25 year olds with any mental illness – 30% meet
criteria for SUD (SAMHSA, 2011)
• Co-morbidity is highest in this age group
• Rates of mental illness among those with SUD vary
from 40-80%
• Treatment BOTH SUD and other mental illness is low
in young adults – 7%
2011
• 8 million adults older than 18 had diagnosable
mental illness AND SUD
• 33% received mental health care only
• 4% received SUD treatment only
• 7% received treatment for both SUD and MI
• 57% received NO TREATMENT AT ALL
CASE: MALLORY
• 21 year old junior with OCD, Trichotillomania, MDD, and
severe Cannabis Dependence
• Failed sophomore year; skipped class; smoking MJ “all
day” most days, drinking ETOH socially & experimenting
with other drugs
• Rx by psychiatrist at home (3 hours away) – Paxil 30 mg,
Xanax XR 2 mg daily.
• Judicial Affairs – involved in Back-on-Track program then
referred for psychiatric evaluation
• Adjusted Paxil (50 mg), Added Wellbutrin and Buspar,
tapering to less Xanax XR
• Worked with substance abuse counselor & family
JASON
• 35 year old non-traditional student. Bipolar d/o.
Extensive drug/ETOH use abuse hx – crack, opiates,
MJ, ETOH
• Involved in CRC and referred for psychiatric eval
• Treated for 4 years – sober off and on but compliant
with medications
• Relapsed to crack use and left school
• Most successful in sobriety when compliant with
psychiatric treatment
COLLEGIATE RECOVERY COMMUNITY
(CRC)
CRC
• CRCs – provide
environment for
students in recovery to
remain sober
• Safe Haven promoting
Abstinence
• Positive Reinforcement
for Sobriety
• 40 + programs in the
Country
UA CRC
CO-MORBIDITY
• Rates of Co-Morbidity –
unknown in CRC population
• Substance Use CANNOT be
considered separate from
other mental health issues
• Mental Health – can
interfere with recovery
• Students in Recovery must
have mental health support
& psychiatric treatment, if
necessary
SUBSTANCE ABUSE SERVICES
• designed for students whose excessive use of
substances has created serious consequences
• holds substance-abusing students to a high level of
accountability while providing, holistic treatment
and rigorous compliance monitoring for both short
and long term programs
• unites campus leaders, student conduct personnel,
and programming professionals
SUBSTANCE ABUSE SERVICES
• Students referred by Office of Student Conduct,
Dean of Students Office: Student Care & Wellness,
Student Health Center etc.
• Meet with Dr. Adam Downs for evaluation
• Placed into appropriate program based on
interview and collaboration with referral source.
SUBSTANCE ABUSE SERVICES
• 3 Programs
• Alcohol & other Drug Awareness Program (AODA)
• 4-8 weeks
• Education w/ monitoring
• University Community Program
• 12-16 weeks
• Life & Coping skill development w/ monitoring
• Focus on academic success
• Campus Drug Court
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8-10 months
Diversion program through OSC or SCW
Life & Coping skill development w/monitoring
Focus on academic success
AODA PROGRAM
Program Contents: (4-8 weeks)
• 4 psycho-educational classes
• Random drug screens – Color Code
• Center for Academic Success (CAS)
• Case management (weekly)
• Recovery meeting (weekly)
• Individual counseling (as needed)
• Psych/medical evaluations (as needed)
AODA PROGRAM
Psycho-Educational Groups:
• Alcohol and Other Drugs: The Mind Body
Connection
• Pleasure Unwoven – Brain disease concept
• Strength Identification workshop
• Building character and changing behaviors
UNIVERSITY COMMUNITY PROGRAM
•
Phase 1: - Understanding the Problem (4 weeks)
• Individual Therapy & Group Case Management
• 1 individual
• 1 group
• Psychiatrist for medication management as needed
• Extended Assessment Phase Personality Type
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Value’s
Goals/Objectives
Family Functioning
Depression inventories
Parent/Peer Attachment
• Career Center
• Degree Works
• Strength finder
• Treatment plan development
UNIVERSITY COMMUNITY PROGRAM
• Phase 2 – Learning the Solution (8-10 weeks)
• Objective/Goals developed based on Treatment Plan
• Group Therapy 2x a week
• Life skill/coping skill development
• Individual & Psychiatrist for medication Management as needed
• Case management
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Academics – custom academic success plan
Drug screens – color change
Weekly requirements
Treatment plan compliance
• Family Program
• Monthly updates
• Family Dynamic education and support
• Weekly recovery/support meetings
UNIVERSITY COMMUNITY PROGRAM
• Phase 3 – Applying the Solution (4-6 weeks)
• Group therapy 2x week
• Less case management
• Present their own case management to group
• Mentorship
• Tutoring
• Assigned a junior group member
• Outreach
• Service project with group
CAMPUS DRUG COURT
• All students have been found responsible for a
dismissible violation of the Student Code of
Conduct
• Clinical Components are same as UCP
• Length of stay is longer (8-10 months)
• Involvement from Office of Student Conduct
• Open Case Review (drug court)
• Weekly team meetings: Representatives from OSC, UAPD, Law
School Extern, Student Housing, Dean of Student office,
Substance Abuse Services, Office of Counsel
CAMPUS DRUG COURT
• Involvement from Office of Student Conduct
• Community service hours assigned (40hrs)
• Open Case Review
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Judge (retired drug court judge)
All students attend weekly
Weekly updates
Receive rewards/sanctions
• Closed Case Review
• Present application to phase up
• If in noncompliance must go before the team for individual
attention
COLLEGIATE RECOVERY COMMUNITY
(CRC)
• Mission
• The mission of the Collegiate Recovery Community is to
support students in recovery and help them achieve their
academic goals while participating in the collegiate
experience without the use of drugs, alcohol, or other
behavioral or process addictions. The program also provides
opportunities for families to engage in and support students
in their recovery and education.
CRC
• Goals
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Support lasting recovery for addiction
Aid in development of recovery & life skills
Inform/educate student & community about addiction
Provide service (ASAS)
Raise awareness of recovery process
CRC
• Stats
• Average Length of Sobriety for UA CRC : 5.4 years
• UA CRC Grade point average: 3.67
• 100% of UA CRC student graduates have obtained jobs in
their field after graduation, or have been accepted to
graduate schools. Job fields of UA CRC students include
engineering, finance, and marketing.
A STUDENT’S PERSPECTIVE