College Student
Mental Health
Primer
Mark Gold, M.D.
Drmarkgold.com
17th University of Florida Distinguished
Alumni Professor
Chairman, Scientific Advisory Boards,
RiverMend Health, Atlanta, Georgia
Professor, Adjunct, Washington University
School of Medicine
Professor , Eminent Scholar, Distinguished
Professor, & Chairman University of Florida ,
retired
Active Minds--• Mental health issues are prevalent among college students:
• An estimated 26 percent of Americans ages 18 and older – or about 1 in 4 adults - live with a diagnosable mental health disorder.
• Half of all serious adult psychiatric illnesses – including major depression, anxiety disorders, and substance abuse – start by 14
years of age. Three-fourths of them are present by 25 years of age.
• Compared to older adults, the 18-24 year old age group shows the lowest rate of help-seeking.
• Mental health issues impact students' ability to succeed:
• Almost one third of all college students report having felt so depressed that they had trouble functioning.
• Mental health issues in the college student population, such as depression, anxiety, and eating disorders, are associated with
lower GPA and higher probability of dropping out of college.
• More than 80 percent of college students felt overwhelmed by all they had to do in the past year and 45 percent have felt things
were hopeless.
• Mental health issues can be deadly:
• Suicide is the 2nd leading cause of death among college students, claiming the lives of 1,100 students each year.
• 67% of college students tell a friend they are feeling suicidal before telling anyone else.
• More than half of college students have had suicidal thoughts and 1 in 10 students seriously consider attempting suicide. Half of
students who have suicidal thoughts never seek counseling or treatment.
• 80-90% of college students who die by suicide were not receiving help from their college counseling centers
September, 2015
Yellow flags for suicide
prevention decorate
MIT’s campus.
Nationally, an average of one in 10 students
will visit their college’s counseling center
before they graduate. And more students are
coming to college with pre-diagnosed
conditions, which means they’re seeking
help before they reach the university level.
Students are driving the process. The
number of mental health advocacy groups on
college campuses has risen. Active Minds,
which was founded at the University of
Pennsylvania in 2000 to combat the stigma
against mental illness, now has more than
400 branches on college campuses
nationwide.
"It's clear that for the past seven or eight years there has
been an increase in marijuana use among the nation's
college students," Johnston said. "And this largely
parallels an increase we have been seeing among high
school seniors."
Just under 6 percent of the full-time students
surveyed by University of Michigan researchers for
the annual "Monitoring the Future" study reported
using pot either every day or at least 20 times in
the previous 30 days.
By contrast, 5 percent of respondents identified
themselves as heavy cigarette smokers, a steep
decline from the 19 percent who said they smoked
daily in 1999.
The percentage of daily and near-daily pot users
from the 2014 survey was the highest ever
recorded and marked the first time that regular
weed consumption outpaced habitual cigarette
use, the study states.
Twenty-one percent of the college students
surveyed said they had used marijuana at least
once during the previous month, and 34 percent
said they had used it in the past year
With a growing number of high school students using e-cigarettes, more
are using those devices to vaporize marijuana, a new Yale University
study has found (September 2015) .
• While the Pediatrics study did not ask the question, researchers are concerned that teens are vaping rather than smoking pot in
order to keep from being caught, according to lead author Meghan Morean, assistant professor of psychology.
• “Kids are using these things and one of the interesting things about vaporizing cannabis is that it doesn’t smell nearly as strong” as
burning weed, she said. It lacks “that real characteristic odor.”
• “This is a concern that has been raised by the police and in media stories,” she said. “It’s pretty easy to conceal.”
• A total of 3,847 Connecticut high students were surveyed for the study, which found that 27.9 percent of them have tried ecigarettes. Of those, 18 percent have used them to vape marijuana, researchers found. That means a total of 5 percent of all the
students surveyed have used e-cigarette devices to vape marijuana, she said.
• “This is a relatively novel form of consuming cannabis and kids are picking it up,” Morean said.
• E-cigarettes are battery-powered devices that heat up a nicotine fluid as a substitute for a cigarette.
• The researchers found that high students were using hash oil or a wax infused with THC, the active ingredient that brings a high to
the user. These forms can be more powerful than burning the marijuana plant itself. Some e-cigarettes have been specifically
designed for use with marijuana leaves or wax, according to a Yale release.
• The researchers did not determine whether vaping is leading to increased marijuana use, the release said. Also, Morean said, “We
don’t know where they’re getting” hash oil or wax — presumably where they’re getting their regular combustible pot.”
Risk Taking vs Risk Benefit & The Brain
• Adolescence is a time of major brain development—particularly the maturation of prefrontal cortical regions
involved in self-control and the neural circuits linking these areas to the reward regions. The prefrontal
cortex, where we make decisions and comparative judgments about the value of different courses of action,
is crucial for regulating our behavior in the face of potential rewards like drugs and food. Adolescents are
prone to risky behaviors and impulsive actions that provide instant gratification instead of eventual
rewards. In part, this is because their prefrontal cortex is still a work in progress.
• The incomplete maturation of the prefrontal cortex is a major factor in why young people are so susceptible
to abusing drugs, including alcohol, tobacco, marijuana, and prescription drugs. There are numerous
pressures in their lives to try these substances (stress and peers, for example), but inadequate cognitive
resources to help them resist. Because their brain architecture is still not fully developed, adolescents’ brains
are more susceptible to being radically changed by drug use—often specifically by impeding the
development of the very circuits that enable adults to say “later” … or “not at all” … to dangerous or
unhealthy options. Thus, when drug abuse begins at a young age, it can become a particularly vicious cycle.
Research shows that the earlier a teen first uses drugs, the likelier he or she is to become addicted to them
or to become addicted to another substance later in life. It is likely that the same dynamics are at play when
it comes to fattening food and the brain’s reaction to it.
• Though parents may get frustrated by their teens’ poor decisions at times, they usually forgive them—
because on some level adults understand that kids’ internal guidance systems aren’t yet fully functional.
Averting obesity and drug use also requires that, as a society, we take responsibility for the environments we
create for young people. Instead of school cafeterias with an array of cheap, tempting foods high in calories
and low in nutrients, we must expose young decision makers to food options that strengthen their health
and resolve. Instead of stress-filled or empty time that promotes drug use, kids need access to appealing,
healthy, and meaningful activities that encourage them to take pride in themselves and their behavior.
Brain changes , emphasis, and function with
adolescent experiences and drug use
• A representation depicting the age-related
changes in connections between brain
regions on a surface rendering of the brain.
Connections that increase with age are shown
in orange; those that decrease with age are
shown in green. The local interactions
between brain regions seem to decrease (
green) with age, whereas a more distributed
organization (orange) emerges with age. Also
shown are the relative weights of various
brain regions (160 ROIs), quantified by the
weights of afferent and efferent connections
of each region. The color-coding of these
regions is based on six resting-state networks
(e.g., cingulo-opercular in gray)
K2 = Synthetic Marijuana
What
is
it?
• K2 is a substance originally sold as
incense in coffee shops and
convenience stores. Now a new street
drug sold as K2, Spice, Spice Gold, King
Krypto.
• Made up of herbs plus JWH-018 and/or
JWH-073 (synthetic cannabinoids that
mimic the mind-altering effects of
marijuana).
• Since no THC in K2, it does not show up
in urine testing.
• Neither K2 nor its ingredients are
currently controlled substances, except
in Kansas.
A Depressed Rat?
• It is an impossible quest to mimic major depressive disorders completely
in rodents
• Instead of anthropomorphizing
the human condition, as in
the cartoon, investigators
have developed paradigms
that detect specific behavioral
endophenotypic differences
(clear-cut behavioral outputs)
that are sensitive to the effects
(both pharmacological and
non-pharmacological) of antidepressant treatments
Setting the standard for recovery:
Physicians’ Health Programs
DuPont RL, McLellan AT, White WL, Merlo LJ, Gold MS. Journal of Substance Abuse Treatment, 2009; 36:159-171.
• 904 physicians admitted to 16
state PHPs studied for 5 years
Elements of success:
• Abstinence-based programs
• Frequent random tests for 5
years
• Close linkages to 12-step
programs
• Use of residential/outpatient
programs rated excellent
What is recovery? A working definition from the
Betty Ford Institute
The Betty Ford Institute Consensus Panel. Journal of Substance Abuse Treatment , 2007; 33:221-228.
Recovery = a voluntarily maintained
lifestyle characterized by:
• Sobriety
•
•
•
Early (1-11 months)
Sustained (1-5 years)
Stable (> 5 years)
• Personal health
•
•
•
Physical
Mental
Social
• Citizenship
•
•
“Giving-back”
Quality of life
“Stopping smoking is the easiest thing
I have ever done – I have done it
hundreds of times.”
Mark Twain: Smoking
- Mark Twain
(1835-1910)
Naltrexone
prefrontal
cortex
Ethanol
Dopamin
e
nucleus
accumbens
VTA
Beta endorphin
release
potentiated
Firing
The Reward
Pathway
Eight Steps to Relapse Prevention
and to a Drug Free Balanced Life
•
•
•
•
•
•
•
•
Sound physical health
Sound mental health
Stay off drugs and stay busy
Take care of business: out of jail and on the job
Taking personal responsibilities
Live in harmony with family and friends
Be a good member of the community
Search for a meaning in life.
From bedside to bench and
back again: A 30-year saga.
• Since the 1970’s through observation
and experience, drugs of abuse and
the drive for food appeared to be
quite related.
• As pioneered by Bart Hoebel, food
can become an object of desire and
act in most respects as a drug of
abuse.
• The Gold lab is investigating working
models for pathological attachment
to sugar, eating and food addiction.
Gold MS. Physiol Behav. 2011 Jul 25;104(1):157-61. PMID: 21530563.