College Student Mental HealthPrimer

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, 2015Yellow 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

e-cigarettes. 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 interactionsbetween brain regions seem to decrease ( green) with age, whereas a more distributed organization (orange) emerges with age. Alsoshown 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 inthe cartoon, investigatorshave developed paradigmsthat detect specific behavioralendophenotypic differences(clear-cut behavioral outputs)that are sensitive to the effects(both pharmacological andnon-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

Mark Twain: Smoking

- Mark Twain(1835-1910)

“Stopping smoking is the easiest thing I have ever done – I have done it

hundreds of times.” 

The RewardPathway

The RewardPathway

Ethanol

Dopamine

Dopamine

Beta endorphin release potentiated

Beta endorphin release potentiated

Naltrexone

prefrontal cortex

nucleus accumbens

VTA

Firing

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.