There’s a post making its way to “viral” status right now on social media that bears some discussion, and a share here in this forum at the request of the poster that as many people as possible see the message.
The post was made by parents that lost their son to suicide after his struggle with addiction to Adderall. Told from the heartbreaking perspective of a family deep in the throes of recent loss, the story gives deeper context to two problems that I see and experience as a mental health professional.
I had been writing a blog inspired by my attempts to work with area doctors serving some of my clients. I see some problems in that arena that I’d like to shed some light on, even if it is more of a shout into the grand canyon hoping the echo doesn’t distort the message too much for the folks on the bottom. Seeing this post today caused me to pause a little bit and switch gears.
The College Issue
First, there is a well-documented issue with Adderall type drugs among college students. This is a population that I work with, as my practice is located inside a state university town. The thinking behind the non-medical use of these drugs is that they will allow a student to be more alert to study, attend class, or be more alert for tests. Students believe that these help improve college performance. About 10% of college students report using stimulants intended to treat ADD/ADHD nonmedically. About 5% of college students are currently prescribed ADHD medications, and most who use these drugs nonmedically report that friends give them pills or that they’re purchased from friends with prescriptions very cheaply.
In college we’re looking to succeed, make friends, be liked, and we’re usually a bit short on cash flow. ADHD medications step in to fill these worrisome gaps. Want to do better? Study longer with Adderall! Want people to like you? Share your pills. Short on cash? Sell a handful for a few bucks.
Students with standing prescriptions that report diverting medications to peers rather than using them as prescribed are about 61% of that 5% of students overall with a prescription. Prescription holders who are most likely to sell or distribute to friends are those with childhood conduct histories and cannabis use disorder.
Interestingly, these drugs are also perceived as among the easiest to obtain for nonmedical use. Of high school seniors surveyed 47% reported it was “very easy” to obtain these drugs.
The characteristics most commonly associated with nonmedical use of these types of drugs are excessive drinking and other drug use, lower GPA, low perceived harmfulness of using stimulants nonmedically, attention difficulties, skipping classes, depressed mood, and affiliation with sororities/fraternities.
Addressing the issue at the college level is important. There are some things that university administrators can do or are doing to try to address this issue. Providing early intervention by flagging students who have sudden grade drops, providing students with resources at on campus facilities for mental health and substance abuse, and preparing students for the shift from high school to college culture with lengthy orientation/student support programs are all good ways of addressing it at the school level.
Doctors who prescribe these drugs need to be mindful of the risk factors for diversion, sit and talk with patients going off to college about the ways the medicines are supposed to be used or not used and what can happen when they are abused or used by people other than the patient. Doctors that live in college towns like mine should be particularly aware of the issues in their communities and take part in substance abuse intervention education programs in their communities. Doctors in these areas also need to know the counselors in their communities and what we can provide by way of support to students struggling with addiction, stress, depression, ADHD, etc.
Parents and students alike need to understand that there aren’t many shortcuts to college success. Hard work and dedication to positive activities are what drive success. Drug abuse isn’t ever associated with collegiate success in the research. Good sleep, a solid routine, exercise, proper nutrition, and active support networks are vital to supporting students through college.
The Physician Issue
I wrote earlier this had previously been a blog-jam session on working with physicians. There is a serious lack of psychiatrists in Texas. The one nearest to my office is about 90 miles away, only treats certain problems and ages, doesn’t accept Medicaid/Medicare, and presently has a 3 month waiting list.
Before I go on I feel the need to preface what I’m about to say with the fact that I really love doctors. My area is blessed with some great family doctors who often refer mental health concerns to the mental health professionals prior to giving out samples of drugs. Doctors work hard and they get stuck in a healthcare 2.0 rut just like the rest of us. They see all the need for preventative care, the shortages in psychiatrists, the shortages in reliable or evidence based mental health pros, and they have two options. They can jump in with the considerable amount they know and help the people in smaller rural communities to the best of their abilities, or they can refer them out to month and longer waiting lists.
Doctors are often trapped by consumer satisfaction metrics, which tend to bottom out when your patients come in asking for help for anxiety and you send them away with nothing much but a referral. People want to feel better now with little effort. They want and expect medication to do the work of reversing heart disease effects rather than eating well and exercising. They want and expect medication to numb them to painful emotions and experiences rather than learning to stand in pain and cope through it. Doctors and mental health counselors alike end up caught in the middle of those demands.
Naturally over the course of time family doctors step in to help alleviate this issue.
When a college student under maximum stress, having trouble paying attention, difficulty sleeping, problems fitting in, and faltering grades present there’s a tendency to medicate for stress, depression, and/or ADHD. Some people truly need medication to help support wellness and that need is not a weakness of any sort. Period. But, people also need education about how to support themselves through stress, coping skills for difficult situations and problems, and to know the basic tenets of wellness. If that imaginary student from the beginning of this paragraph comes in and is partying every weekend, eating high carb meals once a day, sleeping 3 hours a night, and taking far more hours of class than necessary - the talk needs to be about more than medication. It should include coping skills for stress, decision making, general wellness education.
It should include referral to a counselor who can spend time with this person in education and support. There are risks and side effects with all medications, abused or not. There is clinical research support for the use of CBT and other methods in coping with stress, addiction, depression, anxiety, and many other problems we wind up in the doctor’s office for.
Doctors have an option outside of referral to psychiatrists or addressing mental health immediately with medication. They can network with, learn about, and know counselors in their communities and create a powerful alliance of resources that will support prevention and wellness. We’re here! We’ve spent almost as much time in school and residencies (internships) as you did, but focused solely on mental health and wellness. We know how to help, but we can’t if you don’t work with us! You all can really help us and your patients out by normalizing mental health counseling, educating patients on its effectiveness, and by referring to us when clients present with mental health concerns. The more normal you make it, the easier it will be for people to get help, and the fewer stories like Devan’s we’ll read.
For my counselor friends - this is a two way street. Are you reaching out to medical professionals in your communities? Do your area doctors know that you specialize in treating ADHD behaviorally? Or non-suicidal self injury? Or whatever it is that you do well? Are you advocating for your clients by supporting their education in their treatment and wellness? Are you offering releases and to connect with prescribing physicians when your clients are on medications?
Providing support to the young adult and college populations is a team effort. Doctors, counselors, parents, and school administration have to unite in learning about the issues this population faces with empathy. We all have to educate one another and support each other’s efforts to stop some of these problems in their tracks and give people the tools to contribute to their own wellness. Working together to provide and refer, consult and collaborate, we can lay the foundation for lasting wellness, prevention versus cure, and sound habits that create healthy bodies, minds, and relationships.
Whitney White is a counselor working in Texas in multiple settings with diverse populations. Some of her areas of passion are anxiety, non-suicidal self-injury, and compassion fatigue. With an integrated approach utilizing client strengths, she supports others in achieving their best self. For more information please visit counselingbywhitney.wordpress.com. The thoughts expressed in Whitney’s blogs do not represent her employers.