Substance use affects mental health — and prescriptions — in college

Editor’s note: This story is the third in a series chronicling mental health issues on a college campus through a central character, a UNC junior who asked to keep her real name private. Sara Salinas, a reporter for The Daily Tar Heel who knows “Charlotte” personally, is following her as she navigates her diagnosis and takes steps to find help throughout the semester.

It’s been almost two months since Charlotte paid her first visit to a psychiatrist.

In that time, she’s made considerable progress in treating her attention deficit disorder and anxiety. She’s lightened her course load, started weekly therapy and begun the trial-and-error process of finding the right prescription medications.

“You get used to the new you on medication,” Charlotte said. “It’s not a different person, but your different characteristics are coming out more than others.”

“You’re constantly trying to get to know yourself.”

Charlotte was prescribed an antidepressant after her initial visit to a psychiatrist in early February. Anxiety and ADD are often closely linked in women, Charlotte said, so it’s typical to medicate for one and consequently treat both.

Charlotte said she felt the effects of the antidepressants within three days.

“When I’m walking around, I’m not constantly feeling like my heart’s going to jump out of my chest anymore,” she said. “It was really working for my anxiety, but it didn’t do anything for my focus academically.”

At a follow-up appointment, Charlotte asked for a prescription to specifically target her ADD. She was told the antidepressants could still be building up in her system, so her psychiatrist wanted to wait until the antidepressants were acting at full capacity.

“I respect that decision,” Charlotte said after her second visit in early March. “But it’s really unfortunate timing because if my next appointment isn’t for another month, that’s over half the semester spent without medication for something that’s pretty crucial in academics ... Most of the percentage of my grade would be already determined.”

At her third and most recent appointment, Charlotte was prescribed the ADD medication she’d been asking for, but she worried because her therapist said stimulants can make anxiety worse. She’s been taking both a stimulant and antidepressant in combination for a little over a week.

“I definitely noticed that it makes my anxiety worse,” Charlotte said. “I don’t know if that’s something that you have to give time for your body to just get used to this very specific chemical balance.”

Charlotte is scheduled for another visit with her psychiatrist on Monday to discuss possible changes in her medication.

It’s been challenging enough to balance her prescribed medications, she said, and the substance-related pressures of a college environment add another variable to the equation.

Director of Counseling and Psychological Services Allen O’Barr said understanding how medications interact with other substances is especially important for college students.

“Some physicians are going to say, ‘This is the medication. You must take no drugs or alcohol with this medication. See you in two weeks,’” he said.

“And then they’re in a position of ‘So is this going to kill me if I take the meds with this, or is it just not advised? ... Because if it’s going to kill me, I’m not going to do it. But if it’s just going to make me feel really bad tomorrow, I might do it.’”

Instead O’Barr asks his students what substances they use and recommends medication that will combine safely.

“Let’s talk about reasonably, can you take an antidepressant and get out of your depression and still be drinking as a lifestyle?” he said. “The most important thing is for people to be educated. They really need to know what the drugs are doing.”

Charlotte said neither her psychiatrist nor her therapist provided any instruction about drinking while on her medications, but she’s taken measures herself to reduce the effects of alcohol on her mental health.

“Since my anxiety has gotten much worse, I’ve noticed that heavy drinking is not really a good idea because things that you’re hiding from yourself all of a sudden come uncovered,” Charlotte said. “I didn’t really drink that heavily very frequently anyway, but now I know it’s just never a good idea.”

Charlotte has learned that alcohol feeds her anxiety. It’s a pattern common with those facing mental health concerns, said Tara Bohley, a professor in the School of Social Work, and one that can have long-term effects left unchecked.

“Alcohol, over time, and with the more volume you drink — it increases anxiety,” Bohley said. “And then what they find is because their level of anxiety is actually heightened, they feel the need to drink more frequently or to drink more volume.”

For many young people, mental health issues and unhealthy coping mechanisms can lead to substance abuse, Bohley said.

“You continue to replace your natural chemicals with these substances to get a certain effect,” Bohley said. “And then your body’s natural chemicals stop working the way they’re supposed to and then you rely on those substances to just function.”

But the interplay of mental health and substance abuse is really a matter of the chicken and the egg, she said. Mental health can affect substance abuse, but the reverse can also be true.

“What we know is that a brain does not stop developing until age 24, 25,” she said. “So any chemical you introduce before that age is going to affect the full development of the brain.”

At 21, Charlotte said alcohol is a part of her college experience, but she doesn’t use other substances because there are too many other influences to balance. She’s already noticed changes in herself since starting her prescriptions.

“I definitely noticed changes in the way I make decisions, and the way I have conversations with people now,” she said. “Everything is a lot more calm than it used to be.”

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