Preventing Addiction and Mental Health Issues in College Students

I'd like to welcome everybody today's presentation on preventing addiction and mental health issues in college students. I am your host, Dr. Donnelly Snipes. We are going to review some of the unique triggers for co occurring issues in adolescents and college students, identify current best practices for preventing those, and explore ways to enhance college student engagement in prevention and health promotion activities. Almost half of college age individuals had a psychiatric disorder in the past year, which was not different between college attending and their non college attending peers. So we don't want to just say, okay, it's just students who are in college or in community college. We want to remember that anybody who's in that age range, 18 to 23ish, you know, almost half of them have had a psychiatric disorder in the past year, which means there are some things we need to pay attention to. That number is far too high in my Humble opinion. About 12% reported anxiety disorders and in females, anxiety disorders were correlated with an increase in alcohol use disorder, depression. About 9% of the of people who had depression, about 6.7 had suicidal ideation. And as people's depression went up, their use of tobacco and cannabis also went up. So there's a strong correlation between tobacco and cannabis use with depression and more so alcohol with anxiety, which I thought was a little bit interesting. But either way we do when we're screening people, not just college students, when we're screening for mental health issues, we also want to screen for substance use issues, whether it is nicotine, cannabis, alcohol or opioids, stimulant medications, whatever. 8% had ADHD, 2% had autism specific spectrum disorders, and about 10% had clinical levels of eating disorders. But about 35 to 45% of adolescent females report body image issues. So almost half of adolescent females report body image issues. Only about 10% theoretically rise to the level of a DSM diagnosis. You know, I don't get too hung up on diagnostic threshold. If somebody is symptomatic, we really need to start taking a look at it because, you know, an ounce of prevention worth a pound of cure, as they say. And 3% had bipolar disorder. 47% of females who went, of people who went on to develop schizophrenia, 47% of females and 62% of males had their first symptoms before the age of 25 years. It is very, very common. Unfortunately, for someone who does have the propensity to develop schizophrenia, who has risk factors for schizophrenia, it is very common for them to have their first episode in late high school or in college. We want to be aware of that and be able to screen for those sorts of things. Now if you've taken my classes before, you know that I'm not interested in you knowing all these particular statistics. I just want you to, to really grasp the breadth of the issue that's going on. I mean a lot of these youth, about half are struggling with mental health issues which are, is going to impact their concentration, impact their ability to succeed in college. And one of the things if you're working in a college arena is one of the, one of your goals is going to be, be to engage the students and prevent student attrition. The risk of alcohol use disorders was significantly greater for college students than their non college attending peers. Now you know, this could be true. This one study said it was true. However, I think it's really important to take it at face value with, in one study the risk was higher. We also want to look at the environment. We want to look at where people are. And I know in some of the rural counties that I used to work in, in Florida, on the weekends, in the evenings there was literally nothing to do. People would hang out in the Walmart parking lot and, and smoke weed and drink alcohol. So you know, we do want to look at the environment. It may be different in New York than it is in, or Nashville or Miami than it is in, you know, rural Dixie county in Florida. We do want to pay attention to the fact though that a lot of people start drinking alcohol long before they are legally able to. 20% of college students meet the criteria for alcohol use disorder and 44% report binge drinking. So they may not drink during the week, but come the weekend when they're going to parties or football games. Oh, look out. Risk factors for the development of substance use disorders in college and pretty much anywhere. Low self efficacy. When students don't feel, feel like they have control over their lives. When they don't feel like they can succeed in college, when they don't feel like they can succeed in relationships, they may be more tempted to self medicate that anxiety or sense of hopelessness and helplessness or depression with substances. People who don't enjoy their courses. Obviously this pertains more to college. Students may be more at risk for substance use disorders. I've interacted with a lot more college youth recently because my kids are in college. And there is this repetitive theme that people are bored. You know, they hate their classes, they're bored, they're not getting engaged, they have difficulty going to courses. And some people will self medicate if you will, to take the edge off Going to a class they hate. Some people just don't even go. But lack of enjoyment in courses leads to oftentimes lack of attendance at courses, which often negatively impacts gpa and low GPA increases the risk of substance use disorders. So sometimes we have to do a little bit of backward chaining to figure out how we got to this point when we talk about enjoyment of courses. And I'm going to, as usual, kind of be all over the place sometimes giving you interventions before we actually get to that part of the presentation. But whatever. Students who don't enjoy courses, we want to ask them why. And I've told you all before, I am a visual learner. I can read all day long and love every minute of it, but I am not an auditory learner. And going to those 1, 2, 3 hour lecture classes was like, you know, pulling teeth for me. And it was really difficult for me to sit in this dark lecture hall and just listen to somebody talk at me. I do much better in an interactive sort of situation. I'm an active learner. Not that we can necessarily change that. In some courses, like at the University of Florida, there were a lot of our undergraduate courses, there were a hundred to four hundred people in the class. There is no way you can interact with the teacher. But when can help students figure out, okay, how can you make this work for you? If they're an auditory learner, then they're probably going to be right at home. If they're a visual learner, then it's going to be important for them to bring their book with them, maybe follow along, take notes, make graphs or charts or something that will help them learn the information. So not only will it encourage them to attend class and learn, know, take notes and all that kind of stuff, but when they're using their preferred learning style to take in the information, they're probably going to have to study less on the back end. When they're getting ready for exams, if they've already drawn the charts and those sorts of things, then, you know, they're ready to scan it over and get ready for their exam. We do want to pay attention to educating students about their learning style and ways that they can modify their classroom experience to meet those particular needs. Another example I'll give you is math. And I math is not my strong suit. So sitting in a, in a math class when the professor was up there just writing equations on the board and going, of course this is the next step and the next step, and I'm just sitting there drooling on myself, Going, sure, that makes sense. Knowing that I didn't understand a dagum thing that was going on got very frustrating, and it was very disempowering for me at that point in time. And so it's important for us to help students figure out, okay, what do you need to do? I found for me, for math classes, a lot of times I would have to read the chapter ahead of time, and then I would always try to go into office hours or tutoring or something else ahead of time to go over the information before the professor even taught it. So when the professor was teaching it, I had some clue about what was going on. We do want to be flexible. A lot of colleges do have tutoring available. A lot of times it's graduate students that are available to, to tutor or whatever. But there are resources on campus that we need to take advantage of. Another neat tool that didn't exist back in the dark ages when I was in College is YouTube. There are professors on YouTube that have done nothing but create these short little videos to explain concepts in math. For example, there is a guy, I think it's Professor Rob Bob. And my son swore by his videos to help him get through his, his math classes when, when he was in high school and, and in his associate's degree. So finding somebody on YouTube that can help explain the material can also make it more helpful. Sometimes they'll explain it a little bit differently than the professor does and in, in a way that you will get it and just about anything from history to zoology and anatomy and physiology, you know, let's do the whole Alphabet there. There are tutors, if you want to call them that online, so we can encourage students to, to find ways to help them learn better. We also want to ask them, and I do this with a lot of my clients who really don't want to, you know, go to support groups or go to this thing or that thing, but for whatever reason, they have to ask them to figure out, you know, what is it that you can get out of this class? Maybe it's just an easy A. You know, I remember my History of Greek architecture. That was one of my humanities classes, and I had absolutely no interest in this, but it was a class I had to take. So trying to figure out, you know, what is the benefit to this class? How can I make it work for me? Poor accommodation of special needs is another risk factor for substance use disorders. Again, as we see hopelessness, helplessness, and efficacy become issues, then we see an increased risk of substance use disorders. When people don't have their special needs accommodated, it is going to contribute to more difficulty in them succeeding. We want to make sure that people are screened for any issues that they may have. Not everybody's already been diagnosed with ADHD or some other issue prior to coming to college. So if we have a student that is struggling, it's important to note that and try to work with the student. And that's part and parcel on faculty. We need to know, note for ourselves if there's something that, that is, that seems like it's not developmentally appropriate or where the person may need special accommodations. Maybe you're reading a term paper and it is very clear that this person has dyslexia. You know, that's one of those things that you may want to, you may need to address in order to make sure that they are screened for it. And if they do qualify for special accommodations, they get it. Students who rely on external validation are at great risk of substance use disorders in college because guess what, there is not a lot of, you know, pats on the back in college. It's, it's very self directed. And you know, think back to undergrad, graduate school. It was, we had a much smaller cohort, so there was a lot more interaction, a lot more feedback. But in undergraduate, not so much. And people who are used to being the big fish in the little pond are now the little fish in the ocean. And they may feel ignored, they may feel overlooked, forgotten. And if they derive their self esteem from external validation, then we're going to see their depression start to increase because they're not going to get that as much. People who have a low GPA can also be at risk for substance use disorders. Some may be at risk for abusing stimulants in order to try to help them study more. Others may be at risk of abusing other drugs in order to help them feel happier or less stressed because they're having difficulty switching gears. High school has a much different rubric for scoring and grading and success than college does. And there is no nice transition. It's like when way back when, when children go from kindergarten where there's nap time and unstructured time and whatever, to first grade when there are classes and homework. And it's, it's, they're worlds apart, they're very different. And if there's no transition, which there isn't, it can be very difficult for youth to make that transition. So a lot of students get to college and they find that where they coasted through high school, now it's a Lot harder. And they're, they're not getting straight A's and that's not something they're used to. And that can be a huge hit to their self esteem and their sense of efficacy. If they're experiencing a mental health issue, they're at greater risk for substance use disorder. Whether that mental health issue was pre existing or it's a development as a result of, you know, dropping grades, not getting external validation, homesickness. There's a variety of, of ingredients that can combine to contribute to the development of adjustment disorder. I hate that term, but you know, it's there, or depression or anxiety. And interestingly enough, and I am not knocking sorority and fraternity involvement, there is, there are a lot of benefits to it, but it is a risk factor in multiple studies for the development of substance use disorders. Now, before people get all up in arms about it, you know, a lot of sororities and fraternities have very positive effects on their, their members because they insist on a minimum gpa, because they insist on involvement in activity. So there's a lot of social support. So sororities and fraternities can be a good influence. But you know, if there's a lot of drinking, obviously, or substance use or pressure on body image, there can be a strong correlation unfortunately also with the development of substance use disorders or even eating disorders. And that is for sororities and fraternities. Earlier when I mentioned sororities or when I mentioned eating disorders, I only talked about females. The reason for that was because there's very little research on males with eating disorders and even less research on collegiate males with eating disorders. So I just don't have those statistics. But we do know that men now more than ever are developing eating disorders. So we don't want to be foolhardy and only assume that females are developing eating disorders. The risk of other drug misuse, including opioids, benzodiazepines or stimulants is about 35%. In college students now notice the term drug misuse. That's not substance use disorder. That can mean, you know, occasionally using opioids for non prescription means or Valium or any of the other benzodiazepines that you didn't get a prescription for. You're using it to party or for relaxation. Lack of identification or denial of mental health symptoms and, or lack of or inadequate treatment options are common problems among college students. The University of Florida was a wonderful, there was a very robust counseling center and a lot of resources that were available. Obviously that's my alma mater, but a lot of smaller colleges and community colleges do not have those resources available. It's going to be important to figure out, okay, where are those resources available for these youth? I'm sorry, Amanda, you know, I will be a gator, but you know, go Knowles. I won't discriminate. Students report that they do not seek help because because of limited time or worry about what others may think. There's still a huge stigma a regarding seeking services. And I remember again back in the day going to the counseling center, there was a little bit of stigma associated with that. And it's important that the college, the university, the community do as much as possible to destigmatize as much as possible to make early intervention and prevention activities available to students. And we're going to talk about a lot of ways to do that to prevent things from getting to the point where they need formal counseling. Because people are more likely to participate in informational or psychoeducational activities. There's less stigma associated with that than they are to talk about going to counseling. The greater the depressive symptoms, the higher the risk of suicide. However, and this is really important, there may be no difference on measures of everyday functioning. If you have two students who are clinically depressed that you are working with and you know, one has more significant fatigue, more, more significant apathy, more significant sleep problems, for example, but both of them are attending class at the same rate, are bathing at the same rate, you know, those everyday functioning activities of daily living, the one that has the more significant or more severe symptoms is the one that's at greater risk for a suicide attempt. Now, the reason that's important is a lot of times if people have good ADL's, we minimize the intensity of their depressive symptoms. Don't do that. You know, people can fake it for quite a while until they hit a wall. And we don't want to perpetuate that idea. Recognize that regardless of whether somebody's bathing and doing their hair and putting on makeup or whatever, that doesn't necessarily mean they are not at risk for suicide. Myths around stimulant use and I just wanted to put these out here because they were a little bit surprising to me that they even still existed. But they do. Anecdotal evidence exists that stimulants are performance enhancers. And yes, there is a lot of talk about if you use certain stimulant medications, it helps you focus and concentrate. They've actually found that students concentration is lower unless they have adhd. Students concentration is lower when they take stimulant medications because they are so hyped up. They have more difficulty focusing. Those with ADHD respond differently to stimulant medications and it actually does help them focus. A prevailing attitude, unfortunately, and this shocked me, shared by many parents and physicians, is that non medical use of prescription stimulants is benign. Oh my gosh. Okay. Stimulant use in and of itself activates that HPA axis. It puts a lot of stress on the body, whether we're talking about caffeine, nicotine or something more intense like Adderall. The notion that non medical use of these, of the prescription stimulants is benign is just mindboggling to me because it does mess with the neurotransmitters. It does activate that HPA axis. It does create a whole system, a whole set of physiological changes and alterations. It is not benign. It puts people at much higher risk for developing mood and other issues. Non medical prescription stimulant users are more than, more likely than other students to be heavy drinkers, users of other illicit drugs. Guess what? You take stimulants, they're uppers. What do you follow it with? Something that's going to help you calm down. Like guess what? Alcohol. Opioids for some marijuana. So it's important to recognize that a lot of times the other substance is a self, is a medication or a self medication for the stimulant use. And so they are constantly monkeying and turning on and off their, their neurotransmitters. That is so hard on the body. Non medical users should be evaluated for adhd. So if you find you have a student who is using stimulants for non medical uses for, for studying, you know, we may want to evaluate and ask them, does it help you focus? And if the answer is yes, then let's see about getting them evaluated for adhd. We really want to educate. A lot of our job with college students is not to force them to do anything or, or what have you, but to educate them to provide feedback and information so they can start making their own health related decisions. Issues contributing to distress, psychosocial development. Think about it. When you look at Erickson's stages of psychosocial development during this period, people are going through the development of identity and they're also going progressing to intimacy. So there, there's a lot of stuff going on right there. There's a lot of changes going on. The brain does not fully finish developing until about age 24, especially the prefrontal cortex. And there is A lot of need to recognize that adolescents, including those up to the age of about 24, have more difficulty with emotion regulation and impulse control because those areas of the brain are actually some of the last two finally develop separation from home and friends. You know, homesickness can contribute to distress, grief over family changes, and we often overlook this. But when somebody goes home, they've gone away to college and they go home for Thanksgiving break, and what used to be their bedroom is now, you know, a den or somebody's workout room, it can feel like they have been, you know, forgotten or sort of kicked out of the house. These transitions can be very difficult if the college student leaves home and they leave behind, for example, younger siblings. The power dynamic between the parents and the younger siblings is going to change now that the college student is no longer, you know, part of that system on a daily basis. So when they come home and there is going to be a different dynamic and they may feel grief over, you know, the changes that happen in their family, there's a need to establish new peers. You leave. A lot of times people leave their, their high school and the college that they go to, they know nobody. And so they go from knowing a lot of people to, to knowing nobody. And that is a huge change. Think about if you've ever moved from, from one city to, you know, somewhere else in a completely different state, you know, you didn't know anybody and you had to start over. For some students, you know, especially people whose families were in the military, they may have more skills and tools to deal with this because they may have moved frequently. But for a lot of students, they grew up in the same house or in the same city and went to the same school with people from the time they were in diapers until they graduated. And it can be a daunting task to figure out, okay, how do I even make friends? You know, I, I knew those people since before I could talk. We may need to help people figure out how to establish this new peer group. There's less enforced structure, and I can tell you from being a student as well as from being a, a resident assistant and a hall director, watching students either make it or not. One of the big issues that contributed to students lower gpa, failure, development of, of problem behaviors was difficulty with imposing struck self imposed structure. They had difficulty forcing themselves to get up to go to that 7:30 class difficulty, you know, forcing themselves to study. When they were at home, they had somebody that was watching over them more. In high school, generally you had assignments that were due every week or every couple of weeks instead of just a midterm and a final. The lack of structure in college can contribute to a lot of distress because students may feel very like a fish out of water. Changes to sleep hygiene, we're going to talk about that ad nauseam in a few minutes. But a lot of students don't get enough sleep and you know, think back to when you were in college. It's easy to do, but sleep hygiene is one of the most changeable interventions, one of the things that's easiest sort of to fix and one that has a huge impact on mood, concentration, school success, etc. College work and self directedness represent a significant change. Like I, like I mentioned earlier, when I was in high school, the longest paper I ever had to turn in was like four pages and that was double spaced. When I got to college, when I started having to turn in 20 page papers and you know, reading much more significant amounts of material for class, you know, that was a lot more daunting to me and figuring out how to pace myself because again, I didn't have a teacher looming over me, you know, every single day, you know, like you did in high school, making sure that you were doing these little chunks of reading, you know, it was read chapters three through eight and we'll talk about it on, in class on Friday. And that that's a very different approach. And, and students have to learn how to pace themselves so they have time and they don't end up, you know, Thursday night trying to cram in a bunch of material. Financial challenges obviously can be an issue. From housing to tuition to medical care to car problems. There's a lot of issues that come up and a lot of students do not have a lot of extra money. So a lot of students are typically pretty strapped for cash and helping them figure out how to navigate those financial challenges and learn how to budget because when a lot of times when we were in high school, we did not have to budget, we didn't get a check at the beginning of the, of the semester that was supposed to pay for our room, our board, our meals, our, you know, this and that. So we, we didn't learn to pace ourselves, so to speak. Taking on adult responsibilities like paying bills and cooking can contribute to distress because, you know, some people never learned those skills and they're not familiar with, you know, exactly what a credit card is or you know, the fact that you have to pay the bills and it doesn't just automatically withdraw or what a debit card is and how you have to make sure you know how much money is in your account. There's some basic financial fundamentals that we may need to go over. And breakups, just like at any other age, breakups can contribute to distress. Sometimes there are. There's the added issue for incoming freshmen that they broke up with their high school sweetheart to come to college. And now there's, you know, a lot of angst surrounding that. And maybe they start resenting being at college because they miss that person so much. Different needs of traditional and non traditional students. Traditional students are often still dependent on their parents. They're still often on their parents insurance. Parents may be assisting with financial issues, you know, helping with housing or something. A lot of traditional students are still able to go home and, and there, there's a lot of them are adults. So, you know, you don't have the issues where you have to inform parents that if, you know, juniors having difficulty, but they are still largely dependent on their parents. And we need to recognize that and help them bridge that gap. And for some, they may want help figuring out how to differentiate. They may have more scholarship opportunities that they can take advantage of than other students. So that may help with financial issues. We need to make sure that we're communicating with the financial aid department. They may need help with study skills and life skills. There's just so much that we take for granted that children know and we find out later that they didn't. And some of these are basic things. I remember as an ra, we used to have to put on programming every week. And some of the program we did, we went over different types of study skills. We went over budgeting, we went over, you know, how to do laundry and get stains out. I mean, there were a lot of different things that we were able to go over. Traditional students are at different biosocial developmental stages. We want to recognize that some students are going to be more developmentally advanced. Some are going. When I, I started college when I was 17, my, my daughter just started college. Well, she will next week. She's 16. So she's going to be developmentally different than her peers that are 18 or 19. And we do need to recognize that. Likewise, you know, seniors are, you know, more in the range of, you know, 21, 22. So they are going to have different needs and different stresses as they're leaving the college environment. We don't want to forget about those. You know, transitioning to college is a huge change. But then leaving college and having to find a job and get your first apartment if you haven't already, you know, there are a lot of huge milestones during this period that people may need assistance figuring out how to do it. You know, what is the step by step process, process and roommate difficulties. Most college students live with roommates, whether it's in the residence halls or in an apartment of sorts. Most college students do have roommates and may need assistance figuring out how to communicate with those roommates because, you know, not everybody goes to sleep at the same time or one is messy and the other one's not. This is tends to be more true for students who were only children because they never had to negotiate those sorts of things before. And, and you know, that's another one of those things. We want to keep in mind that not everybody has had the experience of sharing a room with a sibling or, or what have you. Non traditional students are students, typically students over traditional age is what we're talking about here. They can be prior military, they may have had a career and come back. There's a lot of different reasons. People may be older and in college, but those students may struggle with issues because they have children and families. They may struggle with time management issues, getting to class, doing homework, finding a space where they can do homework because, you know, they may have toys everywhere and what have you. It's important that we recognize they may have unique needs that we can help them address in how to create a space where they can study and how to help them structure their time so they feel like they are doing what they need to do to succeed in school. Yet they don't feel guilty, they don't feel like they're abandoning their family. A lot of students, not just non traditional students, may work part or full time. We do want to recognize that because it is, this is just one more thing that takes away from sleep time, takes away from recreation time and draws down on energy. Now sometimes it's necessary. I worked all through college and, and you know, it's not the end of the world. But people do need to recognize that that is, you know, an added time stress and an added stress stress. And some non traditional students may have issues with self confidence because they're in a room, they're in a classroom, as with students who are younger than them, sometimes significantly younger than them, and they may feel out of place. We do want to help empower this non traditional students. We want to draw on their skills and their experiences. We want to make them feel like they're, you know, a part of the classroom. And that's going to be really important to help Them feel like they're integrated and not just the, you know, odd personnel. Now, online students, one of you had asked about this, Carolyn. Okay, not a lot of student, a lot of colleges are not opening because of the pandemic this year. And they are having online classes. They aren't just not opening at all, but they're not having traditional face to face brick and mortar classes. And a lot of students are very angry about that, number one, because a lot of teachers don't know how to teach online and they don't know how to engage students online. And there is, when you're doing, you know, full classes and workshops and things, there are a lot of things that you can do that are interactive. There are a lot of ways to engage students that teachers may not know yet. So that's one issue that, you know, faculty may need assistance figuring out how to engage students because remember, if students are bored or not engaged, it sets them up for failure. So we need to address that circadian related issues. A lot of students, if they're not having to get up and drive to campus or ride their bike or whatever it is, they're not getting that morning sunshine, they're not getting that awakeness. And some, even worse, some of them may be sitting at home with the blinds drawn in the dark, staring at a computer and watching their lectures all day long. That is going to completely, completely obliterate their circadian rhythms, which is going to make it harder for them to get quality sleep and it's going to contribute to problems. We, and I'll, I'll talk about how to address that in a minute. Feelings of isolation. This is huge in for online students, especially for your extroverted online students. And you know, I, I'm have told you before, I'm an extrovert. I would feel very lonely if all I did was, you know, lecture, you know, watch lectures all day long. You know, I love interacting with people. And so addressing those feelings of isolation is going to be really important. Helping students figure out how can they feel connected, helping teachers figure out how to connect youth, whether it's through chat rooms or video chats, you know, having breakout groups where people can go and have small group discussions in, in breakout chat rooms. There are a lot of different ways to do that, but the colleges are also going to need, ideally to do things in order to engage the general student population in an interactive fashion. As much as possible. We want to encourage students that are, you know, learning from home to get involved in something, you know, maybe they're not able to go to their campus. Maybe that campus is far far away, but they need to get involved in something and not just sit home all day, all night in front of the computer. As I mentioned, online learning is difficult for extroverts and active learners. Active learners. We learn while we go, we learn while we talk. We talk out the answers. We do really well in small group discussions. We don't do really well if we're having to sit there and just listen and twiddle our thumbs. It's going to be important to pay attention to learning styles and haha. I actually have it this time. Effective Teaching, Effective Learning by Alice M. Fairhurst and Lisa L. Fairhurst. It is a very old book, but it is one of my absolute favorite go to's for figuring out how to modify the classroom experience based on temperament. And that goes back to the whole Myers Briggs Kirsty thing. Love this book. You can get it really cheap. Since it's so old, you can get it really cheap used on Amazon. Anyway, Less interactive means less instructor monitoring of comprehension. When I was teaching at the college level and I was working with people in a face to face situation, I could see people drifting off. I could see people looking at me like what are you talking about? In environments like this, it is often more difficult to monitor that comprehension and students may not realize that they're not understanding it until after class is over. It's going to be really important for students to be able to know how to take advantage of office hours. And it's going to be important again for teachers, faculty, professors to learn how to There's a whole different pedagogy for teaching online suicide prevention interventions. Educate faculty and staff. This includes janitors, residence life staff, counselors, food service staff, library staff, coaches, you know, anybody who comes into contact with students. We need to educate them about the signs of mental health issues and substance abuse issues. Because, you know, the more people who have had. Training in it, and there's a word I'm looking for and I'll find it later, it's later in the presentation. The more Mental Health first aid the more people who have had mental health first aid, substance abuse first aid, the more likely someone is to get identified and referred for services early. Early on. It's recommended that students are required to take a health literacy suicide prevention course at the beginning of the year. They require them to take other courses and you know, this doesn't have to be a long course, it can be 30 minutes. But to provide them information about, you know, what depression looks like, what anxiety Looks like yada yada. Where to find other resources and where to find help if they need it. Reduce the stigma of seeking help. It's important that as a college community or as a community, the college promotes the idea that, you know, about half of you are going to have some sort of mental health issue or struggle with distress at some point during your college career. And that's okay. That is unfortunately very common. And we're here to help make information and resources available in a culturally sensitive fashion, both in person and online. And in person. You know, I've talked before about posters in the hallways. You know, even in, in college buildings, there are those big cork boards and stuff that you can post information on the back of bathroom stall doors. One of the best places to put information because you got a captive audience. Online is another great place where students can go when they're on their mobile device, when they're on the bus, wherever, but they can do it with some amount of privacy in order to access resources. About what? For example, screenings, screenings for depression. There's lots of online screening tools available. Promote well being in a holistic manner. Recognizing the individual, the biopsychosocial aspects. So we have to have medical, psychological, as well as the sociocultural environment. You know, what is the culture like? What is the culture on campus like? What messages are being sent, what is the person's environment like? Maybe they're living in a sorority house, maybe they're living in a residence hall. You know, what is that environment like and how is that, how is that affecting them? Sleep. I told you we'd get here. Biopsychosocial factors conspire to limit the quantity of sleep for many adolescents, resulting in a number of negative consequences. The suprachiasmatic nucleus. I had to practice on saying that. 1. The suprachiasmatic nucleus of the hypothalamus is the circadian timekeeper, or our biological clock. Melatonin levels rise just before sleep onset. Okay, we knew that. What we didn't probably know is that in adolescence, the timing of melatonin release naturally shifts to a later time, making it much harder for teenagers to fall asleep before 10pm who knew? Self reported sleep duration was positively correlated with bilateral hippocampal gray matter volume in the frontal and anterior cingulate cortex. So as sleep duration went up, gray matter volume went up, especially in those frontal areas where we've got higher order thinking, cognitive processing and all important impulse control. Causes of lack of sleep, screen time and technology use. Too late at night, too much blue light, get a Blue light, filter and unplug. Turn the screens off an hour before bed if you can. Social engagements in the evening, it's very easy to get caught up in these early class times. And this is true for high school as well as college. They found that the ideal time was for most adolescents to start class is at the very earliest, 8:30, but preferably a little bit later. They, they need to get at least eight hours of sleep. If they're not going to bed until not able to get to sleep until 10, then they need to sleep until 6. So 8:30 is really the earliest for, you know, making sure that they get good quality sleep. Noise, especially in shared living quarters. I remember living in the residence halls in my room. You know, it was quiet. You know, being an ra, I was by myself, but I could hear people coming up and down the hallway at all hours of the night and it was disruptive. Noise canceling headphones, earplugs. Super helpful for people who share a room with, with other people. You may end up with somebody in your, in, in your residence hall room that snores like a chainsaw. Again, noise canceling headphones or earplugs can be helpful. Poor time management also causes lack of sleep. I talked about difficulty pacing themselves. Well, that's what leads up to, you know, all nighters where you just didn't study and now you're cramming all night long. We want to help people learn how to manage their time. Difficulty transitioning to collegiate expectations, which also means forcing yourself to study, forcing yourself to go to sleep. Stress and homesickness consequences of sleep deprivation. I'm just going to go through these real quick. Sleepiness, fatigue, impaired learning. That's a problem. Reduced class attendance because they're sleepy and fatigued and can't concentrate. Mood issues because their grades are dropping and they're not getting enough sleep. Increased emotional dysregulation. A lot of people, not just college students, when you get overtired, you tend to emotionally dysregulate. More interestingly, eating disorders and obsessive compulsive disorder are also related to sleep deprivation. As deprivation goes up, the risk of those things also increases. Impaired immunity, behavioral issues, substance misuse, especially in the form of caffeine, nicotine or stimulants. Obesity a lot of times because people who are not getting enough sleep do a lot of comfort eating and don't have a lot of energy to work out. So they put on the pounds and pain. Surprisingly enough, pain goes up. Part of that is with that HPA axis activated Serotonin levels are going to go down, inflammation is going to go up, so pain will likely go up. There is no single evidence based practice that has shown effectiveness. Unfortunately, like I said earlier, later class time starting the earliest 8:30 is one recommendation. Limited late night activities, for example, closing the student union at 10 o' clock on weekdays, dimming dormitory hall lights at 9 o' clock on weekdays. To start getting everybody into that sleep mode can be helpful. It's kind of a way of forcing people to start winding down health education about the prevalence of different issues, risks that might contribute to that. Those issues like anxiety, depression, you know, illness and interventions. We want to help them understand what the problem is, what the risks are for developing the problem, but also provide them tools to know that it's not an unsolvable problem. These are the resources available. And along with health education, stigma reduction, as I said earlier, we want to use integrative approaches to student health. Some students are going to do more somat sizing than emoting and vice versa. We need to make sure that there are physical health resources as well as mental health resources available. Motivational interviewing approaches have been in show, have been shown to be especially helpful in increasing engagement with the college student population. Remember they're, according to Erickson, this is a time of developing independence. So this is a time where they don't want us to be paternalistic, as if they ever want us to be, but they want to be empowered. And by using the frames format that's from motivational interviewing, we can help empower them. And frames, if you remember stands for, provide them feedback about the issue, put the responsibility for change on their shoulders. We're not going to force them, give them advice and a menu of options about, you know, different ways they can address this, be empathetic, this is a challenging time for them and be there to support them once they make a decision, support them in any way possible. We need to reduce peer pressure and address, address campus wide negative messages, making sure, you know, things like body image we are addressing, especially around times like right before spring break. I noticed that there is a lot of propaganda that goes up regarding losing weight, getting in, getting in shape for your vacations or whatever. And there's a lot of pressure that is communicated to people about their weight. There's also a lot of pressure in some organizations about looking a particular way. So we want to make sure that we promote the notion of body positivity and health. You know, being obese has a lot of health risks with it, but we want people to Recognize that when they are a healthy weight and that's a pretty broad range, you know they are going to be different shapes. Information about goal setting, self esteem enhancement messages, you know, putting those out in push notifications, push text messages on the television, student television station, whatever. Increase efficacy by making sure that students know how to access to tutoring and mentoring services. Make sure there are extracurriculars that are available. Maybe somebody's not succeeding really well this semester in their academics, but if they feel like they're succeeding in their extracurriculars, you know, they can deal with not being as successful. I remember there were some semesters that I struggled. Improve interpersonal skills and assertiveness. Improve stress tolerance and coping skills. Encourage daily pleasant activities. And that's really important to encourage people to do things each day that make them happy, whether it's going on a nature walk or whatever. Educate students about learning styles to enhance the classroom experience. We talked about that. Increase social support by encouraging group activities in classes, you know, get people together, residence hall activities. Those are super helpful. We used to do something called mudfest and we had four different dormitories that were all in in a quad and in the middle of the quad we would dig out this big mud pit that was 100 by 50 and we would have our own little sort of Olympics games and each floor of each dormitory would develop their own team and compete. And it was a fun thing and people got to know one another that way. Encourage the participation in clubs and through as a university you can promote campaigns like random acts of kindness or smile a day encouraging people to remember to smile at one another or do random acts of kindness. Peer specialist facilitated online and face to face support groups can also be really helpful. You know, having somebody who is 20 something, you know, they just went through undergraduate facilitating some of these groups and can be super helpful because they've been there and recently and in that environment at that particular university or college. Technology based programs for screening and treatment have provide anonymity, accessibility and cost effectiveness. 74% of students acknowledged and have received health information online. And more than 40% of frequently searched the Internet for health information. One thing that I found that was really interesting was the universal screening and stepped care model. It appeared to be more cost effective to university based psychotherapy than just the whole wait and treat. If they get bad enough, they'll come to counseling. So it started out with psychoeducation and as people's symptoms progressed it would gradually step up and you know, by the time they reached the level of having a DSM diagnosis. Obviously they were stepping into real time interaction either virtually or in person. Mental Health first aid for mental health, addiction and eating disorders. They have different mental health first aid curricula to teach these things, but we want to make sure that faculty and staff can identify these things early so they can point people in the direction of helpful resources should they choose to take advantage of them. And an eight week Internet based cognitive behavioral program called Student Bodies included a moderated online discussion group. What they found was no participant with an elevated baseline base metabolic or body mass index in in the treatment group developed an eating disorder, while rates of eating disorder development in the control group were 4.7 at one year and 11.9 at two years. So student Bodies seem to be really effective. Interactive cognitive behavioral based psychoeducational programming needs to focus on risk factors and dispelling myths. And there are nine prevention programs you can look at in in this article later if you are interested in that. Remember though, with technology it can be a help or a hindrance. Mental health apps like those that help with guided meditation or cognitive behavioral therapy can be really helpful as therapist extenders or early intervention tools. Mood Cow is one that again helps people basically become more mindful. That's something that the university would look into purchasing and making available to students. We also want to educate students about disinhibition and online safety and social media. And disinhibition is just knowing that when people are online and they're anonymous, they are going to say things that they wouldn't say to your face. They may take things out on you that have nothing to do with you. Unfortunately, being behind a screen allows people to be nastier, but it also allows people to connect in a meaningful way. So we need to help people figure out how to find the meaningful and avoid or set boundaries with the nasty. And sites with active moderation and peer reviewed education in can be really helpful. So you can have a for example a a peer support group that is actively moderated on your intranet at the university. Other Tips Bring comfort foods. Comfort foods? Gosh, sorry, no. Bring comforts from home like you know, your pillow or pictures. Don't spend too much time alone in your room because you can get stuck wallowing and feeling isolated. Set a 24 hour rule for homesickness when you start feeling homesick, you know, maybe give yourself permission to feel homesick for 24 hours, but then you know the next day it's time to reset. Be realistic. Remind yourself that every day at college is not a wild party. There are going to be some days that are pretty mundane. Explore your surroundings. The more you get to know your new environment, the more you will feel at one with it. Get involved. Choosing real life over social media. Take lots of photos and personalize your space. And if you need to video chat with people at home so you don't feel as isolated. Most college students are away from home for the first time. They have to quickly learn to live alone, develop new friends and adjust to collegiate life. A stepwise approach to prevention is recommended. Mandatory universal education. You know that initial online class that addresses risk factors has been found to be very helpful in preventing a lot of problems. Universal screening either online or face to face for mental health issues at least once a year is recommended. Mental health first aid Trained staff and faculty. Development of social support, efficacy and self esteem in the college population. Figuring out how to do that for your students and making sure there's an availability of blended, you know, like in person and online and face to face support and treatment services. Again, both medical and mental health. Alrighty. Ran a little bit over. I apologize for that. But hopefully this will give you some ideas of different things you can do now. Remember those students who aren't able to participate in on campus activities this year because of COVID we're going to need to encourage them to find similar activities where they are at. So for example, extracurricular activities. I know a lot of community centers are starting to reopen, so encouraging them to get out there and still engage with people and think about what was it that they wanted their first year in college to be like and what can they do to make this current situation as much like that as possible. And there are a lot of things that they can do to, you know, affect change and to create a and experience in their first year. Similar, not the same. Similar to one they may have had had they gone on campus. If this podcast helps you help your clients or yourself, please support us by purchasing your ceus@allce.com or getting your agency to sponsor an episode. A direct link to the on demand CEUs for this podcast is at allce.com/podcastce. That's allce. Com podcastce to sponsor an episode of Counselor Toolbox and reach over 50,000 clinicians per week. Go to allce. Com sponsor. Thank you.