Latest / College Is Fine, Everything's Fine / #24 How College Culture Has Normalized Drug Use: A Psychiatrist’s Break Down of Study Drugs and Why You Should Just Say No

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#24 How College Culture Has Normalized Drug Use: A Psychiatrist’s Break Down of Study Drugs and Why You Should Just Say No · College Is Fine, Everything's Fine

Hi Dr. Bush. We are so excited to have you today.I'm glad to be here. Thanks for inviting me.So why don't you introduce yourself to our audience?Sure. So I am an adult child adolescent psychiatrist, which means that I prescribe medications and also provide psychotherapy for people who have anxiety or depression or just generally struggling. Um, and not quite for why.Gotcha. And a lot of people might not know the difference. I've figured that people are constantly calling me a psychiatrist, um, and I'm like, no, I'm a psychologist. They're like, well, what's that? And what's the social worker? So psychia in short, psychiatrists prescribe the medications. Psychologists do the talk therapy as well as social workers and other kinds of therapists, and many psychiatrists also do therapy.But you guys are the ones who know the most of the information out there and then prescribing the medication,Right, and I usually also say, you know, one thing that's distinguishing is that we've been to medical school, so I've like done surgeries and delivered babies and done all of these kinds of things that have decided to focus specifically on the mind body connection.right? But you've seen inside a body, and I have notYes,exactly. um,you call yourself the college psychiatrist. Is that right? Do I have that?Yes, absolutely. Yes. . Yeah. I love working with college students. Um, that's my main focus and you know, one of the reasons why I like to do this is because, um, one, it's just a lot of fun, um, as adolescents are becoming adults, but also my own experience in college. Um, you know, I had struggled. I really struggled.I came from. A public school in Albuquerque, New Mexico to the University of Chicago, which is like a huge change. And I went to get help at student counseling and they said, oh, you're depressed. And I was like, okay. And sad. But um, you know, And that totally turned me off, and I didn't find out until later that I really had my own different learning challenges.And so, um, I wish I would've known that in college. And so what I am hoping to do is really provide a more nuanced assessment and treatment planning for college students. That's okay. Maybe you have these mental health things going on, but what else is going on? What is underlying.Yeah. Versus is just smacking a big depressed label right. On top of a lot, much more complicated story. Yeah, that'd be, that sounds. We are really excited to have you here today because it's the first time we're speaking with a psychiatrist. We've gotten a lot of feedback about access to prescription medications that maybe were not prescribed to them, that a lot of college students are using on college campuses, and even if they are prescribed to them, I think there's a lot of misuse of.Prescribed medications. And so what we would broadly maybe call these are study drugs. So maybe you could tell us a little bit about what are these types of medications, what would they typically be prescribed for? Yeah, so study drugs are things that are typically in the psycho stimulant category. It's a big word, but basically stimula. Um, that would be prescribed for adhd. And so that would be things like Adderall, Vince Concerta, Ritalin, Focalin, those kinds of things. Um, they act on the brain to help people. Focus is really the big gist of it.And so they're really effective and that's the thing. Um, of all the medicines that I prescribe, these are probably the most effective. I think 70% of the people that take these medications will notice a difference in how they're able to focus in. Now just because you take them and see that difference doesn't mean that you necessarily have adhd.So I will say that about this medication. So anyhow, um, these medications, they come in long-acting forms. They come in short-acting forms, um, and they are prescribed by. Either a psychiatrist or pediatrician or primary care doctor, and they're regulated. They have a special classification, um, within, uh, the DEA a's classification system.And so you have to have a special license to prescribe them, and they're also monitored in a different way. Um, so these are the medications that people are often either pres prescribed and or using when they're not prescribed. The way I think about it is, you know why someone with. might need them is because the stimulant for them is really stimulating the part of their mind that struggles, right? The executive functioning piece that regulates things like attention body, kind of hyperactivity, the part of their mind that where that those pieces are stored right, is asleep sometimes, and the stimulant acts to wake that up as opposed to somebody who doesn't have that, they don't need that to be woken up.It's already.Mm-hmm. No, I love that. I love that. So, so not only, um, awaken that part of the brain, but also like helping to organize and focus that part of the brain, because that's the other thing, right? Um, that part of the brain really helps people, , organize themselves, uh, put things together.And the stimulant you might also kind of think about as like the glue, the kind. puts it all together, um, so that people can do the things that they need to do. And you're right, people who have ADHD are sort of missing that. Um, and the medication helps them. Well, actually, I learned this of course from a child psychiatrist that I worked closely with who I, and I stole this from her, but she said, That medication for adhd, it's almost like the part of our brain that organizes things is the conductor, like of an orchestra. And so you might have the wind section and the string section and the percussion section, and all those sections might play really beautifully, but the conductor falls asleep and so they don't know sort of when to come in if they're gonna be quiet loud, just stop all together, and the conductor has fallen asleep.So the medicine helps sort of wake the conductor. So that he can help or she can help like organize the different sections of the brain. Um, and I think to your point, when you said, it just reminded me when you said it has to sort of organize and it's the glue of it, but Right. Everyone has these different beautiful parts of their brain and we're trying to stimulate or wake up the conductor so they can describe and kind of help the different pieces work together and not against each other.But if you don't have adhd. Your conductor's working just.Yeah, your conductor's working just fine and or you know, there are people who might be having some different challenges.right.So another way that ADHD is diagnosed, I can diagnose it as a psychiatrist, but there are also psychologists who can diagnose with other formalized testing, sort of that comes together in a report called a neuropsych, neuropsychological testing or neuropsychological report, right?And so in those, during that testing, you might find that you have a difference in the way that. Read, um, or the way that you process math problems and those kinds of things. And so, um, I think it's important you know, that people understand what other challenges they might have. Cause taking these study drugs may not actually help, right?Like if your conductor is awake, but the wind section is not playing the right music. It doesn't matter if you wake up the conductor. Right. So, and that, you know, one section might be a learning, like a reading difference or how you're processing math or things like that.Right. A memory issue, all sorts of things.  Dr. Bush some things you said earlier. I do wanna unpack a little bit that, um, you alluded to the fact that these medications are regulated, meaning that there's something about the quality of the medication and how it works, that we really wanna be mindful, like other drugs, I believe, but you can correct me. You have a tendency to form a dependence or be abused or misused. Right. So, you know, stimulants are kind of, uh, work on the brain in the same way that like cocaine does essentially. Um, and so, uh, as we know, cocaine is a substance that, um, is an illicit drug, right? And so, Uh, in the same way stimulants can be habit forming. And so this is part of the reason why they are so regulated.Um, you know, as our opiate, as our, um, other things. Um, Interestingly enough, other things that can be happen forming like alcohol, tobacco are not necessarily regulated, but conversation for another time. So anyhow, um, these things are regulated not only for their potential to form, um, addiction, uh, but also because they impact the body in ways that can be very dangerous and.You know, when I'm prescribing these medicines, I'm doing a careful history, a careful medical history. Uh, these medicines are not indicated for people that have a family history of sudden cardiac death. because they increase the heart rate, the blood pressure must, can really predispose someone who has this in their family to death.That's a very serious thing. Um, so, so there's that also contraindicated for people who have a history of disordered eating or eating disorders and that they can really make eating disorders worse. And eating disorders can also be, . So, um, they have, these medications have to be prescribed carefully, um, to people who, who don't have these contraindications because the implications are serious, really can be a matter of, of life or death.I will also say, and this isn't, you know, um, necessarily they're so regulated, but it's an important factor in considering who they're prescribed to. , they can increase anxiety. And so one thing that I find is that sometimes folks are having problems with their academic studies because of anxiety and the treatment is completely different.Stimulants can actually make anxiety worse, and they can increase the physiologic sensation of anxiety, heart rate, uh, blood pressure, uh, respiratory rate. And so this is another reason why they have to be prescribed thoughtfully and carefully. Uh, someone who, who knows what they're doing.What are sort of the pros but mostly cons of using these and you said death, so that's, you know, it's a pretty big one. , sothere you go. That's great. Are there other reasons outside of, you know, life threatening reasons why you might say, you know, and again, you already mentioned things like if it's anxiety, it's not really helping, but any.Potential reasons why these probably shouldn't be your first go if they're not prescribed.Yeah. So, um, a couple of things. One, you know, common side effects of these medications can lower appetite. So if there's someone who is already struggling with maintaining a healthy weight, whether they have diagnosed anorexia or not, maybe they're just underweight, uh, this can be a challenging medication, not a total contraindication.Um, but it's a, a thought when we are prescribing it. Um, if they're already having difficulty with sleep, you know, uh, these, uh, medications can interfere with sleep. And so you, you would sort of adjust the time of day that you take them, but also being attentive to if this is impacting your sleep. I, I was gonna say, you said that, um, these medications work really similar to cocaine would, right. And if I were to survey college students, and if I were to say, you're having a hard time studying, you need to kind of focus and stay awake. Would you do cocaine versus take an Adderall from your friend?I think most people would tell me that they've probably already taken the Adderall from their friends versus the cocaine. So what are your thoughts, Dr. Bush, about why. college students might be more agreeable to taking a friend's prescription or potentially even getting a prescription, even though it's not warranted, even though you're saying it's well-regulated. Mm-hmm. , I mean, it seems safer, right? It's prescribed by a doctor. Um, you are not getting it from X dealer on the street where it might be laced with X, Y, or Z, right? They see it as a safer option, um, than getting something, something that's not prescribed by a doctor. Um, I think that's, that's the biggest reason, and again, it.It probably works, right? 70% of people respond to it. They might say, oh yeah, this really worked. Now it's actually interesting. In the literature we see that in the long run, there is no correlation with taking stimulants that are prescribed for someone else with higher academic achievement. Which I think is really interesting, right?Because I, in the minds of a lot of college students, and listen, I'll say even non-college students, I have parents who come to me and say, oh, I took my child's Adderall. Like, I think I might have ADHD anyway. Um, in the minds of them, they think, oh, if I take this, I'm gonna be better at X, Y, or Z. I'm gonna be more successful.And so it's kind of interesting that you see in the literature that's not always the case. Um, so yeah, to answer your question, I think that people are taking them because they think it's safer than getting something from the street and then, , you know, there's just a lot of need to achieve and have good academic performance to get ready for internships or to be competitive internships, and then to be competitive for jobs or graduate school.So I just wanna acknowledge like there's a lot of pressure to perform and to perform at a high level.Mm-hmm.Yeah, we talk. We've talked a lot about how in these situations we can give a ton of advice, but we also recognize that the environment's really powerful and it might be worth trying to look at other ways. To not combat that necessarily, but to, to pay attention to that piece of it. Um, I know we're talking a lot about people who aren't prescribed these medicines and take them maybe are friends or from in some other way, but there's ways to abuse it even if it's prescribed to you.Mm-hmm. . Absolutely.let me just snort it. Oh What do you say to them?I say this is not good for your nasal cavity. Um, that's what I like your nostrils. very practical thing. And I mean, listen, when I'm working with my students, I do have a harm reduction approach. So I, you know, there are some folks who I think just thinking about substance misuse in general, that abstinence is the best policy.I really try to do, keep an open door so you can have a conversation I can talk to you about, okay, well what is this doing to your body? And so for folks who are using cocaine, I'm like, okay, well let's think about reducing your use. What can we do to protect your body? And those kinds of things. So one, I would say, okay, let's think about what this is doing to your body.How can we. Reducer used to do it more safely. So that's one thing. And the reason why people do it is cuz it gets into the bloodstream faster than if you take it orally. Obvi, you know, maybe that's not obvious, but that is why people will snort as opposed to taking it orally. Um, and so, you know, this is one thing I should bring up.If people are abusing this means that they're probably taking it as it's not prescribed. So crushing it up, sorting it, taking it more frequently. , you know, um, I might have someone who comes, says, oh, I'm out of my prescription. I need more, or sometimes I lost it, or these kinds of things. And so either they're giving it to friends or they're using it more frequently.So if maybe it's prescribed to take once a day. Maybe they're taking it twice a day. Maybe they're taking it three times a day. Um, . And so, and that can be for a number of reasons. Either they're feeling like they've got to get on top of their assignments or they like the way that it makes 'em feel, um, awake or whatever it may be.I see a lot of college students, um, misusing their medication in the sense of feeling like it's an advantage that they can stay up later. Right. Um, you know, back to that achievement piece, I think they're very attached to, um, they might need it, you know, just in terms of the, what their brain chemistry looks like.But then they're running out of the medication, like you said, they're misusing it, they're using it as a way. That in the long term causes more impairment, right? They're not sleeping, et cetera.Mm-hmm. . Mm-hmm. . And you know, the thing that, so again, I provide a lot of psychoeducation, and I'm sure you guys know this, like your brain needs time to consolidate the information that it learns and that happens during. Sleep. So it's actually working against yourself if you're not sleeping at night. And so that's one thing that I talk about.Okay. And, and thinking about other things that we can do so that you're alert for longer time or you know, like maybe we start with exercise in the morning and that's really a natural way of treating adhd. And then you take your stimulant, you know, At whatever time and you're just sort of having a longer duration for the day where you're attentive and can focus on things.So I do a lot of, you know, behavioral modifications. Okay. If you're more awake in the morning, let's try to get the bulk of your studying done in the morning. Or, you know, you guys probably do all of these things. Um, but that is one of the things that I talk about is like your brain just needs time to get all that information in and make sense of it.It happens when you're asleep. So we wanna make sure you're getting good.Yeah, I think about when you have sort of a sinking ship because of a lot of different holes, right? Lack of. A powerful environment. Maybe you think that the taking medicine is gonna plug a hole, but it really just does that, it plugs a hole, but the water's coming in in terms of the fact that you're not able to consolidate your sleep.Or maybe you're technically finishing reading a book, but you have not absorbed it cuz your mind is working too quickly and that in the way it's used to. And we also know that learning is state dependent. So if you are learning while high, or if you're learning while activated on a stimula, You're probably gonna need to really be high for the test to A, access the information in the same way.So our brains don't really work the way that we sometimes want them to from that perspective. And yeah, sleeping, eating, these are some of the foundations and pillars of, of a happy mood or a kind of a regulated mood. So if you're anxious and you're taking these things, but then now you're not sleeping or eating effectively, I mean, it just starts to become. a snowball effect, really. But I do think that I've had people who are prescribed these things because they do have adhd. They really need them to regulate. They'll take two because they have a big paper and then suddenly they don't have enough at the end of the month, and the doctor is not going to prescribe them more because they're aware, Hey, we know that you double up.You know, we can't, it's regulated. We can't just keep on allowing this to happen. And so it's a real risk. to take more of than prescribed or to give them to your friends, especially for somebody who does need them to do the work.And I would say, you know, um, This can be important to have a good relationship with the person who's prescribing your medicine, right? Because if someone comes to me and says, Hey, I'm feeling like my medication is wearing off by three o'clock, but I really need to be able to study until less time, we can talk about how do we change the dosing so that you really are covered for the times that you need to be covered.So I think a, a good conversation can be had. Um, with your, with your doctor about how can you make the adjustments that you need so that you're not running out, uh, you're still having a reasonable dose and that kind of thing.All right, so let's say you have to go into your doctor and fess.Mm-hmm.something that they might be able to say and how could you preview that conversation for them? You said harm reduction before, but what would that look like in a back and forth with you?Oh, that's a good question. Um, you know, I, so it can go, it can go a number of ways, right? I really do encourage transparency. I, I, I can't really see a lot of people coming to me and say, Hey, I've given this medicine out to my friends. Right? Because I think that would be sort of a no-go for continuing to prescribe.Right? Um, and, and I think that's reasonable for anyone to say like, okay, that is a, a very clear misuse of the medication and it's not safe to continue prescribing. You know, if it's, again, hey, I find that if I take, you know, my Adderall is five milligrams twice a day and I find that if I take an extra one in the late afternoon, I can get a little bit more homework done.I think that's reasonable to say in that way to your doctor and say, is there anything that we can do to change my medications? Because I know that I'm running out early. Um, and I think it is okay to be honest about that. Right. Um, So that's what I would do is really say, Hey, I'm finding that this medication is not helping them the way that it used to, or it's not lasting as long.I think that's a great way to start the conversation, um, about it. And, you know, different places have different policies. Sometimes doctors will have a contract that you have with them for controlled substances. And if you are. running out of them early, that can be sort of a violation of the contract and, and potentially in the patient physician relationship.So there are some different considerations there, but I think, um, you know, if you're having, if you're using more because you feel like you need it, you can approach 'em that way. Um hmm. I think also if you're finding that you're using it in a way that you can't control, , that's also something that you can talk about with your doctor because there are resources, there are things that we can think about doing to help you. So you're to say like, I find myself like just really wanting to use this and feeling like I just, I, I need it and I can't stop. Um, that's a different conversation to have one that I also welcome. Right. And to sort of extend beyond study. I just, when people are using other drugs, I say, well, what does it do for you?How is it helping you? And see if we can come up with a safer way for you to get help. Is there an alternative that I can thrive? Or something like that. So, um, so I guess the best policy would be to be honest, uh, and sort of say what's going on for you. And I think that we as doctors might have more to help than, than you, than you know.I'm pausing just so I don't make sure I interrupt.No, I was just gonna say quickly, um, I know there's a lot of barriers to college students finding psychiatric care, but everything you're saying, I just, I see a lot of college students. Um, I. undervalue their relationship and communication with their psychiatrist or whoever's prescribing their medicine.And they're like, well, I have you, you're my psychologist. Like, I love you and I like talking to you. but I'm like, I'm not, it's really important, like how, like how important it is to feel comfortable talking about your symptoms, talking. If you're struggling, uh, with the medicine you're on or other drugs that you're taking, and as you were talking Dr.Bush, I'm like, oh my gosh, I wanna refer some of my patients to you. Um, but I think, um, I know not everyone has the luxury to being able to shop around for different psychiatric providers. Um, but I love the language that you just gave for them to hopefully have a script that if they're in a position where they feel like they're struggling to come up with the words to talk about what they're going through, uh, that they heard it.One other thing I would say, because you're right, not everyone has the luxury to shop around. I have the luxury of time because of the way that I've structured my practice. So my follow-up visits are at least 30 minutes and sometimes longer. Not everyone practices in that way or can practice in though there are a lot of pressures.So another thing I would say if, if you're finding that you need to have a longer conversation is to maybe say that for your follow-up appointment. I know a lot of follow-up appointments for ADHD management can be 15 minutes.Hmm.sometimes it can get even shorter than that five or 10 in practice. And so you might say to the person prescribing your medicine, Hey, I have some questions.Can we have more time at our next That's Can this be a 30 minute visit instead of a 15 minute visit?It's a nice, easy way to advocate for yourself,and I also basically, what I heard you saying is that no one's going to get in trouble by telling you the truth, and at best we'll be able to get some really feasible help from you by telling them the truth. I try to tell people all the time, like, there's not one thing you're gonna tell me that's going to be shocking by any stretch.I've heard it before and if I hadn't heard it before, I'm still in the place of trying to help you. That's still the goal, always. I like that idea that you're gonna be looking at what is part of the picture. And so from that perspective to zoom out, if someone is abusing stimulants, whether they're, whether they are prescribed or not, that's probably a sign that they're feeling maybe overwhelmed or that they don't have another skillset to put in place or a community or college that's supporting them.I mean, I think we can start to look at if this is happen.whether you continue or not. Cuz I can't control that. At the very least we can start to figure out why is this feeling like your only option? I would just say because a lot of the times people don't know when they have a problem because a lot of people around them might also like, it might be normalized. Right. So I just wanna say here are a couple of questions that you could ask yourself to determine, um, if you're using in a way that could potentially not be healthy for you.Right. And this would be kind of wondering, am I using too much so. questions. You've tried to cut back and you can't. Others have found a problem with how you use or have been critical. Like, man, you're doing that again. Like, um, you feel guilty about how you're using and you feel like you need to use a study drug or something.Just sort of in the first thing in the morning to get up or to combat feeling hungover or. You just don't feel normal unless you use it. So those are kind of four questions, and if you answer yes to any of those, um, it's probably worth talking about with a person who's prescribing the medicine or finding some resources on campus for help, which I can, um, give you guys that you could either put in the show notes or something.Yeah, definitely. I also think it's really important to think. Yes. Cuz you said it's normalized and there's some. There's some places where it's normalized. There's some groups where it's normalized. And so sometimes you also wanna make sure that you're peeking, and not to compare yourself necessarily, but it's just to peek out if any of those answers are Yes.But you're finding, you're saying, but my friends.Well, you know, sometimes we find people who help us feel better about current bad decisions or unhealthy decisions, but you might start to pay attention to is that actually helping me in the goal of using this Less,Mm-hmm.stop being friends with them, but maybe not to, but, but to be able to use yourself as the barometer and not just the people in your immediate.right.Mm-hmm. . Absolutely. All right. Dr. Bush, if people are gonna try to find you, where would they go?So you can find me@collegepsychiatrist.com, and I'm also on Instagram, TikTok, Facebook, LinkedIn, but Instagram, TikTok, and Facebook. At College Psychiatrist. So you can go to any of those places to find more information. And if you'd like to book, um, an initial 15 minute consultation, I'm licensed in Illinois, Texas, Massachusetts, and New York.You can go to my website and there's an easy link to book a free 15 minute consultation.All right, easy. We already follow you. So highly recommend for other people to do it, and thanks again for coming on.Thank you for having.