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#63 Party Smart: A Psychologist's Guide to College Drinking and Drug Use · College Is Fine, Everything's Fine

riverside_college_is fine pod_raw-video-cfr_alcohol_to regulate_0002: [00:00:00] Hi everybody. I know I've said this a lot lately, but I really am so excited to have our guest on today because. James, Dr. James McOwen. We met in graduate school, um, as just young, carefree 20 somethings, and it was such a special friendship. Um, and again, it's not the only reason I started this podcast, but a big reason I love it is to see people who I don't get to see as much every day.We had this like four to five years of like, what trauma bonding. James, would you say?riverside_james_mckowen_raw-video-cfr_alcohol_to regulate_0001: would say trauma bonding is the right way toriverside_college_is fine pod_raw-video-cfr_alcohol_to regulate_0002: Yeah.riverside_james_mckowen_raw-video-cfr_alcohol_to regulate_0001: it.riverside_college_is fine pod_raw-video-cfr_alcohol_to regulate_0002: And now that we're happy and healthy in adults, we, we don't see each other nearly as much. So, um, anyway, so this is my excuse to hang out with you, but I'll stop there for a little bit. And James, why don't you tell people the, uh, yeah, your, your fancy titles and stuff.riverside_james_mckowen_raw-video-cfr_alcohol_to regulate_0001: Thank you so much and thanks for having me here. Uh, so James McCann, I'm a [00:01:00] clinical child psychologist. I'm a, uh, assistant professor at Harvard Medical School and Mass General Hospital, where I run a clinic for teenagers and young adults with substance use disorders and mental health issues. So I work a lot with college students.You know, Boston,we have a hundred thousand colleges in Boston, so, uh, and we see a lot of college kids and I have lots of college kids as my, as my patients' clients.riverside_college_is fine pod_raw-video-cfr_alcohol_to regulate_0002: So, um, I, it's interesting how many, isn't there some statistic, like there's x number of students in Boston versus non-students? I mean, it's a, it's like,riverside_james_mckowen_raw-video-cfr_alcohol_to regulate_0001: Right. It's like sheep in New Zealand versus humans type of thing. Right? It's way more, way more college students than like non-college, college people. Mm-hmm.riverside_liz_raw-video-cfr_alcohol_to regulate_0003: James, I'm detecting an accent. Are you from somewhere?riverside_james_mckowen_raw-video-cfr_alcohol_to regulate_0001: Not New Zealand. Actually, I'm from the United Kingdom. There are a lot of sheep in the UK as well. Talking about sheep today or alcohol, I forget. Anyway, um, I'm British. Yes.riverside_liz_raw-video-cfr_alcohol_to regulate_0003: Yes. [00:02:00] Okay. I mean, I have been to New Zealand and I did see a lot of sheep, so I really, I really got that. But no, we are gonna talk about alcohol. Um, and we're so lucky to have somebody who's really, um, seasoned and research about this and also sees a lot of people clinically, so, um, okay. So we know that college is a time for experimenting with alcohol.Um, and for, I feel like a lot of teenagers, it's like their first, um. You know, exposure to the drinking culture. Um, what's your opinion though? And I, I really, this is a big debate amongst patients that I see about what's typical versus atypical in terms of drinking as well as drug use in college. And I'd love to hear your thoughts about that.I.riverside_james_mckowen_raw-video-cfr_alcohol_to regulate_0001: Yeah, I think, um. College drinking, if we talk about alcohol specifically versus other substances. So people that go to college do have high rates of alcohol use compared to people that don't go to college. Um, and we know that it's more normative in college, right? You think about going as a [00:03:00] freshman, I mean, I went to the United Kingdom where like drinking culture's even bigger than the United States.And the first week or quote freshers week as you're a fresh person there, I guess, I don't know, um, is characterized as a lot of. Partying and drinking. And we don't have kind of Greek culture in the uk, but there's a lot of drinking in sports. And, um, and here in America too, a lot of fraternities and, and, um, athletes tend to drink a lot, so it's definitely normative to drink in college.I think about 70% of college kids. Do drink, but problematic drinking is much less, of course, but about still a decent amount, about seven to 10% depending on the study, um, which is higher than non-college populations. Um, and it's normative as a freshman, sophomore, and then drinking starts to kind of turn towards lower use as a junior and a senior. Um, and so by the time people leave college, their drinking is definitely much lower than it is as a freshman.riverside_college_is fine pod_raw-video-cfr_alcohol_to regulate_0002: How many, um, sheep drink? No, I'm teasing. Um. [00:04:00] I am curious about that. I actually did not realize, although it makes sense, thinking back, like I didn't realize that it would be going down junior and senior year. Do, is there a couple of reasons why that is? I.riverside_james_mckowen_raw-video-cfr_alcohol_to regulate_0001: Yeah, I think a couple. I think some people who struggled with to regulate their drinking in freshman and sophomore year of maybe I. Had to leave, like I work with a lot of college students on medicalleaves or they need to go on, um, treatment leave. And so it might sort of filter out. Um, but then again, people start to become more serious about their academics and they look to do kind of internships and they're looking at graduation, so. They're a little older too, and so I think they've accrued some consequences, you know, the tired being hungover or, or whatever it might be. So I think there's, there's a, a shift there as well. Plus the peer, right? The peer influence is so huge in college that your peer group is also, tends to be drinking a little bit less, so it all kind of affects each other.riverside_college_is fine pod_raw-video-cfr_alcohol_to regulate_0002: Yeah. Yeah. [00:05:00] I, um, I was curious. I was also thinking a lot of the Greek culture frat rush and sort of rush and the drinking and parting that goes around that as well. I can imagine It feels like, okay, you can stick with the, the herd, so to speak, mentality of that. So there's a lot of drinking with those types of events.But if you do still plan, right, because I, I know that a big part of what we don't wanna say is like, hey. All drinking is bad. You know, of course we could list all the different health reasons why it's safer to drink less, but it is college. We know, to your point, you said that around 70% of people are drinking. So let's say you still plan to drink, you know, you're not listening to this because you wanna drink less, but you're drink, you're listening to this so that you can stay safe.What are some safe ways, um, to drink, smoke, do drugs? Is there a safe way to do [00:06:00] it?riverside_james_mckowen_raw-video-cfr_alcohol_to regulate_0001: Yeah, great question. It depends on who you know. If you think about just, you know, what's your doctor gonna tell you? They're gonna tell you that any alcohol and drug use. Is bad for your health and they're correct. Itis not good for our health. Right? We know that. And at the same time, we still do certain things.So if we think about harm reduction, which is this idea of like, if you're gonna do it, let's try and do it in a safer way as possible. So, um, that would be watching how much of the substance you drink in a short period of time. So college is particularly like, you know, you pregame, you drink some shots, then you go to the. The party or whatever, and you're doing flip cup and there's a keg and like you just, you're drinking quickly. You're drinking a lot of booze really quickly. You're often drinking mixed drinks. You don't know what was in it. Some dude is pouring it for you. It could be two units of vodka. It could be four.You have no idea. It all tastes terrible, right? As I remember, kind of terrible mixed drinks from various parties, Right.So you just gotta be careful, like how many drinks you're drinking per hour. Um, and so binge drinking is obviously five in two hours for a guy and four for a female. And so if [00:07:00] you can watch how many drinks you drink per hour, so maybe one to two an hour at most. If you can switch out to like a soda or you don't want to be the kid that's walking around with nothing in your hands, so feel your like red cup with soda water or, or alight beer or something like that. And, and theliquor is often where I. Kids that I work with get in trouble. Um, certainly you can drink a lot of beer, and beer can be quite strong, right?Um, but liquor is where people get into trouble.Um, and so watching liquor, watching mixed drinks, um, making sure if you've eaten right, so have that pizza before you head out. Eat the burger fries. That doesn't. Change the amount of alcohol, but it releases it more slowly. Um, 'cause what happens is that you drink that alcohol so quickly, it just kind of really floods your system.But ifyou eat, it releases it more slowly, more gradually. So it's a little bit safer in that way. Um, so those I think are some top tips I [00:08:00] think for, um, you know. Women in particular, you've got to be careful, um, with binge drinking and drink that. That's where unfortunately, women both metabolize alcohol more slowly.And so four drinks for a woman is actually way more than it is for a guy, and that's to do with fat and all that kind of stuff. So girls nowadays are almost drinking. To catch up with guys or as much asguys, and there's a culture around that, but they can get drunker faster as well. So that's definitely something to pay attention to depending on kind of your, your gender identity or your gender.riverside_college_is fine pod_raw-video-cfr_alcohol_to regulate_0002: Yeah.riverside_liz_raw-video-cfr_alcohol_to regulate_0003: Okay, so that's not a good transition. I wanna like respond in some way, but I need to think about it. Um, um. Okay. So there are some tips I think that are really helpful in terms of, and things I probably wish I knew in college around, um, how many drinks you can kind of keep an eye on in terms of staying safe when you are drinking.[00:09:00] Um, so we're talking a lot of like social factors as to maybe, and that's what I think about even my experience in college was like everyone getting together, going to a party. Going to tailgate before a game, um, and drinking, but that might not be the only reason why college students are drinking. Can you share some other reasons why there's an increase in alcohol use in college?riverside_james_mckowen_raw-video-cfr_alcohol_to regulate_0001: Yeah. I think for some people it's like you said earlier, Liz, like the, the first time being away from home, they're not in their high school. And so there's this sense that this, this is something you can do. There's a belief, right, that this is what you do at college. You kind of use substances and you get drunk.So that's a piece of it, right? Our cognitions are thinking patterns. Um, there's definitely more availability, right? So people often go to colleges and cities. They may have more access through parties, so they may, um, just encounter alcohol more frequently. Um, athletes, like I said, those in particularly lacrosse, kids have high rates of alcohol[00:10:00] use compared to kind of other, it's definitely, it's not my total area, but I know I. Different sports groups have,some, have higher rates of use than others. Um, gender, right? We talked about boys tend to drink more than girls broadly. Um, and then of course, those who are struggling with a mental health issue,I. Um, so if you already have sort of an anxiety depression, O-C-D-A-D-H-D, you may, if that's not well managed or controlled, tend to when you drink you might end up drinking more to kind of self-medicate. Um, and then of course there's other factors like if you have a family history of addiction, you're gonna be more at risk for, uh, more problematic alcohol use than say you don't have that family history, which sucks 'cause there's nothing you can do about your gen genetics. So,riverside_college_is fine pod_raw-video-cfr_alcohol_to regulate_0002: Yeah, I know. And um, and some people might be aware of. That as they go in. And some people might be figuring that out a bit as they go. So I know that that certainly can happen where it's like, wait, why am I having a harder time with this than my friends are? Um, and it might have to do simply with, with [00:11:00] genetics or something that you can start to do a little, a little digging about perhaps if that's the case.Um, I do think the idea of struggling with a mental health issue or even if you're just dealing with some general college stress, you know, we've talked about. The amount and kind of kind of where that might be normal or atypical. But what about more problematic reasons for drinking? Do you find that there's times when you start to worry about that self medication and do you have any signs of what that would be different from your typical just going out with friends and.riverside_james_mckowen_raw-video-cfr_alcohol_to regulate_0001: Yeah, definitely. I think, um, we think about a lot of substance uses to have fun, right? Like pretty normative to, and that's been, you know, that's pretty evident that people do that to enhance their experience. And that's pretty normative and, andtends to be okay, but when use is either done alone or as a way to manage depressional stress. Um, I'm so anxious I need to drink to calm down, [00:12:00] or I'm so anxious socially I'm gonna get drunk before I go out. So when it starts to take on a functional role to manage difficult emotions to escape or avoid or change something, um, that's when it can start to become. A problem because that is very reinforcing. Um, and so that's when I think drinking or any of, uh, drug use really can become sort of start to move into the n not so functional space.Um. riverside_college_is fine pod_raw-video-cfr_alcohol_to regulate_0002: I was wondering if, um, and obviously I know you wouldn't talk about a specific person or, or patient of yours, but can you give an anecdote of like, Hey, here's what it can look like when you start to do that and you mentioned, oh, it can be really reinforcing or the function. Is it like, is there a sort of a story you can tell about a typical student names have been changed for the sake of this podcast kind of thing to say, here's a cycle that looks familiar to me when I start to see this.riverside_james_mckowen_raw-video-cfr_alcohol_to regulate_0001: [00:13:00] Yeah, I can think of, uh, one recently a college student. Um, and he had social anxiety disorder, so really struggled socially, you know, whenever he would, um, talk to other people, raise his hand in class, he got anxious and sometimes would avoid that. And so, um, trying to build friends and connections was really hard for him.Um, he would often sustain his room and was missing out and then started to, to use alcohol and cannabis. Um, to. You know, dull those feelings of social anxiety. And so would then find himself, you know, drinking by himself in his room before he would go out to meet friends socially. And, uh, started off, you know, not that big of a deal, would've a couple of drinks, but then started to get tolerant and then needed more and more alcohol and cannabis to feel comfortable. And so found himself buying liquor like shots. And then would. Uh, go to the bathroom while he was out and drink [00:14:00] more, and eventually. Would get quite intoxicated. And, and it became sort of this problem because he would then sort of make a fool of himself, to be honest.Like other people would be like, he would be way more drunk than other people. He would get aggressive. Um, he was, uh. Maybe, uh, struggled with boundaries, you know, touching people inappropriately. So it actually started to exacerbate his anxiety because people would talk to him the next day, like, you were kind of a fool lastnight, and you were, you were sort of a mess. And, and it started to have this vicious cycle experience with him.Um, and so then eventually kind of he got so intoxicated that. You know, campus police came to the, his, his dorm and that's how he ended up coming to our clinic. And so we were working on, uh, really addressing both his alcohol and his social anxiety.riverside_liz_raw-video-cfr_alcohol_to regulate_0003: That's, that's such a, I see that all the time. A common example, I can think of like three people that I'm like currently seeing, but this pattern of, um. [00:15:00] Anxiety going out right? Then engaging in behaviors that are shameful and embarrassing. And then I tend to see a lot of cannabis use during the daytime the following day.Um, which then has led to like a lot of academic impairment, of course. Um, but then of course, like eventually like getting the willpower to like go out again, but needing more alcohol. But like this, like, um. Leading to a lot of academic impairment, of course, but I see, I see that a lot. And particularly in females where they might have engaged in dating behaviors or sexual behaviors when they're intoxicated.Um, and then using cannabis as a way to avoid, um, some of the difficult emotions they're experiencing as well as the come down from drinking.riverside_james_mckowen_raw-video-cfr_alcohol_to regulate_0001: Yeah, super common. Yep. I, another young female college student where that was a very similar patent. This was more depression than anxiety, but you know, was missing home and missing her friends and was really struggling to adjust to college life. Um, you know, which I think isn't talked about a lot. I think I.[00:16:00] Some, some people think, oh, you're just gonna be great and it's gonna be the best experience of your life. Andshe really struggled with her academics and so she would use cannabis and, and alcohol to, to deal with depression, um, which become, became its own kind of vicious cycle. Um, one thing to note is, you know, uh, mixing substances is something I didn't share before, is something to think about.Um, and so mixing alcohol, cannabis. Alcohol, cocaine, alcohol, anything else is gonna really intoxicate you much faster. Um, and then the other one is if you happen to be on psychiatric medication. So if you're on A-S-S-R-I or you take a stimulant, you're gonna get drunk a faster.Um, and some people don't knowthat.And so four drinks for them plus their psych med makes 'em really intoxicated quickly.riverside_college_is fine pod_raw-video-cfr_alcohol_to regulate_0002: Yeah. Right. They might have had, had some sense of their tolerance before and after, not realize, oh, this is, I can't, I can't do it like I used to necessarily. Um, you know, and I was, I, you know, we, we've talked about where things can [00:17:00] be difficult and kind of why social anxiety might lead someone, or depression might lead someone to go there.And I can imagine. That the things that they could do differently. Um, like, okay, we're gonna work on social anxiety. We're, we're gonna work on depression. A lot of times when I'm talking with people in college, I'm like, there's nothing I can probably offer you that's gonna have that in the moment. Quick fix of relaxation, the same way that alcohol can.Right. So, um, so I know this is not gonna be a simple answer, but I'm just curious for those people who are like, okay, I, I'm ready to try something different. What would be a good first potential step? Or what would be something for you for them to know? Like, hey, even though it might not, you know, nothing's gonna make you feel rela as relaxed as quickly as a shot, right?Um, there are other alternatives. What would you say is the starting point?riverside_james_mckowen_raw-video-cfr_alcohol_to regulate_0001: it's a really good point to admit that that's true, right? Because I think [00:18:00] often. People don't admit that actually drugs and alcohol work really well in the short term and you can't really deny that nothing is gonna feel as good typically in terms of sort of the dopamine rush and the reinforcing pieces of it. So sometimes just admitting that that's trueis an important first step. And then I think it's, it's, it is really tricky to navigate how to manage, you know, difficult emotions with social. Situations when you've been so reliant on a substance to do that job for you.And so definitely, um, working with a counselor, obviously a therapist, to look at what are the triggers for you?What are your situations that are hard for you to deal with? What are some strategies to navigate that? Um, relaxation techniques, you know, cognitive behavioral therapy. Um. As well as finding other ways to socialize, right? That often I talk to college kids around. This doesn't mean you can never socialize.It might mean that you have to shift up the ways in which you socialize. So maybe you're not always gonna parties, but maybe you can do [00:19:00] other stuff that's fun, um, that's rewarding for you that may not increase your risk of using a substance.Um, it does for some students who have more problematic use, meaning they may have to shift up some friendships, um, they may have to expand their network to maybe people that don't use as much, um, join other groups or societies that may not be associated with heavy use.So sometimes it does need, uh, for the person to make it a, a substantial change. Um. But you know, it is just generally a, a journey and a process of figuring out how you can still have fun. 'cause that's, that's, if you're not having fun and you're not enjoying it, then why would you stop doing it? So you haveto figure out how to, how to find something enjoyable and fun to do.riverside_college_is fine pod_raw-video-cfr_alcohol_to regulate_0002: right, right. Um, I'm also curious about people who would worry if I drink less. What would people think of me socially?riverside_james_mckowen_raw-video-cfr_alcohol_to regulate_0001: Yeah.riverside_college_is fine pod_raw-video-cfr_alcohol_to regulate_0002: become sort of an outsider? Have you had any, do you have [00:20:00] any insight into, is that automatically true? Any riverside_james_mckowen_raw-video-cfr_alcohol_to regulate_0001: Yeah, a really common, it's a really common thought to have for sure. Right. Especially if you are prone to depression or anxiety, you know, think people are judging you and all that kind stuff. So I generally think that most people aren't. Paying that much attention to your drinking behavior when you're out.Certainly they might be like, come on, have a drink. Have a drink, and you can say, you know, I have one and I'm good. And you know, weteach college kids refusal skills, which is just this a, a quick line to say, I'm good, or I'll get one in a minute, or I'm on a med right now. Just something you can say quickly just to divert, uh, divert someone's attention.Um, but generally most people aren't sort of counting your drinks and aren't that, you know, focused on you. Um, and then having a. Okay. Quick cup with you. Like, uh, something to carry around. You know, there's tons of non-alcoholic drinks nowadays. They look the same. They taste pretty much the sameother options in that space as well to do that.riverside_college_is fine pod_raw-video-cfr_alcohol_to regulate_0002: Yeah. Yeah.riverside_liz_raw-video-cfr_alcohol_to regulate_0003: Something that I've noticed, um, you know, there's a trend and even among with my [00:21:00] patients around sober curiosity, right? And I've seen a huge shift from. Replacing alcohol with cannabis, um, and somewhat normalizing cannabis use. And kind of in some ways saying to me, my patients at least, like, it's not as bad as drinking, even though I tend to say, and if any of my patients are listening to this, I'm always like, would it be normal to like.Wake up in the morning and take a shot, or take a shot before you go to bed at night and do that every single day. And they're like, no, my God, I'd be an alcoholic. Right, of course. Um, so I'm just curious if like, any thoughts of, I mean, I think it is a substitute behavior. People think it's not as bad, right?Um, maybe their behavior is not as dysregulated as it might be if they're using alcohol, but. Is there any like research or like why people might be more prone to alcohol use versus using cannabis? And any thoughts about if you've seen this pattern that I've seen in terms of maybe using cannabis as a replacement strategy for alcohol use?[00:22:00] riverside_james_mckowen_raw-video-cfr_alcohol_to regulate_0001: Yeah, a really important question when we talk about other drugs, right? So alcohol is just much more prevalent. 70% or so of college kids use alcohol, but it's still pretty high for cannabis, about 40% ish, depending on the study, which is also higher than non-college students. Um, other drugs like stimulants, right?We think about Adderall,a lot of use of those. This idea that it's gonna improve my academic performance,I'll just do it for finals. The data on that is pretty clear. It actually. Doesn't improve your academic performance. You may perceive yourself to be more attentive, but you'reactually not doing as well. Um, and, um, opioids tend to be lower in for college kids to misuse than than non-college samples. So it varies a little bit on the substance, but cannabis itself, 'cause it's the second most commonly used, there's definitely a huge social conversation around cannabis. Um, a lot of misinformation, unfortunately, about the effects of cannabis. Of course, it is less risky and [00:23:00] dangerous than alcohol. It's about the ninth most dangerous substance you can use. A study was done looking at 16 substances, right? So ecstasy, cocaine, Adderall, mushrooms, right? Cannabis fell about halfway. Um, and only about one in nine people do get dependent on cannabis.So most people don't. If you started using before 16 or under 25, you have a one in five chance of developing cannabis use disorder. So the younger you are and the younger you start. The more likely you are to develop problems with it.I think most people don't have a problem with cannabis. Right. I think that's That's true. And it is less harmful. Doesn't mean no harm. And I think legalization has confused that a bit for people. I.It's legal, it must be okay. Right? Or it's somehow legitimized. Medical cannabis is also confusing. The research is really clear on, it does not improve psychiatric symptoms. Um, but it does [00:24:00] improve cancer pain, nausea, HIV related, other sort of medical, physical things, butnot psychiatric status.Um, so there's just a lot of confusion about the role for cannabis in, in terms of, um, mental health.riverside_college_is fine pod_raw-video-cfr_alcohol_to regulate_0002: Yeah. Uh, we might have to get that list from you and, and put that in our show notes. Something to cite, like in case you're curious right, where the, you know, where does perhaps some of the ones you're trying, where do they fall? Um, 'cause that's one of the things I was curious about too. Do you notice, and this might not be.The, the kind of question with the most data behind it, but do you notice that there are certain things people would try? Like if I'm feeling depressed, I might try this. Or if I'm feeling socially anxious, I might try this, or I'm gonna try, you know, study drugs for, you know, or a DHD, they call them, right?Like, the study drug is Adderall, the pep me up drug is alcohol, like, right. What are, are there types of substances based on the, the thing you're trying to fix? Or [00:25:00] do you find it kind of depends on the person.riverside_james_mckowen_raw-video-cfr_alcohol_to regulate_0001: I would say ish. Yeah. I think there's some trends, but it does vary a lot by individual, you know? Um, definitely for like fun and social, uh, social pressures. There's, um, alcohol, right? Andthen definitely for anxiety, cannabis, like the downers, you know, the cannabis. The opioids, the alcohol even tend to be used for folks that are, um, struggling with like anxiety orthose kind of up, even anger.Uh,very physical, physical experiences. And then, um, the stimulants for studying and there's a cocaine sometimes to kind of bring you up from alcohol so they can be all mixed around. There's a general trend, but everybody's just a little bit different as to what is the kind of. Key to their lock,um, as to what works for them.Exactly. Um, and that's a comp, you know, there's lots of reasons why that might be.riverside_college_is fine pod_raw-video-cfr_alcohol_to regulate_0002: Right, right. riverside_james_mckowen_raw-video-cfr_alcohol_to regulate_0001: but yeah, just general trends. Yeah.riverside_college_is fine pod_raw-video-cfr_alcohol_to regulate_0002: All.riverside_liz_raw-video-cfr_alcohol_to regulate_0003: All right, so what [00:26:00] are some signs? I think this is, you know, we started this conversation talking about atypical and typical alcohol use and maybe we can end the conversation talking about what would be some signs if you're listening and are like maybe curious, like, and you are like on the line, do I have a problem, do I not?riverside_college_is fine pod_raw-video-cfr_alcohol_to regulate_0002: in typical versus atypical category,riverside_liz_raw-video-cfr_alcohol_to regulate_0003: Right, um, that you might need some more help or support with your alcohol use.riverside_james_mckowen_raw-video-cfr_alcohol_to regulate_0001: Yeah, I think, um, although frequency and quantity, so like how often you drink and how much you drink on in our sort of fancy medical. DSM four diagnosis manual, um, per se, that is definitely something to be paying attention to. So if you're drinking probably more than once or twice a week, um, and when you do drink your binge drinking, right, so thefour or five drinks, um, that's not per se. A huge red flag. But if you start to go above thatdrinking maybe three, four times a week, you may be noticing you need to [00:27:00] drink more now, 6, 7, 8, to have the same effect. Um, you're starting to have some consequences. So you don't have a diagnosis of an alcohol use disorder yet, but you're in that kind of moving into problem use.So you know you're sleeping in frequently from class. You notice some of your. Grades might be dipping. You laid on a few assignments because you were hungover or too stoned to really remember whatyou were learning in class, right? Um, even a, a red flag can be, you know, your friends are a little nervous or worried about how much you drank.They'resaying, you know, you might wanna cut down, or you got really angry last night. And I'm a little worried about how much you're drinking. So if you get some peer feedback, that can be a warning sign too.Um. I think those are some, some big ones. So sort of peer feedback impacting your kind of functioning, right?You don't play as well at lacrosse or swimming because you kind of low energy, tired, hungover, [00:28:00] um, and some academic impacts as well. Or you're starting to use a sub substance to try and kind of. Improve your performance. Right. So I think you were saying earlier, Liz, like sometimes people might use a, a little bump to get them throughtheir swim meet.Right? That's when it might start to sort of have this sort of reliant pattern of, of the relationship between, um, some kind of substance and functioning. And then when we get to kind of disorder level, that means it's really problematic, which is about five to 7% of college kids have some kind of. Substance use disorder, um, that's really having tolerance. You might have withdrawal symptoms. You got pretty consistent impact on functioning. Um, maybe you drove under the influence or you engaged in risky sex behaviors while you're under the influence you don't remember, you know, it's really starting to move into, it's, it's greatly impacting.You might have gone to trouble at campus police more than once.Um, that's sort of the space where it's moving into kind of [00:29:00] maybe more likely disorder level. Um, and you are gonna have a hard time controlling it without really professional help.riverside_college_is fine pod_raw-video-cfr_alcohol_to regulate_0002: Yeah. Well, so piggybacking on that then, what are the resources you found? I know that that is gonna vary by college, et cetera. Right. I'm sure that all the colleges that are in the Cambridge and Boston area probably have a different set of resources that they're. There are kind of different strengths maybe, but do you find that there are some go-tos for the average listener to say, all right, if you're starting to ask a question like, and actually even before, I would say that we had a.Friendship episode at some point saying some friends are just sort of anchor friends. Right. When you were saying if people are starting to express concern, maybe if you're sitting there, there's a friend who you could trust, you could just kind of spitball with them and like, Hey, this is a question I have.Right? You're not asking 'em to diagnose it, but is there somebody in your life, friend or. Family member who you could just start to ask a few questions. Right. I could imagine. That'd be really [00:30:00] nice. Not everyone has that. What are some additional resources you think are on deck for them?riverside_james_mckowen_raw-video-cfr_alcohol_to regulate_0001: Yeah, certainly a lot of people start with looking online, right? And so you cango to websites like N ni, uh H, national Institute of Health, ni uh, nida, national Institute of Drug Abuse. You can look up some online questions that can do a quick screen of to whether you have a drinking problem. There's some shortones, and I'm happy to send those to you guys.And that's often where most people start looking on Google, right? And sothere's pros and cons to health searches on Google, as we all know. But that can be a good place to just. Take a look and see, you know, am I drinking too much? And a ask, answer some of the questions. Um, there's a, a couple of questions there that you could fill out that are free. Um, other than that, I think, um, bouncing it off with a friend, like you said, uh, have they noticed any concerns or behaviors with you? Definitely thinking about your college campus resources. Um, they obviously, depending on the college, tend to have at least a physician or maybe even a mental health social worker. Could walk in and talk to them. [00:31:00] Of course, those are all private and confidential and that's not gonna affect your academics or your standing as a student just to go talk privately and confidentially with someone about your substance use. If you're nervous about that, you can certainly look outside your college campus.Maybe, um, do a search for a local therapist or local expert in substance use. Um, that you could go and maybe talk to them about that. Um, and there's some online kind of college resources. I can send you guys some links to that to share with your listeners about, um, just some broad resources for college students who might be wondering if they have an issue.riverside_college_is fine pod_raw-video-cfr_alcohol_to regulate_0002: Yeah, that'd be great. No, we'll, we'll make sure we share a lot of that because to your point, it's easy to Google, but sometimes it's hard to know where that's gonna lead you. So we'd love to. To find the right resource for them. Um, and, and thank you so much. This is amazing. I think that it's so nice to hear that like it's typical to wanna have fun and that it's okay also to decide that you can change [00:32:00] certain things that are no longer working for you.Right? If, if it was fun at some point at that started the shift, we just want people to know. What to do when that, when that's the case. So, um, so amazing. You're so smart, James. You're so smart.riverside_james_mckowen_raw-video-cfr_alcohol_to regulate_0001: Why thank you.Uh, I'm, riverside_college_is fine pod_raw-video-cfr_alcohol_to regulate_0002: Yes. I,riverside_james_mckowen_raw-video-cfr_alcohol_to regulate_0001: you for having me. I appreciate being hereriverside_college_is fine pod_raw-video-cfr_alcohol_to regulate_0002: no, no. We'll have you again sometime soon, so we'll come up with some other, other topics so that way you're forced to talk to me at least, at least twice a year. I want something biannual. Alright, well.riverside_liz_raw-video-cfr_alcohol_to regulate_0003: James. riverside_james_mckowen_raw-video-cfr_alcohol_to regulate_0001: sure. riverside_liz_raw-video-cfr_alcohol_to regulate_0003: So nice to meet you. Thanks for being on.riverside_james_mckowen_raw-video-cfr_alcohol_to regulate_0001: You're so welcome.