The second in a two-part series exploring substance use and abuse at Brown.
On a perfect April afternoon, Fred, then a first-year, was stoned for the first time. By the end of May, he was smoking on a near-daily basis. After a few months, Fred “greened over the cliff.” He was smoking at least three joints a day by winter break of his sophomore year.
Fred, a junior whose name has been changed to maintain confidentiality, said he didn’t realize that “the short-term pleasure and immediate gratification smoking gave” him would lead to a habit that spiraled out of control.
Fred identifies as someone who has struggled with addiction. But according to the diagnostic criteria and varying expert opinions, the boundaries between abuse, dependence and addiction are often cloudy.
A survey from the 2012-2013 academic year found that at least once a month roughly 25 percent of University students smoke marijuana and 80 percent drink alcohol, according to University data. A smaller subset of students lurk in the shadows of these numbers — those who become dependent on chemical substances.
“Chemical dependence is a diagnostic term used by health professionals to refer to what the general population would call ‘addiction,’” wrote Kathleen McSharry, dean of chemical dependency, in an email to The Herald. Chemical dependence is characterized by a loss of control over frequency of use and dosage levels as well as a craving for the substance, she wrote.
Until last year, substance abuse and dependence were distinct categories in the Diagnostic and Statistical Manual of Mental Disorders. This understanding changed when the DSM’s fifth edition collapsed these categories into the mild-to-severe continuum of “substance use disorder,” said Jane Metrik, assistant professor of behavioral and social sciences.
But the criteria put forth in the DSM “were not designed with a residential college student in mind,” she said.
Each year, McSharry sees approximately 50 students who come to her wanting to cut back on alcohol or other substance use, generally providing “moderate or intensive support” to roughly 12 of these students who are attempting to maintain total sobriety, she wrote.
McSharry works with more students who are struggling with alcohol problems than with marijuana, which she believes “reflects patterns of use in the student population,” she wrote.
“Brown has a very small number of undergraduate students who have accepted a diagnosis of chemical dependency,” McSharry wrote.
“We don’t place a heavy emphasis on specific diagnoses,” said Sherri Nelson, director of Psychological Services, which provides counseling for students struggling with mental health issues, including substance dependence. Psychological Services’ assessment of a student’s substance abuse problem instead depends on how it impedes that student’s ability to function academically and socially, she said.
The college bubbler
“When I was headed over to the party, I was like, ‘I’m only going to have a couple drinks,’” Paul said, but “it was never enough.”
One night last fall, during one of his worst relapses, Paul woke up drunk with scratches on his knees and over thirty marks on his arm, one for each drink he had consumed the previous night.
Paul, a senior whose name has been changed to maintain confidentiality, still doesn’t know what happened that night.
Paul started imbibing heavily when he was young — he was only 12 when he first blacked out from drinking. Alcohol helped him deal with his anxieties, he said.
At Brown, he drank with friends at pregames, but said he might as well have been drinking alone. “It wasn’t about going to the party or having a good time, it was about drinking and smoking,” Paul said.
In residential college communities, the perception of what constitutes normal drug use is skewed, Fred said.
At first, “I was smoking and still doing totally fine in school,” Fred said. “I knew many, many people who did the same thing.”
The flexibility granted to residential college students can help expedite drug dependency due to a lack of “real-world consequences,” McSharry said.
Jordan, a first-year whose name has been changed to maintain confidentiality, said he appreciates the lax attitude toward marijuana on campus, especially since high school had “an awful detrimental impact on (his) psyche” and “killed (his) creativity.”
“This society works so hard to make me closed-minded, and drugs are one efficient and accessible way to counteract that,” he said.
After a month-and-a-half streak of staying clean over summer vacation, Fred couldn’t resist smoking when he returned to Brown.
“If you go back to where your problem started, the environment is triggering,” McSharry told The Herald.
On College Hill, McSharry said students are most likely to acknowledge drug dependency during their sophomore or senior years. “Sophomore year is the first hump, when students who used a lot in high school and their first year of college start to struggle academically and come to Brown’s attention,” McSharry said. Students who ask for help during their final semesters “are usually not in trouble, but they recognize their drug use is not consistent with their future goals.”
A ‘furnished hell’
Red flags begin to flutter when a student devotes a disproportionate amount of time to a substance at the expense of academics and other commitments, McSharry said.
Fred started focusing on extracurriculars he could do while high, and his grades began to slip. The decline led to stress, which he coped with by smoking more. Though he was aware of his family’s strong history of alcoholism, he never expected that it would predispose him to a dependence on marijuana.
Genes are a major player in the development of all substance abuse disorders, Metrik said.
When Fred noticed his appetite had become virtually nonexistent when he was sober, he realized something was wrong.
“One of the most elemental ways to survive wasn’t an instinct to me unless I was high,” he said. “That was a huge wake-up call.”
For Jordan, drug use that felt like “fits of joy and ecstasy, shedding a layer of skin and being reborn” soon induced bouts of pessimism. He realized that the happiness that comes with marijuana is “fleeting.”
At first, smoking serves as a way to deal with problems, but “then you’re having more problems that stem from this plant,” Jordan said.
The constant need to return to a substance often leads to introversion, which Jordan said feels like a “furnished hell that you can never leave.”
“I used to study until I would go to sleep, but now I study until it’s time to smoke,” said Michael, a sophomore whose name has been changed to maintain confidentiality.
Even when students make the choice to put down the joint, they face another obstacle — withdrawal symptoms.
“If someone dependent on marijuana abruptly quits using, withdrawal symptoms may develop between 24 to 48 hours later,” Metrik said, adding that symptoms like anger, irritability, anxiety, decreased appetite, weight loss, nervousness and difficulty sleeping typically resolve in about one or two weeks.
When Fred forced himself to stop smoking for one month last year, he said it was “probably the lowest” point in his life. He suffered multiple breakdowns and his outlook on life “just (went) to the gutter,” causing him to quickly relapse.
Michael recently challenged himself to abstain from smoking for a week “to see if I could do it and to see if it would help me cut down,” he said.
During that week, he noticed a slight increase in his stress level, difficulty falling asleep as well as cravings, though he said none of these symptoms were particularly challenging to deal with. Still, when the week was over, he immediately returned to his normal levels of use.
Some students don’t experience withdrawal symptoms, Metrik said, though the absence of symptoms does not mean they are not dependent upon a substance.
Road to recovery
The University’s resources and policies surrounding drug dependency are predicated on “an educational harm-reduction model,” McSharry said.
“As far as resources go for students with drug dependency, Brown is better than most schools,” she said, citing on-campus support groups such as Alcoholics Anonymous and the Early Sobriety Group as safe spaces for students to discuss their substance use disorders. “Brown is the only school in the country to have a dean of chemical dependency,” she added.
The Early Sobriety Group is a resource specifically for Brown students who choose “to abstain from substances.” The group “connects students with others who do not use,” creating an environment conducive to avoiding past drug habits, McSharry said.
Paul met with McSharry the first day he stepped on campus. A week before leaving for college, Paul told his mother he was scared — he didn’t know if he would be able to stay sober. They searched for resources online and easily found the Early Sobriety Group.
Members of the Early Sobriety Group were “the biggest support in my freshman year,” Paul said. “I was locked in as soon as I got here — within a week I had eight really close friends that understood me.”
For Paul, chapters of AA, both on campus and in the Providence community, have been another source of support throughout his addiction and recovery.
Paul said AA “cultivates a spiritual experience,” for him.
Even with the University’s support networks, the stigma attached to drug dependency prevents some students from seeking help.
Fred decided to seek out on-campus resources to help him stay clean. But even after speaking with McSharry, he was under the impression that there was no peer support group for students struggling with substance problems, he said.
A little help from my friends
Alex, a first-year whose name has been changed to maintain confidentiality, said he would always smell marijuana when returning to his room late at night. “I wondered if he just started or started six hours ago,” he said, referring to his roommate.
Alex had never met someone who smoked as much as his first-year roommate before coming to college. Alex “didn’t have a problem with anyone smoking,” but grew concerned when he became aware of weed’s potent effect on his roommate’s behavior.
“My roommate that smokes and roommate that doesn’t smoke are two completely different people,” Alex said about his roommate’s dual behavior.
Alex struggled internally for a solution but ultimately avoided confronting his roommate in order to maintain a peaceful living environment.
He sometimes wonders if he is passing on the opportunity to help a friend, feeling that his subtle attempts to address his roommate’s behavior have been ineffective.
Many students become discouraged if their efforts to help a friend dealing with dependence don’t lead to immediate changes in behavior, McSharry said.
McSharry said she advises students to talk to a professional “to develop a script” and “adopt an attitude of curiosity” rather than condemnation to help a friend with drug dependence.
“I try to help students understand that what they achieve is very modest,” while reminding them that even if change isn’t immediately noticeable “there is always an impact,” she said.
A random phone call from her older brother made Kerry, a first-year student who said she smokes on a nearly daily basis, consider quitting.
“He told me, ‘I don’t like smoking because I don’t like feeling happy for no reason — I want to be happy because I’m doing work I’m proud of, because I’m hanging out with cool friends,’” said Kerry, whose name has been changed to protect confidentiality. “That really resonated.”
Fred, who is now six months sober, said he would not have accomplished this feat without his friends.
Michael does not plan to curb his smoking in the near future. “I haven’t had any concrete goals, just a sort of floating ‘oh, I should smoke less’ concept. I guess my problem now is that my priorities are a little skewed because of how much I smoke,” he said, adding that he plans to cut down at some point but that he does not think his current smoking habits will “severely impact” his life “in the long run.”
Paul has been sober for three months, but he still attends Alcoholics Anonymous meetings nearly every day. The space where he addressed his addiction has become a place for Paul to help others struggling with drug dependency.
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