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Summary
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A college student describes repeated substance use alongside anxiety and depression despite previous rehabilitation. Insight into the problem has not stopped relapse, and new alcohol use and academic difficulties are worrying.
The response stresses that depression does not have one typical presentation and raises coexisting conditions only as possibilities, not diagnoses.
It recommends honest professional evaluation and treating substance use and underlying mental health difficulties together, beginning with available campus health services.
Question
Reader · Identity withheldI’ve been feeling anxious and depressed since before high school, though I can’t pinpoint exactly when it started. At first, I thought it was just a normal part of growing up and dealing with high school. But now, at almost 20, nothing has really changed. I have a history of substance abuse. I turned to drugs to cope with my anxiety and depression, never intending to form a habit. Since then, I’ve overdosed, been hospitalized, gone through rehab, and told everyone I’ve “moved on” but the truth is, I haven’t. I don’t feel any different than the first time I tried drugs.
\nI’ve lied to everyone I care about, claiming I’ve been clean, when in reality I’ve relapsed many times. Often, I use so much that I scare myself, which only plunges me deeper into depression afterward. Then, I go weeks doing nothing, letting the stress and sadness build back up. Recently, I’ve started drinking regularly, and that scares me. Even though alcohol wasn’t my drug of choice before, it’s still a drug, and I fear it will lead me down the same destructive path.
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I constantly wonder why I can recognize what’s wrong with me but can’t fix it. Why I can admit I have a problem but can’t resist my urges. I think this frustration fuels my anxiety, which has become more and more overwhelming. I’m in college now, and I’m terrified I’ll fail because I can’t motivate myself to focus on classes. Three-quarters of my day is spent stuck in my head, consumed by anxiety and depression. I get angry at myself for not having control.
\nSome days, I feel normal, neither anxious nor sad or confused but on those days, I convince myself I should use drugs, and the next day I’m either using or terrified I’m about to. I don’t believe drugs caused all my problems. I was depressed first, used drugs to cope, quit, and then sank even deeper into depression. I don’t fit the typical profile of someone with depression, I don’t constantly cry, sleep all day, or experience many of the classic symptoms. Is there a category for people who are just generally unhappy?
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Answer
Allan Schwartz, Ph.D.First, let me comment on a very beautifully constructed and descriptive email. You appear to have a lot of insight into yourself, be quite intelligent and very aware. It is a good thing that you are in college where you can build your future.
\nNow, let’s address some of the issues you present. There is no \"typically depressed person.\" Yes, we form categories in modern medicine, psychology and psychology but, in reality, each person is unique and does not fit into nice and neat categories.
\nYou seem aware that there is something that is driving or motivating your substance abuse and that seems to be some form of depression. That is very possible. In fact, it is possible that you have some form of Bipolar Disorder. Now, please remember, I do not know you and I am NOT making any diagnosis but merely speculating. Certainly, depression, bipolar disorder, Attention Deficit Disorder (and other disorders) often have co-existing substance abuse issues because the individual is attempting to self medicate, whether or not they are aware of this. Of course, this type of self medication (substance abuse) only makes things worse.
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I would suggest that you be seen by a psychologist for evaluation for your problems. That evaluation could yield a diagnosis and, assuming I am correct about this, have both the substance abuse and the psychological diagnosis treated together. You are a young person and, to repeat, quite intelligent and have a great future ahead of yourself.
\nAs happens in many substance abuse treatment centers (and good work is done in many of them) it is the addiction that is treated without looking at and treating the underlying psychological problems, such as the ones I already mentioned.
\nNow, most colleges and universities have treatment or health centers for their students and even provide health insurance for them. The reason for this is that you are not alone with your problems. So, what I want to strongly urge and convince you to do is go to your college treatment center and have your self seen by their staff, be honest about your problems and ask to have yourself evaluated for depression, etc, and referred for help.
\nBest oflLuck
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