University students’ perceptions of the link between substance use and mental health

Young adulthood can be a vulnerable time for young people. Young adults have the highest levels of alcohol use and related harms among all age groups. Mental health symptoms are also most likely to first present during late adolescence and early young adulthood. But what connection, if any, is there between mental health and substance use for this age group? And what does this mean for post-secondary students?

Rates of mental health concerns and psychological distress symptoms are high among Canadian university students. Data from the 2013 National College Health Assessment Survey showed that 10% of university students have been diagnosed with depression, and 11% diagnosed with anxiety in the past 12 months. Many more students report distress symptoms which can cause significant dysfunction or impairment for young people and may be precursors to later mental health problems. For example, in the last 30 days, 35% of students reported overwhelming anxiety and 40% felt very exhausted.

Research suggests that youth with mental health problems are two to three times more likely to have problems with substance use, and vice versa. Although these issues tend to co-occur, it is not always clear which comes first. Youth with mental health problems may use substances to cope with symptoms of the mental health issue that they find disruptive or uncomfortable. For example, someone suffering from social anxiety may drink to feel more comfortable in social situations.

Alternatively, substance use can create problems that trigger or exacerbate mental health symptoms. For example, alcohol use increases the chances of being a victim of sexual assault or poor-decision making, which could impact mental health. It is also possible that both substance use and mental health symptoms are caused by similar risk factors, such as environmental triggers like stress or trauma, therefore increasing the likelihood of co-occurrence.

But do young people perceive there to be a link between substance use and mental health?

In focus groups, our research lab asked university students about the link between mental health and substance use. Most students believed that mental health influenced student’s use of substances reporting that using substances to cope with stress and other negative situations or emotions, such as bad grades or break-ups, is a common and accepted practice among students. Students reported that support from friends regularly included suggestions of getting “wasted” to “forget about your problems.” However, students did not identify a bi-directional link; meaning they see few mental health consequences from substance use, although some students noted that going out and drinking sometimes prevented them from meeting their deadlines or getting their work done, which increased their levels of stress. Students appear to know that substance use is not a “healthy” way to cope with their stress and problems, but noted that it has the fastest effects and is accepted and encouraged among peers.

Students seem to underestimate the impacts of both mental health and substance use on their overall health and academic success. Would greater discussions in post-secondary settings about the links between these issues help students better understand the relationship between substance use and mental health?

Kara Thompson, CARBC

Author: Kara Thompson, Postdoctoral Fellow, Dalhousie University

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC.

Plant the Seeds and See What Grows: Education and Culture Change

When I try to explain the kind of work that I do for CARBC, I often use the analogy of being a farmer. I am the Coordinator of the Changing the Culture of Substance Use Project, a multi-year project to build a vibrant community of practice on BC’s post-secondary campuses. But my work is similar to the farmer; I research, prepare and plan what we should grow, examine the growing conditions, help plant the seeds, and then I, along with my team, continuously encourage their growth so that we will have a fruitful harvest. Of course, our seeds are very different from the farmer’s. Ours are the seeds of thought as to how we might change a culture of substance use in a growing campus community of practice. And what we hope to eventually see is the changing norms, attitudes, programs, policies, and practices that reflect this kind of thinking on campus.

Education with respect to culture change is a unique challenge. When the goal is culture change, education becomes about engagement. We need to think about whom we engage in this learning, how we engage them and what we engage them about. We are not necessarily concerned with equipping these folks with the tools to manage their own patterns of use (although that may be a by-product of the process). Rather, we hope that they will become part of a larger concerted effort to co-develop efforts on campus that have the power to significantly impact generations of students.

  • So who should we engage in this kind of learning? We engage those who are intrinsically interested and motivated to be part of a culture change effort on campus. These could include counselling staff, health practitioners, faculty members, students, access and support services, deans, as well as many others.  Our basic premise is that all members of a campus community can potentially be or become leaders in culture change.
  • And how do we engage them? Our engagement is constructivist and collaborative. We harness the expertise in the room and in this field around what might change a culture on a particular campus. Campuses will learn from each other and pick up tools and techniques that have been successful for others for adaptation. For instance, Selkirk College recently developed an innovative Dinner Basket program that encourages students to share a meal and discuss substance use in a nonjudgmental manner. Several other campuses are now adapting this approach for their own contexts.
  • And what do we engage about? Often it is a combination of a wide variety of topics. These topics generally focus on how we go about shifting a culture. For instance, we might begin with some discussions on the role of culture in influencing behavior around substance use. As we become more familiar with the topic, we look at mechanisms for changing a culture, such as community of practice building, motivational approaches or situational assessment. The goal is to build the toolbox campuses have at their disposal with the best in current thinking and see what takes hold. This may sound haphazard, but it allows us to avoid being prescriptive in what we endorse and encourages campuses to identify their own goals, resources, areas of strength and required efforts in this process.

This type of work is not easy or simple. Much like the farmer’s work, it requires patience, flexibility, responsiveness and the ability to see the forest for the trees. It also requires the ability to release control and allow the community to grow and develop, guided by a caring hand. With dedicated, strategic and consistent efforts, we are hopeful for a plentiful harvest.

To learn more about the Changing the Culture of Substance Use Project and/or how to join our community of practice, please check out this article in CMHA-BC’s Visions Journal or visit our website at

Catriona Remocker

Author: Catriona Remocker, Research Associate, Centre for Addictions Research of BC; Coordinator of the Changing the Culture of Substance Use Project

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC.