College brings a tidal wave of change: a new environment, a sea of new faces, and often the first time navigating each day with full independence. It’s liberating, exciting, overwhelming, and terrifying, sometimes all in the same afternoon. 

Along with this milestone come new stressors, from academic pressure to social dynamics that are suddenly much harder to read. For many students, substance use becomes a go-to coping mechanism, made easier by unmonitored access, the absence of parental oversight, and simply not yet having the experience to know where the line is. 

If you’re a parent, you might be wondering whether your teen’s drinking or drug use has crossed from “typical college stuff” into something more concerning. If you’re the student, you might be the one asking yourself, “Do I actually have a problem, or am I overthinking this?” 

To help answer that question, we spoke with Holly Mareski, LCSW, LICSW, CADC, CCTP, a Senior Primary Clinical Therapist in Compass Health Center’s Virtual Adult Evening Program who specializes in substance use and trauma.  

Q&A 

Understanding the Connection Between College Stress and Substance Use 

Q: Why are college students at higher risk for stress, anxiety, and substance use? 

Holly Mareski: College asks students to absorb a lot of change at once. They’re adjusting to a new environment, a new level of independence, and often a level of personal autonomy they’ve never had to manage without parental oversight. On top of that adjustment, they’re still dealing with the same stressors that have always been part of student life, like peer pressure, financial strain, and academic demands, but just with fewer of the guardrails that used to soften them. That combination of newness and stress is exactly what makes this period so high-risk for stress and substance use to intersect. 

Recognizing Normal College Stress vs. Mental Health Concerns 

Q: What are common signs of stress and anxiety in college students? 

Holly Mareski: A student who’s stressed, but not yet burned out, tends to show a fairly recognizable set of symptoms. They may become over-engaged with everything on their plate, and their emotions may feel more reactive or overactive than usual. Many describe a constant sense of urgency or hyperactivity, paired with energy that feels lost or diminished. Feelings of anxiety are common, and stress often shows up physically too, in the form of headaches, stomach aches, chest pain, or difficulty breathing. 

Q: How can students tell the difference between college stress, anxiety, and burnout? 

Holly Mareski: College burnout develops when a student experiences chronic stress over an extended stretch of time, rather than a stressful moment that passes. These students often develop symptoms like fatigue, detachment, and a general loss of interest in academics, and burnout is far more common than most people realize. According to the National College Health Assessment, 80% of college students reported feeling overwhelmed, and 40% said it was difficult to function.  

Burnout tends to bring exhaustion, a lack of motivation and interest, reduced creativity and concentration, increased irritability, feelings of depression and anxiety, and even more frequent illness. The clearest way to tell stress and burnout apart is this: stress always has an end in sight, while burnout can feel like it doesn’t. Caught early, students can learn to manage stress before it has the chance to turn into burnout. 

The Relationship Between Stress, Mental Health, and Substance Use in College Students 

Q: Why do some college students use substances to cope with stress or mental health challenges? 

Holly Mareski: Several things tend to happen at once. On a psychological and physiological level, substances can offer quick relief, functioning as a form of self-medication or an avoidant coping strategy that isn’t necessarily healthy. Environmental and social pressures play a role, too, from academic demands to the culture of campus life itself.  

There’s also a developmental piece: the human brain continues developing until about age 25, meaning the prefrontal cortex—the part responsible for impulse control and future planning—isn’t fully mature yet in most college students. Because of this stage of brain development, young adults process rewards more intensely than older adults, which means they can move from casual use to abuse or dependence much faster. 

Q: How does peer pressure contribute to substance use among college students? 

Holly Mareski: Peer pressure can strongly influence substance use in college. In fact, peer pressure has been linked to 21% of teens using an illicit drug at least once. It can push a student toward using drugs reluctantly, even when it comes with real risks to their physical and mental health. 

Warning Signs of Substance Use Problems in College Students 

Q: What are the warning signs of substance use problems in college students? 

Holly Mareski: Substance use tends to move into the realm of concern when it starts to show clear warning signs: impaired control, changes in social behavior, and extreme mood shifts among them. These signs suggest that drug or alcohol use has started to interfere with someone’s daily life, health, and relationships.  

On the behavioral side, a student might start neglecting responsibilities at work, school, or home, or become secretive. They may withdraw socially from family and old friends while gravitating toward a new peer group that encourages heavier use. Risky choices, like driving under the influence, can start to appear, along with financial strain from constantly asking for money or, in some cases, taking things that aren’t theirs. 

Emotionally and psychologically, warning signs can look like sudden outbursts of anger or irritability over minor issues, moods that swing quickly from high energy to deep sadness, or unfounded paranoia and fearfulness with no clear cause. A student might lose their drive and interest in hobbies or goals they once cared about, or become noticeably defensive when the topic comes up. 

Q: How can substance use affect a college student’s academics, relationships, and daily life? 

Holly Mareski: Academically, warning signs often show up first in performance and attendance. A student’s GPA or test scores might drop sharply, or they may start frequently skipping classes or showing up late. Assignments and projects might go unfinished or turned in late, and participation in class discussions may drop off noticeably.  

Cognitively and behaviorally, a student might struggle to concentrate, focus, or retain what they read, or appear sleepy, groggy, or hungover during lectures. They may start offering frequent excuses for poor academic performance, alongside a broader sense of disinterest. 

Q: How can substance use affect mental health conditions like anxiety, depression, and ADHD in college students? 

Holly Mareski: Substance use can actually make mental health symptoms worse rather than better. Anxiety is a clear example of this: a student might turn to alcohol or another substance to calm their anxiety in the moment, but as the substance wears off, it can trigger a rebound effect that leaves them feeling more anxious than before, making the very thing they were trying to manage worse in the long run. 

When Should a College Student Seek Mental Health Support? 

Q: What should college students do if they recognize signs of substance use or mental health concerns? 

Holly Mareski: The first step is reaching out—to a parent, another trusted relative, or one of the support resources available on campus. 

Q: How can parents and friends talk to a college student about substance use concerns? 

Holly Mareski: The most helpful approach is to listen without judgment and ask direct, honest questions. Having resources on hand, whether that’s campus support services or treatment options, can make it easier to turn concern into an actual next step. 

Mental Health Treatment Options for College Students 

Q: What mental health treatment options are available for college students, including PHP and IOP programs? 

Holly Mareski: Options like IOP and PHP mental health treatment programs are built for this balance. Compass offers both virtual and onsite programming, so students can stay in treatment and stay in school at the same time, without their academics being compromised. 

Seeking Help Is a Strength: Mental Health Support for College Students 

Q: What’s one message you’d want a struggling student to take away from this post? 

Holly Mareski: You are not alone. Struggling in college is far more common than it feels in the moment, and change is never easy. With the right supports in place, college can still be the experience you hoped it would be. 

Ready to Take the Next Step?  

College students don’t have to navigate mental health challenges alone. Compass Health Center provides specialized mental health and substance use treatment for teens, young adults, and adults, including virtual and in-person PHP and IOP programs designed to support recovery while helping students stay connected to school and their goals. 

Reach out today to schedule an assessment and learn more about available treatment options. 

Bios 

Holly Mareski is a licensed clinical social worker, certified alcohol and drug counselor and certified clinical trauma professional . Holly is a senior primary clinical therapist in the evening virtual program at compass health centers. In addition, she works in private practice specializing in treating trauma and SUD disorders with adults and adolescents. Holly also works part-time  as an Adjunct professor in the graduate school of social work at Aura University. She is is the current chair of the NASW-IL Chapter Ethics Committee. Holly has been working in the field for over 15 years and is currently licensed to practice therapy in 5 states (IL, WI, MD, VA, and DC). 

Britt Teasdale is a writer, photographer, and creative strategist. As Associate Director of Brand and Content at Compass Health Center, she has spent nearly a decade shaping narratives that translate complex clinical ideas into stories that resonate, reduce stigma, and help families access care. She holds a degree in Broadcast and Investigative Journalism, MFA in Creative Nonfiction Writing, and began her career as a reporter. She is also co-host of Compass’s podcast, You Only Know What You Know.