By David Sack, M.D.,

Thousands of recent high school grads are stocking up on dorm essentials and packing their bags for college. Since your blossoming young adult may be far from home for the next few years, and they’ll be none too quick to call with updates, there’s a good chance you’ll be in the dark about what really happens at college. Here are five of the less savory aspects of college life every parent should be on the lookout for:

#1 Stress Leads to Drug Use, Binge Drinking

Transitions can be extremely stressful, especially for young people trying to balance a full load of classes, a part-time job, a social life, and new responsibilities like cooking, shopping and cleaning. Whether it’s the stress of school, the first taste of freedom or an attempt to fit into an unfamiliar environment, studies show substance abuse and other risky behaviors increase significantly during this time.
Alcohol is by far the most popular drug among college students, more than 40 percent of whom have reported binge drinking at least once in the past two weeks, according to a report by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). In a study by the National Center on Addiction and Substance Abuse at Columbia University, 22.9 percent of college students met the definition for alcohol or drug abuse or dependence (significantly higher than the rest of the population, at 8.5 percent).
Although common, heavy drinking comes with serious risks. Per year, the NIAAA cites an estimated 1,700 deaths of college students from unintentional alcohol-related injuries; more than 696,000 assaults by another student who has been drinking; more than 400,000 unprotected sexual encounters that result from drinking; and alcohol-related academic consequences for approximately 25 percent of college students.
Prescription drugs, especially stimulants, pain relievers and sedatives, are also increasingly being abused on college campuses. About one in four college students has illegally used prescription drugs, according to the 2008 National Survey on Drug Use and Health.

#2 Casual Sex Is Common.

For many college students, sex isn’t a big deal. With greater freedom, closer living quarters and a wider pool of potential partners, opportunities for hook-ups abound. But because relationships occur more often, move faster and have greater intensity, the stakes can be high.
In addition to the usual risk of heartbreak, young people may be at increased risk of unwanted pregnancies, sexually transmitted diseases, date rape or sexual assault, substance abuse, low self-esteem and depression.

#3 Competition Is Fierce.

College is more competitive than ever, as is the job market. While some students find college courses surprisingly similar in difficulty to high school, others find themselves sinking under a pile of homework, papers and tests that they can’t get ahead of despite their best efforts.
To get an edge, some college students misuse prescription stimulants, also known as “study drugs.” Full-time college students are twice as likely to abuse a stimulant compared to those who aren’t in college or only attend part-time, reports the Substance Abuse and Mental Health Services Administration. Study drug abuse has been associated with consequences ranging from depression, mood swings and psychosis to irregular heart rate and blood pressure and addiction.

#4 Eating Disorders Hit Prime Time.

Eating disordered behaviors often make their first appearance during college. An estimated 95 percent of those who have eating disorders are between the ages of 12 and 25.8, according to the National Association of Anorexia Nervosa and Associated Disorders.
Sometimes prompted by stress or other overwhelming emotions, a need for control or a sense of accomplishment, negative comments from peers or to stave off the “freshman 15,” excessive dieting, binging and purging are common on some campuses. There are also a few unusual disordered eating behaviors showing up in college, such as “drunkorexia” where students starve themselves all day so they can binge drink at night without gaining weight. If students know their behaviors are unusual, they may hide them and avoid asking for help for fear that it’ll affect their reputation or academic standing.

#5 Mental Health Is Tenuous.

Many people look back on college as a highlight of their young lives but others find the stress and pressure crushing.  Students are reporting higher rates of depression and more use of psychiatric medication to manage mental health issues. Yet many schools have a dire shortage of qualified treatment professionals that has only worsened as a result of recent budget cuts in mental health programs.
Why are parents in the dark about such important health issues? For one, most of these issues are difficult for parents to detect because they aren’t physically present to see the signs. Meanwhile, new friends lack the frame of reference to know when their classmate is acting uncharacteristically. Anxious to prove themselves, college students are also reluctant to talk about their struggles, especially with their parents.
During the transition from high school to college, it is more important than ever to keep the lines of communication open and to encourage your child to come to you if they’re struggling in any way. Although your college student is no longer a child, they may not be fully equipped to handle young adulthood on their own. They want a close relationship with you, but it has to be based on a realistic understanding of the stresses of their day-to-day life.

David Sack, M.D., is board certified in psychiatry, addiction psychiatry and addiction medicine. Dr. Sack currently serves as CEO of Elements Behavioral Health, a network of addiction treatment centers for adolescents and adults that includes Promises Treatment Centers, The Ranch, Sexual Recovery Institute, The Recovery Place, Right Step, Promises Austin, Lucida, Journey, Sundance, and Clarity Way.