For many young people, college means finding themselves in a new environment, freed from parental oversight, making their own decisions, and struggling to keep up academically and fit in socially. It\u2019s pretty much a recipe for alcohol and drug use. But what\u2019s really going on with campus substance use these days? Is the tradition of underage drinking and teen drug abuse still going strong? Or have times changed? What can students \u2014 and those who care about them \u2014 expect as part of that higher education? As the chief medical officer of a nationwide addiction treatment network that includes rehab programs for young adults, Dr. David Sack has had a front-row seat to the drug and alcohol problems that can develop when students go away to college, and he shared that knowledge in a recent Reddit \u201cAsk Me Anything\u201d forum on substance use on campus. Among the questions submitted were many that focused on specific drugs and their effects while others touched on broader themes. One commenter, for example, said she\u2019s never been attracted to drugs or drinking and wasn\u2019t sure how to respond to college friends who love to get wasted and who depend on her to be their designed driver. \u201cI worry that I\u2019m just helping them have problems and get themselves in trouble. Whenever I say anything, they laugh me off. But I\u2019m pretty sure at least a couple of them are alcoholics. And I\u2019ve seen all of them do things they really regret later. How can I actually get through to them about the risks they are taking in a way they might actually listen to? Or should I just shut up and let them make their mistakes and learn the hard way?\u201d The reality, Dr. Sack answered, is that our ability to influence others has limits, but it shouldn\u2019t stop us from trying. \u201cPeople change their drug use when they see it as being more of a problem than a help. When people use a lot they often wind up in situations they regret or where they are injured. You can help your friends by trying to have a conversation with them (when they are sober) about the things they like and don\u2019t like about what happens to them when they get high.\u201d From Study Drugs to Tech Addictions In terms of the drug use picture overall, the campus numbers continue to go up, Dr. Sack said, and leading the charge are marijuana, alcohol and opioids. Also popular these days is the prescription stimulant Adderall, he said, \u201cbecause it is used as both a club drug as well as to pull all-nighters.\u201d As to whether those study drugs actually work as advertised, Dr. Sack noted that they can improve concentration, memory and attention in the short term, but over time, the user will develop tolerance and the benefits will be limited. And trying to up the dose can have an opposite effect, causing restlessness and distractibility. \u201cThere is always a price to pay in terms of insomnia, weight loss, irritability and rebound poor concentration when amphetamines or other stimulants are used regularly.\u201d Visitors to the forum also asked about: \tThe link between college binge drinking and alcoholism later in life. \tHow to know what\u2019s really in the drugs you\u2019re using. \tAnd the truth about what appears to be the most prevalent campus addiction of all \u2014 dependence on technology such as smartphones, apps and social media. In answering the questions, Dr. Sack drew upon his decades of experience as an addiction psychiatrist and as a recognized leader in the addiction and mental health treatment field. In addition to overseeing the medical care at the Promises Behavioral Health network, he is a guest blogger for Huffington Post, Psychology Today and Psych Central. To read the complete questions and answers, visit Dr. Sack\u2019s Reddit forum on substance abuse on campus.