By Eric M. Plakun, M.D. and Thomas Franklin, M.D.

Yolanda and Vi met when they arrived on campus, assigned as roommates in the freshman dorm. As they got to know one another, they learned they each struggled with depression and suicide, early trauma, and both had been in a psychiatric hospital in the past. Both had histories of alcohol and drug use as well.

As a result of pandemic isolation, both Yolanda and Vi had lost out on social experiences, learning how to develop relationships with others and being part of a group. Both also had the experience of family members being concerned about their pattern of substance use.

Despite her challenges, Yolanda thrived in the first semester. With the help of therapy and medication, she attended sessions regularly, built a strong rapport with her therapist, addressed past traumas, stayed drug-free, attended classes enough to earn good grades, and developed friendships that reduced her isolation.

Vi struggled to attend sessions or use them effectively, having difficulty trusting her therapist. Once a good student, she now missed classes, neglected assignments, and became isolated, spending time on video games or social media. While her drug use decreased, her struggles continued, and she eventually left school after a suicide attempt and hospitalization.

Back home, Vi had trouble holding a part-time job, getting to therapy sessions or to the groups that were part of an intensive outpatient program (IOP). She remained isolated, with few social contacts. A course of transcranial magnetic stimulation (TMS) offered little benefit. Vi tried returning to school after a semester away, but her difficulties........

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