ABSTRACT
This case study examines the impact of cannabis use, relational complexity and academic alienation on the psychosocial functioning of a 27 year old undergraduate student. The client is a bisexual male, re-enrolled in a university Computer Science undergraduate programme after a previous academic dismissal from another university. He presented with severe anxiety, feelings of isolation due to a significant age gap with his peers, underlying health struggles and heavy reliance on cannabis as a coping mechanism. Furthermore, he engaged in multiple concurrent romantic and sexual relationships with both male and female partners which served as a distraction from academic pressures. Over 8 individual therapy sessions, a brief harm-reduction and Acceptance and Commitment Therapy (ACT) approach was utilized. Results indicated a reduction in academic anxiety and a decrease in daily cannabis use. Implications for supporting non-traditional, neuro-diverse and LGBTQ+ students in highly competitive academic environments are discussed.
Introduction
The transition back to undergraduate studies for adult learners is often fraught with distinct psychosocial challenges. Students who return to university after previous academic failure and a significant often experience high levels of performance anxiety and "imposter syndrome." In highly competitive fields like Bachelors in Computer Science, where cohorts are typically young (ages 18–20), older returning students frequently report feelings of alienation and social isolation. To manage this distress, some students turn to substance use. Cannabis is frequently used as a self-medication strategy to manage anxiety, chronic health issues and sleep disturbances, though chronic use can negatively impact executive functioning, working memory and academic motivation. Additionally, coping mechanisms can extend to interpersonal dynamics; hyper-engagement in complex romantic or sexual relationships can serve as an avoidance strategy to distract from academic stressors.
Case introduction
"Alex" (a pseudonym) is a 27 year old bisexual male currently enrolled in a Bachelor of Science in Computer Science. He independently sought therapy at Mind Vista Associates due to failing grades, severe procrastination and self-reported burnout. Alex previously attended university at age 19 but dropped out due to academic failure and declining physical health. Upon re-enrolling at age 26, Alex found himself struggling to relate to his much younger classmates, leading to profound feelings of isolation.
To cope with academic pressure and somatic health symptoms (chronic fatigue and headaches), Alex began using cannabis daily. Furthermore, Alex reported maintaining multiple concurrent romantic and sexual relationships with both men and women. While he valued his bisexuality, the constant management of these multiple partners created severe emotional turbulence and drastically reduced the time available for his rigorous coursework.
Therapy model
A brief, time-limited Acceptance and Commitment Therapy (ACT) framework was integrated with a Harm-Reduction approach to substance use. ACT focuses on psychological flexibility helping the client stop avoiding negative emotions like the shame of his previous dropout and commit to actions aligned with his core values completing his degree. The harm-reduction model was used to address his cannabis use and relational impulsivity without judgment, focusing on reducing the negative impacts rather than demanding immediate abstinence.
Research design and measures
This is a qualitative case study triangulated with self-report psychometric data. Assessments were administered pre-therapy (Session 1) and post-therapy (Session 8):
Generalized Anxiety Disorder Assessment (GAD-7): To measure anxiety related to academic performance and peer alienation.
Cannabis Use Disorder Identification Test-Revised (CUDIT-R): To monitor the severity and impact of his cannabis consumption.
Qualitative Interviews: Session transcripts and clinical observations were analysed to track themes of identity, isolation and relational boundaries.
Typical interactions in the sessions and initial strategy
Initial sessions (Sessions 1-2) were highly unstructured, as Alex presented with scattered thoughts, likely exacerbated by his cannabis use. He frequently used therapy to vent about interpersonal drama with his various partners and avoiding discussions about his academic deadlines. The initial strategy involved rapidly building a strong, non-judgmental therapeutic alliance. The therapist at Mind Vista Associates validated his feelings of isolation regarding the age gap with his peers and affirmed his bisexual identity, while gently bringing the focus back to how his coping strategies (weed and relationships) were impacting his stated goal of graduating.
Therapeutic journey
The middle phase of therapy (Sessions 3-4) focused on "defusion" (an ACT technique). Alex was taught to observe his anxiety about failing again without immediately reaching for cannabis or messaging a romantic partner to distract himself. We explored the function of his multiple relationships: while he enjoyed the validation, the chaotic nature of managing several partners was serving as an active avoidance mechanism for his academic deadlines. We also addressed his physical health, exploring how chronic cannabis use initially intended to soothe his physical discomfort, was creating a cycle of lethargy that worsened his academic performance.
Turning point in therapy
A significant breakthrough occurred in Session 5, following a mid-term exam failure. Instead of his usual pattern of isolating, smoking heavily and seeking validation from a new partner, Alex attended his session and processed the grief and shame of his previous university dropout. He realized that the "younger classmates" were not actively judging him; rather, he was projecting his own insecurities about his age and past failures onto them.
Final Phase
The final phase of therapy (Sessions 7-8) focused on consolidation and relapse prevention. Alex established a "study-first" boundary, significantly reducing his daytime cannabis use to improve his focus. He also made the decision to pause dating new people, choosing to maintain only one stable relationship to reduce emotional volatility by choosing arranged marriage. The termination process celebrated his resilience, acknowledged the difficulty of his non-traditional path, and established a plan for maintaining these boundaries post-therapy.
Quantitative analysis
Pre and post therapy data indicated noticeable improvements over the brief 8-session period:
Anxiety (GAD-7): Scores dropped from 16 (Severe Anxiety) pre-therapy to 8 (Mild-to-Moderate Anxiety) post-therapy.
Cannabis Use (CUDIT-R): Scores reduced from 14 (indicative of hazardous use) to 9, reflecting a shift from daily coping use to more managed, less disruptive use.
Academic metrics: Alex successfully stabilized his grades in his core modules, preventing academic probation.
Discussion
Overview of findings and theoretical implications
The findings suggest that for non-traditional adult students, academic struggles are rarely just about the coursework. Alex’s case highlights how the intersection of past academic trauma, age-related alienation, and health issues can drive complex coping mechanisms (substance use and hyper-relationality). It supports the theoretical premise of brief ACT interventions: when individuals learn to tolerate difficult emotions (shame, isolation), they can reduce experiential avoidance and re-engage with their long-term goals.
Clinical implications
Clinicians should assess for substance use and relational chaos not as primary pathologies, but as potential distractors from academic anxiety. Brief therapeutic interventions can be highly effective in realigning a student's coping mechanisms when long-term therapy is not feasible.
Limitations and directions for future research
As a single case study utilizing a brief 8-session model, the findings cannot be broadly generalized. The study relied on self-reported psychometric data, which can be subject to bias. Future research should investigate larger cohorts of non-traditional STEM students, specifically exploring how LGBTQ+ identities and age disparities intersect to affect academic retention and substance use in short-term therapy settings.
Conclusion
This case study illustrates the complex psychosocial landscape of a 27 year old returning computer science student. By utilizing a brief ACT and harm reduction approach over 8 sessions, therapy successfully helped the client reduce his reliance on cannabis and chaotic interpersonal dynamics, allowing him to process his academic anxiety and stabilize his coursework. His journey underscores the need for holistic, identity affirming support for undergraduate students.