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WEBMISTRESS speculates:
A lot was going on in Lindey's life when he wrote the songs for Go Insane. As we know from I Must Go, he was in the midst of a drug-related break-up with his girlfriend at the time. Perhaps she is the girl "willing to lose just to keep herself from falling apart" - she is the one who can't deal with the world that "treats [her] oh so rough"; she doesn't believe in herself, doesn't think she's "tough enough" - so she has to turn to drugs.
What's the drum stand for? Well, I don't know, but here's some guesses: If you bang on a drum loud, you call attention to yourself, raise the alarm, so to speak, and maybe he's trying to call Carol's attention to her drug addiction. It's not working, so he bangs it "louder" in a desperate attempt to get her to listen to him. (The lyric sheet says "louder" but for the life of me it sounds like he's just saying "loud".) Or maybe the drum is like the drum one hears when armies are marching towards a battle that could lead to death (in the Civil War and such) because using drugs is a march towards death if one loses the battle of addiction..... and the further along you get the louder the drum gets.... OK, I'm reaching, I know it, but I'm doing my best!