• Skip to main content
  • Skip to primary sidebar

Tracking Health and Wellness Applications of Brain Science

Spanish
sb-logo-with-brain
  • Resources
    • Monthly eNewsletter
    • Solving the Brain Fitness Puzzle
    • The SharpBrains Guide to Brain Fitness
    • How to evaluate brain training claims
    • Resources at a Glance
  • Brain Teasers
    • Top 25 Brain Teasers & Games for Teens and Adults
    • Brain Teasers for each Cognitive Ability
    • More Mind Teasers & Games for Adults of any Age
  • Virtual Summits
    • 2019 SharpBrains Virtual Summit
    • Speaker Roster
    • Brainnovations Pitch Contest
    • 2017 SharpBrains Virtual Summit
    • 2016 SharpBrains Virtual Summit
    • 2015 SharpBrains Virtual Summit
    • 2014 SharpBrains Virtual Summit
  • Report: Pervasive Neurotechnology
  • Report: Digital Brain Health
  • About
    • Mission & Team
    • Endorsements
    • Public Speaking
    • In the News
    • Contact Us

Misuse & Abuse of ADHD Meds among college students: Updated review of a growing concern

March 26, 2013 by Dr. David Rabiner

amphetamine-moleculeThe mis­use and abuse of pre­scrip­tion med­ica­tion is a grow­ing con­cern. I remem­ber speak­ing with col­leagues 15–20 years ago as reports about the non­med­ical use of stim­u­lant med­ica­tions used to treat ADHD (non­med­ical use is defined as use by indi­vid­u­als with­out a pre­scrip­tion) were first appear­ing in the media. At the time, these were gen­er­al­ly thought to be iso­lat­ed inci­dents that were being over-dra­ma­tized in the press.

It has become clear, how­ev­er, that this is not the case today and that the non­med­ical use of ADHD meds, as well as mis­use by indi­vid­u­als for whom med­ica­tion is pre­scribed, is an impor­tant prob­lem. Below is a brief overview and sum­ma­ry of research on these issues.

How com­mon is non­med­ical use of stim­u­lant medications?

Between 2000 and 2011, the annu­al preva­lence of non­med­ical use of amphet­a­mines — this includes drugs used to treat ADHD but is not lim­it­ed to ADHD med­ica­tions — declined from 6.5% to 3.5% among 8th graders, from 11.7% to 6.6% among 10th graders, and from 10.5% to 8.2% among 12th graders. Among col­lege stu­dents, how­ev­er, the rate increased from 6.6% to 9.3%. For non-col­lege adults ages 19–28, the rate also increased — from 5.4% to 7.2%. This data is from the Mon­i­tor­ing the Future Study, an annu­al sur­vey of alco­hol and drug used con­duct­ed with a nation­al­ly rep­re­sen­ta­tive sam­ple. You can find an overview results from the 2011 sur­vey online Here (opens PDF).

These data may under­es­ti­mate non­med­ical use of ADHD stim­u­lants because the MTF sur­vey does not inquire about all wide­ly pre­scribed med­ica­tions and indi­vid­u­als using med­ica­tions not men­tioned may inad­ver­tent­ly fail to men­tion non­med­ical use.

How fre­quent­ly do indi­vid­u­als engage in non­med­ical use?

Pub­lished research on the fre­quen­cy of non­med­ical use has focused on col­lege stu­dents. Results obtained from a nation­al­ly rep­re­sen­ta­tive data base of col­lege stu­dents indi­cat­ed 32% of non­med­ical users had used only once in the pri­or year, 45% used 2–10 times, and 19% used 11 or more times 15. In a study of adults in the gen­er­al pop­u­la­tion, 30% of non­med­ical users report­ed using only 1–2 times per year while 70% report­ed using 3 or more times.

Although most indi­vid­u­als who use non­med­ical­ly do so through oral routes of admin­is­tra­tion only, reports of crush­ing and snort­ing are not uncom­mon. In fact, this was report­ed by near­ly 20% of non­med­ical users in one recent­ly pub­lished study of col­lege students.

Where do those with­out pre­scrip­tions get medication?

The vast major­i­ty of non­med­ical users among col­lege stu­dents obtain med­ica­tion from a friend with a pre­scrip­tion. And, results from sev­er­al stud­ies indi­cate that stu­dents with pre­scrip­tions are com­mon­ly approached by peers ask­ing for their meds. Research with mid­dle school and high school stu­dents makes clear that younger stu­dents are also approached for their meds, although at what appears to be a low­er rate than for col­lege students.

Feign­ing ADHD to obtain med­ica­tion is also a grow­ing con­cern. Stud­ies with col­lege stu­dents sug­gest that many who self-refer for an ADHD eval­u­a­tion exag­ger­ate their symp­toms, per­haps to obt­ian stim­u­lant med­ica­tion. In a study of non-col­lege adults, 20% of those who used non­med­ical­ly report­ed that they had ‘faked’ ADHD to obtain a pre­scrip­tion from a physician.

What are the char­ac­ter­is­tics of non­med­ical users of ADHD medication?

Reports in the pop­u­lar press some­times imply that tak­ing ADHD med­ica­tion with­out a pre­scrip­tion has become almost ‘nor­mal’ behav­ior for col­lege stu­dents, part of a ‘work hard, play hard’ lifestyle. Research does not sup­port this view, however.

Mul­ti­ple stud­ies con­duct­ed with col­lege pop­u­la­tions indi­cate that com­pared to their peers, non­med­ical users:

- have high­er rates of drug and alco­hol use.
— per­form less well academically.
— are more con­cerned about their abil­i­ty to suc­ceed academically.
— report sig­nif­i­cant­ly greater prob­lems with attention.

High­er rates of sub­stance use has also been found among non­med­ical users of ADHD med­ica­tion in the gen­er­al adult population.

Thus, rather than being nor­ma­tive behav­ior, it appears that many indi­vid­u­als engag­ing in non­med­ical use also mis­use oth­er sub­stances and/or feel that atten­tion prob­lems are under­min­ing their abil­i­ty to be successful.

What are the main moti­va­tions for non­med­ical use of ADHD medications?

Most research on the motives for non­med­ical use has been con­duct­ed with col­lege stu­dents. Among stu­dents, the pri­ma­ry moti­va­tion for most non­med­ical users is to enhance aca­d­e­m­ic per­for­mance, espe­cial­ly the abil­i­ty to concentrate/focus while study­ing. How­ev­er, oth­er motives are also report­ed by a sig­nif­i­cant minor­i­ty of indi­vid­u­als, includ­ing using to ‘get high’.

Less is known about motives for use out­side of col­lege pop­u­la­tions. In one study using a nation­al­ly rep­re­sen­ta­tive sam­ple of adults, 40% of non­med­ical users indi­cat­ed that their pri­ma­ry motive was to ‘be more pro­duc­tive’. Anoth­er 13% report­ed that their pri­ma­ry motive was to ‘feel good or get high’.

What are the con­se­quences of non­med­ical use of ADHD medication?

The vast major­i­ty of col­lege stu­dents who engage in non­med­ical use to enhance their aca­d­e­m­ic per­for­mance believe that it is help­ful. In one study, 70% rat­ed the over­all impact of non­med­ical use as being either ‘pos­i­tive’ or ‘very pos­i­tive’ and only 5% rat­ed the over­all impact as ‘neg­a­tive’ or ‘very negative’.

This is strik­ing because there is no data on whether non­med­ical use actu­al­ly improves aca­d­e­m­ic per­for­mance. One recent review con­clud­ed that “…the cog­ni­tive effects of stim­u­lants on healthy adults can­not yet be char­ac­ter­ized definitively…”

Fur­ther­more, most work on this issue is con­duct­ed in lab set­tings and exam­ines the impact of stim­u­lant med­ica­tion on research mea­sures of cog­ni­tive per­for­mance. Whether tak­ing stim­u­lants to pull an ‘all nighter’ improves exam per­for­mance the next day is unknown. In fact, a plau­si­ble hypoth­e­sis is that stu­dents who delay study­ing because they expect stim­u­lants to help them cram the night before would per­form worse than if they pre­pared using a more rea­son­able schedule.

Adverse con­se­quences

Side effects — Although most stu­dents in the study men­tioned above report­ed over­all pos­i­tive effects of non­med­ical use, adverse events were also fre­quent­ly report­ed. These includ­ed sleep dif­fi­cul­ties (report­ed by 72%), irri­tabil­i­ty (62%), dizzi­ness and light­head­ed­ness (35%), headaches (33%), stom­achaches (33%), and sad­ness (25%).

In addi­tion, rough­ly 5% believed that non­med­ical use had con­tributed to their using oth­er pre­scrip­tion drugs and illic­it sub­stances. Approx­i­mate­ly 10% report­ed occa­sion­al wor­ries about obtain­ing stim­u­lant med­ica­tion and about becom­ing depen­dent on it. Over 10% believed that they need­ed stim­u­lants to per­form their best aca­d­e­m­i­cal­ly. This does not seem like a use­ful cog­ni­tion to have.

Abuse and depen­dence — The abuse poten­tial of stim­u­lants when used by indi­vid­u­als with­out ADHD has been doc­u­ment­ed in mul­ti­ple stud­ies, although this is reduced in longer-act­ing for­mu­la­tions. Although infor­ma­tion on how often non­med­ical use of ADHD stim­u­lants meets cri­te­ria for stim­u­lant abuse or stim­u­lant depen­dence is lim­it­ed, data from the 2002 Nation­al Sur­vey on Drug Use and Health showed that near­ly 5% of indi­vid­u­als report­ing past-year use of ADHD med­ica­tions met screen­ing cri­te­ria for these disorders.

Adverse reac­tions — Between 2005 and 2010 the num­ber of emer­gency depart­ment vis­its result­ing from the non­med­ical use of stim­u­lant drugs near­ly tripled, from 5,212 to 15,585. The num­ber of emer­gency depart­ment vis­its linked to adverse reac­tions to pre­scribed ADHD stim­u­lants near­ly dou­bled, from 5,085 vis­its to 9,181 visits.

Thir­ty-sev­en per­cent of all emer­gency depart­ment vis­its relat­ed to stim­u­lant med­ica­tion involved stim­u­lant med­ica­tions exclu­sive­ly; the remain­der involved use in com­bi­na­tion with oth­er drugs – fre­quent­ly oth­er phar­ma­ceu­ti­cals — and alcohol.

What about the mis­use and diver­sion of pre­scribed medication?

The mis­use of stim­u­lant med­ica­tion by those with a pre­scrip­tion is also a concern.

Although most indi­vid­u­als use their pre­scribed stim­u­lant med­ica­tion appro­pri­ate­ly, use in ways that devi­ate from those intend­ed by the pre­scrib­ing clin­i­cian is not uncom­mon. This gen­er­al­ly takes the form of tak­ing med­ica­tion at high­er dos­es or more fre­quent­ly than pre­scribed, which has been report­ed by between 27% and 36% of col­lege stu­dents across sev­er­al stud­ies. How­ev­er, up to 25% of col­lege stu­dents have report­ed using pre­scribed ADHD med­ica­tion to get high and up to 30% have report­ed using in con­junc­tion with alco­hol and/or oth­er drugs.

Sim­i­lar to what has been found for non­med­ical users, aca­d­e­m­ic enhance­ment was the most fre­quent­ly report­ed motive and most col­lege stu­dents mis­us­ing for this pur­pose felt that it was help­ful. Nonaca­d­e­m­ic rea­sons for mis­use, e.g., to feel bet­ter or to lose weight, were report­ed as fre­quent rea­sons for mis­use by rel­a­tive­ly few stu­dents. Data on motives for mis­us­ing pre­scribed med­ica­tion out­side of col­lege sam­ples is limited.

As not­ed above, diver­sion of pre­scribed stim­u­lant med­ica­tion is a sig­nif­i­cant prob­lem. In stud­ies of col­lege stu­dents, giv­ing away or sell­ing med­ica­tion to peers has been report­ed by 26% in the pre­vi­ous 6 months, 35% in the pre­vi­ous 12 months, and 62% in their life­time. Diver­sion of pre­scribed stim­u­lants – gen­er­al­ly to friends and rel­a­tives – was also report­ed by a sig­nif­i­cant minor­i­ty of non-col­lege adults.

Con­clu­sions

Con­cerns about the non­med­ical use of stim­u­lant drugs used to treat ADHD are war­rant­ed, with near­ly 10% of col­lege stu­dents report­ing this is a recent nation­al sur­vey; in some stud­ies, the rates are far higher.

Although rel­a­tive­ly infre­quent use is most com­mon, per­haps 20% of non­med­ical users do so reg­u­lar­ly and engage in intranasal routes of admin­is­tra­tion. Rough­ly 5% of non­med­ical users may meet cri­te­ria for stim­u­lant abuse or stim­u­lant depen­dence and emer­gency depart­ment vis­its asso­ci­at­ed with non­med­ical use are increasing.

In addi­tion to non­med­ical use, many indi­vid­u­als with pre­scrip­tions for ADHD med­ica­tion occa­sion­al­ly mis­use their med­ica­tion by tak­ing it in high­er dos­es or with greater fre­quen­cy than pre­scribed; some also use intranasal­ly to ‘get high’ and/or in con­junc­tion with oth­er drugs or alco­hol. As with non­med­ical use, this is asso­ci­at­ed with high­er rates of oth­er sub­stance use. Divert­ing med­ica­tion to friends and fam­i­ly mem­bers is not uncom­mon and many are approached to do so, plac­ing them at repeat­ed risk for engag­ing in ille­gal behavior.

To address these issues, physi­cians should instruct patients about the abuse poten­tial of their med­ica­tion, the need to store it in a secure loca­tion, and obtain a com­mit­ment not to divert it. Chil­dren and ado­les­cents may need coach­ing on how to respond if approached by peers seek­ing their medication.

Col­leges should con­sid­er revis­ing their con­duct poli­cies to address the mis­use and diver­sion of ADHD med­ica­tion, pro­vide stu­dents with secure stor­age places, and edu­cate stu­dents about the poten­tial dan­gers asso­ci­at­ed with non­med­ical use, espe­cial­ly when used with alco­hol and oth­er substances.
Rabiner_David– Dr. David Rabin­er is a child clin­i­cal psy­chol­o­gist and Direc­tor of Under­grad­u­ate Stud­ies in the Depart­ment of Psy­chol­ogy and Neu­ro­science at Duke Uni­ver­sity. He pub­lishes Atten­tion Research Update, an online newslet­ter that helps par­ents, pro­fes­sion­als, and edu­ca­tors keep up with the lat­est research on ADHD, and teach­es the online course  How to Nav­i­gate Con­ven­tion­al and Com­ple­men­tary ADHD Treat­ments for Healthy Brain Devel­op­ment.

Ref­er­ences — Infor­ma­tion pro­vid­ed above is drawn from the fol­low­ing sources among others.

  • Arria AM, Gar­nier-Dyk­stra, KM, Caldeira, KM, et al.: Per­sis­tent non­med­ical use of pre­scrip­tion stim­u­lants among col­lege stu­dents: Pos­si­ble asso­ci­a­tion with ADHD symp­toms. J Atten Dis­ord 2011, 15:347–356.
  • Dupont RL, Cole­man JJ, Buch­er RH, Wil­ford BB. (2008). Char­ac­ter­is­tics and motives of col­lege stu­dents who engage in non­med­ical use of methylphenidate. The Amer­i­can Jour­nal on Addic­tions 2008, 17:167–171.
  • Gar­nier-Dyk­stra LM, Caldeira, KM, Vin­cent, KB, et al.: Non­med­ical use of pre­scrip­tion stim­u­lants dur­ing col­lege: Four year trends in expo­sure oppor­tu­ni­ty, use, motives, and sources. J Am Col­lege Health 2012, 60:226–234. One of the few lon­gi­tu­di­nal stud­ies of non­med­ical use of stimulants.
  • John­ston LD, O‑Malley PM, Bach­man, JG, et al.: Mon­i­tor­ing the Future nation­al sur­vey results on drug use, 1975–2011: Vol­ume II, Col­lege stu­dents and adults ages 19–50. Ann Arbor: Insti­tute for Social Research, The Uni­ver­si­ty of Michi­gan. Includes recent nation­al data on non­med­ical use of stim­u­lant medications.
  • McCabe SE, Teter, CJ. Drug use relat­ed prob­lems among non­med­ical users of pre­scrip­tion stim­u­lants: a web-based sur­vey of col­lege stu­dents from a Mid­west­ern uni­ver­si­ty. Drug Alco­hol Depen 2007, 91:69–76.
  • Novak SP, Kroutil LA, Williams RL, Van Brunt DL. The non­med­ical use of pre­scrip­tion ADHD med­ica­tions: Results from a nation­al Inter­net pan­el. Sub­stance Abuse Treat­ment, Pre­ven­tion, and Pol­i­cy 2007, 2:32.
  • Peterkin, AL, Crone CC, Sheri­dan MJ, Wise, TN (2010). Cog­ni­tive per­for­mance enhance­ment: Mis­use or self-treat­ment? J Atten Dis­ord 2010, 15:263–268.
  • Rabin­er, DL, Anastopoulus AD, Costel­lo EJ et al.: Motives and Per­ceived Con­se­quences of Non­med­ical ADHD Med­ica­tion Use by Col­lege Stu­dents: Are stu­dents treat­ing them­selves for atten­tion prob­lems? J Atten Dis­ord 2009a, 13:259–270. Care­ful exam­i­na­tion of motives for non­med­ical use and asso­ci­a­tion of non­med­ical use with atten­tion problems.
  • Rabin­er DL, Anastopoulus AD, Costel­lo, EJ et al.: The mis­use and diver­sion of pre­scribed ADHD med­ica­tions by col­lege stu­dents. J Atten Dis­ord 2009, 13:144–153.
  • Sepul­ve­da DR, Thomas LM, McCabe, SE, et al.: Mis­use of pre­scribed stim­u­lant med­ica­tion for ADHD and asso­ci­at­ed pat­terns of sub­stance use: Pre­lim­i­nary analy­sis among col­lege stu­dents. Jour­nal of Phar­ma­cy Prac­tice 2011, 24:551–560.
  • Sul­li­van, BK, May K, Gal­bal­ly L. Symp­tom exag­ger­a­tion by col­lege adults in atten­tion-deficit hyper­ac­tiv­i­ty dis­or­der and learn­ing dis­or­der assess­ments. Appl Neu­ropsy­chol 2007, 14:189–207.
  • Upad­hyaya HP, Rose K, Wang W, Brady KT. Atten­tion-deficit/hy­per­ac­tiv­i­ty dis­or­der, med­ica­tion treat­ment, and sub­stance use pat­terns among ado­les­cents and young adults. J Child Ado­lesc Psy­chophar­ma­col 2005, 15:799–809.

Share this:

  • Tweet
  • Email
  • Print
  • More
  • Share on Tumblr
  • Pock­et

Filed Under: Attention & ADD/ADHD, Brain/ Mental Health, Education & Lifelong Learning Tagged With: academic-performance., amphetamines, cognitive effects, cognitive-performance, college, side effects, stimulant medications, treat ADHD

Primary Sidebar

Top Articles on Brain Health and Neuroplasticity

  1. Can you grow your hippocampus? Yes. Here’s how, and why it matters
  2. How learning changes your brain
  3. To harness neuroplasticity, start with enthusiasm
  4. Three ways to protect your mental health during –and after– COVID-19
  5. Why you turn down the radio when you're lost
  6. Solving the Brain Fitness Puzzle Is the Key to Self-Empowered Aging
  7. Ten neu­rotech­nolo­gies about to trans­form brain enhance­ment & health
  8. Five reasons the future of brain enhancement is digital, pervasive and (hopefully) bright
  9. What Educators and Parents Should Know About Neuroplasticity and Dance
  10. The Ten Habits of Highly Effective Brains
  11. Six tips to build resilience and prevent brain-damaging stress
  12. Can brain training work? Yes, if it meets these 5 conditions
  13. What are cognitive abilities and how to boost them?
  14. Eight Tips To Remember What You Read
  15. Twenty Must-Know Facts to Harness Neuroplasticity and Improve Brain Health

Top 10 Brain Teasers and Illusions

  1. You think you know the colors? Try the Stroop Test
  2. Check out this brief attention experiment
  3. Test your stress level
  4. Guess: Are there more brain connections or leaves in the Amazon?
  5. Quick brain teasers to flex two key men­tal mus­cles
  6. Count the Fs in this sentence
  7. Can you iden­tify Apple’s logo?
  8. Ten classic optical illu­sions to trick your mind
  9. What do you see?
  10. Fun Mental Rotation challenge
  • Check our Top 25 Brain Teasers, Games and Illusions

Join 12,620 readers exploring, at no cost, the latest in neuroplasticity and brain health.

By subscribing you agree to receive our free, monthly eNewsletter. We don't rent or sell emails collected, and you may unsubscribe at any time.

IMPORTANT: Please check your inbox or spam folder in a couple minutes and confirm your subscription.

Get In Touch!

Contact Us

660 4th Street, Suite 205,
San Francisco, CA 94107 USA

About Us

SharpBrains is an independent market research firm tracking health and performance applications of brain science. We prepare general and tailored market reports, publish consumer guides, produce an annual global and virtual conference, and provide strategic advisory services.

© 2022 SharpBrains. All Rights Reserved - Privacy Policy