Study: Why do (some) college students misuse ADHD medication?
The use of ADHD meds without a prescription, i.e., nonmedical use, is a large and perhaps growing problem on college campuses nationwide. Although the percent of students who engage in nonmedical use of ADHD meds varies widely across different schools, rates exceeding 30% have been reported at some campuses.
In addition to health risks for students who engage in nonmedical use, this behavior also creates problems for students with prescriptions. They are often approached to sell or give away their medication which is illegal. If they do so, they will wind up skipping doses that they need. Concerns about diversion also contributes to some college counseling/health centers deciding not to provide evaluation or treatment services for ADHD, making it more difficult for students with ADHD to get help they need.
Myths about nonmedical use of ADHD drugs
The media frequently reports on college students misusing ADHD drugs. This is often portrayed as part of a ‘work hard, play hard’ college lifestyle, implying that it is almost typical or normative behavior among college students.
This is not true. Prior research — including my own work — has shown that students who use ADHD drugs nonmedically differ from nonusers in important ways. Specifically, they have lower GPAs, are more concerned about their academic performance, consume more alcohol, are more likely to engage in illict drug use, are more likely to smoke, and report more symptoms of depression and anxiety. Thus, as a group, they are struggling in a variety of areas.
Attention problems and nonmedical use
One particularly interesting finding is that nonmedical users also report significantly higher rates of attention problems. In my own work, self-reported attention problems were not only higher in college students who were nonmedical users, but also predicted who became a nonmedical user over the first 2 years in college. Self-reports of greater attention problems by students who use ADHD drugs nonmedically has now been replicated in multiple studies, suggesting that at least some students are attempting to ‘treat’ attention difficulties that they feel undermine their academic success.
An important limitation of these studies is that they relied on self-reported attention difficulties and have not included any objective assessments. As a result, we don’t know if students who misuse ADHD meds truly struggle with attention relative to their peers, or just think that they do.
This issue was addressed in a recently published study titled ‘Attention, motivation, and study habits in users of unprescripted ADHD medication’. Participants were 128 college students, 61 of whom reported prior nonmedical use of ADHD drugs and 67 of whom did not. These students were compared on self-reported attention difficulties as well as a computerized measure of attention called the TOVA (Test of Vigilant Attention).
In addition to examining how the groups compared on these key variables, the researchers also examined whether they differed in the quality of their study habits and their motivation to engage in cognitive tasks, two additional characteristics that may contribute to nonmedical use among students seeking to enhance their academic performance.
To replicate findings from prior studies, participants were also asked to report on their level of substance use and symptoms of depression and anxiety.
Self-reported attention problems — Consistent with prior work, students who had used ADHD drugs nonmedically reported significantly higher rates of attention problems. And, among nonmedical users, the more attention difficulties reported the more frequently they had used.
Objectively measured attention problems — As noted above, a computerized attention test called the TOVA was used to obtain an objective measure of attention. Nonmedical users had significantly poorer attention on this measure than nonusers, although the differences were not as great as for self-reported attention.
Motivation for cognitive tasks — Motivation to engage in cognitive tasks was measured by having participants report on their level of boredom and motivation during the TOVA; this is a 22-minute repetitive task that can certainly be experienced as boring and monotonous. Nonmedical users reported significantly lower motivation during the task and also experienced it as more boring.
Study habits — The measure of study habits assessed practices known to be related to better academic performance, e.g., use of self-testing to measure ones’ understanding of the material, learning material over time rather than cramming, attending class regularly, time spent studying, etc. Nonmedical users reported poorer study habits relative to other students. And, among nonmedical users, the poorer their study habits the more frequently they had used ADHD drugs in the past year.
Substance use, depression, and anxiety — Consistent with prior work, nonmedical users reported higher levels of substance use as well as more symptoms of depression and anxiety.
Summary and implications
Results from this study highlight that nonmedical use of ADHD drugs by college students should not be construed as ‘typical’ college student behavior and part of the ‘work hard, play hard’ lifestyle that characterizes many students.
Building on prior work, nonmedical users were found not only to have higher self-reported difficulties with attention, but also showed poorer attention on an objective assessment. They also reported greater boredom during a repetitive cognitive task and lower motivation to do well. And, they were less likely to employ study habits associated with academic success. As has been found numerous times, they were also more likely to misuse alcohol and other substances, and reported more symptoms of anxiety and depression. Thus, rather than being ‘typical students’ they were likely to be struggling relative to peers in multiple ways.
Results from this study suggest that some students turn to nonmedical use to address attention difficulties, to enhance their motivation to engage in academic work, and perhaps to compensate for poor study habits. Unfortunately, although students may perceive that using ADHD drugs in this way is helpful to them, there is no evidence that this is effective. Clearly, it would be far preferable for these students to seek professional assistance for these difficulties, which may or may not have anything to do with ADHD.
Although not specifically a focus of the current study, it is important to emphasize that the widespread diversion of ADHD meds on college campuses places students with legitimate prescriptions at risk. They are at risk for being approached to divert their medication, an illegal behavior. Doing so means missing doses they presumably need. Not doing so can mean turning down a friend who is asking for help, which may be difficult.
Parents and physicians should make sure that youth with ADHD prescriptions are aware that they may be approached in this way and understand the problems associated with diverting their meds. Telling students not to do this is not sufficient, however. Instead, youth need to be instructed on how to handle these situations so that they can feel more comfortable and capable of handling themselves appropriately. Schools should also be more vigilant about developing and implementing policies related to the diversion of prescription medications on their campus.
– 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 the Attention Research Update, an online newsletter that helps parents, professionals, and educators keep up with the latest research on ADHD.