Study: Why do (some) college students misuse ADHD medication?

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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.

Results

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.

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 the Atten­tion Research Update, an online newslet­ter that helps par­ents, pro­fes­sion­als, and edu­ca­tors keep up with the lat­est research on ADHD.

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SHARPBRAINS es un think-tank y consultoría independiente proporcionando servicios para la neurociencia aplicada, salud, liderazgo e innovación.

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