Misuse of Prescription Stimulant Medication Among College Students: Summary of the Research Literature and Clinical Recommendations

A number of studies demonstrate a clear association between high sensation-seeking and misuse of stimulant medication. These results are not surprising given the well-documented relation between sensation seeking and substance use [25–27]. One study found a significant interaction between sensation seeking and perceived harmfulness of misusing stimulant medication: those with high sensation seeking and low perceived harmfulness were most likely to misuse [20].

Other Substance Use Associated with Stimulant Misuse

Many of the reviewed studies found a positive correlation between misuse of stimulant medication and other substance use or a significant difference between stimulant misusers and nonusers in rates of other substance use. These findings held across all substances examined, including alcohol, cigarettes, marijuana, illicit stimulants (eg, ecstasy, cocaine, or amphetamines), and non-stimulant prescription medications. For instance, significant associations were found between misuse of stimulant medication and several alcohol-related constructs, such as binge drinking [28,29], problematic drinking behavior [30], or meeting the Diagnostic and Statistical Manual of Mental Disorders [21] criteria for alcohol abuse [22]. With respect to cigarettes, 50.3% of misusers were found to have smoked cigarettes in the last 6 months compared to 13.3% of nonusers [16]. Similar findings emerged for illicit drug use. One study found that 73.5% of stimulant medication misusers reported use of marijuana in the last 6 months, compared to 18.2% of nonusers [19], while another study found that 93% of misusers used marijuana in the last year compared to 34% of nonusers [5]. This same study found that 33% of stimulant medication misusers also reported cocaine use in the last year compared to 2% of stimulant nonusers [5]. Finally, many of the studies reviewed examined the association between other substance use in general and stimulant medication misuse. Results were striking; the odds of becoming a stimulant medication misuser increased by 3.81 for each standard deviation increase in the amount of other substance use [9].

Summary

The research literature reviewed in this section provides a descriptive characterization of which college students (and, by extension, adolescents and young adults not in college) may be at the greatest risk of misuse of stimulant medication. Significant risk factors include being male, being a member of a college sorority or fraternity, struggling academically, having elevated symptoms of ADHD and/or depression, being a high sensation-seeker, and using/misusing alcohol, cigarettes, and/or other illicit drugs. It is important to recognize that one, several, or many of these risk factors may be present in a given individual who is misusing stimulant medication. Moreover, there may be other risk factors not yet identified in the research literature. The following sections of this paper draw from the literature reviewed here to provide a number of clinical recommendations for reducing and preventing misuse of stimulant medications among college students, other young adults, and adolescents.

Clinical Recommendations

It is important for health care providers to be aware of the benefits and risks associated with stimulant medications, the prevalence of and risk factors for stimulant misuse, and the psychiatric, psychological, and medical comorbidities associated with the misuse of stimulant medication. Knowledge about stimulant medications, misuse of stimulant medications, and a thorough evaluation of the patient will enable health care providers to address the misuse, as well as any comorbidities or other factors that may contribute to stimulant medication misuse, either pharmacologically or through referral for more specified psychotherapeutic interventions.