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

Motives For Misuse and Perceived Risk

Researchers have also evaluated college students’ motives for misusing stimulant medication and the risks they associate with misuse. All of the studies that asked misusing students about their motives for misuse reported that the most commonly endorsed motives were related to academics. “To concentrate better while studying” [16], “to improve study skills” [17], “to stay awake to study longer” [11], and “to improve concentration” [18] were some of the most commonly endorsed motives in these studies. Nonacademic reasons, such as to get high, to prolong effects of alcohol and other drugs, and to lose weight, were less commonly endorsed [7,12,19]. In studies where participants were able to indicate multiple motives for misuse [16], very few students misused for only nonacademic reasons.

Several studies measured the relation between misuse of stimulant medication and perceived risk associated with misuse. Perceived risk was conceptualized as perceived harmfulness [20], perception of safety [14], concern with health risk [18], and the inverse of positive outcome expectancies [21]. These articles found that when college students perceive more risk or have less positive expectancies about stimulant medication misuse, they are less likely to misuse stimulant medication. For instance, those who associated stimulant medication misuse with low perceived harmfulness were over 10 times more likely to have used in the last year than those who associated misuse with high perceived harmfulness [20].

Academic Outcomes Associated with Misuse

Interestingly, despite academic motives being most common for college students who report misusing stimulant medication, a number of studies have found a negative association between academic outcomes and misuse of stimulant medication. For instance, nonusers reported an average grade-point average (GPA) of 3.28 compared to 3.16 for misusers [16]. Other research demonstrates that the lower the student’s GPA is, the greater the odds are of the student misusing stimulant medication [8]. Misuse is also significantly related to other detrimental academic behaviors such as skipping class and less studying [20,22].

Psychological Correlates of Misuse

Researchers have evaluated the relation between several different psychological variables and misuse of stimulant medication. The strongest association is between symptoms of ADHD and stimulant medication misuse. Studies are consistent in reporting a significant correlation between greater symptoms of ADHD and higher rates of misuse or a significant difference in rates of misuse between those who have an ADHD diagnosis and those who do not. One study found that 71.1% of stimulant medication misusers screened positive for adult ADHD symptoms [17]. Another study found that for every standard deviation increase in attention problems, the odds of becoming a stimulant misuser increased by 1.78 [9]. Two studies asked participants if they believed they had ADHD. Advokat, Guildry, and Martino found that 12% of misusers believed they had ADHD [7]. Twenty-nine percent of “self-diagnosers” reported misusing, compared to 11.4% of “non-diagnosers” in another study [18].

Although the literature base is smaller than for ADHD, several studies have suggested a significant difference in symptoms of depression between stimulant medication misusers and nonusers. Zullig and Divin [23] found that misusers were significantly more likely to feel very sad, feel depressed, and consider suicide than nonusers. More frequent misuse has also been shown to be significantly associated with depressed mood [24].