Misuse of Stimulant Medication Among College Students: A Comprehensive Review and Meta-analysis

  • Kari Benson
  • Kate Flory
  • Kathryn L. Humphreys
  • Steve S. Lee
Article

Abstract

The misuse of stimulant medication among college students is a prevalent and growing problem. The purpose of this review and meta-analysis is to summarize the current research on rates and demographic and psychosocial correlates of stimulant medication misuse among college students, to provide methodological guidance and other ideas for future research, and to provide some preliminary suggestions for preventing and reducing misuse on college campuses. Random-effects meta-analysis found that the rate of stimulant medication misuse among college students was estimated at 17 % (95 % CI [0.13, 0.23], p < .001) and identified several psychological variables that differentiated misusers and nonusers, including symptoms of attention-deficit/hyperactivity disorder, problems associated with alcohol use, and marijuana use. A qualitative review of the literature also revealed that Greek organization membership, academic performance, and other substance use were associated with misuse. Students are misusing primarily for academic reasons, and the most common source for obtaining stimulant medication is peers with prescriptions. Interpretation of findings is complicated by the lack of a standard misuse definition as well as validated tools for measuring stimulant misuse. The relation between stimulant medication misuse and extra curricular participation, academic outcomes, depression, and eating disorders requires further investigation, as do the reasons why students divert or misuse and whether policies on college campuses contribute to the high rates of misuse among students. Future research should also work to develop and implement effective prevention strategies for reducing the diversion and misuse of stimulant medication on college campuses.

Keywords

Stimulant medication Misuse College students Motives Psychological correlates 

References

  1. Advokat, C. D., Guildry, D., & Martino, L. (2008). Licit and illicit use of medications for attention-deficit hyperactivity disorder in undergraduate college students. American College Health, 56(6), 601–606. doi:10.3200/JACH.56.6.601-606.CrossRefGoogle Scholar
  2. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.Google Scholar
  3. Angold, A., Costello, E., & Erkanli, A. (1999). Comorbidity. Journal of Child Psychology and Psychiatry, 40(1), 57–87. doi:10.1111/1469-7610.00424.CrossRefPubMedGoogle Scholar
  4. Arria, A. M., Caldeira, K. M., Vincent, K. B., O’Grady, K. E., & Wish, E. D. (2008a). Perceived harmfulness predicts nonmedical use of prescription drugs among college students: Interactions with sensation-seeking. Preventative Science, 9(3), 191–201.Google Scholar
  5. Arria, A. M., & Dupont, R. L. (2010). Nonmedical prescription stimulant use among college students: Why we need to do something and what we need to do. Journal of Addictive Diseases, 29, 417–426.CrossRefPubMedCentralPubMedGoogle Scholar
  6. Arria, A. M., Garnier-Dykstra, L. M., Caldeira, K. M., Vincent, K. B., O’Grady, K. E., & Wish, E. D. (2011). Persistent nonmedical use of prescription stimulants among college students: Possible association with ADHD symptoms. Journal of Attention Disorders, 15(5), 347–356.CrossRefPubMedCentralPubMedGoogle Scholar
  7. Arria, A. M., O’Grady, K. E., Caldeira, K. M., Vincent, K. B., & Wish, E. D. (2008b). Nonmedical use of prescription stimulants and analgesics: Association with social and academic behaviors among college students. Journal of Drug Issues, 38(4), 1045–1060.CrossRefPubMedCentralPubMedGoogle Scholar
  8. Arria, A. M., Wilcox, H. C., Caldeira, K. M., Vincent, K. B., Garnier-Dykstra, L. M., & O’Grady, K. E. (2013). Dispelling the myth of “smart drugs”: Cannabis and alcohol use problems predict nonmedical use of prescription stimulants for studying. Addictive Behaviors, 38(3), 1643–1650.CrossRefPubMedCentralPubMedGoogle Scholar
  9. Austerman, J., & Muzina, D. J. (2014). Turning attention to ADHD: U. S. Medication trends for attention deficit hyperactivity disorder. Retrieved from http://lab.express-scripts.com/publications/~/media/89fb0aba100743b5956ad0b5ab286110.ashx
  10. Barkley, R. A. (2006). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (3rd ed.). New York: Guilford Press.Google Scholar
  11. Borenstein, M., Hedges, L. V., Higgins, J. P., & Rothstein, H. R. (2009). Introduction to meta-analysis (1st ed.). Hoboken, NJ: Wiley.CrossRefGoogle Scholar
  12. Brown, S. A., Goldman, M. S., & Christiansen, B. A. (1985). Do alcohol expectancies mediate drinking patterns of adults? Journal of Consulting and Clinical Psychology, 53(4), 512.CrossRefPubMedGoogle Scholar
  13. Caplan, J. P., Epstein, L. A., Quinn, D. K., Stevens, J. R., & Stern, T. A. (2007). Neuropsychiatric effects of prescription drug abuse. Neuropsychology Review, 17(3), 363–380.CrossRefPubMedGoogle Scholar
  14. Chai, G., Governale, L., McMahon, A. W., Trinidad, J. P., Staffa, J., & Murphy, D. (2012). Trends of outpatient prescription drug utilization in US children, 2002–2010. Pediatrics, 130(1), 23–31.CrossRefPubMedGoogle Scholar
  15. Dennhardt, A. A., & Murphy, J. G. (2013). Prevention and treatment of college student drug use: A review of the literature. Addictive Behaviors, 38(10), 2607–2618.CrossRefPubMedGoogle Scholar
  16. DeSantis, A., Noar, S., & Webb, E. (2010). Speeding through the frat house: A qualitative exploration of nonmedical ADHD stimulant use in fraternities. Journal of Drug Education, 40(2), 157–171.CrossRefPubMedGoogle Scholar
  17. DeSantis, A. D., Webb, E. M., & Noar, S. M. (2008). Illicit use of prescription ADHD medications on a college campus: A multimethodological approach. Journal of American College Health, 57(3), 315–323. doi:10.3200/JACH.57.3.315-324.CrossRefPubMedGoogle Scholar
  18. DuPaul, G., Schaughency, E., Weyandt, L., Tripp, G., Kiesner, J., Ota, K., & Stanish, H. (2001). Self-report of ADHD symptoms in university students: Cross-gender and cross-national prevalence. Journal of Learning Disabilities, 34, 370–379.CrossRefPubMedGoogle Scholar
  19. DuPaul, G., Weyandt, L., O’Dell, S., & Varejoa, M. (2009). College students with ADHD: Current status and future directions. Journal of Attention Disorders, 13, 234–250.CrossRefPubMedGoogle Scholar
  20. Dussault, C. L., & Weyandt, L. L. (2013). An examination of prescription stimulants misuse and psychological variables among sorority and fraternity college populations. Journal of Attention Disorders, 27(2), 87–97.CrossRefGoogle Scholar
  21. Findling, R. L., & Dogin, J. W. (1998). Psychopharmacology of ADHD: Children and adolescents. Journal of Clinical Psychiatry, 59(suppl 7), 42–49.PubMedGoogle Scholar
  22. Garnier, L. M., Arria, A. M., Caldeira, K. M., Vincent, K. B., O’Grady, K. E., & Wish, E. D. (2010). Sharing and selling of prescription medications in a college student sample. Journal of Clinical Psychiatry, 71(3), 262–269. doi:10.4088/JCP.09m05189ecr.CrossRefPubMedCentralPubMedGoogle Scholar
  23. Garnier-Dykstra, L. M., Caldeira, K. M., Vincent, K. B., O’Grady, K. E., & Arria, A. M. (2012). Nonmedical use of prescription stimulants during college: Four year trends in exposure opportunity, use, motives, and sources. Journal of American College Health, 60(3), 226–234.CrossRefPubMedCentralPubMedGoogle Scholar
  24. Graff Low, K., & Gendaszek, A. E. (2002). Illicit use of psychostimulants among college students: A preliminary study. Psychology, Health & Medicine, 7(3), 283–287.CrossRefGoogle Scholar
  25. Gudjonsson, G. H., Sigurdsson, J., Sigfusdottir, I., & Young, S. (2012). An epidemiological study of ADHD symptoms among young persons and the relationship with cigarette smoking, alcohol consumption and illicit drug use. Journal of Child Psychology and Psychiatry, 53(3), 304–312. doi:10.1111/j.1469-7610.2011.02489.x.CrossRefPubMedGoogle Scholar
  26. Hakkarainen, P., & Metso, L. (2009). Joint use of drugs and alcohol. European Addiction Research, 15(2), 113–120. doi:10.1159/000209244.CrossRefPubMedGoogle Scholar
  27. Hall, K. M., Irwin, M. M., Bowman, K. A., Frankenberger, W., & Jewett, D. C. (2005). Illicit use of prescribed stimulant medication among college students. Journal of American College Health, 53(4), 167–174. doi:10.3200/JACH.53.4.167-174.CrossRefPubMedGoogle Scholar
  28. Hedges, L. V., & Olkin, I. (1985). Statistical methods for meta-analysis (1st ed.). Orlando, FL: Academic Press.Google Scholar
  29. Humphreys, K. L., Eng, T., & Lee, S. S. (2013). Stimulant medication and substance use outcomes: A meta-analysis. JAMA Psychiatry, 70(7), 740–749.CrossRefPubMedGoogle Scholar
  30. Hustad, J. T., Barnett, N. P., Borsari, B., & Jackson, K. M. (2010). Web-based alcohol prevention for incoming college students: A randomized controlled trial. Addictive Behaviors, 35(3), 183–189.CrossRefPubMedCentralPubMedGoogle Scholar
  31. Jaffe, L. T., & Archer, R. P. (1987). The prediction of drug use among college students from MMPI, MCMI, and sensation seeking scales. Journal of Personality Assessment, 51(2), 243–253.CrossRefPubMedGoogle Scholar
  32. Jeffers, A., Benotsch, E. G., & Koester, S. (2013). Misuse of prescription stimulants for weight loss, psychosocial variables, and eating disordered behaviors. Appetite, 65, 8–13.CrossRefPubMedGoogle Scholar
  33. Judson, R., & Langdon, S. W. (2009). Illicit use of prescription stimulants among college students: Prescription status, motives, theory of planned behaviour, knowledge and self-diagnostic tendencies. Psychology, Health & Medicine, 14(1), 97–104. doi:10.1080/13548500802126723.CrossRefGoogle Scholar
  34. Kayloyanides, K. B., McCabe, S. E., Cranford, J. A., & Teter, C. J. (2007). Prevalence of illicit use and abuse of prescription stimulants, alcohol, and other drugs among college students: Relationship with age at initiation of prescription stimulants. Pharmacotherapy, 27(5), 666–674.CrossRefGoogle Scholar
  35. Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: Reconsideration and recent applications. Harvard Review of Psychiatry, 4(5), 231–244.CrossRefPubMedGoogle Scholar
  36. Lee, S. S., Humphreys, K. L., Flory, K., Liu, R., & Glass, K. (2011). Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: a meta-analytic review. Clinical Psychology Review, 31(3), 328–341.CrossRefPubMedCentralPubMedGoogle Scholar
  37. Lookatch, S. J., Dunne, E. M., & Katz, E. C. (2012). Predictors of nonmedical use of prescription stimulants. Journal of Psychoactive Drugs, 44(1), 86–91. doi:10.1080/02791072.2012.662083.CrossRefPubMedGoogle Scholar
  38. Martins, S. S., Storr, C. L., Alexandre, P. K., & Chilcoat, H. D. (2008). Adolescent ecstasy and other drug use in the National Survey of Parents and Youth: The role of sensation-seeking, parental monitoring and peer’s drug use. Addictive Behaviors, 33(7), 919–933.CrossRefPubMedCentralPubMedGoogle Scholar
  39. McCabe, S. E. (2008). Misperceptions of non-medical prescription drug use: A web survey of college students. Addictive Behaviors, 33(5), 713–724.CrossRefPubMedCentralPubMedGoogle Scholar
  40. McCabe, S. E., & Boyd, C. J. (2005). Sources of prescription drugs for illicit use. Addictive Behaviors, 30(7), 1342–1350.CrossRefPubMedCentralPubMedGoogle Scholar
  41. McCabe, S. E., Cranford, J. A., Morales, M., & Young, A. (2006a). Simultaneous and concurrent polydrug use of alcohol and prescription drugs: prevalence, correlates, and consequences. Journal of Studies on Alcohol, 67(4), 529–537.PubMedCentralPubMedGoogle Scholar
  42. McCabe, S., Teter, C. J., & Boyd, C. J. (2006b). Medical Use, Illicit Use, and Diversion of Abusable Prescription Drugs. Journal of American College Health, 54(5), 269–278. doi:10.3200/JACH.54.5.269-27.CrossRefPubMedCentralPubMedGoogle Scholar
  43. McCabe, S., Teter, C. J., & Boyd, C. J. (2006c). Medical use, illicit use and diversion of prescription stimulant medication. Journal of Psychoactive Drugs, 38(1), 43–56. doi:10.1080/02791072.2006.10399827.CrossRefPubMedCentralPubMedGoogle Scholar
  44. Morisano, D., Hirsh, J. B., Peterson, J. B., Pihl, R. O., & Shore, B. M. (2010). Setting, elaborating, and reflecting on personal goals improves academic performance. Journal of Applied Psychology, 95(2), 255.CrossRefPubMedGoogle Scholar
  45. Morton, W. A., & Stockton, G. G. (2000). Methylphenidate abuse and psychiatric side effects. Primary Care Companion Journal of Clinical Psychiatry, 2(5), 159–164.CrossRefGoogle Scholar
  46. Pedersen, W. (1991). Mental health, sensation seeking and drug use patterns: a longitudinal study. British Journal of Addiction, 86(2), 195–204.CrossRefPubMedGoogle Scholar
  47. Peterkin, A. L., Crone, C. C., Sheridan, M. J., & Wise, T. N. (2011). Cognitive performance enhancement: Misuse or self-treatment? Journal Of Attention Disorders, 15(4), 263–268. doi:10.1177/1087054710365980.CrossRefPubMedGoogle Scholar
  48. Pilcher, J. J., & Walters, A. S. (1997). How sleep deprivation affects psychological variables related to college students’ cognitive performance. Journal of American College Health, 46(3), 121–126. doi:10.1080/07448489709595597.CrossRefPubMedGoogle Scholar
  49. Rabiner, D. L., Anastopoulos, A. D., Costello, E., Hoyle, R. H., McCabe, S., & Swartzwelder, H. (2009a). The misuse and diversion of prescribed ADHD medications by college students. Journal of Attention Disorders, 13(3), 259–270.CrossRefPubMedGoogle Scholar
  50. Rabiner, D. L., Anastopoulos, A. D., Costello, E., Hoyle, R. H., McCabe, S., & Swartzwelder, H. (2009b). Motives and perceived consequences of nonmedical ADHD medication use by college students: Are students treating themselves for attention problems? Journal Of Attention Disorders, 13(3), 259–270. doi:10.1177/1087054708320399.CrossRefPubMedGoogle Scholar
  51. Rabiner, D. L., Anastopoulos, A. D., Costello, E., Hoyle, R. H., & Swartzwelder, H. (2010). Predictors of nonmedical ADHD medication use by college students. Journal of Attention Disorders, 13(6), 640–648. doi:10.1177/1087054709334505.CrossRefPubMedGoogle Scholar
  52. Rahmati, A., & Sharifi, P. (2013). The effect of note taking skills training on the academic self-efficacy of students. Strides in Development of Medical Education, 10(1), 27–35.Google Scholar
  53. Rappley, M. D. (1997). Safety issues in the use of methylphenidate. Drug Safety, 17(3), 143–148.CrossRefPubMedGoogle Scholar
  54. Rozenbroek, K., & Rothstein, W. G. (2011). Medical and nonmedical users of prescription drugs among college students. Journal of American College Health, 59(5), 358–363.CrossRefPubMedGoogle Scholar
  55. Schoenfelder, E. N., Faraone, S. V., & Kollins, S. H. (2014). Stimulant treatment of ADHD and cigarette smoking: A meta-analysis. Pediatrics, 133(7), 1070–1080.CrossRefPubMedGoogle Scholar
  56. Sepúlveda, D. R., Thomas, L. M., McCabe, S., Cranford, J. A., Boyd, C. J., & Teter, C. J. (2011). Misuse of prescribed stimulant medication for ADHD and associated patterns of substance use: Preliminary analysis among college students. Journal Of Pharmacy Practice, 24(6), 551–560. doi:10.1177/0897190011426558.CrossRefPubMedCentralPubMedGoogle Scholar
  57. Sharp, J. T., & Rosén, L. A. (2007). Recreational stimulant use among college students. Journal Of Substance Use, 12(2), 71–82. doi:10.1080/14659890601022865.CrossRefGoogle Scholar
  58. Teter, C. J., Falone, A. E., Cranford, J. A., Boyd, C. J., & McCabe, S. E. (2010). Nonmedical use of prescription stimulants and depressed mood among college students: Frequency and routes of administration. Journal of Substance Abuse Treatment, 38(3), 292–298.CrossRefPubMedCentralPubMedGoogle Scholar
  59. Teter, C. J., McCabe, S. E., Cranford, J. A., Boyd, C. J., & Guthrie, S. K. (2005). Prevalence and motives for illicit use of prescription stimulants in an undergraduate student sample. Journal of American College Health, 53(6), 253–262. doi:10.3200/JACH.53.6.253-262.CrossRefPubMedGoogle Scholar
  60. Van Eck, K., Markle, R. S., & Flory, K. (2012). Do conduct problems and sensation seeking moderate the association between ADHD and three types of stimulant use in a college population? Psychology of Addictive Behaviors, 26(4), 939–947.CrossRefPubMedGoogle Scholar
  61. Vetter, V. L., Elia, J., Erickson, C., Berger, S., Blum, N., Uzark, K., & Webb, C. L. (2008). Cardiovascular monitoring of children and adolescents with heart disease receiving stimulant drugs a scientific statement from the American heart association council on cardiovascular disease in the young congenital cardiac defects committee and the council on cardiovascular nursing. Circulation: Journal of the American Heart Association, 117, 2407–2423.CrossRefGoogle Scholar
  62. Volkow, N. D., Ding, Y. S., Fowler, J. S., Wang, G. J., Logan, J., Gatley, J. S., et al. (1995). Is methylphenidate like cocaine? Studies on their pharmacokinetics and distribution in the human brain. Archives of General Psychiatry, 52(6), 456.CrossRefPubMedGoogle Scholar
  63. Weyandt, L. L., Janusis, G., Wilson, K. G., Verdi, G., Paquin, G., Lopes, J., et al. (2009). Nonmedical prescription stimulant use among a sample of college students: Relationship with psychological variables. Journal of Attention Disorders, 13(3), 284–296.CrossRefPubMedGoogle Scholar
  64. Weyandt, L. L., Marraccini, M. E., Gudmundsdottir, B. G., Zavras, B. M., Turcotte, K. D., Munro, B. A., & Amoroso, A. J. (2013). Misuse of prescription stimulants among college students: A review of the literature and implications for morphological and cognitive effects on brain functioning. Experimental and Clinical Psychopharmacology, 21, 385–407.CrossRefPubMedGoogle Scholar
  65. Wolf, L. (2001). College students with ADHD and other hidden disorders: Outcomes and interventions. Annals of the New York Academy of Arts and Sciences, 931, 385–395.CrossRefGoogle Scholar
  66. Zullig, K. J., & Divin, A. L. (2012). The association between non-medical prescription drug use, depressive symptoms, and suicidality among college students. Addictive Behaviors, 37(8), 890–899.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Kari Benson
    • 1
  • Kate Flory
    • 1
  • Kathryn L. Humphreys
    • 2
  • Steve S. Lee
    • 3
  1. 1.Department of Psychology, Barnwell CollegeUniversity of South CarolinaColumbiaUSA
  2. 2.Tulane University School of MedicineNew OrleansUSA
  3. 3.University of California Los AngelesLos AngelesUSA

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