September 14, 2016

Stimulant Misuse in College Students

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Timothy E. Wilens, MD, and Nicholas W. Carrellas, BA

Massachusetts General Hospital (Dr Wilens & Mr Carrellas) and Harvard Medical School (Dr Wilens), Boston, Massachusetts


Our data suggest that college students who misuse prescription stimulant medications, compared to those who don’t, are more likely to manifest clinically relevant neuropsychological dysfunction. Specifically, the stimulant misusers studied in our recent investigation were more likely to endorse overall dysfunction, ADHD, conduct disorder, and alcohol, drug, alcohol plus drug, or any substance use disorder. Higher rates of immediate-release stimulants—relative to extended-release—were reported among misusers, indicating the higher abuse liability of the former. Although we only had sufficient data to examine a subset of stimulant misusers, we found that more than two-thirds met criteria for a full or subthreshold prescription stimulant use disorder when queried specifically via structured interview.

Although motivation varies at the individual level, the interesting thing about prescription stimulant misuse is that not everyone is driven to misuse simply to “get high.” Some misusers may use a friend’s medication if they believe it will improve their academic performance, which is a hopeful outcome that is not associated with alcohol or drug use. Another motivation for stimulant misuse may be an attempt to self-medicate preexisting cognitive deficits or cognitive deficits related to alcohol/drug use. Since ADHD is associated with an increased risk of alcohol and drug use disorders, it is not altogether surprising that we are seeing high rates of co-occurring ADHD, substance use disorder, and stimulant use disorder.

Further, many college-aged individuals do not see the problem or danger in misusing prescription stimulants, although the potential associated health risks are not entirely known. The majority (of the subset) of misusers examined by structured interview in this study actually met criteria for a full or subthreshold stimulant use disorder, suggesting that use may be more frequent and severe than previously thought.

From a clinical standpoint, this study builds upon prior work pointing to the higher abuse liability of immediate-release stimulants, compared to extended-release formulations. This fact, combined with the inherent benefits of extended-release stimulants during both structured and unstructured times of the day, emphasizes the utility of extended-release formulations for college-aged populations. Nonstimulant medications may also be indicated for those college students with a substance use disorder who may be more likely to misuse prescription stimulants.

Conveniently, we have further research investigating the same sample that is nearly ready for publication. It is focused on comparing the neuropsychological functioning of controls versus stimulant misusers, which we believe may be the first study of its kind. We used both objective measures (computerized and oral/written tests) and self-report measures (Behavior Rating Inventory of Executive Function) to describe the two samples.

Financial disclosure:Dr Wilens is a consultant for Euthymics/Neurovance, NIH (NIDA), Ironshore, Sunovion, Tris, US National Football League (ERM Associates), US Minor/Major League Baseball, Bay Cove Human Services, and Phoenix House and has received grant/research support from NIH (NIDA). Mr Carrellas has no relevant personal financial relationships to report. ​

Category: ADHD , Substance Use Disorder
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