As recently as 10-15 years ago, there was
relatively little concern about ADHD medications being diverted, i.e., being
given away or sold to those without prescriptions. Currently, however, the
misuse and abuse of ADHD medications has become an important concern and
it is clear that such diversion is not uncommon. One setting in particular
where the widespread misuse of ADHD medications has been reported to occur
is on college campuses, and you have probably seen a number of articles in
the media about this issue.
Although such articles can provide an important service by drawing attention
to a problem that parents, educators, and health care professionals should
be aware of, most offer little actual data may consist of nothing more than
case histories and anecdotal reports that can be highly inaccurate.
Fortunately, there have been several well-conducted studies on the non-medical
use of ADHD medications by college students, i.e., the use of ADHD medication by students for whom
it is not prescribed, that have been published over the past
several years that have begun to provide solid data on this important issue.
In the largest study of this issue conducted to date, nearly 11,000 students
attending 119 nationally representative 4-year colleges in the US were asked
about their non-medical use (i.e., use without a prescription) of stimulant
medications (McCabe, et al., 2005, Non-medical use of prescription stimulants
among US college students: Prevalence and correlates from a national survey.
Addiction, 99, 96-106). The data from this study was collected in 2001
and participants were assured that their responses would remain completely
confidential so that they could respond in an open and honest manner.
Results of the survey indicated the following:
* Approximately 6.9% of college students reported non-medical use of prescription
stimulants during their lifetime, 4.1% reported non-medical use in the past
year, and 2.1% in the past month.
* Non-medical use was twice as high among males, and was also substantially
higher among white students compared to African Americans or Asians.
* Fraternity/sorority members reported more than double the use of non-members.
* Use was higher among those with a GPA of B or below compared to those with
a B+ or above.
* The rate of non-medical use of prescription stimulants varied dramatically
across colleges, ranging from 0% to 25%. At twenty schools, the reported
past-year use was 0; at 12 schools, the rate exceeded 10%. This clearly
illustrates how much variability there is across schools.
* Use was highest at colleges with the most competitive admissions standards
and lowest at the least competitive schools. More than 80% of schools
with a past year prevalence rate exceeding 10% had highly competitive admissions
standards and were located in the Northeast or South. Among all students
attending three historically black colleges, not a single one reported non-medical
use of prescription stimulants in the past year.
* The illicit use of stimulant medication was associated with other substance
use. Thus, when reporting on their behavior during the past 30 days,
students who used non-prescribed stimulants were more likely than other students
- Use cigarettes (67% vs. 24%)
- Engage in frequent binge drinking (69% vs. 21%)
- Use ecstasy (19% vs. 1%)
- Use cocaine (17% vs. 1%)
- Drive after binge drinking (35% vs. 9%)
- Be the passenger of a drunk driver (66% vs. 21%)
do College Students use ADHD Medications Non-Medically? -
In addition to documenting the prevalence of non-medical ADHD medication
use by college students, recent studies have examined the reasons why students
engage in this behavior.
Results from one study conducted at a large public university in the mid-west
found that the motives most commonly reported by students were to help with
concentration (58%), to help with alertness (43%), and to “get high” (43%)
(Teter, McCabe, Cranford, Boyd, & Guthrie, 2005. Journal of American
College Health, 53, 253-262). These results were largely replicated in a
second recent study conducted at the same university, where the most commonly
reported motives were to help with concentration (65.2%), to help with studying
(59.8%), to increase alertness (47.8%) and to “get high” (31%) (Teter, McCabe,
LaGrange, Cranford, & Boyd, 2006. Pharmacotherapy, 26, 1501-1510.).
Similar findings from a study conducted at a public university in the northeast
have also recently been reported (White, Becker-Blease, & Grace-Bishop,
Thus, it appears that the majority of non-medical users are motivated to
by reasons directly related to enhancing academic performance. However,
use for purely "recreational" reasons is also quite common.
- Limitations of Prior
While these studies have provided important information on the non-medical
use of ADHD medications by college students, there are several issues that
have not yet been adequately addressed.
First, when inquiring about motives for use, students in these studies were
simply asked to check any reason that they had ever taken ADHD medication
non-medically, and not to rate the relative importance of different reasons.
Thus, it is hard to know whether using to "get high" is truly a frequent
motive for use.
Second, little attention has been paid to how students perceive non-medical
use of ADHD medication to affect them and how helpful vs. harmful they perceive
this to be. Such knowledge could be important in efforts to reduce
or prevent this behavior from occurring.
Finally, the possibility that at least some students are using ADHD medication
non-medically to treat undiagnosed ADHD has not been considered. Because
many individuals with ADHD are never diagnosed or treated, it is possible
that some students turn to ADHD medication to address difficulties they experience
as undermining their academic success.
- Recent Findings on
Recently, my colleagues and I completed a study of these issues at two universities
in the southeastern US. Nearly 4,000 students participated in our web-based
survey study, which represented roughly 35% of those invited to participate.
This is a lower participation rate than we had hoped for, but is in the range
of other studies of this issue with college students. Students were assured
that their responses would remain completely confidential and anonymous so
that they could respond freely. Although these results are not yet published,
I wanted to share with you some of our preliminary findings.
- Nearly 9% of students reported using ADHD medication without a prescription
since beginning college. About 15% of this group had used more than
10 times during the prior six months. Most were having it given to
them by peers who had a prescription but some were purchasing it from students,
not all of who had prescriptions.
- As in the studies noted above, use was higher among whites, among fraternity
and sorority members, and among students who engaged in illicit substance
use. Students who used also had lower GPAs.
- By far, the most important reason for taking ADHD medication was to enhance
the ability to study outside of class, e.g., to be able to study longer,
to be able to concentrate better while studying, and to feel less restless
while studying. Students rarely reported using in order to concentrate
better in class.
- Although roughly 25% of non-medical users had used medication to "get high",
this was rated a frequent reason for use by only about 3% of these students.
- Reasons related to enhancing academic performance were the sole reasons
for use reported by over 50% of non-medical users. Over 40% reported
using for both academic and non-academic (e.g., to feel better, to get high,
to lose weight, to be able to party longer) reasons, and fewer than 10% reported
using exclusively for non-academic reasons.
- Most students who use ADHD medication non-medically believe that it is
helpful. Over 70% reported that the overall impact was either "positive"
or "very positive" and fewer than 5% rated the impact as negative.
The actual impact on students, however, remains unknown and cannot be answered
from our study.
- Reports of adverse effects were common. About 60% reported that non-medical
use contributed to sleep difficulties and appetite reduction and about 50%
reported irritability. More concerning side effects were reported to
occur relatively infrequently. Thus, about 5% believed that using ADHD
medication contributed to their use of other substances, and/or resulted
in their having to see a doctor, and/or that they sometimes worried about
becoming dependent on ADHD medication.
- Are Students Treating
their own ADHD Symptoms? -
We were particularly interested to find that students who used ADHD medication
non-medically reported significantly higher attention difficulties than other
students. In fact, after controlling for a wide range of factors, including
other substance use, students with high rates of self-reported attention
difficulties were about twice as likely as other students to report non-medical
ADHD medication use. Nearly 25% reported attention difficulties that
were higher than the average score reported by students who indicated a current
diagnosis of ADHD.
Interestingly, attention problems did not predict the non-medical use of
other prescription medications nor did it predict alcohol use or illicit
drug use. Instead, it was only related to using ADHD medication.
- Summary and Implications
Data from these studies indicate that non-medical use of ADHD medication
is not uncommon among college students. The most important motives
for using ADHD medication is to enhance academic performance, particularly
the ability to study outside of class. Although recreational use also
occurs, this is rarely a frequent motive for use. The majority of students
who use ADHD medication non-medically believe that it is beneficial and relatively
even though adverse affects are not uncommon. Future studies are needed to
try and document what the actual consequences of non-medical use may be.
While it would be an overstatement to suggest that most students who use
ADHD medication non-medically are doing so to treat undiagnosed ADHD, our
recent data strongly suggests that many non-medical users turn to ADHD medication
to address attention difficulties that they experience. For these students,
popular notions of taking ADHD medication in order to "party harder" or to
obtain an "academic edge" over their peers do not apply.
While we cannot determine this from our study, it is very likely that some
of these students have undiagnosed ADHD and would benefit from an appropriate
evaluation and treatment. Those who do not actually have ADHD, but
who nonetheless experience problems with attention, would also benefit from
an evaluation to ascertain the reasons for their attention difficulties so
that an appropriate course of action can be undertaken.
Reducing the non-medical use of ADHD medications by college students is thus
likely to require a significant effort to educate students about ADHD, about
other problems that can contribute to difficulties with attention, and about
the importance of seeking professional assistance for these issues rather
than opting for self-medication. It also points to the ongoing need
to develop and test non-medical interventions that can assist children and
adults with ADHD.
Finally, given that significant numbers of students seek ADHD medication
to enhance their academic performance, as well as for other reasons, the
importance of not diverting their medication needs to be emphasized to students
for whom it is prescribed.