College students who misuse stimulants more likely to have ADHD, substance-use disorder

August 8, 2016, Massachusetts General Hospital

A new study by Massachusetts General Hospital (MGH) investigators finds that college students who misuse stimulant drugs are more likely to have attention-deficit hyperactivity disorder (ADHD), conduct disorder or substance-use disorder than are students not misusing stimulants. The report published in the Journal of Clinical Psychiatry also finds immediate-release stimulants are more likely to be misused than extended-release versions of the drugs.

"Our data suggest that who misuse prescription stimulant medications are more likely to exhibit clinically relevant psychiatric dysfunction," says Timothy Wilens, MD, chief of Child and Adolescent Psychiatry at MassGeneral Hospital for Children (MGHfC) and co-director of the MGH Center for Addiction Medicine, corresponding author of the report. "In addition to higher levels of ADHD, , and alcohol or drug use disorders, the majority of those misusing met or approached criteria for stimulant-use disorder."

Stimulant drugs are widely prescribed to treat ADHD, which is believed to affect up to 8 percent of U.S. college students, and several studies have documented frequent nonmedical use - either without a prescription or taking higher-than-prescribed doses - particularly among college students. One recent study found that almost two thirds of college students had been offered stimulants for nonmedical use and 31 percent had actually used them over a four-year period.

The current study differs from previous investigations in that - instead of relying only on participants' answers to survey questions about their use of stimulants and other drugs, alcohol consumption and other factors including quality of life - it relied on structured interviews that have been validated for the diagnosis of neuropsychiatric disorders, including substance-use disorders. Wilens explains, "Someone may report on a survey that they misused stimulants on 'a handful of occasions' and have never been diagnosed with a substance-use disorder. But during the intensive interview process it may be found that they mixed prescription stimulants with alcohol and that they had problematic interactions with others that led to legal action. While that misuser may deny having a stimulant-use disorder, when systematically queried, it may be found that he or she met or approached the criteria for a full disorder."

Study participants were all enrolled as undergraduates in Boston-area colleges and universities and were ages 18 to 28. As part of the enrollment process they were screened for "college lifestyle" factors, which included whether they had been diagnosed or treated for ADHD, whether they had ever misused stimulant medications, and their use of alcohol or other drugs. For the purpose of this study, stimulants were considered those approved by the FDA for treatment of ADHD, and even a single reported nonmedical use categorized a participant as a stimulant misuser.

Of the 300 students who were enrolled, 100 were classified as misusers based on their responses to the recruitment surveys, and 200 were considered control participants. Both groups included individuals diagnosed with ADHD, and those who never misused their prescriptions were included in the control group. The structured interviews were conducted by specially trained interviewers with backgrounds in psychology, and the results reviewed by a panel of child psychiatrists and licensed psychologists, who confirmed diagnoses indicated by interview results. Participants with potentially serious substance-use issues were referred to local treatment centers.

Stimulant misusers were more likely than controls to have been diagnosed with ADHD or to have exhibited related symptoms - being easily distracted, having trouble paying attention - during childhood. They also were more likely as adults to have difficulty following instructions and to dislike tasks requiring attention. Misusers were more likely to meet criteria for substance-use disorder - including use of drugs and alcohol together - and 67 percent actually met or approached criteria for stimulant-use disorder. They acquired or purchased stimulants from friends or acquaintances, were more likely than controls to indicate they used any drugs to "get high" and reported a lower overall sense of well being.

"Not everyone is driven to misuse simply to 'get high'," Wilens explains. "Some misusers may be pressured to use a friend's prescription if they believe it will improve academic performance, which is not likely if combined with alcohol or other drugs. We know that untreated ADHD is associated with increased risk of alcohol- and drug-use disorders, so it is not surprising that we found high rates of co-occurring ADHD and of stimulant-use and overall substance-use disorders in those misusing stimulants."

An associate professor of Psychiatry at Harvard Medical School, Wilens adds, "It's possible that pre-existing cognitive deficits may lead some individuals to develop stimulant misuse as they try to self-medicate. The extent of an actual stimulant-use disorder in those who misused stimulants at all suggests that this problem may be more prevalent and severe than previously thought. And finding in this population that immediate-release stimulants have a much higher likelihood of being misused than do extended-release stimulants emphasizes the usefulness of prescribing extended-release versions or possibly nonstimulant ADHD drugs for college students."

Explore further: Risk of drug abuse lower for teens prescribed stimulant medications early in life

More information: Timothy Wilens et al, Nonmedical Stimulant Use in College Students, The Journal of Clinical Psychiatry (2016). DOI: 10.4088/JCP.14m09559

Related Stories

Risk of drug abuse lower for teens prescribed stimulant medications early in life

April 27, 2016
Teens who take prescribed stimulant medications such as Ritalin, Adderall, Concerta and methylphenidate within a medical context early in life are at lower risk for developing substance use problems in adolescence, according ...

Many Ivy League students don't view ADHD medication misuse as cheating

May 1, 2014
Nearly one in five students at an Ivy League college reported misusing a prescription stimulant while studying, and one-third of students did not view such misuse as cheating, according to a study to be presented Saturday, ...

Do ADHD medicines boost substance abuse risk?

July 15, 2016
(HealthDay)—Parents often worry that their children who take stimulants to treat attention deficit hyperactivity disorder (ADHD) may be at higher risk for substance abuse later.

College students say prescription stimulants easy to find on campus

October 16, 2015
Seven out of 10 college students say it is somewhat or very easy to obtain controlled stimulants without a prescription, according to a new survey conducted on eight U.S. campuses.

Study highlights multiple factors of ADHD medication use

June 8, 2016
Youth who take Ritalin, Adderall or other stimulant medications for ADHD over an extended period of time early in life are no more at risk for substance abuse in later adolescence than teens without ADHD, according to a University ...

Teens start misusing ADHD drugs and other stimulants earlier than you might think

June 2, 2015
Despite stereotypes about college students resorting to black-market Ritalin to help them cram for exams, young people are actually most likely to start misusing prescription stimulant drugs in their high school years, according ...

Recommended for you

For children with ADHD, a brief, school-based program can help dramatically with homework problems, study finds

December 6, 2017
Children with attention deficit hyperactivity disorder who took part in a brief, school-based program displayed significant improvements in their homework, organization and planning skills, according to a new study led by ...

What can twitter reveal about people with ADHD?

November 9, 2017
What can Twitter reveal about people with attention-deficit/hyperactivity disorder, or ADHD? Quite a bit about what life is like for someone with the condition, according to findings published by University of Pennsylvania ...

Brain imaging reveals ADHD as a collection of different disorders

November 8, 2017
Researchers have found that patients with different types of attention-deficit/hyperactivity disorder (ADHD) have impairments in unique brain systems, indicating that there may not be a one-size-fits-all explanation for the ...

Can adults develop ADHD? New research says probably not

October 20, 2017
Adults likely do not develop ADHD, according to new research by FIU clinical psychologist Margaret Sibley.

Nearly a third of college kids think ADHD meds boost grades

October 16, 2017
(HealthDay)—Many college students who abuse ADHD drugs mistakenly believe that doing so will lead to better grades, a new survey suggests.

School year 'relative age' causing bias in ADHD diagnosis, says research

October 9, 2017
Younger primary school children are more likely to be diagnosed with attention deficit hyperactivity disorder (ADHD) than their older peers within the same school year, new research has shown.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.