Licit and illicit use of prescription psychostimulants in upperclassmen and alumni.

Author:Underhill, Brynne
Position:Report
 
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ABSTRACT

Use of prescription stimulants after college has not been well researched. In an online survey, current upperclassmen undergraduates (N = 96) and recent alumni (N = 33 7) reported licit and illicit use of prescription stimulants, perceptions of peer use, self-diagnosis of attention disorder, and plans for continued use. Post-graduate rate of use was significantly lower than undergraduate levels, though alumni reported significantly greater post-graduate use than they had expected in college and this alumni rate was also significantly greater than current students' predictions for post-graduate use. While college environment appears to be an ecological factor in prescription stimulant use, other factors, such as perceived peer use and self-diagnosis, also play c role. Educating undergraduates about long term and illicit stimulant use would be beneficial.

Keywords: prescription stimulants, illicit use, social norms, college students, alumni

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College students' use of prescription psychostimulants has emerged as an important area of research. Attention-deficit-hyperactivity disorder (ADHD) was once believed to exist only in children and adolescents, but accumulating evidence suggests that young adults can experience symptoms well into their college years (Weyandt & DuPaul, 2012). Reports show that approximately 2-6% of college students are being treated for ADHD with stimulant medications (DeSantis, Webb, & Noar, 2008; McCabe, Teter, & Boyd, 2006; White, Becker-Blease, & Grace-Bishop, 2006) and there is some evidence of a protective effect of prescription psychostimulants for emotional well-being (e.g., Wehmeier, Schact, Lehmann, Dittmann, Silva, & March, 2008) and substance abuse (e.g., Wilens et al., 2008). The illicit use of these medications, however, is more prevalent. Studies report that upwards of 35% of college students engage in the illicit use of psychostimulants (Low & Gendaszek, 2002), although rates are usually reported at 6-7% (e.g., McCabe, Knight, Teter, & Weschler, 2005). Such use occurs more frequently among students who self-identify as White, are male, attend a more competitive school, have a lower GPA, are in a fraternity or sorority, use other substances (McCabe, et al., 2005; Rabiner, Anastopoulos, Costello, Hoyle, McCabe & Swartzwelder, 2008), or believe that they have undiagnosed ADHD (Judson & Langdon, 2009). Furthermore, students who hold a prescription for ADHD medications are at an increased risk for misusing these medications (Judson & Langdon, 2009; Sepulveda, Thomas, McCabe, Cranford, Boyd, & Teter, 2011).

Psychostimulant medications have a number of documented and serious side effects, such as "nervousness, insomnia, psychosis, hallucinations, and agitation...anorexia, weight loss, nausea, headaches, tachycardia and hypertension." (p. 603, Ashton, Gallagher, & Moore, 2006). While these side effects present a problem for prescription and illicit users alike, the lack of medical supervision among self-medicators and illicit users may increase the potential for harm. Most concerning, perhaps, is that illicit users who do not have a prescription have little knowledge about potential health issues (DeSantis, Noar, & Webb, 2010), including increased negative effects with caffeine (Vanattou-Saifoudine, McNamara, & Harkin, 2012) and poorer sleep quality with use (Clegg-Kraynok, McBean, & Montgomery-Downs, 2011). The risks become more pronounced if students use stimulants concurrently with other substances, with polyuse of substances a common occurrence in illicit users (e.g., Arria et al., 2008; Egan, Reboussin, Blocker, Wolfson, & Sutfin, 2013). McCabe, Cranford, Morales, & Young (2006) reported that 6% of their college sample used prescription stimulants and alcohol simultaneously within the previous year. Egan et al. (2013) found a similar rate of concurrence as well as its association with several negative outcomes. Previous research has focused on college students' use of prescription psychostimulants, but little is known as to whether the use of stimulants continues after college.

Although 30-70% of former students with ADHD continue to have symptoms many years after graduating from school (Ashton, et al., 2006), until the later part of the last century, the condition was considered limited to childhood. Broad scale awareness and treatment for young adults with ADHD after college, then, is a newer phenomenon (e.g., Barkley, Murphy, & Fischer, 2008). Evidence suggests that prolonged use of psychostimulant medication may be harmful (Klein-Schwartz, & McGrath, 2003). Ashton et al. (2006) found that the longer individuals took psychostimulants, the greater their chances were of becoming psychologically dependent. Researchers reported that patients might suffer withdrawal symptoms like sleep disturbances and depression upon discontinuation of use (Kutcher, Aman, Brooks, Buitelaar, van Daalen, Fegert, et al., 2004). Another potential issue of concern, especially for young adults in their childbearing age, is the effect of psychostimulant medication on prenatal development. Although research has not yet examined potential teratogenic effects, other stimulants are known to affect fetal development (Ashton et al., 2006) and psychostimulants are cautioned during pregnancy (Novartis Pharmaceuticals Corporation, 2010). Therefore, psychostimulant users need to consider these factors when deciding whether to continue using these medications into young and middle adulthood.

Few studies have specifically examined illicit use in adults. From a nationally representative sample, Novak et al. (2007) found that 4.3% of individuals between the ages of 18 and 25 and 1.3% of those 26 and older had misused prescription stimulants within the past year. White et al. (2006) compared traditional undergraduate students with students over 24 years of age (whom they defined as nontraditional), and found fewer of the older students misused prescription psychostimulants than traditional students. McCabe et al. (2005), similarly found that 1.6% of students over 24 misused stimulants compared to 4.5% of younger students. However, research with students in competitive graduate schools, including medical school (Bucher et al., 2013; Emanuel et al., 2013; Tuttle, Scheurich, & Ranseen, 2010) and dental school (McNiel, Muzzin, DeWald., McCann, Schneiderman, Scofield, & Campbell, 2011) showed higher prevalence of illicit use even with an older student population. This parallels McCabe et al.'s 2005 findings of higher use in more competitive academic environments. Overall, there seems to be a general trend that illicit stimulant use decreases with age. However, the specific ecological influence of the college environment is not accounted for in these studies.

Research on prescription stimulant use during the transition from college to early post-graduate is generally non-existent. An estimation of stimulant use may be gained from the statistics regarding patterns of alcohol use before and after graduation. In general, drinking patterns change significantly after college. Bartholow et al. (2003) found that individuals in fraternities and sororities drank far less once they graduated than while they were still in school. Another study of the recently graduated concluded that factors such as being male and having a full time job after college were related to decreased alcohol consumption after graduation (Gotham, Sher, & Wood, 1997). Campbell and Demb (2008) found several distinguishing factors for persisting in or maturing out of college alcohol consumption patterns, including behavioral factors such as consistency and frequency of college drinking. If prescription stimulants are being used recreationally, one might expect to see reductions in behavior...

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