Prescription stimulants are often helpful in the treatment of attention deficit hyperactivity disorder (ADHD). However, there are a significant number of college students not being treated for this disorder who obtain and misuse these drugs. Timothy Wilens and colleagues evaluated the characteristics of a group of college students who misuse prescription stimulants. They recently published their results in the Journal of Clinical Psychiatry.

Several previous studies demonstrated that 25% or more of college students use prescription stimulants for nonmedical purposes. Students often obtain the drugs from fellow students who have been prescribed the drugs for ADHD. Some students misuse these drugs to get an added boost of energy in order to help them study longer. Some use these drugs purely for recreational purposes.

Prior to the study by Wilens and colleagues, little was known about the characteristics of college students who misuse these drugs. These investigators studied a group of 100 college students in the Boston area who acknowledged misusing stimulants and compared them to a control group of 198 students who had never misused prescription stimulants. None of the students was being treated with stimulants medically. They were recruited into the study via internet advertisements. Because of the way they were recruited, the students in this study may not be representative of a more randomly selected group of college students. During the study, the students participated in a variety of assessments including a DSM-IV-based, structured diagnostic interview.

The majority of the students who admitted misusing stimulants had multiple symptoms of a stimulant abuse or dependence disorder. In other words, many had progressed from casual use to more regular use that was interfering with their everyday functioning.

Many of those who misused stimulants also fulfilled criteria for alcohol use disorder. In fact, this group demonstrated a two-fold increase in the prevalence of alcohol use disorder when compared to the students who did not misuse stimulants. Abuse of multiple substances was also increased in the group misusing stimulants.

The rates of major depression, bipolar disorder, and psychotic disorders were not significantly different between the two groups of students. However, 10% of those misusing stimulants had a history of conduct disorder compared with only 3% of controls. Also, more of the students misusing stimulants had either a full syndrome of ADHD or a sub-threshold group of ADHD symptoms when compared with the control group (27% vs. 16%).

The results of this study indicate that college students who misuse prescription stimulants may also abuse alcohol and other substances including marijuana. Additionally, these students may have symptoms suggestive of untreated ADHD. There is also an increased likelihood that they had symptoms of conduct disorder while growing up, although the number with conduct disorder traits was small.

The authors of this study suggest that it may be helpful to screen students for stimulant misuse. Such screening may identify students with undiagnosed ADHD as well as those who may be on their way to developing serious alcohol and other substance use disorders. Identifying and counseling such students during their college years may help prevent potentially devastating problems down the road, although long-term data about the outcomes of these students are lacking.

This column was written by Eugene Rubin MD, PhD and Charles Zorumski MD.

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