Assessing Non-Prescription ADHD

Medication Use in College Students:

A Midwest Pilot Study

Matthew DwyerFaculty Sponsor: Dr. Carrie Fried

Winona State University

Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) has been a highly diagnosed mental health condition in recent decades:

Since the mid 1990s, more than 4.4 million children between ages 4 and 17 years old have been diagnosed with ADHD. (DeSantis, Webb, & Noar, 2008)

30-70% of children diagnosed with ADHD in childhood continue to have symptoms into adulthood. (Vollmer, 1998)

According to the U.S. Centers for Disease Control and Prevention, as of 2011, 11% of people ages 4–17 have been diagnosed with ADHD.

ADHD Stimulant MedicationNIMH: Stimulants activate dopaminergic brain circuits that support attention, reducing hyperactivity, reduced impulsivity, and improve ability to focus, work, and learn.

The use of stimulant medication has increased exponentially:40% increase in the United States since 1993. Ritalin was the fourth most prescribed medication in 2003 after hydrocodone, oxycodone and codeine. (White, et. al., 2003)

Increased by 90% from 2002 to 2005, with adults receiving one third of all prescriptions (Okie, 2006)

ADHD medication is readily accessible to many and easy to abuse (Okie, 2006;White, et. al., 2003)

Although illegal to take without a prescription, the incidence of abusing ADHD medication among college undergrads is increasing.

Non-Prescription Use in College4% -34% of college students have used ADHD medication without a prescription (DeSantis, Webb, & Noar, 2008; Hall, et. al., 2005; Teter, et. al., 2005; Weyandt, et. al., 2009).

Average national level: 6.9% of college students had abused Adderall at some point in their college years (McCabe, et. al., 2005).

Certain student groups are more likely to take stimulant medication over others:

white students

males over females

affiliation with Greek society

increased competitiveness of the school (McCabe, et. al., 2005).

Schools in the northeastern United States had the highest reported use rates

Reasons for (Mis)Use

“Bro, I have a speech tomorrow that I haven’t started! But its all chill, I’ll just pop an Addie and pull an all-nighter.”

Using stimulant medication as a “study aide” is the most common reason (Low & Gendaszek, 2006, Teter, et. al., 2006, Weiner, 2000).

Other reasons: Weight loss

Improved athletic performance/focus

Party drug (get high, use with alcohol, lower social inhibitions)

Justifications for Use: Is it Cheating?

“’Adderall is Definitely Not a Drug’: Justifications for the Illegal Use of ADHD Stimulants” DeSantis, A. and Hane, A. (2010)

False dichotomy: prescription stimulants vs. street narcotics

Moderation: only use certain times

Self-medication: belief in ADHD symptoms

Minimization of negative effects

“Judging cheaters: Is substance misuse viewed similarly in the athletic and academic domains?” Dodge, T., Williams, K., Marzell, M. and Turrisi, R., (2012)

Anabolic steroids: cheating in athletics

Stimulant medication: not cheating in academics

Significant difference between users and non-users in rating

Current Study Research Questions

Do the results of existing research are generalizable to a small, Midwestern state school (Winona State)?

Why students would use stimulant medication without a prescription?

Do students view using stimulant medication for academic purposes without a prescription as a form of cheating?

Current Study Hypotheses

1) Winona State University would have comparable results to existing research despite being a smaller Midwestern school

2) Students would mainly use stimulant medication for academic purposes

3) Students would not consider using stimulant medication without a prescription as a form of cheating.

Methods: Materials & Procedure

Qualtrics online survey was modeled after the one done in Dodge, et. al. (2012).

Demographic information (question1)

Information about use (question2)

Opinions of cheating (question3).

Data was then compiled and statistical analysis was done using IBM SPSS 22.

Methods: Cheating Questions & Reasons for Using

Cheating Questions:

I would consider taking Attention Deficit Hyperactivity Disorder (ADHD) medication, such as Adderall or Ritalin, for non-prescription, academic purposes as a form of cheating

Reason QuestionStudy Aide

Weight Loss

Improved Athletic Performance

Get High

Lower Social Inhibitions

Other

Methods: Participants

133 total sample31 males

101 females

1 unspecified

Recruited from psychology student research board

Compensated with extra credit

Results: Gender Differences

Figure 1-1 shows an overall usage rate of 21%

Figures 1-2 and 1-3 show that males are more likely to use stimulant medication (11/20, 35%) than females (17/84, 17%). Non-

user; 20;

65%

User; 11; 35%

Malestotal out of 31

Figure 1-2

Non-user; 84; 83%

User; 17; 17%

Females total out of 101

Figure 1-3

Female Users;

17; 13%

Female Non-users; 84; 64%

Male Users; 11; 8%

Male Non-

users; 20;

15%

Total Sample of 132

Figure 1-1

Results: Class and Major CollegeFigure 2 shows the results by year in school.

Largest user groups in younger years.\

Not limited to only freshman

Figure 3 shows the results by major college.

Similar usage rates in liberal arts and nursing.

Not enough data in other major colleges.

Not enough data for ethnic background, socioeconomic background, and Greek life affiliation.

Fresh

man

Sophomore

Junior

Senior

Fifth Year

Other

0

10

20

30

40

50

60

41 26 25 14 3 2

8

7 9

3

1 0

User Non-user

Liberal A

rts

Educatio

n

Business

Nursing/ H

ealth

Science

/ Engineerin

g

Undeclare

d/ Oth

er0

102030405060

46 24 35 11 7

12

01

8

3 4

User Non-user

Figure 2

Figure 3

Results: Reason for Use

“study aide” was the most common and unanimous response among the 28 users surveyed.

“other” was the second most common response with 6

“weight loss” was third at 4.

Study A

ide

Weig

ht Loss

Impro

ved A

thlet

icism

To Get

High

Lower In

hibiti

onsOth

er0

5

10

15

20

25

30 28

42 1 1

6

Reason for Using Stimulant Medication

Un

mb

er o

f Res

pon

ses

(Ou

t of

28

)

1

2

3

4

5

3.93 3.983.83

2.86

4.05

Average Cheating Score

User Cheating Score

Non-user Cheating Score

Ave

rage

Ch

eati

ng

Scor

e

Repeated Measures ANOVA: significant difference between forms of cheating F(3.07,402.5)=40.39, p<.001.

Question 4 was the only one not rated as a form of cheating (M: 2.85, SD: 1.41).

Bonferroni post-hoc testing showed Question 4 was rated significantly lower than the other examples.

Independent samples t-test: no significant difference between users and non-users, t(131)=-1.64, p=.104.

Results: Cheating Questions

Discussion: InterpretationsEthical concerns

Students do not view stimulant medication use as cheating.

No distinction between users and non-users.

Major League Baseball: stimulant medications are now considered performance-enhancers allowed only with a confirmed A.D.H.D. diagnosis.

Health concerns

Misconception of stimulant medication as harmless.

Emergency room visits related to nonmedical use of prescription stimulants among adults 18 to 34 tripled from 2005 to 2011, to almost 23,000. (Federal Substance Abuse and Mental Health Services Administration)

Addiction risks.

2010 to 2012, people entering substance rehabilitation centers cited stimulants as their primary substance of abuse 15 percent more often than in the previous three-year period. (Federal Substance Abuse and Mental Health Services Administration)

Academic performance

Using stimulants to enhance academic performance doesn’t work; lower GPA on average. (Hall, et. al., 2005; Teter, et. al., 2005)

Discussion: Limitations and Future Plans

Sample Too small/lacking male participants

Needs more diversity (ethnic/socioeconomic background)

Greek life/other student groups?

Different ages/college majors

Survey: clarity and validity concerns

Follow-up study at Winona State University

Eastern Michigan UniversityLarger school

Different state

Graduate students?

ReferencesCooper, O., Habel, A., Sox, M., Chan, K., Arbogast, G., Cheetham, T., & Ray, A. (2011). ADHD drugs and serious cardiovascular events in children and young adults.

The New England Journal Of Medicine, 365(20), 1896-1904. doi:10.1056/NEJMoa1110212

DeSantis, A. D., Webb, E. M., & Noar, S. M. (2008). Illicit use of prescription ADHD medications on a college campus: A multimethodological approach. Journal of American College Health, 57, 315–324. doi:10.3200/JACH.57.3.315-324

DeSantis, A. D. and Hane, A. C., (2010) “Adderall is definitely not a drug”: Justifications for the illegal use of ADHA stimulants. Substance Use & Misuse, 45, 31-46

Dodge, T., Williams, K., Marzell, M. and Turrisi, R., (2012) Judging cheaters: Is substance misuse viewed similarly in the athletic and academic domains? Psychology of Addictive Behaviors. 26, 678-682.

Gould, S., Walsh, B., Munfakh, J., Kleinman, M., Duan, N., Olfson, M., & Cooper, T. (2009). Sudden death and use of stimulant medications in youths. The American Journal Of Psychiatry, 166(9), 992-1001. doi:10.1176/appi.ajp.2009.09040472

Hall, K. M., Irwin, M. M., Bowman, K. A., Frankenberger, W., & Jewett, D. C. (2005). Illicit use of prescribed stimulant medication among college students. Journal of American College Health, 53, 167–174. doi:10.3200/JACH.53.4.167-174

Low, K. G., Gendaszek, A. E. (2002). Illicit use of psychostimulants among college students: A preliminary study. Psychology, Health & Medicine, 7:283–287.

McCabe, S. E., Knight, J. R., Teter, C. J. & Wechsler, H. (2005) Non-medical use of prescription stimulants among US college students: Prevalence and correlates from a national survey. Society for the Study of Addiction. 99. 96-106.

Okie, S. (2006). ADHD in adults. New England Journal of Medicine, 354:2637–2641.

Teter, C. J., et. al. (2005) Prevalence and motives for illicit use of prescription stimulants in an undergraduate student sample. Journal of American College Health. 53. 253-266.

Vollmer, S. (1998). ADHD: it’s not just in children. Family Practice Recertification, 20:45–68.