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, finds a new study by Massachusetts General Hospital (MGH) investigators. 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.
‘The majority of those misusing stimulants met or approached criteria for stimulant-use disorder, in addition to higher levels of ADHD, conduct disorder, and alcohol or drug use disorders.’
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"Our data suggest that college students 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, conduct disorder, and alcohol or drug use disorders, the majority of those misusing stimulants 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.
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"Not everyone is driven to misuse prescription stimulants 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."
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Source-Eurekalert