Illicit Use of Prescription ADHD Medications on a College Campus: A Multimethodological Approach
Abstract
The authors used quantitative and qualitative methodologies to investigate college students' perceptions and use of illegal Attention Deficit Hyperactivity Disorder (ADHD) stimulants during spring and summer 2006.
From fall 2005 through fall 2006, the authors studied 1,811 undergraduates at a large, public, southeastern research university in the United States.
The authors administered surveys to these students and conducted 175 in-depth interviews.
Of the study participants, 34% reported the illegal use of ADHD stimulants. Most illegal users reported using ADHD stimulants primarily in periods of high academic stress and found them to reduce fatigue while increasing reading comprehension, interest, cognition, and memory. Furthermore, most had little information about the drug and found procurement to be both easy and stigmafree.
This study supplies a rich understanding of the growing national trend of illegal ADHD stimulant use. The authors discuss strategies for stemming the tide of ADHD stimulant use.
315
Abstract. Objective: The authors used quantitative and qualitative
methodologies to investigate college students’ perceptions and
use of illegal Attention Deficit Hyperactivity Disorder (ADHD)
stimulants during spring and summer 2006. Participants: From
fall 2005 through fall 2006, the authors studied 1,811 under
-
graduates at a large, public, southeastern research university in
the United States.
Methods: The authors administered surveys to
these students and conducted 175 in-depth interviews.
Results:
Of the study participants, 34% reported the illegal use of ADHD
stimulants. Most illegal users reported using ADHD stimulants
primarily in periods of high academic stress and found them to
reduce fatigue while increasing reading comprehension, interest,
cognition, and memory. Furthermore, most had little information
about the drug and found procurement to be both easy and stigma-
free. Conclusions: This study supplies a rich understanding of the
growing national trend of illegal ADHD stimulant use. The authors
discuss strategies for stemming the tide of ADHD stimulant use.
Keywords: Adderall, ADHD, college students, prescription drug
abuse, stimulants
he rise in the number of diagnoses and subsequent
treatment of American children with Attention Defi-
cit Hyperactivity Disorder (ADHD) has been well
documented since the mid-1990s.
1–5
According to the
Centers for Disease Control and Prevention,
6
more than 4.4
million children aged 4 to 17 years—a national prevalence
rate of 7.8%—have been diagnosed with ADHD. Of these,
doctors have prescribed stimulants to 2.5 million to treat
the disorder.
6
Adderall (mixed salts amphetamine), Ritalin (methylphe-
nidate), and Dexedrine (dextroamphetamine) are considered
first-line pharmacotherapy for ADHD, with Adderall being
T
Illicit Use of Prescription ADHD
Medications on a College Campus:
A Multimethodological Approach
Alan D. DeSantis, PhD; Elizabeth M. Webb, MA; Seth M. Noar, PhD
the most widely prescribed of the 3. Because of the poten-
tial for abuse and psychological and physical dependency,
the US Drug Enforcement Administration (DEA) classifies
these stimulants as Schedule II substances.
7
In recent years, researchers have begun investigating
the illegal use of stimulants prescribed for the treatment
of ADHD on American college campuses.
8–16
Estimates of
the prevalence of use have tended to vary. McCabe et al
11
conducted a multisite study in which they surveyed 10,904
students at 119 nationally representative 4-year US col-
leges. They found that 4.1% of the students surveyed had
used an illegal prescription stimulant in the past year and
reported that illicit use was highest among (1) white frater-
nity members, (2) students from the US Northeast, and (3)
students from colleges with more competitive admission
standards. They also found that nonmedical prescription
stimulant users were more likely to report use of alcohol,
cigarettes, cocaine, marijuana, and ecstasy, along with other
high-risk behavior.
11
Other investigations of the prevalence of illegal prescrip-
tion stimulant use have yielded values higher than those
found by McCabe et al.
11
For instance, Babcock and Byrne
8
found that 16% of their sample used Ritalin (methylpheni-
date) recreationally. Hall et al
9
reported a sex difference,
in that 17% of college men and 11% of college women
surveyed illicitly used stimulant medication. Furthermore,
while examining the use of amphetamines in a convenience
sample of college students, Low and Gendaszek
10
found a
prevalence rate of 35.5%.
Exploring the issues of ethnicity and motivation, Teter
et al
15
asserted that white and Latino college students were
more likely to use prescription stimulants illegally than
were African American and Asian students. They also found
that the majority of students who used illegal prescription
stimulants, regardless of ethnicity, did so to enhance their
The authors are with the Department of Communication at the
University of Kentucky, Lexington.
Copyright © 2008 Heldref Publications
JOURNAL OF AMERICAN COLLEGE HEALTH, VOL. 57, NO. 3
316 JOURNAL OF AMERICAN COLLEGE HEALTH
DeSantis et al
academic performances. Sixty-five percent reported using
these drugs to aid concentration, 59.8% to help study, and
47.5% to increase alertness. Other motives not associated
with academic performance included getting high (31.0%)
and experimentation (29.9%).
Although these data provide some understanding of the
prevalence of stimulant abuse and basic answers as to why
students use these substances, they stop short of supplying
an in-depth description of users’ behaviors, conceptions,
and choices, which can be mined only through qualitative
methods. Thus, we investigated how and why college stu-
dents at an American public university use illicit prescrip-
tion stimulants. We examined (1) factors that led to first
use of prescription ADHD medications, (2) motives for
continued use of these medications, and (3) where and how
students access these medications.
METHODS
We used both quantitative surveys and in-depth qualita
-
tive interviews. The university’s institutional review board’s
human subjects committee approved all quantitative and
qualitative methods for the current study.
Quantitative Surveys
Survey data collection occurred in 2 waves. In part 1,
we administered the surveys to a convenience sample of
1,340 students enrolled in a large, lecture-hall, introduc-
tory communication theory class, over the course of 3
semesters (fall 2005, spring 2006, and fall 2006). This
class meets the university’s social science requirement;
thus, it provides a sample of students from a multitude of
majors from across campus. Given that students who take
the course are disproportionately freshmen or sophomores,
we made additional efforts to survey upperclass students.
Thus, in part 2 of survey data collection, we administered
an additional 471 surveys to convenience samples in upper-
division (n = 188) communication classrooms, and paid
undergraduate research assistants administered surveys to
the general student body outside of the classroom (n = 283).
These assistants administered surveys to upper-division
students at popular places on campus (eg, libraries, dining
halls, Greek houses). The undergraduates had completed an
upper-division research methods class and were certified by
the university’s institutional review board.
We designed and pretested the 25-item survey for this
study. We revised question wording and survey structure
after conducting a pilot study of 94 students and receiv-
ing their feedback. The first 9 questions obtained basic
demographic information. Two questions inquired about
respondents’ awareness of others’ use of nonprescribed
stimulant medication and whether they had ever personally
used a prescription stimulant. Nine questions inquired about
the details, perceptions, and reasons for personal use. Five
questions inquired about other drug and alcohol use.
In part 1 of survey data collection, we entered the lecture
hall at the beginning of class and described the study. We
explained that participating in the study was completely
voluntary and would amount to an educational experience.
We then obtained informed consent from students interested
in participating, handed out the surveys, and asked students
to complete them. On average, students took approximately
7 minutes to complete the survey. In part 2 of data collec-
tion, we handed out surveys in upper-division communica-
tion classes, and 6 trained upper-division undergraduates
handed out surveys to fellow students. We followed the
previously described procedure.
The final sample consisted of 1,811 students: 45% male
and 55% female, 92% white, 4% African American, 1%
Asian/Pacific Islander, 1% Latino, and 2% other race/multi-
racial. More than one-third (37%) of the sample were fresh-
men, 27% sophomores, 19% juniors, and 17% seniors; 44%
were members of Greek organizations. These demographics
roughly mirror campus figures, which are 47% male and
53% female, 82% white, 6% African American, 2% Asian/
Pacific Islander, 1% Latino, and 9% other race/multiracial.
Campus figures also indicate that 28% are freshmen, 21%
sophomores, 21% juniors, and 30% seniors; 18% are mem-
bers of Greek organizations.
Qualitative Interviews
During spring and summer 2006, we interviewed an
additional 175 full-time undergraduates using handheld
audio tape recorders. Along with the primary author (AD),
6 paid undergraduate students also conducted interviews.
The undergraduate interviewers had all completed an
upper-division research methods class and were certified
by the university’s institutional review board. In addition,
we trained and supervised the undergraduate interviewers
in interviewing procedures, ethical guidelines, and tran
-
scription protocol. We gave each undergraduate interviewer
a detailed script to follow; they obtained written consent
before each interview.
We strategically selected the undergraduate interview-
ers to facilitate the comfort and trust levels of the under-
graduates being interviewed. We assigned interviewers
specific demographic segments of the campus population
to interview based on comfort and fit with these groups.
For instance, women interviewed female students and men
interviewed male students.
Last, during the transcription stage, we changed all
names and replaced them with arbitrary pseudonyms to pro-
tect interviewees’ privacy. Furthermore, we either changed
or deleted from the transcription record any identifying
markers or references to people, organizations, or events
that could jeopardize participants’ anonymity.
RESULTS
Survey Overview of Adderall Users
Of the 1,811 students who completed the surveys, 4%
(78) reported having a legal prescription for an ADHD med
-
ication, and as such, we removed them from the dataset.
However, 34% (585 of the remaining 1,733) had used
ADHD medications illegally. Of these 585, 49% were men
and 51% were women. Most (94%) illicit users were white
VOL 57, NOVEMBER/DECEMBER 2008 317
Illicit Use of Prescriptions
students; the remainder were African American (3%) and
other/multiracial (3%) students. In addition, 22% were
freshman, 25% sophomores, 28% juniors, and 25% seniors.
Last, 61% of illegal users were in fraternities or sororities.
To estimate the proportion of individuals who used
Adderall by demographic category, we divided the num-
ber of users in each category by the total number sur-
veyed (excluding individuals with legal prescriptions). For
instance, we surveyed 708 men. Of these, 278 (39%)
reported illicitly using prescription ADHD stimulants and
430 (61%) had not used. We also surveyed 895 women, of
whom 266 (30%) reported using and 629 (70%) reported
not using. Table 1 displays the results by demographic
categories, including sex, race, year in school, and Greek
status. In this table, we cross-tabulated stimulant use and
nonuse by these same demographic factors and conducted
chi-square analyses to examine statistically significant dif-
ferences. The resulting data suggest that illicit use of
ADHD prescription medications was significantly more
common in men, white students, upperclassmen, and Greek
members (versus non-Greeks). These subgroup differences
are consistent with previous research.
11
First-Time Use
Of the illegal users in our study, 63% (n = 368) first
used nonprescribed stimulants in college. Such statistics,
however, can tell us only so much about first-time use. With
the augmentation of qualitative interviews, we were able
to investigate what factors led to their first use of illegal
stimulants and what type of early information about the
advantages and risks of stimulants were provided to them.
The first thing that became evident during the course of
our interviews was how prevalent the use and casual discus-
sion of stimulants were on the college campus. First-time
users did not need to seek out or discover information about
the drug; ADHD stimulants were a salient part of their uni-
versity culture. Jill remembers, for instance, how “everyone
was taking it” in the dorms her freshman year. “It was just
normal, you know, common.” When we asked Lauren, a
second-year accounting major, how she first heard of stimu-
lants, she similarly told us that after arriving on campus,
“everyone was talking about it, so it became no big deal.”
Although discussions about ADHD drugs may have been
both omnipresent and casual on campus, the first-time use of
stimulants for most of the students in our study was almost
always accompanied by periods of high academic stress and
anxiety. It was, as Maggie claimed, “an emergency. I was
stressed, overwhelmed, exhausted because I had to do a lot
and there was no way I could do it. So I decided to see if it was
like what everyone was saying.” For John, a junior architec-
ture major, it was the anxiety produced by his “first big project
that had to be completed by the morning” that “pushed him
over the edge. . . . There was just no other choice.”
More than two-thirds of our interviewees, however, said
the pressure-filled nature of finals created the ideal situ-
ation for illegal stimulant use. “My first time was during
my freshman finals,” Joe said. “I had a lot of pressure to
do well, and I just felt like I needed help.” It was also “first
semester during finals week” for Lisa when she made the
decision to try Adderall. “I had to cram for a really big test
that next day. Pressure makes you do things like that.”
Although everyone we spoke with acknowledged the
stress of finals, many reported that it was not just end-of-
the-year test taking that drove them to try stimulants but
having to take multiple final exams on the same day. This
combination seemed to create a perfect storm in which
stress and exhaustion collided with students’ desperation. “I
didn’t want to try it. I was even a little scared,” remembered
Jackie. “But I had 2 other tests besides that one [her biology
exam], so it was 3 tests on 1 day.” Similarly, Brian’s first use
came on the eve of 2 business exams. “There was just no
way I was gonna pull it out. I just could not focus. It saved
me. Still does.”
The most disturbing aspect of these students’ first-time
use was how little information they had about stimulants
before trying them. In almost all cases, the only knowledge
these students had about ADHD medication was what they
had heard from other students. John told us that he heard
from his fraternity brothers that it was a “miracle” and
a “study drug.” Janet was told by her roommates that “it
keeps you awake all night long and makes you not hungry.”
For Alan, Martin, and Chris, it was the repeated testimony
from friends who “loved it,” “did well on tests on it,” and
“got better grades” because of it. None of the 175 people we
interviewed, however, sought out information from health
professionals, medical or pharmaceutical reference guides,
or even Internet sites before taking their first dose.
Motivations for Taking Illegal ADHD Medications
Academic Motives
Unlike most other illegal substances that these college
students took, they did not use stimulants primarily for
social or entertainment purposes. Although respondents
told us that alcohol, marijuana, prescription barbiturates,
and cocaine were used almost exclusively to “get high” and
to “have fun,” ADHD medications were used predominantly
for the more serious pursuit of “getting good grades.”
Of the students who reported using illicit stimulants, 72%
(n = 420) reported doing so to stay awake to study longer
(see Table 2). “If I procrastinate,” explained Peter, a junior
agriculture, economics major, “then it helps me cram. If I
need to stay up all night, then I kind of need it.” For Jason,
procrastination was not the problem: it was finals. “They
suck. That’s the only time I take it. Every year during finals
week. But I don’t usually take it during the semester when
my tests are spread out.”
The students’ use of amphetamines to stay awake,
although disturbing, was not surprising. Fighting fatigue
and increasing energy levels are the most obvious and well-
known effects of stimulants. As Justin told us, “That’s why
they call it speed.” What did surprise us, however, were the
illicit users who touted ADHD medications for their ability
to help them focus on academic tasks.
318 JOURNAL OF AMERICAN COLLEGE HEALTH
DeSantis et al
Of the 585 students who reported using illicit stimulants,
66% (n = 389) reported taking them “to help concentrate”
on school work. After analyzing the interviews, however,
we discovered that, below the surface of these statistical
data, the students’ conception of concentrating had multiple
and layered meanings. Specifically, these students claimed
that they could study longer, stay focused without distrac-
tion, and be more productive.
For many in our study, the most important aspect of
concentrating was the ability to study for longer periods of
time. Chris, for example, told us he “can stay focused for
a lot longer. Instead of going for 45 minutes and getting
distracted, I can study for 3 straight or 4 straight hours.”
Lauren, who said she was easily distracted, claimed she
could “work and read for 5 hours straight without a break.
I normally can’t make it more than a half an hour without
it [Adderall].” Even more remarkable, Brad “swears” he is
able to “focus 10 times more. . . . instead of just reading a
little part, I can sit down and actually read you know, a lot
of pages of a book. Like 50 to 60 pages of a book instead
of reading 2 pages.”
For others in our study, the motivation for taking Adderall
was not necessarily their ability to study for longer periods
of time but their ability to focus on a single task without dis-
traction. For example, John said he took Adderall because he
believed “it blocks out outside noise. I personally pick up on
everything: distractions, you know, and things like that. So for
me, it’s about focus and concentration.” “For me,” remarked
Tara, “it just zones me in to what I’m doing. It zones me out
to all the outside noises around me. It’s incredible.”
Most of the students we interviewed also claimed that
stimulants made them more productive. For Nancy, this
TABLE 1. Illicit Use of Prescription ADHD Medications in Various
Demographic Subgroups
Using Not using
Demographic
n % n %
Overall 585 34 1,148 66
Sex
***
Male 278 39 430 61
Female 266 30 629 70
Race
*
White/Caucasian 547 35 1,032 65
Other race/ethnicity 34 25 101 75
Year in school
***
Freshman 101 18 473 82
Sophomore 127 31 288 69
Junior 144 49 150 51
Senior 137 55 112 45
Greek status
***
No 228 23 747 77
Yes 357 48 389 52
Note. ADHD = attention deficit hyperactivity disorder.
*
p < .05.
**
p < .01.
***
p < .001.
TABLE 2. Reasons for Illegal Use of Prescription ADHD Medications
(N = 585)
Reason for use
n %
To stay awake to study 420 72
To concentrate on your work 389 66
To help memorize 213 36
To stay awake and have fun 127 22
To make work more interesting 70 12
For the high (the good feeling) 39 7
To suppress your appetite 32 5
To self-medicate your ADHD 22 4
Other 10 2
Note. ADHD = attention deficit hyperactivity disorder.
VOL 57, NOVEMBER/DECEMBER 2008 319
Illicit Use of Prescriptions
was her primary motivation for stimulant use. “I get every-
thing done, quickly. I am crazy on it that way. I can have so
much work to do, and I can just sail through it.” Similarly,
Cameron explained that he is “so much more productive.
I mean, I’m generally productive. It’s just a different level
on Adderall.”
The most interesting, and unexpected, advantage that
led students to use stimulants was not productivity but
increased intelligence and heightened cognitive aptitude. As
Mitch simply but succinctly remarked, “The stuff is like an
academic anabolic steroid.” This effect can best be under-
stood as the enhanced ability to memorize, grasp ideas, and
recall information.
For 36% (n = 213) of stimulant users in our study,
“being smarter” was equated with a heightened facility to
memorize and retain information. “Normally, I’m slow,”
explained Josie, “but on Adderall I can memorize anything.
It just goes in, and you got it.” Similarly, John, a junior his-
tory major, told us of an exam where he “had to memorize,
like, over 10 essays.” Without stimulants, “there is no way
I could do it,” he said. “But it was just easy. I read it and I
got it. It was crazy.”
For others, like Justin, a senior economics major, the
belief is that stimulants dramatically increase the ability
to “grasp ideas” that would “normally be too hard to get.”
He told us that “stuff just registers better” when he is on
it. “Reading or trying to figure out problems, it just comes
easier.” Neil also reported a noticeable difference in “grasp-
ing ideas.” “I can tell the difference,” he explains, “between
when I am on it or not. I grasp everything so much easier. . .
I feel like a genius on it.”
And still for others, like Caroline, the ability to “recall
information quicker” is the primary cognitive advantage of
stimulants. “Information just comes to me,” she said, “in a
really easy way. I don’t have to search for it. I memorize it
once, and it is there.” In a similar vein, Nathan told us that
he can better recall information during tests. “I feel like I
get finished with it quicker” because “it’s automatic, like, I
recall things quicker.” During his ACT, for example, Nathan
was “able to zoom through it. I remembered everything that
I think I would have forgotten.”
Last, 12% (n = 70) of users reported taking stimulants to
“make academic work more interesting.” As Scott, a sopho-
more sociology major, told us, academics can be boring,
but, “You pop that pill and that is all, you are really into
that subject.” For Andrea, stimulants make work enjoyable.
“It was about a week ago on a Sunday,” she described, “and
I had a lot of work to do and was really stressed.” After
taking 20 milligrams of a stimulant, however, “work just
became really fun, enjoyable. I actually enjoyed going to
the library on it.”
In summary, our survey data showed that the students’
primary motive for taking ADHD medications was to
earn better grades in school. With the augmentation of our
qualitative data, we discovered a myriad of more subtle
motives defining when and why these students take stimu-
lants. We know, for instance, that participants who took
stimulants did so primarily during finals week or during
periods of high academic stress. We also know that these
same students took stimulants (in order of importance) to
stay awake, concentrate (eg, focus longer, avoid distrac-
tion, be more productive), increase cognitive aptitude (eg,
aid memorization, comprehension, recall), and make study
material more engaging. But academic improvement was
not the only motive for stimulant abuse. In the following
section, we discuss the nonacademic motives for taking
ADHD medications.
Nonacademic Motives
It is clear from both our quantitative and qualitative data
that students primarily use stimulants to earn better grades
and to do better in school. At times, however, these students
turned to stimulants for recreational purposes. Of the 585
students who reported using illicit stimulants, 7% (
n = 39)
also reported taking them to have fun. Inside these numbers,
however, our interviewees detailed several ways that stu-
dents used stimulants to promote their idea of fun.
The primary social advantage for stimulant use is the
additional energy it supplies to the users. “If you have a
big night,” explained Jake, “and you are tired, you just take
Adderall and you are set to go all night.” For John, it was
“this big camping trip [I] took last semester, in the spring,”
that convinced him to use stimulants. “We all decided that
we were going to drink all night and stay up until the sun
rises, so we all just took, like, 25 milligrams of Adderall.
It worked!” Stacy first decided to try Adderall on her prom
night in high school. “I was 17, senior year, and everyone
was gonna stay up all night after prom. So, some of us took
it. It was a pretty cool night.”
Along with staying awake, users said stimulants made
them more social and talkative during their marathon party
sessions. Kevin, who said he is “naturally a little shy,”
believed he is “just funner and funnier.” He continued, “I
am really good, or at least I think I am, when I am on it. I
can really talk. People think I am funny on it.” Caroline had
a similar feeling. “I go out, and I am really outgoing. I am
set to go. I can just go up to anybody and start conversa-
tions. And they are good ones. Not the drunken kind.”
Others sought the effects associated with combining
alcohol and stimulants. Interestingly, our interviewees
could not agree on what specifically happens when you
combine alcohol and stimulants. Rebecca said, for instance,
that “people take it before they drink because it doesn’t get
you as drunk. So you can drink more over a long period of
time and not get ridiculous.” Many people we spoke with,
however, claimed that “the best thing about it [stimulants]
is that it gets you drunker” (Mason, sophomore business
major). Francis told us that since high school, she and
her friends take it before they “drink because it gets you
drunker, or at least that is what we think.” Cam, who
also liked having the extra energy, articulated this same
advantage. “So, it is like this: we take it before we drink
because we get drunker quicker, and you can go forever.
It’s like 2 for 1.”
320 JOURNAL OF AMERICAN COLLEGE HEALTH
DeSantis et al
Some in our study, however, preferred the unaltered
effects of stimulants. Seven percent (n = 39) of users
reported taking stimulants because they are a cheap, easily
accessible high. “It’s such a new craze,” Brad said. “I don’t
know if it is going to spread like pain killers, but people
are snorting it like coke.” “The best way to do it,” Keith
explained, “is to mash it up. It [Adderall capsules] is time
released, and if you mash it up, you get it all at once, like a
rush. So you snort it.” “The best thing,” Matthew said, “is
that it is cheap coke. You know you get that same high, but
you can get it for like 5 bucks.”
A disproportionate number of women in this study touted
stimulants for their ability to suppress appetite. For some
women in our study, the loss of appetite was simply a ben-
eficial side effect of stimulants. Nancy, for instance, told us
that although she only took Adderall to study, “It is kind
of cool that you also don’t want to eat either.” For other
women in our study, however, suppressing appetite was
the primary motive for stimulant use. “The first time I used
it,” Brenda said, “was because one of my sorority sisters
told me how great it was. She said you don’t want to eat,
and it is safe and everything.” Like the use of stimulants
for academic reasons, however, most of the women said
they were strategic about when and why they use ADHD
medications for weight loss. “Spring break is a big one,”
explained Jackie. “Most of the girls in my sorority will use
it before spring break so they look thin—special occasions
like that.” Fraternity formal gatherings were another recur-
ring event inviting extreme dieting in many sorority houses.
Said one respondent: “Sometimes you need a little help.
You put on a little weight, and you know you have to get
in a tight dress. It really takes your hunger away for a few
days. I don’t use it all the time though, no. But sometimes,
you have no choice.”
Thus, for many participants, they also use stimulants for
purposes other than academics. These students found great
utility, for instance, in stimulants’ ability to fight fatigue
(especially during extended periods of partying), increase
sociability, heighten the effects of alcohol, decrease the
depressant qualities of alcohol, simulate cocaine, and sup-
press appetite. The obvious question left unanswered is,
how do so many students obtain such a popular, versatile,
and highly controlled narcotic?
Obtaining Illegal Stimulants
The DEA classifies the ADHD medicines we investi
-
gated as Schedule II drugs because of their high potential
for abuse and risk of severe psychological and physi-
cal dependence.
17
Because of this, Adderall, Ritalin, and
Dexedrine are legally available only through prescription,
with a limit of 30 days’ worth of doses and no refills.
In addition, Schedule II drugs are subject to DEA pro-
duction quotas. Other often-discussed Schedule II drugs
include cocaine (used as a topical anesthetic), morphine,
phencyclidine (PCP), short-acting barbiturates, injectable
methamphetamine, and most pure opioid agonists, such as
opium and OxyContin.
12
For most of the students in our study, however, the DEA’s
Schedule II classification means little. As Mark, a senior
marketing major, claims, “The stuff is everywhere. Just ask
anybody, and they will either have it or know somebody that
has it. It’s really no biggie.” And Mark is not alone in his
sentiments. When asked how difficult it is to obtain illegal
stimulants, 39% (n = 231) reported that it was “very easy,”
43% (n = 250) thought it was “somewhat easy,” 13% (n =
76) claimed it was “somewhat difficult,” and less than 1%
claimed (n = 3) it was “very difficult.”
Disturbed that nearly 85% of our 1,811 participants thought
obtaining illicit stimulants was either very or somewhat easy,
we sought a richer understanding of these numbers. We
asked participants to expand on where they get their drugs
and what procedures are involved in their procurement.
We discovered that the students in this study did not
get their stimulants from drug dealers standing on street
corners. Instead, 89% (n = 521) of users said they got
substances from friends (87%) or significant others (4%);
8% (n = 44) said they procured stimulants from strangers
or, as Leslie more aptly defined them, “friends of friends.”
Only 4% (n = 78) in our overall sample reported having a
prescription from a doctor to treat their diagnosed ADHD.
Apparently, this 4% is also the primar distribution source
for 34% of the general student population and 48% of the
Greek population.
So where is this 4% found? According to Margaret,
“They seem to be everywhere. Somebody that you know
personally has a prescription. It’s not like they hide it.
Everyone knows. It’s cool.” Said Beth, “I think everyone
knows a few people with it. Today it seems like everyone
is ADHD, aren’t they? Everybody is medicated on some-
thing.” Jeremy told us, “You know which of your friends
have it; people aren’t really discreet that they have it. They
become famous.”
For members of sororities and fraternities, accessing
these stimulants is even more effortless. Although 46%
reported that obtaining prescription stimulants was some-
what easy and 43% claimed it was very easy, only 2 of
the sorority and fraternity members surveyed reported that
obtaining prescription stimulants was very difficult. “In our
house, there is always a few brothers with it. So we really
turn to them, especially during finals,” one fraternity mem-
ber said. “They are really good about hooking us up first.
It’s easy. Except during finals when we all want it.” Lauren,
a member of the Omegas, told us that in her house, “there
are 2 sisters that are really great about helping us. They will
always give us their extras.” The close proximity, according
to Abby, is the key. “You are always there, so you just ask
somebody. At dinner or just walking through the rooms. If
you can’t find any, there is always somebody around that
knows somebody, in a fraternity or somewhere.”
For those without such bonds, there is always the uni-
versity’s library, the seeming epicenter for stimulant drug
distribution. What makes this site so ideal is that it has
open “core areas” ergonomically designed to facilitate
human interaction. Most importantly, participants collec-
VOL 57, NOVEMBER/DECEMBER 2008 321
Illicit Use of Prescriptions
tively defined the library as the open and safe site for
obtaining ADHD medications. “You probably look for it at
the library,” answered Brittney when asked where to find
stimulants. “Believe it or not, that’s probably the hot spot.
You go to the library if you want Adderall, ’cause that is
where it is.” Supplying more detail, Christi claimed that
“literally, each core of the library will have 2 or 3 people
that have it. Literally, each core. Like, core 1 through 4 will
have, like, 3 people with it. It really is kind of funny.”
With such a high demand for the product and its
restrictive Schedule II classification, one may assume that
acquiring these stimulants would be expensive. It is not.
Approximately 15% of the people we interviewed, in fact,
said they got their stimulants for free from close friends
with prescriptions.
For paying customers, the going rate ranges from $3 to
$10 per pill. William, a junior who often sells his prescribed
surplus, has created his own pricing method. “I have 30
milligrams. My going rate is $1 for every 5 milligrams. So
I sell them for usually $6.” Robert, another seller, prices
Adderall at “10s [milligrams] for $3, 20s for $4, and $5 for
the big 30s.” Buyer Caroline simply pays a flat rate of $5:
“I don’t normally worry about the milligrams.”
Most buyers and sellers, however, agreed that stimulant
sales are not about the money. Although there are a few
exceptions, like Mark, who fills his prescription each month
and sells “the whole bottle for $100 to $150,” most buyers
perceive, and sellers claim, to do it as a service for their
friends. As buyer Charles saw it, “I think they do it just to
be good guys. I mean, come on, what’s a few bucks?” Seller
Abraham explained his situation this way: “I don’t charge
to make money, really. But I charge $5 or so because of the
inconvenience that it causes me.”
But how and why do these diagnosed ADHD students
have surplus pills for sale if these stimulants are so highly
regulated? The answer, as Patrick told us, is because “no one
takes it everyday. That would kill your system and really
screws up your body.” Similarly, Katie told us that she “does
not think it is smart to put that sort of chemical in your body
every day.” Some of the more common side effects that users
mentioned include the inability to sleep, sweating, increased
heart rate, loss of appetite, and, for some men, the inability
to get an erection. “To take it every day,” explained David,
“would really mess you up. You would never eat or sleep
well. You just can’t do it, really.”
Thus, every student with a prescription that we spoke
with was strategic about their stimulant use. Many, for
example, never took their medication on weekends. Others
took it only on the days they had classes. Still others took it
only when their workload demanded a heightened level of
attention and concentration. Gena, a diagnosed ADHD stu-
dent, explains her decision-making process: “I don’t need it
every day. You don’t need them on the weekends. Or maybe
you might need it on a Sunday but not on a Friday. So you
always have extra to give to friends if they need them.”
For most prescribed students, therefore, having surplus
stimulants at the end of each month is common. Selling
their leftovers is simply seen as a morally inconsequential
win/win decision. As James framed it, “What am I going to
do with all those pills? So I figure, if I can help out some
friends and make some beer money, life is good.”
COMMENT
We wanted to gain a broader understanding of college
students’ illicit ADHD stimulant use using quantitative
and qualitative methods. The quantitative data suggest that
the overall rate of use was 34%, which is higher than rates
found in previous studies.
8,10,11
Although our sample was in
many ways one of convenience, as reported in the Methods
section, it is somewhat representative of the campus as a
whole because of the surveying of an introductory class
that a broad cross-section of students take. Thus, we found
at least 3 possible explanations for the higher overall rate of
use found in this study. First, ADHD stimulant use may be
rising nationwide as time passes and this phenomenon con-
tinues to grow. Rates of use may vary on different college
campuses, and this campus may have had higher prevalence
rates. In fact, the state in which the current study took place
has been ranked as 1 of the top 3 states in the United States
for ADHD diagnosis, which may contribute to higher preva-
lence rates.
18
Last, the relatively high proportion of Greek
students in our study may have contributed to the higher
prevalence rates.
In addition to basic statistical data on use, user demo-
graphics, and motivations for use, we also aimed to obtain a
richer understanding of illegal stimulant use through quali-
tative methodologies, an approach that has been neglected
in previous research. Through the augmentation of 175
in-depth interviews, we discovered, for example, that most
users possessed limited knowledge of prescription stimu-
lants, appropriate doses, physiological or psychological
side effects, or legal consequences of illicit use. We also
found that first-time use almost exclusively took place dur-
ing periods of heightened academic stress. In particular,
participants reported that finals week produced a context of
anxiety and desperation that made students exceptionally
vulnerable to the highly publicized promises of stimulants.
In addition, most students reported that procuring illegal
stimulants was easy and unobtrusive. In interview after
interview, students told us not only how stimulants had
become part of the campus culture—being openly and
positively discussed in public settings—but also how, as
Robert, an undeclared freshman, said, “Anybody really
can get it just about anytime they want it. It is easier than
beer to get.”
The qualitative data also reveal a general perception
among illegal users that consumption of nonprescribed
ADHD medications enhanced cognitive abilities. Some
interviewees’ statements almost advertise this prescription
drug misuse as a miracle for any student striving for aca-
demic success. We, however, did not attempt to measure
whether prescription stimulants actually improved non-
ADHD students’ abilities in the classroom. The prolifera-
tion of research examining how ADHD medications affect
322 JOURNAL OF AMERICAN COLLEGE HEALTH
DeSantis et al
cognitive functioning focuses on individuals diagnosed
with ADHD; thus, we know little about how these medica-
tions actually work on a physiological level among non-
ADHD users.
19–22
Future researchers should investigate
these claims of enhanced cognitive aptitude to better under-
stand and assess such claims.
Perhaps the most disturbing finding from our qualitative
investigation was students’ general lack of guilt or disso-
nance over taking illegal stimulants. Most viewed its use as
not only physically and psychologically harmless, but also
morally acceptable, because it was used for academic pur-
poses and not for social entertainment. “We’re not getting
high off it,” explained Nancy, “we are doing it to do better
in school. So, no, I don’t feel bad or anything.” The fact that
these stimulants are also prescribed pharmaceuticals that
can be purchased at any local pharmacy and not street drugs
sold by felonious drug dealers also supplies moral solace to
many users. In short, the illegal use of ADHD medication
seems to be stigma free for the overwhelming majority of
our participants. This finding does not bode well for tradi-
tional intervention efforts.
There were a number of limitations of this study that
should be taken into account when interpreting the results.
As discussed throughout this paper, the quantitative sample
was a convenience sample that exhibited many character-
istics of the campus as a whole; however, given that it is a
convenience sample, there is no guarantee that it represents
the population from which it was drawn. Our sample also
appeared to include more Greek students than the campus
population as a whole. Moreover, all data came from 1
large public university in the southeast region of the United
States, and researchers have found that stimulant use var-
ies according to factors such as region of the country and
school competitiveness.
11
Thus, the rates of stimulant use
we found may be different than those at other universities,
and the reasons for use and issues related to access of stimu-
lants may also differ.
Implications for Interventions and Campaigns
What can be done to stem the tide of this growing prob-
lem of ADHD stimulant use on college campuses? Our
findings illuminate at least 3 possible answers to this ques-
tion. The first, and perhaps most efficient, answer is to tar-
get the student suppliers of the stimulants. Given that only
a small segment of college students have legal prescriptions
for ADHD medications but apparently supply the entire
campus with these stimulants, focusing on this small group
may be an efficient intervention strategy. We discovered
that prescribed users almost never take their ADHD medi-
cation every day. Many reported taking their medication
only on heavy workdays, days when they have classes, or
weekdays. Thus, at the end of each month, most prescribed
users have a surplus of stimulants that become the basis
for illegal exchanges on campus. The medical community,
therefore, may consider limiting the monthly allotment of
pills to 20—except in cases where patients can clearly show
the need for daily use.
The need for educating the illegal consumers of ADHD
stimulants must also be part of any intervention strategy.
As our qualitative data highlighted, these individuals have
a dearth of salient information regarding the physical and
psychological dangers of stimulant use and even less infor-
mation about the legal ramifications of obtaining a Schedule
II controlled substance. Many were surprised that it was a
crime. Mass communication campaigns across a variety of
health behaviors have been successful in improving various
health knowledge, attitudes, and behaviors.
23,24
In addition,
administrators may consider campus-wide campaigns that
educate the student population about the health risks and
legal penalties associated with illegal stimulant use. Exist-
ing structures such as freshman orientation programs, cam-
pus speaker series, and classroom discussions incorporated
in appropriate curricula (eg, chemistry, biology, psychology
classes) could be used to educate students about the dangers
of these prescription drugs.
Last, college and university leaders may consider reduc-
ing the demands placed on students during finals week.
As discussed earlier, an overwhelming majority of illegal
users claimed to have started, and continue to use, during
their highly stressful finals week. They reported that the
amount of work that is asked from them in such a limited
time frame necessitates the use of illegal stimulants. Thus,
extending finals over a 2-week period or managing student
schedules to guarantee that only one final can be taken per
day may help reduce the contextual factors that give rise to
illicit stimulant use.
The biggest barrier to prevention efforts, however, may
be the professed effectiveness of the drug itself. Almost all
participants claimed that ADHD medications were highly
effective in increasing their attention span, making work
more interesting, improving their cognitive abilities, and
fighting fatigue. With the multifaceted demands placed
on college students (eg, grades, social life, finances) and
the increasingly competitive workforce that awaits them
after graduation, these students believe they have found the
“magic bullet.” “It works!” explained Lisa, a senior pre-
med major. “Why wouldn’t you use it if it works? The stuff
is great. Great!” We are left to wonder, therefore, how to
persuade students not to take stimulants that are so soundly
praised for their effectiveness in a culture that increasingly
justifies the means by the ends.
NOTE
For comments and further information, address corre-
spondence to Dr Alan D. DeSantis, University of Kentucky,
Dept of Communication, 234 Grehan Building, Lexington,
KY 40506, USA (e-mail: desantis@uky.edu).
REFERENCES
1. McCabe SE, Teter CJ, Boyd CJ. The use, misuse and diver
-
sion of prescription stimulants among middle and high school
students. Subst Use Misuse. 2004;39:1095–1116.
2. Olfson M, Marcus SC, Druss B, Pincus HA. National
VOL 57, NOVEMBER/DECEMBER 2008 323
Illicit Use of Prescriptions
trends in the use of outpatient psychotherapy. Am J Psychiatry.
2002;159:1914–1920.
3. Robinson LM, Sclar DA, Skaer TL, Galin RS. National
trends in the prevalence of attention-deficit/hyperactivity disorder
and the prescribing of methylphenidate among school-age chil
-
dren: 1990–95. Clin Pediatr. 1999;38:209–217.
4. Rushton JL, Whitmire JT. Pediatric stimulant and selective
serotonin reuptake inhibitor trends: 1992 to 1998. Arch Pediatr
Med. 2001;155:560–565.
5. Safer DJ, Zito JM, Fine EM. Increased methylphenidate
usage for attention deficit disorder in the 1990s. Pediatrics.
1996;98:1084–1088.
6. Centers for Disease Control and Prevention. Mental Health
in the United States: prevalence of diagnosis and medication treat
-
ment for attention-deficit/hyperactivity disorder—United States,
2003. MMWR Morb Mortal Wkly Rep. 2005;54:842–847.
7. Woodworth T. DEA Congressional Testimony. Presented to:
the Committee on Education and the Workforce: Subcommittee on
Early Childhood, Youth and Families. May 16, 2000. http://www
.dea.gov/pubs/cngrtest/ct051600.htm. Accessed June 21, 2007.
8. Babcock Q, Byrne T. Student perceptions of methylphe
-
nidate abuse at a public liberal arts college. J Am Coll Health.
2000;49:143–145.
9. Hall KM, Irwin MM, Bowman KA, Frakenberger W, Jewett
DC. Illicit use of prescribed stimulant medication among college
students. J of Am Coll Health. 2005;53:167–174.
10. Low KG, Gendaszek AE. Illicit use of psychostimulants
among college students: a preliminary study. Psychol Health Med.
2002;7:283–287.
11. McCabe SE, Knight JR, Teter CJ, Wechsler H. Non-medical
use of prescription stimulants among US college students:
prevalence and correlates from a national survey. Addiction.
2005;99:96–106.
12. McCabe SE, Teter CJ, Boyd CJ. Medical use, illicit use,
and diversion of abusable prescription drugs. J Am Coll Health.
2006;54:269–278.
13. Shillington AM, Reed MB, Lange JE, Clapp JD, Henry
S. College undergraduate Ritalin abusers in southwestern Cali
-
fornia: protective and risk factors. J Drug Issues. 2006;(Fall):
999–1014.
14. Teter CJ, McCabe SE, Cranford JA, Boyd CJ, Guthrie
SK. Prevalence and motives for illicit use of prescription stimu
-
lants in an undergraduate student sample. J Am Coll Health.
2006;53:253–262.
15. Teter CJ, McCabe SE, LaGrange K, Cranford JA, Boyd
CJ. Illicit use of specific prescription stimulants among college
students: prevalence, motives, and routes of administration.
Phar-
macotherapy.
2006;26:1501–1510.
16. White BP, Becker-Blease KA, Grace-Bishop K. Stimu
-
lant medication use, misuse, and abuse in an undergradu
-
ate sample and graduate student sample. J Am Coll Health.
2006;54:261–268.
17. US Dept of Justice Drug Enforcement Administration.
Section II: General Requirements. In: Practioner’s Manual.
http://www.deadiversion.usdoj.gov/pubs/manuals/pract/section2
.htm. Accessed July 30, 2007.
18. Centers for Disease Control and Prevention. Percent of
Youth 4–17 Ever Diagnosed With Attention-Deficit/Hyperactiv
-
ity Disorder: National Survey of Children’s Health, 2003
[map].
http://www.cdc.gov/ncbddd/adhd/adhdprevalence.htm.
Accessed
June 1, 2007.
19. Pietrzak RH, Mollica CM, Maruff P, Snyder PJ. Cognitive
effects of immediate-release methylphenidate in children with
attention deficit/hyperactivity disorder. Neurosci Biobehav Rev
.
2006;30:1225–1245.
20. Wilson HK, Cox DJ, Merkel RL, Moore M, Coghill
D. Effect of extended release stimulant-based medications on
neuropsychological functioning among adolescents with atten
-
tion-deficit/hyperactivity disorder. Arch Clin Neuropsychol.
2006;21:797–807.
21. Hood J, Baird G, Rankin PM, Isaacs E. Immediate effects
of methlyphenidate on cognitive attention skills of children with
attention-deficit/hyperactivity disorder. Dev Med Child Neurol
.
2005;47:408–414.
22. Mollica CM, Maruff P, Vance A. Development of a sta
-
tistical approach to classifying treatment response in individ
-
ual children with ADHD. Hum
Psychopharmacol-Clin Exp.
2004;19:445–456.
23. Derzon JH, Lipsey MW. A meta-analysis of the effec
-
tiveness of mass communication for changing substance use
knowledge, attitudes, and behavior. In: Crano WD, Burgoon
M, eds. Mass Media and Drug Prevention: Classic and Con
-
temporary Theories and Research. Mahwah, NJ: Erlbaum;
2002:231–258.
24. Noar SM. A 10-year retrospective of research in health mass
media campaigns: where do we go from here? J Health Commun.
2006;11:21–42.
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- CitationsCitations149
- ReferencesReferences32
- "The growing number of prescribed AMPHs (e.g., Adderall) has increased their availability , particularly for college students (Lakhan & Kirchgessner, 2012). A study conducted between 2005 and 2006 revealed that over one-third of interviewed college students reported nonmedical use of prescription stimulants (DeSantis, Webb, & Noar, 2010). Due to the extensive development of brain and behavior during adolescence, the initiation of use by younger populations is cause for significant concern. "
[Show abstract] [Hide abstract] ABSTRACT: Adolescence is a transitional period between childhood and adulthood that coincides with heightened vulnerability to dependence to amphetamines and other drugs of abuse. The ontogeny of adolescent-typical behaviors, cognition, and neurobiological characteristics appear to be responsible for conferring heightened vulnerability to drug dependence. Accumulating evidence suggests that adolescent exposure to amphetamines results in unique cognitive and neurobiological consequences compared to adult exposure, particularly when the withdrawal period following the last drug exposure is held constant. The current literature is limited due to its use of diverse age ranges for modeling adolescence, imprecise reporting of subject ages, and the frequent lack of adult comparison groups. To encourage forward progress in this field, we issue a call to action to implement more appropriate methodological practices and to widen the scope of inquiry.- "The use of cognitive enhancers seems to be growing in several competitive contexts, such as schools, universities, firms and even the army (though its use in the latter context is certainly less surprising as soldiers have been historically prone to function as " guinea pigs " for a number of enhancers destined to eventually benefit civilians [1, 2]. This phenomenon has triggered a significant debate in philosophy and bioethics345678 , and has received an increasing attention from the media, a fact that highlights the social relevance of the issue91011121314. The situation is made even more complex by the non-univocal definition of what an enhancer is and, more specifically, what a cognitive enhancer is. "
[Show abstract] [Hide abstract] ABSTRACT: Although some of the most radical hypothesis related to the practical implementations of human enhancement have yet to become even close to reality, the use of cognitive enhancers is a very tangible phenomenon occurring with increasing popularity in university campuses as well as in other contexts. It is now well documented that the use of cognitive enhancers is not only increasingly common in Western countries, but also gradually accepted as a normal procedure by the media as well. In fact, its implementation is not unusual in various professional contexts and it has its peak in colleges (where the trend has been characterized as “academic doping”). Even when certain restrictions in the legislation of a country are indeed in place (i.e. through prescriptions requirements), they are without doubts easy to overcome. The legitimacy and appropriateness of such restrictions will not be the focus of our investigation. Our concern is instead related to the moral and social reasons to publicly acknowledge the use of cognitive enhancers in competitive-selective contexts. These reasons are linked to a more neutral analysis of contemporary Western society: it is a fact that an increasing number of competitive-selective contexts have a substantial number of contenders using cognitive enhancers. Through the use of five explicative examples, in this paper we want to analyse the problems related to its use. In particular, it will be our aim to show the tension between one of the main argument used by bio-liberals (the use of cognitive enhancers is an eligible procedure that society does not impose on anyone) and the actual implementation of the drugs in competitive, or semi-competitive contexts.- "This relationship is likely for several reasons. First, stimulants are widely available to college students (Advokat et al. 2008; Benson et al. 2015; DeSantis, Noar, and Webb 2008; Gallucci et al. 2011). In addition, many college students believe that NMUPS is normative or acceptable behavior (Benson et al. 2015; Dodge et al. 2012; Weyandt et al. 2013). "
[Show abstract] [Hide abstract] ABSTRACT: Data show that the prevalence of non-medical use of prescription stimulants is higher among college students than their same-age peers who do not attend college. Because of this, most of the research in this area focuses on data from samples of college students and on use motivated by academic demands. There is little research that examines whether attending college increases the odds of non-medical use of prescription stimulants while including important covariates in the analytical models. The current research addresses this gap in the literature using data from the 2013 National Survey on Drug Use and Health for respondents aged 18 to 25 years old. We estimate a multivariate logistic regression model to determine whether college attendance increased the odds of non-medical use of prescription stimulants. The analysis showed that young adults who enrolled in college full-time were more likely to report non-medical use of prescription stimulants than their same-age peers who did not attend college. There was no significant difference between part-time college students and non-college students. Future research should focus on how specific aspects of the college environment, other than academic stress, may increase the risk of non-medical use of prescription stimulants.
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