Who Persists and Who Desists? A Prospective Study of Prescription Stimulant Misuse in College Graduates

Prescription stimulant misuse (PSM) has been studied extensively in college populations, but few studies have examined how PSM changes after graduation. We used a longitudinal design to follow individuals at risk for PSM two years after college graduation to document PSM prevalence, motives, and predictors of PSM persistence. Participants from two small, private colleges completed online surveys focused on intrapersonal, interpersonal, and sociocultural predictors of PSM. Overall, PSM declined over time. Lack of premeditation, perceived peer norms, positive expectancies, media exposure, and other substance use were associated with continued PSM; however, only lack of premeditation, descriptive norms, and other substance use predicted PSM in a multivariate model. This preliminary study suggests dispositional and behavioral risk factors may help to explain why PSM persists after college. Interventions that enhance decision-making skills, correct misperceptions about peers' PSM, and reduce polysubstance use may be effective in curbing PSM in college graduates.

Academic factors associated with college students' prescription stimulant misuse in daily life: An ecological analysis of multiple levels

ObjectiveTo identify academic factors pertaining to college students, calendar timing, and particular moments that are uniquely associated with elevated likelihood of prescription stimulant misuse (intentions and actual behavior) in daily life. Participants: Participants were 297 freshmen and sophomores at a large public university in the United States in 2017-2019. Methods: Participants completed survey measures during lab visits and ecological momentary assessment procedures in daily life. Hypotheses were tested using multilevel models that accounted for the nested data and demographic covariates. Results: Student, calendar-based, and momentary academic factors were uniquely associated with stimulant misuse intentions in daily life. Real-time academic events, beyond the proportion of academic events experienced, emerged as a robust predictor of misuse behavior. Within-person links between real-time momentary predictors and misuse behavior were moderated by finals week timing. Conclusions: Findings offer implications for prevention and intervention strategies for college students at risk for prescription drug misuse.

Study strategies and "study drugs": investigating the relationship between college students' study behaviors and prescription stimulant misuse

ObjectiveThe current study examined the regular use of study strategies between college students who misused prescription stimulants (N = 36) and college students who did not misuse prescription stimulants (N = 298) in an undergraduate sample. Participants: 334 college students at a large, Midwestern university. Methods: Using logistic regression, we examined whether students who misused prescription stimulants did so to compensate for poor study strategies and/or a lack of study strategies overall. We hypothesized that regularly spacing studying, using more study strategies, and using more effective study strategies would predict lower odds of prescription stimulant misuse among students. In contrast, we hypothesized that using more ineffective study strategies would predict higher odds of prescription stimulant misuse. Results: Results indicated that a greater number of total study strategies and effective study strategies, and higher importance of school predicted higher odds of prescription stimulant misuse. Conclusions: Thus, students may not be misusing prescription stimulants as a substitute for effective studying but, rather, to augment effective study habits.

Outcomes and Predictors of Stimulant Misuse in College Students with and Without ADHD

In recent years, rates of prescription stimulant misuse have increased among young adults ages 18 to 25 along with increases in dispensing rates of these medications. Preliminary studies suggest that college students with Attention-Deficit Hyperactivity Disorder (ADHD) may be more likely to misuse their stimulant medication than their non-ADHD peers. Research is needed to further explore possible rates, correlates, and outcomes of prescription stimulant misuse among college students with and without ADHD. Data regarding study strategies, psychological functioning, stimulant misuse, and GPA were collected from students from universities within the US (N = 144), showing significantly higher rates of misuse among college students with ADHD. With depression and anxiety entered into the predictive model, inattentive symptoms were the only significant predictor of misuse in the full sample. The present findings have implications for academic interventions aimed at supporting the success of college students with and without ADHD and inform academic outcomes of prescription stimulant misuse.

Assessing prevalence, knowledge and use of cognitive enhancers among university students in the United Arab Emirates: A quantitative study

BACKGROUND

Cognitive enhancers (CE) are often used to improve memory, alertness and cognitive capacity. These products are commercially and pharmaceutically available. Due to high academic pressure, university students are at risk of CE misuse. However, data regarding this issue are limited, especially in the United Arab Emirates (UAE).

AIMS

To assess the prevalence of CE intake; evaluate students' knowledge of these substances; and identify student characteristics associated with CE usage.

METHOD

A cross sectional study based on a validated online survey that was distributed using university-licensed software (Qualtrics) as a direct web link via email and social media to all Medical, Pharmacy, Dentistry, Nursing and Engineering students enrolled in six UAE universities. Associations between student characteristics and CE use were investigated using the chi-squared test and multiple logistic regression. Reasons for CE use, temporal patterns of use, details regarding purchase and types of CE used were compared by gender.

RESULTS

One quarter of students had used CEs. There was a clear difference between users and non-users in terms of gender (p<0.001). CE users were disproportionately represented by students from either UAE or other Arab countries (p<0.001), and by students of Medicine, followed by Pharmacy, Dentistry, and Engineering (p<0.001). CE use increased with year of study, reaching the highest level in the fourth year (p<0.001), which for most programmes is the final year. Modafinil was self-administered, especially in males, for concentration and alertness; B12 was typically taken by female students for academic performance and concentration; and high-dosage caffeine compounds were ingested to improve alertness levels. Use of the internet for both obtaining information and purchasing CEs was frequently reported. Multiple logistic regression analysis showed that gender, nationality, and year of study were associated with CE use among UAE university students.

CONCLUSIONS

Universities need to address the prevalence of CE use amongst their students by providing effective support programs.

Substance use and mental health problems among graduate students: Individual and program-level correlates

OBJECTIVE

This study evaluated variation in substance use and mental health among graduate student subgroups.

PARTICIPANTS

A sample of 2,683 master's and doctoral students completed an online survey in October 2017.

METHODS

Subgroup variation in behavioral health by demographic and program characteristics, particularly degree type and academic discipline, was explored.

RESULTS

Compared with academic doctoral students (ie, PhD students), professional doctoral students (ie, MD, JD, etc.) were significantly more likely to report high stress levels and moderate or severe anxiety symptoms. Master's students were more likely to report moderate or severe anxiety symptoms and use marijuana than academic doctoral students. Students in the behavioral and social sciences, social work, and arts and humanities disciplines were more likely to use substances and report mental health problems than engineering and business students.

CONCLUSIONS

These findings highlight graduate student subgroups who might require closer attention with respect to access to behavioral health services.

Attitudes of medicine, pharmacy, and dentistry students about psychostimulant use to enhance cognition

INTRODUCTION

The use of psychostimulant drugs to increase academic success is common among young people. There is no study examining this issue in Turkish population. In this study, the prevalence, attitudes, knowledge, and ethical evaluations of Pharmacological Cognitive Enhancement (PCE) in university students were investigated.

METHOD

A structured online survey was carried out with 1148 undergraduate and postgraduate (master, PhD and residency) students in different faculties of Medicine, Dentistry and Pharmacy in Turkey. Comparisons between groups, correlation and regression analysis about associated variables were made.

RESULTS

The general prevalence of PCE in our study was found to be 7.4%. The highest prevalence was seen in the faculty of medicine (8.4%), among the residency students (15.5%). There was no significant difference prevalence of PCE between the faculties. Education level, smoking, study performance satisfaction, and knowledge level were found to be factors associated with PCE. Around 40% of PCE users stated that they used it with the recommendation of their friends. PCE users had a lower perception of harm and risk, and rated the use of it as more acceptable and normal behaviour.

CONCLUSION

PCE is a method used by young with high knowledge, low study performance satisfaction, to increase their academic success, especially during exam periods. Peer effect is an important factor in increasing prevalence.

Prescription stimulant use among young adult college students: Who uses, why, and what are the consequences?

To examine prescription stimulant use among college students, particularly use with versus without prescriptions or attention deficit hyperactive disorder (attention-deficit/hyperactivitydisorder (ADHD)) diagnoses. Participants: Data were drawn from a diverse sample of college students from seven colleges/universities in Georgia participating. Methods: Measures assessed ADHD-specific factors, prescription stimulant use, access, motives, side effects, and covariates. Results: Of the 219 students reporting prescription stimulant use (average age 20.72 years, 54.8% female, 82.1% White), 45.7% did not have prescriptions or ADHD diagnoses. Correlates of use without prescriptions/diagnoses included lower parental education, attending private school, not having depression- or anxiety-related diagnoses, and past 30-day marijuana and tobacco use. Those without prescriptions/diagnoses were more likely to use to stay awake longer, to have more enjoyable time, and to party longer; they also reported fewer adverse side effects. Conclusions: Campuses should educate students about ADHD, facilitate screening and treatment, and emphasize adverse consequences of recreational use.

The Use and Impact of Cognitive Enhancers among University Students: A Systematic Review

INTRODUCTION

Cognitive enhancers (CEs), also known as "smart drugs", "study aids" or "nootropics" are a cause of concern. Recent research studies investigated the use of CEs being taken as study aids by university students. This manuscript provides an overview of popular CEs, focusing on a range of drugs/substances (e.g., prescription CEs including amphetamine salt mixtures, methylphenidate, modafinil and piracetam; and non-prescription CEs including caffeine, cobalamin (vitamin B12), guarana, pyridoxine (vitamin B6) and vinpocetine) that have emerged as being misused. The diverted non-prescription use of these molecules and the related potential for dependence and/or addiction is being reported. It has been demonstrated that healthy students (i.e., those without any diagnosed mental disorders) are increasingly using drugs such as methylphenidate, a mixture of dextroamphetamine/amphetamine, and modafinil, for the purpose of increasing their alertness, concentration or memory.

AIM

To investigate the level of knowledge, perception and impact of the use of a range of CEs within Higher Education Institutions.

METHODOLOGY

A systematic review was conducted in adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Whilst 1400 studies were identified within this study through a variety of electronic databases (e.g., 520 through PubMed, 490 through Science Direct and 390 through Scopus), 48 papers were deemed relevant and were included in this review.

RESULTS

The most popular molecules identified here included the stimulant CEs, e.g., methylphenidate, modafinil, amphetamine salt mixtures and caffeine-related compounds; stimulant CEs' intake was more prevalent among males than females; drugs were largely obtained from friends and family, as well as via the Internet. It is therefore suggested that CEs are increasingly being used among healthy individuals, mainly students without any diagnosed cognitive disorders, to increase their alertness, concentration, or memory, in the belief that these CEs will improve their performance during examinations or when studying. The impact of stimulant CEs may include tolerance, dependence and/or somatic (e.g., cardiovascular; neurological) complications.

DISCUSSION

The availability of CEs for non-medical indications in different countries is influenced by a range of factors including legal, social and ethical factors. Considering the risk factors and motivations that encourage university students to use CE drugs, it is essential to raise awareness about CE-related harms, counteract myths regarding "safe" CE use and address cognitive enhancement in an early stage during education as a preventative public health measure.

Pharmacological Neuroenhancement: Current Aspects of Categorization, Epidemiology, Pharmacology, Drug Development, Ethics, and Future Perspectives

Recent pharmacoepidemiologic studies suggest that pharmacological neuroenhancement (pNE) and mood enhancement are globally expanding phenomena with distinctly different regional characteristics. Sociocultural and regulatory aspects, as well as health policies, play a central role in addition to medical care and prescription practices. The users mainly display self-involved motivations related to cognitive enhancement, emotional stability, and adaptivity. Natural stimulants, as well as drugs, represent substance abuse groups. The latter comprise purines, methylxanthines, phenylethylamines, modafinil, nootropics, antidepressants but also benzodiazepines, β-adrenoceptor antagonists, and cannabis. Predominant pharmacodynamic target structures of these substances are the noradrenergic/dopaminergic and cholinergic receptor/transporter systems. Further targets comprise adenosine, serotonin, and glutamate receptors. Meta-analyses of randomized-controlled studies in healthy individuals show no or very limited verifiability of positive effects of pNE on attention, vigilance, learning, and memory. Only some members of the substance abuse groups, i.e., phenylethylamines and modafinil, display positive effects on attention and vigilance that are comparable to caffeinated drinks. However, the development of new antidementia drugs will increase the availability and the potential abuse of pNE. Social education, restrictive regulatory measures, and consistent medical prescription practices are essential to restrict the phenomenon of neuroenhancement with its social, medical, and ethical implications. This review provides a comprehensive overview of the highly dynamic field of pharmacological neuroenhancement and elaborates the dramatic challenges for the medical, sociocultural, and ethical fundaments of society.

Professionals' attitudes towards the use of cognitive enhancers in academic settings

INTRODUCTION AND AIMS

The non-medical use of prescription stimulants such as methylphenidate, dexamphetamine and modafinil is increasing in popularity within tertiary academic settings. There is a paucity of information on awareness, attitudes, and acceptability by professionals of use in this context. This study aimed to investigate professionals' knowledge of and attitudes towards the use of cognitive enhancers (CEs) in academic settings, and their willingness to use a hypothetical CE.

DESIGN AND METHODS

A mail survey was sent to doctors, pharmacists, nurses, accountants and lawyers in New Zealand. These disciplines were chosen as they require professional registration to practice. The questionnaire comprised four sections: (1) demographics, (2) knowledge of CEs, (3) attitudes towards the use of CEs, and (4) willingness to use hypothetical CEs.

RESULTS

The response rate was 34.5% (414/1200). Overall, participants strongly disagreed that it was fair to allow university students to use CEs for cognitive enhancement (Mdn = 1, IQR: 1,3), or that it is ethical for students without a prescription to use cognitive enhancers for any reason (Mdn = 1, IQR: 1,2). Professions differed in their attitudes towards whether it is ethical for students without a prescription to use CEs for any reason (p = 0.001, H 31.527).

DISCUSSION AND CONCLUSION

Divergent views and lack of clear consensus within professions and between professionals on the use of CEs have the potential to influence both professionals and students as future professionals. These divergent views may stem from differences in the core values of self-identity as well as extrinsic factors of acceptability within the profession in balancing the elements of opportunity, fairness and authenticity in cognitive enhancement. Further research is required to inform the development of policy and guidelines that are congruent with all professions.

"Study Natural" without Drugs: An Exploratory Study of Theory-Guided and Tailored Health Campaign Interventions to Prevent Nonmedical Use of Prescription Stimulants in College Students

Nonmedical use of prescription stimulants (NMUPS) among college students continues to rise. While some anti-NMUPS campaigns are available, little is known about the campaign development process and how well college students evaluate these messages. To bridge this gap, we developed theory-guided anti-NMUPS campaign interventions that are tailored to college students’ characteristics and evaluated students’ response towards them. A total of 445 college students (74.4% female; Mean_age of 20; 18 to 35 years old) reviewed the campaign interventions and offered their evaluation via an online survey. Findings indicate that students responded to the campaigns positively. Results also indicate that female students are more likely to perceive the campaigns as effective than their male counterparts. Overall, the findings of this study suggest that theory-guided and tailored anti-NMUPS campaigns have great potential in changing students’ attitudes and behavior towards NMUPS. While this study fills critical gaps in the literature, considering the progress needed to strengthen the research field, more research is needed to further identify effective strategies that could prevent college students’ participation in NMUPS activities.

‘’Pílula do estudo’’: uso do metilfenidato para aprimoramento cognitivo entre estudantes de psicologia da Universidade do Estado de Minas Gerais (UEMG)

Objetivo: Avaliar o uso do metilfenidato para o aprimoramento cognitivo entre estudantes de Psicologia da Universidade do Estado de Minas Gerais. Métodos: Estudo epidemiológico, transversal, quantitativo. A amostra foi composta por discentes devidamente matriculados no segundo semestre de 2017 (N = 318). Os instrumentos utilizados para a avaliação foram o questionário de saúde geral, de uso do metilfenidato e o ASSIST. Resultados: A maioria dos participantes era mulher (80,8%), com idade entre 18 e 63 anos (média de 26,5 anos). Vinte e seis estudantes (8,5%) declararam já ter usado metilfenidato em algum momento na vida, doze declararam ter consumido o medicamento para fins de aprimoramento cognitivo, sendo que, destes, sete obtiveram através de amigos e nove começaram a usá-lo após o ingresso no ensino superior. Ter sono regulado (36%), tomar café (35,6%) e praticar exercícios físicos (17%) também foram mencionadas como estratégias adotadas para aumentar a capacidade cognitiva e rendimento acadêmico. O uso do metilfenidato esteve correlacionado ao uso de tabaco (r = 0,12; p < 0,05), anfetamina ou ecstasy (r = 0,20; p < 0,01), inalantes (r = 0,13; p < 0,05) e alucinógenos (r = 0,22; p < 0,01). Conclusão:  O uso do metilfenidato para o aprimoramento cognitivo tem ocorrido entre os estudantes de Psicologia. Como proposta de intervenção, sugere-se a implementação de ações que promovam a escuta, o acolhimento, o debate e a reflexão desses estudantes, visando auxiliá-los no manejo das dificuldades da vida acadêmica, amenizando assim, os possíveis impactos ocasionados pelo uso do medicamento.

Predictors of Prescription Stimulant Misuse in U.S. College Graduates

Background: Research has shown that prescription stimulant misuse (PSM) is prevalent among college students and that full-time college attendance is associated with PSM following graduation. Few studies, however, have examined predictors of PSM in college graduates. Objectives: We examined constructs from the Theory of Triadic Influence (TTI) to determine predictors of PSM in this population. Methods: We utilized Amazon's Mechanical Turk and snowball sampling in 2018-2019 to anonymously survey 219 adults in the United States (56% male, M_age = 32.5) with a college degree and history of college PSM. We assessed sensation seeking, ADHD symptoms, negative affect, social norms, workload, positive beliefs and perceived safety, other substance use, PSM motivations, and source(s) of prescription stimulants. Measures were administered online. Results: Over half (55%) of participants reported PSM after college; 36% used in the previous year. Ordinal logistic regressions for each domain of the TTI (i.e. intrapersonal, social/normative, cultural/attitudinal) showed that college graduates engaging in PSM in the previous year were younger and reported higher sensation seeking, more friends/coworkers who engaged in PSM, a heavier workload, and more positive beliefs about PSM. Chi-square analyses showed that college graduates engaging in PSM in the previous year also were more likely to use other substances (e.g. prescription opioids, tobacco/nicotine, cocaine) and to have misused stimulants in college to socialize or to get high. Conclusions: Preventive interventions could target college students and recent graduates who engage in PSM and who demonstrate the aforementioned risk factors, with the goal of curbing PSM and possibly other substance use.

Nonmedical Use of Stimulants Is Associated With Riskier Sexual Practices and Other Forms of Impulsivity

BACKGROUND

This study sought to examine the occurrence of the nonmedical use of prescription stimulants (amphetamines and methylphenidate) in a university sample and their associated physical and mental health correlates, including potential relationships with risky sexual practices.

METHODS

A 156-item anonymous online survey was distributed via e-mail to a sample of 9449 university students. Current use of alcohol and drugs, psychological and physical status, and academic performance were assessed, along with questionnaire-based measures of impulsivity and compulsivity.

RESULTS

A total of 3421 participants (59.7% female) were included in the analysis. 6.7% of the sample reported current/recent nonmedical use of prescription stimulants, while an additional 5.8% reported misuse in the past. Nonmedical use of prescription stimulants was associated with lower grade point averages, and with taking a broad range of other drugs (including alcohol, nicotine, illicit substances, and consumption of caffeinated soft drinks). Nonmedical use of stimulants was also significantly associated with impulsivity (Barratt scale), prior treatment for substance use problems, and elevated occurrence of disordered gambling, post-traumatic stress disorder, and anxiety; but not depression symptoms or binge-eating disorder (though it was associated with using drugs to lose weight). The relationship with probable attention-deficit/hyperactivity disorder (ADHD) on screening was not significant but was numerically elevated. Finally, those using nonmedical prescribed stimulants were significantly more sexually active (including at a younger age), and were less likely to use barrier contraception.

CONCLUSIONS

Nonmedical use of prescription stimulants is common in young adults and has profound public health associations including with a profundity of other drug use (licit and illicit), certain mental health diagnoses (especially gambling, anxiety, and post-traumatic stress disorder ), worse scholastic performance, and riskier sexual practices. The majority of people with nonmedical use of prescription stimulants do not have ADHD, and its link with current ADHD symptoms was less marked than for certain other disorders. Clinicians should screen for the misuse of prescription stimulants as they may be associated with a range of problematic behaviors. Risk of diversion (which may be higher for those living in shared accommodation and those with substance use disorder history) merits careful assessment before prescribing stimulant medication.

Top-Cited Articles from Dental Education Journals, 2009 to 2018: A Bibliometric Analysis

The number of citations an article receives is an important indicator to quantify its influence in its field. The aim of this study was to identify and analyze the characteristics of the 50 top-cited articles addressing dental education published in two journals dedicated to dental education (European Journal of Dental Education and Journal of Dental Education). The Web of Science database was searched to retrieve the 50 most-cited articles from the two journals in December 2018. The top-cited articles were analyzed for journal of publication, number of citations, institution and country of origin, year of publication, study type, keywords, theme and subtheme, and international collaborations. The results showed the 50 top-cited articles were cited between 24 and 146 times each. The majority of these top-cited articles (n=34) were published in the Journal of Dental Education Half (n=25) of the articles were by authors in the U.S. The most common study types were surveys (n=26) and reviews (n=10). The main themes of these top-cited articles were curriculum and learner characteristics. This bibliometric analysis can serve as a reference for recognizing studies with the most impact in the scholarship of dental education.

Undergraduate Prescription Stimulant Misuse and Academic Strain: The Role of College Major and Graduate School Plans

The literature has shown that undergraduates engage in the misuse of prescription stimulants in large part to meet academic demands and as an attempt to alleviate academic stress. The current study examined the relationship between misusing prescription stimulants for academic purposes and academic strains (academic stress, grade strain, and academic impediments) to determine whether prescription stimulant misuse (PSM) and the types of academic strains experienced by undergraduates differed based on their college major and postgraduate education plans. We utilized survey data that had been collected from 924 students at a large southeastern university in 2014, which specifically assessed for PSM. Results indicated significant differences in the misuse of prescription stimulants based on the types of academic strains experienced, college major, and postgraduate education plans. Implications and suggestions for future research are discussed.

Use of cognitive enhancers among medical students in Lithuania

Aims

The purpose of this study is to analyse the use of cognitive enhancers among medical students in Lithuania, determine the reasons for usage and evaluate the contributing factors such as socio-demographic characteristics, stress levels, sleep quality and knowing somebody who has used a neuro-enhancing drug.

Design

A cross-sectional survey study was performed by analysing a convenience sample of n=579 in the two universities offering medical education in Lithuania, Vilnius University and the Lithuanian University of Health Sciences. In 2014, students were asked to fill in anonymous paper questionnaires consisting of 13 items on prevalence of substance use to enhance cognitive performance, and on reasons and correlates (response rate 95%) during lecture time.

Results

Of the respondents, 8.1% indicated that they had used cognitive enhancers. Among those who had used these drugs, nootropics were the most frequently mentioned (59.6%), while psychostimulants, such as modafinil, methylphenidate and amphetamine-derived drugs were mentioned less frequently (38.3%). Other substances were indicated by 23.4% of the respondents. Improvement of concentration and increased studying time were predominant purposes (55.3% and 48.9% of users, respectively). Male students reported three times higher prevalence rates than females (14.6% vs. 5.1%, p<0.05). Prevalence was also higher in students who knew someone using these substances than among those who did not know such persons (17.3% vs. 5.1%, p< 0.05). This was the most associated factor with cognitive-enhancing drug-taking behaviour. No correlation between cognitive enhancement usage and sleep quality or stress levels was found, nor between usage and belonging to a student organisation or having a job.

Conclusions

In Lithuania, 1 of 12 medical students admits to having used neuro-enhancing drugs. Our study results provide an overview of the actual situation on correlates and reasons for taking performance-enhancing substances.

Attention-deficit hyperactivity disorder medication use: factors involved in prescribing, safety aspects and outcomes

While treatment of patients with attention-deficit hyperactivity disorder (ADHD) is based on a multimodal approach that combines medication with specific psychological interventions, pharmacotherapy alone is generally considered an essential and cost-effective element. This paper aims to comprehensively and critically review factors involved in prescribing and medication use in individuals diagnosed with ADHD, focusing on the difficulties facing patients with ADHD seeking treatment, as well as the safety and tolerability aspects of ADHD pharmacotherapies, with particular attention on the cardiovascular adverse events and the potential risk of misuse or diversion of ADHD medications. A comprehensive and systematic literature search of PubMed/MEDLINE database was conducted to identify studies published in peer-reviewed journals until 1 August 2016. Children, adolescents and adults often encounter significant difficulties in the process of accessing specialist assessment and treatment for ADHD as a consequence of disparities in service organization and available treatment provision. Despite the well-established efficacy and overall safety profile, ADHD medications are not exempt from adverse events. The cardiovascular safety of pharmacotherapies used for treating individuals with ADHD has raised particular concerns; however there is little evidence of serious cardiovascular adverse events, including no serious corrected QT (QTc) abnormalities associated with stimulants, atomoxetine or α2-adrenergic receptor agonists. Although the abuse of prescription stimulant drugs, particularly, short-acting stimulants is a prevalent and growing problem, nonmedical use of prescription stimulants within the clinical context is very limited. In addition, nonstimulant ADHD medications lack any reinforcing effects and consequently any abuse potential.

Non-Medical Prescription Stimulant Use in Graduate Students: Relationship With Academic Self-Efficacy and Psychological Variables

OBJECTIVE

The objective of this study was to examine graduate students' non-medical use of prescription stimulant medication, and the relationship between non-medical use of prescription stimulants with academic self-efficacy, psychological factors (i.e., anxiety, depression, and stress), and internal restlessness.

METHOD

The sample consisted of 807 graduate students from universities located in five geographic regions of the United States.

RESULTS

Past-year rates of self-reported non-medical use were determined to be 5.9%, with overall lifetime prevalence of 17.5%. Observed self-reported non-medical use of prescription stimulant medications was significantly correlated with self-reported levels of anxiety and stress, various aspects of internal restlessness, and perceived safety of the medications.

CONCLUSION

Findings support graduate students' motivations of non-medical prescription stimulant use to be both academic and social in nature. Effective prevention and education efforts are needed to help address the non-medical use of prescription stimulants by graduate students on university campuses.

A systematic review of the motivations for the non-medical use of prescription drugs in young adults

BACKGROUND

Young adults (18-25) are most at-risk for the non-medical use of prescription drugs (NMUPD). Understanding this population's motivations for use can help inform efforts to reduce NMUPD. Therefore, this systematic review synthesizes the findings from research on young adults' motivations to engage in NMUPD.

METHODS

Based on PRISMA guidelines, relevant databases were systematically searched for articles that assessed the motivations for NMUPD in young adults and college-aged students. Search strings included a range of prescription drug classes and terms to ensure an exhaustive review.

RESULTS

The search resulted in identifying 353 potential articles after duplicates were removed, and 37 articles were included in the final qualitative synthesis. Of the final articles, the majority investigated the non-medical use of prescription stimulants in U.S. student populations cross-sectionally. Seven studies, either exclusively or in combination with other medications, researched prescription opioids, and five investigated central nervous system depressants. Only one study investigated motivations over time.

CONCLUSION

There are many ways in which the current literature can be expanded, including researching other populations and focusing on prescriptions other than stimulants. Using the medications for their prescribed properties and known side effects emerged as a consistent theme. It was also fairly common for young adults to report recreational motives. Issues with measurement and definitions of key terms (e.g., non-medical) would benefit from consistency in future work. Research on motivations should continue and be incorporated into the larger drug use context, as well as existing prevention and intervention strategies.

Prevalence of and motives for pharmacological neuroenhancement in Switzerland--results from a national Internet panel

AIMS

To estimate the prevalence of self-reported pharmacological neuroenhancement (PNE) with prescription or recreational drugs among the Swiss general population and correlates of PNE.

DESIGN

A population-based cross-sectional study using a self-administered online survey.

SETTING

A telephone-recruited highly representative internet panel in Switzerland.

PARTICIPANTS

A total of 10,171 Swiss employees and students (unweighted n = 10,084) aged 15-74 years (mean age: 39.1 ± 13.3; 46.6% female).

MEASUREMENTS

Self-reported life-time, past-year and past-month use of prescription or recreational drugs for PNE, motives for use and correlates of PNE, including socio-demographic, health and recreational drug use characteristics.

FINDINGS

The life-time prevalence of PNE was 4.0% [95% confidence interval (CI) = 3.62, 4.38], and the past-year prevalence was 2.1% (95% CI = 1.82, 2.38). Life-time pharmacological mood enhancement (3.1%; 95% CI = 2.76, 3.44) was more prevalent than pharmacological cognitive enhancement (1.4%; 95% CI = 1.17, 1.63). Fifty-four participants reported both (0.5%; 95% CI = 0.36, 0.64). PNE was associated with studying rather than full-time [odds ratio (OR) = 0.35; 95% CI = 0.21, 0.57] or part-time employment (OR = 0.39; 95% CI = 0.23, 0.67), stress (OR = 1.51 95% CI = 1.31, 1.75), cocaine (OR = 2.40; 95% CI = 1.51, 3.82) and amphetamine use (OR = 2.44; CI 95% = 1.37, 4.33), diagnosis of a mental disorder (OR = 4.26; 95% CI = 3.14, 5.80), and perceived poor health (OR = 0.76; 95% CI = 0.64, 0.90).

CONCLUSIONS

Taking prescription or recreational drugs for pharmacological neuroenhancement is rare among Swiss employees and students (4.0%). Pharmacological mood enhancement (3.1%) is more prevalent than direct pharmacological cognitive enhancement (1.4%).

The Illicit Use of Prescription Stimulants on College Campuses: A Theory-Guided Systematic Review

The illicit use of prescription stimulants (IUPS) is a substance use behavior that remains prevalent on college campuses. As theory can guide research and practice, we provide a systematic review of the college-based IUPS epidemiological literature guided by one ecological framework, the theory of triadic influence (TTI). We aim to assess prevalence, elucidate the behavior's multietiological nature, and discuss prevention implications. Peer-reviewed studies were located through key phrase searches (prescription stimulant misuse and college, "prescription stimulant misuse" and "college," illicit use of prescription stimulants in college, and nonmedical prescription stimulant use in college students) in electronic databases (PubMed, PubMed Central, and EBSCO Host) for the period 2000 to 2013. Studies meeting inclusion criteria had their references reviewed for additional eligible literature. Statistically significant correlates of IUPS in the 62 retrieved studies were organized using the three streams of influence and four levels of causation specified in the TTI. Results show that the prevalence of IUPS varies across campuses. Additionally, findings suggest the behavior is multifaceted, as correlates were observed within each stream of influence and level of causation specified by the TTI. We conclude that IUPS is prevalent in, but varies across, colleges and is influenced by intrapersonal and broader social and societal factors. We discuss implications for prevention and directions for future research.

Nonmedical Use of Stimulants Among Medical Students

Context: Proliferation of the use of psychopharmacologic drugs for the treatment of individuals with attention and behavior disorders has promoted discussion of the illicit use of such drugs to enhance academic performance. Previous research has focused on the use of such drugs by undergraduate students; however, inquiry into the nonmedical use of prescription stimulants by medical students is warranted because of the unique qualities of the medical school environment (including academic pressure, stress, and competition with peers) and the demographic characteristics common to many medical students.

Objective: To examine the nonmedical use of prescription stimulants among osteopathic medical students, focusing on such key associated variables as academic stress, social network connections, and use of other substances.

Methods: In 2012, first- and second-year students at a large osteopathic medical school were surveyed on the nonmedical use of prescription stimulants, stress, social networks, perceptions of drug use, and related topics. Data were compared with national data and assessed using analysis of variance and χ2 statistical tests.

Results: A total of 380 students completed the survey. Of those, 56 (15.2%) reported using prescription stimulants nonmedically to help them study in medical school. This percentage is significantly higher than the national estimated rate of diagnosis of attention-deficit/hyperactivity disorder in similar populations (t=3.72, P<.001). Both positive perceptions of the nonmedical use of stimulants (F=14.89, P<.001) and the use of other substances (χ2=18.00, P<.001) were positively associated with the nonmedical use of stimulants. Social network connections did not positively predict use by medical students, and certain types of social connectivity had a negative association with use.

Conclusion: In contrast with research on undergraduate populations, addressing academic stress and feelings of competitiveness may not be viable strategies for mitigating nonmedical use of stimulants among medical students.

Patterns of non-medical use of methylphenidate among 5th and 6th year students in a medical school in southern Brazil

Objectives: To evaluate the prevalence of methylphenidate (MPH) use among 5th and 6th year medical students, to discriminate MPH use with and without medical indication, and to correlate MPH use with alcohol intake. Methods: This is a cross-sectional study in which medical students were invited to answer a questionnaire to evaluate academic and socioeconomic status, MPH use patterns, and attitudes towards neuroenhancing drugs. The Alcohol Use Disorders Identification Test (AUDIT) was used to assess alcohol intake; a score ≥ 8 suggests potentially hazardous alcohol use. Results: Fifty-two participants (34.2%) had already used MPH, of which 35 (23.02%) had used it without medical indication. The number of 6th year students who had used MPH was more than twice higher than that of their 5th year counterparts (32.89 vs. 13.15%, respectively; p = 0.004). Also, 43.6% (p = 0.031) of the users of MPH had an AUDIT score ≥ 8; 33.3% (p = 0.029) of non-medical users of MPH had an AUDIT score ≥ 8. Conclusions: In this study, the use of MPH without medical indication was prevalent. Our findings also confirmed the association between non-medical use of MPH and potentially hazardous alcohol use.

The use and misuse of prescription stimulants as "cognitive enhancers" by students at one academic health sciences center

PURPOSE

Prescription stimulant use as "cognitive enhancers" has been described among undergraduate college students. However, the use of prescription stimulants among future health care professionals is not well characterized. This study was designed to determine the prevalence of prescription stimulant misuse among students at an academic health sciences center.

METHOD

Electronic surveys were e-mailed to 621 medical, pharmacy, and respiratory therapy students at East Tennessee State University for four consecutive weeks in fall 2011. Completing the survey was voluntary and anonymous. Surveys asked about reasons for, frequency of, and side effects of nonprescription misuse of prescription stimulants. Given the sensitive material, an opportunity to win one of ten $50 gift cards was used as an incentive.

RESULTS

Three hundred seventy-two (59.9%) students completed the survey from three disciplines (47.6% medical, 70.5% pharmacy, and 57.6% respiratory therapy). Overall, 11.3% of responders admitted to misusing prescription stimulants. There was more misuse by respiratory therapy students, although this was not statistically significant (10.9% medicine, 9.7% pharmacy, 26.3% respiratory therapy; P = .087). Reasons for prescription stimulant misuse included to enhance alertness/energy (65.9%), to improve academic performance (56.7%), to experiment (18.2%), and to use recreationally/get high (4.5%).

CONCLUSIONS

Prescription stimulant misuse was prevalent among participating students, but further research is needed to describe prevalence among future health care workers more generally. The implications and consequences of such misuse require further study across professions with emphasis on investigating issues of academic dishonesty (e.g., "cognitive enhancement"), educational quality, and patient safety or health care quality.

Determinants of physicians' prescribing behaviour of methylphenidate for cognitive enhancement

The non-medical use of methylphenidate for cognitive enhancement becomes a more and more common practice among college and university students. Although physicians are a source of access, little is known about the underlying mechanisms that might lead to physicians' intention and behaviour of prescribing methylphenidate to improve students' academic performance. Applying Ajzen's theory of planned behaviour (TPB), we tested whether attitudes, subjective norms (controllability and self-efficacy) and perceived behavioural control predicted the intention and the prescribing behaviour of physicians. Participants were 130 physicians (62.3% males). Structural equation modelling was used to test the ability of TPB to predict physicians' behaviour. Overall, the present study provides support for the TPB in predicting physicians' prescribing behaviour of methylphenidate for cognitive enhancement. Subjective norms, followed by attitudes, are the strongest predictors of physicians' intention to prescribe methylphenidate. To a lesser extent, controllability predicts the intention of physicians, and self-efficacy predicts the self-reported behaviour. Compared to their male colleagues, female physicians seem to have more negative attitudes towards prescribing methylphenidate for cognitive enhancement, feel less social pressure and perceive more control over their behaviour. Intervention programmes that want to decrease physicians' intention to prescribe methylphenidate for improving academic performance should primarily focus on alleviating the perceived social pressure to prescribe methylphenidate and on converting physician neutral or positive attitudes towards prescribing methylphenidate into negative attitudes.

Tweaking and tweeting: exploring Twitter for nonmedical use of a psychostimulant drug (Adderall) among college students

Background

Adderall is the most commonly abused prescription stimulant among college students. Social media provides a real-time avenue for monitoring public health, specifically for this population.

Objective

This study explores discussion of Adderall on Twitter to identify variations in volume around college exam periods, differences across sets of colleges and universities, and commonly mentioned side effects and co-ingested substances.

Methods

Public-facing Twitter status messages containing the term “Adderall” were monitored from November 2011 to May 2012. Tweets were examined for mention of side effects and other commonly abused substances. Tweets from likely students containing GPS data were identified with clusters of nearby colleges and universities for regional comparison.

Results

213,633 tweets from 132,099 unique user accounts mentioned “Adderall.” The number of Adderall tweets peaked during traditional college and university final exam periods. Rates of Adderall tweeters were highest among college and university clusters in the northeast and south regions of the United States. 27,473 (12.9%) mentioned an alternative motive (eg, study aid) in the same tweet. The most common substances mentioned with Adderall were alcohol (4.8%) and stimulants (4.7%), and the most common side effects were sleep deprivation (5.0%) and loss of appetite (2.6%).

Conclusions

Twitter posts confirm the use of Adderall as a study aid among college students. Adderall discussions through social media such as Twitter may contribute to normative behavior regarding its abuse.

The prescription drug abuse epidemic

In the United States, the nonmedical use of prescription drugs is the second most common illicit drug use, behind only marijuana. This article discusses the abuse issues with three of the most widely abused prescription drugs: opioids, central nervous system (CNS) depressants (eg, benzodiazepines), and stimulants (eg, amphetamine-dextroamphetamine and methylphenideate) in the United States. Efforts to deal with the problem are described as well.

Prescription stimulants in individuals with and without attention deficit hyperactivity disorder: misuse, cognitive impact, and adverse effects

Prescription stimulants are often used to treat attention deficit hyperactivity disorder (ADHD). Drugs like methylphenidate (Ritalin, Concerta), dextroamphetamine (Dexedrine), and dextroamphetamine-amphetamine (Adderall) help people with ADHD feel more focused. However, misuse of stimulants by ADHD and nonaffected individuals has dramatically increased over recent years based on students' misconceptions or simple lack of knowledge of associated risks. In this review, we discuss recent advances in the use and increasing misuse of prescription stimulants among high school and college students and athletes. Given the widespread belief that stimulants enhance performance, there are in fact only a few studies reporting the cognitive enhancing effects of stimulants in ADHD and nonaffected individuals. Student athletes should be apprised of the very serious consequences that can emerge when stimulants are used to improve sports performance. Moreover, misuse of stimulants is associated with dangers including psychosis, myocardial infarction, cardiomyopathy, and even sudden death. As ADHD medications are prescribed for long-term treatment, there is a need for long-term safety studies and education on the health risks associated with misuse is imperative.

Cognitive-enhancing substance use at German universities: frequency, reasons and gender differences

BACKGROUND

The purpose of this study was to give an overview whether German students regularly use stimulants for enhancing their academic performance. Reasons associated with the use of these substances were explored. Moreover, gender differences were analyzed.

METHODS

A cross-sectional survey study was performed analyzing a random sample of 1,053 students of different fields of study in Germany. Students were asked to complete an anonymous self-administered web-based survey containing questions on cognitive performance-enhancing substance use. We used statistical analyses, e.g. non-parametric tests to evaluate the data of our questionnaire.

RESULTS

Among 1,053 students, 61 % responded to our questionnaire. The average age was M = 24.58; 635 participants were female and 418 were male students. Total 1-13 % of the participating students have taken prescription stimulants (e.g. modafinil) or illicit drugs (e.g. cannabis) at least once in their lifetime. The most common reasons for taking stimulants were to support concentration, to relax and to increase alertness. We found significant gender differences with regard to frequency and reason for using performance-enhancing substances.

CONCLUSIONS

Our study results give an overview about the actual situation on frequency and reasons for taking performance-enhancing substances. Departments of Public Health should address this issue in national health debates and discussions. Based on our study findings health education programmes should be developed.