College Students Who Abuse Stimulants Might Be At Higher Risk for Conduct Disorder, Substance Abuse, and ADHD

August 20, 2016

Those who take stimulant medications to treat ADHD have long scoffed at those who abuse it — particularly opportunistic college kids who misuse a friend’s Adderall to finish an essay or stay out all night. Stimulant abuse is a real problem, contributing to obstacles for legitimate prescriptions, drug shortages, and in some rare cases, even deaths.

But a small study may challenge classic theories of stimulant abuse, finding that there may be something going on with these users beyond just the desire for an academic advantage or a quick burst of energy. In fact, those who misuse stimulants may be more likely to have psychiatric difficulties like substance abuse disorder, conduct disorder, or even undiagnosed ADHD.

The study, published in the July 2016 issue of The Journal of Clinical Psychiatry, was conducted by Massachusetts General Hospital on a group of students from Boston-area colleges. Three hundred students, all between the ages of 18 and 28, sat through clinical interviews designed to gauge not only their use of stimulant medications, but also their overall psychiatric health. Of the 300 subjects, 100 were classified as “stimulant misusers,” while the other 200 served as controls. Both groups included students who had been diagnosed with ADHD, including some who were already prescribed stimulant medications. If they had never abused their prescriptions by taking a higher dose than they were supposed to, they were placed into the control group.

The results showed that the stimulant misusers were more likely than the control group to have a general substance abuse problem — a conclusion that is perhaps unsurprising, given the evidence. But they were also nearly three times as likely to have conduct disorder — a serious behavioral disorder that sometimes develops from ODD — and about 1.5 times as likely to have previously undiagnosed ADHD. The results, researchers say, indicate that rather than using the drugs for more straightforward reasons like gaining an academic advantage, many of these stimulant misusers might actually be trying to self-medicate.

“Not everyone is driven to misuse prescription stimulants simply to ‘get high’,” said Timothy Wilens, M.D., a coauthor of the study. “Some misusers may be pressured to use a friend’s prescription if they believe it will improve academic performance, which is not likely if combined with alcohol or other drugs. We know that untreated ADHD is associated with increased risk of alcohol- and drug-use disorders, so it is not surprising that we found high rates of co-occurring ADHD and of stimulant-use and overall substance-use disorders in those misusing stimulants.”

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