In the NSDUH, those who reported lifetime stimulant use were asked about prescription stimulant misuse, defined as stimulant use “in any way a doctor did not direct: using it without a prescription . . . in greater amounts, more often, or longer than you were told to take it; using it in any other way a doctor did not direct . . . .” For this analysis, motives for stimulant misuse were grouped into four categories: weight loss only, cognitive enhancement only (i.e., to improve concentration, alertness, and/or studying), recreational only (i.e., to experiment, get high, alter other drug effects, and/or “because I’m hooked”), and combined.
The analysis included 86,918 adolescents and young adults between the ages 14 and 25. (Twelve- and 13-year-old adolescents were excluded because of low rates of prescription misuse.) Overall, 5.6% of the participants engaged in past-year prescription stimulant misuse, which was more common among young adults (7.4%) than adolescents (2.3%).
In adolescents and young adults, significant differences were found with regard to motives driving stimulant misuse. While 71.2% of young adults 24 to 25 years of age reported using stimulants for cognitive enhancement, only 40.4% of adolescents 14 years of age reported using stimulants for this reason. Adolescents in this younger age group more commonly reported recreational use only (14 years = 25.8%; 24 and 25 years = 9.8%; P < .0001) or combined motives (14 years = 32.3%; 24 and 25 years = 18.0%; P = .008).
Educational status did not have an impact on motives reported in adolescents; however, motives differed significantly according to educational status in young adults. College students and graduates more commonly reported cognitive enhancement only as the motivation for misuse (college = 78.2%; graduates = 74.7%; non-college = 63.5%).
While any type of prescription stimulant misuse was associated with higher odds of substance use disorder and mental health issues during the past year, including suicidal ideation, odds were the highest for those who reported recreational or combined motives. Compared to those who reported no stimulant misuse, the odds ratio (OR) for past-year substance use disorder was 6.29 in those using stimulants for cognitive enhancement, but much higher — with ORs of 14.77 and 16.08 — in those reporting recreational or combined motives, respectively. Compared to those who reported no stimulant misuse, the odds of past-year suicidal ideation was 54% in the cognitive enhancement group, versus 202%, and 252% higher in those in the recreational or combined motive groups, respectively.
Clinical Implications
According to the findings of this study, adolescents were more likely to report prescription stimulant use for recreational reasons, whereas young adults, particularly college students and graduates, were more likely to report cognitive enhancement as the primary reason for prescription stimulant misuse. In both adolescents and young adults, the misuse of prescription stimulants for any reason was linked to increased risk for substance use disorder and other psychopathology, including suicidal ideation. This link was the strongest in adolescents reporting prescription stimulant misuse for recreation reasons.
Given the prevalence of prescription stimulant misuse among adolescents and young adults, the authors highlight the importance of prevention, screening, and intervention programs in this population. In addition, they recommend that screening for prescription stimulant misuse should include a further exploration of motivation. Specifically, asking about stimulant misuse to get high may be employed as a screening tool, as recreational use identifies those with a greater risk for substance use disorder and other psychopathology. This group more likely needs more intensive and multi-pronged interventions which address overall vulnerability to substance use disorders and other types of psychiatric illness.
References:
Schepis TS, Ford JA, Wilens TE, Teter CJ, McCabe SE. Differences in Prescription Stimulant Misuse Motives Across Adolescents and Young Adults in the United States. J Clin Psychiatry. 2020 Nov 3;81(6):20m13302.
Schepis TS, Wilens TE, McCabe SE. Prescription Drug Misuse: Sources of Controlled Medications in Adolescents. J Am Acad Child Adolesc Psychiatry. 2019 Jul;58(7):670-680.
