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ADHD, conduct disorder common in students who misuse stimulants

College students who misused prescription stimulants were more likely to have attention-deficit/hyperactivity disorder, conduct disorder, substance use disorder and overall dysfunction, according to recent findings.

“Our data suggest that college students who misuse prescription stimulant medications are more likely to exhibit clinically relevant psychiatric dysfunction,” Timothy Wilens, MD, chief of child and adolescent psychiatry at Massachusetts General Hospital for Children, said in a press release. “In addition to higher levels of ADHD, conduct disorder, and alcohol or drug use disorders, the majority of those misusing stimulants met or approached criteria for stimulant-use disorder.”

Timothy Wilens

To determine associations between stimulant misuse, ADHD, substance use disorders and other psychopathology among college students, researchers conducted a cross-sectional analysis of 100 college students who misused stimulants and 198 students without misuse. Study participants completed Structured Clinical Interviews for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition and self-reports. Mean age was 20.7 years.

Stimulant misusers were more likely to report alcohol, drug, alcohol and drug, and any substance use disorder (P < .01 for all).

Analysis of a subset of stimulant misusers indicated 67% had full or subthreshold prescription stimulant use disorder.

Stimulant misusers were more likely to have conduct disorder (10% vs. 3%; P = .02), ADHD (27% vs. 16%; P = .02), and lower Global Assessment of Functioning scores (P < .01), compared with those who did not misuse stimulants.

Immediate-release stimulant misuse was more common than extended-release stimulant misuse, according to researchers.

“Not everyone is driven to misuse prescription stimulants simply to ‘get high’. 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,” Wilens said in the release. “It’s possible that pre-existing cognitive deficits may lead some individuals to develop stimulant misuse as they try to self-medicate. The extent of an actual stimulant-use disorder in those who misused stimulants at all suggests that this problem may be more prevalent and severe than previously thought. And finding in this population that immediate-release stimulants have a much higher likelihood of being misused than do extended-release stimulants emphasizes the usefulness of prescribing extended-release versions or possibly nonstimulant ADHD drugs for college students.” – by Amanda Oldt

Disclosure: Wilens reports receiving grant support from NIH, NIDA and Pfizer; serving as a consultant for Euthymics/Neurovance, NIH, NIDA, Ironshore, Sunovion, Theravance and Tris Pharma; authoring Straight Talk about Psychiatric Medications for Kids (Guilford Press), coediting ADHD in Children and Adults (Cambridge Press), General Hospital Comprehensive Clinical Psychiatry (Sage); co-owning a copyrighted diagnostic questionnaire (Before School Functioning Questionnaire); and holding a licensing agreement with Ironshore (BFSQ Questionnaire). Please see the full study for a list of all authors’ relevant financial disclosures.