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Attention Deficit Hyperactive Disorder Medication Abuse at
Washington State University
By Kyle W. Geiger
Spring 2016
Advisor: Raymond M. Quock, Ph.D., Honors College Distinguished Professor,
Washington State University, Department of Psychology
Précis
Since the early 1990s, amphetamine salts have been used to treat Attention Deficit
Hyperactivity Disorder (ADHD). Rising numbers of diagnoses and prescriptions have been
correlated with increasing rates of abuse in people with and without ADHD prescriptions (Setlik
et al. 2009). The stimulant effects of these medications propose a unique demand on these “study
aids” on college campuses and throughout the United States. A survey of students at Washington
State University (WSU) found that the rate of ADHD medication abuse exceeds that of the
national average and far exceeds the national average within the WSU Greek Community. This
relates to a view of non-medical ADHD medication abuse as “acceptable.” ADHD medication
abuse has also been correlated with lower academic success (Rabiner et al, 2009). Information
from The Academic Opportunity Cost of Substance Abuse Report, compiled in 2013, indicates
that the misuse of stimulants can eventually lead to a delayed graduation and even failure to
graduate. This is expected to be associated with the compounding effects of neurostimulants on
sleep and cognitive performance.
Keywords: ADHD Medication, Adderall, Drug Abuse, University/ College, Stimulants, Academic
Success.
Table of Contents
Introduction and Literature Review
Thesis Statement
Methodology
Data Collection and Security
Results
Discussion
Potential Biases
Acknowledgments
References
List of Figures and Tables
Figure 1 Gender of Survey Respondents
Figure 2 Greek Affiliation of Survey Respondents
Figure 3 Race/ Ethnicity of Survey Respondents
Figure 4 Academic Class Standing of Survey Respondents
Figure 5 Academic Area of Study of Survey Respondents
Figure 6.1 Social Normalization Pie Chart
Figure 6.2 Social Normalization Compared with Usage Table
Figure 7 Motivation for ADHD Medication Use
Figure 8 Mechanism of Administration
Figure 9 Compound Drug Use
Figure 10 GPA and Usage Table
Figure 11 Differences in Use Between Academic Areas of Study
Figure 12 Differences in Use Between Gender Table
Figure 13 Differences in Use Between Greeks and Non - Greeks
Introduction and Literature Review
Attention Deficit Hyperactive Disorder (ADHD) medication affects our natural reward
system through the mesolimbic dopamine pathway. This can lead to problems with misuse and
abuse of these neurostimulant drugs. Adderall® has been used clinically to treat ADHD since the
1990s. By the beginning of the 21st century, Adderall® constituted 25% of the prescriptions for
ADHD. Amphetamine salts and isomers are believed to promote presynaptic dopamine release in
the striatum and inhibit the reuptake ability of the dopamine transporter (Joyce et al, 2007).
Any drug with known dopamine-releasing and reuptake-inhibiting properties has the potential
for recreational abuse. With rising numbers of ADHD diagnoses and more prescription drugs
becoming available to treat ADHD, it is not a surprise that these drugs have become more
commonly abused. Setlik and colleagues (2009) set out to better understand abuse patterns of
ADHD medications in teenagers. Using data from the American Association of Poison Control
Center's National Poison Data System (Bronstein et, al. 2006) regarding cases of ADHD
medication abuse in teenagers ages 13 to 19, it was found that over the eight-year period they
investigated (1998 to 2005), ADHD medication abuse rose a staggering 76% for teenagers. The
study suggests that increased rates of ADHD diagnoses have led to a greater number of ADHD
medication prescriptions being issued, primarily amphetamines like Adderall®. The increased
availability of the drug corresponds with higher levels of abuse, especially in young individuals.
This pattern of abuse also translates to later stages in life, particularly in the academic
setting. Rabiner et al. (2009) concluded that the misuse of prescription ADHD medication is
alive and well on college campuses. Risk factors for non-medical use include the following:
being white; membership in Greek organizations; a lower GPA; engaging in other risky
activities; and, interestingly, attending more competitive colleges. The authors provided a web-
based survey to students at public and private universities. Of the 3,407 respondents, only 115
students (3.4%) had ADHD medication prescriptions, and these were the students who were put
through a more rigorous survey process. The questions asked in the subsequent survey focused
on topics such as diversion (selling) of ADHD medication, characteristics of students who
misuse ADHD medications, and the use of ADHD medications with alcohol and other drugs. Of
the 115 students, 69% were using their prescription drugs as described; however, 31% had
misused their medication by taking larger or more frequent doses than prescribed or had used
someone else's medication. Eight percent of students reported intranasal use in the previous six
months, and 26% reported giving or selling their prescription drugs to peers. Enhancing
academics was found to be the primary motive for misuse. ADHD medications are stimulants
that can increase focus and energy; this creates a specific demand for the drug on college
campuses. Because Adderall® is the most common ADHD medication for college students, it
often takes the spotlight in ADHD medication discussions, especially on social media. Hanson et
al. (2013) used trends on social media to analyze public health. The results from a Twitter
analysis indicate that the use of the term Adderall® peaks during final examinations. The
northeastern and southern regions of the United States had the highest correlation of Adderall®
tweets. Alcohol was the most common drug mentioned along with Adderall®, and the most
common side effect was lack of sleep followed by lack of appetite.
Moore et al. (2014) found that key predictors of lifetime non-prescriptive
psychostimulant use included students' perception of non-prescriptive psychostimulant use as
normative on campus, self-reported procrastination and poor time-management. It is possible
that students rely so heavily on the effects of stimulant medication (increased alertness, focus
and energy) that there is an inherent procrastination effect. Students may elect to procrastinate on
their studies simply because they know they will be able to take a drug that will allow them to
study for longer periods of time. This procrastination effect may be correlated with lower
academic success.
Teter et al. (2006) constructed a self-administered survey in 2006 that found the primary
motive for illicit use of prescription stimulants was to help with concentration (65.2%) followed
by study help (59.8%) and increased alertness (47.5%). It is clear that many students take these
drugs to enhance their academics performance and may view these drugs as cognitive enhancers.
Advokat (2010) reported that studies in non-ADHD adults indicate that stimulants “do not
promote acquisition of new information, might improve retention of previously acquired
information, and facilitate memory consolidation, but may actually impair performance of tasks
that require adaptation, flexibility and planning.” In a literature review done by Advokat and
Scheithauer (2013), it was noted that these drugs do have negative effects on cognition and that
this effect includes the use of these drugs to promote wakefulness in a last-minute study effort
(procrastination). These authors hypothesized that this may explain the lack of academic benefit.
Lakhan and Kirchgessner (2012) report that misuse of ADHD medications has risen in recent
years based on students’ lack of understanding of the drugs and a belief that the drugs function as
performance enhancers. In the same review, they concluded that the impression of these
medications as “smart drugs” may be a false promise as the research suggests that these drugs
function to correct deficits rather than improve performance.
These factors described in this literature review were measured in an online student
survey conducted at Washington State University.
Thesis Statement
There is substantial ADHD medication abuse among Washington State University
students compared to the national average. This increased use is correlated with a social
perception of abuse as “acceptable” and occurs at a higher rate within some WSU living groups.
The misuse of ADHD medications leads to a decrease in performance. This is expected to be
associated with the compounding effects of neurostimulants on sleep and cognitive performance.
Methodology
Washington State University students with internet access who either received the survey
link via email, Facebook or accessed the survey through the WSU Human Subject Pool were
included in the study. The following respondents were exuded from the study: individuals who
reported that they are not currently enrolled at WSU and those who did not fully complete the
survey.
A 19- item web-based survey, administered through Qualtrics (Provo, Utah), was used to
access characteristics of students at WSU (undergraduate, masters and Ph.D. candidates). The
survey was created with the help of the WSU Social and Economic Sciences Research Center.
The study was exempt from Institutional Review Board approval on February 24th, 2016. The
specific variables assessed included the following: demographic information including race;
academic major; class standing; and living-group information (e.g., Greek vs. non-Greek
affiliation); diversion of prescription medication; frequency of abuse; types of abuse; other
associated polydrug use; motivation for abuse; and perception of social norms on campus. The
survey also used a Likert scale to measure agreement and disagreement with questions such as,
“It is socially acceptable to use non-prescription ADHD on our campus.” Answer choices
included ranges such as: very acceptable; somewhat acceptable; neither acceptable nor
unacceptable; somewhat unacceptable; and very unacceptable.
The survey was administered online via two different links. One link was generated
through the WSU Human Subject Pool, which generated 37 responses. The other link was made
public through Facebook and a mass email to the WSU Greek Community. This link generated
139 responses. Results were downloaded from Qualtrics into a Microsoft Excel file. The excel
file was normalized to account for incomplete surveys and respondents who did not meet the
requirements of the study. Tableau software and Microsoft Excel was used to create visual
representations of the data.
Data Collection and Security
Participants were recruited via mass email, Facebook, and the WSU Human Subject Pool.
No individuals were personally asked to take the survey. The link was posted to Facebook
groups with a high concentration of WSU students. The survey weblink directed potential
subjects to an informed consent page providing additional information about the study and
ensuring that all responses were confidential and anonymous. No individually identifiable data
was collected and individual results were password-protected through Qualtrics.
Results
When both survey links were closed on March 18th, 2016 there were (139) attempts on
the public survey and (37) attempts on Subject Pool Survey. Forty attempts were excluded for
either not completing the survey, or not meeting the requirement of being a WSU student, or
both. A total of (n=136) Washington State University students were included on this analysis.
For the purpose of displaying results the following academic majors were combined into
these academic areas:

Business: Finance: Hospitality Business Management; Marketing; Management;
Information Systems; Business Administration; Accounting; Finance; Agricultural
Business; International Business; Sports Management; and Masters of Business
Administration (M.B.A).

Biological Sciences: Basic Medical Sciences; Biochemistry; Biology; Genetics;
Kinesiology; Microbiology; Nursing; Pharmacy; Neuroscience; Zoology; and
Environmental Science.

Social Sciences: Economics; Psychology; Criminal Justice; International Politics;
Philosophy; Political Science; Agriculture Technology Management; Human
Development; and Education.

Computer Science and Engineering: Engineering; Civil Engineering; Mechanical
Engineering; Mathematics; Computer Sciences; Digital Technology and Culture; and
Construction Management.

Communication: Communication; and Journalism and Media Production.

Unspecified: General Education; not specified; and undecided.
Figure 1 Gender of Survey Respondents
Figure 2 Greek Affiliation of Survey Respondents
Figure 3 Races/ Ethnicity of Survey Respondents
Figure 4 Academic Standing of Survey Respondents
Figure 5 Academic Area of Study of Survey Respondents
Figure 6.1 Social Normalization Pie Chart
Figure 6.2 Social Normalization Compared with Usage Table
Motivation for Use
Academic Purposes
Increased Energy/Stay Up Later
Euphoria
88%
32%
6%
Figure 7 Motivations for ADHD Medication Use
Mechanism of Administration
Oral
96%
Intranasal
49%
Figure 8 Mechanism of Administration
Compound Drug Use
Caffeine
68%
Alcohol
54%
Tobacco
43%
Marijuana
35%
Cocaine
7%
Figure 9 Compound Drug Use
GPA
Has Used
3.5 - 4.0
35%
3.0 - 3.5
62%
2.5 - 3.0
56%
2.0 - 2.5
50%
1.5 - 2.0
0%
1.0 - 1.5
100%
n Has Never Used
18
65%
33
38%
15
44%
1
50%
0
100%
1
0%
n
33
20
12
1
2
0
Figure 10 GPA and Usage Table
Academic Area
Biological Sciences
Business
Communication
Computer Sciences and Engineering
Social Sciences
Unspecified
Has Used
27%
61%
44%
63%
35%
92%
Figure 11 Differences in Use Between Academic Areas of Study
n
30
38
16
16
23
13
Gender
Male
Female
Used
69%
28%
Have Never Used
31%
72%
Figure 12 Differences in Use Between Gender Table
Greek Affiliation
Greek
Non-Greek
Used
67%
19%
Have Never Used
33%
81%
Figure 13 Differences in Use Between Greeks and Non - Greeks
Prescription Diversion
Of the 136 respondents, only five (3.8%) reported having a prescription for ADHD medication.
Of these five respondents, three reported selling or giving away the prescription, and all of them
reported being Greek-affiliated. Of the five people with prescriptions, four reported using once
per month, and only one reported daily use.
Procrastination
When asked if they often procrastinate on school work, 107 students strongly or somewhat
agreed. Of those 107, over half (57%) report abusing ADHD medications. Of those who
somewhat or strongly disagree that they procrastinate (21), only 5 (24%) report using ADHD
medication.
Discussion
Because of the immediate stimulant effect and dopamine-releasing and reuptake-inhibiting
properties, these drugs are extremely reinforcing proximally in both chemical effect and
observational level of excitement. In a hypothetical situation, students are able to consume
alcohol on Friday and Saturday night, and avoid the alcohol withdrawal on Sunday and begin
studying by taking a low-dose amphetamine salt. Proximally, this works extremely well. The
student may succeed academically on Monday, but the subsequent stimulant withdrawal on
Tuesday through Thursday may have the student working harder cognitively to accomplish tasks
and re-establish a normal sleep schedule. This cognitive decline associated with a stimulant crash
may be compounded by the effects of neurostimulants and alcohol on sleep. According to the
survey, alcohol was commonly abused in combination with ADHD medication (54%). This was
second only to caffeine (68%). Rohers and Roth (2001) found that alcohol distributes sleep
quality and impairs function (daytime alertness) on the following day. Egan and colleges (2012)
reported that among non-medical prescription stimulant (NMPS) users, 46.4% used NMPS
simultaneously with alcohol within the past year and that simultaneous NMPS and alcohol use
was associated with low grade point averages. Egan and colleagues also concluded that
simultaneous use of NMPS and alcohol was high among NMPS users in their sample of
undergraduate students.
Desantis and colleges (2009) discovered that students frame stimulant use as both
physically harmless and morally acceptable. Of the 136 students surveyed at WSU, 103 (76%) of
students report viewing non-prescription use of AHDH medication as very or somewhat
acceptable. There is an obvious disconnect between student’s view of the drugs and the reality.
According to Washington State’s RCW 69.50.401: Amphetamine, including its salts, isomers,
and salts of isomers, is classified as a schedule II controlled substance, and unlawful possession
is considered a class B felony; this is the same as methamphetamine.
Of the students surveyed at WSU, only 3.8% reported having a prescription for ADHD
medication. It is important to note while less than 4% of students report having a prescription for
the drug, 50% of students report having used the drug. Of the 5 students who reported having a
prescription, only one reported using the drug daily. This may be hinting that those who do have
prescriptions are deciding to divert the drug rather than take it as prescribed. It is possible that
Greek students are abusing the drug at higher rates simply because of access. The average
membership of Greek chapters at WSU is 77 (taken from gogreek.wsu.edu on March 22, 2016).
Students may be more likely to seek and obtain a drug from a friend who they trust.
There is a failure of students to attribute academic decline to the use of AHDH
medication. The procrastination effect studied in this survey may be the first layer in uncovering
the problem in a way that students can understand. Of the students who report taking
nonprescription ADHD medication, 88% take it for academic purposes. What students do not
realize is that taking the ADHD medication may actually be hindering their academic success in
the long term. The Academic Cost of Substance Abuse Report, published in 2013, states the
following: “Substance abuse has an insidious way of interfering with a student’s ability to take
advantage of all that college has to offer. Interventions to reduce rates of substance use should be
part of any college’s plan to improve student retention.” According to Washington State
University’s Strategic plan (accessed March, 22nd, 2016 at strategicplan.wsu.edu) WSU’s 2015
four-year and six-year graduations rates were 32.4% and 63.7%, respectively. This can be
compared to the national average of 59% for a four-year graduation rate in 2013 (National
Center for Education Statistics nces.ed.gov accessed March 22nd, 2016). This continued pattern
of alcohol use, ADHD medication abuse, and sleep disruption could eventually lead to mental
health disorders including anxiety and depression. It is imperative that Washington State
University takes the time to educate students of this phenomenon associated with ADHD
medication abuse.
Potential Biases: This survey administered using Facebook as a recruitment method. We did not
have a way to tell absolutely that respondents who reported being WSU students are in fact
current students without recording further identifiable information. The survey link was also
posted in Facebook groups with a high concentration of Greek students which resulted in a
sample size with a disproportionately large Greek demographic.
Acknowledgments
I would like to thank Dr. Raymond M. Quock, Audra Biermann, Dr. Samantha Gizerian, Dr.
Catherine Elstad, Patricia Maarhuis, and the Washington State University Social and Economic
Sciences Research Center for their support and guidance throughout this project.
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