The Pressure to Be Perfect: How College Stress is Causing Students to Succumb to Prescription Psychostimulant Abuse
by Leah Alexander
If one walks into a college library at any hour past midnight, it is not uncommon to see a multitude of students still toiling away on their history papers or cramming for their organic chemistry exams. While observing this late-night library spectacle, one may recognize by the Starbucks cups and Red Bull cans that a decent amount of the students in the library are on a stimulant used for centuries: caffeine. What the observer may fail to realize, however, is that some students in the library are getting their energy and focus from a different kind of stimulant: a prescription psychostimulant.
Prescription psychostimulants are currently the most frequently prescribed medications for the treatment of the behavioral condition known as attention-deficit hyperactive disorder (ADHD), which affects approximately 2-8% of college students in the United States (Weyandt and DuPaul, Greenhill et al., Sepulveda et al.). ADHD is believed to be caused by an overabundance of dopamine transporter protein, which results in abnormally rapid reabsorption of dopamine (Krause, et al. 2000) (Fig. 1).
This rapid reabsorption leads to a reduction in dopamine to a level that may be insufficient to stimulate the postsynaptic neuron and therefore, could potentially cause a decrease in activity in certain areas of the brain (Krause et al.). Psychostimulants, such as Ritalin, have been found to increase brain activity in these affected brain areas by binding to the dopamine transporters, which inhibits the reabsorption of dopamine (Vaidya et al., Fig. 2).
Over the past decade, the rate of doctors prescribing stimulants for ADHD has skyrocketed, which is most likely a result of a much broader array of ADHD diagnostic criteria, a longer duration of treatment, or a greater awareness of the ability of the disorder to continue into adulthood (Wilens, et al., Sepulveda et al.). Although prescription psychostimulants successfully help more than 70% of college students with ADHD (Staufer and Greydanus), many students either use psychostimulants without a prescription or do not use their medications as prescribed (Sepulveda et al.).
Several studies have extensively documented the nonmedical use of psychostimulants (Sepulveda, et al. 2011). For example, a random sample of 4580 undergraduate college students at a Midwestern university showed that 5.9% of the students self-reported past-year nonmedical use of prescription psychostimulants, such as Ritalin, Dexedrine, Adderall, Concerta, and methylphenidate (Teter et al.). Another study, which focused on the nonmedical use of a variety of prescription drug types in a small liberal arts college in the Northeast, concluded that the most commonly used type of prescription drugs were psychostimulants, and the most commonly used of those psychostimulants was Adderall (Brandt et al., Fig. 3).
Other studies focused on the presence of metabolites from psychostimulants in campus wastewater samples (Burgard et al., Moore et al.). One study measured the amounts of amphetamine, the metabolite of Adderall, in campus wastewater samples and found that there was an increase in amphetamine levels during periods of high stress, such as midterms and finals week, in comparison to baseline amphetamine levels found during periods of low stress, such as the first week of classes (Burgard et al.). The study also measured the levels of ritalinic acid, the metabolite of Ritalin, in campus wastewater and found that, although it had less of a trend with academically stressful periods, ritalinic acid levels also rose as the semester became more burdensome for students (Burgard et al.).
A similar study, which also measured the metabolites of Adderall and Ritalin in college wastewater samples, found similar results, suggesting that stimulant usage directly correlates with high levels of stress (Moore et al., Fig. 4). However, in addition to high levels of stress, this study suggests another plausible cause for an increase in stimulant usage as the semester progresses: easy accessibility to psychostimulants (Moore,et al.).
Being that the data collected during low periods of stress occurred during the beginning of the semester, it is possible that, later in the semester, students are more aware of where—or whom—they could obtain psychostimulants (Moore et al.). The previously mentioned survey of non-medical prescription drug use amongst students at a small liberal arts college in the Northeast found that 78.6% of the college students surveyed received their psychostimulants from a friend, while only 21.4% had their own prescription (Brandt et al.). In addition, the survey reported that 41.4% of the college students surveyed purchased their psychostimulants from a friend, while 14.3% purchased theirs from an acquaintance (Brandt et al.). Another study found that college students looking to use an ADHD psychostimulant illicitly were likely to attempt to buy the drugs from their classmates who had prescriptions for the drug, with 54% of college students with ADHD psychostimulant prescriptions reporting that they had been asked to sell some of their medication at some point in their college experience (McCabe and Boyd). A study of 334 college students with prescriptions for psychostimulants also found that nearly 29% of the students had sold or given their medications to others (Upadhyaya et al.). Additionally, some students have been found to be faking ADHD in order to receive access to stimulant medication, which has ultimately let to a shortage in ADHD medications, such as Ritalin, as the supply for such medications is not enough to meet the demand (Mitchell, DeNoon). According to the U.S. Food and Drug Administration (FDA), the increase in demand for several types of drugs, including ADHD medications, has led to the number of drug shortages tripling from 61 to 178 in the years 2005 to 2010. The FDA lists that such shortages are largely due to problems at the manufacturing facility (43%), delays in manufacturing or shipping (15%), and shortages of the active ingredient (10%)—all issues that appear to have increased with an increase in demand (U.S. Department of Health & Human Services).
So why are so many students going out of their way—and, in some cases, breaking the law and spending money participating in drug deals—to obtain prescription stimulants? One study that examined the motives for illicit stimulant use amongst college students reported that 65.2% of stimulant-using students used stimulants to help with concentration, 59.8% used stimulants to help with studying, and 47.5% used stimulants to increase alertness (Teter et al.). The study also reported that 31.0% of stimulant-using students used stimulants to get high, and 29.9% used stimulants to experiment (Teter et al.).
Ostensibly, many students misuse psychostimulants for a variety of reasons, such as to achieve euphoria or to help deal with the stresses associated with their learning environment (Lakhan and Kirchgessner). Stimulants are particularly popular at the end of an academic term when students may take these drugs in order to stay awake through the night to study for final exams or complete projects (Lakhan and Kirchgessner). Pressure to succeed academically, poor sleeping habits due to large workloads, and strains due to underlying social and financial demands often cause an increase in stimulant usage amongst students (Kadison, Teter et al.).
But what many college students fail to recognize is that the positive effects they may believe they are receiving from stimulants come with consequences. Common adverse drug reactions associated with stimulant usage include abdominal pain, anorexia, constipation, dizziness, dry mouth, headache, insomnia, jitteriness, irritability, nausea, and palpitations (Greydanus and Strasburger). Large doses of stimulants can lead to psychosis, seizures, and cardiovascular effects, such as hypertension and tachycardia (Lakhan and Kirchgessner). In more severe cases, stimulants—in particular, Adderall—has led to myocardial infarctions and even death (Gandhi et al., Jiao et al.).
The boom in stimulant usage by college students raises a multitude of important questions: Has college life become so stressful that students feel that the only way to cope is through prescription stimulant abuse? Or have students lost their willpower and work ethic and, therefore, turn to stimulants to get by? Are some students more vulnerable to the various pressures associated with college than others and, therefore, are more likely to use stimulants to cope with such pressures? The answers to these questions are not entirely known, but some studies have found links between particular attitudes and beliefs and stimulant usage. For example, a study that focused on psychostimulant usage amongst college students during periods of high and low stress revealed that the most notable predictors of psychostimulant usage are procrastination and poor time management—reported as sources of stress—and the perception that stimulant usage on campus is more commonplace than it actually is (Moore et al.). According to the study, these particular variables accounted for a significant proportion of variance beyond demographic variables, and both factors could hold powerful implications for prevention and intervention programs targeting non-prescription stimulant usage amongst college students (Moore et al.).
Although more studies are necessary to address the underlying mechanisms of association for these variables (Moore et al.), they definitely provide valuable avenues for future research. For example, if further research determines procrastination to be a significant stress linked to stimulant abuse, then it might prove beneficial to examine what specific factors lead procrastinating students to turn to stimulants versus other coping mechanisms and whether or not attempts to improve time management skills have any bearing on a student’s decision to seek out stimulants. Likewise, if misinformed perceptions about stimulant usage on campus prove to be a notable factor in causing stimulant misuse, then it may prove worthwhile to educate college students about the actual rates of non-prescriptive psychostimulant use on campus, as well as the harmful effects associated with misuse of the drug. If students are dismantled of false perceptions, then they may be more likely to make informed and educated decisions regarding their own choice to delve into stimulant usage. Although further research into psychostimulant misuse on college campuses is certainly necessary, awareness of alternative coping methods and education regarding non-prescriptive psychostimulant use can both potentially serve as catalysts in combatting stimulant abuse on college campuses.