Taylor Lott

Joel Williams
Health 2400 001
April 22, 2014
Attention-Deficit/Hyperactivity Disorder Stimulant Drug Abuse in College Students
College. This term has diverse notions attached to it. Two polar ideas associated
with college are the excitement of fun and the anxiety of stress. Because partying and
high stress levels are ever-present on a college campus, drug use and abuse is an issue
that is observed. Drug abuse is when an individual has a habit of taking addictive or
illegal drugs. One particular type of drug that seems to be readily abused is stimulant
prescriptions and non-prescriptions for attention-deficit/hyperactivity disorder, also
known as ADHD. ADHD is a behavioral disorder that is very common. Indicators of
this disorder are the individuals having trouble focusing, hyperactivity, and acting
without thinking about the action (Robinson, Smith, Segal, & Ramsey, 2014). While
these characteristics may not seem unordinary from normal childhood behavior, ADHD
may be the result if these types of issues occur over a long period of time. Prescriptions
for this attention-deficit/hyperactivity disorder help the individual with the disorder
improve concentration and focus, plan ahead, control certain impulses, and follow
through with tasks (Robinson et al., 2014). What tends to draw college students into
abusing these types of stimulant drugs is the notion that these medications help students
to stay up for extended periods of time to either study or work on assignments that are
due in a limited amount of time (Greydannus). Also, abuse of these particular types of
drugs can be to get a type of euphoric high or lose weight (Greydannus).
The misuse of ADHD stimulants has not always been a concern in society. This
problem is becoming more and more evident in the culture of todays society. While this
problem can be seen in cross sections of numerous different populations and age groups,
the area scientists are most focused on are college students.

Lott 2
Prevalence and Rate Data for Target Population
The target population for this type of unhealthy behavior is college students.
Because college students are thrust into a highly stressful environment and are not
monitored as closely, stimulant drug abuse in college-aged individuals is more evident.
One study done on stimulant use in college students shows both lifetime prevalence and
past-year prevalence rates, these numbers being 8.3% and 5.9% (Teter, McCabe,
LaGrange, Cranford, & Boyd, 2006). While abuse of both prescription and nonprescription stimulant drugs are seen in the college population as a whole, there are
subgroups that are more likely to abuse drugs that are often prescribed for ADHD. White
males who are members of fraternities and have lower grade averages are at a higher risk
of ADHD stimulant drug abuse (Greydannus). Also, prevalence rates for this type of
behavior were higher for northeastern colleges with more competitive standards
(McCabe, Knight, Teter, & Wechsler, 2005). Because the risk of stimulant drug abuse is
higher in college students, the data and studies for this particular behavior in the general
population is not widely available.
Because college students are at more of a risk of abusing and misusing stimulant
pharmaceuticals prescribed for ADHD, scientists have focused research efforts into
learning more about the complications of this particular type of drug use. College
students seem to think because a doctor prescribes medications for ADHD, they have
little negative effects and the benefits far outweigh the costs. Unfortunately, the college
students are incorrect in their thinking.
Health Problems
While many stimulant drugs are not necessarily addictive for ADHD patients,
individuals who do not have the disorder and take these drugs are more likely to become
addicted to the medications (Greydannus). ADHD medications are meant to help patients
with this disorder experience a calming effect to aid them in focusing. However, for
individuals without this disorder who abuse these drugs, the opposite result occurs.
There are many harmful side effects for abusing ADHD stimulant drugs. These side
effects include irregular heartbeat, dangerously high blood pressure, seizures/tremors,

Lott 3
breathing difficulties, and mood disorders (McCarthy, 2010). Even more dangerous side
effects, which are the risk with high levels or repeated use of the drugs, include stroke,
confusion, delusions, paranoia, and hallucinations (McCarthy, 2010). Riskier behavior of
the stimulant-abusing individual can result, which can lead to accidents or even criminal
behavior. One study in 2010 found that for all stimulant-related emergency visits, 50%
were due to nonmedical use of the drugs (Substance Abuse and Mental Health Services
Administration, Center for Behavioral Health Statistics and Quality, 2013).
With these extreme side effects of prescription stimulants coupled with the
increase in numbers of college students who abuse stimulants, scientists and researchers
have set out to try and rid this problem. One particular way scientists are able to create a
way to track the progress being made in this area is from the objectives listed in Healthy
People 2020.
Healthy People 2020 Objective
Healthy People 2020 is a list of objectives and goals for a 10-year time period to
improve the health of the United States population while promoting health and disease
prevention. One objective for Healthy People 2020 relating to ADHD drug abuse is SA19.3, which is to reduce the past-year nonmedical use of stimulants (HealthPeople.gov,
2013). The reason this objective is relevant to attention-deficit-hyperactivity disorder is
because pharmaceuticals used to treat this common behavioral disorder are stimulants
and widely abused by the college-aged population as well as other groups of the general
population. The nonmedical use of stimulants has increased in the past years and
continues to remain an issue in our society. The Healthy People 2020 objective can be
targeted such that stimulant drug abuse can decline and this negative health behavior can
vastly improve the health of our nation.
After researchers establish goals they wish to meet for the upcoming decade in the
area of stimulant abuse, these researchers must develop studies to discover the underlying
or intrapersonal factors for the abuse. If researchers are better able to understand the
reasons why college students abuse stimulants prescribed for attentiondeficit/hyperactivity disorder, then prevention programs and interventions can be
developed to aid in eliminating the problem.

Lott 4

Beliefs, Values, Attitudes, Knowledge

Abuse of stimulant drugs used for attention-deficit/hyperactivity disorder is an
ever-growing issue for our nation, particularly for college students. Although the
environment on a college campus is a potential reason for abuse of stimulant drugs, there
are other intrapersonal factors involved when deciding to participate in this type of
behavior. Adderall, a prescription drug for ADHD, is one of the most abused stimulants
by the college-aged population. This drug is categorized by the federal government as a
schedule II drug, which means it has the highest potential for abuse due to its
addictiveness (Cooper, 2011). The general population has an awareness that it is illegal
to take drugs which are not prescribed to them, however, this knowledge is not enough to
stop college students from abusing these simulant drugs. Many college students have the
belief that stimulant pharmaceuticals will help them to focus more so they are able to
finish an assignment in a short amount of time. One student interviewed for a CNN
article believes the stimulant drug, Adderall, helps him to make high grades and ace
exams. "I'm just in a really good mood right now, he says, leaving a university building.
I just did great on the test (Cooper, 2011). A study conducted to find links between
certain attitudes and reasons why college students misused ADHD stimulants indicates
the belief that academic achievement was the outcome when using stimulants illegally
(Hall, Irwin, Bowman, Frankenberger, & Jewett, 2005). The attitude of college students
towards stimulants is positive (Addiction Treatment In Drug Abuse, 2013). Because of
the positive test results received by many college students who have used ADHD
stimulants, the intrapersonal factors to deter individuals from the drug use are over
looked. Many times students rely on the belief the stimulants will help improve test
scores, when in reality this is not true. A study done on high school and middle school
students showed that there was little to no correlation between academic benefits and use
of prescription stimulants (Hall et al., 2005). Many people lack the knowledge that
stimulants can cause harmful effects on the population who are not diagnosed with
attention-deficit hyperactivity disorder. Because others notice the increased
concentration for students with the disorder, students lacking ADHD think the medication
will cause the same result for them. They also feel as though the medication is safe to

Lott 5
take because a doctor for an ADHD patient prescribed it. The preexistence of a positive
attitude toward ADHD pharmaceuticals allows students to not see how detrimental it is to
ones health when taking these types of drugs. Students look past the potential harmful
and negative effects of these stimulants and believe there is nothing wrong with a little
boost from these pharmaceuticals.
Not only are the intrapersonal factors extremely pertinent to the understanding of
the why abusing ADHD stimulants have increased in the college population, it is also
very important to look at cultural and environmental factors as well. Additional factors
include where someone lives and what social or economic status and tier these
individuals socialize within.
Demographics and Socioeconomic Status
While attention-deficit/hyperactivity disorder medications are abused throughout
the entire population, the trend of stimulant abuse of college students is more cause for
concern. College campuses are very diverse with students from many different races,
ethnicities, languages, backgrounds, and cultures. A study done nationally for the 20102011 school year found that roughly half of the juniors and seniors on college campuses
used Adderall or Ritalin illegally. This study also found about 80 percent of juniors and
seniors who belonged to either a fraternity or sorority used the same stimulant drugs
without prescriptions (Morris, 2013). Another study showed stimulant abusers were
more likely to be male, White, a member of a fraternity or sorority, have a lower GPA,
and have multiple sex partners (Arria, Caldeira, OGrady, Vincent, Johnson, & Wish,
2008). Within this study, data was obtained on 1253 students on a college campus. The
representation of this college campus had roughly half of the participants being female
and a little over 70 percent were White with 73.5 % indicated their mother had attained a
4-year college degree or more as representation of socioeconomic status (Arria et al.,
2008a).
Another area that can be very difficult to reveal findings is the characteristics of a
person. This can be personality traits or an individuals brain chemistry. The psychology
of individuals can help scientists learn more about why certain regions of the population
are more at risk for misusing prescription stimulants.

Lott 6
Psychological or Personality Characteristics
Personality traits are highly indicative of what types of behaviors people tend to
participate in. One personality characteristic that is prevalent in numerous cases is the
idea of risk-taking or sensation seeking. One study found that those who scored higher
on a sensation seeking scale were more likely to abuse ADHD medications (Jardin,
Looby, & Earleywine, 2011). After a link was found between the idea of risk-taking and
abuse of stimulant pharmaceuticals for ADHD, other studies were done to see if a similar
link existed among abuse of psychostimulants and psychiatric disorders. A recent
research study found that one very important psychiatric disorder that may significantly
elevate the risk for psychostimulant misuse is an actual diagnosis of ADHD (Jardin et
al., 2011). Also, those who tend to misuse stimulant medications are more likely to
participate in the use of marijuana, alcohol, and nicotine. Those who were diagnosed as
attention-deficit/hyperactivity disorder at a young age showed a higher risk for abusing
hard drugs at a younger age (Jardin et al., 2011). Psychological distress symptoms were
evident in many of the students who took nonprescription stimulants who did not have
ADHD. However, those students who were diagnosed with ADHD and using their
prescribed stimulants were less likely to experience psychological distress symptoms
(Grasgreen, 2011). Although there are many speculations as to what the different
personality and psychological characteristics are for college students who misuse
stimulant drugs, refined observations and hard evidence have not been rampantly
found. This is due to the nature of college students busy schedules and not being able to
regularly be evaluated by health professionals in the Psychology field (Grasgreen, 2011).
While intrapersonal factors can be very telling for ones character and motives,
the interactions and relationships students have with others can be very influential. The
support of family and friends, whether the influences are positive or negative, can have a
great impact on why the college population has seen such a significant increase in abuse
of stimulants.
Social Support and Interactions
For college students, being away from home is a new experience. No longer do
they have parents constantly watching their every move and they are able to do anything
they want, outside of breaking the law. Unfortunately, due to this newfound freedom,

Lott 7
many college students are exposed to illegal actions; one of these illegal actions is the
abuse of attention-deficit/hyperactivity disorder stimulant pharmaceuticals. This drug
abuse has become an ever-growing problem for college-aged students and scientists are
working to understand the motivations and behaviors for why college-age students are so
easily susceptible to ADHD stimulants. One area that could potentially bring answers
lies in the area of social support. Social support, at its core, is the perception and the
actuality that a person is taken care of physically and emotionally. A study done in 2009
named two main areas where college students receive social support: parents and oncampus peers (Anderson, Bugayev, Gaetz, Guglielmina, Kirkegaard, & sixth author,
2009). Most parents of college students have supported their children throughout their
life, which may be one of the reasons the students are in college. Although parents may
not be with their children at college, social support is still observed via payment of the
education, phone calls, and visits. While many parents may be unaware of their children
participating in the misuse of stimulants, some parents may have some knowledge of the
behavior and either look the other way or enable the abuse (Arria & Dupont, 2010).
Parents could also inadvertently be supporting the misuse of ADHD medications by
pushing their children to make good grades so they can one day have a suitable job. To
try and achieve the academic success that parents want for their children, stimulants can
be used to achieve the desired grades. Researchers suggest parents educate themselves
on this behavior to better equip themselves to deter their children from either beginning
misuse of stimulant drugs or continuing the drug abuse (Arria et al., 2010).
Social support in college students can also come from peers. Organizations and
clubs are where a lot of influence and support for college students can be found. These
are the areas where students begin to fit in and find people that have things in common
with them. Statistics among college students who abuse ADHD pharmaceuticals show
that students that belong to either a fraternity or sorority have a higher risk of stimulant
misuse (Aria et al., 2008a). Because Greek life is a huge part of many students college
experiences, this can be a strong influential factor on whether students decide to partake
in the abuse of stimulant pharmaceuticals. Although some students admit using ADHD
stimulants for increased concentration and focus, staying awake and use as a party drug is
another reason why college students abuse ADHD medications (Arria et al., 2008c).

Lott 8
Social interactions with Greek life, organizations, or clubs can cause students to have a
desire to abuse the drugs. Parties and other social gatherings are opportunities for college
students who use ADHD stimulants to get a high and stay awake for the events. These
types of social interactions are only one aspect of the abuse of stimulants. College and
University administrators/staff are responsible for the campuses and the students. The
administration has a large scope of responsibility and sometimes, drug use or trying to
eliminate drug use gets overlooked or ignored (Arria et al., 2010). If these administrators
were able to designate more attention to the area of ADHD drug abuse, this behavior
could potentially be deterred.
Because the target population for many studies dealing with stimulant misuse is
college students, influential organizations and social institutions must be investigated
thoroughly because of the substantial impact on students. Students spend a large majority
of their time with these organizations/institutions and are easily swayed by the decisions.
If scientists can develop strategies to implement within these institutions and
organizations, they will likely be able to positively impact the number of college students
who abuse prescription stimulants.
Organizations and Social Institutions
Attention deficient/hyperactivity disorder drug abuse is an ever-growing problem
in our nation; however, there is one target population that shows alarming statistics.
Stimulant abuse affects a large proportion of college students. A survey of 390 students
showed that 20.8 percent of students were misusing ADHD medications (Grasgreen,
2011). College institutions, being concerned with other issues pertaining to running a
university, are unable to deter and monitor the stimulant abuse (Arria et al., 2010). While
these institutions report a high percentage of ADHD drug misuse in their student body,
there are student organizations that are more likely to abuse these pharmaceuticals as
opposed to other organizations. An organization is basically a group of people who have
similar interests who share a particular purpose. Greek affiliation is a high predictor of
the misuse of stimulant abuse (Desantis, Anthony, & Cohen, 2013). This should be no
surprise that sororities and fraternities show a higher level of drug misuse because not
only do these groups have similar interests, they also traditionally involve themselves in
the party atmosphere where this type of behavior is apt to be more rampant. Also, those

Lott 9
students who abuse these types of pharmaceuticals are more likely to be white males who
tend to have lower grades (Grasgreen, 2011).
While the actual organizations and institutions can provide stability for students, it
is those relationships formed within these communities that cause the most influence.
Understanding the bond formed within clubs and social groups will be good insight for
researchers to devise plans on how to attack the growing issue.
Relationships Between Organizations and Communities
Because certain organizations, like fraternities or sororities, are more likely to
misuse stimulants, the surrounding communities may also feel the effect of this drug
misuse. One portion of the impacted community would be the family of college-aged
children. One aspect scientists believe college stimulant misuse involves is the parent or
communitys lack of knowledge on the subject (Arria et al., 2010). If the community was
better informed on how salient the issue of drug misuse for college students was, they
may be more likely to help do something about it. Many organizations are included in a
community and can be shaped by the ideologies of a community. Health centers in a
community can serve as a resource for preventing the stimulant misuse by organizations
(Greydanus).
College students rely heavily on their peers and surrounding community to help
them to make decisions for them in the present and the future. However, while
organizations and clubs can be different for numerous students the physical environment
in college is similar for the majority. This physical environment can be the reason the
abuse has been able to continue.
Physical Environment
There are numerous reasons as to why college students misuse stimulants
prescribed for ADHD; one is stress. Stress that students undergo is intense and affects
every part of their life. This stress causes students to feel as if they need to take
something to enhance their concentration and give them the ability to be able to stay up
through the night thus allowing more time to study. When students are under the pressure
to do well and are stressed, they may turn to study aids such as Adderall or some other
popular study drug. One study showed that a little over 70 percent of students used
ADHD stimulants to focus on schoolwork (Arria et al., 2008a). The physical

Lott 10
environment of a college campus also involves partying and staying out late with friends.
College-aged students are away from the supervision of their parents and are curious
about different illegal products that may give them a risk-taking rush or high. Almost
16 percent of drug users from the same study reported using stimulant medications for
recreation (Arria et al., 2008a). Also, because the demand is so high for these study
drugs, these stimulants are becoming more readily available and students are finding
these drugs easy to acquire (Grasgreen, 2011).
Laws and policies are made to help keep the public safe; however, college
students have always viewed themselves as somewhat bulletproof and might be
described as thinking they are above the law or the law does not apply. The idea the law
is not fair and makes no sense also can be a explanation for why college students bypass
the law and continue with the illegal activity.
Public Policy, Law, and Regulations
There are numerous medications that are prescribed to aid ADHD, and these
medications are categorized as C-II medications. This means that these particular
substances have a high potential for abuse with severe psychological or physical
dependence (University of North Carolina, 2012). Federal law mandates that a doctor
must prescribe ADHD medications and no refills are permitted. Prescriptions last up to
90 days and a date to receive another supply of the medication can be observed on the
label (University of North Carolina, 2012). Also, other personal information about the
patient and prescription are provided. Adderall is one stimulant that is commonly
prescribed for attention deficit/hyperactivity disorder. The result of possessing even a
small amount of this medication without a prescription can result in penalties or even jail
time. If caught selling such drugs, one can be charged with a felony and goes against
policies set by universities (Johnson, 2011).
The factors as to why college students abuse ADHD stimulants and how they are
able to gain access to these prescription drugs are extremely telling. If researchers are
able to target how students are getting the medications and what the benefits are of taking
the pharmaceuticals, the issue with attention-deficit/hyperactivity disorder prescriptions
being misused could be improved.

Lott 11
Predisposing, Enabling, and Reinforcing Factors
Drug abuse, particularly in the college-aged population, is a complicated subject
with numerous aspects. Specifically, there are three distinct types of factors that
influence this type of drug behavior: predisposing factors, enabling factors, and
reinforcing factors. Predisposing factors precede the actual behavior, which can be any
extent of knowledge, attitudes, beliefs, or motivation. Although these factors can differ
from individual to individual, there are a few specific predisposing factors or motivations
that seem to overlap. One study that randomly sampled roughly 9,000 college students
found there were about four reasons why college students abused ADHD stimulants. One
of the reasons, which has been seen as a strong determinant of stimulant abuse, was that
the attention deficit/hyperactivity disorder medication helped students to concentrate. A
second reason provided by the sampled undergraduates was that students were able to be
more alert. Two additional reasons that were provided from the study were that the
stimulants would counteract other drugs and students were also able to obtain a high
(Teter, McCabe, Cranford, Boyd, & Guthrie, 2005). Enabling factors, in the most basic
form, are the accessibility to facilitate the actual behavior. Between four and ten percent
of high school aged to college aged students are diagnosed with attention
deficit/hyperactivity disorder (Greydanus). Access to ADHD stimulants can come from
students with prescriptions, such as the four to ten percent stated earlier, who sell their
pills for extra money. Also, one article stated, Many students admit to actually seeing
doctors and purposefully exaggerating symptoms of ADHD to acquire medication
(Jenkins, 2007). Reinforcing factors, which provide a particular type of feedback such as
a reward, were found to be studying or receiving a particular academic grade and
acceptance by a social group at a party or some other social interaction (Teter et al.,
2005). These three types of factors contribute to the understanding of why students take
the risk of abusing ADHD stimulants. The predisposing factors such as wanting to stay
alert and have increased concentration lead students to acquire the ADHD medications,
which are categorized as an enabling factor. The risk is seen as worth it to students
because of the reinforcing factors such as receiving high academic marks from their
university. The consequence of the reinforcing factors allows students to continue with

Lott 12
the cycle; because students receive good grades from taking ADHD medications, such as
Adderall, students want to do it again and still have the access to the prescriptions.

The social ecological model provides a visual as to the different areas and
influences that college students are being affected by. While models are extremely
helpful in being able to actually see the factors in question, theories are able to explain
reasons or show correlations between college students and the misuse of ADHD
medication.
Theory of Reasoned Action and Theory of Planned Behavior
Researchers and scientists to find a specific correlation between a persons
attitude and that persons behavior use the Theory of Reasoned Action and Theory of

Lott 13
Planned Behavior. The model for these cohesive theories is extensive and provides many
constructs that must be studied. The use of ADHD stimulants as study aids is a problem
in the college population and scientists are turning to these particular theories to
understand the conscious and unconscious reasons for why students turn to these
particular drugs. One study done on a sample of college students focused on sensationseeking characteristics and a particular construct of the TRA/TPB: perceived
harmfulness. The researchers who conducted this study wanted to find a correlation
between characteristics dubbed sensation-seeking and whether these particular traits
influenced perception and also because there has not been another study done to reveal a
correlation of this nature (Arria, Caldeira, Vincent, OGrady, & Wish, 2008). The idea
that individuals who seek dangerous activities are less likely to see drug abuse as a
serious issue but a potential thrill-seeking event. Questions using MTF surveys were
used to determine the level of perceived harmfulness (high or low) of abusing
nonprescription stimulants (Arria et al., 2008b). Explanations and definitions were also
provided to help the participants have a clear understanding of what was being asked
(Arria et al., 2008b). To measure perceived harmfulness, participants of the survey were
asked, How much do you think people risk harming themselves (physically or in other
ways) if they take [drug] occasionally (nonmedically)? (Arria et al, 2008b). The results
in the study showed that 67.4% of the participants thought consumption of stimulants
was defined as either moderate or great risk in terms of perceived harmfulness while
only about 26% viewed the consumption of stimulants at a low perceived harmfulness
(Arria et al., 2008b). Another study that in kept with the previous theories focused more
on perceptions but also students motivations (Gallucci, 2011). A web-based survey was
used to determine the motivations and perceptions of stimulant abuse on college students
(Gallucci, 2011). One motivation discussed in this particular study was academic
standing and its relationship with stimulant abuse. Analysis of the association between
academics and abuse of stimulants showed that students who neglected their classes
(16%) and did not devote a certain amount of time to their studies were more likely to
misuse pharmaceuticals such as stimulants (Gallucci, 2011). The suggestion of a catch
up academically for time spent in social pursuits describes the motivation for the results
noticed (Gallucci, 2011). The perception that stimulants would help students perform

Lott 14
better on schoolwork in a short amount of time without harm is expressed. Also, losing
weight was another motivation identified by undergraduate students who misuse
medications such as ADHD stimulants (Gallucci, 2011). It was also found that students
who admit to abusing these medications had the knowledge of this misuse being illegal
but were not so focused on this or the possible consequences of their health in relation to
stimulant use (Gallucci, 2011). Questions in this study addressed 11 items assessing
attitudes, 10 assessing subjective norms, and 6 items related to perceived behavioral
control and a range from -3 to +3 was used as measurement (Gallucci, 2011). Overall,
the theories of Reasoned Action and Planned Behavior help researchers understand the
underlying reasons as to why college students abuse attention-deficit/hyperactive disorder
medications.
Theory of Reasoned Action and Theory of Planned Behavior

Theory of Triadic Influence

The theory of triadic influence is characterized as a meta-theory; this means it is
composed of constructs from numerous other theories. These theories include the theory
of planned behavior, expectancy-value theory, and social cognitive theory (Bavarian,
Flay, Ketcham, Smit, Kodama, Martin, & Saltz, 2014). The framework for this theory is
composed of influences on self-efficacy, behavioral norms, and attitudes toward certain
behaviors (Bavarian et al., 2014). The purpose of this study was to predict the misuse of
ADHD stimulants in college students and test the theory of triadic influence in relation to
this drug misuse (Bavarian et al., 2014). To study this theory, scientists emailed roughly

Lott 15
150 undergraduate classes at a public university in California (Bavarian et al., 2014). A
questionnaire included items related to both influence and causation with respect to the
theory of triadic influence (Bavarian et al., 2014). To study intrapersonal factors,
researchers asked questions associated with sensation-seeking, ADHD, study habits,
academic concerns, and avoidance of self-efficacy (Bavarian et al., 2014). The culture
and environment was questioned by studying if students were associated with religion
and what the drug culture was on campus (Bavarian et al., 2014). Intentions and direct
drug behavior were also questioned in the survey to determine the influences on stimulant
misuse in college students. Measurements of the study were done by way of a 1 to 5
scales, whereas 1 meant the individual strongly disagreed with the statement. The results
of the study revealed that approximately 18% of students reported engaging in IUPS
(illicit use of prescription stimulants) during college, and the distribution for the
frequency of use was positively skewed (Bavarian et al., 2014). These statistics indicate
that there is a correlation between strong influences on the students, both intrapersonal
and interpersonal, and the misuse of prescription stimulants. Not only does this particular
theory focus on the influences on a health behavior, but level of causation is also studied
(Bavarian et al., 2014). This theory also stresses that an independent variable will be
associated not only with measures in its own stream, but also with measures in the two
additional streams (cross stream) (Bavarian et al., 2014). The study found that lower
concern with grades and academics were correlated to higher sensation-seeking attitudes
in the individual (Bavarian et al., 2014). Researchers also discovered that the social
situation stream was greatly associated with individuals who suffered from an ADHDlike symptomology (Bavarian et al., 2014). This study revealed helpful notions on how
to conduct prevention efforts for the misuse of prescription stimulants in the college-aged
population. Target areas for preventing this IUPS in college students are behavioral
norms, attitudes toward the stimulant misuse, and avoidance of self-efficacy (Bavarian et
al., 2014).

Lott 16

Theory of Triadic Influence

Theories are very helpful in determining relationships between different aspects

of students personal lives and the community that is influencing them. All of the
theories, factors, models, relationships, and studies can be combined to aid in the
development of interventions. With these interventions, scientists will be able to better
understand why college students abuse ADHD medications and they will be better
equipped in solving the problem.
Intervention Plan
In recent years, more and more of the population is being diagnosed with
attention-deficit/hyperactivity disorder, which results in being prescribed stimulants to
help treat the condition. Unfortunately, with the increase of ADHD diagnoses comes the
increased cases of misuse and abuse of these prescription stimulants. Most notably, the
college population is suffering from this issue. Students are using these medications as
study drugs without necessarily realizing the harmful effects. The role of scientists and

Lott 17
researchers in this nationwide issue is to devise interventions and strategies to hinder the
abuse of ADHD stimulants. The first step for developing a strategy to help diminish the
growing issue is to define the abuse of the ADHD pharmaceuticals (Greydanus). This
abuse can be characterized by not having a prescription for the particular medication or
using it beyond what the prescription label states. Also, observation of prevalence will
help to determine what type of intervention or on what scale the intervention must be
developing. Nonmedical use of prescription medications represents the second most
common form of illicit drug use in the college population (Greydanus). A study done in
2002 showed similar results, but noted that males are more likely to misuse prescription
stimulants than females (Greydanus).
Although this stimulant abuse problem has evidently increased in the population
more recently, interventions or strategies have been established in the past. The theory of
reasoned action and theory of planned behavior have both been used to pinpoint a
correlation between the attitudes and behavior of a person. These theories also delve into
the perception of prescription stimulants by college-aged students. This is key in trying
to deter college students from turning to ADHD stimulants for a study drug. Because
scientists have determined that many students use ADHD medications illegally to study
for extended amounts of time, researchers are better equipped at tackling the issue of this
particular type of drug abuse. The predisposing, enabling, and reinforcing factors are
also items scientists look at to help develop strategies to eliminate the drug problem
associated with college students. The predisposing factors or motivations that were
shown in college students who abuse prescription stimulants was to help with
concentration, attain a high, be more alert, and counteraction of other drugs (Teter et al.,
2005). The accessibility of drugs is extremely pertinent as well as the reinforcing factors.
Because roughly four to ten percent of high school aged and college aged students are
diagnosed as having attention deficit/hyperactivity disorder, students are more capable of
acquiring the drugs (Greydannus). The reinforcements for this type of behavior would be
the academic grades resulting from students using the ADHD pharmaceuticals (Teter et
al., 2005).
The construction of a strategy as an intervention for ADHD stimulant abuse in
college students can be a very complicated process due to numerous factors amongst

Lott 18
differing individuals. However, it is always good to try a hand at reducing the issue.
Some areas of the social ecological model that I think would be most helpful at targeting
would be the interpersonal and intrapersonal levels. These regions focus on the
knowledge, attitudes, and beliefs of the individual and they also focus on the
relationships these individuals have with friends and family. If college students knew
what actually happens to individuals who use prescription stimulants but are not
diagnosed with ADHD, I think students would be less likely to take the medication. I
think maybe adding a section about the effects of such drugs on the human body to the
education classes about alcohol could help get that information to the students. If the
idea that taking prescription stimulants helps improves grades significantly was no longer
reinforcement, college students would most likely be inclined to cease the use of ADHD
pharmaceuticals. The combination of outside relationships putting less pressure on
individuals about grades and created more of a social stigma geared towards the misuse
of stimulants, I believe a decline could be seen in the research for this growing problem.
Targeting the predisposing, enabling, and reinforcing factors for this type of behavior
could also aid in the elimination of ADHD stimulant misuse and abuse. The combination
of using previous theories such as the theory of reasoned action and theory of planned
behavior, looking at predisposing, enabling, and reinforcing factors, as well as examining
certain levels of the social ecological model would help to decrease the ever-growing
statistics on stimulant misuse in college students.

Lott 19
Works Cited
Addiction Treatment in Drug Abuse (2013, November 29). Deterring college
students from stimulant, study drug abuse. Retrieved from
http://www.addictiontreatmentmagazine.com/addiction/drug-abuse/deterringcollege-students-from-stimulant-study-drug-abuse/
Anderson, R., Bugayev, P., Gaetz, G., Guglielmina, C., Kirkegaard, K., & sixth author.
(2009, December 18). Peer and parental support among college students.
Retrieved from http://wp.stolaf.edu/sociology/peer-and-parental-support-amongcollege-students/
Arria, A. M., Caldeira, K. M., OGrady, K. E., Vincent, K. B., Johnson, E. P., & Wish, E.
D. (2008, February). Nonmedical use of prescription stimulants among college
students: associations with ADHD and polydrug use. Pharmacotherapy, 28(2).
156-169.
Arria, A. M, Caldeira, K. M., Vincent, K. B., OGrady, K. E. & Wish, E. D. (2008,
September). Perceived harmfulness predicts nonmedical use of prescription drugs
amond college students: interactions with sensation-seeking. Prevention Science
9(3). 191-201.
Arria, A. M., OGrady, K. E., Caldera, K. M., Vincent, K. B., & Wish, E. D. (2008,
October 1). Nonmedical use of prescription stimulants and analgesics:
associations with social and academic behaviors among college students. Journal
of Drug Issues, 38(4). 1045-1060.
Arria, A. M. & DuPont, M. D. (2010, October 29). Nonmedical prescription stimulant
use among college students: why we need to do something and what we need to
do. Journal of Addictive Diseases, 29(4). 417-426.
Bavarian, N., Flay, B. R., Ketcham, P. L, Smit, E., Kodama, C., Martin, M., & Saltz, R.
F. (2014, May 1). Using structural equations modeling to understand prescription
stimulant misuse: a test of the theory of triadic influence. Drug and Alcohol
Dependence 138. 193-201.
Cooper, A. (2011, September 1). College students take ADHD drugs for better grades.
Retrieved from http://www.cnn.com/2011/09/01/health/drugs-adderallconcentration/

Lott 20
DeSantis, A. D., Anthony, K. E., & Cohen, E. L. (2013, September 29). Illegal college
ADHD stimulant distributors: characteristics and potential areas of intervention.
Substance Use & Misuse, 48(6). 446-456.
Gallucci, A. R. (2011). A survey examining the nonmedical use and diversion of
prescription stimulant medications among college students using the theory of
planned behavior (Unpublished doctoral dissertation). University of Alabama,
Alabamba.
Grasgreen, A. (2011, August 19). Who misuses prescription drugs. Retrieved from
http://www.insidehighered.com/news/2011/08/19/american_psychological_associ
ation_presentation_shows_how_adhd_influences_prescription_drug_abuse
Greydannus, D. E. Stimulant misuse: strategies to manage a growing problem. Use
and Misuse of Stimulants. Retrieved from
http://www.acha.org/Continuing_Education/docs/ACHA_Use_Misuse_of_Stimul
ants_Article2.pdf
Hall, K. M, Irwin, M. M., Bowman, K. A., Frankenberger, W., & Jewett, D. C. (2005,
January 1). Illicit use of prescribed stimulant medication among college students.
Journal of American College Health, 53(4). 167- 174.
HealthyPeople.gov. (2013, August 28). Substance abuse: policy and prevention.
Retrieved from
http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?
topicId=40
Jardin, B., Looby, A., Earleywine, M. (2011, April/May). Characteristics of college
students with attention-deficit hyperactivity disorder symptoms who misuse their
medication. Retrieved from http://www.google.com/url?
sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0CDAQFjAC&url=http%3A
%2F%2Fwww.researchgate.net%2Fpublication
%2F51057880_Characteristics_of_college_students_with_attentiondeficit_hyperactivity_disorder_symptoms_who_misuse_their_medications
%2Ffile
%2Fe0b495196698e3b097.pdf&ei=msD3UpvEEIiUkQeknYCACA&usg=AFQjC
NF6ghh16uosVdr5kiT7RemVnCDSUQ

Lott 21
Jenkins, K. (2007, April 17). Adderall: college students best friend-or worst enemy?
Retrieved from http://serendip.brynmawr.edu/exchange/node/366
Johnson, Jenna (2011, November 27). College administrators worry that use of
prescription stimulants is increasing. Retrieved from
http://www.washingtonpost.com/local/education/college-administrators-worrythat-use-of-prescription-stimulants-isincreasing/2011/10/18/gIQAKBPw2N_story.html
McCabe, S. E., Knight, J. R., Teter, C. J., & Wechsler, H. (2005, January). Non-medical
use of prescription stimulants among US college students: prevalence and
correlates from a national survey. Journal of Addiction, 100(1), 96-106.
McCarthy, A. A. (2010, November 1). Misuse and abuse of ADHD medication.
Retrieved from
http://www.clinicaladvisor.com/misuse-and-abuse-of-adhdmedication/article/189985/
Morris, C. (2013, February 10). More college students abusing ADHD drugs.
Retrieved from http://www.troyrecord.com/general-news/20130210/more-collegestudents-abusing-adhd-drugs
Robinson, L., Smith, M., M. A, Segal, J., & Ramsey, D. (2014, February). ADD/ADHD
medications. Retrieved from
http://www.helpguide.org/mental/adhd_medications.htm
Substance Abuse and Mental Health Services Administration, Center for Behavioral
Health Statistics and Quality. (2013, January 24). The DAWN report: emergency
department visits involving attention deficit/hyperactivity disorder stimulant
medications. Retrieved from http://www.samhsa.gov/data/2k13/dawn073/sr073add-adhd-medications.htm
Teter, C. J, McCabe, S. E., Cranford, J. A., Boyd, C. J., Guthrie, S. K. (2005,
May/June). Prevalence and motives for illicit use of prescription stimulants in an
undergraduate student sample. Journal of American College Health, 53(6). 253262.

Lott 22
Teter, C. J, McCabe, S. E., LaGrange, K., Cranford, J. A., & Boyd, C. J. (2006,
October). Illicit use of specific prescription stimulants among college students:
prevalence, motives, and routes of administration. Pharmacotherapy: The
Journal of Human Pharmacology and Drug Therapy, 26(10). 1501-1510.
University of North Carolina (2012, June 27). ADD/ADHD C-II medications policy &
procedure: UNC internal medicine clinic. Retrieved from
http://www.google.com/url?
sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0CD8QFjAC&url=http%3A
%2F%2Fwww.med.unc.edu%2Fim%2Fstaff%2Fclinic%2Ffiles%2Fadhd-policyand-procedure-062712&ei=sUIVUTTAorukQeDq4DgBA&usg=AFQjCNF4Gc4wiTg73_VeqlcXT2BrrBwCA&bvm=bv.62286460,d.eW0