Elsevier

Addictive Behaviors

Volume 38, Issue 3, March 2013, Pages 1643-1650
Addictive Behaviors

Dispelling the myth of “smart drugs”: Cannabis and alcohol use problems predict nonmedical use of prescription stimulants for studying

https://doi.org/10.1016/j.addbeh.2012.10.002Get rights and content

Abstract

This study tested the hypothesis that college students' substance use problems would predict increases in skipping classes and declining academic performance, and that nonmedical use of prescription stimulants (NPS) for studying would occur in association with this decline. A cohort of 984 students in the College Life Study at a large public university in the US participated in a longitudinal prospective study. Interviewers assessed NPS; Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) cannabis and alcohol use disorders; and frequency of skipping class. Semester grade point average (GPA) was obtained from the university. Control variables were race, sex, family income, high school GPA, and self-reported attention deficit hyperactivity disorder diagnosis. Longitudinal growth curve modeling of four annual data waves estimated the associations among the rates of change of cannabis use disorder, percentage of classes skipped, and semester GPA. The associations between these trajectories and NPS for studying were then evaluated. A second structural model substituted alcohol use disorder for cannabis use disorder. More than one-third (38%) reported NPS for studying at least once by Year 4. Increases in skipping class were associated with both alcohol and cannabis use disorder, which were associated with declining GPA. The hypothesized relationships between these trajectories and NPS for studying were confirmed. These longitudinal findings suggest that escalation of substance use problems during college is related to increases in skipping class and to declining academic performance. NPS for studying is associated with academic difficulties. Although additional research is needed to investigate causal pathways, these results suggest that nonmedical users of prescription stimulants could benefit from a comprehensive drug and alcohol assessment to possibly mitigate future academic declines.

Highlights

► Nonmedical prescription stimulant use (NPS) for studying among 984 college students. ► Four-year trajectories of cannabis/alcohol use problems, skipping class, GPA. ► Increasing cannabis use problems predicted declining GPA via skipping class. ► Indirect path: cannabis trajectory to skipping trajectory to GPA trajectory to NPS. ► Results were similar for separate models on alcohol and cannabis use problems.

Introduction

Nonmedical use of prescription stimulants (NPS), defined as use without one's own legitimate prescription or using the drug in a way that is inconsistent with a doctor's orders, is quite prevalent among college students (Arria, Caldeira, O'Grady, Vincent, Johnson, et al., 2008, Arria and DuPont, 2010, Arria, O'Grady, Caldeira, Vincent and Wish, 2008, Carroll et al., 2006, DeSantis et al., 2008, Garnier-Dykstra et al., 2012, McCabe et al., 2007), and is now the second most common form of illicit drug use after cannabis (Johnston, O'Malley, Bachman, & Schulenberg, 2012). An earlier report by our group observed that more college students initiated NPS between their freshman and sophomore year than any other drug (Arria, Caldeira, O'Grady, Vincent, Fitzelle, et al., 2008). Lifetime prevalence estimates of NPS vary, but are as high as 35% at some US universities (DeSantis et al., 2008, Low and Gendaszek, 2002).

While several cross-sectional research studies have found that nonmedical users of prescription stimulants tend to have lower grade point averages (GPA) than non-users (Clegg-Kraynok et al., 2011, McCabe et al., 2005, McCabe et al., 2006), media reports (Carey, 2008, Talbot, 2009, April 27) and some scientific commentaries (Greely et al., 2008, Maher, 2008) have debated the potential benefits of prescription stimulant use for individuals without attention deficit hyperactivity disorder (ADHD) to improve concentration and academic performance. Although these purported benefits have yet to be substantiated scientifically, research with college student samples has shown that the most frequently reported reason for NPS is to purportedly improve concentration so as to enhance academic performance (Clegg-Kraynok et al., 2011, DeSantis et al., 2009, DeSantis et al., 2010, DeSantis et al., 2008, Garnier-Dykstra et al., 2012, Low and Gendaszek, 2002, Rabiner et al., 2009, Teter et al., 2005, Teter et al., 2006, White et al., 2006). Yet the academic motives for NPS contrast with a pattern of other associated behaviors that would appear to impede nonmedical users' of prescription stimulants academic performance, such as spending less time studying, skipping more classes, and spending more time socializing than their counterparts (Arria, O'Grady, Caldeira, Vincent, & Wish, 2008).

Earlier cross-sectional studies have also consistently shown that nonmedical users of prescription stimulants have a history of heavy alcohol use and illicit drug involvement, particularly cannabis use (Arria, Caldeira, O'Grady, Vincent, Johnson, et al., 2008, DeSantis et al., 2009, McCabe et al., 2005, Teter et al., 2003). McCabe et al. (2005) found that students who engaged in NPS were more than ten times more likely to use cannabis during the past year than non-users. Other correlates of NPS include demographic characteristics, with minorities being at lower risk than whites (DuPont et al., 2008, McCabe et al., 2005, McCabe et al., 2006, Teter et al., 2006). Although men are more likely to engage in NPS, there are no significant sex differences in the motivations for use (Low and Gendaszek, 2002, Teter et al., 2005). Fraternity/sorority membership and high levels of parental education are also significantly associated with NPS (McCabe et al., 2005).

The aim of the current study was to extend previous cross-sectional findings by using latent growth curve modeling to explicate the longitudinal relationships between cannabis/alcohol use disorder, skipping class, and academic performance. Furthermore, using this statistical modeling approach, we attempted to investigate the relationship between the various rates of change over time in cannabis/alcohol use disorder, skipping class, and GPA and NPS. We tested the following hypotheses: a) increases in cannabis use disorder predict increases in skipping class, which in turn predict decreases in academic performance as measured by a declining GPA; and b) NPS for study purposes occurs in association with these cannabis-related decreases in academic performance. Given that students who engage in NPS are likely to have alcohol-related problems, we also evaluated parallel models substituting alcohol use disorder for cannabis use disorder.

Section snippets

Study design

This study uses data from the College Life Study, a longitudinal prospective study of college students (Arria, Caldeira, O'Grady, Vincent, Fitzelle, et al., 2008, Vincent et al., 2012). Sample selection took place in two stages. First, a screening survey was administered to 3401 incoming first-time, first-year students ages 17 to 19, during new-student orientation in 2004 at one large, public university in the mid-Atlantic region of the US. The first stage response rate was 89%. Next, a

Sample characteristics

As shown in Table 1, almost equal proportions of males and females engaged in NPS. The majority of the NPS group were white (80.5%), and they were significantly more likely than non-users to have been diagnosed with ADHD by Y4 (12.8% vs. 6.2%) and to have met DSM-IV criteria for alcohol or cannabis use disorder at Y1 (40.4% vs. 18.5% for alcohol; 25.4% vs. 7.1% for cannabis). Family income was significantly higher for the NPS group ($78,600) than non-users ($71,400). There was considerable

Discussion

Despite evidence that substance use tends to increase during adolescence and peak by age 18 (Kandel and Logan, 1984, Kosterman et al., 2000), college students are still at risk for illicit drug use (Sessa, 2005). A majority of college students are exposed to and given the opportunity to try illicit drugs early in their college career (Arria, Caldeira, O'Grady, Vincent, Fitzelle, et al., 2008). Unfortunately, few studies have examined the consequences associated with illicit drug use among

Role of funding source

Funding for this study was provided by the National Institute on Drug Abuse (R01-DA14845 and P50-DA027841). The National Institute on Drug Abuse had no further role in the study design; in the collection, management, analysis, and interpretation of the data; in the writing of the manuscript; or in the decision to submit the paper for publication.

Contributors

A.M. Arria and K.E. O'Grady contributed to the overall scientific direction of the project. A.M. Arria, H.C. Wilcox, and K.M. Caldeira developed the manuscript. K.M. Caldeira, L.M. Garnier-Dykstra, and K.B. Vincent managed the literature searches and summaries of previous work. H.C. Wilcox and K.M. Caldeira performed the statistical analyses. K.B. Vincent managed the day-to-day operational aspects of data collection and supervised staff involved in data collection. All authors assisted with

Conflicts of interest

Amelia M. Arria received a small research grant from Ortho McNeil Janssen Scientific Affairs in 2008. All other authors declare that they have no conflicts of interest.

Acknowledgments

Special thanks are given to Gillian Pinchevsky, Emily Winick, Rebecca Baron, the interviewing team, and the participants.

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