Alcohol use, impulsivity, and the non-medical use of prescription stimulants among college students
Introduction
The non-medical use of prescription drugs (NMUPD) is defined as the use of a controlled substance without a prescription, or the use of a prescribed medication in a manner that was not intended by the prescribing medical professional (McCabe, Teter and Boyd, 2006, McCabe, West, Morales, Cranford and Boyd, 2007). Illicit psychotherapeutic use is highest among 18–25 year olds, and is the second most abused class of drugs among individuals 12 and older (Substance Abuse and Mental Health Services Administration, 2012). Stimulants are one of the most widely used psychotherapeutics among the college population (McCabe, Knight, Teter, & Wechsler, 2005). Data from the Monitoring the Future Study (MTF) indicated that 12.1% of college students reported using Adderall or Ritalin in the past year (Johnston, O'Malley, Bachman, & Schulenberg, 2012). Stimulants may be of particular importance to examine as they show the highest ratio of illicit use to medical use across the different drug classes, and are the second most commonly abused psychotherapeutic (McCabe, Teter, et al., 2006) following prescription opiates. The non-medical use of prescription stimulants (NMUPS) has also been associated with negative consequences as a result of use, some of which include engaging in illegal activities to obtain drugs, withdrawal symptoms, cardiovascular risk, and interpersonal consequences (McCabe and Teter, 2007, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, 2013, January 24). Data from the Drug Abuse Warning Network (DAWN) report a nearly fourfold increase in emergency department visits related to stimulant medications from 2005 to 2010 among those aged 18 to 25 (Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, 2013). Finally, despite the perception of academic benefits, misuse of prescription stimulants among college students is associated with missing class as well as earning lower grades (Arria et al., 2008).
Emerging research may suggest a potential relationship between NMUPS and alcohol use. Rates of binge drinking (defined as four or more standard drinks for a female and five or more for a male consumed in a single sitting) among college students have remained static despite increased public attention and intervention efforts and it remains a significant public health concern (Hingson & White, 2012). Non-medical use of prescription stimulants has been reported to be highest among students who engage in binge drinking, and those who report alcohol use disorders (Arria et al., 2013, McCabe, West, Morales, Cranford and Boyd, 2007, McCabe, West and Wechsler, 2007). In addition, students who engage in NMUPS are more likely to report risky alcohol consumption as well as other illicit drug use (McCabe, Cranford, Morales, & Young, 2006).
Given the mechanisms of action for typical psychostimulants and alcohol, co-ingestion (i.e., consuming psychostimulants and alcohol simultaneously or in close temporal proximity) brings the prospect of a potential negative interaction between these drugs (Julien, Advokat, & Comaty, 2008). Mixing alcohol and engaging in NMUPS can lead to a diminished sense of drunkenness, perhaps leading to excessive intoxication and toxic effects (Simons, Gaher, Wray, & Reed, 2012). The co-ingestion of a psychostimulant with alcohol is not a novel phenomenon. An extensive body of research exists examining the negative consequences of the co-ingestion of alcohol and the psychostimulant caffeine. Compared to those who only consume alcohol, individuals who co-ingest the psychostimulant caffeine and alcohol are twice as likely to experience one or more negative consequences as a result of drinking (Brache and Stockwell, 2011, O'Brien et al., 2008), three times more likely to leave a bar over the legal drinking limit, and four times more likely to intend on driving (Thombs et al., 2010). However, we are unaware of studies comparing those that engage in NMUPS and alcohol co-injection to those that use NMUPS in the absence of alcohol.
The nature of the association between binge drinking and stimulant medication use has largely been unexplored, and variables that impact this association require further elucidation. Impulsivity is one potential variable that may account for some degree of the association. Impulsivity is a broad construct that is commonly operationalized as either a difficulty in inhibiting responses or as a tendency to overvalue immediate relative to delayed rewards (Madden & Bickel, 2010). Measures of impulsivity have been predictive of substance abuse acquisition and maintenance across multiple substances (Anker et al., 2009, Carroll et al., 2010, Perry and Carroll, 2008, Stanford et al., 2009) and with specific risky outcomes among college students including 21st birthday drinking and the presence of alcohol related problems (Day-Cameron et al., 2009, Petry, 2001, Vuchinich and Simpson, 1998). Individuals who report stimulant use also show elevated impulsivity on both personality and behavioral (e.g. delay discounting) measures (Madden and Bickel, 2010, Stanford et al., 2009). However, the relationships between impulsivity, alcohol use, and past year NMUPS have yet to be established. The current study seeks to assess the relationship between weekly alcohol consumption, binge drinking, alcohol related problems, and impulsivity among those who have engaged in NMUPS and NMUPS with alcohol co-ingestion within the past year. Based on previous research, we hypothesize that those who engage in NMUPS and NMUPS with alcohol co-ingestion within the past year will report higher rates of alcohol consumption, more binge drinking episodes, a greater number of alcohol related problems, and higher levels of impulsivity compared to their non-using counterparts. Additionally, we hypothesize that those that engage in NMUPS with alcohol co-ingestion will show significantly higher ratings on these variables when compared to individuals that engaged in NMUPS in the past year with no co-ingestion
Section snippets
Participants
Participants were 1016 undergraduate students recruited from a large southeastern public university who were awarded extra credit in their courses for their participation. The participants were at least 19 years old; the average age of the sample was 20.51 (SD = 2.26) years old. The majority of the participants were female (70.5%) and Caucasian (86.1%). Participants from other racial categories were also represented in the sample (African American = 10%, American Indian/Alaskan Native = 3.4%,
Prevalence
Of the 1016 participants 25.4% (n = 258) reported engaging in NMUPS at least once in the past year, and 10.8% (n = 110) reported having co-ingested a combination of prescription stimulants and alcohol at least once over the past year. Males (M = 1.71, SD = 1.47) and females (M = 1.61, SD = 1.26) did not differ significantly with respect to past year stimulant use [t(1004) = 1.02, p = ns], nor did males (M = 1.27, SD = 0.88) or females (M = 1.20, SD = 0.75) differ with respect to co-ingesting alcohol and stimulants [t
Discussion
The purpose of this study was to replicate and expand our understanding of the prevalence and correlates of NMUPS. A unique aspect of this study was to look at correlates of NMUPS and alcohol co-ingestion. The current study provides additional evidence that the use of NMUPS and its co-ingestion with alcohol are fairly prevalent behaviors among college students. This study has replicated and expanded previously established relationships between alcohol use and NMUPS by indicating that alcohol
Role of funding sources
No grant funding was provided for this study.
Contributors
Silvestri, Diulio, Murphy, Garza and Correia were responsible for the study design and data collection. Messina was responsible for the data analysis and writing of the first and final drafts of the manuscript, and all authors provided feedback on the drafts.
Conflict of interest
All authors declare that they have no conflicts of interest.
Acknowledgments
None.
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