The Study Drug: Strain, Social Learning, and Prescription Stimulant Use
Sandra Patlan University of La Verne
A senior thesis submitted to the faculty of the University of La Verne in the Sociology Department in partial fulfillment of the requirements of the degree of Bachelor of Science in Behavioral Science Spring 2013 Advisor: Dr. Roy Kwon
The Study Drug: Strain, Social Learning, and Prescription Stimulant Use ABSTRACT The use of prescription stimulants such as Adderall and Ritalin is a growing problem across American college campuses today. Although there is a roust literature that explains these usage trends, there is a surprising lack of literature that attempts to ground these empirical findings in theory. This paper uses General Strain Theory and Social Learning Theory to present a model of prescription stimulant use. By doing so, the paper attempts to show how the various stresses in a college student’s life as well as the company they keep are strong determinants of prescription stimulant use. As such, this study conducts a survey at a small private university to gather information on the stress, associations, and stimulant usage patterns of college students. The results of the study show that both academic stress and one’s association with other drug users is significantly associated with one’s own stimulant drug usage. The paper then ends with some suggestions for heads of universities to remedy some of these issues.
The Study Drug: Strain, Social Learning, and Prescription Stimulant Use College is regarded as an essential requirement to succeed in America. Over the years, the university has gradually taken the place of the more traditional model of immediate employment during one’s post-secondary life. However, there are a number of challenges that await each new college cohort. Concurrent with all the benefits that college entails, students can find themselves stressed over their academics and exposed to a number of socio-environmental factors that may produce negative influences on their behavior. To this end, the use of prescription stimulants has been on the rise as many students often resort to the use of Schedule II drugs to help cram for examinations and to optimize their study time. Contributing to the use of prescription stimulants such as Adderall and Ritalin, is the fact that they are typically not seen as being hazardous, especially when compared to the many other drugs that may circulate in college campuses. But this belief is largely misplaced. Schedule II drugs are commonly referred to as “study drugs” that–albeit, can help increase focus and memory retention–are addictive and illegal, if not prescribed by a medical professional. Students who use these medications can become physically and psychologically dependent on these drugs while many students are not aware of the fact that they are committing a crime by using a Schedule II drug without a prescription. It is important to note that not all students who are experiencing high levels of academic stress resort to prescription stimulant use. Rather, problematic is the fact that users of these particular drugs are exposed to others that use these medications. For example, it is well-known that if a student has close friends or a parent who condones the usage of drugs or are themselves users, they are more likely to use drugs themselves. This pattern holds true for illicit users of prescription stimulants across college campuses, particularly because peer influence is a pervasive force in a young adult’s life.
Although there is vast literature on the demographics of prescription stimulant users in U.S. colleges, there seems to be a limited number of works on the theoretical explanations of prescription stimulant use amongst college students (Schroeder and Ford 2012). According to this literature, there is a notable rise in the popularity of prescription stimulants on college campuses (McCabe, Knight, Teter and Wechsler 2005; Quintero, Peterson, and Young 2006). To this end, a majority of respondents in various studies note that the primary reason behind their use of prescription stimulants is academically based. Also, the literature reveals that those respondents who were in Greek fraternities/sororities, as well as those who knew people that used prescription stimulants, were much more likely to use the “study drug” themselves. Furthermore, although many believe students at the top of their class take prescription stimulants in order to stay ahead, it is proven that students who take prescription stimulants do so in order to “catch up” in their classes, because they are not focusing on their academics in the first place. This paper presents the characteristics of prescription stimulant users and looks into the theoretical explanations behind the use of prescription stimulants in the academic setting. Using general strain theory and social learning theory, this paper extrapolates a set of measurements from each theory in order to examine their influence on student prescription stimulant use. The majority of users studied in the literature are white males in fraternities, many of whom are more likely to report the use of other drugs and also have lower grade point averages (GPA). Instead, this study contributes to the literature by studying a sample of all college students at a small private university in Southern California, not just members of Greek organizations. It is very important to study the factors behind the illicit use of prescription stimulants so that the head of universities, of where much of this activity occurs, can alleviate some of the pressures that force students to take these dangerous drugs.
GENERAL STRAIN THEORY AND ACADEMIC STRAIN Strain theories have been developed to help explain certain strains and their connections to delinquent behavior. Robert Agnew points out that there is no direct relationship between general strain and criminal behavior (1992). Rather, the General Strain Theory predicts that stress leads to criminal behavior through its negative effect. In other words, when an individual/group experiences stress, the strain can lead to a variety of negative emotional states such as anger, depression, anxiety, etc. As such, the individual/group in strain resort/s to criminal or delinquent behavior to cope with the accompanied negative emotional states (Agnew 1992). Although there was much criticism of General Strain Theory in the 1970s for its perceived class bias, Agnew states that the stressors do not necessarily have to be related to those of low-class but can be broadened to middle-class individuals as well (1992). The idea of goal blockage was created to partially remedy these criticisms of Strain Theory and was defined as the failure to reach positively valued goals (Agnew 1992). As such Strain Theory was eventually expanded to include two alternative categories or sources of strain: first, the loss of positively valued stimuli and, second, the presentation of negatively valued stimuli (Agnew 1992). Loss of positively valued stimuli can include loss of a romantic relationship, withdrawal of parental love, etc. In contrast, the presentation of negatively valued stimuli can include bullying, harassment, lowered grades, or negative relations with peers (Agnew 1992). According to General Strain Theory, a delinquent or criminal response to strain is to seek immediate relief from the emotional distress that is derived from the strain being experienced (Agnew 1992). It is important to note, as Agnew points out, that not all individuals resort to criminal behavior when in strain (1992); rather, there are a number of conditions that need to be available for individuals to eventually resort to criminal/delinquent behavior such as the nature
of the strain, one’s coping abilities, the resources available to an individual, and the extent to which the individual in strain is exposed to crime (Agnew 1992). By extending strain to encompass a variety of stressors, Agnew allowed for the possibility of academic strain in a collegiate setting to be a possible causal factor of criminal behavior. As such, Strain Theory is useful in analyzing academic strain and prescription stimulant use by allowing researchers to see what potential factors of strain can influence criminal behavior. Strain found in the college culture can come from the three major sources (Agnew 1992): the failure to achieve positively valued goals, the loss or removal of positively valued stimuli, and the presences of noxious stimuli. What this means is that the failure to achieve academic success can generate strain on a student while certain individuals (professors and other students) and situations (rumors, fights, and unexpected grades) can severely damage a student’s collegiate experience (Ford and Schroeder 2009). The loss or removal of positively valued stimuli can further negatively affect a student and place greater strain that can hinder their academic success. The loss of such positively valued stimuli can range from the loss of a romantic relationship, death of a loved one, or the divorce of one’s parents (Ford and Schroeder 2009). Finally, the presence of noxious stimuli in an academic setting can also influence students to resort to substance use/abuse. Such stimuli in a collegiate setting can include harassment by peers, negative relationships with faculty, and poor grades (Ford and Schroeder 2009). The failure to achieve academic success in a collegiate setting fits well within Agnew’s General Strain Theory (Ford and Schroeder 2009) but still does not show a direct relationship between strain and criminal behavior (Agnew 1992). Rather, by having an increased level of academic strain, students can feel a wide range of negative emotions; those emotions will then lead to a higher probability of committing a crime or delinquency (Agnew 1992; Ford and
Schroeder 2009). Yet, amongst college students, crime or violence are rarely used due to being ineffective mechanisms by which to obtain a positively valued stimuli (Ford and Schroeder 2009). Drugs and alcohol, however, have been a popular response to stress in an academic setting (Ford and Schroeder 2009). In particular, various studies have concluded that prescription stimulants are the drug of choice amongst college students experiencing academic strain, which mainly stems from the perceived positive effects from taking prescription stimulants.
Academic Strain Academic stress can stem from a variety of factors; drug use and accessibility in college culture can be seen as a presence of a noxious stimulus (Agnew 1992; Ford and Schroeder 2009). Meanwhile, the loss of positively valued stimuli, such as low grades, can come from a hectic college student schedule. Testimonials from surveyed college students reveal overly ambitious and extended lifestyles such as class time, studying time, extra-curricular involvement, physical activity, and active social lives (Varga 2012). Some other factors of strain that will be studied in this thesis include employment, academic major and extra-curricular involvement. According to Lang (2012), students who work while attending college have few differences than students who do not work but as the number of hours they work increases, the number of hours spent socializing decreases. The number of college students who also have a job while in school has been increasing since the 1960s (Stern and Nakata 1991), the effect of which is fewer time spent towards studying and socializing. Stern and Nakata (1991) contribute the rising number of students holding jobs to rising tuition costs, decreased availability of financial aid, and a growing desire for financial independence. However, Lang (2012) notes that there are many conflicting studies surrounding the relationship between the hours spent working and a
student’s academic performance. For example, in Hawkins et al. (2005), the number of hours spent working had a negative effect on the GPA of students. Hawkins et al. (2005) did not find a discernible difference in between number of hours worked and the GPA of white and minority students; however, these scholars did find that minority students were more likely to report financial responsibilities towards their parents and families than their white student counterparts. Certain academic majors can determine if a student has a hectic academic schedule, regardless of extra-curricular involvement. A study by May and Casazza (2012) divided the various majors of colleges into two categories: “hard” and “soft” majors. Their argument is that different majors require a varying amount of units to complete, as such the higher amount of “hard science” classes required of majors may account for a higher level of academic stress. May and Casazza (2012) found that students in undergraduate pharmacy and engineering majors had more perceived stress than students in undergraduate history, art, English, psychology, and business. The stress level differences found between “hard” and “soft” majors persisted despite controlling for other known predictors of stress. The presumption in May and Casazza’s study (2012) is that the higher number of math intensive classes in a major led to the higher stress levels being reported by those in the “hard” sciences. Extra-curricular involvement in school can help students find their “niche” on campus and provide a vast network system; things such as MUN, GSA, Greek societies, and athletics fall under extra-curriculars but also bring upon time-consuming dedication that can detract from studying time for college students. For example, due to the nature of rush week, initiation, and various events in a school year, students belonging to a Greek society report higher levels of stress and anxiety (Dussault and Weyandt 2013). Socialization that is often encouraged when belonging to a Greek society can also take time away from studying and preparing for classes
and exams. It can be concluded that this is the case for any other extra-curricular, although, to different levels for each. With increasingly busy schedules for typical college students, drugs may be the coping mechanism sought after; many students seek prescription stimulants for academic, recreational, and self-medication purposes (Varga 2012). Prescription stimulants are labeled as a Schedule II drug by the DEA but students perceive these drugs to not be “so” illegal and can easily avoid repercussion if caught by stating it is not theirs (Varga 2012).
SOCIAL LEARNING THEORY AND SOCIAL EXPOSURE Social learning theory is built upon the assumption that primary groups have a large influence on the criminal actions of individuals (Akers 1985; Peralta and Steele 2010). According to Akers (1985), there are four components to the theory: differential associations, differential reinforcements, definitions, and imitation. Differential associations focus on the exposure to normative definitions and interactions with primary relationships such as close friends, significant others, and/or parents (Akers 1985; Ford 2008). The associations that have the greatest impact on the deviant behavior learning process are ones that occur early in life, more often, over longer periods of time, and the salience to the individual experiencing the associations (Akers 1985). Differential reinforcements are based on assumed and actual consequences of behavior (Akers 1985). When the rewards for deviant behavior outweigh the consequences, individuals learn to make that connection and have a higher likelihood of committing deviant behavior (Akers 1985). Behavior can be positively or negatively reinforced; positive reinforcement includes rewarding outcomes or encouragement from others while negative reinforcement occurs when individuals seek to escape or avoid a distressful event
(Akers 1985; Ford 2008) Definitions are the meanings and attitudes attached to behaviors (Akers 1985). When individuals internalize positive definitions of criminal behavior, they are more likely to commit such behavior. This works as well for negative definitions about criminal behavior such as an individual with more negative definitions of a deviant behavior being less likely to commit such behavior (Ford 2008). Finally, imitation is modeling after another person’s behavior; during social interactions, individuals study the behavior of other individuals with whom they are interacting with. If such behavior is punished, imitation of that specific behavior will likely not happen (Akers 1985; Ford 2008). Yet, if the peer’s behavior is rewarded, that behavior will likely be imitated. Thus, deviant behavior is, according to social learning theory, learned from associations that one has with his or her intimate groups (Akers 1985; Ford 2008). This theory can be applied to current trends in deviant behavior such as the persisting prevalence of drug and alcohol abuse across college campuses. More importantly, Akers’ theory can be used to find how it relates to college students and prescription stimulant use. Because peer drug use and attitudes towards drugs can greatly affect the likelihood of using drugs, college students are bombarded with a variety of conflicting views and can get influenced. Commonly associated with college life are late-night partying, all-night studying, and rigorous schedules (Varga 2012). Partying in college provides new experiences, positive or negative, for students; not only do they get to spend time with fellow students and friends, but drug and alcohol use is almost always present and available. According to Quintero et al. (2006), college is a time for drug experimentation and discovering one’s self. Several interviewees in the article specified college as a time for drug use but did expect this behavior to diminish in their post-graduation life (Quintero et al. 2006). A study by Jaffe and Archer (1987) found that a student’s drug use/abuse can be predicted by using the following instruments: the Psychopathic
Deviancy scale, the McAndrew Alcoholism scale, the Sensation Seeking scale, the Milon Alcohol Abuse scale, and the Milon Drug Abuse scale; the Sensation Seeking scale was the most powerful predictor of college student drug use/abuse with higher scores on the SSS correlating to higher likelihood of drug use/abuse (Jaffe and Archer 1987). Experimentation with drugs amongst young adults in a college or university setting has historically been present and, to an extent, glamorized by the media through such movies as “Animal House” and “National Lampoon’s: Van Wilder.” College students are at risk for illicit drug use and a majority is exposed to, and has access to, illicit drugs early in college (Arria, Wilcox, Caldeira, Vincent, Garnier-Dykstra, and O’Grady 2013). Students in Greek fraternities and sororities are also found to be more likely to report heavier alcohol use and drug use than non-Greek society students (Scott-Sheldon, Carey, Carey 2008). In the same study, Scott-Sheldon et al. (2008) found that Greek members reported more lifetime and past 30 day use of cannabis and other drug use. This can be derived from the rituals or socially accepted behaviors that are integrated in Greek life (Scott-Sheldon et al. 2008). Certain drugs are also classified into “hard drugs” and soft drugs, according to interviewees in Quintero et al.’s study (2006). “Soft” drugs allow for pleasure and performance if used wisely while “hard” drugs were associated with greater physical and legal risk such as “loss of control, role failure, and addiction” (Quintero et al. 2006). Perceiving prescription drugs as “soft” drugs has allowed for its misuse to increase dramatically across college campuses (Quintero et al. 2006). Students consider such drugs to be safer than other illicit drugs because prescription drugs are tested, manufactured in clean facilities, and are measured to know what to expect with a certain dosage (Quintero et al. 2006).
PRESCRIPTION STIMULANTS Prescription drug abuse is a concern for the medical field; doctors have had to regulate prescription medication due to people using them non-medically, or without a prescription. The most commonly abused prescription drugs, according to the U.S. Department of Health and Human Services, includes opioids, central nervous system depressants, and stimulants (2001). Opioids are prescribed as strong painkillers and they include morphine, codeine, oxycodone (OxyContin), hydrocodone (Vicodin), propoxyphene (Darvon), and hydromorphone (Dilaudid). They affect the body by attaching themselves to opioid receptors and block the transmission of pain messages to the brain (National Institute on Drug Abuse 2001). Central Nervous System depressants slow brain function by affecting gamma-amino butyric acid (GABA), a neurotransmitter that decreases brain activity (NIDA 2001). The two common types of CNS depressants are barbiturates (Mebaral and Nembutal) and benzodiazepines (Xanax and Valium) and are used to treat anxiety and sleep disorders (NIDA 2001). The opposite of CNS depressants are stimulants; stimulants enhance brain activity which increases alertness, attention, and energy. Historically, these drugs were used to treat asthma, obesity, and neurological disorders. Currently, they are most commonly used for patients with attention deficit hyperactivity disorder (NIDA 2001). Their short-term effects include elevated blood pressure, increased heart rate and respiration, suppressed appetite, and sleep deprivation. Although they can help people with ADHD focus and be more productive, stimulants have a high potential for addiction. Abusing these drugs can lead to cardiovascular failure, seizures, or feelings of hostility and/or paranoia (NIDA 2001). The Adderall Medication Guide reports that with the use of prescription stimulants, there have been problems either heart-related (stroke or
heart attack) or psychiatric problems (new or worse behavior, bipolar illness, aggressiveness) (2011). Stimulants can be legally acquired through a doctor’s prescription after meeting the criteria for ADHD. According to the Centers for Disease Control and Prevention, there are two categories by which children with ADHD are defined: Inattention or Hyperactivity and Impulsivity. The patient must have six or more of the following symptoms of either category that have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level (2010). The symptom checklist, according to the DSM-IV includes: troubles starting tasks, procrastination on assignments and other tasks, frequent loss or misplacing of items, poor time management skills, forgetfulness, trouble comprehending readings, saying or acting without thinking, feeling as if they are on the go, avoiding required sustained mental effort, difficulty waiting in turn, and interrupts or intrudes on others (American Psychiatric Association 2000). Although there is recognition that ADHD persists into adulthood, there is no consensus on the criteria for giving an ADHD diagnostic to an adult patient (McGough and Barkley 2004). Thus, many adults can become misdiagnosed with ADHD and take stimulants they do not need and people with an ADHD diagnosis can sell their medicine. Labeled by the U.S. Drug Enforcement Administration as Schedule II, alongside cocaine and PCP, prescription stimulants are highly addictive. Treatment options do exist for those who find themselves addicted to the various stimulants; after a detoxification process, behavioral therapies can aid in stimulant addiction that include contingency management and cognitivebehavioral intervention (NIDA 2001). Recovery support groups usually accompany behavioral therapies and both, used in stimulant addiction, have been proven effective for treating cocaine and methamphetamine addiction as well (NIDA 2001).
STRAIN, SOCIAL LEARNING, AND PRESCRIPTION STIMULANT USE Academic strain in college students can lead to a variety of negative emotional states such as anxiety, depression, irritability, etc. (Agnew 1992; Ford and Schroeder 2009), while increased psychological distress may lead to a greater risk of using prescription stimulants amongst the college-aged population (Weyandt, et al. 2009). In the literature, the strain theory has proven to be a strong predictor of marijuana use, the use of prescriptions, and other illicit drugs (Schroeder and Ford 2012). Although strain theory has been used to predict prescription drug and marijuana usage, whereby strain increases one’s probability of using drugs by approximately 17%, it does not predict other illicit drug use (Schroeder and Ford 2012). In a study by Arria et al. (2012), thse scholars show that there is a natural chain of events that links substance abuse, primarily marijuana and alcohol, with a range of academic problems as a result of students missing class. There was also a strong correlation with students experiencing this chain of events often resorting to prescription stimulants to catch up with the material they have missed in class due to their marijuana and alcohol abuse (Arria et al. 2012). This indirect relationship is similar to Ford and Schroeder’s (2009) adaption of Agnew’s (1992) General Strain Theory. In other words, the link of events explained by Arria et al. (2012) includes substance abuse (presence of a noxious stimulus), lowered GPA (loss of a positively valued stimuli), and prescription stimulant use (delinquent act used to correct and attain positively valued stimuli again). It is also found in the Arria et al. (2012) study, that students who reported taking prescription stimulants did so to stay afloat academically instead of gaining an extra advantage. This motive is possibly due to their substance abuse of other drugs irrespective of the prescription stimulants itself.
Prescription stimulants are misused widely on college campuses (Quintero et al. 2006). According to the United States Drug Enforcement Administration (2002), methylphenidate production increased nearly 900% from 1990 to 2000. In DeSantis, Webb, and Noar’s study (2008), approximately 63% of illegal users first used non-prescribed stimulants in college, which is not surprising given that ADHD stimulants are consumed recreationally at many universities, but are taken primarily in times of high academic stress (DeSantis et al. 2008). High academic stress in college students can range from projects to multiple finals in a day that can drive students to seek alternatives to add studying time. The General Strain Theory can help explain why stimulants are being used non-medically on college campuses at increasing rates; foremost, students who illicitly used prescription stimulants did so to enhance their academic performance by being able to stay up longer (72%), enhance concentration (66%), and being able to memorize/retain information better (36%) (DeSantis et al. 2008). Students react to high academic stress levels by taking prescription stimulants for the reasons listed above to increase studying time. Various studies have been done across universities in relation to illicit drug use and college students. Specifically, prescription stimulant use (such as Adderall or Ritalin) was higher amongst college students who were white, male, fraternity and sorority members, had lower grade point averages, and attended more selective schools in the North-Eastern region of the United States (McCabe et al. 2005). Nonmedical prescription stimulant users were also more likely to report use of alcohol, cigarettes, and illegal substances (DeSantis et al. 2008). The protective factors, as stated by Shillington et al. (2006), included being a commuter, having a high GPA, non-Greek member, and being in a committed relationship, all of which were less likely to report Ritalin/Adderall use during the past 30 days and past year. Interesting to note is that the study conducted by Shillington et al. (2006) was not concurrent with other research (see
McCabe et al. 2005; DeSantis et al. 2008) in that there was no significant differences between prescription stimulant use between females and males and between whites and non-whites. The social learning theory can help explain the increasing rates of prescription stimulant misuse on college campuses by including exogenous and endogenous conditions (Peralta and Steele 2010). Emphasizing social norms and socialization, social learning theory has proven to be successful in explaining nonmedical prescription stimulant use (Ford 2008; Peralta and Steele 2010; Schroeder and Ford 2012). Of the four components of the social learning theory, imitation, or a friend’s reaction to drug use, helps explain more nonmedical prescription drug use than a friend’s attitude towards such drug use (Peralta and Steele 2010). Schroeder and Ford (2012) found that applying the social learning theory to prescription stimulant use amongst college students, that it had the strongest impact on drug use from marijuana, prescription medication, and other illicit drugs. Peer substance use and respondent’s attitude toward substance abuse were correlated with all types of substance abuse (Schroeder and Ford 2012). Unlike Peralta and Steele’s findings (2010), peer substance abuse and respondent’s own attitude were the weakest associations (Schroder and Ford 2012). The social learning theory was the most significantly associated theory that impacted the odds of drug use with each unit increase in positive associations and influences reducing odds of prescription drug misuse by 40.6% (Schroeder and Ford 2012). In addition, a study by Higgins, Mahoney, and Ricketts (2009), concluded through their results that differential association had a link between all types of nonmedical prescription drug use that they were not able to show with nonsocial reinforcement and self-control. College students also have relatively easy access to stimulants, such as Adderall, because of the laxity in diagnosing ADHD (Stolz 2012). Stolz claims that universities are complicit in
their illicit stimulant drug use because their health clinics are lenient when they are prescribing Adderall after an ADHD diagnosis (2012). This and an increase in misdiagnosis has increased prescription stimulant production; the US Drug Enforcement Administration reports that production of amphetamines (Adderall) has increased by 5,767% from 1993-2001 (2002). Another method of attaining stimulant prescription drugs on college campuses is through other students who sell them. Money and helping fellow classmates out are the prime motivators for people who sell their prescription stimulants despite the repercussions for being caught usually include academic probation or expulsion (Stolz 2012). Members of fraternities and sororities can access prescription stimulants through their friends in the fraternity/sorority or other networks; for students not in the Greek system, the library seems to be the central hub for prescription stimulant distribution (DeSantis et al. 2008). For men, accessibility was a determining factor in illicit prescription stimulant use while for females, being offered the stimulant medication was the determining factor (Hall et al. 2005). More specifically, certain prescription stimulants are used more than other types; amphetamine-dextroamphetamine is being used widely more than methylphenidate stimulants (Teter et al. 2006). The larger availability of Adderall prescriptions could explain as to why amphetamine-dextroamphetamines are more common than methylphenidate stimulants. Also, Adderall works for an approximate 10-12 hours compared to immediate-release methylphenidates that, at the most, last 6 hours. Adderall, an amphetamine-dextroamphetamine, also works like methylphenidates by blocking the dopamine transporter but it causes the presynaptic release of dopamine, leading to higher levels of dopamine when compared to methylphenidates (Teter et al. 2006). Of the methylphenidate prescription stimulants, Ritalin was used more than other brands according to 54% of respondents in a specific study (DuPont,
Coleman, Bucher, and Wilford 2008). Another insight into the reasons why abuse-resistant methylphenidate use (Concerta) over other methylphenidates or amphetaminedextroamphetamine use is less amongst college student are due to abuse-resistant methylphenidates being: less preferred for nonmedical use, less likely to be used via routes of administration other than oral, and users of Concerta, etc. are less likely to be users of other drugs (DuPont, et al. 2008). Prescription stimulants also do not carry the same stigma as other drugs, steroids for example. When surveyed, students perceived prescription stimulants to be less harmful to the user and others than performance enhancing steroids (Dodge, Williams, Marzell, and Turrisi 2012). There is a perceived harmlessness, less stigma, and lower risk of arrest or consequences when using prescription stimulants (Schroeder and Ford 2012). Students may view that some drugs, such as Ecstasy or cocaine, are much more harmful physiologically than prescription stimulants (Quintero et al. 2006). In a study by Ricketts and Higgins (2007), students were divided into non-criminology majors and criminology majors; Ricketts and Higgins (2007) found that despite criminology majors knowing more on the legal status and consequences of prescription stimulants, there was no significant difference between them and non-criminology majors’ illicit use. Prolonged use of stimulants can be detrimental and students may not be aware of the effects of taking prescription stimulants non-medically. Even with students who are diagnosed with ADHD, studies have to figure out how many of those students are over-using their doctor’s prescription order (Prudhomme, Becker-Blease, and Grace-Bishop 2006). Students, as stated earlier, may also find other ways to get the prescription stimulants such as faking ADHD symptoms for planned misuse or for resale (Prudhomme et al. 2006). As Varga (2012) states,
prescription stimulant use without the supervision of a physician can lead to a path of addiction and to harder drugs such as cocaine and heroin. Short-term effects increase with continual use and long-term effects can result in hallucinations, psychosis, cardiac arrest, comatose, or death (Varga 2012).
SYNTHESIS OF LITERATURE AND HYPOTHESES Although the social learning theory was found to be more powerful than general strain when predicting drug use, they both are relatively weak in predicting any other drug use other than marijuana (Schroeder and Ford 2012). The issues related to prescription stimulant use on students are not only of a concern to them but their peers, faculty, and the school as well. Given the various studies presented in this literature review, certain groups, such as Greek society members, males, previous drug users, and low grade earners, are more prone to using illicit prescription stimulant medication. This holds true through racial groups where Caucasian and Latino students are the racial/ethnic groups more likely to use illicit prescription stimulants with African American students being the least likely to use them (Teter et al. 2006). In the prescription stimulant family, students were more likely to use Adderall than other brands and/or types of stimulants. Students in more competitive schools may be taking prescription stimulants to get ahead of their classmates (McCabe et al. 2005). Academic dishonor is not taken lightly in postsecondary institutions and using prescription stimulants puts classmates who are not using prescription stimulants at an academic disadvantage. Although performance enhancing steroids are viewed as more stigmatized and unfair since there are competitors, students need to realize that fighting for a spot in college or grad school or getting the highest grade in a class also
+ Prescription Stimulant Use
Figure 1. Theoretical Causes of Prescription Stimulant Use
involves competitors. Aside from the ethical issues of academic disadvantage, prescription stimulants are a Schedule II drug that, if misused, can be addicting. Questions surround the future of students who depend on prescription stimulants for academic achievement such as if they will be able to function in the working world without resorting to drug use and if this will be a growing concern for the future of academia. The best ways to help regulate the illicit use of prescription stimulants would be to make it more difficult to obtain a prescription for them and drug testing at educational facilities, according to Stolz (2012). By prohibiting university health centers from giving out prescriptions for stimulants and make students seek a psychiatrist off-campus, many seeking the drugs that do not have the medical requirements will be discouraged. The Supreme Court has ruled random drug testing of students to be constitutional only if: 1) the school has demonstrated a need for the testing and 2) the testing was narrowly defined and administered reasonably (Stolz 2012). By focusing on groups strongly associated with nonmedical prescription stimulant use and avoiding health centers from giving prescriptions to people who do not need it, universities can hopefully see a decline in nonmedical prescriptions stimulant use.
Prescription stimulant use is increasing in the United States, particularly across college campuses. A high number of respondents claim their reasons for using prescription stimulants are to enhance focus, stay up longer, and have better memory retention; also, a majority of students who have used prescription stimulants also got the drug from someone they knew, usually for free or a cheap price. Prescription stimulants are commonly referred to as “study drugs” and the perceived harmlessness of prescription stimulants is commonly held across college campuses. Users of prescription stimulants also report use of other drugs such as marijuana and other illicit drugs. As such, consistent with strain and social learning theory, the hypotheses of this study are as follows (see Figure 1 for illustration):
Hypothesis 1: The higher one’s academic stress the more likely they are to utilize prescription stimulants Hypothesis 2: The higher one’s social learning/exposure to drugs the more likely they are to utilize prescription stimulants
METHODS Participants were recruited from a variety of classes taught at a small private suburban university in Southern California. Surveys were handed out at the beginning of the class period with the instructor’s permission. A copy of the completed instrument and consent form were sent via email to the professors where the surveys would be handed out. Consent forms were handed out first and informed students that their participation was voluntary and confidential. Consent forms were detached and handed in separately from the surveys to provide anonymity. As such, the participants of this dataset were 141 undergraduate students from a small private university in
Southern California. Participants ranged from ages 18-57 with a mean age of 23.27. There were 56 males and 85 females. There were 19 “hard-science” majors and 122 “soft-science” majors. GPAs ranged from 2.3 to 4.0 with a mean GPA of 3.35. 20 respondents were in a sorority or fraternity while 120 were not. 112 were traditional undergraduates and 29 were CAPA students. Below is a more detailed description of the variables utilized in the impending analysis.
Demographic Variables Information on age, gender, ethnicity, socioeconomic status, major, GPA, Greek society membership, and undergraduate program (traditional/CAPA) were collected by asking a series of questions. Age was collected by a single item fill-in question asking their age in years. Gender was collected by asking a single item two options with male and female being the possible options. Ethnicity was asked by using a single item multiple options with the possible options as African American, Asian American, Arab American Euro American, Hispanic/Latino American, Native American, Pacific Islander American, and Other. Socioeconomic status was collected by asking a single item multiple options with the possible options as poverty level, working class, lower-middle class, middle class, upper-middle class, and upper class. Major was collected by asking a single item fill-in; majors were later coded into “hard science” and “soft science”. Majors that fell under “hard science” included anything similar to biology, mathematics, chemistry, physics, and computer science. Majors that fell under “soft science” included any other majors that did not have at least 6 required math-based courses. GPA was collected by asking a single item fill-in questions. Greek status was collected by asking if they were a member of a fraternity or sorority, single item yes or no question. Undergraduate type was
collected by asking a single item, two options with traditional undergraduate and CAPA student as the two possible options.
Dependent Variable: Prescription Stimulant Use The concept of prescription stimulant use was defined as the use of any amphetaminedextroamphetamines and methylphenidate stimulants that are medically prescribed to patients normally with Attention-Deficit/Hyperactivity Disorder. Prescription stimulant was measured by asking a variety of questions that not only addressed if respondents have used them but the times they have considered using prescription stimulants, medical prescription, and usage frequency. Times they have considered prescription stimulants was collected by asking a single item multiple option question with possible responses being never, a few times, more than a few times, and many times. Prescription stimulant use was collected by using a single item yes or no question asking if they have ever used prescription stimulants such as Adderall, Ritalin, Concerta, etc. Medical prescription for stimulants was collected by a single item yes or no question that asked if they have ever had/have a medical prescription for stimulants such as Adderall, Ritalin, Concerta, etc. If students responded Yes to the last questions, they were asked three sub-questions. The first sub-question was a single item yes or no question asking if they have ever exceeded their physician prescribed dosage. The second sub-question was single item multiple option asking how they would characterize their use of stimulants with the possible responses being seldom, frequent, very frequent, and chronic. Finally, the third sub-question was a single item multiple option asking to the best of their knowledge, how many times in the past year have they used stimulants with possible responses being 1-3 times, 4-6 times, 7-9 times, or 10+ times.
Independent Variable of Interest 1: Academic Stress The concept of academic stress was defined as a state of negative affect derived from academic factors. The failure to reach positively-valued stimuli, the loss of positively-valued stimuli, and the presence of noxious stimuli are all components of the general strain theory (Agnew 1992), a theory in which academic stress can fit into. Academic stress was measured to possibly attain a relationship to the dependent variable, prescription stimulant use. The Perceived Stress Scale (PSS) (Cohen and Kamarck, and Mermelstein 1983) was used to measure academic stress. It is the most widely used instrument for measuring perceived stress. The PSS consists of 10 items rated on a 5-point Likert scale ranging from 0 (Never) to 4 (Always). The predictive validity of PSS falls off after about four to eight weeks due to the ever-changing nature of life stressors. Changes were made to the original PSS by adjusting the 6 negative questions to specifically negative academic stimuli and the 4 positive questions to specifically positive academic stimuli. To input the data into SPSS, the four positive questions were reversed such as a 0 input as a 4 and a 4 input as a 0. The questions that measured stress negatively asked how often in the past year has a participant felt upset because of school work, unable to stay on top of assignments, stressed about projects, assignments, or exams, overwhelmed with schoolwork, angered by receiving a lower grade than expected, and classes that were too difficult to receive a passing grade. The questions that measured stress positively asked how often in the past year has a participant felt confident about their school performance, felt that their grades were good or outstanding, able to get a passing grade on assignments and/or exams, and felt on top of their class work.
Independent Variable of Interest 2: Social Exposure Social associations were defined as relationships to people with strong influence on one’s own behaviors and/or thoughts. The social learning theory was used to help define social associations that are based on parental and peer reinforcements, parental and peer behavior, and own behaviors. Questions to measure parental and peer reinforcements included 4 questions, all single item yes or no. They asked if parents and friends condoned the use of excessive amounts of coffee and/or energy drinks and the use of drugs. 4 additional questions measured parent and peer behaviors, all single item yes or no questions. They asked if parents and friends used excessive amounts of coffee and/or energy drinks and if they used drugs. Personal behavior was measured in 5 questions. The first 4 were single item, yes or no questions asking the participants if they have ever used excessive amounts of coffee and/or energy drinks, alcohol, marijuana, and illicit drugs other than prescription stimulants. The last question was single item multiple option asking in the last year, how many parties or similar social events have the participants attended with non, 1-2 times, 3-5 times, and 6+ times as the possible responses.
Statistical Techniques Statistical analysis was conducted through the use of SPSS predictive analytic software. Oneway analysis of variance was conducted for discrete and continuous pair of variables; examples for ANOVA in this study include GPA and prescription stimulant use, academic stress levels and prescription stimulant use, GPA and considering prescription stimulant use, and academic stress levels and considering prescription stimulant use. Pearson correlation analysis was used to measure the relationship between two continuous variables such as GPA and academic stress levels. Finally, Chi square crosstabs were used to compare two discrete variables; nearly all
demographics and social exposure variables were tested against prescription stimulant use and considering to use prescription stimulant.
RESULTS Participants were 141 undergraduate college students attending a private university in Southern California. Participants ranged in age from 18 to 57 years, with a mean age of 23.27 (SD=6.64). 56 (39.7%) of the respondents were male and 85 (60.3%) were female. There were 6 (4.3%) African Americans, 15 (10.7%) Asian Americans, 2 (1.4%) Arab Americans, 24 (17.1%) Euro Americans, 66 (47.1%) Hispanic/Latino Americans, 1 (0.7%) Native Americans, 5 (3.6%) Pacific Islander American, and 21 (15.0%) Other with 1 missing data (0.7%). Of the socioeconomic statuses that were listed, there were 3 (2.1%) in poverty level, 27 (19.1%) in working class, 24 (17.1%) in lower-middle class, 53 (37.9%) in middle class, 33 (23.6%) uppermiddle class, and 0 (0.0%) in upper class with 1 missing data (0.7%). Participants were asked to write down their major, which was coded into two categories: (1) “hard-science” majors and (2) “soft-science” majors. 19 (13.5%) were “hard-science” majors and 122 (86.5%) were “softscience”. Participants’ GPA ranged from 2.3 to 4.0 with a mean GPA of 3.35 (SD= .39). 20 (14.2%) belonged to a sorority or fraternity while 120 (85.1%) did not belong to a sorority or fraternity. 112 (79.4%) were traditional undergraduates and 29 (20.6%) were CAPA undergraduates. For the demographics data, please refer to Appendix Table A. According to Table 1, a one-way analysis of variance compared the GPA of people who have used prescription stimulants and those who have not. The mean for prescription stimulant users (M = 3.33) is slightly lower than the mean for non-prescription stimulant users (M = 3.35),
Table 1: ANOVA for Academic Stress and GPA by Prescription Stimulant Use Have Used (N=21) M SD GPA 3.33 0.45 Academic Stress 19.67 5.24 † = p < .1, * = p