Sources for Prescription Stimulant Misuse: A Person-Centered Approach to Understanding Links to Substance Use and Psychiatric Impairment

Prescription stimulant misuse (PSM) is most prevalent among college students and is associated with numerous negative academic and psychosocial outcomes. A large body of literature has identified predictors of PSM in this population, however few studies have utilized a person-centered approach to examine how the sources from which students procure prescription stimulants are associated with substance-related and psychiatric impairment. We used latent class analysis (LCA) to classify a geographically and racially/ethnically diverse sample of U.S. undergraduates (N = 538) who misused prescription stimulants into groups based on their endorsement of nine sources of medication. We selected a five-group classification from the LCA with classes of peer/dealer, given by friend, own prescription, lower multiple sources (i.e., relatively infrequent endorsement of multiple sources), and any source. Compared to the reference group (given by friend), the own prescription class was less likely to report marijuana use, simultaneous alcohol and marijuana use, alcohol or marijuana consequences, and nonoral routes of administration. On the other hand, the own prescription class was more likely to screen positive for anxiety, anger, and suicidality. Similarly, the lower multiple sources group was more likely to screen positive for depression, anxiety, anger, and suicidality. Prevention and intervention efforts focused on PSM may be tailored differently for students who are misusing their own medication and/or endorsing multiple sources. Specifically, these students may need broader assistance with comorbid psychiatric conditions, particularly suicidality, while students who obtain stimulants from peers or a dealer may benefit more from substance-focused interventions. Public Health Significance Findings from the present study showed that more than one in 10 college students misused prescription stimulant medication in the previous year and these students experienced more psychiatric difficulties, including suicidality, compared to a normative sample of college students. Students who misused their own stimulant medication or who procured the medication from multiple sources were especially vulnerable to these psychiatric difficulties, suggesting that these subgroups of students may benefit from comprehensive interventions that address comorbid psychiatric problems, in addition to their prescription drug misuse.

Automated summary

This study reveals the prevalence of prescription stimulant misuse among college students and its association with negative psychiatric outcomes. The findings suggest the importance of tailored prevention and intervention strategies based on the sources of medication procurement.