Neuropsychological functioning in college students who misuse prescription stimulants

Abstract

Background and Objectives Relatively little is known about the neuropsychological profiles of college students who misuse prescription stimulant medications. Methods Data presented are from college students aged 18 to 28 years who misused prescription stimulants prescribed for attention-deficit/hyperactivity disorder and controls (no prescription stimulant misuse). Students were assessed neuropsychologically using the self-report Behavioral Rating Inventory of Executive Functioning (BRIEF-A), the Cambridge Automated Neuropsychological Test and Battery (CANTAB), and other tests of cognitive functioning. The analyses included 198 controls (age 20.7 ± 2.6 years) and 100 prescription stimulant misusers (age 20.7 ± 1.7 years). Results On the BRIEF-A, misusers were more likely than controls to endorse greater dysfunction on 8 of 12 measures including Inhibition, Self Monitor, Initiation, Working Memory, and Plan/Organize, when adjusting for race and sex (all p’s <0.05). Similarly, when dichotomizing the BRIEF-A as abnormal (T score ≥ 65), misusers had more abnormalities on 5 of 9 subscales, as well as all major indices (p’s<0.05). Misusers also performed worse on several subtests of the CANTAB and standardized cognitive battery (p’s <0.05). A proxy of prescription stimulant misuse frequency was positively correlated with greater executive dysfunction on the BRIEF-A. Discussion and Conclusions These data demonstrate elevated risk for neuropsychological dysfunction among students who misuse prescription stimulants compared to non-misusing peers. The presence of ADHD contributed significantly to these cognitive findings. Students who misuse prescription stimulants should be screened for neuropsychological dysfunction. Scientific Significance These data may better elucidate the neuropsychological profile of college-aged prescription stimulant misusers.

Disentangling the Social Context of Nonmedical Use of Prescription Stimulants in College Students

“…We also found that students with NMUPS reported subjective reductions in ADHD‐like cognitive symptoms as a major reason for misuse. These data, coupled with previous data showing that stimulant misusers have high rates of ADHD 10 and neuropsychological dysfunction, 11 highlight the NMUPS for perceived pro‐cognitive effects and the need to screen those who engage in NMUPS for the presence of cognitive dysfunction. Of interest, recent controlled studies suggest only a perceived, subjective cognitive enhancement effect of stimulants in those without ADHD 30…”

Sources of Prescription Medication Misuse Among Young Adults in the United States

“…24 Regional and national studies have demonstrated PDM involving each drug class is associated with short-term and long-term consequences, including neuropsychological functioning, depressed mood, sleep problems and higher rates of SUD symptoms in adulthood. 25–29 Clinicians can easily assess educational status when screening for PDM among young adults and make their patients aware of the growing evidence for adverse consequences associated with PDM.…”

Prescription Drug Misuse: Taking a Lifespan Perspective

“…136,[145][146][147][148][149]167 Initiation of stimulant PDM before high school graduation is associated with higher rates of problematic substance use at 35 years of age. 22,150 Stimulant PDM is also associated with neuropsychological impairment 151 and psychopathology, particularly with ADHD symptoms and diagnosis in college undergraduate samples. 44,152 Stimulant PDM is less consistently linked with depressive and anxiety symptoms in adolescents (10-18 years) and college undergraduates, 136,[153][154][155] mirroring findings from the adult population 18 and older, where stimulant PDM was only inconsistently associated with such psychopathology.…”