Parting With Pills: Why Students with ADHD "Share" Medication With Peers

Laura J. Holt, PhD, with Trinity College

Laura J. Holt, PhD

Researchers with Trinity College and Texas State University completed a study to determine not only why emerging adults (EAs) with attention-deficit/hyperactivity disorder (ADHD) choose to "share" prescription stimulants with peers, but also how, and to what effect, EAs with ADHD are approached.

The study of 149 EAs with ADHD determined several "predictors" to diversion of prescribed medications as well as several methods by which peers seeking prescription stimulants might request stimulants from EAs with ADHD. The researchers suggest that identifying how EAs with ADHD are approached for medication sharing, or diversion, may allow for the development of interventions designed to inoculate EAs with ADHD against peer requests.

Laura J. Holt, PhD, with Trinity College in Hartford, Connecticut, served as lead author on the study centering on nonmedical prescription stimulant use (NMPSU). Holt and colleagues point out that although there have been a series of studies identifying predictors of which students might be more inclined to share or sell their prescription drugs to friends, classmates or acquaintances, few studies explore the dynamics of student-to-student interactions and how they relate to diversion.

To, as Holt writes, address this gap in the literature, researchers recruited EA students over 18 years old, with a self-reported ADHD diagnosis, and a previous or current prescription of stimulant medication for treatment of ADHD from 2 demographically dissimilar colleges in the Northeast and Southwest US: Trinity College (a small, private, liberal arts college) and Texas State University (a large, more diverse, public research university in San Antonio, Texas).

Holt and colleagues hypothesized that in focusing on the means by which EAs with ADHD were asked to comply with peer diversion requests, they might obtain more specific predictors to illuminate how, and why, EAs comply with peer requests, and to what extent and by what means EAs could be deterred from that compliance.

Study participants were asked to respond to demographic questions, as well as questions about prescription history (including history of medical misuse of those prescriptions). Researchers also assessed ADHD symptom severity of participants using the Adult ADHD Self-Report Scale Symptom Checklist before presenting study participants with 5 compliance-gaining scenarios that measured how often students with a prescription were exposed to compliance-gaining strategies and how their expected response.

Holt and colleagues compiled responses to the scenarios to determine overall strategy exposure scores and willingness to divert scores, which were designed in order to determine if diverters were more likely to divert across some, or all situations compared to nondiverters.

Data were also collected on participants responses to a 10-question Resistance to Peer Influence (RPI) Scale and a question about the percentage of students on their campus and on other campuses who might be engaged in NMPSU behaviors.

The study results determined that 36% (n = 53) of students in the study diverted their medication in the previous year and that more than half of all study participants (53%) had been approached by peers desiring NMPSU. Data confirmed the findings of previous studies predicting diversion behaviors, determining that members of Greek organizations on campuses had a higher odds ratio (OR) of diversion (OR = 8.50; 95% CI).

Study data also determined that higher ORs for divergence among study participants existed among northeast college attendance (OR = .079, CIs [.014, .431]), greater exposure to compliance-gaining strategies (OR = 1.888, CIs [1.132, 3.148]), fewer concerns about being caught (OR = .482, CIs [.298, .780]), and less anticipated guilt about diversion (OR = .453, CIs [.260, .790]), and that private school attendance carried an additional increased OR (OR = 6.377, CIs [1.089, 37.341]).

Unexpectedly, Holt and colleagues reported that they found no link between previously reported predictors of gender, race, previous misuse of medication, or perception of NMPSU among colleagues and increased OR. Additionally, data showed that lower scores on RPI indicating decreased resistance to peer pressure were not associated with diversion, but instead with an unwillingness to divert based on participants feelings of being manipulated or used.

Scenarios that increased the likelihood of diversion were requests that consisted of rational-academic requests by peers, wherein peers asked for diversion based on an academic need — 2 exams the following day and the need to pull an all-nighter to finish studying. EAs with ADHD were less likely to comply with diversion requests for peers when scenarios centered on requests based on recreational NMPSU, promises of favors, direct requests without reasons, or manipulation/guilt tactics (i.e. inability of peer to complete assignments on time without NMPSU).

Holt and colleagues believe that their findings identify additional predictors of diversion among EAs with ADHD, and could assist in the development of programs offering students a means to enhance their resistance skills to diversion requests from peers. Development of interventions that ask students to articulate specific and personal reasons not to divert may also prove effective in inoculating students against future diversion requests, and assist students with formulating specific responses to declining diversion requests from their peers.

Knowing when diversion is most likely to occur, may help researchers tailor interventions to specific populations, and provide assistance to students facing diversion requests. Holt and colleagues conclude that although it's tempting to assume that students with stimulant prescriptions bear primary responsibility for the rise in NMPSU on college campuses, the assumption downplays the influential role of peers persuading students with prescriptions.

Development of interventions that provide strategies for EAs with ADHD to respond to that influence may provide the best solution to NMPSU on campuses.

Holt, L. J. "Pursued for Their Prescription: Exposure to Compliance-Gaining Strategies Predicts Stimulant Diversion in Emerging Adults" appears in the February 2018 issue of the Psychology of Addictive Behaviors.

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