A substantial proportion of college students in this study have used prescription analgesics and/or stimulants nonmedically in their lifetime (19.6%wt
) and in the past year (15.6%wt
). Given that prescription drugs are used nonmedically by more college students than any other illicit drug after marijuana and that they are associated with polydrug use, campus health professionals and administrators should address the widespread availability and perceived safety that make them particularly enticing to college students. Prescription drugs may be perceived as less harmful than “street drugs” because they have medically sanctioned uses (Friedman, 2006
), and some research has already pointed toward the perception among college students that prescription stimulants are safe (Low & Gendaszek, 2002
). These perceptions are compounded by the messages of tacit approval conveyed in the popular media for the use of “smart drugs” (Richardson, 2006
; Ross, 2006
To our knowledge, this is the first longitudinal study examining the mechanism by which nonmedical use of prescription drugs among college students might result in lowered GPA. In our sample, the social and academic behaviors of nonmedical users were significantly different from those of nonusers: they studied less, socialized more, and skipped more of their classes. Not surprisingly, they also earned lower GPAs, on average, by the end of their first year of college, even controlling for high school grades and other factors.
Consistent with our hypothesis, nonmedical use of prescription drugs has a detrimental effect on GPA, and appears to be partially mediated by skipping class. Furthermore, our post-hoc analyses indicated that the observed effect of nonmedical use on skipping class and subsequent lowered GPA was independent of other illicit drug involvement, suggesting that more than a general deviance factor is explaining this relationship. In contrast to skipping class, we did not find evidence that decreases in studying time or increases in socializing time were mechanisms by which nonmedical use affected GPA (even though decreased study time independently predicted lower GPA).
One possible interpretation of these findings is that students who engage in nonmedical use of prescription stimulants could be using these drugs in a compensatory fashion to “catch-up” with their studying because of the classes they missed as a result of drinking more or socializing more during the week. Rather than a group preoccupied with achieving academically, the general picture that emerges is that these students, because of the greater time they spend socializing, are seeking a way to make their few study hours more efficient through the use of prescription stimulants. For these students, prescription stimulants may be perceived as instrumental in helping them stay afloat academically while sustaining their partying lifestyle.
The present findings call into question this line of reasoning by students. First, as obvious as it may seem, this study demonstrated that skipping class has a major negative effect on GPA. Second, the data suggest that college students cannot circumvent the negative effects of skipping class on their GPA by using prescription stimulants as a study aid. Overall, college students do not improve their grades by using prescription stimulants nonmedically. Rather, their grades appear to suffer, perhaps because of their poorer academic habits and greater overall drug involvement.
From the present study, nonmedical use of analgesics is also related to decreases in GPA. Because analgesics are not used for the compensatory purposes described above, this effect might be more closely related to an overall deviance factor, similar to other drug use. Alternatively, the adverse effect on GPA could be related to the physiological effects of analgesics. Nevertheless, this finding draws attention to an important, measurable consequence (i.e., college grades) of nonmedical use, one which might serve as a proxy for a more generalized decrease in overall functioning and success.
The findings of this study must be seen in light of several limitations. First, although academic data were derived from administrative datasets, our findings rely heavily on self-reported data of illicit drug use, and while we have no indication that underreporting occurred, the possibility of social desirability bias cannot be ruled out. Second, because all participants were sampled from one university, results may not be generalizable to institutions located in other regions of the country or small private colleges. Furthermore, we used past-year drug use as a dichotomous predictor of academic performance, rather than using a more graduated measure of drug involvement (e.g., frequency of use). However, this limitation is mitigated by the low overall variability observed in the frequency of nonmedical use in our sample. Lastly, our models to predict academic performance, while comprehensive, did not contain other possible covariates which might influence GPA, such as academic major, goal orientation, and alcohol consumption.
If replicated, the present findings may have important implications for prevention. First, to reduce the availability of prescription drugs for nonmedical use, physicians should be encouraged to educate their patients about the risks of nonmedical use—especially for patients who are either college students or parents of college students—and provide clear guidance for how to prevent their medications from being diverted. These types of one-on-one educational interventions may be particularly effective in correcting parents' misperceptions that nonmedical use of prescription stimulants is a safe way for their children to cope with the demands of college life. Moreover, given what is already known about the association between prescription drugs and use of other illicit drugs (Barrett, Darredeau, Bordy, & Pihl, 2005
; Herman-Stahl, Krebs, Kroutil, & Heller, 2006
; McCabe, Knight et al., 2005
; Teter et al., 2003
), parents and providers should regard nonmedical use of prescription stimulants or analgesics as a warning sign for more serious drug involvement. Within campus communities, social marketing strategies may be helpful in correcting students' misperceptions that nonmedical use will help them achieve better grades. Armed with information about the adverse academic consequences of nonmedical use, such as from the present study, campus administrators should consider reaching out to parents and students with educational messages aimed at discouraging nonmedical use, and college health providers should routinely screen students for nonmedical use, especially when students are struggling academically.
Although many promising avenues for prevention are apparent, more research is needed to better inform prevention strategies, especially regarding the underlying factors that promote nonmedical use. One intriguing possibility is that undiagnosed or untreated attention deficit hyperactivity disorder (ADHD) may be a contributing factor in some cases of nonmedical use of stimulants, especially if students derive a performance benefit—whether real or perceived—from using the drugs. Future studies should perform clinical assessments of ADHD among nonmedical users of prescription stimulants to determine the extent of undiagnosed and untreated ADHD in this population. Moreover, to clarify the findings from the present study, future studies should explore the relationship between more fine-grained measures of drug use and academic outcomes. In particular, it would be interesting to know whether prescription drugs, when used concurrently or simultaneously with alcohol and other drugs, are associated with an even greater risk for academic performance problems than what was observed in this study. Researchers should also consider additional factors with a possible influence on GPA which were not accounted for in this study, such as academic major and attitudes such as goal-orientation. Future studies with this cohort will determine whether the reasons for nonmedical use (e.g., studying, partying, relaxation) have any bearing on academic performance.
Finally, there is an urgent need for research to fill critical gaps in our understanding of the long-term psychosocial and physical consequences of nonmedical prescription drug use. Longitudinal investigations of college students such as our study will provide a unique opportunity to gain understanding of these issues. Future research with this cohort will shed light on the extent to which nonmedical drug use patterns continue throughout college and whether they lead to longer-term consequences such as continued risk of academic underachievement, dropout, drug dependence, and perhaps subsequent reliance on stimulants in occupational settings later in life.