"Study Drugs": The Rest of the Story

As important as the issue of off-label and "self-prescribed" use of psychostimulants, Adderall and Ritalin, is for all in higher ed to consider, the focus has historically and unfortunately remained stubbornly on the user of these drugs rather than the student who provides access. True, these drugs can be purchased "on the street," as can any other psychoactive substance, but all to frequently, access is via a friend or known peer. Although higher ed is appropriately concerned about this issue, its focus in addressing it is routinely--and all but exclusively--on the risks associated with that use, and then only for the user, not the purveyor. As there is much written about both of these issues--the use of psychostimulants and the associated risks for the user of "study drugs" (for an excellent overview, read this 9 June 2012 NY Times article on the subject, "In Their Own Words: 'Study Drugs'),  I will restrict my comments to what Paul Harvey used to call, “the rest of the story.”

1. The literature shows that when approaching collegians regarding losses associated with high-risk drinking as opposed to the gains realized by avoid such consumption, students respond more and better to gains-based information than to loss-based info. Although anecdotal information, my experience and that of colleagues across the country is that loss-based prevention efforts all but ensure that a prevention message is ignored. 
• Recommendation: Identify the benefits of avoiding the use of psychostimulants unless prescribed and then focus on these. If including any information about risks, make this a secondary focus; an almost, “oh, by the way,” type after thought. 
2. Focus on the legitimate user who has the prescription if not make this the primary focus on at least ’some’ prevention messages. Many students with legitimate prescriptions are hounded by peers for these drugs because of their perceived mythical ability to enhance cognition and academic prowess. "Assertively challenged" students are ill equipped to resist the manipulation of a determined, aggressive collegian.
• Recommendation #1: Again, focus on the gains of not sharing rather than the losses, either for the provider or the user
• Recommendation #2: Provide tips on basic refusal skills. This may be as simple as the printed handout with suggested ways to resist the insistent friend or roommate to the more formal production of BRIEF video clips (no more that 1.5 – 2-min) for YouTube, demonstrating a series of professionally scripted and well produced demonstrations of refusal skills, for example: Something that informs students that “Faux excuses” for not doing something high-risk are lies God lets you tell and still get into Heaven :)

As with so many issues of social significance, addressing something as provocative as the off-label use of prescription drugs is rarely as simple as just dealing with its most obvious elements. All social problems are complex. They are the result of what epidemiologists so often discover are multiple factors: the host or in this case the student who uses psychostimulants off-label, the agent or the psyhcostimulants themselves, and the environment, again in our case, the college campus. Consequently, the resolution of the problem is going to take a concerted effort that addresses each of these elements and its contributions to the problem with an integrated strategy. 

Regarding the "host," student's view these drugs as legitimate "study aids" that can enhance their cognitive performance and provide the competitive edge believed necessary to succeed. This is why there seems to be a correlation between the proportion of students reporting the use of these drugs and institutions with the most competitive entrance requirements. Regarding the "agent," there are significant numbers of students legitimately taking these drugs to effectively control an otherwise debilitating disorders that seriously challenges the academic performance of otherwise capable students. Lastly, regarding the "environment," college and university campuses represent a unique culture complete with its own attitudes, values, and beliefs. Affecting this culture in any significant fashion, let alone trying to completely change it, is a task that has challenged administrators and student affairs professionals since institutions of higher education were chartered in the 17th century.

Addressing the use of "study drugs," as with collegiate drinking, sexual behavior, or any other behavior, necessitates taking a comprehensive look at student perceptions regarding impossibly complex social issues--what middle aged administrators see and what traditionally aged collegians believe are frequently "horses of a different color." As such, many of the strategies designed to prevent high-risk and dangerous drinking are likely to be as useful in changing student perceptions regarding "study drugs." Social Norms campaigns, environmental management strategies, and harm reduction techniques employing evidence-based intervention strategies such as BASICS--Brief Alcohol Screening and Intervention for College Students--hold promise. In addition higher education is advised to address the issue of student understanding of these drugs and their use. As with alcohol and drinking, students ascribe meaning to psychostimulants based on their interactions with peers who use them and others who pass along their beliefs regarding these drugs. Until and unless we are able to change the way these drugs are viewed by students, we are not going to change the way they are used.

There is no easy fix; any effective effort is likely to necessitate a consideration of both those who choose to use these substances and those from whom these users procure them. Further, higher education's efforts to affect how each party views its role is likely to result from efforts to motivate change by showcasing gains-based incentives rather than engaging in the more traditional loss-based approach.

What do you think?

Dr. Robert