College chat

Lina Begdache, Binghamton University, State University of New York

Nonmedical use of Attention Deficit Hyperactivity Disorder (ADHD) drugs on college campuses, such as Adderall, Ritalin, Concerta and Vyvanse, has exploded in the past decade, with a parallel rise in depression disorders and binge drinking among young adults.

These ADHD drugs act as a brain stimulant that are normally prescribed to individuals who display symptoms of ADHD. These stimulants boost the availability of dopamine, a chemical responsible for transmitting signals between the nerve cells (neurons) of the brain.

But now a growing student population has been using them as “study” drugs – that help them stay up all night and concentrate. According to a 2007 National Institutes of Health (NIH) study, abuse of nonmedical prescription drugs among college students, such as ADHD meds, increased from 8.3 percent in 1996 to 14.6 percent in 2006.

Besides helping with concentration, dopamine is also associated with motivation and pleasurable feelings. Individuals who use these ADHD drugs nonmedically experience a surge in dopamine similar to that caused by illicit drugs which induces a great sense of well-being.

My journey with investigating the effect of the stimulant use nonmedically on college campuses started with a question from a student seven years ago. The question was about the long-term effect of misuse on brain and physical health. Having an educational background in cell and molecular biology with a concentration in neuroscience, I started a literature review and soon became an educator on the topic to teach students about the effects of such stimulant misuse on the maturing brain.

College students who take ADHD drugs without medical need could risk developing drug dependence as well as a host of mental ailments.

Substance abuse in college

College students have been reported to use many stimulants, including but not limited to Adderrall, Ritalin and Dexedrine.

According to the 2008 National Survey on Drug Use and Health, students who used Adderall for nonmedical purposes were three times more likely than those who had not used Adderall nonmedically to use marijuana. They were also eight times more likely to use cocaine. In addition, 90 percent of the students who used Adderall nonmedically were binge alcohol consumers.

Generally, college students who abuse ADHD drugs are white, male and part of a fraternity or a sorority. Often they have a low GPA as well.

ADHD drugs appear harmless to many, as often they are prescribed by physicians, even though these drugs have a “Black Box warning,” which
appears on a prescription drug’s label to call attention to serious or life-threatening risks. Despite such a strict warning from the FDA, many practitioners end up prescribing them based on subjective reporting of symptoms of ADHD. The lack of a gold standard for ADHD diagnosis has, in fact, led to physicians overprescribing the drug.

Furthermore, students who get hold of these prescriptions can easily sell pills on the black market. Students who buy these pills illicitly miss seeing the warning about potential abuse, addiction and other side effects.

What’s more, a chewable form of an ADHD drug has been recently introduced in the market. These are fruity-flavored extended-release drugs that dissolve instantly in the mouth. They are targeted for children for a fast medicated response, but present a great potential for abuse.

The neurobiology of addiction

What are the consequences of taking these drugs without a medical condition?

The nonmedical use of the ADHD drugs (stimulants) is of great concern because it raises levels of dopamine the same way illicit drugs do. Therefore, abuse of these drugs may cause the same effect on addiction, brain rewiring and behavioral alteration.

While students may be aware of the harmful effects of “doing drugs,” the use of the ADHD drugs nonmedically may seem harmless because they are prescription medicine.

There is a limited body of knowledge on the effect of long-term nonmedical ADHD drug abuse on the developing brain. Of concern are potential permanent alterations taking place in the pathways of nerve cells of the maturing brain.

ADHD drugs could be addictive, if used without medical necessity. Since brain development continues into the mid-20s and the young brain is remarkably plastic, this sets up a risk of developing chronic substance abuse, addiction and mental ailments.

Nonmedical ADHD drugs, like any illegal drug, collectively activate a nerve pathway known as the “reward system of the brain.” This reward system is responsible for positive feelings such as motivation and pleasure. From an evolutionary point of view, the circuit controls an individual’s responses to motivation and pleasure (e.g., food and sex) which promote survival and fitness, respectively.

The response of the brain reward system to natural cues is highly regulated by a homeostatic mechanism – a process by which the body maintains its constant internal environment.

However, a nonmedical ADHD drug, like an illegal drug, overactivates this “reward circuit,” thereby disturbing the brain’s internal balance. This causes the brain to maladapt (structurally and functionally) and turn the brain into being “substance-dependent.” These changes happen at the genetic level.

A consequence of this is that the brain starts to need an increased dosage of the drug to respond to the natural cues for motivation and life pleasures. This sets the stage for more substance abuse. The individual then reaches for higher doses and more potent substances. Eventually, a cycle of further dependence and drug abuse ensues.

Impact of abuse

The concern with the nonmedical ADHD drug abuse is that it might prime the brain for use of other substances such as alcohol, cocaine and marijuana (something that the national surveys mentioned above revealed).

Major behavioral changes emerge such as compulsive drug seeking, aggression, mood swings, psychosis, abnormal libido and suicidal thoughts.

In fact, there have been documented cases of college students who have taken their lives following an addiction to nonmedical ADHD drugs.

Animal studies show that the changes that lead to rewiring of the brain are due to an alteration in gene function. Some of these changes become permanent and heritable, especially with prolonged abuse, meaning that the altered (newly programmed) genes are passed down to offspring.

In fact, a body of evidence is linking the process of addiction (among many chronic diseases) to altered gene function profile passed down by ancestors. This altered profile could predispose their offspring to certain disorders.

Currently, prescription of ADHD drug is based mostly on subjective self-reported symptoms, and a gold standard for ADHD diagnosis remains to be perfected. As a lyric from the rock band Marilyn Manson says:

Whatever does not kill you, it’s gonna leave a scar.

That’s the case with nonprescription ADHD drug abuse.

Lina Begdache, Research Assistant Professor, Binghamton University, State University of New York

This article was originally published on The Conversation. Read the original article.

Leah Daigle, Georgia State University

When students come to pursue their educational interests, they believe they are entering a safe environment. But while colleges are thought of as “ivory towers,” they can also be places where students could become victims of a crime.

In my research on victims of crime, I have found that particular types of students are more exposed to risks in a college environment. The risks are often tied to the party culture endemic on college campuses, where alcohol consumption is a major feature.

Who is on campus

Often these students choose to enroll in universities in the U.S. for a quality education or to be able to pursue the major and career path of their choice.

For almost all young people, this is the first time that they are away from home, responsible for themselves, without adult supervision and an abundance of unstructured time. Part of college culture involves spending time at parties and bars, recreational drug use and engaging in other risky behaviors (e.g., binge drinking, hooking up).

Alcohol consumption becomes a major feature of such activities. Data indicate that about 65 percent of college students consume alcohol in a given month, and less than half of college students engage in binge drinking.

Research shows that such behaviors increase the likelihood of being a crime victim.

Drinking alcohol can increase the chances of being a crime victim because alcohol use impairs judgment and perception, decreases the ability to recognize and react to risk, impairs decision-making and delays reaction time.

Are all college students at risk?

Research shows about a third of college students could be victims of a crime during a given year. However, the risks could be different for different ethnic and racial groups on campus.

For example, there could be a higher risk for some groups such as non-Hispanic white men. This group faces the highest risk – most likely a result of participation in the party culture. White, male college students drink alcohol at greater levels and engage in more risky drinking than do female or African-American college students.

But there is a small percentage of international students who come to American campuses as well. In 2015, there were 1.13 million international college students enrolled in the U.S., with the largest percentage coming from China.

What is the risk international students face of being a victim?

Our research explored this possibility, given that international students may have unique experiences before and while attending college in the U.S.

Our study used data from the Fall 2012 American College Health Association’s National College Health Assessment II. This study is a national survey of college students that is done in the fall and spring. Our study sample included 26,012 students, 8.6 percent of whom were international students.

We found that overall, when asked about their experiences from the previous 12 months, international students were less likely to be “violently victimized” – that is, physically assaulted and/or verbally threatened – compared to domestic students. A physical assault might include being hit, punched, kicked, bitten or even shot, while a verbal threat might be experienced when a person is told that he or she is going to get beaten up or is going to be shot.

Nineteen percent of domestic students in our study indicated that they had been physically assaulted or verbally threatened, compared to 17 percent of international students.

Female international students are safer?

Subsequently, we looked at differences in risk for male and female international college students. We found that male international students were less likely to be victims of a crime, and so were international female students.

Our study found 22 percent of male international students had been assaulted or threatened, compared with 26 percent of male domestic students. Fourteen percent of female international students had been assaulted or threatened, while 16 percent of female domestic students faced these experiences.

These differences may seem small, and in magnitude, they are. But, we used a large sample of over 26,000 students, which leads us to feel confident that our findings are unlikely to be a result of a problem with our sample. Also, when you consider how many students attend college, a two percent difference (such as what we found between female international students and female domestic students in their risk) could be tens or hundreds of thousands of students.

In an additional set of analyses, we included other factors that previous research has shown to be related to risk on campus, such as alcohol consumption and being a first-year college student. We found that female international students faced fewer risks than did female domestic students. In fact, female international students’ odds of being harmed were 14 percent lower than female domestic students.

And why might this be the case? We found that female international students tended to have a less risky profile than their domestic student counterparts – they binge-drank less, were less likely to use drugs, were less likely to be a first-year undergraduate and were less likely to have a disability.

While there are still some unanswered questions, we believe there must be something unique about how female international students experience college. It is possible that female international students may not be fully engaging in college life. It is possible they might be under increased levels of guardianship or they may experience culture conflict.

Colleges should work to ensure that international students are a thriving part of the campus community while ensuring that they remain safe. Colleges should also provide culturally sensitive victim responses to international students.

Leah Daigle, Associate Professor of Criminal Justice and Criminology, Georgia State University

This article was originally published on The Conversation. Read the original article.