Prescription Drug Misuse on College Campuses: An Interview with Dr. Laura Holt (Part 1 of 2)

Adults ages 18-25 misuse prescription drugs more than any other age group. Recently, we interviewed Dr. Laura Holt, Clinical Psychologist and Charles A. Dana Research Associate Professor of Psychology at Trinity College. For the past 14 years, she has conducted research on substance use and misuse in college settings, and most recently collaborated with Kognito as a subject matter expert on our Prescription Drugs product. Her expertise is in prescription stimulants, as opposed to prescription opioids or anti-anxiety medications.

Continue reading for highlights of Dr. Holt’s research on prescription drug use and misuse on college campuses and how her research helped Kognito with the development of our newly released product for higher education, Prescription Drugs.

Q&A with Dr. Laura Holt, Associate Professor, Clinical Psychologist, and Prescription Stimulant Researcher

Kognito: What are students saying about why they are using these stimulant drugs (i.e Adderall, Ritalin, etc.) and are they aware that there are negative consequences that can impact their health?

Dr. Laura Holt:
“We have conducted extensive research on students who are using stimulant medications without a prescription. One thing we learned is that most students, about 70-80%, are getting these medications

Dr. Laura Holt, Clinical Psychologist and Charles A. Dana Research Associate Professor of Psychology at Trinity College

from peers and friends with legitimate prescriptions. Only a small percentage buy from dealers or from the Internet. For that reason, our most recent research has focused on students that have legitimate prescriptions for stimulant drugs, typically students that have ADHD, to understand prescription stimulant misuse from their perspective. Given that these drugs are misused so often, [we wondered] how often they are approached or asked for their medication.

 

[Much of] prescription stimulant misuse is motivated, frankly, by a desire to stay up when students have work that’s piling up such as studying for an exam or writing a paper. In some cases, it’s to counteract the effects of alcohol, if they’ve been particularly tired or have not gotten enough sleep and they need to go to class. Students will sometimes say that it helps to make more monotonous work more interesting, like they’re able to focus on it and stick with it for longer.

I think one motivation that maybe hasn’t been discussed as widely is when students mix these drugs with alcohol when they go out at a party to counteract the depressant effects of alcohol. That’s not quite as common as the academic motivations, but it’s definitely still a motivation that students cite for using.

We’re also concerned and curious about the students who did have stimulant prescriptions. Were they running out early, meaning they didn’t have the medication they needed to manage their symptoms? Were they being put in awkward positions if someone found out they had medication? The answer to these questions is yes, not for every student but for some of our students for sure. If word gets out that you have this medication, there can be a presumption that, ‘well, if you have a little bit of extra’ or ‘I need this to study for a test. If you’re a good friend, you’ll give it to me.’”

Kognito: Are the students that use these prescription drugs typically high achievers striving for a high GPA? Or do students feel the need to take these prescription drugs when they are struggling academically?

Dr. Laura Holt:
“The literature has shown that there are several risk factors that might make a student more likely to engage in prescription stimulant misuse. On the academic side, interestingly, a lower GPA is typically a risk factor for misusing these medications. A prominent researcher in this field, Amelia Arria at the University of Maryland, has found that students who misused stimulants were more likely to engage in heavy drinking and use other substances like marijuana. These behaviors may be more likely to leave students in an academic bind that makes stimulant misuse more likely. And, Dr. Arria and her colleagues followed a large sample of students for one year and found that students who had started misusing stimulants did not improve their GPA.

There are several other risk factors, and they vary depending on the study, but involvement in Greek life has been shown to predict prescription stimulant misuse. In some cases, gender [plays a factor], in that students who identify as male are more likely to report prescription stimulant misuse.

Kognito: Do you find that students will continue to use these prescription drugs upon graduation, if they haven’t been medically prescribed?

Dr. Laura Holt:
“My colleagues Susan Langdon and Richard Feinn and I have a paper under review now where we followed students for two years after graduation to see how prescription stimulant misuse changed. We expected that misuse would decrease once students are out of the college context or even if they’re in graduate school. Maybe stimulants aren’t as readily available because students aren’t in contact with as many of their peers. The key takeaways from our study were that the rate of prescription stimulant misuse was essentially halved each year. So, I think the good news is that prescription stimulant misuse is probably a behavior that a lot of students discontinue. But I think it could depend on the type of industry that they’re in. Our study wasn’t large enough to really tease apart the rates of continued use by industry.

One finding that stood out to us was that if you perceived that people around you were using, you were more likely to continue using [prescription stimulants]. So not unlike other substance use among adolescents and college students, your perceptions of what your peers are doing really seem to matter.”

Kognito: Are these medications addictive or highly addictive like opioids?

Dr. Laura Holt:
“They are classified as Schedule II drugs by the federal government. That classification indicates that these drugs have a high potential for abuse and dependence. They work relatively quickly to increase the neurotransmitters dopamine and norepinephrine and you feel the effects pretty immediately. At the same time, I think it’s important we’re careful how we talk about these medications. We want to remind students who have legitimate prescriptions that their use of the medications is appropriate, since they are being monitored by a healthcare professional. I think if students use them as they are prescribed and are honest about the side effects they’re having and the doses they’re taking, the medications can be used safely. But their classification as a Schedule II drug does suggest the potential for significant problems when these medications are used in ways they aren’t prescribed.”

Kognito: What are college campuses doing, or maybe even specifically in the college campus where you’re currently teaching, to educate students about the risks and the dangers of these stimulant medications?

Dr. Laura Holt:
“I’m not 100% well versed in all of the prevention efforts – in part because they change from year to year – but my understanding is that students complete required online education courses upon entering our institution. In my experience, these trainings typically focus on alcohol and marijuana. This makes sense given that these substances are used most often. I think some of the issues around prescription drugs, particularly stimulants, are somewhat different, though. If students are asking other students for their prescription medications, this behavior isn’t just potentially causing harm to the individual misusing the medication, but it can become an issue where again, students don’t have the medication that they need, or they’re put in awkward positions. These situations likely warrant different interventions than those for alcohol and marijuana.”

Kognito: Are students honest about their use of these medications if they’re asked in research studies or by counseling centers on campus? Is it something that they’re transparent about?

Dr. Laura Holt:
“It’s hard to know without having biochemical verification of a student’s behavior. From my perspective as a researcher, ensuring confidentiality is critical so that students feel as though they can be honest. They don’t want to worry that their responses are going to get back to a professor or a college official. We work diligently to make sure that those safeguards are in place to help students feel comfortable being open and honest.

When I look at the prevalence of prescription misuse and diversion in our research, particularly among colleges in the Northeast and competitive colleges, the estimates tend to be higher than what we see as a national average. This would suggest to me that students are being truthful. However, I think if students are not being truthful, it would be more likely that they would be underreporting rather than overreporting, so our research may underestimate the actual prevalence.”

Kognito: What would your advice be to a student who is looking for help because they’re feeling overwhelmed and suffering academically? What would you recommend as an alternative?

Dr. Laura Holt:
“We talk with students about the fact that using prescription stimulants without a prescription is unlikely to give you an edge in terms of your GPA. I understand there’s a difference between trying to solve a short-term problem of a term paper due next week versus thinking that you’re going to have a higher GPA. Perhaps students don’t necessarily think they’re going to have a higher GPA, but I still believe it’s worth sharing the evidence with them. I think we assume that students arrive at college and they know how to organize their work, how to plan, and how much time to devote to different tasks. Most students are still developing these skills well into college and even afterwards. As faculty and advisors, [it’s important to] help students be strategic about how they’re spending their time, particularly during the day, as opposed to leaving all their work until the end of the day. Students can end up with circadian rhythms that are highly dysregulated if they are in a pattern of staying up really late and getting little sleep.

When there is an upcoming assignment or exam in one of my courses, I talk with students about what their preparation might look like. I also encourage students to use electronic calendars and to set interim goals, which can help them to stay on track. These tools aren’t earth shattering, but I think they are critical to helping students avoid situations where they have to cram or do all of their work at the last minute.”

Experience the Prescription Drugs simulation

Prescription Drugs allows students to assess misconceptions about prescription drugs use; learn to safely use, store and dispose of their prescriptions; practice applying refusal skills and explore help-seeking strategies for themselves and friends.

Want to experience the interactive role-play simulation? Take an interactive demo or contact us for more information.

Stay tuned for Part 2 of our interview with Dr. Laura Holt.

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