• prescription stimulants;
  • substance abuse;
  • drug abuse;
  • attention-deficit–hyperactivity disorder;
  • ADHD;
  • young adults;
  • college students

Study Objective. To examine associations between age at initiation of prescription stimulants and illicit use and abuse of prescription stimulants, alcohol, and other drugs among college students in the United States.

Design. Web-based survey of college students.

Setting. A large (full-time undergraduate population > 20,000) university.

Intervention. A Web-based survey was sent to a random sample of 5389 undergraduate college students plus an additional 1530 undergraduate college students of various ethnic backgrounds over a 2-month period.

Measurements and Main Results. Alcohol abuse was assessed by including a modified version of the Cut Down, Annoyance, Guilt, Eye-opener (CAGE) instrument. Drug use-related problems were assessed with a slightly modified version of the Drug Abuse Screening Test, short form (DAST-10). The final sample consisted of 4580 undergraduate students (66% response rate). For the analyses, five subgroups were created based on age at initiation of prescription stimulant use: no prescription stimulant use, grades kindergarten (K)–4, grades 5–8, grades 9–12, and college. Undergraduate students to whom stimulants were prescribed in grades K-4 reported similar rates of alcohol and other drug use compared with that of the group that had no prescription stimulant use. For example, students who started prescription stimulants in grades K-4 were no more likely to report coingestion of alcohol and illicit prescription stimulants (odds ratio [OR] 1.4, 95% confidence interval [CI] 0.2–11.5, NS] than the group that had no prescription stimulant use. However, undergraduate students whose prescription stimulant use began in college had significantly higher rates of alcohol and other drug use. For example, students who started a prescription stimulant in college were almost 4 times as likely (OR 3.7, 95% CI 1.9-7.1, p<0.001) to report at least three positive indicators of drug abuse on the DAST-10 compared with the group that had no prescription stimulant use.

Conclusions. In concordance with results of previous research, these results indicate that initiation of prescription stimulants during childhood is not associated with increased future use of alcohol and other drugs.