From Recreational to Functional Use

From Recreational to Functional Use:The New Wave of Collegiate Drug Use in Changing Times

Prepared for 2011 ACHA Conference

Phoenix, AZ

by Ross Aikins, Ph.D.

University of California,Los Angeles

6 . 4 . 2011

Presentation Overview• From recreational to purposive: the history of functional

drug use in higher education.

- “Tuning in, turning on, dropping out:” 1960 -1995

- “Smart drugs” hit the scene: 1995 - present

• Question for discussion (and brief Q & A)

• Cognitive enhancement: what college students are saying about and doing with drugs?

- Original qualitative research

• Conclusions, more discussion, Q & A

Learning outcomes1. Understand the context of “changing times”

in higher education as it relates to ATOD, 1960 to present.

2. Better understand the student perspective

3. Discuss evolving strategies and messages to address the evolved use of nootropic drugs on campuses.

Why 1960?

• Lots of college students discovering drugs for the first time

- Mostly marijuana, LSD, psilocybin

• 1967: 33% of UCLA students had tried MJ

- Ivies: Harvard, 25%; Yale, 20%; Princeton, 15% (Suchman, 1968)

• Led to MTF, AOD research initiatives

“The Drug Years” (2006)

The quest for “creative enhancement”

• Higher education more than just a loci of conflict in the “era of mind expansion”


The quest for “creative enhancement”

• Prominent cultural figures also took note

+

+ =

Drug culture changes dramatically: 1970-1995

• Age of innocent exploration ended

- Symbolic cultural end marked by tragedies

• Historical shifts in public policy:

- LSD becomes Schedule I (1970)

- Nixon declares “War on Drugs” (1972)

- Reagan begins “Just Say No” campaign

- MDMA, others made Schedule I (1985)


“Hot Legal Highs: Best Web Drugs”- Rolling Stone, Oct. 2010

“Generation Rx” 1995 - now

What are abusable Rx medications?“Prescription drugs that are abused or used for nonmedical reasons can alter brain activity and lead to dependence. Including opioids, central nervous system (CNS) depressants, and stimulants.” – National Institute on Drug Abuse (NIDA)


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The role of stimulants in our“enhancement” culture

“Street drugs”(schedule II)

Legal

cocaine

methamphetamine (meth)

Rx drugs(schedule II)

methylphenidate (e.g. Ritalin, Concerta)

dextroamphetamine(e.g. Addeall)

The role of nootropics in our“enhancement” culture

• What is a “nootropic” substance?

- Cognitive or memory enhancing drugs, “smart drugs,” nootropes, etc.

- From the Greek “noos” for “mind” and “tropein” for “towards” (Rose, S.P. 2002).

• Alleged nootropic drugs include: Alzheimer’s medications (ampakines), ADHD medications, narcolepsy medications.


“Drugs designed for psychotherapy can also be used to enhance certain regular mental functions. Just as Ritalin can improve the academic performance of hyperactive children, it can dothe same for normal children.It is commonly thought toboost SAT scores by morethan 100 points, for both thehyperactive and the normaluser. Many healthy young peo--ple now use it that way forthat purpose, and quite frankly,there is no stopping this abuse.”

– Gazzaniga, M. (2005)


– Greeley, et al. 2008

Our enhancement culture

“Bigger, Stronger, Faster*” (Dir.: Bell, 2010)

Our enhancement culture

“The Tenth Inning” (PBS: Ken Burns, 2010)

Halftime

“Academic PerformanceEnhancement in Higher

Education”

How “smart drugs” came to campus: ADHD

“Generation Rx”: 7.5% of children ages 5-19 are diagnosed with ADHD. Prevalence among college freshmen (self- and parent-reported DSM-IV): Male: 7.8%, Female: 3.1% (Lee, et. al., 2008; Kluger, 2003).

Production of methylphenidate (e.g. Ritalin, Concerta) increased 900% between 1990 and 2000 ...

... and amphetamine (Adderall, Dexedrine) grew 5,767% between 1993 and 2001 (Hall et al, 2005).

Recreational use of stimulants is higher among 18 to 25-year-olds than any other age group (Hall et al., 2005)

Non-medical prescription drug use has increased five fold between 1999 and 2005 (Arria et al., 2005; McCabe et al., 2005).

27% of medicated college students were approached to divert (i.e. redistribute) medication; 54% of those cases involved stimulant solicitation (McCabe et al., 2006).

58% of non-prescribed stimulant users reported obtaining medication is “easy to somewhat easy” (White et al., 2006).

Overall illicit use prevalence as high as 25% on some campuses (Greeley et al., 2008).

Meanwhile, on campus ...

“60 Minutes” (Apr. 25, 2010)

Where do students get these drugs?Opioids(n=787)

Stimulants(n=458)

Sedatives(n=249)

Sleeping meds (n=166)

Peers 57.8% 67.7% 58.2% 51.2%Family 12.2% 3.1% 9.6% 17.5%Other 30.0% 29.3% 32.1% 31.3%

McCabe & Boyd (2003)

• Random survey of 9,161 undergraduate students at large Midwestern Public Research University.

The science behind “cognitive enhancement”

Improvements in intelligence, concentration, learning and memory, even among healthy individuals (Riis et al., 2008).

Physiological/psychological side-effects may include: stroke, cardiac arrest, violent/erratic behavior, suicidal ideation, risk of developing dependence.

Still, do the benefits of “responsible use” outweigh the risks associated with misuse/abuse? (Greeley et al., 2008).

Research Questions:1. What are the perceptions of students who use stimulant

medications?- Perceived benefits & risks vs. AOD.- Use motivations, how/can dependency develop?

(Greeley et al., 2008).- Cheating/academic integrity? (Sahakian & Morein-

Zamir, 2007).2. What are their use habits?- Including diversion (White et al., 2005).

3. How do illicit and licit users compare?4. What are the theoretical implications of collegiate

cognitive enhancement?

Theory

• Albert Bandura: Perceived Self-efficacy

- Effects student motivation, engagement, perseverance on tasks; correlates with academic persistence, achievement; can shape aspirations and career trajectories (Bandura, et al., 2001, 2008)

- Perceptions of self-efficacy include: “judgments of bodily states and various forms of somatic information” (Bandura, 1989, p. 734)

Methods• Data collected at an elite “West Coast

University” (WCU) between March 2008 and July 2010.• Purposive sample of 12 students recruited

Methods• Data collected at an elite “West Coast

University” (WCU) between March 2008 and July 2010.

• Purposive sample of 53 students recruited

- Demographic questionnaire to determine eligibility & desirability (13 questions).

- Qualitative data from semi-structured interviews (30-60 min.). Slightly different protocol for licit/illicit users.

Sample (n=53)

Licit/illicit use:

(24)

Med. age: 22; Avg.: 22.8

GPA: 2.5-3.98;avg. 3.41

illicit39

licit11

both3

Women:Men:

(27)

Gender:

3

28

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FreshmenSophomores

JuniorsSeniorsGrad students

M.A.Ph.D.

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Class standing

Use factors, variables

• Varying dosages, use frequencies

• Use peaks around academic deadlines

“The weekends are where I probably won't be taking it. But if I do, it's 'cause maybe I'm writing an essay or I'm studying for an exam … it's more or less structured around my academic life more than anything ... Definitely seven days a week in midterms and finals.” - Vinny, (licit, Adderall)

• Varying medication types

“Adderall made me concentrate, and Ritalin just – I don't know. It was just a different – I couldn't concentrate basically, and I just wanted something [where] I could be able to study for a long period of time ... Ritalin did not do that for me.” - Meredith (illicit)

“For an all-nighter? Me? A 20 … I liked Ritalin. Like I would take four of them just towards the end just ‘cause I liked the skittishness. I liked the feeling.” - Mike (illicit)

• Mode of administration: oral vs. intranasal

- “They snort it because it has a quicker effect. I've never tried that. I think it's insane to do … whether it was recreational or not, I don't know. But I don't want to do it.” – Vinny (licit)

- “Sometimes I’d chop it up and snort it. … just on the kitchen counter or a glass table or something …‘Cause it would kind of hit me quicker, and so I’d have more of an initial rush. … I probably prefer to take [Adderall] intranasally because it tends to work a little quicker … it’s just a lot stronger. And it kind of helps the come down from the coke after it wears off, after 20, 30 minutes or something. And then the Adderall would kind of keep me from completely crashing.” - Megan (illicit)

Perceptions: what are other students saying about nootropic drugs?

• Available, easy to get

- especially among upperclassmen, but “depends who you know”

• Discussed openly

“I mean, if you’re on a college campus, you’ll hear about it. … I think it’s normalized.” – Zoey (Adderall, illicit/licit)

“I feel like Adderall is actually more accepted on college campuses just because students know that most students use it for academic purposes. And so it's not like you're smoking pot and then you're just having fun with it. People do it just because they have to study.” – Tanya (Adderall, illicit)

• “Superhero stories” pique interest:

“The guys who were pledging fraternities—I’ve never seen them working, never with a book, and then next to their finals they’re up for two or three days straight, and they [are] coming out with like, a 3.5 [GPA]. “What are you guys doing? Like, you just got heart to just study?” There’s a little bit of that heart but then a little extra, too.” – Mike (illicit, Ritalin)

“They say it really helps them study. Like she said she wouldn’t get off her seat for like 12 hours. She sat in her seat doing her work.” So I’m like, “Wow, I want one, too.” You know?” – Stephanie (illicit, Provigil)

• “Superhero stories” pique interest (cont’d ...):

David: It was pretty crazy, actually. I've never seen them [friends] so focused, which was why it was impressive. I had another friend who just disappeared for a night, and came back, and had an entire notebook full of notes with like really ordered, really well done notes, that pretty much summed up the entire class in like ten pages ... I was just like, "Holy crap, what this is stuff you've been on?" Then he was like, "Dude, I took Adderall. I've been working on this all night, like I literally read through like every chapter." ... That was like, an impressive feat, especially in like a one-night sitting.

Interviewer: Did that sort of pique your curiosity?

David: Yeah. Definitely – it definitely legitimized it in my mind, because before, I didn't know what to think about it … But I saw a few other friends. I have one friend who knew nothing about Econ, study the entire night on Adderall … just absorbed everything I told him. … Then, I mean, he ended up pulling off like a B something, which is incredible – for never going to class, not reading, just not doing anything, and he's not exactly the sharpest person I know either.

Interviewer: Interesting.

David: There're some people I know who can naturally pull that off … not him.

• Are nootropics more for good or bad students?

“I have gotten negative comments from people on my floor. … They think it's a weakness. … I think people know that you use Adderall to study, but it just depends, like, “Oh, she's taking it because like she hasn't studied for the past two weeks, she's not prepared, or she's not a good student. I'm a better student. I wouldn't need it,” kind of thing.” - Meredith

“Senioritis [was] definitely peaking, and also, my First Amendment class [was] easily one of the most difficult classes I've ever taken [at WCU]. So I was sort of just like, "Dammit!" … It was the end of four years, and I was just like, "Screw it. I'm done with this. I don't want to struggle anymore." … so I was like, "All right. I'll take a pill." … Adderall is kind of a cop-out, I think. It's literally just because I had slacked off to an enormous degree – in other words, it was completely my fault.” - David

Bad

• Are nootropics more for good or bad students?

“This one kid who is a pre-med science major, like a really good kid. Didn’t drink or anything. He’s like, yeah, to study I take Adderall. And I was like, okay, well I guess it’s not that bad. So then I got some from him.” - Amanda

“[My friend] was applying to Brown, it was like his dream school, and he was talking about how he took Adderall to write one of his essays. And I had obviously heard of it before, but that was the first time I’d heard of it being used in that context … so when he said that, I was intrigued, and so I did that, because I had something like 14 essays to write. … He was someone who, academically, I identified with, because people in high school … they weren’t on the same path as far as the future, but he was, and so whenever he was doing that, I saw it as something that I more considered as an option.” - Jessica

Good

Where are students getting their information?

• Peers

• The internet

• Research literature

• Coursework

• Doctors, counselors, therapists

• Family, parents, siblings

• Popular culture

• From me, clarifying misinformation

Information (cont’d ...)

• Research literature

Joe: I don’t know if you’ve looked this up like through your study, but “The New Yorker” had a huge article on Adderall. … It’s really interesting … pretty cool article.

Interviewer: Did that contribute to your curiosity, or did you first try Adderall in part because of that?

Joe: Yeah, it really did. Like there’s a part in the article … [that] said so many students are doing it, like the ethics … and I was like – I had always thought about taking it, but I figured if a lot of other people are doing it, I might as well try it.

• Popular culture

Other motivations: partying, to get high, curiosity, experimentation, to augment exercise, to counter the effects of alcohol and other drugs, and weight loss (Teter, et al. 2005; Low & Gendazsek, 2002).

Academic reasons: improving attention/concentration, study habits, organization, grades, reducing hyperactivity, and treating undiagnosed ADHD (Teter, et al. 2005; Barrett et al. 2005).

Why? (... use motivations)

• Safety

Perceptions: (cont’d ...)

“I just felt like because it’s a pill and you don’t know what’s in it, I didn’t want to die or like, faint or something stupid happen to me over a test. I just didn’t think it was worth it and then once I actually started reading up on it, I realized it’s basically like a salt I guess that helps the brain and stuff and it didn’t seem so bad when I actually did some research.” – Paul

“I think most people think of it as relatively safe. I think most of us know that it's illegal,” - Tanya

“I mean, technically, it’s illegal if you don’t have a prescription, but I don’t consider it illegal at all,” - Joe

“I think it's seen in a much more positive light than other, especially illegal drugs, because there is a perceived fit, and it's very academic. Whereas, illegal drugs, a lot of people don't see any benefit to those ...You never really hear of people dying on Adderall … So yeah, Adderall is definitely less stigmatic than something like cocaine.” – Kendall

“I think people are pretty aware that all prescription medications are to some degree abused ... but I think people would probably mention pain pills and things like that before stimulant medication in terms of abuse.” – Frank

• Stigmas

“Operation Sudden Fall”

SDSUMay 6, 2008

Adderall

Nootropics as an issue of social equality

“The apple doesn't fall far from the tree, exactly. So when it comes down to it, it's the parent that doesn’t' know. Then when they [the kids] get to college, or for whatever reason, they get somewhere to a different area, you learn just like I learned, this is like cheating. You take Adderall – you take this medication [and] all my thoughts are more controlled. I’m constantly thinking about that. I'm like, this is great. It's unheard of. And then when you come up to the, I want to say, suburbs, or well-off people—as we say in [my neighborhood], "the people on the hill"—basically they have the knowledge. Their parents are educated. They know what their child needs to continue to grow and learn. So I tell people, this whole Adderall thing is the white version of cheating. You want to get good grades, you want to do everything – you want to know why you has a 4.3 GPA, or whatever, and he does all of that? There's a reason.” – Ryan

Social equality (cont’d ...)

Mike: Black and Latino people would come to me but not proportional to the numbers on campus.

Interviewer: How do you feel about that? I mean, as a Latino gentleman yourself?

Mike: I just think it comes out to the dollars. I don’t even think it’s about drive, ‘cause I have the means. I probably would have cut the prices for them, but I just don’t think that’s an investment that they’re making or they’ve really been – they’ve really known about.

Interviewer: Do you worry about that? Like, do you ever think about your role in terms of like, your customer base being proportionally more white and Asian?

Mike: Yeah.

Interviewer: Do you worry about …

Mike: … widening that gap?

Interviewer: Yeah. Do you worry about students of color getting left out?

Mike: I do think about that, and it’s f--ked up but it’s about the bottom line. And when I say bottom line, I just mean dollars. Making dollars and cents.

• Studying/cramming

• Essays/writing assignments

• Multi-tasking

• Co-curricular activities

• Exercise

Habits: what are students doing with nootropic drugs?

Use patterned around academic tasks

• In terms of specific tasks, paper writing was especially divisive: Some found it helpful, others claimed it stifled their creativity; Maryam wrote a paper while binging on “Vyvanse” and upon checking it later “not everything made sense.”

+Positive uses cited: “cramming,” problem sets, reading, labwork, procrastinating, math problems, graphs, during timed exams.

- Bad uses: social tasks, creative tasks.

Adverse effects(bad stuff)

• “Focus traps”

• Weight loss

• “Crash-like” effects

• Moody/irritable

• Social withdrawal, feeling not “like self”

• Psychological dependence

• Caffeine and prescription stimulants

Functional polydrug use:

“[After using Provigil to study for an all-nighter] … a friend called and asked me to go get coffee and I figured it couldn't hurt to have that also … I made it to the test. I think I maybe even started falling asleep during the test. And I had like a Monster energy shot in my backpack that I even took. So it was just—everything at that point.” – Gabe (modafinil)

“Yeah, it's become a habit … I drink Red Bull each time with the Adderall to help me the most. … They both help in and of itself, but if you combine it, it's even more effective. ... I think if the peak amount of studying efficiency is 100 percent, the Adderall contributes 80 percent of it. But if I take it, the Red Bull will contribute the extra 20 percent.” – Minh

“I have taken Adderall and coffee before. I didn’t really like that … it just wasn’t as effective as I thought it would be.” – Joe

• Alcohol and stimulants

Polydrug use (cont’d ...)

“[It’s] definitely not like, “Oh, I'm gonna drink now and take Adderall at the same time.” I don't like doing it. I prefer to make sure that Adderall's out of my system before I drink. But occasionally I do. I don't know. It takes longer for me to get drunk. That's for sure. My body seems to deal with the alcohol differently, and I don't get so drunk, if you will.” – Vinny (licit)

“I knew that if, on Friday night, I wanted to go get sloshed, and then come back Saturday at 9:00 a.m. and take that pill, and I can get on it [studying]. … Whereas no one else could do that, really. They would be hung over.” – Meredith

• Stimulants and Marijuana

Polydrug use (cont’d ...)

“Well, after I take Adderall, remember how I said I feel like s--t? So I smoke to kind of like make that feeling go away. … My friend told me about it. He's like oh yeah, you should, you're going to feel like s--t after so just do this, smoke pot. [Interviewer: Was it helpful?] Yeah … after I'm done with Adderall for that night, like I'm not doing anything anyway so I think with pot, it kind of helps me feel more relaxed and kind of numbs the physical exhaustion that I feel after I take Adderall.” – Tanya

“I would say the majority of the time taking Adderall I smoked after … I like to smoke after studying. It’s my me time. Time to relax. – Amanda

“Weed and Adderall? I smoke the weed to control. If I get too jittery – too uppity, and I'm grinding [teeth] way too much, okay, I need to smoke to calm down some, and let myself know I got to eat something. If I'm way up in this altitude off of this [Adderall], I need to come down. And it [weed] definitely allows me to levitate.” - Ryan

Rx stimulant use as “cheating”

• “I dislike it on the whole because I think it’s cheating in a sense … using a chemical substance, and I don’t know what the exact WCU policy is on academic honesty, but it’s chemical academic dishonesty to me.” – Derek (licit, Concerta)

• “It totally is … Not cheating, but it is performance enhancing.” – Maryam (illicit)

• “[My boyfriend] is pre-med and he’s getting all these straight A’s and we were having a GPA competition and I was like ‘you’re cheating’ because you’re taking like, brain-aid, this is a learning aid for you, like you’re getting extra help … this has to be a fair playing field.” – Helena (illicit)

On ADHD, “doctor shopping”•Christine - 3rd year Ph.D. student, biological sciences

- First took Ritalin and Adderall illicitly, thus leading her to acquire her own Ritalin prescription: “it really helped me doing schoolwork, and so I thought well, maybe I’ll just see if I can get this for myself.”

- “I really thought it was all like, a hoax … I think I have what people call ADD, I guess I just don’t really feel like it’s really a disorder.”

• Patrick - 4th year, social sciences

- [on ADHD]: “I think it’s bulls--t if you want to know the truth. I mean seriously man, I went in there like “oh no, boo hoo [crying noises]” and I covered my face for a second, I just put on a little acting show and the guy gave me Adderall … I think if they were to do anything, they should probably have a stricter definition of ADHD. ”

- In a fraternity, often sells or gives medication to housemates; has also counseled peers on how to acquire diagnoses and medications through medical channels.

“Doctor shopping” (comparing MMJ & Rx)

• “It’s also weird how anyone can get a medical marijuana card, like as long as you have the money. It’s kind of an abuse of the system as well. I’ve heard too with getting a prescription for Adderall, you just have to go to the doctors and say you have trouble focusing, or something. … Have you seen the medical marijuana doctor [near campus]? It’s right there [off-campus] and right on the window for the shop it lists all the reasons why you can get a marijuana card, like anorexia, trouble sleeping, you know, all that stuff. They’re just telling you how to do it.” – Amanda

• “I don’t really know anybody that’s tried to get a prescription [for Adderall], but I do know people that have tried to get club cards, for example. [Interviewer: For weed?] Yeah, like medicinal marijuana. Like, where they don’t really need it, but they want to get the drugs kinda thing.” – Jenny

Drug diversion and acquisition

• Some purchase stimulants, but many are given it for free. Calling, texting, IM, online forums, residence halls, Greek organizations, and non-WCU sources were all mentioned as methods or networks of obtaining stimulants. Peaks around academic calendar:

• “I’ve bought it … usually you can get it for like 15 mg for $5 … They have ridiculously high prices. Like, they’re making a killing.” – Emily

• “Compassionate diversion”: Adderall $4-$8 (10/20mg), “which is kind of unusual. I know people who say their friends with prescriptions just give it to them.” – Maryam

1. Procrastinators use nootropics to bail them out

2. Experienced users came to rely on nootropics, encouraging procrastination

3. Students used nootropics in advance of deadlines to avoid procrastinating

4. Envisioning life without nootropics, students felt that they would have to procrastinate less; or, assuming that they develop better study habits, nootropics would then become unnecessary

On procrastination ...

“Academic dependence”

• A negative effect is just being dependent on the drug … From an academic perspective, yeah, like I need to take this drug in order to perform to the fullest of my potential … if I had a choice, yeah, I wouldn’t take it—I mean, that doesn’t make sense—I do have the choice, that’s why I’m taking it but if I could not take the drug and still perform better or at the same level, then I wouldn’t take it.” – Eddie

• I’m trying to figure out how to function without it because it’s kind of, you know, necessary … I can’t take the stuff all my life, and the side effects are kind of disagreeable for me. – Derek

• I’m just going to use it to get through graduate school … I would never do something where I would have to take a drug to like, do, but I have to get the Ph.D. I have to get it to do what I want to do which is teach and write.” – Christine

(L/I/C)

“Academic dependence”

• I don’t feel like I need it in any way because I have, you know, gotten here without it and I made it through the first year without it, like I don’t need it, but it’s like “that’s nice” but that’s definitely not something that I’d really go out of my way to get, I don’t think. – Helena

• I definitely want to avoid it, and … I have no intention to like try it again, but I’m not going to say that I won’t … Because when it comes down to it, if I really need to cram for a test and I know my friend has one, then I’ll go ahead. – Sarah

(L/I/C)

Marijuana & Salvia: habits and perceptions, compared to nootropics

• MJ policies currently in flux

• “Creative enhancement” ideals returning:

- Academic benefits less-direct

- Less prone to “academic reliance”

Theoretical Conclusions

• Nootropics inflate perceptions of self-efficacy

• Student Development:

+ Competence

- Autonomy

- Integrity

? Managing emotions

Conclusions

• Many students are self-medicating

- Generally knowledgable, misinformation persists

• Stigmas not a barrier to use

- Unique appeal of nootropics problematizes “prevention”

• ADHD identity confusion (new DSM soon)

• “Drugs” vs. “medicine”; “Doctors” vs. “dealers”

Conclusions & Discussion

• Analogous enhancement in society

• Science is getting better, faster

• Is cessation even a desired outcome in light of perceived benefits? Could more widespread responsible use actually increase human capital?

• What messages are effective at preventing irresponsible nootropic use? Is there such thing as “responsible” illicit use?

Thank you ACHA.Questions? ...

From Recreational to Functional Use

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