College Students Who Abuse Psychoactive Substances Might Land in a “Vicious Loop”

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Abusing psychoactive substances, such as ADHD medication, cannabis, and nicotine, not only creates an addiction but can impact mental distress.

A survey of college students found people who use psychoactive substances may or may not be inclined to use other psychoactive substances, creating a “vicious loop.” This may affect brain functions in the brain stem, amygdala, and prefrontal cortex, and this vicious cycle may impact their mental distress.1

“The results of this study indicate many hallmarks of using different kinds of drugs tend to be correlated with negative mental distress while others have positive mental distress as well as an inclination to use certain other drugs and declination to use certain drugs simultaneously,” wrote investigators, led by Nicole Scott from Binghamton University.

College students may turn to ADHD medications, such as Adderall and Vyvanse, to help with studying—hence why they are often referred to as “study drugs.” Students may also take ADHD medications to manage mental health issues. Although the stimulant in Adderall, methylphenidate, was considered “non-addictive” to treat children with ADHD in 1944, abusing Adderall may lead to dependence.

It can be easy for a college student to get their hands on ADHD medication. Many will seek a healthcare provider and feign ADHD symptoms hoping to get a prescription—and they do.

Using ADHD medication illicitly can make it become a gateway drug, leading students to abuse the other common substances on a college campus, such as cannabis, nicotine, or other psychoactive drugs. Before the study, it was unknown what type of drug students might turn to. Additionally, it was not known what psychoactive substances were linked to mental distress.

To answer these questions, investigators conducted a study evaluating the psychoactive substances college students abuse after using illicit ADHD medication, as well as how psychiatric substances are linked to mental distress. Another recent study explored how substance use is linked to psychiatric symptoms and Randi Schuster, PhD, from Massachusetts General Hospital, told HCPLive how “substance use is often the smoke, but not the fire itself."2,3 Meaning, people who engage with substance use are often already dealing with symptoms of distress.

In total, 702 college undergraduate students completed an anonymous online survey.1 The survey collected data on demographics, use of ADHD medication, cannabis, nicotine, other psychoactive drugs, alcohol, academic performance, and mental distress. Students also reported their views on the use of illicit study drugs.

Investigators assessed mental distress using the Kessler Psychological Distress 6 Scale. Additionally, the Stress Mindset Scale and the Perceived Stress Scale assessed the potential relationship between substance use and a stress mindset leading to stressful feelings. The Brief Resilience Scale assessed the impact of these substances on resilience.

The study included people aged 18 – 29 years, 30 – 39 years, 40 – 49 years, ≥ 50 years, and the 18 – 29-year age group made up approximately 94.3% of the respondents. Approximately 60% of the respondents were female.

Many respondents attended Binghamton University (about 76%) with the predominant major being the natural sciences (biology, chemistry, neuroscience, engineering, and math). Most of the respondents had a GPA between 3.5 and 4.0. Although most students studied in North America or Central America, a small percentage studied in South America, Europe, Asia, Africa, Middle East/North Africa, and some preferred not to say.

The team found using ADHD medication, cannabis, and nicotine had both statistically significant positive and negative correlations to specific psychoactive substances. For instance, for those who used ADHD medication, participants reported either cannabis use 3 – 5 times or 10 – 19 times in the last 12 months, adrenochrome use 6 – 9 times in the last 12 months, ecstasy/MDMA use either not in the past 12 months or 6 – 9 times in the last 12 months, and smoking ≥ 100 cigarettes in life or ≥ 1 cigarette every day during the last month. The team found a statistically significant negative correlation between ADHD medication use and the use of glue or other solvents 6 – 9 times in the last 12 months (P < .05).

Also, using ADHD medication, cannabis, and nicotine had statistically significant positive and negative relationships to specific mental distress experiences.

Participants who illicitly or non-illicitly used ADHD medication had a positive correlation with feelings of worthlessness, hopelessness, inability to work or complete normal activities, and rating their mental health (P < .01). The team saw a statistically significant negative correlation between using ADHD medication and feeling restless or fidgety (P < .01). Investigators also noted a statistically significant positive correlation between using ADHD medication feeling like everything took too much (P < .05).

“Our results showed conflicting correlations, stating that ADHD medication usage had a positive correlation to self-rated mental health and a negative correlation to feelings of restlessness/fidgetiness,” investigators wrote. “Since that correlation focused on overall ADHD usage, not differentiating between prescribed and illicit use, it may be accounting for the benefits of ADHD medication usage on people who have been diagnosed with ADHD/ADD and have been prescribed the medication by a physician.”

Frequent cannabis use (P < .01), as well as non-frequent (P < .01) and frequent nicotine use, are both linked to worsened mental health (P < .01). Examples of mental distress for frequent cannabis use include getting upset because something happened unexpectedly, feeling unable to control important aspects in your life, and feeling like everything was an effort.

Investigators pointed out limitations, such as the small sample size, self-reported data, the influence of cultural norms and outside pressures, participants not knowing what a specific drug was, gender-neutral participants, or people who put “prefer not to say” for gender not being included in the results, and the survey mostly being advertised in the Binghamton area.

“To aid with the substance abuse epidemic experienced by 18-29-year-olds in college, who are the largest impacted population, colleges should aim to educate their students through educational programs or presentation of healthy alternatives, better ways to cope with stress, and ways to get help either through mental health or substance abuse counseling,” investigators concluded.


Scott, N, Dwyer, E, Patrissy, C, et al. Association between ADHD Medication, Cannabis, and Nicotine Use, Mental Distress, and Other Psychoactive Substances. World Academy of Science, Engineering and Technology, Open Science Index 205, International Journal of Psychological and Behavioral Sciences. 2024; 18(1), 62 - 71.

Derman, C. Single Substance Not Linked to Single Psychiatric Symptom in Adolescents. HCPLive. January 29, 2024. Accessed March 29, 2024.

Derman, C. Understanding the Link Between Substance Use and Psychiatric Symptoms, with Randi Schuster, PhD. HCPLive. January 31, 2024. Accessed March 29, 2024.