Predicting college student prescription stimulant misuse: An analysis from ecological momentary assessment.

Abstract

Prescription stimulant misuse (PSM) is common in young adult college students, at over 10% in the past year, and it is associated with other substance use and risk behaviors. Research focused on the real-time drivers of PSM is absent, impeding prevention and intervention. This research aimed to fill that gap by examining the relationships between affect, global stress, or academic stress and PSM via ecological momentary assessment (EMA); we also investigated baseline predictors of PSM frequency during the 21-day EMA period. Forty-one full-time college students (mean age: 20.5, 66% female) who endorsed current PSM (Ն 6 past-year episodes) participated. Participants were asked to complete EMA questions in response to 3 daily investigator-initiated prompts and after every PSM episode. Assessments were selected based on affect regulation (e.g., positive affect [PA], negative affect [NA]) and drug instrumentalization (e.g., academic stress and/or demands) theories of substance use. Mixed-effects linear models examined EMA data, and negative binomial regression analyses examined baseline predictors of PSM episode frequency. PA was higher on PSM days and increased post-PSM, whereas NA was unrelated to PSM. Although global and academic stress were largely unrelated to PSM, when the motive endorsed for PSM was "to study," pre-PSM ratings of academic demand and stress were significantly higher. Finally, a history of recreational motives (e.g., to get high) or higher levels of attention-deficit/ hyperactivity disorder symptoms predicted a greater number of PSM episodes over the EMA period. The results offered mixed support for both affect regulation and instrumentalization as applied to PSM.

Real-time momentary mood as a predictor of college students’ prescription drug misuse in daily life: Direct links and the moderating role of background mental health.

“…Theory suggests that problematic substance use occurs as a means to reduce negative mood (Khantzian, 1997), which provides a simple and reasonable explanation for the documented within- and between-person links between negative mood and prescription misuse behaviors. Interestingly, the unexpected finding of elevated momentary positive mood predicting misuse does align with recent evidence from a different college-based sample: Schepis et al (2020) collected participants’ reported motives for prescription stimulant misuse soon after the occurrence of the behavior in daily life. They found that positive mood reliably increased in the hours following misuse occurrence, and thus interpreted positivity enhancement —or the motivation to increase positive feelings—as a key driver of students’ prescription stimulant misuse in daily life (Schepis et al, 2020).…”

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The present study addressed calls for research to identify real-time predictors of prescription drug misuse (Schepis et al, 2020) by testing young adults' momentary reports of their negative mood and positive mood as predictors of event-level misuse in daily life. We implemented a 28-day ecological momentary assessment (EMA) procedure that collected individuals' mood and other contextual experiences in moments preceding prescription drug misuse.

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Academic factors associated with college students’ prescription stimulant misuse in daily life: An ecological analysis of multiple levels

“…Interestingly, recent research that collected college students' motivations for stimulant misuse soon after the behavior had occurred documented greater positive affect on days with the misuse. 50 Clearly, incorporating multiple domains of real-time triggers of prescription drug misuse is warranted in future research.…”

College-based social and situational predictors of real-time prescription drug misuse in daily life

“…Such misuse is commonly documented via retrospective reports of behaviors over the past year (McCauley et al, 2011) or previous semester (Chinneck et al, 2018). Researchers (Nargiso et al, 2015;Schepis et al, 2020) have called for ecologically-based investigations of prescription drug misuse to identify its triggers in real-world environments to advance prevention and intervention efforts. Ecologically-based methods, such as ecological momentary assessment (EMA), offer advantages of reducing recall biases and -critically for research on misuse in which the clinical effect of the medications can reinforce expected outcomes-collecting contextual and psychological experiences prior to the occurrence of the behavior (Ferguson & Shiffman, 2011;Shiffman et al, 2008).…”

“…Ecologically-based methods, such as ecological momentary assessment (EMA), offer advantages of reducing recall biases and -critically for research on misuse in which the clinical effect of the medications can reinforce expected outcomes-collecting contextual and psychological experiences prior to the occurrence of the behavior (Ferguson & Shiffman, 2011;Shiffman et al, 2008). Recent studies assessing substance use behavior close to its occurrence Schepis et al, 2020) have been useful for identifying predictors of behavior, offering useful information for prevention and treatment efforts. EMA also allows assessment of the contextual setting of substance use behaviors.…”