Adolescents’ prescription stimulant use and adult functional outcomes: a national prospective study
Open accessAbstract
Objective To assess the prospective 17-year relationship between the medical and nonmedical use of prescription stimulants during adolescence (age 18 years) and educational attainment and substance use disorder (SUD) symptoms in adulthood (age 35 years).Method A survey was self-administered by nationally representative probability samples of US high school seniors from the Monitoring the Future study; 8,362 of these individuals were followed longitudinally from adolescence (age 18, high school senior years 1976-1996) to adulthood (age 35, 1993-2013).Results An estimated 8.1% reported medical use of prescription stimulants, and 16.7% reported nonmedical use of prescription stimulants by age 18 years. Approximately 43% of adolescent medical users of prescription stimulants had also engaged in nonmedical use of prescription stimulants during adolescence. Among past-year adolescent nonmedical users of prescription stimulants, 97.3% had used at least one other substance during the past year. Medical users of prescription stimulants without any history of nonmedical use during adolescence did not differ significantly from population controls (i.e., non-attention-deficit/hyperactivity disorder [ADHD] and non-stimulant-medicated ADHD during adolescence) in educational attainment and SUD symptoms in adulthood. In contrast, adolescent nonmedical users of prescription stimulants (with or without medical use) had lower educational attainment and more SUD symptoms in adulthood, compared to population controls and medical users of prescription stimulants without nonmedical use during adolescence.Conclusion Nonmedical use of prescription stimulants is common among adolescents prescribed these medications. The findings indicate youth should be carefully monitored for nonmedical use because this behavior is associated with lower educational attainment and more SUD symptoms in adulthood.
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In a US prospective study, non-medical prescription stimulant users were 17% less likely to earn a bachelor's degree than those with neither medical nor non-medical use.
“Those who used prescription stimulants non-medically were 17% less likely to earn a bachelor’s degree than those who had neither medical or non-medical use (McCabe et al., 2017).”
From The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder (2021) · cites this paper as McCabe et al., 2017
The Methods (Measures; page unavailable) define population controls as adolescents with neither medical nor nonmedical stimulant use. The Results (Predicting adult educational attainment; page unavailable) report significantly lower odds of earning a bachelor’s degree by age 35 among adolescent nonmedical users than among those controls, but the passages in our copy do not give the claimed 17% figure. (LLM, conf=0.86)
Experimental — accuracy not yet measuredNon-medical use of prescription stimulants in individuals without ADHD is associated with lower educational attainment.
“The non-medical use of prescribed stimulants in individuals without ADHD is associated with lower educational attainment.”
From The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder (2021) · cites this paper as McCabe et al., 2017
The Results section ('Predicting adult educational attainment'; page unavailable) reports that adolescents who used prescription stimulants nonmedically had lower odds of obtaining a college degree by age 35. It does not report this association specifically for individuals without ADHD; the nonmedical-use groups include people with and without a history of medical stimulant use. (LLM, conf=0.86)
Experimental — accuracy not yet measuredADHD is itself an important risk factor for illicit stimulant misuse and SUD.
“While multiple studies have shown that ADHD is itself an important risk factor for illicit stimulant misuse and SUD, 5,12,15,[20][21][22][23][24]”
From Is Age of Onset and Duration of Stimulant Therapy for ADHD Associated with Cocaine, Methamphetamine, and Prescription Stimulant Misuse? (2024) · cites this paper as [12]
The Discussion states that ADHD is associated with higher rates of SUD. It also reports nonmedical stimulant use among adolescents prescribed stimulants, but does not establish that ADHD itself is a risk factor for illicit stimulant misuse; its discussion identifies other possible risk factors. No page numbers are available in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measured
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“Those who used prescription stimulants non-medically were 17 % less likely to earn a bachelor ’ s degree than those who had neither medical or non-medical use (McCabe et al., 2017).”
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“A nationally-representative longitudinal study that followed individuals to age 35 found that adults who reported stimulant misuse in adolescence had lower educational attainment and more symptoms of substance use disorder than those who never used prescription stimulants and those who used prescription stimulants med…”
BackgroundMcCabe, S. E., Schulenberg, J. E., Schepis, T. S., McCabe, V. V., & Veliz, P. T. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.5324 · Cited by 79 · see citing works
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Self-citationMcCabe, S. E., Figueroa, O., McCabe, V. V., Schepis, T. S., Schulenberg, J. E., Veliz, P. T., Werner, K. S., & Wilens, T. E. (2024) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13807 · Cited by 22 · see citing works
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- Authors
- McCabe, S. E., Veliz, P., Wilens, T. E., & Schulenberg, J. E.
- Affiliations
- University of Michigan (US)
- Harvard University (US)
- Corresponding author
- McCabe, Sean Esteban
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2017-03
- Volume
- 56
- Issue
- 3
- Pages
- 226-233.e4
- ISSN
- 0890-8567 (ISSN-L)
- PMC
- PMC5462599
- OpenAlex
- W2564050511
- Cited by
- 76
- References
- 45
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 6 · 2023: 6 · 2022: 12 · 2021: 12 · 2020: 13 · 2019: 6 · 2018: 11 · 2017: 4
- FWCI
- 4.44
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (R01DA036541, R01DA031160, R01DA016575, R01DA001411)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neuroethics, Human Enhancement, Biomedical Innovations
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- stimulant medication, nonmedical use, medical use, adolescents, ADHD medication, stimulant abuse, substance use disorders, educational attainment, long-term outcomes, high school seniors, Monitoring the Future
- MeSH terms
- Adolescent, Adult, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Educational Status, Female, Health Surveys, Humans, Male, Prospective Studies, United States, Substance-Related Disorders, Prescription Drug Misuse
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