Subtypes of prescription stimulant misuse among students: a nuanced story

Research on stimulant misuse among students has been rising. These medicines are generally prescribed to treat ADHD, but they are also used by students to enhance their academic performance. To date, qualitative research on the topic is limited, specifically in understanding the process of misuse, i.e. the motivations embedded in a particular academic and social context driving students' decision to use. The aim of this research was to develop subtypes by disentangling patterns in the process of stimulant misuse. We conducted a focus group (n = 5) and semi-structured interviews (n = 28) with Flemish university students who had misused stimulants during their academic career. We employed abductive analysis principles, in which we build on Conrad's medicalization and enhancement theory and Cox and Klinger's motivational model of alcohol use. Two dimensions were key in differentiating theoretically meaningful subtypes: (1) perception of academic need and (2) frequency of use. The normalization subtype indicates having concentration problems and structurally uses stimulants to deal with these problems; the rescue subtype is able to study without stimulants, but occasionally uses them to cope with academic demands and/or personal stressors; the experimental subtype does not have an academic need to use stimulants, but temporarily uses them out of curiosity; the performance subtype does not need the medication, but perceives it as a convenient tool to structurally facilitate academic life, e.g. to shorten the study process. Our study shows a nuanced story of students' stimulant misuse and helps inform the development of tailored preventive measures.