Prevention Science

, 9:191 | Cite as

Perceived Harmfulness Predicts Nonmedical Use of Prescription Drugs Among College Students: Interactions with Sensation-Seeking

  • Amelia M. Arria
  • Kimberly M. Caldeira
  • Kathryn B. Vincent
  • Kevin E. O’Grady
  • Eric D. Wish


This study describes the level of perceived harmfulness of nonmedical prescription stimulant and analgesic use in a sample of college students, and examines the prospective relationship between perceived harmfulness and subsequent nonmedical use. In addition, we explore whether the association between perceived harmfulness and nonmedical use varies by level of sensation-seeking. Personal interviews, including questions on sensation-seeking and drug use, were conducted with 1,253 first-year college students. Participants were then followed-up twice at 6-month intervals. Perceived harmfulness of nonmedical use of prescription drugs was assessed at 6 months via a web-based survey. At the 12-month follow-up interview, drug use was again assessed. Students who never had the opportunity to use prescription drugs nonmedically were excluded from all analyses. Results revealed that one in four students perceived a great risk of harm from occasional nonmedical use of prescription stimulants (25.2%) and analgesics (27.8%). As expected, low perceived harmfulness and high sensation-seeking were independently associated with increased risk of nonmedical use, holding constant demographic characteristics. The protective effect of high perceived harmfulness could be seen at all levels of sensation-seeking with one important exception: Among high sensation-seekers, perceived harmfulness was not related to nonmedical use of prescription analgesics. Perceived harmfulness appears to distinguish nonmedical users from non-users, given the opportunity to use. Increasing perceived harmfulness may be a viable prevention strategy for most students, but alternative approaches might need to be developed that are tailored to high sensation-seekers.


Nonmedical prescription drug use College students Prevention Risk-taking Perceived harm 



The investigators would like to acknowledge funding from the National Institute on Drug Abuse (R01DA14845, Dr. Arria, PI). Special thanks are given to our Lead Interviewer, Elizabeth Zarate, our Graduate Assistant, Laura Garnier, the interviewing team, and the participants.


  1. Anthony, J. C., Warner, L. A., & Kessler, R. C. (1994). Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants: Basic findings from the National Comorbidity Survey. Experimental and Clinical Psychopharmacology, 2, 244–268. doi: 10.1037/1064-1297.2.3.244.CrossRefGoogle Scholar
  2. Arria, A. M., Caldeira, K. M., O’Grady, K. E., Vincent, K. B., Fitzelle, D. B., Johnson, E. P., et al. (2008a). Drug exposure opportunities and use patterns among college students: Results of a longitudinal prospective cohort study. Substance Abuse, 29.Google Scholar
  3. Arria, A., O’Grady, K., Caldeira, K., Vincent, K., & Wish, E. (2008b). Nonmedical use of prescription stimulants and analgesics: Associations with social and academic behaviors among college students. Journal of Drug Issues, 38.Google Scholar
  4. Arria, A. M., & Wish, E. D. (2005). Nonmedical use of prescription stimulants among students. Psychiatric Annals, 35, 228–235.Google Scholar
  5. Bachman, J. G., Johnston, L. D., & O’Malley, P. M. (1990). Explaining the recent decline in cocaine use among young adults: Further evidence that perceived risks and disapproval lead to reduced drug use. Journal of Health and Social Behavior, 31, 173–184. doi: 10.2307/2137171.PubMedCrossRefGoogle Scholar
  6. Bachman, J. G., Johnston, L. D., & O’Malley, P. M. (1998). Explaining recent increases in students marijuana use: Impacts of perceived risks and disapproval 1976–1996. American Journal of Public Health, 88, 887–892.PubMedCrossRefGoogle Scholar
  7. Bachman, J. G., Johnston, L. D., O’Malley, P. M., & Humphrey, R. H. (1988). Explaining the recent decline in marijuana use: Differentiating the effects of perceived risks, disapproval, and general lifestyle factors. Journal of Health and Social Behavior, 29, 92–112. doi: 10.2307/2137183.PubMedCrossRefGoogle Scholar
  8. Barrett, S. P., Darredeau, C., Bordy, L. E., & Pihl, R. O. (2005). Characteristics of methylphenidate misuse in a university student sample. Canadian Journal of Psychiatry, 50, 457–461.Google Scholar
  9. Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Cambridge, MA: Harvard University Press.Google Scholar
  10. Carroll, B. C., McLaughlin, T. J., & Blake, D. R. (2006). Patterns and knowledge of nonmedical use of stimulants among college students. Archives of Pediatrics & Adolescent Medicine, 160, 481–485. doi: 10.1001/archpedi.160.5.481.CrossRefGoogle Scholar
  11. Catalano, R., & Hawkins, J. D. (1996). The Social Development Model: A theory of antisocial behavior. In J. D. Hawkins (Ed.), Delinquency and crime: Current theories (pp. 149–197). New York: Cambridge University Press.Google Scholar
  12. Chambers, R. A., Taylor, J. R., & Potenza, M. N. (2003). Developmental neurocircuitry of motivation in adolescence: A critical period of addiction vulnerability. The American Journal of Psychiatry, 106, 1041–1052. doi: 10.1176/appi.ajp.160.6.1041.CrossRefGoogle Scholar
  13. Chassin, L., Presson, C. C., Rose, J. S., & Sherman, S. J. (2001). From adolescence to adulthood: Age-related changes in beliefs about cigarette smoking in a midwestern community sample. Health Psychology, 20, 377–386. doi: 10.1037/0278-6133.20.5.377.PubMedCrossRefGoogle Scholar
  14. Donohew, L., Helm, D. M., Lawrence, P., Shatzer, M. J., & Watson, R. R. (1990). Sensation seeking, marijuana use, and responses to prevention messages: Implications for public health campaigns. In Watson, R. (Ed.) Drug and alcohol abuse prevention (pp. 73–93). Totowa, NJ: Humana.Google Scholar
  15. Drug Abuse Warning Network (2007). DAWN, 2005: National estimates of drug-related emergency department visits. Rockville, MD.Google Scholar
  16. Duistman, D. M., & Colbry, S. L. (1995). Perceived risk and use as predictors of substance use among college students. Health Values: The Journal of Health Behavior. Education & Promotion, 19, 44–52.Google Scholar
  17. Friedman, R. A. (2006). The changing face of teenage drug abuse: The trend toward prescription drugs. The New England Journal of Medicine, 354, 1448–1450. doi: 10.1056/NEJMp068010.PubMedCrossRefGoogle Scholar
  18. Fuster, J. M. (2002). Frontal lobe and cognitive development. Journal of Neurocytology, 31, 373–385. doi: 10.1023/A:1024190429920.PubMedCrossRefGoogle Scholar
  19. Gonzalez, G. M., & Haney, M. L. (1990). Perceptions of risk as predictors of alcohol, marijuana, and cocaine use among college students. Journal of College Student Development, 31, 313–318.Google Scholar
  20. Hall, K. M., Irwin, M. M., Bowman, K. A., Frankenberger, W., & Jewett, D. C. (2005). Illicit use of prescribed stimulant medication among college students. Journal of American College Health, 53, 167–174. doi: 10.3200/JACH.53.4.167–174.PubMedCrossRefGoogle Scholar
  21. Hawkins, J. D., Catalano, R. F., & Miller, J. Y. (1992). Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: Implications for substance abuse prevention. Psychological Bulletin, 112, 64–105. doi: 10.1037/0033–2909.112.1.64.PubMedCrossRefGoogle Scholar
  22. Herman-Stahl, M. A., Krebs, C. P., Kroutil, L. A., & Heller, D. C. (2007). Risk and protective factors for methamphetamine use and nonmedical use of prescription stimulants among young adults aged 18 to 25. Addictive Behaviors, 32, 1003–1015. doi: 10.1016/j.addbeh.2006.07.010.PubMedCrossRefGoogle Scholar
  23. Johnston, L. D., O’Malley, P. M., & Bachman, J. G. (2004). Monitoring the future: National results on adolescent drug use. Overview of key findings, 2003. Ann Arbor, MI: University of Michigan Institute for Social Research.Google Scholar
  24. Krawczyk, D. (2002). Contributions of the prefrontal cortex to the neural basis of human decision making. Neuroscience and Biobehavioral Reviews, 26, 631–664. doi: 10.1016/S0149-7634(02)00021-0.PubMedCrossRefGoogle Scholar
  25. Low, K. G., & Gendaszek, A. E. (2002). Illicit use of psychostimulants among college students: A preliminary study. Psychology Health and Medicine, 7, 283–287. doi: 10.1080/13548500220139386.CrossRefGoogle Scholar
  26. McCabe, S. E., Knight, J. R., Teter, C. J., & Wechsler, H. (2005a). Non-medical use of prescription stimulants among US college students: Prevalence and correlates from a national survey. Addiction, 100, 96–106. doi: 10.1111/j.1360-0443.2005.00944.x.Google Scholar
  27. McCabe, S. E., Teter, C. J., & Boyd, C. J. (2005b). Illicit use of prescription pain medication among college students. Drug and Alcohol Dependence, 77, 37–47. doi: 10.1016/j.drugalcdep.2004.07.005.PubMedCrossRefGoogle Scholar
  28. McCabe, S. E., Teter, C. J., & Boyd, C. J. (2006a). Medical use, illicit use and diversion of prescription stimulant medication. Journal of Psychoactive Drugs, 38, 43–56.PubMedGoogle Scholar
  29. McCabe, S. E., Teter, C. J., & Boyd, C. J. (2006b). Medical use, illicit use, and diversion of abusable prescription drugs. Journal of American College Health, 54, 269–278. doi: 10.3200/JACH.54.5.269-278.PubMedCrossRefGoogle Scholar
  30. McCabe, S. E., Teter, C. J., Boyd, C. J., Knight, J. R., & Wechsler, H. (2005c). Nonmedical use of prescription opioids among U.S. college students: Prevalence and correlates from a national survey. Addictive Behaviors, 30, 789–805. doi: 10.1016/j.addbeh.2004.08.024.PubMedCrossRefGoogle Scholar
  31. Miller, N. S. (2004). Prescription opiate medications: Medical uses and consequences, laws and controls. The Psychiatric Clinics of North America, 27, 689–708. doi: 10.1016/j.psc.2004.07.004.PubMedCrossRefGoogle Scholar
  32. Nelson, C. B., Bloom, F. E., Cameron, J. L., Amaral, D., & Pine, D. (2002). An integrative multidisciplinary approach to the study of brain-behavior relations in the context of typical and atypical development. Development and Psychopathology, 14, 499–520. doi: 10.1017/S0954579402003061.PubMedCrossRefGoogle Scholar
  33. Palmgreen, P., Donohew, L., Lorch, E. P., & Rogus, M. (1991). Sensation seeking, message sensation value, and drug use as mediators of PSA effectiveness. Health Communication, 3, 217–227. doi: 10.1207/s15327027hc0304_4.CrossRefGoogle Scholar
  34. Prudhomme-White, B., Becker-Blease, K. A., & Grace-Bishop, K. (2006). Stimulant medication use, misuse, and abuse in an undergraduate and graduate student sample. Journal of American College Health, 54, 261–268. doi: 10.3200/JACH.54.5.261-268.CrossRefGoogle Scholar
  35. Reyna, V. F., & Farley, F. (2006). Risk and rationality in adolescent decision making: Implications for theory, practice, and public policy. Psychological Science in the Public Interest, 7, 1–44. doi: 10.1111/j.1529-1006.2006.00026.x.CrossRefGoogle Scholar
  36. Rolison, M. R., & Scherman, A. (2002). Factors influencing adolescents’ decisions to engage in risk-taking behavior. Adolescence, 37, 585–596.PubMedGoogle Scholar
  37. Romer, D., & Hennessy, M. (2007). A biosocial-affect model of adolescent sensation seeking: The role of affect evaluation and peer-group influence in adolescent drug use. Prevention Science, 8, 89–101. doi: 10.1007/s11121-007-0064-7.PubMedCrossRefGoogle Scholar
  38. Spear, L. P. (2000). The adolescent brain and age-related behavioral manifestations. Neuroscience and Biobehavioral Reviews, 24, 417–463. doi: 10.1016/S0149-7634(00)00014-2.PubMedCrossRefGoogle Scholar
  39. Substance Abuse and Mental Health Services Administration (2001). Results from the 2001 National Household Survey on Drug Abuse: Volume III. Detailed Tables. Retrieved December 17, 2007 from
  40. Substance Abuse and Mental Health Services Administration (2003). 2002 National Survey on Drug Use and Health Questionnaire. Retrieved September 26, 2006 from
  41. Substance Abuse and Mental Health Services Administration (2007a). Results from the 2006 National Survey on Drug Use and Health: National Findings (No. DHHS Publication No. SMA 7-4293).Google Scholar
  42. Substance Abuse and Mental Health Services Administration (2007b). Treatment Episode Data Set (TEDS): 1995–2005: National admissions to substance abuse treatment services. Rockville, MD, USA.Google Scholar
  43. Teter, C. J., McCabe, S. E., Boyd, C. J., & Guthrie, S. K. (2003). Illicit methylphenidate use in an undergraduate student sample: Prevalence and risk factors. Pharmacotherapy, 23, 609. doi: 10.1592/phco.23.5.609.34187.PubMedCrossRefGoogle Scholar
  44. United States Food and Drug Administration (2005). Patient information sheet: Adderall and Adderall XR Extended-Release Capsules.Google Scholar
  45. United States Food and Drug Administration (2007a). Medication guide: Adderall® CII.Google Scholar
  46. United States Food and Drug Administration (2007b). Medication Guide: Concerta® (kon SER-ta) (methylphenidate HCl) Extended-release Tablets CII.Google Scholar
  47. United States Food and Drug Administration (2007c). Medication Guide: Ritalin LA® (methylphenidate hydrochloride) extended-release capsules CII.Google Scholar
  48. Vincent, K. B. (2005). The ecstasy and methamphetamine drug epidemics: Implications for policy and control. Unpublished thesis. University of Maryland, College Park, MD, USA.Google Scholar
  49. Zickler, P. (1999). NIDA launches initiative to combat club drugs. NIDA Notes, 14(6), 2.Google Scholar
  50. Zuckerman, M. (1994). Behavioral expressions and biosocial bases of sensation seeking. New York: Cambridge University Press.Google Scholar
  51. Zuckerman, M. (2002). Zuckerman–Kuhlman Personality Questionnaire (ZKPQ): An alternative five-factorial model. In B. de Raad & M. Perugini (Eds.), Big Five assessment (pp. 377–396). Seattle: Hogrefe & Huber.Google Scholar
  52. Zuckerman, M., & Kuhlman, D. M. (2000). Personality and risk taking: Common biosocial factors. Journal of Personality, 68, 999–1029. doi: 10.1111/1467–6494.00124.PubMedCrossRefGoogle Scholar
  53. Zuckerman, M., Neary, R. S., & Brustman, B. A. (1970). Sensation-Seeking Scale correlates in experience (smoking, drugs, alcohol, ‘hallucinations,’ and sex) and preference for complexity (designs). Proceedings of the Annual Convention of the American Psychological Association, 5, 317–318.Google Scholar

Copyright information

© Society for Prevention Research 2008

Authors and Affiliations

  • Amelia M. Arria
    • 1
  • Kimberly M. Caldeira
    • 1
  • Kathryn B. Vincent
    • 1
  • Kevin E. O’Grady
    • 2
  • Eric D. Wish
    • 1
  1. 1.Center for Substance Abuse Research (CESAR)University of MarylandCollege ParkUSA
  2. 2.3147F Biology/Psychology Building, Department of PsychologyUniversity of MarylandCollege ParkUSA

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