Relations between medical and nonmedical prescription stimulant misuse, cannabis use, alcohol use, and related consequences among college students.

OBJECTIVE

Prescription stimulant misuse (PSM) is prevalent among young adults, particularly college students. This study utilized structural equation modeling to examine differences in alcohol use, cannabis use, and alcohol consequences across PSM groups, (no use, appropriate use, medical misuse [i.e., not using one's own prescription as directed], and nonmedical misuse [i.e., using prescription stimulants not prescribed to oneself]) while controlling for psychological factors and other prescription drug use.

METHOD: Participants (N = 1,692, Mage = 19.1, 52.5% male, 70.5% White, 19.5% Hispanic/Latinx) were undergraduates who completed self-reported measures of prescription drug use, alcohol use, cannabis use, alcohol consequences (Brief Young Adult Alcohol Consequences Questionnaire), impulsivity (Short UPPS-P Impulsive Behavior Scale), and internalizing symptoms (Depression Anxiety and Stress Scales-21 [DASS-21]).

RESULTS

Compared to no stimulant use, nonmedical stimulant misuse was associated with higher alcohol use (Wald χ² = 7.288, p = .007, d = 0.275) and cannabis use (Wald χ² = 25.491, p < .001, d = 0.444). Compared to appropriate use, nonmedical misuse was also associated with higher alcohol use (Wald χ² = 4.928, p = .026, d = 0.271) and cannabis use (Wald χ² = 8.215, p = .004, d = 0.349). Medical misuse was linked to greater cannabis use compared to nonuse (Wald χ² = 6.488, p = .011, d = 0.375), but not to alcohol use or consequences.

CONCLUSIONS

Nonmedical misuse was associated with higher alcohol and cannabis use, while medical misuse was more specifically linked to cannabis use. These findings support tailored interventions addressing unique misuse subtypes and substance use patterns. Future research should explore motivational and contextual factors. (PsycInfo Database Record (c) 2026 APA, all rights reserved).