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For college students, peer use of compliance-gaining strategies predicts diversion of medication

Previous research has found that students who engage in nonmedical prescription stimulant use (NMPU) report obtaining these drugs from a friend, peer, or acquaintance with a legitimate prescription. A new study examined whether emerging adults with a stimulant prescription who reported greater exposure to compliance-gaining (i.e., how people persuade others “to perform a desired behavior”) attempts from peers, specifically rational appeals for academic work, would be more likely to divert (i.e., sell or give away medication), as would emerging adults who reported lower resistance to peer influence. Participants (N = 149) were recruited from two college campuses and had to be at least 18 years old and have a self-reported diagnosis of ADHD for which they had been prescribed stimulant medication at some point in college. Participants completed an online survey, in which they responded to questions about demographic characteristics, prescription history and medication misuse. The survey also measured ADHD symptom severity using the Adult ADHD Self-Report Scale Symptom Checklist. Exposure and responses to compliance-gaining strategies as well as willingness to divert was measured by presenting participants with five compliance-gaining scenarios followed by their responses to questions, such as “I would give or sell my medication”. Resistance to peer influence was assessed using the Resistance to Peer Influence (RPI) Scale. Lastly, perceived prevalence of NMPSU was measured by having participants indicate the percentage of students on their campus as well as at other colleges that they believed engaged in NMPSU. The authors used a multiple logistic regression model to assess which study variables predicted membership in the diversion group. They also used between-within subjects ANOVAS to examine the relationship between the compliance-gaining strategies and willingness to divert. In addition, chi-square tests were used to assess categorical variables such as gender and t-tests for the continuous variables such as ADHD symptom severity. Results showed that 36% of participants endorsed diverting their medication in the previous year and 58% reported being approached in college. Furthermore, students who diverted were more likely to endorse Greek organization membership (OR = 8.50 [1.879, 38.817]), northeast college attendance (OR = .079 [.014, .431]), greater exposure to compliance-gaining strategies (OR 1.888 [1.132, 3.148]), fewer concerns about being caught (OR .482 [.298, .780]), and less anticipated guilt about diversion (OR .453 [.260, .790]). In addition, private high school attendance was a predictor of diversion (OR 6.377 [1.089, 37.341]). Diverters reported greater overall exposure to the compliance-gaining strategies than nondiverters (p < .001). Participants were exposed to the rational-academic strategy more often than the other compliance-gaining strategies. Moreover, participants were most likely to divert in response to the rational-academic strategy followed by the negative feelings strategy (p = .10). Among participants who diverted, 39% agreed “somewhat” or “strongly” that they felt manipulated after diverting and 34% reported feeling used. In addition, 24% agreed “somewhat” or “strongly” that they ran out of their medication because they diverted it.

Take away: Exposure to compliance-gaining strategies, Greek involvement, Northeast college attendance, and less guilt and worry about diversion predicted diversion among college students. More specifically, rational appeals for academic work and guilt-inducing strategies were associated with the greatest likelihood of diversion.

Holt, L. J., Marut, P. N., & Schepis, T. S. (2017). Pursued for Their Prescription: Exposure to Compliance-Gaining Strategies Predicts Stimulant Diversion in Emerging Adults. Psychology of addictive behaviors: journal of the Society of Psychologists in Addictive Behaviors.

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