Attention-deficit/hyperactivity disorder (ADHD) is one of the most common disabilities among college students, and its prevalence has increased over time. Although stimulant medications effectively ameliorate ADHD symptoms and improve executive functioning, they also carry risks such as side effects and prescription stimulant diversion (PSD)—the giving, selling, or trading of prescribed medication. Because most students who misuse stimulants obtain them from peers with prescriptions, PSD has become a growing concern. Prior research suggests that equipping prescribed students with effective strategies to resist diversion requests may reduce both PSD and misuse. Research on refusal strategies from the communication literature, particularly those addressing offers of drugs and alcohol, provides useful guidance on the types of resistance strategies—explanations, excuses, direct refusals, and alternatives—that prescribed students might employ when approached for their medication. Building on this literature, the present study aims to examine how college students resist requests for their stimulant medication and whether the use of previously identified effective resistance strategies is associated with PSD or being approached for one’s medication, within the context of a web-based intervention providing explicit resistance skills training.
This study was part of a larger randomized controlled trial (RCT; N=235) aimed at preventing prescription stimulant diversion (PSD) and misuse. The RCT included an active web-based intervention—grounded in social learning and planned behavior theories—and a placebo tutorial, with both groups receiving booster sessions and follow-up assessments. Participants in the present study (N=71) were individuals aged 17–25 with a current prescription for stimulant medication who were enrolled at one of the three participating universities during the six-month study period. To be eligible for this sub-study, participants had to report being approached to give away, sell, or trade their stimulant medication in the past three months and provide at least one open-ended response describing how they refused such requests. Data were collected through online surveys administered at baseline, 3 months, and 6 months, which assessed experiences with diversion requests and resistance strategies. Qualitative responses were analyzed using deductive content analysis to categorize resistance strategies based on established theoretical frameworks.
According to the study findings, most participants’ responses aligned with the four resistance strategy categories identified in prior research—explanations, excuses, direct refusals, and alternatives—with the current study identifying an additional category, non-response (deflecting/ignoring). Within explanations, internal explanations (e.g., emphasizing one’s own need for medication) were most frequent, followed by external explanations (e.g., citing the national stimulant shortage) and less common ineffectiveness concerns (noting potential side effects for peers). Excuses (e.g., running out of pills) were used by about one-quarter of participants, while direct refusals were brief and assertive, and alternatives included suggesting other activities or ADHD testing. Strategy use was evenly distributed across intervention and placebo groups, and the intervention did not significantly increase the proportion of more effective strategizers at 3 or 6 months. However, at 6 months, less effective strategizers were more likely to report diversion compared to more effective ones. Although the frequency of being approached varied widely more frequent approaches were reported among those who diverted. Finally, resistance strategy use remained largely consistent over time, with most participants maintaining the same level of effectiveness across both follow-ups.
Takeaway: College students primarily used explanations, excuses, direct refusals, alternatives, and non-response strategies to resist stimulant diversion requests, and using more effective resistance strategies was associated with a lower likelihood of diversion over time.
Holt, L. J., Looby, A., & Schepis, T. S. (2025). ‘Sorry, I don’t give away my medication’: an examination of refusals to divert stimulant medication. Addiction Research & Theory, 1-12. https://doi.org/10.1080/16066359.2025.2560899