Popping smart pills in medical school: Are competition and stress associated with the misuse of prescription stimulants among students?

• Published in: Substance use & misuse 2019-06, Vol.54 (7), p.1191-1202
• Main Authors: De Bruyn, Sara, Wouters, Edwin, Ponnet, Koen, Van Hal, Guido
• Format: Article
• Language: English
• Subjects: biomedicalization; Careers; Central Nervous System Stimulants - therapeutic use; Competition; Competitive Behavior; Environmental aspects; Family physicians; Female; Graduate students; Humans; Male; Medical schools; Medical students; Medicine; methylphenidate; misuse; Physicians; Prescription Drug Misuse - statistics & numerical data; Prescription drugs; Prescription stimulants; Questionnaires; Response rates; School environment; Specialists; Stimulants; Stress; Stress management; Stress, Psychological - complications; Stress, Psychological - psychology; Structural equation modeling; Students; Students, Medical - psychology; Substance-Related Disorders - complications; Substance-Related Disorders - psychology; Surveys and Questionnaires; theory of triadic influence; Vulnerability; Young Adult
• ISSN: 1082-6084; 1532-2491
• DOI: 10.1080/10826084.2019.1572190

Background: There has been increasing attention in both popular and scientific circles to the misuse of prescription stimulants by students. However, it is unclear which student groups are most vulnerable and what environmental factors could influence this misuse. Medical students might be more at risk because of high levels of competition and related stress in medical school, making them a relevant population to explore these interrelationships. Objectives: This study aims to answer two research questions: (1) Does competition lead to higher stress and greater likelihood of misuse? and (2) Do the levels of and interrelationships between competition, stress and misuse vary between students with different post-graduate aspirations? Methods: In total, 3159 Flemish medical students (48.99% response rate) participated anonymously in a 2016 questionnaire on stimulants. Misuse was defined as use to enhance study performance, but not as part of an applicable treatment. We performed (multiple group) structural equation modeling to answer the research questions. Results: Results indicate significant associations between competition, stress and misuse: the higher the perception of medical school as being competitive, the higher the stress level and the more likely the misuse. Against our expectations, the association between competition and stress was significantly stronger for future general practitioners (GPs) compared to future specialists. Conclusion: The competitive climate in medical school creates high stress levels, rendering students vulnerable to misuse of stimulants. Students need to be educated about how to cope with stress in a non-pharmaceutical way, making them more resilient to stress during studentship and in their future careers.