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School Stimulant Use as 'Socioeconomic Advantage'? Study Suggests It Could Be.

Whether your child's drug use is a path to jail or an edge for college may depend in part on your family income.

A new study in the American Sociological Review finds that middle and high school students from wealthier backgrounds are more likely than students in poverty to "selectively use stimulants only during the academic year," and they are most likely to do so in states with the most stringent academic accountability.

The use of prescription stimulants in response to academic pressure may be "a new pathway through which medical interventions may act as a resource for families of higher socioeconomic status to transmit educational advantages to their children, either intentionally or unwittingly," conclude the study's authors, Marissa D. King of  the Yale School of Management, Jennifer Jennings of New York University, and Jason M. Fletcher of the University of Wisconsin-Madison.

While scientists have found no silver-bullet "smart drug," a wide array of different chemicals can be "nootropic," enhancing cognition by easing stress responses in challenging situations or boosting mental acuity after late-night study sessions. As I reported back in 2012, the use of stimulants like methylphenidate (the active ingredient in Ritalin) and modafinil (often known by the brand name Provigil) under legal but so-called "off-label" precriptions has been on the rise. Some students may use them to get high, but many others are using them to gain an academic edge—be it real or imagined. The study authors noted that those stimulants have been found to improve note-taking, quiz and test performance, homework completion, and even social skills among students with attention-deficit disorders—but also noted some evidence that stimulants can improve memory and learning in those without attention deficits.

That's where socioeconomic status and family responses to academic pressures start to play a role.

King, Jennings, and Fletcher analyzed the nearly 4 million patients ages 20 and younger who filled more than 15.7 million stimulant prescriptions from Sept. 1, 2007 to August 31, 2008. They also tracked low- and high-income students who were served by the same doctor, and cross-referenced the patients' home states and the intensity of their academic accountability systems.

The researchers found that while elementary school students typically fill prescriptions for stimulants like Ritalin year round, in middle and high school, students are 30 percent more likely to have a prescription filled during the school year than in summer. 

"The mismatch between children's academic and social behaviors and the schooling environment is a strong driver of stimulant prescriptions," they found. The rate at which prescriptions were filled even suggested that students were taking the medicines during the school week but not neccessarily on weekends or holidays.

Moreover, the gap varied by students' family income. Teenagers from higher socioeconomic backgrounds—defined as those who used private insurance—were 36 percent more likely to fill a stimulant prescription in the school year than in the summer, while low-income students— those using public Medicaid or state Children's Health Insurance programs—were only 13 percent more likely to use stimulants in the academic year than in the summer. While some doctors do allow "drug holidays," some studies have found that parents often move students on and off of medication frequently and without first consulting a doctor. Moreover, the American Academy of Pediatrics notes, "These breaks may speak to a desire of parents or children to minimize the use of stimulants, but there is no reliable evidence indicating that the breaks are helpful or necessary from a medical point of view."

Those gaps remained even when high- and low-income students were served by the same doctor, and they got worse in states with high academic accountability, as defined by the Education Week Research Center's 2008 Quality Counts report.

accountability drug.JPG

Not 'For Fun'

These are prescription drugs, and the long-term impact of their use on children and teenagers, whose brains are still undergoing major changes, is nowhere near known. But doing drugs to do better in school, as opposed to using them for recreational purposes, doesn't get tracked in the same way, and doesn't seem to trigger the same alarm among even groups that generally oppose adolescent drug use.

For example, the most recent survey on adolescent drug use by the National Center on Addiction and Substance Abuse at Columbia University has an entire chapter devoted to academic performance and drugs, but it focuses on statistics on how students who have lower grades in school are more likely to drink alcohol or smoke tobacco or marijuana. As might be expected, when asked for "the most important problem facing people your age—that is, the thing which concerns you the most," the most common answer, given by a quarter of the respondents, was drug, alcohol or tobacco use—but, when asked for their biggest personal source of stress: 56 percent said "academics/doing well in school," another 3 percent said "balancing school and other activities," and 1 percent said "getting into college."

But all of the questions related to prescription-drug use clarify to students that they are talking about drugs used without a prescription, specifically to "get high." They were not asked about their or their friends' or peers' use of stimulants to perform better academically. 

Chart Source: Yale, American Sociological Review

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