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An Exploratory Study of Substance Use and Misuse Among College Students With and Without ADHD and Other Disabilities
Grace M. Janusis and Lisa L. Weyandt Journal of Attention Disorders 2010 14: 205 originally published online 17 May 2010 DOI: 10.1177/1087054710367600 The online version of this article can be found at: http://jad.sagepub.com/content/14/3/205

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Current Perspectives

An Exploratory Study of Substance Use and Misuse Among College Students With and Without ADHD and Other Disabilities
Grace M. Janusis1 and Lisa L. Weyandt1

Journal of Attention Disorders 14(3) 205215 2010 SAGE Publications Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1087054710367600 http://jad.sagepub.com

Abstract Objective: The present study investigated potential differences between college students with and without disabilities (including ADHD, Aspergers syndrome, executive functioning disorder, and learning, mental health, vision, hearing, and physical/chronic disabilities) regarding self-reported substance use and misuse, perceived stress, and sensation seeking. Method: Students responded to a Stimulant Survey Questionnaire (SSQ), Perceived Stress Scale (PSS), Sensation-Seeking Scale (SSS), and items from the National College Health Assessment (NCHA). Results: The hypotheses were part supported as MANOVA results revealed that students with disabilities provided significantly lower ratings on the SSS and also reported lower alcohol and marijuana use. Students with ADHD were more likely to use or misuse prescription stimulant medication but were less likely to use alcohol than did students without ADHD. Conclusion: Students with disabilities compared to those without disabilities differed on levels of sensation seeking and alcohol and marijuana use. Keywords ADHD, college, stimulant medication, substance use

Approximately 6% to 8% of all first-time, full-time college students report having a documented disability (Henderson, 2001; Horn & Berktold, 1999). The number of students with disabilities has increased steadily over the past few decades, and students with disabilities are graduating from college in record numbers (Henderson, 2001). A disability, as defined by the Americans with Disabilities Act (ADA; U.S. Department of Justice, 2005) is as follows: A person who has a physical or mental impairment that substantially limits one or more major life activities, a person who has a history or record of such an impairment, or a person who is perceived by others as having such an impairment. (p. 3) The most common types of disabilities that are reported among college students include learning disability (29%), orthopedic impairment (23%), vision (16%), hearing (16%), speech (3%), or other (21%; Horn & Berktold, 1999). Current research indicates that ADHD is one of the most common disabilities among college students (Weyandt & DuPaul, 2006).

College Students With ADHD

Relative to what is known about ADHD in children, there is substantially less info available about ADHD in adults, especially college students. According to Weyandt and DuPaul (2006), approximately 2% to 4% of the college student population experiences symptoms of ADHD, but the actual percentage of college students with ADHD is unknown. In general, college students with ADHD are more likely to have psychological, educational, and social difficulties than their peers without ADHD (Weyandt & DuPaul, 2006). Research has found college students who have been diagnosed with ADHD are more likely to have lower mean grade point averages (GPAs; Heiligenstein, Guenther, Levy, Savino, & Fulwiler, 1999), placed on academic probation, have academic problems (Heiligenstein et al., 1999), and are less likely to graduate from college ultimately (Murphy,
1

University of Rhode Island

Corresponding Author: Grace M. Janusis, 73A Quannacut Rd., Westerly, RI 02891 Email: gracey81@gmail.com

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206 Barkley, & Bush, 2002) than their peers without ADHD. Young adults with ADHD are also more likely to have a comorbid learning disorder than their peers (Murphy et al., 2002). In addition to the academic difficulties presented to college students with ADHD, these students may be at greater risk for developing psychological difficulties. College students with ADHD more frequently report internal restlessness than do their non-ADHD peers and report higher levels of sensation seeking (Hines & Shaw, 1993; Weyandt et al., 2003). Furthermore, Murphy et al. found college students with ADHD to be more likely to abuse alcohol and cannabis than do college students without the disorder. Treatments available for ADHD in college students range from academic accommodations to prescription medication. Although prescription stimulant medication can vastly improve the lives of children and adults with ADHD, their potential for abuse can be problematic (Teter, McCabe, Boyd, & Guthrie, 2003).

Journal of Attention Disorders 14(3) a positive predictor of stress, as was conflict with a roommate, faculty, or staff member, whereas drug use was a negative predictor of stress. Grace (1997) indicated that chronic excessive stress could contribute to the development of addictive behaviors among the college population. Stress is also associated with suicidal thought, tobacco use, and alcohol use among college students (Hirsch & Ellis, 1996). College students with disabilities compared to nondisabled students may be particularly prone to stress and experience more stress throughout their lifetime (Margalit, 1998; Morrison & Cosden, 1997; Reiff, Hatzes, Bramel, & Gibbon, 2001). Indeed, studies have found students with a learning disability experience psychological stress significantly differently from students without a learning disability and often have more challenges with psychological difficulties such as anxiety than their peers (Barton & Fuhrman, 1994; Gregg, Hoy, King, Moreland, & Jagota, 1992).

Stimulant Use and Misuse in College

According to Tagayuna, Stodden, Chang, Zeleznik, and Whelley (2005), increasingly more students with disabilities of all types, including ADHD, are attending college. This change in enrollment has been accompanied by an increase of students using prescription stimulants such as Ritalin, Adderall, and Concerta to treat ADHD symptoms on campus, as well as increased reports of use and misuse of prescription stimulants (Gunter, Arndt, & Wenman, 2006). Research indicates that more than 20 million Americans above the age of 12 (about 8.8%) have tried prescription stimulants at least once without the use of a valid prescription (Office of Applied Studies, 2005). Specifically, the number of college students who have reported using a prescription stimulant for nonmedical use in the past year varied from 0% to 25% (McCabe, Knight, Teter, & Wechsler, 2005; Weyandt et al., 2009). Although students with ADHD compose a large percentage of students with disabilities, students with other disabilities have also been found to abuse substances (Gilson, Chilcoat, & Stapleton, 1996). Particular groups of students at college such as men, Whites, members of Greek life, and students who earn lower grades are more prone to misuse prescription stimulant medication (McCabe et al., 2005). College students with or without ADHD who have a comorbid psychiatric disorder are at a greater risk of substance abuse (Wolf, 2001).

Sensation-Seeking Behavior in College Students

A higher degree of sensation seeking has been shown to correlate with a higher rate of use of illegal drugs such as marijuana (Zuckerman, 2000). Research suggests that men tend to be higher sensation seekers than women, and adolescent men have the highest rate of sensation seeking (Zuckerman, 2000). In addition, in college populations, higher scores in sensation seeking have been related to higher levels of drug abuse (Jaffe & Archer, 1987). Although research suggests that students with disabilities, including those with ADHD, are at greater risk for using illicit substances, many questions remain unanswered. Preliminary studies suggest that a significant percentage of college students (i.e., 2%-8% in the past month) are abusing prescription stimulants (McCabe et al., 2005; Weyandt et al., 2009). However, information concerning substance use, particularly that of nonmedical use of prescription stimulants among college students with disabilities, is limited. More importantly, there is a dearth of research regarding psychological variables and whether perceived stress, risk-taking, and sensation-seeking behaviors are related to stimulant abuse. Therefore, the purpose of the present study was to explore the use and misuse of substances, including prescription stimulant medication, among college students with and without disabilities at a public university in the northeast region of the United States. In addition, this study explored whether there was a relationship between sensation seeking and use of substances, including prescription stimulant medication. Disability status served as the independent variable (two levels of disability status were no disability or disability present). Ratings on the Sensation Seeking Scale (SSS), Stimulant Survey Questionnaire (SSQ), and Perceived Stress Scale (PSS) were dependent variables (three dependent variables in

Stress in College Students With Disabilities

A variety of factors may be related to college student use of substances, including psychological stress, alcohol, and sensation-seeking behavior. For example, Dusselier, Dunn, Wang, Shelley II, and Whalen (2005) found alcohol use was

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Janusis and Weyandt total). Ratings on two questions from the National College Health Assessment (NCHA) about substance use were also analyzed by descriptive statistics. The study sought to evaluate three hypotheses. The first hypothesis was that college students with disabilities would endorse higher ratings on the Stimulant Survey Questionnaire than college students without disabilities. The second hypothesis was that college students with disabilities would endorse higher ratings on the Sensation Seeking Scale than would college students without disabilities. Lastly, the third hypothesis was that college students with disabilities would endorse higher ratings on the Perceived Stress Scale than would college students without disabilities. This study was the first of its kind to explore the relationship between psychological variables and substance use and misuse among college students with and without ADHD and other disabilities.

207 19.2% of students did not know who provided the diagnosis. For students who reported having any type of disability, 33.9% (n = 21) of the students responded that they were taking a prescribed stimulant medication. More than 65% of the students with ADHD (n = 17) reported taking a prescribed stimulant medication, and these included Adderall, Ritalin, Concerta, Dexedrine, Focalin, and Vyvanse. The most common type of prescribed stimulant medication was Adderall.

Procedures
Participants were recruited through the universitys DSS office and psychology classes. Students recruited through psychology classes were informed about the study through an announcement in their psychology class. Participants recruited through the universitys DSS office were given the choice to participate when they registered for an appointment for accommodations. All participants were informed about what the study entailed and received an anonymous, no sign consent form. The participants in the study completed, in a randomized order, a demographic form and four measures: SSS, SSQ, PSS, and selected questions from the NCHA. Participation took an estimated 25 to 40 minutes. The participants were compensated for their participation in the study by receiving class credit or having their e-mail address entered in a raffle with a US$100 cash prize when the study was completed.

Method Participants
The study was approved by the universitys institutional review board. The sample consisted of 165 college students (freshmen to seniors) from a public university in the Northeast region of the United States in 2008. The status of disability was determined by registration with Disability Services for Students (DSS) and self-identification on a demographic form. The following types of disabilities were included in the study: ADHD, learning disability, mental health disability, vision disability, hearing disability, physical and chronic disability, executive functioning disorder, and Aspergers syndrome (n = 62). Students who did not report both having a disability and registration with DSS were excluded from the analysis (n = 25). Participants without a disability were solicited from introductory psychology classes and were used as a comparison group. The total participants consisted of 62 with a disability 78 without a disability. The participants were predominantly women (76.9%) and White (91.6%), with a mean age of 20 years and a mean GPA of 3.45. Of the students who reported having a disability, 41.9% reported having ADHD, with 20% ADHD Predominantly Inattentive subtype, 8% ADHD HyperactiveImpulsive subtype, and 12% ADHD Combined subtype. Almost 60% did not know ADHD subtype. Of the students who responded that they had a disability, 76.7% reported having a disability other than ADHD, indicating that several students with ADHD have a comorbid disability. Disabilities other than ADHD were categorized into seven groups: mental health (35.6%), learning (31.1%), vision (2.2%), hearing (2.2%), physical/chronic (20%), executive function (6.7%), and Aspergers syndrome (2.2%). The majority of students identified with ADHD were diagnosed by a psychologist (23.1%), a neurologist (23.1%), or a psychiatrist (19.2%), and

Measures/Instrumentation
SSS-V. The SSS-V measures the amount of stimulation and arousal that someone needs or wants, and how often someone is likely to seek out novel stimuli (Zuckerman, 1994). The SSS-V has 40 forced-choice items and takes approximately 15 minutes to complete. The total score for the measure is the summation of all 40 items (with higher sensation-seeking items scored as 1 and lower sensation-seeking items scored as 0). The total possible score ranges from 0 (low sensation seeking) to 40 (high sensation seeking). According to Jaffe and Archer (1987), the SSS was highly sensitive in predicting drug use in college students, even more so than the Minnesota Multiphasic Personality Inventory (MMPI) and Millon Alcohol Abuse Scale (MCMI). The SSS has adequate psychometric properties. For example, in a study by Ridgeway and Russell (1980) using the SSS with college students, the total score of the SSS had moderate reliability with a coefficient alpha of .75. For the present study, the total score served as the dependent variable. PSS. The PSS consists of 10 items intended to measure how an individual handles uncontrollable and unpredictable life events and their perception of demands exceeding their ability to cope with a situation (Cohen, Kamarck, & Mermelstein,

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208 1983; Cohen, Tyrrell, & Smith, 1993). Each item has a forced 5-choice response of never, almost never, sometimes, fairly often, and very often during the past month for each stressful event (Cohen & Williamson, 1988). Then, the score of the PSS is determined by first reverse scoring the 4 positive items (Items 4, 5, 7, and 8). Then, the scores of all 10 items are added together. The total score can range from 0 to 40, with a higher score indicating a higher level of perceived stress. In a nationwide survey in 1988, the PSS had a mean of 13.02 (SD = 6.35; Cohen & Williamson, 1988). The psychometric properties of the PSS are adequate. In addition, Roberti, Harrington, and Storch (2006) found support for normative results, internal consistencies, and construct validity. The PSS has a Cronbachs alpha reliability coefficient of .89 for the total score (Roberti et al., 2006). The convergent validity was assessed, and the PSS was highly correlated with the State-Trait Anxiety Inventory (STAI) total score and was moderately correlated with the multidimensional health locus of control (MHLC) chance subscale (Roberti et al., 2006). The divergent validity was assessed, and no significant correlations were found between the PSS and the SSS-V, Santa Clara Strength of Religious Faith QuestionnaireShort Form (SCSRFQ-SF), and the overt aggression (OA subscale) of the Adult Aggression Scale (Roberti et al., 2006). Overall, Roberti et al. found the PSS to be a reliable and valid instrument for measuring perceived stress in college students. For this study, the total score served as the dependent variable. SSQ. The SSQ is a 40-item questionnaire that was designed to measure the use and misuse of prescription stimulant medications in college students (Weyandt et al., 2009). Items on the survey are statements with a 5-point Likert-type scale response (1 = never, 2 = rarely, 3 = occasionally, 4 = frequently, and 5 = always) in the first section and a yes-or-no response in the second section. The total score ranges from 40 to 170, with a higher score indicating more prescription stimulant medication use and misuse. Stimulants in this survey refer to prescription medications including methylphenidate (Ritalin, Concerta, Metadate) and amphetamine (Adderall, Dexedrine, Desoxyn). Weyandt et al. found the SSQ to have adequate internal consistency with a Cronbachs alpha coefficient of .849. A principal-axis-factor analysis revealed 4 factors accounting for 51.11% of the total variance (Weyandt et al., 2009). The 4 factors were self-reported prescription stimulant use, perception of prevalence of prescription use among peers, knowledge of atypical stimulant use among peers, and perception of safety of stimulants. For this study, the total score served as the dependent variable. National College Health Assessment. Two questions were selected from the NCHA to assess substance use of college students with and without disabilities for descriptive purposes. The NCHA is a questionnaire developed by the

Journal of Attention Disorders 14(3) American College Health Association to collect data about college students health habits, behaviors, and perceptions (American College Health Association, 2003). The NCHA consists of 58 forced-choice items, but for this study, only questions numbered 9 and 10 were used to assess substance use in college students. The survey questions list substances (cigarettes, cigars, smokeless tobacco, alcohol, marijuana, cocaine, amphetamines, rohypnol, and other drugs) in a chart with response choices of never used, have used but not in past 30 days, 1 to 2 days, 3 to 5 days, 6 to 9 days, 10 to 19 days, 20 to 29 days, and all 30 days (American College Health Association, 2007). For this study, the responses from the NCHA were analyzed descriptively.

Results
To test the hypotheses that college students with disabilities were more likely than college students without disabilities to endorse higher ratings on the SSQ, higher ratings on the SSS, and higher ratings on the PSS, MANOVA was performed. The independent variable was disability status, with three dependent variables of ratings on the SSQ, SSS, and PSS. Preliminary assumption testing was conducted to determine whether violations occurred with regard to normality, linearity, homogeneity of variance, and equality of variance. No serious violations were committed, except for equality of variance as demonstrated in the Levenes test of equality of error variances for the SSQ dependent variable. To account for this violation of equality of variance, as suggested by Tabachnick and Fidell (2001), a more conservative alpha level of .025 was used for determining significance for that variable in the univariate F test. There was a statistically significant difference between students with a disability and students without a disability on the combined dependent variables: F(3, 121) = 4.27, p < .01; Wilkss Lambda = .96, partial eta squared = .09, observed power = .85. When the results for the dependent variables were considered separately, the dependent variable of the SSS was the only one to reach a level of statistical significance after using a Bonferroni adjusted level (Tabachnick & Fidell, 2001) of .017: F(1, 123) = 8.96, p < .01, partial eta squared = .06, and observed power = .84. For the ratings on the SSS, students with a disability (M = 17.67, SD = 6.06) scored significantly lower than the students without a disability (M = 20.81, SD = 5.59), indicating that students with a disability are less likely to seek out high-sensation behaviors than do students without a disability. The ratings on the PSS were not significantly different between students with and without disabilities, but the overall mean rating on the PSS (M = 17, SD = 7) was higher than the mean Cohen and Williamson (1988) found in their national study (M = 13.02, SD = 6.35). The overall total ratings on the SSS were very similar to previous studies (Zuckerman, Eysenck, & Eysenck, 1978). Likewise, the

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Janusis and Weyandt overall ratings on the NCHA were also similar to previous studies. One exception is the use of marijuana, which appears to be slightly higher for the students in this study (American College Health Association, 2003). Substance use for students with and without disabilities was assessed post hoc using 2 items from the NCHA. Descriptively, there was a difference between self-use and perception of use by others for all substances; self-use of substances was rated lower than the perception of use by others on all substances in the questionnaire for both students with and without disabilities. The ratings for selfsubstance use and perception of others use were lower for students with disabilities on all items, except for self-use of amphetamines and rohypnol. For amphetamines, the ratings were exactly the same, and for self-use of rohypnol, the ratings for students with disabilities were slightly higher. Nine exploratory post hoc ANOVAs were performed to determine any significant differences between substance use for each substance on the questionnaire between students with and without disabilities. Substance self-use only differed between the two groups for alcohol use and marijuana use. For alcohol self-use, students with a disability (M = 3.37, SD = 1.62) reported significantly lower use than did students without a disability (M = 4.27, SD = 1.68): F(1, 138) = 10.12, p < .01. For marijuana self-use, students with a disability (M = 2.13, SD = 1.85) reported significantly lower use than students without a disability (M = 2.99, SD = 2.15): F(1, 137) = 6.09, p < .05. Although there was no significant difference between the ratings of the SSQ by college students with and without disabilities, the results indicated that both groups are using at a similar level. The level of stimulant use was high for both groups with an overall mean of 70.32 (SD = 13.08) and as evidenced by responses on Item 1 of the SSQ with students endorsing the statement I have used prescription stimulants for non-medical purposes occasionally (11.5%), and frequently (1.4%). Individual responses on the SSQ for the disability and no-disability groups were different on several items as illustrated in Table 1. For instance, even though there was no significant difference between students with and without disability for the total score on the SSQ, when an ANOVA was performed on Item 1 of the SSQ, I have used prescription stimulants for non-medical purposes, students without a disability rated the item significantly higher than students with a disability: F(1, 137) = 10.34, p < .01. Students without disabilities were more likely to use stimulants at parties, with alcohol and to snort stimulants. Additional post hoc ANOVAs revealed that students with different types of disabilities performed at varying levels on the SSQ, PSS, and the SSS. As can be seen in Table 2, students with executive functioning disorders (M = 83.3, SD = 14.9) and ADHD (M = 79.2, SD = 2.8) had the highest ratings on the SSQ. Students with executive functioning disorders performed slightly higher than students with

209 ADHD on the SSQ, PSS, and SSS. Due to the small number of students who reported a diagnosis of executive functioning disorders (n = 3), caution should be used when interpreting these results. On the PSS, the student with a vision disability (M = 33) reported the highest level of stress, followed by the students with mental health disabilities (M = 21.9, SD = 7.2), the students with executive functioning disorder (M = 19.3, SD = 6.3), and those with physical and chronic disabilities (M = 18.8, SD = 2.7). Interestingly, the students with the highest level of sensation seeking as rated by the SSS were students with physical and chronic disabilities (M = 21.2, SD = 6.7) and executive functioning disorder (M = 22.1, SD = 6.0), and students rating the lowest were the students with learning disabilities (M = 15.8, SD = 5.2), mental health disabilities (M = 16.8, SD = 6.9), and Aspergers syndrome (M = 6.0). Post hoc analyses also revealed significant differences between students with ADHD and students without ADHD on several dependent variables. Whereas the results need to be interpreted with caution because of the small sample of students with ADHD (n = 26), a MANOVA was performed to investigate differences in stimulant use, sensation seeking, and perceived stress between college students with and without ADHD. The independent variable was presence of ADHD diagnosis, with three dependent variables of ratings on the PSS, SSS, and SSQ. There was a statistically significant difference between students with ADHD and students without ADHD on the combined dependent variables: F(3, 121) = 9.64, p < .01, Wilkss Lambda = .80, partial eta squared = .19, and observed power = .99. When the results for the dependent variables were considered separately, the dependent variable of the SSQ was the only dependent variable to reach a level of statistical significance after using a Bonferroni adjusted level (Tabachnick & Fidell, 2001) of .017: F(1, 123) = 12.61, p < .01, partial eta squared = .09, and observed power = .94. For the ratings on the SSQ, students with ADHD (M = 79.25, SD = 17.44) scored significantly higher than the students without ADHD (M = 68.38, SD = 11.42), indicating that students with ADHD are more likely to use and/or misuse stimulant medication than are students without ADHD. There were significant differences between students with and without ADHD on specific items on the SSQ. For instance, an ANOVA revealed that students with ADHD (M = 1.35, SD = .79) provided significantly higher ratings on Item 20 of the SSQ (I have been pressured into letting someone else have my prescription stimulant medication) than students without ADHD (M = 1.05, SD = .26): F(1, 138) = 10.55, p < .01. An ANOVA on Item 18 of the SSQ (I have sold prescription stimulant medication to other students) was statistically significant with students with ADHD (M = 1.31, SD = .61) rating the item significantly higher than students without ADHD (M = 1.09, SD = .34): F(1, 138) = 6.14, p < .05. These results indicate that students with ADHD are more likely to be pressured into

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210
Table 1. Frequency of Response of Students Without and With a Disability on the SSQ

Journal of Attention Disorders 14(3)

Response of students without disability (students with disability) Item 1. I have used prescription stimulants for nonmedical purposes. 2. I have used prescription stimulants at parties. 3. I have used prescription stimulants with alcohol. 4. I have snorted prescription stimulants. 5. I have injected prescription stimulants. 6. I have smoked prescription stimulants. 7. I have taken prescription stimulants to focus better in class. 8. I have taken prescription stimulants to perform better on tests. 9. I have taken prescription stimulants to help me socialize better. 10. I have taken prescription stimulants to help me lose weight. 11. I have taken prescription stimulants to perform better in schoolwork. 12. I have taken prescription stimulants to feel energetic. 13. I have taken prescription stimulants to feel better about myself. 14. I have taken prescription stimulants to get high. 15. I have been offered prescription stimulants by other students. 16. I have tried someone elses prescription stimulants. 17. I have purchased prescription stimulants from other students. 18. I have sold prescription stimulants to other students. 19. I have given prescription stimulants to other students. 20. I have been pressured into letting someone else have my prescription stimulant medication. Never 53.2 (79.0) 72.7 (91.9) 68.8 (82.3) 79.2 (90.3) 100 (98.4) 94.7 (96.8) 70.1 (50.0) 70.1 (48.4) 90.9 (75.8) 89.6 (88.7) 59.7 (53.2) 79.2 (67.7) 92.2 (78.7) 75.3 (88.7) 45.5 (67.7) 59.7 (83.9) 74.0 (96.8) 92.2 (87.1) 85.7 (85.5) 96.1 (88.7) Strongly disagree 21. Prescription stimulants are easy to get on this campus. 22. Prescription stimulants are as easy to get as alcohol. 23. Prescription stimulants are as easy to get as marijuana. 24. Using prescription stimulants occasionally is harmless. 25. Using prescription stimulants daily is harmless. 26. Prescription stimulant use on campus is a problem. 27. Prescription stimulants are safer than marijuana. 28. Prescription stimulants are safer than alcohol. 29. I feel I am knowledgeable about prescription stimulants. 30. I feel I am knowledgeable about the side effects of prescription stimulants. 2.6 (11.3) 5.1 (16.1) 5.1 (18.0) 14.1 (29.5) 41.0 (50.0) 5.3 (4.8) 19.2 (33.9) 16.7 (36.1) 6.4 (11.3) 5.1 (12.9) Rarely 27.3 (16.1) 16.9 (6.5) 23.4. (9.7) 13.0 (8.1) () 3.9 () 18.2 (6.5) 18.2 (3.2) 5.2 (11.3) 6.5 (4.8) 29.9 (3.2) 15.6 (12.9) 5.2 (3.3) 16.9 (8.1) 20.8 (12.9) 23.4 (12.9) 13.0 () 6.5 (8.1) 14.3 (14.5) 3.9 (4.8) Occasionally 18.2 (3.2) 10.4 () 6.5 (4.8) 7.8 () () 1.3 (1.6) 11.7 (9.7) 11.7 (9.7) 2.6 (8.1) 3.9 (1.6) 10.4 (8.1) 3.9 (8.1) 1.3 (11.5) 3.9 (1.6) 27.3 (12.9) 14.3 (1.6) 13.0 (3.2) 1.3 (4.8) () (4.8) Frequently 1.3 (1.6) () 1.3 (3.2) (1.6) () (1.6) (14.5) (21.0) 1.3 (3.2) (3.2) (17.7) 1.3 (8.1) 1.3 (3.3) 3.9 (1.6) 6.5 (4.8) 2.6 () () () () (1.6) Always () (1.6) () () (1.6) () (19.4) (17.7) (1.6) (1.6) (17.7) (3.2) (3.3) () (1.6) (1.6) () () () () Strongly agree 14.1 (8.1) 9.0 (4.8) 9.0 (9.8) 3.8 (1.6) (1.6) 6.6 (9.7) 1.3 () (1.6) 7.7 (16.1) 7.7 (12.9)

Disagree 2.6 (4.8) 19.2 (32.3) 20.5 (21.3) 29.5 (36.1) 38.5 (17.7) 23.7 (22.6) 43.6 (35.5) 44.9 (34.4) 29.5 (17.7) 29.5 (12.9)

Neutral 30.8 (45.2) 33.3 (33.9) 30.8 (29.5) 29.5 (23.0) 16.7 (24.2) 47.4 (41.9) 30.8 (17.7) 29.5 (21.3) 34.6 (27.4) 33.3 (29.0)

Agree 50.0 (30.6) 33.3 (12.9) 34.6 (21.3) 23.1 (9.8) 3.8 (6.5) 17.1 (21.0) 5.1 (12.9) 9.0 (6.6) 21.8 (27.4) 24.4 (32.3)

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Janusis and Weyandt

Table 1. (continued) Response of students without disability (students with disability) Yes 31. I know students who use prescription stimulants at parties. 32. I know students who use prescription stimulants with alcohol. 33. I know students who use prescription stimulants with other drugs. 34. I know students who use prescription stimulants while studying. 35. I know students who use prescription stimulants during finals week. 36. I know students who use prescription stimulants during tests. 37. I know students who snort prescription stimulants. 38. I know students who inject prescription stimulants. 39. I know students who smoke prescription stimulants. 40. I hide my prescription stimulant medication so that no one will take it. 75.6 (53.2) 75.6 (61.3) 66.7 (50.0) 87.0 (77.4) 84.6 (74.2) 80.8 (71.0) 52.6 (35.5) 5.1 (8.1) 20.5 (17.7) 12.8 (41.7) No 24.4 (46.8) 24.4 (38.7) 33.3 (50.0) 13.0 (22.6) 15.4 (25.8) 19.2 (29.0) 47.4 (64.5) 94.9 (91.9) 79.5 (82.3) 87.2 (58.3)

211

Table 2. Total Score Means by Disability Category on the SSQ, PSS, and SSS Measure Disability (N) Mental health (16) Learning (14) Vision (1) Hearing (1) Physical/Chronic (9) Executive functioning (3) Aspergers syndrome (1) ADHD (21) No disability (78) SSQ M (SD) 69.1 (21.7) 63.3 (8.7) 73.0 65.0 69.0 (9.4) 83.3 (14.9) 53.0 79.2 (2.8) 70.2 (11.0) PSS M (SD) 21.9 (7.2) 14.3 (6.6) 33.0 16.0 18.8 (2.7) 19.3 (6.3) 14.0 16.7 (1.6) 16.8 (6.3) SSS M (SD) 16.8 (6.9) 15.8 (5.2) 23.0 20.0 22.2 (6.7) 22.1 (6.0) 6.0 17.6 (1.3) 20.7 (5.5)

SSQ = Stimulant Survey Questionnaire; PSS = Perceived Stress Scale; SSS = Sensation Seeking Scale.

letting someone else have their stimulant medication or to sell their own stimulant medication. There was no overall significant difference on the SSQ between students with and without disabilities, yet there was a significant difference between students with and without ADHD on the SSQ. An ANOVA was performed to determine whether there was a significant difference between students with and without disabilities after the students with ADHD were removed from the group. When students with ADHD were removed, there was a statistically significant difference between students with and without disabilities,

F(1, 105) = 5.9, p < .05. Students with disabilities (M = 64.64, SD = 11.27) scored significantly lower on the SSQ than students without disabilities (M = 70.26, SD = 11.06). To further determine the reason for the significant difference on the SSQ, ANOVAs were performed on the first 20 items of the SSQ and on the first 20 items of the SSQ minus the 3 items that may indicate legitimate use (e.g., to focus) of prescription stimulants for students who are prescribed them (Items 7, 8, and 11 on the SSQ). There was a statistically significant difference between the first 20 items of the SSQ between the students with and without

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212 ADHD: F(1, 135) = 29.63, p < .01. When Items 7, 8, and 11 on the SSQ were removed from the total score, however, there was no statistical difference between the students with and without ADHD. This result may indicate that the elevated scores in students with ADHD on the SSQ are due to legitimate use of prescription stimulants as 17 out of the 26 students with ADHD were taking a prescribed stimulant medication. Additional post hoc analyses via ANOVAs were performed to assess a difference between substance use in the past 30 days via the items on the NCHA between students with and without ADHD. There was a statistically significant difference in alcohol use between students with and without ADHD, F(1, 138) = 5.17, p < .05, and students with ADHD rated alcohol use lower than students without ADHD. This difference suggests that students with ADHD are less likely to consume alcohol than are students without ADHD. There was also a statistically significant difference in the intentional use of Rohypnol (also known as roofies, GHB, or Liquid X) between students with and without ADHD. Students with ADHD were more likely to report use of these substances than students without ADHD: F(1, 138) = 4.49, p < .05. This result indicates that even though the overall use of Rohypnol is low, students with ADHD are more likely to use these substances than students without ADHD. Pearsons r two-tailed correlations revealed significant correlations with the entire sample between the SSQ and the SSS (r = .429, p < .01). This finding suggests that students who are higher risk takers also have a higher level of stimulant use. There was also a significant correlation with the entire sample between the SSQ and the PSS (r = .247, p < .01), suggesting that students with a higher level of stress were also more likely to have a higher level of stimulant use or misuse. Pearsons r two-tailed correlations were also performed separately for the students with disabilities and students without disabilities. For the students with disabilities, there was a significant correlation between the SSQ and SSS (r = .479, p < .01), and SSQ and PSS (r = .271, p < .05). For students without disabilities, there was a significant correlation between SSQ and SSS (R = .415, p < .01). This finding suggests that there is a strong correlation between stimulant use and sensation seeking regardless of the presence of a disability. In addition, the finding suggests that there is a significant correlation between stimulant use and perceived stress only for students with disabilities.

Journal of Attention Disorders 14(3) lower ratings on the SSS than did students without a disability. Although speculative, it is possible that students with a disability may be less likely to seek out high-sensation behaviors due to health concerns. As well, symptoms of the disabilities themselves, such as higher anxiety or less motivation due to depression, may influence a students decision to seek out high-sensation behaviors less often. These students may also have a higher appreciation for the value of life if they have been through difficult life challenges. Students with ADHD, interestingly, also scored lower than students without disabilities did, even though typical symptoms of ADHD include impulsivity and lower levels of self-regulation, which would most likely elevate their scores on the SSS. Most students with ADHD in this study were taking a prescribed stimulant medication, however, and one would expect that stimulant medication would lower levels of impulsivity and increase self-regulation. The hypothesis that students with disabilities would have higher ratings on the SSQ than would students without disabilities was not supported. This outcome may have been affected by the diversity of disabilities. It is notable that although there was no significant overall difference between students with and without disabilities, students with ADHD did score significantly higher on the SSQ than students without disabilities. Furthermore, when students with ADHD were removed from the group of students with disabilities, students with disabilities scored significantly lower on the SSQ than students without disabilities. This finding suggests that the diversity of disabilities did, in fact, skew results. In summary, students with ADHD had the highest ratings of stimulant use or misuse, followed by students without disabilities, whereas students with other types of disabilities than ADHD had the lowest ratings of stimulant use or misuse. There are several possible reasons why students with ADHD endorsed higher ratings on the SSQ. The SSQ does not differentiate between prescribed stimulant use and misuse, and high ratings on the SSQ could indicate either prescribed use or misuse of stimulant medication. Students with ADHD, then, may have scored higher on the SSQ because of reporting valid use of prescription stimulant medication for symptom intervention. Several items on the SSQ could increase a students score even in the absence of stimulant medication misuse. In addition, some items on the SSQ related not to self-use, but to that of peers. Endorsing these items would raise the total score on the SSQ even if the individual respondent may not have used a stimulant. In addition, a few items on the SSQ relate to the reason of use for stimulant medication (such as to focus or study better) but do not clarify whether the use is by prescription. As it is likely that students with ADHD could be taking a prescribed stimulant for those intended purposes, their ratings may be higher on those items. In terms of peer use, students with ADHD may

Discussion
Results revealed that students with disabilities endorsed different ratings than students without disabilities, but the results were in the opposite direction of the hypothesis. Specifically, students with disabilities provided significantly

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Janusis and Weyandt also be more likely to know other students with ADHD who are taking stimulant medication, which would further elevate their ratings on the SSQ. Lastly, students with ADHD were significantly more likely to be pressured into letting someone else have their stimulant medication or to sell their own stimulant medication than were students without ADHD, which would lead to a further increase in their ratings on the SSQ. The hypothesis that college students with disabilities would endorse higher ratings on the PSS than would students without disabilities was not supported in this study. Although previous studies found college students with disabilities had higher rates of stress (Morrison & Cosden, 1997; Reiff et al., 2001), the current study did not find a significant difference in ratings of stress between students with and without disabilities. One reason for the difference in outcomes may be because students in the previous study by Reiff et al. responded to a different measure, a subscale of the BarOn EQ-i, which measured stress management rather than perceived stress. Furthermore, all of the students in the Reiff et al.s study as well as in the Morrison and Cosdens study were diagnosed with a learning disability. In the present study, all types of disability were included. It is possible that students with a learning disability may experience more stress than students with other types of disabilities do. It is also interesting to note that the overall ratings on the PSS were higher than previous findings by Cohen and Williamson (1988). This finding may be due to the time that has elapsed since Cohen and Williamsons study was performed, or perhaps the perceived level of stress of all college students is higher now than it used to be. Exploratory post hoc analyses on substance use as measured by the items from the NCHA showed a significant difference in substance use between students with and without disabilities regarding alcohol and marijuana use. For alcohol and marijuana self-use, students with a disability reported significantly lower use than students without a disability. This finding was similar to that of Gilson et al.s (1996) study that found that marijuana use was significantly lower in people with disabilities between the ages of 25 and 34 but not for people between the ages of 18 and 24 (which is around the age of the students in the present study). For the 18- to 24-year-olds, there was a significantly higher use of crack and heroin among people with disabilities than people without disabilities (Gilson et al., 1996). The study by Gilson et al., however, did not include college students but was composed of people with disabilities at any educational level. The demographics of college students between the ages of 18 and 24 may vary greatly from people not enrolled in college in that age range. The difference in results may also be due to a difference in the type and level of severity of disability. Participants in the Gilson et al.s study were defined as having a disability if they were not

213 able to work, whereas most students in the current study are most likely able to work and have less severe disabilities. The level of severity of disability may affect substance use. College students may be more mature than their peers who are not enrolled in college and may, therefore, have a similar level of substance use to a more mature age group such as that of the 25- to 34-year-olds. Although speculative, students with disabilities may be less likely to use alcohol or marijuana because they are using prescription medication for their disability and do not want to mix substances. Perhaps they may also be less likely to take a risk because students with disabilities have lower reports of sensationseeking behaviors as measured by the SSS. Further exploratory analyses on substance use showed a significant difference in substance use between students with and without ADHD for alcohol use and Rohypnol use. Students with ADHD indicated lower ratings of alcohol use than students without ADHD, but students with ADHD also reported higher ratings of Rohypnol use than students without ADHD. The lower ratings of alcohol use of students with ADHD may be because they want to avoid using alcohol while taking a stimulant medication. As one possible symptom of ADHD is impulsivity, some people might hypothesize alcohol use to be higher in this population. However, most students with ADHD in this study were taking a prescribed stimulant medication, so it is likely that their level of impulsivity was lower than expected. This lower level of impulsivity might be a reason why alcohol use ratings were lower for students with ADHD. Conversely, students with ADHD were more likely to use Rohypnol, yet the overall usage rate of this was very low. Because of the small number of students with ADHD in this study, it is likely that the difference may be due to a higher use of Rohypnol by only a few individuals. It is important to note that the findings of the present study suggest a relationship between stimulant use and sensation seeking regardless of the presence of a disability. The higher ratings a student provided for stimulant use, the higher their ratings were on sensation-seeking behaviors. This finding is consistent with the findings of Jaffe and Archer (1987): Sensation seeking has been associated with substance use, and substance use can be considered a sensation-seeking behavior. The correlation between stimulant use and perceived stress, however, was only significant for students with disabilities. This finding may suggest that stress is a mediating variable in stimulant use in students with disabilities. Future research should further investigate this preliminary finding. There are several limitations in this study. The study was conducted at only one university, and the participants were predominantly White and female. A total of 36 participants, however, did not indicate their gender on the demographics form. Additional research should evaluate a larger number of students from more ethnically diverse populations and at

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214 multiple colleges. Also, students for the comparison sample were recruited from psychology classes. Although a variety of majors were present in this study, future research should recruit students from a broader student population. A further limitation was that students in this study who had a disability were required to be registered with the DSS office on campus. There are many students with disabilities in college who do not register with the DSS office (National Center for Education Statistics, 2000). Students with disabilities who register with the office may significantly differ from students who do not register in their level of severity, nature of disability, and need for accommodations. Students not registered with the office are generally not eligible for accommodations. Students who are registered may have a significantly different level of stress, sensation seeking, stimulant use and misuse, and substance use than students with disabilities who are not registered. Future research should address the possible differences. Another limitation is that the SSQ identifies both use and misuse of stimulant medication and does not differentiate on all questions whether the use is legitimate, which may confound the data to some degree. Stimulant use of a prescribed stimulant medication by a doctor and misuse by students will need to be more clearly differentiated. Substance use in college students with and without disabilities warrants further investigation. Given that as many as 25% of college students misuse prescription stimulant medication (McCabe et al., 2005), this issue needs to be further addressed, and especially when most students are unknowledgeable about the effects of the stimulants and any dangers they may pose. Additional studies should evaluate what significant differences exist among groups of students with different disabilities. Disabilities vary greatly. Indeed, the experiences of people with the same disability may vary significantly. A clearer understanding of which students are abusing, what types of substances they are abusing, and what interventions can be done to help prevent and treat substance abuse will help prevent substance abuse and will provide effective interventions when it occurs. In conclusion, results of the present study indicated that college students with disabilities who were sampled in this study reported lower levels of sensation seeking compared to those without disabilities. In addition, college students with disabilities, namely ADHD, endorsed significantly higher ratings of stimulant use and/or misuse of prescription stimulant medication. Students with ADHD were also significantly more likely to sell or give someone else their own stimulant medication, but were less likely to use alcohol than were students without ADHD. This study highlights the need for additional research in college students with disabilities, given that approximately 6% to 8% of college students report having a disability (Henderson, 2001; Horn & Berktold, 1999). Additional research is needed to further explore the social,

Journal of Attention Disorders 14(3) educational, and psychological functioning of college students with disabilities. Acknowledgments
The authors would like to thank all of the staff at Disability Services for students, the SPRIG research team, thesis committee members, and students who participated in this project. An earlier version of this article was presented at the 2009 conference of the American Psychological Association, Toronto, Canada. The authors would also like to thank Dr. Marvin Zuckerman, Dr. Sheldon Cohen, and Dr. Mary Hoban who granted us permission to use the Sensation Seeking Scale, Perceived Stress Scale, and the National College Health Assessment, respectively.

Declaration of Conflicting Interests

The authors declared that they had no conflicts of interests with respect to their authorship or the publication of this article.

Funding
The authors received no financial support for the research and/or authorship of this article.

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Bios
Grace M. Janusis, MA, is a doctoral student in School Psychology at the University of Rhode Island. Lisa L. Weyandt, PhD, is a professor of School Psychology at the University of Rhode Island. Her research interests include the study of ADHD in children and young adults as well as the study of executive functions in clinical and nonclinical populations.

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