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Recent results from a nationally representative sample indicated that young adults exhibited the greatest illicit drug use (SAMHSA, 2013b). The non-medical use of prescription drugs (NMUPD) is the second most commonly reported form of illicit substance use by young adults, preceded only by marijuana (SAMHSA, 2013b). This is a growing public health concern with an estimated 2.4 million Americans engaged in NUMPD for the first time within the past year in 2010, an average of 6,600 initiates per day (SAMHSA, 2013b). Prescription opioid abuse alone was estimated to cost the U.S. $55.7 billion in 2007 (Birnbaum et al., 2011). NMUPD has been linked with abuse and dependence, and a variety of other negative outcomes, including mental illness, (e.g., Bavarian et al., 2013), poor school performance (Arria et al., 2011), emergency room visits (SAMHSA, 2013a, 2013b), more frequent sexual risk behaviors (Benotsch et al., 2011), and death (CDC, 2012; Paulozzi et al., 2012). Additionally, young adults who engage in NMUPD are significantly more likely than their peers to use other illicit drugs and to combine prescription drugs with alcohol and other substances. These practices increase the risk of potentially dangerous drug interactions, and their negative outcomes (Garnier et al., 2009; McCabe et al., 2006; SAMHSA, 2006). Therefore, prevention is key to reducing this great public health concern and its grave costs to society. One way to prevent substance use and abuse is to investigate why specific groups of people use and to target interventions specifically to modifiable predictors. The current study focuses on such potential predictors.

The sample included 193 undergraduate students (70.4% female) from diverse ethnic groups (55% White) attending a large public university who endorsed NMUPD of either pain or stimulant medications in the past year. Participants completed an online questionnaire that assessed their ratings of their problematic NMUPD use, sleep problems, emotion regulation difficulties, depressive symptoms, and post-traumatic stress disorder (PTSD) symptoms from reliable and valid measures. Using regression models run separately for users of pain and stimulant medications, emotion regulation difficulties and PTSD symptoms were found to predict non-medical problematic use of both pain and stimulant medications (betas ranged from .22 - .32, ps < .05). Sleep problems and depressive symptoms were found to only predict problematic use of stimulants (betas = .33, ps < .01). When all the significant predictors were entered into a multiple regression for each prescription category, no one predictor was significant above and beyond other predictors (see Table 1). However, PTSD symptoms explained the most variance in both models.

These results suggest that all of these predictors are important to consider when investigating NMUPD in young adults. Since results from treatment research investigating abuse of other substances have found that integrated approaches that combine mental health and substance use are more effective than interventions that address substance use and mental health problems separately (e.g., Drake et al., 2008), future prevention and intervention efforts should consider all of the variables investigated. If resources are limited targeting PTSD symptoms may be the most effective.

Publication Date



prescription drugs


Clinical Psychology

Faculty Advisor/Mentor

Dr. Wendy Kliewer

Is Part Of

VCU Graduate Research Posters

Predictors of problematic non-medical prescription pain and stimulant use