PS516 Unit 7 Stimulant Medication Paper Example

An Adderall Request in Finals Week: A PS516 Unit 7 Paper on Stimulant Medication, ADHD and Misuse Risk in a College Student

[Student Name]

Purdue University Global

PS516: Psychopharmacology

Unit 7 Stimulant Medication Paper

[Instructor Name]

[Date]

The client, the clinic and every detail of the case are composite and illustrative; the sources cited are real.

The Request

Kayla is 21 and finishing prerequisites for a nursing program at the community college in Walla Walla while working twenty hours a week at a grocery store. She came to our clinic in November and told the front desk she needed "something like Adderall" for finals. She said her roommate had given her two pills during midterms and she "finally got everything done." She has never been evaluated for ADHD. She described trouble focusing in long lectures, falling behind on reading and studying late at night after work.

My first task was to make sure the request went to the right place, an assessment by our psychiatric nurse practitioner, and to understand the medications well enough to talk with Kayla honestly about what an evaluation might and might not lead to.

How Stimulants Act

ADHD stimulants, Stahl (2021) explains, leave more dopamine and norepinephrine active between nerve cells. Methylphenidate mainly blocks the transporters that remove these chemicals from the synapse, while amphetamines both block the transporters and push more dopamine and norepinephrine out of the nerve cell. In the prefrontal cortex, moderate increases in these signals improve attention and control in people with ADHD. Larger and faster increases, especially in reward pathways, produce euphoria and are the basis of misuse. Long-acting forms deliver the drug gradually, which lowers the peak and makes misuse less appealing than with immediate-release tablets.

What the Evidence Says About Treatment

Cortese et al. (2018) ranked the ADHD drugs against each other using controlled trials across all ages. Stimulants were more effective than placebo across age groups. Once side effects were counted alongside benefit, the review's top-ranked option for someone Kayla's age was an amphetamine product, while for school-age children it ranked methylphenidate highest. Those rankings are averages from short trials, which is one reason the nurse practitioner, not the review, makes the choice. Atomoxetine and the other nonstimulants helped as well, though by a smaller margin on average.

These results apply to people who have ADHD. They do not show that stimulants are a good idea for anyone who wants to study better.

What the Evidence Says About Misuse

Benson et al. (2015) reviewed research on the misuse of stimulant medication among college students and estimated that about one in six had misused them, most often to study or stay awake. Students who misused stimulants were more likely to use other substances and to have lower grades, and most obtained the pills from friends with prescriptions. The review also found that the academic benefits students expected were not well supported by evidence.

Kayla's roommate's pills may have made her feel productive, but the research suggests the feeling is a poor guide to whether stimulants are helping.

Applying the Evidence to Kayla

Kayla's story contains several possibilities. She may have ADHD that went unnoticed because she did well enough in high school. She may have attention problems from too little sleep, a heavy work schedule and stress, which stimulants would not fix. She may have anxiety or depression affecting concentration. An evaluation by a qualified prescriber, including her history from childhood, rating scales and screening for sleep problems, mood and substance use, is the only way to tell.

I explained to Kayla that the nurse practitioner would evaluate her rather than simply prescribe, that a diagnosis of ADHD would require evidence that symptoms began in childhood and affect more than one area of life, and that if she did have ADHD, treatment would likely start with a long-acting form. I also said plainly that taking a roommate's pills is illegal and carries health risks, including effects on heart rate and blood pressure, and that I would not judge her for having done it.

The Evaluation

The nurse practitioner saw Kayla two weeks later. The history showed difficulty with attention since elementary school, report card comments about losing work and daydreaming, and problems at work as well as at school. Rating scales completed by Kayla and her mother supported a diagnosis of ADHD, predominantly inattentive presentation. The nurse practitioner discussed medication options with her, including a long-acting stimulant, and agreed to start one after finals, so that dose adjustments would not happen during exams.

Counseling and Supports

Whatever the medication decision, Kayla's schedule was part of the problem. In our sessions we built a study plan around her shifts, moved her hardest reading to mornings and walked her over to the campus office that arranges testing accommodations, such as extra time, for students with a documented diagnosis. We also talked about keeping her prescription safe: roommates and friends are the most common source of misused stimulants, and a locked box and a plan for refusing requests are part of responsible use. Kayla laughed and said her roommate would be the first to ask, which is exactly why we practiced what she would say.

If Kayla Had Not Had ADHD

The evaluation could easily have gone the other way. If the history had not shown symptoms since childhood, the honest answer would have been that her concentration problems came from a twenty-hour work week, short sleep and stress, and that a stimulant would not treat any of those. In that case the plan would have looked much the same apart from the medication: a study schedule built around her shifts, help with sleep and a conversation about whether she could reduce her hours during the hardest terms. I would also have talked with her about the risks of continuing to use a roommate's pills, without lecturing, since shame tends to push people toward hiding use rather than stopping it.

Limits

Cortese and colleagues' meta-analysis looked mainly at short-term outcomes, and Benson and colleagues' review drew largely on self-report surveys. Neither predicts how Kayla will respond.

Conclusion

Kayla's request for "something like Adderall" could have been a request for a performance aid or a sign of untreated ADHD. Stahl explains how stimulants affect attention and why fast-acting forms are misused, Cortese and colleagues show that stimulants are effective for people with ADHD and Benson and colleagues show that misuse in college is common and its benefits are doubtful. The care manager's role was to route the request to a proper evaluation, explain honestly what that would involve and help Kayla build supports that do not depend on a pill.

References

Benson, K., Flory, K., Humphreys, K. L., & Lee, S. S. (2015). Misuse of stimulant medication among college students: A comprehensive review and meta-analysis. Clinical Child and Family Psychology Review, 18(1), 50-76. https://doi.org/10.1007/s10567-014-0177-z

Cortese, S., Adamo, N., Del Giovane, C., Mohr-Jensen, C., Hayes, A. J., Carucci, S., Atkinson, L. Z., Tessari, L., Banaschewski, T., Coghill, D., Hollis, C., Simonoff, E., Zuddas, A., Barbui, C., Purgato, M., Steinhausen, H.-C., Shokraneh, F., Xia, J., & Cipriani, A. (2018). Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: A systematic review and network meta-analysis. The Lancet Psychiatry, 5(9), 727-738. https://doi.org/10.1016/S2215-0366(18)30269-4

Stahl, S. M. (2021). Stahl's essential psychopharmacology: Neuroscientific basis and practical applications (5th ed.). Cambridge University Press.