Can Education Level Predict Prescription Drug Misuse in Young Adults?

A new study examines the extent to which patterns in prescription drug misuse and substance use disorder symptoms can be predicted by education level


In a study recently published in Drug and Alcohol Dependence, Ty Schepisa, Christian Teterb, and Sean Esteban McCabec tackle understudied links between educational attainment and drug use. Specifically, they explore prescription drug use, prescription drug misuse (PDM), and substance use disorder (SUD) symptoms among adolescents and young adults.

The findings indicate that adolescents either not in school, or in school but with poor school adjustment, report the highest rates of prescription use, misuse, and SUD symptoms across enrollment categories. Among young adults (a second, slightly older sample), opioid-PDM rates were highest among those unenrolled in school, specifically those who had not received college diplomas, while full-time college-enrolled young adults and college-graduates demonstrated heightened vulnerability to stimulant-PDM.

Photo Credit: Ben W, CC BY-NC-SA 2.0

“Lifetime and past-year adolescent and young adult PDM is linked to concerning outcomes, including poorer academic performance, psychopathology, and risky behavior,” the researchers write. “Nonetheless, the PDM literature in these groups is limited by the near-exclusive use of school- or college-based samples. When investigated by dichotomous school enrollment, past-year PDM prevalence rates differ in adolescents and young adults. Despite these findings, no research has followed to investigate whether more fine-grained educational differences affect PDM (e.g., level of educational attainment in young adults not in college).”

Recent years have seen an increasing trend in PDM in the United States impacting individuals across demographic subgroups. Adolescents (ages 12-17) and young adults (ages 18-25) engage in disproportionately high rates of PDM with opioids, stimulants, and sedatives/tranquilizers compared to other age groups. Consequences include psychosocial distress, educational/professional difficulty, increased need for medical attention, medical emergencies, and sometimes death.

The consequences of PDM can be devastating. While the opioid crisis, in particular, has received substantial national attention, prescriptions for antianxiety, antidepressant, stimulant, and other pain relief and psychopharmacological medications have been on the rise in recent years. Increased patterns in prescription have occurred alongside associated side effects (known or unknown) and opportunities for addiction.

According to one estimate, approximately half of opioid prescriptions are given to individuals with a mood disorder diagnosis. Prescriptions can pose risks both to patients, as well as those living with and around them. Potential for misuse and addiction should not be confused as a function of a demographic stratum, but awareness of unusually high vulnerabilities within specific groups could improve prevention and support efforts.

This study examines people’s level of education about PDM type (either medical misuse, use in a way that a prescriber did not intend, nonmedical misuse, use without a prescription, or mixed misuse, a combination of prescribed and unprescribed use) and the number of SUD symptoms. The researcher’s treatment of this topic represents the first in which layers of PDM in adolescents and young adults have been dissected and compared to particular dimensions of educational attainment beyond dichotomous enrollment patterns (i.e., in or out of school).

The researchers used data from the National Survey on Drug Use and Health (NSDUH), made up of nationally representative samples of adolescents (n = 13, 585) and young adults (n = 14,553), to establish links between educational attainment, PDM, and SUDs symptoms. Four encompassing educational attainment status categories were selected to reflect adolescent education level, while six were chosen to reflect the education levels of young adult participants. Categories of prescription drug use patterns (examined separately across opioid, stimulant, and sedative/tranquilizer prescription types) included:

  • Any past-year use
  • Any past-year PDM
    1. Nonmedical misuse
    2. Medical misuse
    3. Mixed misuse

Additionally, experiences of SUD symptoms associated with any of the three prescription types were investigated according to the total number that had been experienced by participants in the past year. Prescription use, PDM, and SUD symptoms were analyzed as functions of educational attainment through logistic regression.

“This work highlights adolescents not in school or with poor school adjustment as having elevated rates of PDM, nonmedical misuse, and SUD symptoms,” the researchers write. “Those with poor school adjustment were similar to those not in school, suggesting that PDM elevations predate [high school] dropout. Identifying adolescents in school engaged in PDM may limit both direct and indirect PDM consequences, which could include [high school] dropout. Outreach to adolescents not in school requires community-based, including parental education about medication storage and disposal, as the family is a key source for PDM.”

Further research is needed to replicate and build upon Schepisa and colleagues’ findings to solidify relationships identified in the current study. Additionally, future research could serve to illuminate factors that facilitate relationships identified in this study. Overall, this work provides direction for clinicians and school professionals seeking to provide preventative and supportive services to those vulnerable to cycles of prescription misuse and addiction. Consideration for overarching environmental, political, and cultural factors extending beyond the scope of the current study will be important in the development of modes of education and support to vulnerable adolescents and young adults.



Schepis, T. S., Teter, C. J., & Mccabe, S. E. (2018). Prescription drug use, misuse, and related substance use disorder symptoms vary by educational status and attainment in U.S. adolescents and young adults. Drug and Alcohol Dependence, 189, 172-177. (Link)


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