The association between adverse childhood experiences and treatment response for adults with alcohol and other drug use disorders.

BACKGROUND AND OBJECTIVES: Adverse events during childhood increase the risk for the development of substance use disorders (SUDs). This study examined the association between adverse childhood experiences (ACEs) and SUD treatment response. METHODS: This cohort analysis included data from longitudinal clinical assessments extracted from the records of 438 consenting individuals undergoing SUD treatment (63% male; 88.8% White). Mixed effects models evaluated the relationship between scores on the ACE questionnaire and indicators of treatment response (i.e., alcohol and drug abstinence self-efficacy; symptoms of depression, anxiety, and posttraumatic stress disorder) for individuals with alcohol-related (n = 332) and other drug-related (n = 275) diagnoses, with some participants included in both groups. RESULTS: Treatment response varied as a function of ACEs, with the magnitude of differences varying across time in treatment. Relative to those with no ACE history, those who experienced ≥2 ACEs reported worse depression, anxiety, PTSD symptoms, and alcohol/drug abstinence self-efficacy at baseline, with many differences remaining at the 30-day assessment. All differences abated by discharge, with the exception of PTSD symptoms among those in the drug use group with a history of ≥4 ACEs. Male gender and older age were generally associated with lower symptomology and higher abstinence self-efficacy. DISCUSSION AND CONCLUSIONS: Assessing ACE history early in SUD treatment may improve treatment planning and prognosis. Future studies should evaluate the role of trauma-informed programming and individual interventions to improve treatment response. SCIENTIFIC SIGNIFICANCE: This study demonstrates the association between adverse childhood experiences and symptom severity among patients across participation in SUD treatment.

Barriers to recovery for medical professionals: Assessing financial support through a survey of Physician Health Programs.

BACKGROUND AND OBJECTIVES: There is increasing focus on physician burnout, psychiatric problems, and substance use disorders. Costs of recovery for physicians enrolled in Physician Health Programs (PHPs) remain unexamined with little known regarding funding resources. We sought to elucidate perceived costs of recovery from impairing conditions and highlight resources for financial strain. METHODS: This survey study was distributed by the Federation of State Physician Health Organizations via e-mail to 50 PHPs in 2021. Questions assessed perceptions of costs and ability to pay for recommended evaluation, treatment, and monitoring. Questions also assessed limitation of engagement due to financial concerns, and availability of financial resources. RESULTS: Complete responses were received from 40 of 50 eligible PHPs. The majority (78%) of responding PHPs assessed ability to pay at initial intake evaluation. There is notable financial strain on physicians, particularly those earliest in training, to pay for services. DISCUSSION AND CONCLUSIONS: PHPs are vital to physicians, especially physicians-in-training, as "safe haven programs." Methods to financially assist through PHPs included fee deferrals, sliding scale fees, and fee forgiveness. Health insurance, medical schools, and hospitals were able to provide additional assistance. SCIENTIFIC SIGNIFICANCE: Because burnout, mental health, and substance use disorders are high stakes amongst physicians, it is critical that access to PHPs is available, destigmatized, and affordable. Our paper focuses specifically on the financial cost of recovery, the financial burden placed on PHP participants, a topic lacking in the literature, and highlights remedies and vulnerable populations.

Early Performance of the Patients Over Paperwork Initiative among Family Medicine Physicians.

OBJECTIVES: In 2019, the Centers for Medicare & Medicaid Services began implementing the Patients Over Paperwork (POP) initiative in response to clinicians reporting burdensome documentation regulations. To date, no study has evaluated how these policy changes have influenced documentation burden. METHODS: Our data came from the electronic health records of an academic health system. Using quantile regression models, we assessed the association between the implementation of POP and clinical documentation word count using data from family medicine physicians in an academic health system from January 2017 to May 2021 inclusive. Studied quantiles included the 10th, 25th, 50th, 75th, and 90th quantiles. We controlled for patient-level (race/ethnicity, primary language, age, comorbidity burden), visit-level (primary payer, level of clinical decision making involved, whether a visit was done through telemedicine, whether a visit was for a new patient), and physician-level (sex) characteristics. RESULTS: We found that the POP initiative was associated with lower word counts across all of the quantiles. In addition, we found lower word counts among notes for private payers and telemedicine visits. Conversely, higher word counts were observed in notes that were written by female physicians, notes for new patient visits, and notes involving patients with greater comorbidity burden. CONCLUSIONS: Our initial evaluation suggests that documentation burden, as measured by word count, has declined over time, particularly following implementation of the POP in 2019. Additional research is needed to see whether the same occurs when examining other medical specialties, clinician types, and longer evaluation periods.

Assessment of Burnout, Professional Fulfillment, and Strategies for Improvement in Veterinary Faculty at a Large Academic Department.

Retention and recruitment of clinical faculty is crucial for the success of quality veterinary education. Clinical faculty in busy teaching hospital environments have the potential to experience significant burnout, though few studies have focused on identifying stressors in this group. The objective of this study was to measure burnout and professional fulfillment in clinical faculty using a recently validated instrument, the Stanford Professional Fulfillment Index (PFI). The survey was distributed to faculty in July 2020, a time that coincided with the COVID-19 pandemic. The survey was completed by 80% (52/65) of survey recipients. Scores for Overall Burnout were significantly higher (p = .027) and Professional Fulfillment scores significantly lower (p < .001) for veterinary faculty when compared with a reference group of academic physicians; 61.7% (29/47) of the faculty met the criteria for burnout, and 20.4% (10/49) met the criteria for professional fulfillment. Overall Burnout and Professional Fulfillment scores were not affected by faculty rank or gender, although interpersonal disengagement was greater in faculty who had worked > 6 years at the institution (p = .032). Responses indicated that faculty valued their work and their patients but faced an excessive workload and lacked autonomy to make changes. Faculty proposed improving efficiency, increasing staffing, and distributing work to technical staff. The PFI is a brief, no-cost instrument validated for measuring burnout and fulfillment in health care workers that can be used to assess well-being among veterinary faculty. Involving faculty in suggesting interventions may yield a variety of creative and actionable options.

Essential components of physician health program monitoring for substance use disorder: A survey of participants 5 years post successful program completion.

BACKGROUND AND OBJECTIVES: Physician health programs (PHPs) have demonstrated efficacy, but their mechanism of influence is unclear. This study sought to identify essential components of PHP care management for substance use disorder (SUD), and to assess whether positive outcomes are sustained over time. METHODS: Physicians with DSM-IV diagnoses of Substance Dependence and/or Substance Abuse who had successfully completed a PHP monitoring agreement at least 5 years before the study (N = 343) were identified as eligible. Of the 143 (42%) that could be reached by phone, 93% (n = 133; 86% male) completed the anonymous online survey. RESULTS: Virtually all PHP program components were rated as being at least "somewhat helpful" in promoting recovery, with the plurality of respondents rating almost all components as "extremely helpful." The top-rated components were: signing a PHP monitoring agreement, participation in the PHP, formal SUD treatment, and attending 12-step meetings, with each receiving a mean rating of at least 6.2 out of 7. Notably, 88% of respondents endorsed continued participation in 12-step fellowships. Despite the significant financial burden of PHP participation, 85% of respondents reported they believed the total financial cost of PHP participation was "money well spent." DISCUSSION AND CONCLUSIONS: Components of PHP monitoring were viewed as acceptable and helpful to physicians who completed the program, and outcomes were generally sustained over 5 years. More studies are needed to confirm these preliminary findings. SCIENTIFIC SIGNIFICANCE: This study documents the perceived cost-benefit of participation in a PHP among a small sample of program completers.

A feasibility trial of parent HPV vaccine reminders and phone-based motivational interviewing.

BACKGROUND: We assessed the feasibility and acceptability of a sequential approach of parent-targeted HPV vaccine reminders and phone-based Motivation Interviewing (MI). METHODS: In 2016, we selected all 11- to 12-year-old boys and girls seen in one clinic whose vaccine records did not include the HPV vaccine (n=286). By gender, we individually randomized parents of adolescents to an interactive text message (74 girls and 45 boys), postcard reminder (46 boys and no girls because of previously demonstrated efficacy), or standard care group (75 girls and 46 boys). Reminders were sent with medical director permission and a HIPAA waiver. Two months after reminders, among the adolescents whose vaccine records still did not include the HPV vaccine, we selected a gender-stratified random sample of 20 parents for phone-based MI. We assessed the percentage of deliverable messages, the percentage of parents' responding to the interactive text message, parent acceptability of receiving a text message, and MI parent responsiveness and interviewer competence (MI Treatment Integrity Coding system). RESULTS: Nearly all messages were deliverable (98% of postcards and 74% of text messages). Six of the 88 parents (7%) receiving text messages scheduled an appointment through our interactive system. The acceptability survey response rate was 37% (38/102). Respondents were favorable toward vaccine reminders for all parents (82%). Among 20 sampled parents, 17 were reached by phone of whom 7 completed MI, 4 had or were getting the HPV vaccine for their child, and 5 expressed disinterest. Across the 7 MI calls, the interviewer was rated 100% MI adherent and scored an average 4.19 rating for Global Spirit. CONCLUSION: Without providing explicit consent to receive vaccine-related messages, parents nonetheless found postcards and interactive text messages acceptable. Centralizing MI to phone calls with trained staff was acceptable to parents and resulted in highly MI-adherent interviews.

Gender differences in substance use and psychiatric distress among medical students: A comprehensive statewide evaluation.

BACKGROUND: Medical student wellness has emerged as an important issue in medical education. The purpose of the present study was to obtain a comprehensive assessment of substance use, psychological distress, and help-seeking among male and female medical students in order to identify targets for continued intervention efforts. METHODS: Medical students from all 9 medical schools in the state of Florida were invited via e-mail and/or announcements to complete an anonymous online questionnaire assessing their well-being. Of 5053 matriculating medical students, 1137 (57.1% female) responded to the questionnaire. Descriptive statistics, t tests, and chi-square analyses were computed using SPSS 20. RESULTS: Over 70% of students acknowledged binge drinking, with men reporting higher frequency than women (χ2 = 13.90, P = .003), and 22.7% (n = 201) reported marijuana use during medical school, with higher rates (χ2 = 9.50, P = .02) among men (27.0%, n = 99) than women (18.9%, n = 93). A significant minority of students reported nonmedical use of prescription stimulants and prescription opioids. In addition, 3.3% of male students (n = 12) compared with 0.6% of female students (n = 3) reported problematic drug use. Further, almost 2/3 of respondents reported decreased psychological health since beginning medical school, with women noting greater reductions (χ2 = 12.39, P = .05) and higher levels of stress (χ2 = 16.30, P = .003). Over 10% of students (n = 102) endorsed "thoughts of committing suicide" during medical school, and 70.1% felt they would benefit from mental healthcare (79.3% of women vs. 59.6% of men; χ2 = 41.94, P < .001), although only 39.8% accessed help. CONCLUSIONS: Despite efforts to address medical student wellness, students continue to report concerning levels of psychological distress, suicidal ideation, and substance use. More work is needed to effectively address medical student mental health and well-being.

The initial feasibility of a computer-based motivational intervention for adherence for youth newly recommended to start antiretroviral treatment.

Young people represent the largest number of new HIV infections, thus youth living with HIV (YLH) are likely to be the largest group to initiate antiretroviral treatment (ART). Adherence patterns for behaviorally infected YLH are not adequate to effectively manage the disease; therefore, novel interventions are needed to improve medication adherence. The purpose of the current study, which will precede a randomized controlled trial, was to assess the initial feasibility of an individually tailored computer-based two-session interactive motivational interviewing (MI) intervention for YLH newly recommended to start ART. Intervention development occurred in collaboration with three youth advisory groups. Ten youth (ages 18-24) were recruited to participate in this study. Participants completed the intervention online. Intervention components focused on medication adherence (rating perceived importance and confidence, and goal setting). Retention was 100% for both intervention sessions. All participants (n=10) felt medication adherence was important, but 80% felt confident they could manage their adherence to HIV medications. Ninety percent of participants set the goal of taking their HIV medications exactly as prescribed and reported success achieving this goal at follow-up. Additionally, participants were satisfied with the quality of the sessions and the amount of assistance they received for managing their adherence to HIV medications (90% participants for Session 1; 89% for Session 2). Per exit interview responses, participants felt that the intervention made them think more about their health and was a motivator for them to take better care of their health. In conclusion, the intervention was feasible for YLH enrolled in the study.

Prescription drug diversion among substance-impaired pharmacists.

BACKGROUND AND OBJECTIVES: Prescription drug addiction is a significant problem affecting healthcare professionals. The purpose of the present study was to identify common mechanisms of prescription drug diversion by pharmacists, in order to facilitate the development of effective prevention programs and policies for this high-risk group. METHODS: A total of 32 pharmacists (71% male) who were being monitored by their State professional health program (PHP) due to substance-related impairment participated in anonymous guided group discussions. RESULTS: Participants documented six primary methods of drug diversion by pharmacists: (1) taking expired drugs that can no longer be sold by the pharmacy and are awaiting disposal; (2) assuming responsibility for managing the pharmacy inventory and/or changing inventory records to prevent detection of missing drugs; (3) forging prescriptions for themselves, family members, friends, or customers in order to gain access to the drugs; (4) using "sleight of hand" techniques to acquire drugs while filling prescriptions or shelving products; (5) blatantly stealing drugs from the pharmacy, even in front of coworkers or video cameras, and (6) collecting patients' unused medications and keeping them. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Efforts to address the problem of prescription drug abuse and diversion by pharmacists should be expanded in order to safeguard pharmacies and the patients they serve. Future research should extend this study to larger samples and assess best practices for decreasing prescription drug diversion by pharmacists with addiction.

Brief educational intervention to improve medical student competence in managing patients exposed to secondhand smoke.

BACKGROUND: Secondhand smoke (SHS) exposure may lead to the development of various diseases and conditions. One way to reduce SHS exposure is to screen for it within each primary care examination so that appropriate counseling can be directed to affected individuals. There has been little attention to improving medical education about SHS exposure and screening. The goal of this study was to develop an SHS-related educational intervention for medical students, with the purpose of improving knowledge regarding consequences of SHS exposure, and increasing intent to screen patients for exposure. METHODS: Medical students (N = 405) were given a measure assessing their knowledge of SHS exposure and intent to screen. Two groups of students served as controls (i.e., a posttest-only group and a pre/posttest group), and one group participated in the SHS education intervention. A factorial analysis with repeated measures and chi-square analyses were used to assess the differences between the groups to determine the impact of the SHS education intervention (ie, online lectures and a standardized patient interaction) on knowledge and intent to screen. RESULTS: Results of pretesting demonstrated that medical students had little knowledge of SHS exposure, averaging scores between 63% and 69% on the examination. One control group was reassessed a year later with no educational intervention. They did not demonstrate a significant change in their pre- to posttest scores, although the vast majority (∼95%) reported intending to screen future patients. Students who participated in the SHS educational intervention significantly improved their scores from pre- to posttest (P <.001), and 100% also reported intending to screen future patients. CONCLUSIONS: This study suggests that brief education regarding the consequences of SHS exposure may improve medical students' knowledge and increase intent to screen. Future research should assess the long-term impact of educational programs on improved clinical care.

Characterizing Referrals to Professional Health Monitoring Programs for Unprofessional Sexual Behavior.

Concerns about sexual misconduct by health care professionals have been highlighted by recent high-profile cases. Professional health monitoring programs (PHPs) offer an additional layer of protection when health care professionals with a history of unprofessional sexual behavior (USB) return to practice; however, little is known about the characteristics or outcomes of clinicians referred to a PHP because of USB. Data were extracted from over 35 years of PHP records involving USB-related referrals (N = 570). The majority of cases were deemed ineligible for PHP monitoring and handled by other entities (e.g., licensing board, legal system). Of the 232 monitored cases (46.84 ± 9.42 years; 95.7% male), most were physicians (n = 156, 67.2%), with 75.9 percent of monitored cases involving USB with at least one patient. Most (74.9%) PHP monitoring outcomes were classified as "successful" or "very successful." Only three individuals (1.3%) who completed their monitoring were rereferred to the PHP. Monitored professionals exhibited less severe USB and were less likely to experience legal or disciplinary consequences (57.3% versus 69.8%, Cramer's V = .174, p < .0001) compared with unmonitored professionals. Findings enhance transparency of the PHP process and highlight its utility in safely returning clinicians to practice. Results may inform policies to prevent USB by health care professionals.

Challenges for Nurse Anesthetists Reentering Practice Following Substance Use Disorder Treatment.

Substance use disorder (SUD) is a persistent, relapsing condition that is present in approximately 10% of anesthesia providers, who, compared with other healthcare providers, face a greater risk of developing an SUD by virtue of constant access to medications. The ability of certified registered nurse anesthesiologists (CRNAs) to obtain or maintain employment after treatment for SUD treatment is not well documented. The purpose of this qualitative study was to explore challenges encountered by CRNAs in recovery as they attempt to reenter practice following SUD treatment. The phenomenon was explored through multiple-case study, using qualitative semistructured interviews with participants in four cases: CRNAs in recovery, CRNA colleagues, CRNA employers, and professional health program employees. Thirty-six participants conveyed their perspectives about challenges that CRNAs in recovery face upon reentry into practice following SUD treatment. The Worker Well-Being conceptual model was used to guide this study. The study revealed that more SUD education is a key facilitator for reentry, risk of relapse was a major concern, and stigma was the most significant barrier for CRNAs in recovery. Stigma persists as a considerable barrier in many facets of SUD, contributing to an increase in shame associated with having the disease.

Patterns of substance use initiation among healthcare professionals in recovery.

BACKGROUND AND OBJECTIVES: Substance-related impairment among healthcare professionals has significant public health implications, but little is known regarding factors associated with substance use initiation in this group. METHODS: In this study, 105 healthcare professionals (80% male), who ranged in age from 24 to 68 years (M = 47.1 years, SD = 10.2) completed a self-report questionnaire assessing age at first use, education level at first use, means of access to substances upon first use, order of substance use initiation, and reasons for first and continued substance use. Physicians (51%), pharmacists (19.2%), dentists (11.5%), physician assistants (5.8%), and various other allied health professionals (12.7%) participated. RESULTS: Results demonstrated that 73.2% of the professionals used tobacco, 90.4% used alcohol, and 64.4% used other drugs before beginning professional school. Reasons for first use of substances paralleled those seen in the general public (e.g., curiosity, peer influence, availability), and differed from reasons for continued substance use (e.g., getting high, addiction, stress management). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Given that onset of substance use among health professionals appears to mirror that seen in the general population, their unique treatment success rates likely cannot be solely attributed to later age-of-onset of their substance use disorder. Delaying experimentation with addictive substances and improving efforts at early identification of problematic use are crucial to preventing the development of substance use disorders among healthcare professionals, as well as the public as a whole.

Assessing Psychological Resilience and Distress Among Graduate Health Profession Students During the COVID-19 Pandemic.

Background: Resilience, a person's ability to adapt to adverse events, is associated with positive outcomes, especially in the field of healthcare. Research into the effects of the COVID-19 pandemic may help to understand and combat the long-term mental health burden for trainees in health care. Objective: This cross-sectional study aimed to assess the impact of the pandemic on health profession students' educational experiences, determine the association between their self-reported resilience and psychological distress and assess group differences between students from different graduate health profession programs in an academic medical center. Methods: Graduate health profession students completed a 44-question online survey and the 10-item Connor Davidson Resilience Scale (CD-RISC-10) during the COVID-19 pandemic period between January-March 2021. We used descriptive statistics, independent samples t test, Related-samples Wilcoxon signed rank test, Pearson correlations test and Analysis of variance (ANOVA) to analyze the data. Results: Majority of respondents reported that COVID-19 had a negative impact on their education and caused a reduction in educational opportunities (76.6% and 73% respectively). Majority also reported feeling burned out, lonely/isolated, or frustrated by COVID-19 restrictions (70.0%, 67.4%, and 61.8% respectively). Students reported increased use of both avoidant and adaptive coping strategies during the pandemic. Higher resilience scores were associated with higher self-reported stress, fewer burnout symptoms, and better overall well-being. Conclusion: The COVID-19 pandemic significantly affected students in graduate health profession programs. Instructional quality, educational opportunities, institutional trust, peer socialization, and personal health and wellbeing were perceived to be negatively impacted. Students may require additional support and resources from their training programs to mitigate these concerns. Future studies should evaluate the long-term impact of the COVID-19 pandemic among pandemic-era graduate health profession students.

Relapse Prevention and Prediction Strategies in Substance Use Disorder: A Scoping Review.

BACKGROUND: Relapse prevention for those with substance use disorder (SUD) is an evolving practice. Initiatives focused on relapse prevention from other populations may provide the foundation for future considerations and recommendations for recovering anesthesia providers in the workplace. The purpose of this scoping review was to examine what is known about return-to-use prediction and prevention strategies in various populations struggling with SUDs to inform future considerations and implications for recovering anesthesia providers with a history of SUD. METHODS: The Arksey and O'Malley framework was used to conduct a scoping review of the literature. A systematic search was conducted across three databases (PubMed, CINAHL, and PsycInfo) for relevant literature. Search terms used were "measures predicting relapse in substance use disorder" and "relapse prevention in substance use disorder AND anesthesia." Data from articles that met the eligibility criteria were extracted and summarized by the primary author. RESULTS: The search identified 46 articles highlighting various relapse prediction and prevention strategies related to craving and stress, underlying biological factors, neuroimaging, and mindfulness. Relapse prediction and prevention strategies ranged from cell phone applications, monitoring biological markers, and functional neuroimaging of the brain. CONCLUSIONS: Relapse is a concern for individuals with a history of SUD. For anesthesia providers, immediate access to powerful anesthesia medications requires return-to-use prediction and prevention strategies when anesthesia providers return to work after SUD treatment. Although some identified strategies are practical, more research is needed to predict and prevent return to use for recovering anesthesia providers.

Patient experiences with tobacco use during substance use disorder treatment and early recovery: a mixed method analysis of phone interview responses.

Tobacco use and related mortality remain disproportionately high among individuals with substance use disorders (SUDs). Though engagement in tobacco cessation interventions is associated with improved long-term recovery, many individuals in SUD treatment do not participate. The goal of the present study was to better understand patient views regarding tobacco use/cessation during residential SUD treatment, in order to decrease barriers for this vulnerable population. This study utilized a cross-sectional design and mixed methods analysis. Following discharge from residential SUD treatment, individuals who reported any use of tobacco were invited to participate in a brief phone interview. Forty-one of the 60 who were reached (68%) agreed to participate. Responses were quantified for analysis when appropriate, and descriptive statistics were calculated for quantitative data. Thematic analysis was used to analyze qualitative responses. Most respondents (83%) reported that tobacco cessation was an important goal and were open to tobacco cessation treatment. The vast majority (85%) did not think tobacco use interfered with their recovery from other SUDs. Respondents noted the socially-reinforcing nature of tobacco use in treatment, and indicated a desire for increased access to cessation services. Results suggest increased patient education and changes to treatment center tobacco policies may assist individuals recovering from SUD with tobacco cessation.

Merit-based incentive payment system participation and after-hours documentation among US office-based physicians: Findings from the 2021 National Electronic Health Records Survey.

BACKGROUND: After-hours documentation burden among US clinicians is often uncompensated work and has been associated with burnout, leading health systems to identify root causes and seek interventions to reduce this. A few studies have suggested quality programme participation (e.g., Merit-Based Incentive Payment System [MIPS]) was associated with a higher administrative burden. However, the association between MIPS participation and after-hours documentation has not been fully explored. Thus, this study aims to assess whether participation in the MIPS programme was independently associated with after-hours documentation burden. METHODS: We used 2021 data from the National Electronic Health Records Survey. We used a multivariable ordinal logistic regression model to assess whether MIPS participation was associated with the amount of after-hours documentation burden when controlling for other factors. We controlled for physician age, specialty, sex, number of practice locations, number of physicians, practice ownership, whether team support (e.g., scribes) is used for documentation tasks, and whether the practice accepts Medicaid patients. RESULTS: We included 1801 office-based US physician respondents with complete data for variables of interest. After controlling for other factors, MIPS participation was associated with greater odds of spending a greater number of hours on after-hours documentation (odds ratio = 1.44, 95% confidence interval 1.06-1.95). CONCLUSIONS: MIPS participation may increase after-hours documentation burden among US office-based physicians, suggesting that physicians may require additional resources to more efficiently report data.

Psychiatric medication-seeking beliefs and behaviors among college students.

BACKGROUND: Misuse of prescription psychiatric medications is increasing on college campuses. Sources of medications include friends or family, obtaining prescriptions fraudulently or from multiple physicians, and buying drugs online. OBJECTIVE: This study assessed psychosocial correlates of medication-seeking behaviors in college students to identify characteristics of potential prescription drug misusers. METHODS: The sample included 383 participants (59.2% female) recruited from various campus locations and online classes of a Division I university in the southeastern region of the United States, with an enrollment of approximately 50,000 students. Participants anonymously completed self-report questionnaires. RESULTS: Misusers of prescription psychiatric medication were more likely to have health insurance and to know someone else who had misused that medication. They were more likely to endorse positive attitudes regarding medication-seeking. There was a significant correlation between positive medication-seeking beliefs and reported medication-seeking behaviors. The most common and most accepted form of medication-seeking was asking for the medication from a peer. CONCLUSIONS: Results suggest the need for further education regarding the dangers of psychiatric medication-seeking, particularly related to seeking medication from peers. SCIENTIFIC SIGNIFICANCE: This study is the first to assess psychosocial characteristics of college students who seek prescription psychiatric medications for misuse. The information obtained may be used for risk assessment and preventive efforts.