Driving Under the Influence of Stimulants: Prevalence and Psychosocial Correlates

Background and Purpose: Each month several million Americans use illicit stimulants, such as cocaine and methamphetamine, and—critically—national data suggest that the prevalence of use is increasing. Stimulant misuse can result in myriad adverse behavioral and health consequences, including: erratic and risky behavior; anxiety and mood disturbances; severe medical complications such as stroke and seizure; overdose and even death. Meanwhile, it is well established that a disconcerting number of Americans drive under the influence of alcohol and a growing body of research has begun to examine the prevalence of driving under the influence of cannabis as well. Presently, however, our understanding driving under the influence of illicit stimulants (DUIIS) remains very limited, despite the manifold risks involved in DUIIS. Cognizant of this gap, the present study employs data from a national sample to examine the prevalence and psychosocial/behavioral correlates of DUIIS among adults in the United States.

Methods: This study examines public-use data collected between 2016 and 2018 as part of the National Survey on Drug Use and Health (NSDUH). The full 2016-2018 adult (ages 18+) sample includes 170,944 participants; however, our analytic sample was primarily limited to 4,447 participants reporting past-year illicit stimulant use. We present survey adjusted prevalence estimates overall and by subgroup. In turn, binomial logistic regression was used to determine likelihood of DUIIS by frequency of use, age of initiation of use, mental health conditions (major depressive episode and psychological distress), other automobile-related risky behaviors (driving under the influence of other substances, non-seatbelt use), and criminal justice system involvement.

Results: The overall past-year prevalence of DUIIS was 0.7% (95% CI = 0.7-0.8) in the general population, and 28.3% (95% CI = 26.3-30.3) among illicit stimulant users. Among illicit stimulant users, risk of DUIIS was elevated among men and individuals in rural areas; additionally, comparted to non-Hispanic Whites, rates were significantly lower among African Americans. Frequency of use predicted DUIIS for both cocaine and methamphetamine, but early age of initiation was only significant for cocaine. Over 50% of individuals reporting DUIIS also report driving under the influence alcohol and cannabis, and DUIIS was associated with increased risk of depression (AOR = 2.08, 95% CI = 1.73-2.49), psychological distress (AOR = 2.20, 95% CI = 1.90-2.55), and criminal justice involvement (AOR = 1.99, 95% CI = 1.61-2.45).

Conclusions and Implications: Study findings have a number of implications for policy and practice. One is that our study findings make clear that a disconcerting number of illicit stimulant users report DUIIS. As such, this is an overlooked population in need of evidence-informed intervention. Not only is this behavior injurious to self, but it also—due to the emotion dysregulation and judgment-impairment effects of illicit stimulant use—places others at risk. At a minimum, health and social service providers who screen for illicit stimulants use should discuss DUIIS with individuals reporting use. Additionally, findings underscore the importance of incorporating content on DUIIS in drug treatment programming or in content designed for individuals arrested for driving under the influence in general.