Scoping review finds no integrated anxiety–stimulant pathway in undergraduates

A scoping review of research on undergraduate students found partial evidence connecting anxiety-related constructs, substance-use motives and nonmedical use of prescription stimulants, or NMUPS. Among 13 eligible studies, none tested the complete social anxiety–motive–NMUPS or use-intention pathway within a single model. The review therefore concluded that the available literature does not establish an integrated psychological mechanism linking the proposed factors.

The researchers searched peer-reviewed empirical studies published from January 2000 through April 2026. They identified 443 records, of which 13 met the inclusion criteria. Ten studies examined relationships between social anxiety-related constructs and either actual NMUPS or an intention to use prescription stimulants, while four focused on relationships between motives and actual NMUPS. One study contributed evidence to both categories.

The review used a framework integrating Buckner’s biopsychosocial model of social anxiety with Cooper’s motivational model of substance use. Its central objective was to determine whether the hypothesized pathway had been tested empirically and to map the partial evidence concerning its individual components. Three reviewers independently screened studies for eligibility. One reviewer extracted the data, and two others verified the extraction.

A key limitation was that none of the 10 anxiety-related studies directly measured social anxiety. Nine instead assessed broader anxiety-related constructs, and one examined test anxiety, described in the review as an adjacent social-evaluative construct. This means the studies did not provide a direct test of the role played by social anxiety in the proposed pathway, even though they addressed anxiety-related measures relevant to parts of the framework.

The motive-related evidence was also limited. Four studies examined associations between motives and actual NMUPS, with enhancement motives appearing most frequently among the motivational factors considered. The review did not establish that enhancement motives or any other motive caused nonmedical prescription-stimulant use. Instead, it mapped the associations that had been investigated and identified gaps in how motives had been measured and tested.

Most of the included studies were cross-sectional, and actual NMUPS was the primary outcome across much of the evidence base. The review treated these studies as providing information about relationships among measured constructs rather than establishing temporal order or causal effects. A reported association between an anxiety-related measure and NMUPS, for example, does not by itself show that the anxiety-related factor preceded the behavior.

The outcome measures also differed across the literature. Some studies focused on actual nonmedical use of prescription stimulants, whereas others examined intention to use them. The review did not establish that the same psychological processes apply equally to behavior and intention. Combining findings across these outcomes may help identify areas for further study, but it does not amount to validation of a single mechanism.

Based on the fragmented evidence, the authors call for longitudinal, mechanism-focused research that differentiates social anxiety from other anxiety-related constructs and treats motives as multidimensional. They also recommend examining both actual NMUPS and use intention within a unified structural model. Such research would clarify whether nonmedical stimulant use among undergraduates is related to social-evaluative pressure and perceived functional demands, a possibility raised by the framework but not demonstrated by the studies reviewed.

The review’s central result is therefore a map of an incomplete evidence base rather than proof of a causal chain. It documents where anxiety-related constructs, motives and stimulant-use outcomes have been studied separately, while showing that no study has yet assembled those components into the proposed pathway. For undergraduate students, the current literature does not establish that social anxiety causes nonmedical prescription-stimulant use, and it does not support treating any of the observed associations as a confirmed mechanism.

Subject of Research: Scoping review of social anxiety, substance-use motives and nonmedical prescription-stimulant use among undergraduate students

Article Title: Social anxiety and motives for nonmedical use of prescription stimulants among undergraduate students: a scoping review

Article References: Lee, D., Yang, J., Lim, H., & Kwon, K. (2026). Social anxiety and motives for nonmedical use of prescription stimulants among undergraduate students: a scoping review. BMC Psychology. https://doi.org/10.1186/s40359-026-05539-6

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05539-6

Keywords: social anxiety, prescription stimulants, nonmedical use, undergraduate students, substance-use motives, scoping review, anxiety, use intention, cross-sectional studies, Social, motives, nonmedical