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

Abstract

Social anxiety and substance use motives have been proposed as theoretically relevant vulnerability factors for nonmedical use of prescription stimulants (NMUPS) among undergraduate students; however, the extent to which it has been directly examined remains unclear, and the evidence on stimulant-use motives remains fragmented. This scoping review aimed to determine whether the hypothesized social anxiety–motive–NMUPS/use-intention pathway has been empirically examined and to map the partial evidence relevant to its individual components. A scoping review of peer-reviewed empirical studies published between January 2000 and April 2026 was conducted using a framework that integrates Buckner’s biopsychosocial model of social anxiety and Cooper’s motivational model of substance use. Three reviewers independently screened studies for eligibility. Data were extracted by one reviewer and verified by two others. A total of 443 records were identified, of which thirteen studies were included in the final review. Ten studies examined associations between social anxiety-related constructs and actual NMUPS or use intention, while four focused on associations between motives and actual NMUPS; one study contributed to both categories. However, no study tested the complete social anxiety–motive–NMUPS/use-intention pathway within a single model. None of the ten anxiety-related studies directly measured social anxiety; nine assessed broader anxiety-related constructs, and one assessed the adjacent social-evaluative construct of test anxiety. Among the motive-related studies, enhancement motives were the most frequently examined. Most studies were cross-sectional, using actual NMUPS as the primary outcome. The existing literature provides fragmented evidence concerning broader anxiety-related constructs, motives, and actual NMUPS or use intention, but does not establish an integrated psychological mechanism. Future longitudinal, mechanism-focused research could incorporate differentiated social anxiety, multidimensional motives, and both NMUPS and use intention within a unified structural model to clarify whether and how NMUPS emerges as a goal-directed response to social-evaluative pressure and perceived functional demands among undergraduate students.