In Emotional Poverty, Dr. Ruby Payne explains that affluent female students sometimes take Adderall for the desired side effect of weight loss, a common misuse of the drug in response to social pressure to remain competitive.

Students in poverty more likely need the prescription for focused learning. ADHD is highly inherited, meaning for a child to have ADHD, usually one or both parents have it too. ADHD and associated behaviors frequently serve as a determinate of health, keeping generations in poverty where families are less likely to access prescription assistance. Stimulants commonly prescribed for ADHD are controlled substances producing a requirement that treatment be closely monitored by a medical professional. Affluent families access resources of time, finances, and transportation to attend necessary appointments, but in poverty, monthly appointments burden families heavily where days off work, transportation, and funds are in short supply.

In poverty, having a controlled substance in the home poses a safety risk.

A boy could not pay attention to things that did not interest him. The more he tried, the sleepier he became, as if when it came time to learn, his lights went out. The boy stayed grumpy and angry, so his mother took him to a doctor that prescribed an antidepressant and medicine for ADHD. The boy was not allowed to have anybody in the house while his mom was gone, but one afternoon his friends followed him home from school to borrow a phone charger. An hour later, one friend was stopped by local police and was found to have a pocket full of loose pills he stole from the boy whose doctor prescribed them. The police believed the boy sold his medicine to his friend until it was discovered that the thief stole the wrong medicine. They took his antidepressant and left the abusable drug in the boy’s pill dispenser. The boy’s mother never refilled the prescription.

In affluent homes, security has been addressed for valuable possessions and desired personal safety. The use of Adderall as intended or otherwise poses less risk than in homes of poverty where a prescription for the controlled substance is more likely to compromise safety.