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We used the narrative vignette/storytelling approach to provide a holistic illustration of prescription stimulant misuse [PSM] and diversion [PSD] initiation and maintenance among college-attending emerging adults. We conducted 32 semi-structured, theory-guided interviews with 20 students during spring and summer 2019. The participants were diverse with respect to age, race/ethnicity and gender, and had a history of PSM and/or PSD. We created four narrative vignettes using a multi-step, collaborative process that incorporated patterns of what contributed to initiation and maintenance for four identified student groups (i.e., PSM with and without a prescription and PSD with and without a prescription). Characteristics of the individual, social and broader environments influenced behavior initiation, and positive reinforcement from trial behavior contributed to maintenance. Similarities and differences were identified across the groups. Approaches for PSM and PSD prevention and intervention in college-attending emerging adults should be multifaceted and consider prescription status.