Abstract
Pharmacological cognitive enhancement (CE) is a topic of increasing public awareness. In the scientific literature on student use of CE as a study aid for academic performance enhancement, there are high prevalence rates regarding the use of caffeinated substances (coffee, caffeinated drinks, caffeine tablets) but remarkably lower prevalence rates regarding the use of illicit/prescription stimulants such as amphetamines or methylphenidate. While the literature considers the reasons and mechanisms for these different prevalence rates from a theoretical standpoint, it lacks empirical data to account for healthy students who use both, caffeine and illicit/prescription stimulants, exclusively for the purpose of CE. Therefore, we extensively interviewed a sample of 18 healthy university students reporting non-medical use of caffeine as well as illicit/prescription stimulants for the purpose of CE in a face-to-face setting about their opinions regarding differences in general and morally-relevant differences between caffeine and stimulant use for CE. 44% of all participants answered that there is a general difference between the use of caffeine and illicit/prescription stimulants for CE, 28% did not differentiate, 28% could not decide. Furthermore, 39% stated that there is a moral difference, 56% answered that there is no moral difference and one participant was not able to comment on moral aspects. Participants came to their judgements by applying three dimensions: medical, ethical and legal. Weighing the medical, ethical and legal aspects corresponded to the students' individual preferences of substances used for CE. However, their views only partly depicted evidence-based medical aspects and the ethical issues involved. This result shows the need for well-directed and differentiated information to prevent the potentially harmful use of illicit or prescription stimulants for CE.
Highlights
Substance use for pharmacological cognitive enhancement (CE) by healthy subjects has received increasing attention during the last decade and is defined as the use of legal or illicit substances as well as prescription drugs aiming at the enhancement of various cognitive functions without medical need [1,2,3,4,5]
According to a recent metaanalysis by Wilens and colleagues, past-year prevalence rates of stimulant misuse in general ranged from 5% to 35% among students [6]
Questionnaire and interviewing procedure We developed an extensive semi-structured face-to-face interview guideline with consecutively numbered open and closed questions to gather information about the non-medical use of stimulants and caffeine for the purpose of CE. ‘‘Stimulants’’ are meant to be illicit stimulants (AMPH, cocaine, ecstasy) or prescription stimulants (MPH), but unlike caffeine which was explained to the participants prior to the interview
Summary
Substance use for pharmacological cognitive enhancement (CE) by healthy subjects has received increasing attention during the last decade and is defined as the use of legal (i.e. caffeine) or illicit substances (i.e. illicit stimulants) as well as prescription drugs (e.g. methylphenidate, MPH) aiming at the enhancement of various cognitive functions (e.g. vigilance, concentration, memory) without medical need [1,2,3,4,5].According to a recent metaanalysis by Wilens and colleagues, past-year prevalence rates of stimulant misuse in general ranged from 5% to 35% among students [6]. Whereas Wilens and colleagues did not differentiate prevalence rates with regard to the purpose of use (e.g. getting high, experimentation, concentration, academic performance enhancement) a more detailed analysis of the literature revealed that ‘‘concentration’’ and ‘‘study enhancement’’ is one of the most important intentions for stimulant misuse among students [7,8]. An online poll of the journal ‘‘Nature’’ depicts a lifetime prevalence rate of 20% of readers of this journal for stimulants, modafinil or beta blockers for the purpose of CE [11]. This was a highly biased non-random sample with the lack of representativeness. A preliminary study of our group has shown lifetime prevalence rates of 0.8% for prescription stimulants (MPH) and 2.9% for illicit stimulants (amphetamines (AMPH), cocaine, ecstasy) exclusively for CE purposes among German high school students [1]
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