Use Of Cognitive Enhancing Drugs Research Articles

Cognitive enhancing drug use amongst students in (neoliberal) higher education: a functional response

Over the past number of decades there has been an increasing amount of literature and media attention concerning the use of cognitive enhancing drugs (CEDs), particularly by higher education students. This increased interest in the use of CEDs by contemporary higher education students, has seemingly coincided with the spread of neoliberalism, principally in the West, into every sphere of the social environment, including higher education. Accordingly, along with the trend in wider enhancement drug use, the use of CEDs by higher education students and the apparent significance of neoliberalism to this drug trend, requires innovative theoretical developments in the area of drugs and drug use. Certainly, the use of CEDs by higher education students does not neatly fit within dominant, established drug use theories, often developed in accordance with medical perspectives, which frequently individualise, pathologize and stigmatise, via the subsequent positioning of drug users within dichotomic binaries, such as, the prevailing recreational or problematic, dichotomic binary. Therefore, this paper draws on the author’s qualitative research, to establish an innovative, ‘Functional Response Framework’ for augmenting understandings of CED use by students in higher education. In addition, a Functional Response Framework can make a significant contribution to advancing theoretical understandings of drug use, more broadly.

Cognitive enhancing drug use by students in the context of neoliberalism: cheating? Or, a legitimate expression of competitive entrepreneurialism?

A recurrent theme regarding drug policy and the use of cognitive enhancing drugs (CEDs) by students in higher education (HE), concerns the potential introduction of policy to prohibit the use of CEDs. One of the arguments put forward to support a prohibitive policy framework, is that the use of CEDs by students in HE is a form of academic misconduct; that the use of CEDs constitutes cheating. Now, given that it is widely documented that the use of CEDs by students in HE has been growing steadily over the past decade or more, there is surprisingly, a dearth of in-depth discussion on the topic of whether their use represents academic misconduct and is a form of cheating. Therefore, this commentary will summarise some examples of literature dedicated to the topic, before discussing whether the use of CEDs by students in HE constitutes cheating, when framed contextually, around neoliberalism and the key characteristics of competition and entrepreneurialism. The commentary will propose a potentially useful argument that, given the neoliberal context and those key characteristics, (HE) students could in theory, legitimise their use of CEDs. Consequently, students using CEDs for the purpose of hypothetically increasing academic excellence, would not consider their use of CEDs as a form of academic misconduct, of cheating. Thus, this paper, would in principle, support and endorse a legal, regulatory approach to CED policy and in addition, recommends that individual HE institutions do not prohibit the use of CEDs by students on the grounds of academic misconduct, but instead, advance harm reduction initiatives around their use.

Pharmacotherapy of Traumatic Childhood Aphasia: Beneficial Effects of Donepezil Alone and Combined With Intensive Naming Therapy.

At present, language therapy is the only available treatment for childhood aphasia (CA). Studying new interventions to augment and hasten the benefits provided by language therapy in children is strongly needed. CA frequently emerges as a consequence of traumatic brain injury and, as in the case of adults, it may be associated with dysfunctional activity of neurotransmitter systems. The use of cognitive-enhancing drugs, alone or combined with aphasia therapy, promotes improvement of language deficits in aphasic adults. In this study we report the case of a 9-year-old right-handed girl, subject P, who had chronic anomic aphasia associated with traumatic lesions in the left temporal-parietal cortex. We performed a single-subject, open-label study encompassing administration of the cholinergic agent donepezil (DP) alone during 12 weeks, followed by a combination of DP and intensive naming therapy (INT) for 2 weeks and thereafter by a continued treatment of DP alone during 12 weeks, a 4-week washout period, and another 2 weeks of INT. Four comprehensive language and neuropsychological evaluations were performed at different timepoints along the study, and multiple naming evaluations were performed after each INT in order to assess performance in treated and untreated words. Structural magnetic resonance imaging (MRI) was performed at baseline. MRI revealed two focal lesions in the left hemisphere, one large involving the posterior inferior and middle temporal gyri and another comprising the angular gyrus. Overall, baseline evaluation disclosed marked impairment in naming with mild-to-moderate compromise of spontaneous speech, repetition, and auditory comprehension. Executive and attention functions were also affected, but memory, visuoconstructive, and visuoperceptive functions were preserved. Treatment with DP alone significantly improved spontaneous speech, auditory comprehension, repetition, and picture naming, in addition to processing speed, selective, and sustained attention. Combined DP-INT further improved naming. After washout of both interventions, most of these beneficial changes remained. Importantly, DP produced no side effects and subject P attained the necessary level of language competence to return to regular schooling. In conclusion, the use of DP alone and in combination with INT improved language function and related cognitive posttraumatic deficits in a child with acquired aphasia. Further studies in larger samples are warranted.

An ethical reflection on drug use in eSport

Purpose Highly popular these days, eSport is inviting increasing scholarly attention and research. Scholarly work on eSport, however, remains focused on whether eSport is a “real” sport, that is, its sporting qualities and status, excluding ethical issues. This paper analyzes ethical issues about cognitive enhancement drugs often associated with eSport in order to suggest guidelines for resolving these issues. Methods First, environmental features of eSport are examined to find out types of cheating in eSport, as well as the ways eSport athletes are exposed to drugs. Next, ethical issues of cognitive enhancement drug use and why they are important are discussed, drawing upon multiple scholars. Last, this paper argues that the ban on drug use conventionally implemented in sport is not appropriate to eSport due to the characteristics of eSport. The paper concludes with possible future approaches to this issue. Results The ban lists administered by ESIC and WADA would not work for the need of eSport athletes and even run a risk of stunting the growth of eSport industries. It is thus important to think up an appropriate drug-related policy for eSport. Preemptive education for eSport athletes is also required to promote the ethical consciousness and judgment regarding drug use. Conclusions Insofar as eSport’s huge popularity leads to the increased status of eSport athletes, thereby exerting much influence on young people, ethical questions about eSport, drug use in particular, need to be urgently discussed for the sake of eSport’s wholesome development.

Cognitive enhancement drug use among resident physicians: Prevalence and motivations for use - results from a survey

Background: Non-medical use of prescription drugs for the enhancement of cognitive functioning has gained popularity in recent years, especially among young educated adults. To our knowledge, no previous study investigated this phenomenon among resident physicians.Objective: To analyze cognitive enhancement drugs use motivations and patterns among resident physicians.Methods: A survey and statistical analysis regarding the use of drugs traditionally prescribed for the treatment of Attention Deficit Hyperactivity Disorder: stimulants, amphetamines and modafinil.Participants: 1,453 residents who took their written residency exam in the summer of 2017. The response rate was 32.3%.Results: 28.1% of responders reported past use, with 73.67% of them reporting use without a related medical diagnosis. Almost half of the users (47.1%) acquired the drug with a prescription, but without a diagnosis of a related medical disorder. The first use was predominantly during residency (54.3%), with 45% reporting it as related to the residency exam.Factors found to positively impact non-medical use include: declaring undiagnosed Attention Deficit Hyperactivity Disorder, fear of failing the exam, a belief that more than 30% of other examinees take cognitive enhancements drugs, and a learning disability diagnosis. Self-reports of being a competitive person and being a parent, were negatively correlated with non-medical use.Conclusions: The use of drugs that are taken traditionally for the treatment of Attention Deficit Hyperactivity Disorder is common among resident physicians, both with and without related medical indication. Interestingly, factors associated with the fear of being “left behind” increase non-medical use and not the desire to succeed.

Neuroethical issues in cognitive enhancement: Modafinil as the example of a workplace drug?

The use of cognitive-enhancing drugs by healthy individuals has been a feature for much of recorded history. Cocaine and amphetamine are modern cases of drugs initially enthusiastically acclaimed for enhancing cognition and mood. Today, an increasing number of healthy people are reported to use cognitive-enhancing drugs, as well as other interventions, such as non-invasive brain stimulation, to maintain or improve work performance. Cognitive-enhancing drugs, such as methylphenidate and modafinil, which were developed as treatments, are increasingly being used by healthy people. Modafinil not only affects ‘cold’ cognition, but also improves ‘hot’ cognition, such as emotion recognition and task-related motivation. The lifestyle use of ‘smart drugs’ raises both safety concerns as well as ethical issues, including coercion and increasing disparity in society. As a society, we need to consider which forms of cognitive enhancement (e.g. pharmacological, exercise, lifelong learning) are acceptable and for which groups under what conditions and by what methods we would wish to improve and flourish.

Prevalence and correlates of stimulant and depressant pharmacological cognitive enhancement among Norwegian students.

Aims:To assess the prevalence and factors associated with stimulant and depressant pharmacological cognitive enhancement (PCE) drug use among Norwegian students.Design:In the first wave (T1), 28,553 students were invited to participate, of whom 9370 (32.8%) responded and completed the survey (mean age = 24.9 years, 63.5% female). One year later (T2) those who had responded to some items at T1 were invited to participate in a follow-up survey, where 4783 (47.2%) responded and completed the survey (mean age = 24.8 years, 64.8% female).Results:Lifetime prevalence of stimulant PCE drug use was 2.1% at T1 and 3.6% at T2. The lifetime prevalence of depressant PCE drug use was 1.5% at T1 and 3.3% at T2. Stimulant PCE drug use at T2 was predicted by low scores on agreeableness and anxiety, high scores on intellect/openness, and alcohol use, and stimulant and depressant PCE drug use at T1; while depressant PCE drug use at T2 was predicted by low scores on extroversion, high scores on conscientiousness, intellect/openness, and anxiety, and stimulant and depressant PCE drug use at T1.Conclusions:The rates of stimulant and depressant PCE drug use increased from T1 to T2. Pharmacological cognitive enhancement drug use may be explained by a combination of a motivation for improving academic achievements and a general inclination towards substance use. The current results may suggest that stimulant PCE drug users are more antisocial and indifferent to rules, while depressant PCE drug users are more motivated by coping with stress.

Cognitive Enhancement and Coping in an Australian University Student Sample

Cognitive enhancement (CE) agents are those purported to improve or augment aspects of cognition such as working memory, creativity, and executive function in healthy individuals. CE by university students looking to improve their academic performance, particularly through the use of pharmacological agents (or nootropics), has become an area of increasing interest for researchers. However, studies on the prevalence of, and motivations behind, students’ CE use at Australian universities are limited. This study aimed to contribute a new sample of prevalence data, as well as corroborate previous qualitative research that has suggested that emotion-focused and avoidant coping styles may make students more susceptible to utilizing CE drugs. A sample of N=633 individuals was recruited to complete the “Cognitive Enhancement and Student Lifestyle Survey” online. The key questions of interest concerned students’ enhancement drug usage habits, usage motivations, and coping styles. Analyses found that 6.32% of students indicated lifetime use of prescription CE agents for the purposes of study-related enhancement. Furthermore, dysfunctional coping strategies were associated with an increased likelihood of both lifestyle and prescription CE drug use. Findings from this study refine current understandings of enhancement drug use in Australia and are contextualized in regard to potential avenues for on-campus health interventions and regulatory opportunities. In particular, helping students to maintain manageable stress levels through identifying less harmful coping strategies may prove useful.

Should we use Commitment Contracts to Regulate Student use of Cognitive Enhancing Drugs?

Are universities justified in trying to regulate student use of cognitive enhancing drugs? In this article I argue that they can be, but that the most appropriate kind of regulatory intervention is likely to be voluntary in nature. To be precise, I argue that universities could justifiably adopt a commitment contract system of regulation wherein students are encouraged to voluntarily commit to not using cognitive enhancing drugs (or to using them in a specific way). If they are found to breach that commitment, they should be penalized by, for example, forfeiting a number of marks on their assessments. To defend this model of regulation, I adopt a recently-proposed evaluative framework for determining the appropriateness of enhancement in specific domains of activity, and I focus on particular existing types of cognitive enhancement drugs, not hypothetical or potential forms. In this way, my argument is tailored to the specific features of university education, and common patterns of usage among students. It is not concerned with the general ethical propriety of using cognitive enhancing drugs.

A survey of substance use for cognitive enhancement by university students in the Netherlands.

Background: Pharmacological cognitive enhancement, using chemicals to change cellular processes in the brain in order to enhance one's cognitive capacities, is an often discussed phenomenon. The prevalence among Dutch university students is unknown.Methods: The study set out to achieve the following goals: (1) give an overview of different methods in order to assess the prevalence of use of prescription, illicit and lifestyle drugs for cognitive enhancement (2) investigate whether polydrug use and stress have a relationship with cognitive enhancement substance use (3) assessing opinions about cognitive enhancement prescription drug use. A nationwide survey was conducted among 1572 student respondents of all government supported Dutch universities.Results: The most detailed level of analysis—use of specific substances without a prescription and with the intention of cognitive enhancement—shows that prescription drugs, illicit drugs and lifestyle drugs are respectively used by 1.7, 1.3, and 45.6% of the sample. The use of prescription drugs and illicit drugs is low compared to other countries. We have found evidence of polydrug use in relation to cognitive enhancement. A relation between stress and the use of lifestyle drugs for cognitive enhancement was observed. We report the findings of several operationalizations of cognitive enhancement drug use to enable comparison with a wider variety of previous and upcoming research.Conclusions: Results of this first study among university students in the Netherlands revealed a low prevalence of cognitive enhancement drug use compared to other countries. Multiple explanations, such as a difference in awareness of pharmacological cognitive enhancement among students, accessibility of drugs in the student population and inclusion criteria of enhancement substances are discussed. We urge enhancement researchers to take the different operationalizations and their effects on the prevalence numbers into account.

Humility pills: building an ethics of cognitive enhancement.

The use of cognition-enhancing drugs (CEDs) appears to be increasingly common in both academic and workplace settings. But many universities and businesses have not yet engaged with the ethical challenges raised by CED use. This paper considers criticisms of CED use with a particular focus on the Accomplishment Argument: an influential set of claims holding that enhanced work is less dignified, valuable, or authentic, and that cognitive enhancement damages our characters. While the Accomplishment Argument assumes a view of authorship based on individual credit-taking, an impersonal or collaborative view is just as possible. This paper considers the benefits of this view-including humility, a value often claimed by critics of enhancement-and argues that such a view is consistent with open CED use. It proposes an ethics of cognitive enhancement based on toleration, transparency, and humility, and it discusses how institutions and individuals can build a culture of open cognitive enhancement.

The Rationale for Consuming Cognitive Enhancement Drugs in University Students and Teachers

Cognitive enhancement (CE) is the pharmaceutical augmentation of mental abilities (e.g., learning or memory) without medical necessity. This topic has recently attracted widespread attention in scientific and social circles. However, knowledge regarding the mechanisms that underlie the decision to use CE medication is limited. To analyze these decisions, we used data from two online surveys of randomly sampled university teachers (N = 1,406) and students (N = 3,486). Each respondent evaluated one randomly selected vignette with regard to a hypothetical CE drug. We experimentally varied the characteristics of the drugs among vignettes and distributed them among respondents. In addition, the respondent’s internalization of social norms with respect to CE drug use was measured. Our results revealed that students were more willing to enhance cognitive performance via drugs than university teachers, although the overall willingness was low. The probability of side effects and their strength reduced the willingness to use CE drugs among students and university teachers, whereas higher likelihoods and magnitudes of CE increased this propensity. In addition, the internalized norm against CE drug use influenced decision making: Higher internalization decreased the willingness to use such medications. Students’ internalized norms more strongly affected CE abstinence compared with those of university teachers. Furthermore, internalized norms negatively interacted with the instrumental incentives for taking CE medication. This internalization limited the influence of and deliberation on instrumental incentives. This study is the first to provide empirical evidence regarding the importance of social norms and their influence on rational decision making with regard to CE. We identified previously undiscovered decision-making patterns concerning CE. Thus, this study provides insight into the motivators and inhibitors of CE drug use. These findings have implications for contending with CE behavior by highlighting the magnitude of potential side effects and by informing the debate regarding the ethics of CE use.

Some First Steps Toward Responsible Use of Cognitive-Enhancing Drugs by the Healthy

In December 2008 Barbara Sahakian, John Harris, Ronald C. Kessler, Michael Gazzaniga, Philip Campbell, Martha J. Farah, and I published a commentary in Nature entitled “Towards Responsible Use of C...

Cognitive Enhancement Drug Use Among Future Physicians: Findings from a Multi-Institutional Census of Medical Students

Nonmedical use of prescription psychostimulants such as methylphenidate and amphetamine salts for the purpose of cognitive enhancement is a growing trend, particularly in educational environments. To our knowledge, no recent studies have evaluated the use of these psychostimulants in a medical academic setting. To conduct an online census of psychostimulant use among medical students. In 2011, we conducted a multi-institutional census using a 31-48 item online survey regarding use of prescription psychostimulants. 2,732 actively enrolled medical students at four private and public medical schools in the greater Chicago area. Prevalence and correlates of psychostimulant use 1,115 (41 %) of students responded to the web-based questionnaire (range 26-47 % among schools). On average, students were 25.1 years of age (SD = 2.7, range 20-49), and single (70 %). Overall, 18 % (198/1,115) of this medical student sample had used prescription psychostimulants at least once in their lifetime, with first use most often in college. Of these, 11 % (117/1,115) of students reported use during medical school (range 7-16 % among schools). Psychostimulant use was significantly correlated with use of barbiturates, ecstasy, and tranquilizers (Pearson's correlation r > 0.5, Student's t-test p < 0.01); male gender (21 % male versus 15 % female, Chi squared p = 0.007); and training at a medical school which by student self-report determined class rank (68 % versus 51 %, Chi-squared p = 0.018). Non-users were more likely to be first year students (Chi-squared p = 0.048) or to have grown up outside of the United States (Chi-squared p = 0.013). Use of psychostimulants, including use without a prescription, is common among medical students. Further study of the side effects, medical implications, and use during post-graduate medical training and medical practice is needed to inform evidence-based policy.

Cognitive Enhancement Drug Use Among Medical Students and Concerns About Medical Student Well-Being

and personal development, as well as for the patients for whom they will care throughout their careers. Our society invests a great deal in medical education, and it demands much from students in return. Medical educators remain concerned about both external and internal forces that affect students’ learning and development in ways that we are just beginning to understand. We wonder whether the country will have the physician work force it needs as students face ever increasing debt burdens, and we struggle to understand the effects that debt has on career choices. 1 Once students enter medical school, we become concerned about the pressures that they face and the impact of these pressures on their mental health and on their ability to function optimally. Surveys of medical students have shown high levels of depression, anxiety and substance abuse. 2 Recent studies have demonstrated high rates of burnout and the negative effects of burnout on students’ professionalism and altruism. 3 Much attention has been focused on the mistreatment of medical students by individuals engaged in their training and by others during the learning process, as studies have shown that mistreatment can lead to deleterious consequences that include depression, substance abuse and leaving medicine entirely. 4

The Ethics of “Smart Drugs”: Moral Judgments About Healthy People's Use of Cognitive-Enhancing Drugs

What moral concerns are relevant when judging the use of cognitive-enhancing (CE) drugs by healthy people? University students evaluated competitive fairness, distributive fairness, peer pressure, naturalness, and dosage form. Participants condemned CE drug use when there were long-term negative effects on health and when CE drug use was seen to provide an unfair advantage in an exam situation to someone while others were not taking the drugs. Further, participants judged CE drug use more harshly if the drugs were artificial rather than natural and if they were in the form of an injection rather than a pill, suggesting that moral intuitions relating to purity also influence opinions on CE drugs.

The neuroethics of non-invasive brain stimulation

Transcranial direct current stimulation (TDCS) is a brain stimulation tool that is portable, painless, inexpensive, apparently safe, and with potential long-term efficacy. Recent results obtained from TDCS experiments offer exciting possibilities for the enhancement and treatment of normal or impaired abilities, respectively. We discuss new neuroethical problems that have emerged from the usage of TDCS, and also focus on one of the most likely future applications of TDCS: enhancing learning and cognition in children with typical and atypical development.

Cognitive Enhancement, Cheating, and Accomplishment

An ethics of enhancement should not rest on blanket judgments; it should ask us to distinguish between the kinds of activities we want to enhance. Both students and academics have turned to cognition-enhancing drugs in significant numbers--but is their enhancement a form of cheating? The answer should hinge on whether the activity subject to enhancement is zero-sum or non-zero-sum, and whether one is more concerned with excellence in process or excellence in outcome. Cognitive enhancement should be especially tolerated when the activities at stake are non-zero-sum and when the importance of process is outweighed by the importance of outcome. The use of cognition-enhancing drugs does not unnaturally cheapen accomplishments achieved under their influence; instead, cognitive enhancement is in line with well-established conceptions of collaborative authorship, which shift the locus of praise and blame from individual creators to the ultimate products of their efforts.

Ethically Justified, Clinically Applicable Criteria for Physician Decision-Making in Psychopharmacological Enhancement

Advances in psychopharmacology raise the prospects of enhancing neurocognitive functions of humans by improving attention, memory, or mood. While general ethical reflections on psychopharmacological enhancement have been increasingly published in the last years, ethical criteria characterizing physicians’ role in neurocognitive enhancement and guiding their decision-making still remain highly unclear. Here it will be argued that also in the medical domain the use of cognition-enhancing drugs is not intrinsically unethical and that, in fact, physicians should assume an important role in gating their usage. For finding normative orientation, concepts of disease, normality or medicine will not be helpful since—due to their cryptonormative nature—they rather hamper than allow targeted discussion and decision-making. As an alternative, the common and widely accepted bioethical criteria of beneficence, non-maleficence, autonomy and distributive justice allow a clinically applicable, highly differentiated context- and case-sensitive approach. By embedding decision-making in a participative physician–patient relationship extrinsic objections against neurocognitive enhancement (e.g. invalid perceptions about efficacy, benefit or risk; questionable voluntariness; restrained decision-making capacity) can be curtailed.

Improving introspection to inform free will regarding the choice by healthy individuals to use or not use cognitive enhancing drugs

A commentary in Nature entitled "Towards responsible use of cognitive-enhancing drugs by the healthy" (Greely et al 2008 Nature 456: 702–705) offers an opportunity to move toward a humane societal appreciation of mind-altering drugs. Using cognitive enhancing drugs as an exemplar, this article presents a series of hypotheses concerning how an individual might learn optimal use. The essence of the proposal is that individuals can cultivate sensitivity to the effects of ever-smaller amounts of psychoactive drugs thereby making harm less likely and benign effects more probable. Four interrelated hypotheses are presented and briefly discussed. 1. Humans can learn to discriminate ever-smaller doses of at least some mind-altering drugs; a learning program can be designed or discovered that will have this outcome. 2. The skill to discriminate drugs and dose can be generalized, i.e. if learned with one drug a second one is easier and so on. 3. Cultivating this skill/knack would be beneficial in leading to choices informed by a more accurate sense of mind-body interactions. 4. From a philosophical point of view learning the effects of ever-smaller doses of psychoactive agents offers a novel path into and to transcend the objective/subjective barrier and the mind/body problem.Whatever the fate of these specific hypotheses, discussion of cognitive enhancing drugs for healthy individuals has the potential to inspire innovative educational and public policy initiatives toward all types of mind-altering drugs and the people who use them.