Cognitive Enhancement and Coping in an Australian University Student Sample

The rising use of cognitive enhancement drugs and predictors of use during COVID-19: findings from a cross-sectional survey of students and university staff in the UK

Background

The use of psychoactive substances to increase cognitive performance while studying has been termed 'pharmacological cognitive enhancement' (PCE). In previous years, several large-scale national surveys have focused on their use by students at university, including drug types, prevalence rates, and predictive factors. The recent coronavirus pandemic brought about widespread structural changes for UK universities, as students were forced to adapt to home-based learning and in many cases reduced academic support. No study has yet focused primarily on the impact of pandemic social restrictions on PCE in students and academic staff, and whether personality and demographic factors reveal user profiles that predict use during the pandemic period.

Method

A convenience sample of 736 UK students and staff aged 18-54 (M = 22.2, SD = 5.2) completed a cross-sectional survey assessing PCE prevalence rates, polydrug use, perceived effects, academic self-efficacy and personality during the first year of social restrictions (March 2020 - February 2021) compared with the previous year (March 2019 - February 2020).

Results

There was a significant self-reported rise in the use of all drug types (all ps < 0.001) during social restrictions, particularly with Modafinil (+42%), nutraceuticals (+30.2%) and microdose LSD (+22.2%). Respondents also indicated stronger PCE effects for all substances, except alcohol, in comparison to the previous year. Polydrug use with modafinil and other prescription stimulants increased the most during social restrictions. Personality factors and gender identity reliably predicted PCE use and lower agreeableness was often the strongest predictor, followed by identifying as male and lower conscientiousness. Academic self-efficacy and student/academic staff status were not consistent predictors.

Conclusion

This is the first survey of UK students to investigate PCE during coronavirus social restrictions and to assess predictive factors. Findings reveal a rise in PCE use and polydrug use which we suggest is because of increased pressures on students created by the lockdown and reduced access to university resources.

Opinions towards Medical Students' Self-Care and Substance Use Dilemmas-A Future Concern despite a Positive Generational Effect?

This study examines demographic factors which may influence opinions concerning medical students' self-care and substance use behaviors as a means of providing insights into how future doctors view these issues compared to Australian doctors and members of the public. We conducted national, multicenter, prospective, on-line cross-sectional surveys using hypothetical scenarios to three cohorts- Australian medical students, medical doctors, and the public. Participants' responses were compared for the different contextual variables within the scenarios and the participants' demographic characteristics. In total 2602 medical students, 809 doctors and 503 members of the public participated. Compared with doctors and the public, medical students were least tolerant of alcohol intoxication, and most tolerant of using stimulants to assist with study, and cannabis for anxiety. Doctor respondents more often aligned with the public's opinions on the acceptability of the medical students' behaviors. Although opinions are not equivalent to behaviour, Australian students' views on the acceptability for cannabis to help manage anxiety, and inappropriate use of prescription-only drugs are concerning; these future doctors will be responsible for prescribing drugs and managing patients with substance abuse problems. However, if current Australian medical student's opinions on alcohol misuse persist, one of the commonest substance addictions amongst doctors may decrease in future.

When Stimulant Use Becomes Problematic: Examining the Role of Coping Styles

Objective: Stimulant use among college students is a significant public health concern due to its consequential effects. Given that many students reportedly use prescription stimulants for academic purposes, empirical investigations are needed to identify those students at risk for prescription stimulant misuse (PSM). The purpose of the current study was to examine the role of coping styles on the association between prescription stimulant use and related consequences. We hypothesized that more maladaptive (vs. adaptive) coping strategies would mediate this association, particularly for underclassmen (freshmen/sophomores) and men.Method: Participants were n = 787 college students across seven universities in the United States who completed an online survey assessing substance use and coping behaviors. Prior to hypothesis testing, we conducted factor analysis on the COPE measure and found support for a three-factor solution, which we named maladaptive coping, adaptive coping, and supportive coping.Results: Prescription stimulant use was positively related to stimulant-related negative consequences. Multiple mediation analyses indicated that the maladaptive coping factor partially mediated this direct association. Multi-group analyses revealed that maladaptive coping style was a significant mediator for college women in the sample, but not men. Conclusions: These results scratch the surface of the relationship between coping and risky stimulant use among college students and imply that the building of coping strategies is a useful target in identifying at-risk students.

Students' use of caffeine, alcohol, dietary supplements, and illegal substances for improving academic performance in a New Zealand university

This study aimed to describe patterns of use and attitudes towards a broad variety of substances for improving academic performance at a New Zealand university. 685 students (from 1800 invited) completed an online questionnaire (38% response rate). They were asked about their lifetime and current substance use for improving academic performance, as well as their reasons for use, attitudes and perceptions of: caffeine, alcohol, dietary supplements, prescription stimulants, other prescription substances, and illicit substances. 80% (95% CI: 76.3, 82.5) reported ever using any substance to help improve academic performance, mainly to stay awake and improve concentration. Caffeine (70%, 95% CI: 66.3, 73.3) and dietary supplements (32%, 95% CI: 28.3, 35.5) were most commonly used. 4% (95% CI: 2.7, 5.9) reported use of prescription stimulants, mostly methylphenidate, and another 4% (95% CI: 2.7, 5.9) reported using illicit substances for improving academic performance. Users of prescription stimulants were more likely than non-users to believe that they were safe, morally acceptable, and that they should be available legally for enhancing academic performance. We close with discussions on broadening the focus of substances for improving academic performance in public health debates. Further qualitative research from small countries is also needed to move towards a place-based approach for clarifying ethical implications, inform policy in universities, and understand how injustices are created through the use of and ability to purchase different substances.

Concept generation of cognitive enhancement: healthcare professionals' approach towards the impact and utilization of cognitive enhancers in academic context

Cognitive enhancers (CEs) encompass a wide range of drugs, including prescription medications for attention deficit disorders and pharmacological compounds for cognitive enhancement. It is well-documented that the students are the leading cohort of CEs users. Exploring how healthcare professionals perceive the use of CEs for academic accomplishments is significant to understand their encouragement of CE use. Hence, the purpose of the current study was to look at healthcare professionals' attitudes and perceived understanding about the usage of CEs in academic contexts. The study was a quantitative cross-sectional research design conducted in different healthcare and academic settings of Karachi. The respondents were approached either through social media platforms or the official email addresses of their working organizations. Data were collected through a web link of an online questionnaire that included four sections; inquiring about the respondents' demographics characteristics, their knowledge about CEs, their attitudes towards the use and impact of CEs, and their inclination to use a hypothetical prescription-only CE. The response rate of the study was 73.3%. The majority of the respondents negated to permit university students to using CEs for cognitive boost (n = 360, 67.1%), to concentrate (n = 406, 75.7%), to increase vigilance (n = 394, 73.5%) or to mitigate the effects of other medicines (n = 312, 58.2%). The pharmacists were more likely to refute that using CEs by the students is safe (pharmacists 10.8% vs. physicians 8.3%, p=<0.001), beneficial (pharmacists 12.7% vs. physicians 5.3%, p=<0.001), or necessary (pharmacists 17.6% vs. physicians 12.8%, p=<0.001). The major reasons for not encouraging the use of CEs were fear of misuse (n = 510, 95.1%), safety concerns (n = 495, 92.3%), and their consideration for CE as unnecessary medical intervention (n = 441, 82.2%). The findings indicated that overall, respondents have a clear consensus of not letting university students use CEs for cognitive improvement or any other purpose implying that cognitive enhancement is not yet a common or approved medical practice by the healthcare professionals in Pakistan.

Towards an understanding of how stress and resources affect the nonmedical use of prescription drugs for performance enhancement among employees

Based on assumptions of the Job Demands-Resources model, we investigated employees’ willingness to use prescription drugs such as methylphenidate and modafinil for nonmedical purposes to enhance their cognitive functioning as a response to strain (i.e., perceived stress) that is induced by job demands (e.g., overtime, emotional demands, shift work, leadership responsibility). We also examined the direct and moderating effects of resources (e.g., emotional stability, social and instrumental social support) in this process. We utilized data from a representative survey of employees in Germany (N = 6454) encompassing various job demands and resources, levels of perceived stress, and willingness to use nonmedical drugs for performance enhancement purposes. By using Structural Equation Models, we found that job demands (such as overtime and emotional demands) and a scarcity of resources (such as emotional stability) increased strain, consequently directly and indirectly increasing the willingness to use prescription drugs for cognitive enhancement. Moreover, emotional stability reduced the effect of certain demands on strain. These results delivered new insights into mechanisms behind nonmedical prescription drug use that can be used to prevent such behaviour and potential negative health consequences.

The Use and Impact of Cognitive Enhancers among University Students: A Systematic Review

INTRODUCTION

Cognitive enhancers (CEs), also known as "smart drugs", "study aids" or "nootropics" are a cause of concern. Recent research studies investigated the use of CEs being taken as study aids by university students. This manuscript provides an overview of popular CEs, focusing on a range of drugs/substances (e.g., prescription CEs including amphetamine salt mixtures, methylphenidate, modafinil and piracetam; and non-prescription CEs including caffeine, cobalamin (vitamin B12), guarana, pyridoxine (vitamin B6) and vinpocetine) that have emerged as being misused. The diverted non-prescription use of these molecules and the related potential for dependence and/or addiction is being reported. It has been demonstrated that healthy students (i.e., those without any diagnosed mental disorders) are increasingly using drugs such as methylphenidate, a mixture of dextroamphetamine/amphetamine, and modafinil, for the purpose of increasing their alertness, concentration or memory.

AIM

To investigate the level of knowledge, perception and impact of the use of a range of CEs within Higher Education Institutions.

METHODOLOGY

A systematic review was conducted in adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Whilst 1400 studies were identified within this study through a variety of electronic databases (e.g., 520 through PubMed, 490 through Science Direct and 390 through Scopus), 48 papers were deemed relevant and were included in this review.

RESULTS

The most popular molecules identified here included the stimulant CEs, e.g., methylphenidate, modafinil, amphetamine salt mixtures and caffeine-related compounds; stimulant CEs' intake was more prevalent among males than females; drugs were largely obtained from friends and family, as well as via the Internet. It is therefore suggested that CEs are increasingly being used among healthy individuals, mainly students without any diagnosed cognitive disorders, to increase their alertness, concentration, or memory, in the belief that these CEs will improve their performance during examinations or when studying. The impact of stimulant CEs may include tolerance, dependence and/or somatic (e.g., cardiovascular; neurological) complications.

DISCUSSION

The availability of CEs for non-medical indications in different countries is influenced by a range of factors including legal, social and ethical factors. Considering the risk factors and motivations that encourage university students to use CE drugs, it is essential to raise awareness about CE-related harms, counteract myths regarding "safe" CE use and address cognitive enhancement in an early stage during education as a preventative public health measure.

Medical Students' Attitudes Towards Pharmacological Cognitive Enhancement With Methylphenidate

OBJECTIVE

The aim of this study was to assess medical students' perception of pharmacological cognitive enhancement (PCE) with methylphenidate and to determine whether this perception differs between junior and senior medical students.

METHODS

The second and fifth year medical student groups of 2017 at a specific university completed self-administered questionnaires in order to investigate if there were a difference in their attitudes towards methylphenidate use for PCE.

RESULTS

A total of 353 students were included as follows: 135 second year and 218 fifth year students. Fifth year students were more aware of PCE with methylphenidate than second year students (94% versus 87%; p value = 0.02). Many students (second year = 86%; fifth year = 71%; p value = 0.2469) were of the opinion that methylphenidate could enhance academic performance. Sixty-six percent of all the students were concerned about the fairness of PCE; 93% were concerned about the harmfulness of methylphenidate. There were no statistical significant differences in the attitudes towards methylphenidate use for PCE between the two groups of junior and senior students.

CONCLUSION

In both groups, the majority of students were against the use of methylphenidate for PCE in students without attention deficit and hyperactivity disorder. Their attitudes regarding the use of methylphenidate for non-medical purposes did not differ significantly. Addressing the topic of PCE with medical students is essential, and the impact on their practice can be an important direction for future research.

Medical students' opinions on professional behaviours: The Professionalism of Medical Students' (PoMS) study

Introduction: The Professionalism of Medical Students (PoMS) study aimed to develop a comprehensive understanding of Australian and New Zealand (Aus/NZ) medical students' opinions and experience with professionalism dilemmas.Methods: A confidential, online survey for medical students was developed and distributed to all Aus/NZ medical schools. Students submitted de-identified demographic information, gave opinions on the acceptability of a range of student behaviours for professionally challenging situations, and whether they had encountered similar situations.Results: 3171 medical students participated from all 21 Aus/NZ medical schools (16% of the total student population). Medical students reported encountering many of the professionally challenging situations and had varying opinions on what was acceptable behaviour for the scenarios. In general, students' opinions were not influenced by the seniority, gender or the type of health professional involved in the scenario. Participant demographic factors appeared to have significant effects on professional opinions - particularly male gender and being a student in the latter stages of the course.Discussion: Medical students' professional opinions are a complex area. The PoMS data provides a reference point for students, their educators and other health professionals in identifying current student professional behaviour norms, determining the effects of demographic factors on their decision making, and where important gaps exist in medical students' approaches to professionalism.

Cognitive Enhancing Drugs in Sport: Current and Future Concerns

Sporting authorities and policy makers have warned of a radical increase in the availability and use of so-called 'smart' drugs, which putatively deliver cognitive enhancements in the form of improved focus, concentration, alertness, and rapid decision-making. Although the potential for health risks is well documented when it comes to performance enhancing drugs in sport, the health implications of cognitive enhancing drugs (CEDs) remain unclear. Objectives: This article aims to provide a foundational understanding about CEDs and their application in sport. It considers what little is known about the types, nature, impact, and implications of their use for athletes and sport policy. Method: A narrative literature review was undertaken to ascertain the emerging role of CEDs beyond their clinical use to treat prescribed disorders, including the limited studies in the sporting domain. This review also considered literature pertinent to the impact of CEDs in sport and the challenges for sport policy. Results: Given the prospects of negative health impacts, policy-makers interested in preventing and controlling the use of CEDs, as well as reducing harm to athletes at all levels of performance, need guidance. This article highlights multi-faceted concerns and shines a spotlight on key issues for sporting bodies to consider regarding the critical impact that widespread use and adoption of these substances might entail. Conclusion: While the World Anti-Doping Agency (WADA) is seemingly awake to the threat posed, actions to circumvent the spread of CEDs throughout sport are nascent and require greater understanding and attention.

Building Conceptions of Cognitive Enhancement: University Students' Views on the Effects of Pharmacological Cognitive Enhancers

BACKGROUND

Use of prescription stimulants for cognitive enhancement in healthy individuals has been of growing interest to the academic community. University students can be prone to use these pharmacological cognitive enhancers (PCEs) for their perceived academic benefits.

OBJECTIVES

We aimed to understand university students' beliefs about the factors influencing PCE use, the cognitive and health effects of the drugs, and how these conceptions are interrelated.

METHODS

Data were collected through focus groups with 45 students at the University of Toronto in 2015/2016. We used thematic analysis to extract key themes and cooccurrence coefficients to evaluate the overlap between these themes.

RESULTS

We found that participants perceived users as either struggling students or high-achieving ones. Alleged benefits of PCEs included enhanced focus, attention, memorization, and grades, but did not include increased intelligence or long-term cognitive enhancement. Participants disagreed on whether ADHD diagnosis would affect how PCEs worked and how "needing the drug" was determined. Mentions of nonspecific side effects were common, as was the possibility of misuse (e.g., addiction, abuse). Though not an initial aim of the study, we uncovered patterns pertaining to whom participants used as sources of information about different themes. We propose that social learning theory provides a useful framework to explain how the experiences of peers may shape the conceptions of our participants. Conclusions/Importance: Our findings highlight that conceptions surrounding PCEs are multileveled, and informed by a variety of sources, including peers. This should be considered in the development of interventions geared toward university students.