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Effort–Reward Imbalance at Work and Prescription Drug Misuse—Prospective Evidence from Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137632. [PMID: 35805300 PMCID: PMC9265319 DOI: 10.3390/ijerph19137632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/17/2022] [Accepted: 06/18/2022] [Indexed: 12/04/2022]
Abstract
This study examines how work stress affects the misuse of prescription drugs to augment mental performance without medical necessity (i.e., cognitive enhancement). Based on the effort–reward imbalance model, it can be assumed that a misalignment of effort exerted and rewards received increases prescription drug misuse, especially if employees overcommit. To test these assumptions, we conducted a prospective study using a nationwide web-based sample of the working population in Germany (N = 11,197). Effort, reward, and overcommitment were measured at t1 and the 12 month frequency of prescription drug misuse for enhancing cognitive performance was measured at a one-year follow-up (t2). The results show that 2.6% of the respondents engaged in such drug misuse, of which 22.7% reported frequent misuse. While we found no overall association between misuse frequency and effort, reward, or their imbalance, overcommitment was significantly associated with a higher misuse frequency. Moreover, at low levels of overcommitment, more effort and an effort–reward imbalance discouraged future prescription drug misuse, while higher overcommitment, more effort, and an imbalance increased it. These findings suggest that a stressful work environment is a risk factor for health-endangering behavior, and thereby underlines the importance of identifying groups at risk of misusing drugs.
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Parents’ Perceptions on the Debated Parenting Practice of Cognitive Enhancement in Healthy Children and Adolescents. JOURNAL OF COGNITIVE ENHANCEMENT 2022; 6:373-388. [PMID: 35966365 PMCID: PMC9360129 DOI: 10.1007/s41465-022-00243-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/13/2022] [Indexed: 12/03/2022]
Abstract
First evidence shows that some parents engage in the health-endangering practice of (mis-)using prescription drugs to boost their children’s school performance. But little is known about parental perspectives on this phenomenon. This study aims to better understand parents’ perspectives on the non-medical use of prescription drugs to improve healthy children’s cognitive functioning. We conducted twelve semi-structured face-to-face interviews with a diverse sample of parents in Germany, and applied qualitative content analysis to explore their perspectives on instrumentalizing prescription drugs for improving the performance of healthy children, including their underlying knowledge (gaps), moral evaluations, evaluations of accompanied risks and benefits, opinions on potential motivators, and wishes regarding policy-making. The results show that parents typically believed themselves knowledgeable about such prescription drug (mis-)use, although they were not aware of anyone in their social environment taking them for enhancement. Parents generally considered such behavior to be morally reprehensible, cheating, and similar to doping in sports, and they typically claimed that no situation or occasion could motivate them to administer prescription drugs to their healthy children. Health risks (including side effects or addiction) were a typical expectation of drug use. That doctors should give such drugs to healthy young people was seen as unjustifiable. The results suggest that morality and risk–benefit evaluations of parents play a major role in their decision-making concerning this potentially risky instrumentalization of non-medical drugs. These insights are of distinct importance, especially for future research and further discussions on this topic, such as an evidence-based public dialog and ethics debates.
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Feigning Symptoms to Obtain Prescription Stimulants: A Vignette-Based Study on Its Conditions. JOURNAL OF DRUG ISSUES 2021. [DOI: 10.1177/00220426211055433] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This vignette-based study examined the willingness to feign symptoms to obtain a prescription following an analysis on who might use prescription stimulants to enhance performance ( N = 3,468). It experimentally manipulated three factors: the social disapproval of prescription stimulant use for enhancement purposes, the physicians’ diagnostic efforts, and the medical condition (attention-deficit/hyperactivity disorder and narcolepsy); respondent characteristics of self-control, personal morality, and self-efficacy were also measured. Our results showed that social disapproval of prescription drug use, a personal morality that disapproves of drug use, high self-control, and high self-efficacy were negatively associated with the willingness to use. Willingness increased especially in situations of social approval when there was a stronger personal approval of drug use, or surprisingly when physicians’ diagnostic efforts were higher. The feigning willingness was lower in situations of social disapproval and when personal morality disapproved of feigning. Thus, personal and situational characteristics are relevant to understand both behaviors.
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Narayanan A, Gill M, Leem C, Li C, Mein Smith F, Shepherd B, Ting S, van Bart K, Green JA, Samaranayaka A, Ergler C, Macmillan A. Students' use of caffeine, alcohol, dietary supplements, and illegal substances for improving academic performance in a New Zealand university. Health Psychol Behav Med 2021; 9:917-932. [PMID: 34712515 PMCID: PMC8547821 DOI: 10.1080/21642850.2021.1990763] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
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.
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Affiliation(s)
- Anantha Narayanan
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Malcolm Gill
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Chaey Leem
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Cassandra Li
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Ben Shepherd
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Selene Ting
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Karin van Bart
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - James A Green
- School of Pharmacy, University of Otago, Dunedin, New Zealand.,School of Allied Health, University of Limerick, Limerick, Ireland.,Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Ari Samaranayaka
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Christina Ergler
- Department of Geography, University of Otago, Dunedin, New Zealand
| | - Alexandra Macmillan
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
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5
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Marazziti D, Avella MT, Ivaldi T, Palermo S, Massa L, Vecchia AD, Basile L, Mucci F. Neuroenhancement: State of the Art and Future Perspectives. CLINICAL NEUROPSYCHIATRY 2021; 18:137-169. [PMID: 34909030 PMCID: PMC8629054 DOI: 10.36131/cnfioritieditore20210303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pharmacological neuroenhancement refers to the non-medical use of prescription drugs, alcohol, illegal drugs, or the so-called soft enhancers for the purpose of improving cognition, mood, pro-social behavior, or work and academic performance. This phenomenon is undoubtedly more frequent than previously supposed especially amongst university students. The aim of the present paper was to carefully review and comment on the available literature on neuroenhancement, according to Prisma guidelines. The results showed a great use of all prescribed drugs (benzodiazepines, antidepressants, antipsychotics, nootropic compounds, and especially stimulants) as neuroenhancers amongst healthy subjects, although probably the real prevalence is underestimated. The use of illicit drugs and soft enhancers is similarly quite common. Data on the improvement of cognition by other compounds, such as oxytocin and pheromones, or non-pharmacological techniques, specifically deep brain stimulation and transcranial magnetic stimulation, are still limited. In any case, if it is true that human beings are embedded by the desire to overcome the limits of their intrinsic nature, neuroenhancement practices put into question the concept of authenticity. Therefore, the problem appears quite complex and requires to be deepened and analyzed with no prejudice, although within an ethical conceptual frame.
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Affiliation(s)
- Donatella Marazziti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy
- Unicamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | - Maria Teresa Avella
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy
| | - Tea Ivaldi
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy
| | - Stefania Palermo
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy
| | - Lucia Massa
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy
| | - Alessandra Della Vecchia
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy
| | - Lucia Basile
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy
| | - Federico Mucci
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Italy
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6
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Nguyen NT, Rakow T, Gardner B, Dommett EJ. Understanding the relationship between safety beliefs and knowledge for cognitive enhancers in UK university students. PLoS One 2021; 16:e0244865. [PMID: 33508011 PMCID: PMC7842904 DOI: 10.1371/journal.pone.0244865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 12/17/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cognitive enhancers (CE) are prescription drugs taken, either without a prescription or at a dose exceeding that which is prescribed, to improve cognitive functions such as concentration, vigilance or memory. Previous research suggests that users believe the drugs to be safer than non-users and that they have sufficient knowledge to judge safety. However, to date no research has compared the information sources used and safety knowledge of users and non-users. OBJECTIVES This study compared users and non-users of CE in terms of i) their sources of knowledge about the safety of CE and ii) the accuracy of their knowledge of possible adverse effects of a typical cognitive enhancer (modafinil); and iii) how the accuracy of knowledge relates to their safety beliefs. METHODS Students (N = 148) from King's College London (UK) completed an anonymous online survey assessing safety beliefs, sources of knowledge and knowledge of the safety of modafinil; and indicated whether they used CE, and, if so, which drug(s). RESULTS The belief that the drugs are safe was greater in users than non-users. However, both groups used comparable information sources and have similar, relatively poor drug safety knowledge. Furthermore, despite users more strongly believing in the safety of CE there was no relationship between their beliefs and knowledge, in contrast to non-users who did show correlations between beliefs and knowledge. CONCLUSION These data suggest that the differences in safety beliefs about CE between users and non-users do not stem from use of different information sources or more accurate safety knowledge.
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Affiliation(s)
- Ngoc Trai Nguyen
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Tim Rakow
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Benjamin Gardner
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Eleanor J. Dommett
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
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Kilmer JR, Fossos-Wong N, Geisner IM, Yeh JC, Larimer ME, Cimini MD, Vincent KB, Allen HK, Barrall AL, Arria AM. Nonmedical Use of Prescription Stimulants as a "Red Flag" for Other Substance Use. Subst Use Misuse 2021; 56:941-949. [PMID: 33769195 PMCID: PMC8174530 DOI: 10.1080/10826084.2021.1901926] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Nonmedical use of prescription stimulants (NMPS) has increased on college campuses during the past two decades. NMPS is primarily driven by academic enhancement motives, and normative misperceptions exist as well. However, large, nationwide studies have not yet been conducted to generalize findings more broadly and gain a deeper understanding of the relationship between NMPS and other substance use (e.g. alcohol use, marijuana, etc.). The present study was conducted to lay the foundation for prevention efforts related to NMPS by establishing NMPS prevalence, practices surrounding NMPS, and other substance use. METHODS N = 2,989 students from seven universities around the U.S. completed a web-based survey assessing NMPS practices and related behaviors. Prevalence and factors associated with NMPS were explored. RESULTS Analyses revealed a 17% past-year prevalence of NMPS with associated widespread misperceptions of peer use. NMPS was significantly related to alcohol use, binge drinking, and marijuana use, as well as skipped classes and affiliation with Greek life. CONCLUSIONS Although most college students do not report NMPS, those who do also are more likely to report alcohol use, binge drinking, and marijuana use, and NMPS could be a "red flag" for other risk behaviors worth exploring. Implications for prevention and intervention are discussed.
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Affiliation(s)
- Jason R Kilmer
- Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Nicole Fossos-Wong
- Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Irene M Geisner
- Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Jih-Cheng Yeh
- Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Mary E Larimer
- Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - M Dolores Cimini
- Center for Behavioral Health Promotion and Applied Research, University at Albany, Albany, New York, USA
| | - Kathryn B Vincent
- Center on Young Adult Health and Development, Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Hannah K Allen
- Center on Young Adult Health and Development, Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Angelica L Barrall
- Center on Young Adult Health and Development, Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Amelia M Arria
- Center on Young Adult Health and Development, Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, Maryland, USA
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Dave AA, Cabrera LY. Osteopathic Medical Students’ Attitudes Towards Different Modalities of Neuroenhancement: a Pilot Study. JOURNAL OF COGNITIVE ENHANCEMENT 2020. [DOI: 10.1007/s41465-020-00163-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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9
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Sousa A, Dinis-Oliveira RJ. Pharmacokinetic and pharmacodynamic of the cognitive enhancer modafinil: Relevant clinical and forensic aspects. Subst Abus 2020; 41:155-173. [PMID: 31951804 DOI: 10.1080/08897077.2019.1700584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Modafinil is a nonamphetamine nootropic drug with an increasingly therapeutic interest due to its different sites of action and behavioral effects in comparison to cocaine or amphetamine. A review of modafinil (and of its prodrug adrafinil and its R-enantiomer armodafinil) chemical, pharmacokinetic, pharmacodynamic, toxicological, clinical and forensic aspects was performed, aiming to better understand possible health problems associated to its unconscious and unruled use. Modafinil is a racemate metabolized mainly in the liver into its inactive acid and sulfone metabolites, which undergo primarily renal excretion. Although not fully clarified, major effects seem to be associated to inhibition of dopamine reuptake and modulation of several other neurochemical pathways, namely noradrenergic, serotoninergic, orexinergic, histaminergic, glutamatergic and GABAergic. Due its wake-promoting effects, modafinil is used for the treatment of daily sleepiness associated to narcolepsy, obstructive sleep apnea and shift work sleep disorder. Its psychotropic and cognitive effects are also attractive in several other pathologies and conditions that affect sleep structure, induce fatigue and lethargy, and impair cognitive abilities. Additionally, in health subjects, including students, modafinil is being used off-label to overcome sleepiness, increase concentration and improve cognitive potential. The most common adverse effects associated to modafinil intake are headache, insomnia, anxiety, diarrhea, dry mouth and raise in blood pressure and heart rate. Infrequently, severe dermatologic effects in children, including maculopapular and morbilliform rash, erythema multiforme and Stevens-Johnson Syndrome have been reported. Intoxication and dependence associated to modafinil are uncommon. Further research on effects and health implications of modafinil and its analogs is steel needed to create evidence-based policies.
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Affiliation(s)
- Ana Sousa
- Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ricardo Jorge Dinis-Oliveira
- Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal.,IINFACTS - Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Sciences, University Institute of Health Sciences (IUCS), CESPU, CRL, Gandra, Portugal.,UCIBIO, REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
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10
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Boclin KDLS, Cecílio FFC, Faé G, Fanti G, Centenaro G, Pellizzari T, Gaviolli E, Mario DN, Rigo L. Academic performance and use of psychoactive drugs among healthcare students at a university in southern Brazil: cross-sectional study. SAO PAULO MED J 2020; 138:27-32. [PMID: 32321102 PMCID: PMC9673852 DOI: 10.1590/1516-3180.2019.0182.r1.21102019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/21/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND People have been using psychoactive substances for a long time. Over the last few years, this practice has spread among university students, who use these substances to improve their academic performance, relieve stress and increase concentration and memory. OBJECTIVES To estimate the use of psychoactive drugs among healthcare students at a higher education institution in the city of Passo Fundo (RS), Brazil, and to ascertain the associated demographic and lifestyle factors. DESIGN AND SETTING Cross-sectional study in a higher education institution. METHODS We included 287 undergraduate medicine and dentistry students in this study. They answered a self-administered questionnaire regarding sociodemographic, lifestyle and health variables. The statistical analysis used univariate and bivariate analyses with Pearson's chi-square test (P-value < 0.05). -Multivariate analyses were used to estimate odds ratios (OR) and their respective 95% confidence intervals. The SPSS software, version 20.0, was used. RESULTS The prevalence of use of psychoactive substances among the students was 24.7%. Among these students, high frequencies of psychoactive drugs had been prescribed by physicians (95.8%) and for the purpose of relaxation or stress relief (73.2%). Women, medical students (compared with dental students) and participants with lower academic performance were more likely to use psychoactive drugs. After the multivariate adjustment, the "course" and "academic performance" remained associated with use of psychoactive drugs. CONCLUSION There was high prevalence of psychoactive drug use among the students at the higher education institution investigated. Some variables (female sex, medical students and low academic performance) were associated with the outcome.
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Affiliation(s)
| | | | - Gabriela Faé
- Undergraduate Student, School of Medicine, Faculdade Meridional (IMED), Passo Fundo (RS), Brazil.
| | - Gabriela Fanti
- Undergraduate Student, School of Medicine, Faculdade Meridional (IMED), Passo Fundo (RS), Brazil.
| | - Guilherme Centenaro
- Undergraduate Student, School of Medicine, Faculdade Meridional (IMED), Passo Fundo (RS), Brazil.
| | - Thoany Pellizzari
- Undergraduate Student, School of Medicine, Faculdade Meridional (IMED), Passo Fundo (RS), Brazil.
| | | | - Débora Nunes Mario
- PhD. Professor, School of Medicine, Universidade Federal do Pampa (UNIPAMPA), Uruguaiana (RS), Brazil.
| | - Lilian Rigo
- PhD. Professor, School of Dentistry, Postgraduate Program on Dentistry, Faculdade Meridional (IMED), Passo Fundo (RS), Brazil.
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11
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Khan S, Aziz T. Transcending the brain: is there a cost to hacking the nervous system? Brain Commun 2019; 1:fcz015. [PMID: 32954260 PMCID: PMC7425343 DOI: 10.1093/braincomms/fcz015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 08/08/2019] [Accepted: 08/19/2019] [Indexed: 11/13/2022] Open
Abstract
Great advancements have recently been made to understand the brain and the potential that we can extract out of it. Much of this has been centred on modifying electrical activity of the nervous system for improved physical and cognitive performance in those with clinical impairment. However, there is a risk of going beyond purely physiological performance improvements and striving for human enhancement beyond traditional human limits. Simple ethical guidelines and legal doctrine must be examined to keep ahead of technological advancement in light of the impending mergence between biology and machine. By understanding the role of modern ethics, this review aims to appreciate the fine boundary between what is considered ethically justified for current neurotechnology.
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Affiliation(s)
- Shujhat Khan
- School of Medicine, Imperial College London, London SW7 2AZ, UK
| | - Tipu Aziz
- Department of Neurosurgery, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
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12
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F. Rodrigues C, Lopes N, Hardon A. Beyond health: medicines, food supplements, energetics and the commodification of self-performance in Maputo. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:1005-1022. [PMID: 30847964 PMCID: PMC6850569 DOI: 10.1111/1467-9566.12880] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
With an increasing range of products in global and local markets, more options are available for individuals to enhance their image and their (cognitive, social and physical) performance. These 'performance consumptions' relate to ideals of well-being and improvement, and are based on constructed desires, expectations and needs that go beyond the (often blurred) dichotomy of health and illness. Drawing from mixed-methods research in Maputo, Mozambique, this paper discusses individuals' use of medicines and other substances - pharmaceuticals, food supplements, traditional herbs, cosmetics and energy drinks - for managing different aspects of their everyday lives. Through an overview of the main consumption practices, we explore the underlying purposes and strategies of users, and the perceived legitimacy and risks involved when using a variety of products accessible through formal and informal exchange channels. From tiredness to sexual and aesthetic management, we show how the body becomes the locus of experimentation and investment to perform in accordance with socially expected roles, individual aspirations and everyday tasks. With insights from individuals' accounts in Maputo, we aim to add to discussions on pharmaceuticalisation of body management by showing how the emergence of new performance consumptions is articulated with the reconfiguration of more 'traditional' consumption practices.
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Affiliation(s)
- Carla F. Rodrigues
- Department of AnthropologyAmsterdam Institute for Social Science ResearchUniversity of AmsterdamAmsterdamThe Netherlands
- Department of SociologyEduardo Mondlane UniversityMaputoMozambique
| | - Noémia Lopes
- Instituto Universitário de Lisboa (ISCTE‐IUL)Centro de Investigação e Estudos de Sociologia (CIES‐IUL)LisbonPortugal
- Instituto Universitário Egas Moniz – Centro de Investigação Interdisciplinar Egas Moniz (CiiEM)AlmadaPortugal
| | - Anita Hardon
- Department of AnthropologyAmsterdam Institute for Social Science ResearchUniversity of AmsterdamAmsterdamThe Netherlands
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13
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Sales P, Murphy F, Murphy S, Lau N. Burning the candle at both ends: motivations for non-medical prescription stimulant use in the American workplace. DRUGS: EDUCATION, PREVENTION AND POLICY 2019. [DOI: 10.1080/09687637.2019.1606895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Paloma Sales
- Institute for Scientific Analysis, San Francisco, CA, USA
| | - Fiona Murphy
- Institute for Scientific Analysis, San Francisco, CA, USA
| | - Sheigla Murphy
- Institute for Scientific Analysis, San Francisco, CA, USA
| | - Nicholas Lau
- Institute for Scientific Analysis, San Francisco, CA, USA
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14
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Sattler S. Nonmedical use of prescription drugs for cognitive enhancement as response to chronic stress especially when social support is lacking. Stress Health 2019; 35:127-137. [PMID: 30378254 DOI: 10.1002/smi.2846] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/05/2018] [Accepted: 10/22/2018] [Indexed: 11/06/2022]
Abstract
The nonmedical use of prescription drugs to improve cognitive performance has gained attention due to concerns over its social and political implications as well as side effects and long-term health consequences. Some researchers expect a future trend of an instrumental use of drugs for cognitive enhancement (CE). Thus, getting insights about causes of CE-drug consumption is warranted before the prevalence increases. Because perceived stress is ubiquitous in universities and may decrease cognitive performance, one reaction to cope with stress and its consequences might be the instrumental use of drugs for CE, especially if other resources, such as social support, are lacking. With a prospective design, randomly selected students from four German universities were invited to a web-based survey and reinterviewed after 6 months (N = 2,203). Results show a 6-month prevalence rate of self-reported CE-drug use of about 2%. Higher reported chronic stress is positively associated with CE-drug use. Although social support has no main effect, stress-buffering effects were found. In men with low stress, more support is associated with a higher chance of self-reported CE-drug use. These findings can inform intervention and prevention strategies such as changes in drug regulation or sensitizing (potential) users to unwanted health consequences.
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Affiliation(s)
- Sebastian Sattler
- Institute for Sociology and Social Psychology, University of Cologne, Cologne, Germany.,Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, Québec, Canada
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15
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Steward A, Pickersgill M. Developing expertise, customising sleep, enhancing study practices: exploring the legitimisation of modafinil use within the accounts of UK undergraduate students. DRUGS-EDUCATION PREVENTION AND POLICY 2019; 26:347-355. [PMID: 31391711 PMCID: PMC6636896 DOI: 10.1080/09687637.2018.1555231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 11/01/2022]
Abstract
Introduction and aim: Increasing numbers of students are reportedly using prescription medications to enhance cognition. This study aimed to generate qualitative data on UK students' understandings and perspectives of the risks and benefits surrounding so-called 'study drugs' (particularly, modafinil). Design and methods: Fifteen undergraduate students studying biomedical science subjects were interviewed about their perspectives on study drugs. Interviews were recorded and transcribed for thematic analysis. Users and non-users were included in the sample. Results: The prescription status and comparisons to other legal and illicit stimulants informed accounts of the (lack of) risks associated with study drugs, legitimising use. The customisation of sleep(iness) and wakefulness was described as a key benefit of study drug use. Drivers of use related to university pressures and desires to increase productivity. In periods of heightened stress, such as examinations, students reported altered practices and perspectives on risk. Discussion and conclusions: We noted the contextual nature of students' use and risk appraisals, with fluctuating social contexts and pressures over time being capable of altering prior assessments and current practices (including the legitimisation of study drug consumption). Further, we highlighted the degree to which students leveraged their biomedical and experiential expertise to account for drug consumption.
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Affiliation(s)
- Alice Steward
- Independent, Edinburgh, United Kingdom of Great Britain and Northern Ireland
| | - Martyn Pickersgill
- Centre for Biomedicine, Self and Society, Usher Institute, Old Medical School, Teviot Place, University of Edinburgh, Edinburgh, United Kingdom of Great Britain and Northern Ireland
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Pohl S, Boelsen H, Hildt E. Moral Attitudes Toward Pharmacological Cognitive Enhancement (PCE): Differences and Similarities Among Germans With and Without PCE Experience. Front Pharmacol 2019; 9:1451. [PMID: 30618746 PMCID: PMC6295456 DOI: 10.3389/fphar.2018.01451] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 11/26/2018] [Indexed: 11/17/2022] Open
Abstract
Pharmacological cognitive enhancement (PCE), the use of illicit and/or prescription drugs to increase cognitive performance, has spurred controversial discussion in bioethics. In a semi-structured interview study with 60 German university students and employees, differences and similarities in moral attitudes toward PCE among 30 experienced participants (EPs) vs. 30 inexperienced participants (IPs) were investigated. Substances EPs used most often are methylphenidate, amphetamines, tetrahydrocannabinol and modafinil. Both EPs and IPs addressed topics such as autonomous decision making or issues related to fairness such as equality in test evaluation and distortion of competition. While most EPs and IPs were convinced that the decision of whether or not to use PCE is part of their individual freedom, their views varied considerably with regard to fairness. IPs considered issues related to fairness as much more critical than EPs. Thus, a person’s moral attitudes toward PCE may not only depend on moral common sense, but also on whether they have used illegal and/or prescription drugs for PCE before. This points to the importance of including the various relevant stakeholder perspectives in debates on the ethical and social implications of PCE.
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Affiliation(s)
- Sabine Pohl
- Department of Philosophy, University of Education Karlsruhe, Karlsruhe, Germany
| | - Hannes Boelsen
- Department of Philosophy, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Elisabeth Hildt
- Center for the Study of Ethics in the Professions, Illinois Institute of Technology, Chicago, IL, United States
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London-Nadeau K, Chan P, Wood S. Building Conceptions of Cognitive Enhancement: University Students' Views on the Effects of Pharmacological Cognitive Enhancers. Subst Use Misuse 2019; 54:908-920. [PMID: 30658557 DOI: 10.1080/10826084.2018.1552297] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
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.
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Affiliation(s)
- Kira London-Nadeau
- a Department of Psychology , University of Toronto , Toronto , Ontario , Canada
| | - Priscilla Chan
- b Department of Human Biology , University of Toronto , Toronto , Ontario , Canada
| | - Suzanne Wood
- a Department of Psychology , University of Toronto , Toronto , Ontario , Canada
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18
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Conrad EC, Humphries S, Chatterjee A. Attitudes Toward Cognitive Enhancement: The Role of Metaphor and Context. AJOB Neurosci 2019; 10:35-47. [PMID: 31070552 DOI: 10.1080/21507740.2019.1595771] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The widespread use of stimulants among healthy individuals to improve cognition has received growing attention; however, public attitudes toward this practice are not well understood. We determined the effect of framing metaphors and context of use on public opinion toward cognitive enhancement. We recruited 3,727 participants from the United States to complete three surveys using Amazon's Mechanical Turk between April and July 2017. Participants read vignettes describing an individual using cognitive enhancement, varying framing metaphors (fuel versus steroid), and context of use (athletes versus students versus employees). The main outcome measure was the difference in respondent-assigned level of acceptability of the use of cognitive enhancement by others and by themselves between the contrasting vignettes. Participants were more likely to support the use of cognitive enhancement by others than by themselves and more when the use of enhancement by others was framed with a fuel metaphor than with a steroid metaphor. Metaphoric framing did not affect participants' attitudes toward their own use. Participants supported the use of enhancement by employees more than by students or athletes. These results are discussed in relation to existing ethical and policy literature.
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Lucke J, Jensen C, Dunn M, Chan G, Forlini C, Kaye S, Partridge B, Farrell M, Racine E, Hall W. Non-medical prescription stimulant use to improve academic performance among Australian university students: prevalence and correlates of use. BMC Public Health 2018; 18:1270. [PMID: 30453936 PMCID: PMC6245847 DOI: 10.1186/s12889-018-6212-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Some university students consume pharmaceutical stimulants without a medical prescription with the goal of improving their academic performance. The prevalence of this practice has been well documented in the US, but less so in other countries. The potential harms of using prescription stimulants require a better understanding of the prevalence of this practice within Australian universities. METHODS An internet survey of 1136 Australian students was conducted in 2015 in three large Australian universities. Students were asked about their personal use of prescription stimulants, attitudes and experiences with prescription stimulants. They were also asked about their use of caffeine, energy drinks and illicit drugs to enhance their academic performance. RESULTS Lifetime self-reported use of stimulant medication to improve academic performance was 6.5, and 4.4% in the past year. Students were far more likely to report using coffee and energy drinks (41.4 and 23.6% respectively, lifetime use) than prescription stimulants to help them study and complete university assessments. Non-medical use of prescription stimulants was strongly associated with a history of illicit drug use. CONCLUSION The prevalence of nonmedical prescription stimulant use to improve academic performance is low among university students in Australia, especially when compared with their use of coffee and energy drinks.
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Affiliation(s)
- Jayne Lucke
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, College of Science, Health and Engineering, Building NR6, La Trobe University, Bundoora, VIC, 3086, Australia. .,School of Public Health, The University of Queensland, Herston, Brisbane, QLD, Australia.
| | - Charmaine Jensen
- The University of Queensland Centre for Youth Substance Abuse Research, St Lucia, Brisbane, QLD, Australia
| | - Matthew Dunn
- School of Health and Social Development, Deakin University, Geelong, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Gary Chan
- The University of Queensland Centre for Youth Substance Abuse Research, St Lucia, Brisbane, QLD, Australia
| | - Cynthia Forlini
- Sydney Health Ethics, University of Sydney, Sydney, NSW, Australia
| | - Sharlene Kaye
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Bradley Partridge
- Research Development Unit, Caboolture Hospital, Caboolture, QLD, Australia.,School of Clinical Medicine, Prince Charles Hospital Northside Clinical Unit, The University of Queensland, Brisbane, QLD, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, Quebec, Canada
| | - Wayne Hall
- The University of Queensland Centre for Youth Substance Abuse Research, St Lucia, Brisbane, QLD, Australia
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20
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Dietz P, Iberl B, Schuett E, van Poppel M, Ulrich R, Sattler MC. Prevalence Estimates for Pharmacological Neuroenhancement in Austrian University Students: Its Relation to Health-Related Risk Attitude and the Framing Effect of Caffeine Tablets. Front Pharmacol 2018; 9:494. [PMID: 29946254 PMCID: PMC6006370 DOI: 10.3389/fphar.2018.00494] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 04/25/2018] [Indexed: 01/22/2023] Open
Abstract
Background: Pharmacological neuroenhancement (PN) is defined as the use of illicit or prescription drugs by healthy individuals for cognitive-enhancing purposes. The present study aimed (i) to investigate whether including caffeine tablets in the definition of PN within a questionnaire increases the PN prevalence estimate (framing effect), (ii) to investigate whether the health-related risk attitude is increased in students who use PN. Materials and methods: Two versions of a paper-and-pencil questionnaire (first version included caffeine tablets in the definition of PN, the second excluded caffeine tablets) were distributed among university students at the University of Graz, Austria. The unrelated question model (UQM) was used to estimate the 12-month PN prevalence and the German version of the 30-item Domain-Specific Risk-Taking (DOSPERT) scale to assess the health-related risk attitude. Moreover, large-sample z-tests (α = 0.05) were performed for comparing the PN prevalence estimates of two groups. Results: Two thousand four hundred and eighty-nine questionnaires were distributed and 2,284 (91.8%) questionnaires were included in analysis. The overall PN prevalence estimate for all students was 11.9%. One-tailed large-sample z-tests revealed that the PN estimate for students with higher health-related risk attitude was significantly higher compared to students with lower health-related risk attitude (15.6 vs. 8.5%; z = 2.65, p = 0.004). Furthermore, when caffeine tablets were included into the example of PN, the prevalence estimate of PN was significantly higher compared to the version without caffeine tablets (14.9 vs. 9.0%; z = 2.20, p = 0.014). Discussion: This study revealed that the PN prevalence estimate increases when caffeine tablets are included in the definition of PN. Therefore, future studies investigating the prevalence of, and predictors for, PN should be performed and interpreted with respect to potential framing effects. This study further revealed that the PN prevalence estimate is increased in students with a higher health-related risk attitude compared to students with a lower one. Therefore, future education and prevention programs addressing PN in the collective of students should not only inform about potential side effects of its use but also address the limited effects on cognition and potential alternatives of PN.
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Affiliation(s)
- Pavel Dietz
- Research Group of Physical Activity and Public Health, Institute of Sports Science, University of Graz, Graz, Austria
- Working Group Social and Health Sciences of Sport, Institute for Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Benedikt Iberl
- Research Group of Cognition and Perception, Institute of Psychology, University of Tübingen, Tübingen, Germany
| | - Emanuel Schuett
- Research Group of Cognition and Perception, Institute of Psychology, University of Tübingen, Tübingen, Germany
| | - Mireille van Poppel
- Research Group of Physical Activity and Public Health, Institute of Sports Science, University of Graz, Graz, Austria
- Working Group Social and Health Sciences of Sport, Institute for Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Rolf Ulrich
- Research Group of Cognition and Perception, Institute of Psychology, University of Tübingen, Tübingen, Germany
| | - Matteo Christian Sattler
- Research Group of Physical Activity and Public Health, Institute of Sports Science, University of Graz, Graz, Austria
- Working Group Social and Health Sciences of Sport, Institute for Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
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21
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Brühl AB, Sahakian BJ. Drugs, games, and devices for enhancing cognition: implications for work and society. Ann N Y Acad Sci 2016; 1369:195-217. [PMID: 27043232 DOI: 10.1111/nyas.13040] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 02/15/2016] [Accepted: 02/18/2016] [Indexed: 12/11/2022]
Abstract
As work environments change, the demands on working people change. Cognitive abilities in particular are becoming progressively more important for work performance and successful competition in a global environment. However, work-related stress, performance over long hours, lack of sleep, shift work, and jet lag affect cognitive functions. Therefore, an increasing number of healthy people are reported to use cognitive-enhancing drugs, as well as other interventions, such as noninvasive brain stimulation, to maintain or improve work performance. This review summarizes research on pharmacological and technical methods as well as cognitive training, including game apps for the brain, in healthy people. In neuropsychiatric disorders, impairments in cognitive functions can drastically reduce the chances of returning to work; therefore, this review also summarizes findings from pharmacological and cognitive-training studies in neuropsychiatric disorders.
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Affiliation(s)
- Annette B Brühl
- Department of Psychiatry, and Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom.,Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zürich, Switzerland
| | - Barbara J Sahakian
- Department of Psychiatry, and Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
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22
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Robitaille C, Collin J. Prescription Psychostimulant Use Among Young Adults: A Narrative Review of Qualitative Studies. Subst Use Misuse 2016; 51:357-69. [PMID: 26886251 DOI: 10.3109/10826084.2015.1110170] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Within the last decade, the nonmedical use of prescription drugs has raised concern, particularly among young adults. Psychostimulants, that is to say amphetamine and its derivatives, are pharmaceuticals, which contribute to what has come to be known in Canada and the United States as the "prescription drug crisis." Research in the fields of public health, addiction studies, and neuroethics has attempted to further understand this mounting issue; however, there is a paucity of data concerning the underlying social logics related to the use of these substances. OBJECTIVES The objective of this article is to provide an overview of the current literature related to the social context of prescription psychostimulant use among young adults, and to discuss theoretical considerations as well as implications for future research. METHODS A narrative review of the literature was performed. RESULTS We found that research efforts have chiefly targeted college students, yet there is a lack of knowledge concerning other social groups likely to use these pharmaceuticals nonmedically, such as persons with high strain employment. Three main emerging patterns related to prescription psychostimulant use were identified: (1) control of external stressors, (2) strategic use toward the making of the self, and (3) increasing one's performance. CONCLUSIONS Prescription psychostimulant use among young adults is anchored in contemporary normativity and cannot be separated from the developing performance ethic within North-American and other Western societies. We suggest that pharmaceuticalization and Actor-Network Theory are useful conceptual tools to frame future research efforts.
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Affiliation(s)
- Caroline Robitaille
- a Social and Preventive Medicine, University of Montreal , Montreal , Canada
| | - Johanne Collin
- b Faculty of Pharmacy, University of Montreal , Montreal , Canada
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23
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Maier LJ, Liakoni E, Schildmann J, Schaub MP, Liechti ME. Swiss University Students' Attitudes toward Pharmacological Cognitive Enhancement. PLoS One 2015; 10:e0144402. [PMID: 26657300 PMCID: PMC4675521 DOI: 10.1371/journal.pone.0144402] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 11/17/2015] [Indexed: 11/18/2022] Open
Abstract
Pharmacological cognitive enhancement (PCE) refers to the nonmedical use of prescription or recreational drugs to enhance cognitive performance. Several concerns about PCE have been raised in the public. The aim of the present study was to investigate students' attitudes toward PCE. Students at three Swiss universities were invited by e-mail to participate in a web-based survey. Of the 29,282 students who were contacted, 3,056 participated. Of these students, 22% indicated that they had used prescription drugs (12%) or recreational substances including alcohol (14%) at least once for PCE. The use of prescription drugs or recreational substances including alcohol prior to the last exam was reported by 16%. Users of pharmacological cognitive enhancers were more likely to consider PCE fair (24%) compared with nonusers (11%). Only a minority of the participants agreed with the nonmedical use of prescription drugs by fellow students when assuming weak (7%) or hypothetically strong efficacy and availability to everyone (14%). Two-thirds (68%) considered performance that is obtained with PCE less worthy of recognition. Additionally, 80% disagreed that PCE is acceptable in a competitive environment. More than half (64%) agreed that PCE in academia is similar to doping in sports. Nearly half (48%) claimed that unregulated access to pharmacological cognitive enhancers increases the pressure to engage in PCE and educational inequality (55%). In conclusion, Swiss students' main concerns regarding PCE were related to coercion and fairness. As expected, these concerns were more prevalent among nonusers than among users of pharmacological cognitive enhancers. More balanced information on PCE should be shared with students, and future monitoring of PCE is recommended.
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Affiliation(s)
- Larissa J. Maier
- Swiss Research Institute for Public Health and Addiction (ISGF), Associated Institute at the University of Zurich and WHO Collaborating Centre, Zurich, Switzerland
| | - Evangelia Liakoni
- Division of Clinical Pharmacology and Toxicology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Jan Schildmann
- Institut für Medizinische Ethik und Geschichte der Medizin, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Michael P. Schaub
- Swiss Research Institute for Public Health and Addiction (ISGF), Associated Institute at the University of Zurich and WHO Collaborating Centre, Zurich, Switzerland
| | - Matthias E. Liechti
- Division of Clinical Pharmacology and Toxicology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- * E-mail:
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24
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Ogeil RP, Phillips JG. Commonly used stimulants: Sleep problems, dependence and psychological distress. Drug Alcohol Depend 2015; 153:145-51. [PMID: 26049205 DOI: 10.1016/j.drugalcdep.2015.05.036] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 05/21/2015] [Accepted: 05/21/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Caffeine and nicotine are commonly used stimulants that enhance alertness and mood. Discontinuation of both stimulants is associated with withdrawal symptoms including sleep and mood disturbances, which may differ in males and females. The present study examines changes in sleep quality, daytime sleepiness and psychological distress associated with use and dependence on caffeine and nicotine. METHODS An online survey comprising validated tools to assess sleep quality, excessive daytime sleepiness and psychological distress was completed by 166 participants (74 males, 96 females) with a mean age of 28 years. Participants completed the study in their own time, and were not offered any inducements to participate. RESULTS Sleep quality was poorer in those dependent upon caffeine or nicotine, and there were also significant interaction effects with gender whereby females reported poorer sleep despite males reporting higher use of both stimulants. Caffeine dependence was associated with poorer sleep quality, increased daytime dysfunction, and increased levels of night time disturbance, while nicotine dependence was associated with poorer sleep quality and increased use of sleep medication and sleep disturbances. There were strong links between poor sleep and diminished affect, with psychological distress found to co-occur in the context of disturbed sleep. CONCLUSIONS Stimulants are widely used to promote vigilance and mood; however, dependence on commonly used drugs including caffeine and nicotine is associated with decrements in sleep quality and increased psychological distress, which may be compounded in female dependent users.
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Affiliation(s)
- Rowan P Ogeil
- Eastern Health Clinical School, Monash University, Victoria, Australia; Turning Point, Eastern Health, 54-62 Gertrude St., Fitzroy, Victoria, Australia.
| | - James G Phillips
- Psychology Department, Auckland University of Technology, Auckland, New Zealand
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25
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Maier LJ, Schaub MP. The Use of Prescription Drugs and Drugs of Abuse for Neuroenhancement in Europe. EUROPEAN PSYCHOLOGIST 2015. [DOI: 10.1027/1016-9040/a000228] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Pharmacological neuroenhancement, defined as the misuse of prescription drugs, illicit drugs, or alcohol for the purpose of enhancing cognition, mood, or prosocial behavior, is not widespread in Europe – nevertheless, it does occur. Thus far, no drug has been proven as safe and effective for cognitive enhancement in otherwise healthy individuals. European studies have investigated the misuse of prescription and illicit stimulants to increase cognitive performance as well as the use of tranquilizers, alcohol, and cannabis to cope with stress related to work or education. Young people in educational settings report pharmacological neuroenhancement more frequently than those in other settings. Although the regular use of drugs for neuroenhancement is not common in Europe, the irregular and low-dose usage of neuroenhancers might cause adverse reactions. Previous studies have revealed that obtaining adequate amounts of sleep and using successful learning techniques effectively improve mental performance, whereas pharmacological neuroenhancement is associated with ambiguous effects. Therefore, non-substance-related alternatives should be promoted to cope with stressful situations. This paper reviews the recent research on pharmacological neuroenhancement in Europe, develops a clear definition of the substances used, and formulates recommendations for practitioners regarding how to react to requests for neuroenhancement drug prescriptions. We conclude that monitoring the future development of pharmacological neuroenhancement in Europe is important to provide effective preventive measures when required. Furthermore, substance use to cope with stress related to work or education should be studied in depth because it is likely more prevalent and dangerous than direct neuroenhancement.
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Affiliation(s)
- Larissa J. Maier
- Swiss Research Institute for Public Health and Addiction (ISGF), Associated Institute at the University of Zurich and WHO Collaborating Centre, Zurich, Switzerland
| | - Michael P. Schaub
- Swiss Research Institute for Public Health and Addiction (ISGF), Associated Institute at the University of Zurich and WHO Collaborating Centre, Zurich, Switzerland
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26
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Ram SS, Hussainy S, Henning M, Jensen M, Russell B. Prevalence of cognitive enhancer use among New Zealand tertiary students. Drug Alcohol Rev 2015; 35:345-51. [DOI: 10.1111/dar.12294] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 05/10/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Sanyogita Sanya Ram
- School of Pharmacy, Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
- Centre for Medicine Use and Safety; Monash University; Melbourne Australia
| | - Safeera Hussainy
- Centre for Medicine Use and Safety; Monash University; Melbourne Australia
| | - Marcus Henning
- Centre for Medical and Health Sciences Education, Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
| | - Maree Jensen
- School of Pharmacy, Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
| | - Bruce Russell
- School of Pharmacy, Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
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27
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Reflections on Addiction in Students Using Stimulants for Neuroenhancement: A Preliminary Interview Study. BIOMED RESEARCH INTERNATIONAL 2015; 2015:621075. [PMID: 26064931 PMCID: PMC4433654 DOI: 10.1155/2015/621075] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 01/09/2015] [Accepted: 01/12/2015] [Indexed: 11/17/2022]
Abstract
The use of stimulants for the purpose of pharmacological neuroenhancement (NE) among students is a subject of increasing public awareness. The risk of addiction development by stimulant use for NE is still unanswered. Therefore, face-to-face interviews were carried out among 18 university students experienced in the nonmedical use of methylphenidate and amphetamines for NE assessing aspects of addiction. Interviews were tape-recorded, verbatim-transcribed, and analyzed using a qualitative approach. The interviews showed that participants--the majority had current or lifetime diagnoses of misuse or addiction to alcohol or cannabis-reported an awareness of the risk of addiction development associated with stimulant use and reported various effects which may increase their likelihood of future stimulant use, for example, euphoric effects, increase of self-confidence, and motivation. They also cited measures to counteract the development of addiction as well as measures taken to normalize again after stimulant use. Students were convinced of having control over their stimulant use and of not becoming addicted to stimulants used for NE. We can conclude that behavior and beliefs of the students in our sample appear to be risky in terms of addiction development. However, long-term empirical research is needed to estimate the true risk of addiction.
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28
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Vrecko S. Everyday drug diversions: a qualitative study of the illicit exchange and non-medical use of prescription stimulants on a university campus. Soc Sci Med 2015; 131:297-304. [PMID: 25455480 PMCID: PMC4376379 DOI: 10.1016/j.socscimed.2014.10.016] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 09/08/2014] [Accepted: 10/06/2014] [Indexed: 11/22/2022]
Abstract
This article investigates everyday experiences and practises that are associated with processes of pharmaceuticalization and with practices of 'drug diversion'--that is, the illicit exchange and non-medical use of prescription drugs. It reports results from a qualitative study that was designed to examine the everyday dimensions of non-medical prescription stimulant use among students on an American university campus, which involved 38 semi-structured interviews with individuals who used prescription stimulants as a means of improving academic performance. While discussions of drug diversion are often framed in terms of broad, population-level patterns and demographic trends, the present analysis provides a complementary sociocultural perspective that is attuned to the local and everyday phenomena. Results are reported in relation to the acquisition of supplies of medications intended for nonmedical use. An analysis is provided which identifies four different sources of diverted medications (friends; family members; black-market vendors; deceived clinicians), and describes particular sets of understandings, practices and experiences that arise in relation to each different source. Findings suggest that at the level of everyday experience and practice, the phenomenon of prescription stimulant diversion is characterised by a significant degree of complexity and heterogeneity.
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Affiliation(s)
- Scott Vrecko
- Department of Social Science, Health and Medicine, King's College London, Strand, London WC2R 2LS, UK.
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29
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Caviola L, Mannino A, Savulescu J, Faulmüller N. Cognitive biases can affect moral intuitions about cognitive enhancement. Front Syst Neurosci 2014; 8:195. [PMID: 25360088 PMCID: PMC4197737 DOI: 10.3389/fnsys.2014.00195] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 09/22/2014] [Indexed: 11/20/2022] Open
Abstract
Research into cognitive biases that impair human judgment has mostly been applied to the area of economic decision-making. Ethical decision-making has been comparatively neglected. Since ethical decisions often involve very high individual as well as collective stakes, analyzing how cognitive biases affect them can be expected to yield important results. In this theoretical article, we consider the ethical debate about cognitive enhancement (CE) and suggest a number of cognitive biases that are likely to affect moral intuitions and judgments about CE: status quo bias, loss aversion, risk aversion, omission bias, scope insensitivity, nature bias, and optimistic bias. We find that there are more well-documented biases that are likely to cause irrational aversion to CE than biases in the opposite direction. This suggests that common attitudes about CE are predominantly negatively biased. Within this new perspective, we hope that subsequent research will be able to elaborate this hypothesis and develop effective de-biasing techniques that can help increase the rationality of the public CE debate and thus improve our ethical decision-making.
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Affiliation(s)
- Lucius Caviola
- Department of Experimental Psychology, University of Oxford Oxford, UK
| | - Adriano Mannino
- Department of Philosophy, University of Bern Bern, Switzerland
| | - Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, University of Oxford Oxford, UK ; Oxford Centre for Neuroethics, University of Oxford Oxford, UK
| | - Nadira Faulmüller
- Department of Experimental Psychology, University of Oxford Oxford, UK ; Oxford Centre for Neuroethics, University of Oxford Oxford, UK ; Department Values, Technology and Innovation, Delft University of Technology Delft, Netherlands
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Sanders A, Stogner J, Seibert J, Miller BL. Misperceptions of peer pill-popping: the prevalence, correlates, and effects of inaccurate assumptions about peer pharmaceutical misuse. Subst Use Misuse 2014; 49:813-23. [PMID: 24502373 DOI: 10.3109/10826084.2014.880485] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Peer behaviors may significantly influence personal behavior yet individuals may not accurately estimate their peers' actions. Overestimations of peer substance use may encourage initiation or exacerbate extant problems. The present study examines misperceptions of peer pharmaceutical misuse and explores the relationship between reported misuse and perceptions of misuse for four categories of prescription drugs. Data collected from 2,349 college students in the Southeastern United States were analyzed and results indicated that overall perceptions of misuse were significantly higher than actual misuse. These findings suggest that intervention efforts may benefit from addressing misperceptions of pharmaceutical misuse. Study limitations and implications are addressed.
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Affiliation(s)
- Amber Sanders
- 1Department of Criminal Justice and Criminology, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
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Schelle KJ, Faulmüller N, Caviola L, Hewstone M. Attitudes toward pharmacological cognitive enhancement-a review. Front Syst Neurosci 2014; 8:53. [PMID: 24860438 PMCID: PMC4029025 DOI: 10.3389/fnsys.2014.00053] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 03/21/2014] [Indexed: 11/13/2022] Open
Abstract
A primary means for the augmentation of cognitive brain functions is “pharmacological cognitive enhancement” (PCE). The term usually refers to the off-label use of medical substances to improve mental performance in healthy individuals. With the final aim to advance the normative debate taking place on that topic, several empirical studies have been conducted to assess the attitudes toward PCE in the public, i.e., in groups outside of the academic debate. In this review, we provide an overview of the 40 empirical studies published so far, reporting both their methodology and results. Overall, we find that several concerns about the use of PCE are prevalent in the public. These concerns largely match those discussed in the normative academic debate. We present our findings structured around the three most common concerns: medical safety, coercion, and fairness. Fairness is divided into three subthemes: equality of opportunity, honesty, and authenticity. Attitudes regarding some concerns are coherent across studies (e.g., coercion), whereas for others we find mixed results (e.g., authenticity). Moreover, we find differences in how specific groups—such as users, nonusers, students, parents, and health care providers—perceive PCE: a coherent finding is that nonusers display more concerns regarding medical safety and fairness than users. We discuss potential psychological explanations for these differences.
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Affiliation(s)
- Kimberly J Schelle
- Department of Industrial Design, Eindhoven University of Technology Eindhoven, Netherlands
| | - Nadira Faulmüller
- Department of Experimental Psychology, University of Oxford Oxford, UK ; Department of Values, Technology and Innovation, Delft University of Technology Delft, Netherlands
| | - Lucius Caviola
- Department of Experimental Psychology, University of Oxford Oxford, UK
| | - Miles Hewstone
- Department of Experimental Psychology, University of Oxford Oxford, UK
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Hildt E, Lieb K, Franke AG. Life context of pharmacological academic performance enhancement among university students--a qualitative approach. BMC Med Ethics 2014; 15:23. [PMID: 24606831 PMCID: PMC3973848 DOI: 10.1186/1472-6939-15-23] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 03/03/2014] [Indexed: 11/24/2022] Open
Abstract
Background Academic performance enhancement or cognitive enhancement (CE) via stimulant drug use has received increasing attention. The question remains, however, whether CE solely represents the use of drugs for achieving better academic or workplace results or whether CE also serves various other purposes. The aim of this study was to put the phenomenon of pharmacological academic performance enhancement via prescription and illicit (psycho-) stimulant use (Amphetamines, Methylphenidate) among university students into a broader context. Specifically, we wanted to further understand students’ experiences, the effects of use on students and other factors, such as pressure to perform in their academic and private lives. Methods A sample of 18 healthy university students reporting the non-medical use of prescription and illicit stimulants for academic performance enhancement was interviewed in a face-to-face setting. The leading questions were related to the situations and context in which the students considered the non-medical use of stimulants. Results Based on the resultant transcript, two independent raters identified six categories relating to the life context of stimulant use for academic performance enhancement: Context of stimulant use beyond academic performance enhancement, Subjective experience of enhancement, Timing of consumption, Objective academic results, Side effects, Pressure to perform. Conclusions The answers reveal that academic performance enhancement through the use of stimulants is not an isolated phenomenon that solely aims at enhancing cognition to achieve better academic results but that the multifaceted life context in which it is embedded is of crucial relevance. The participants not only considered the stimulants advantageous for enhancing academic performance, but also for leading an active life with a suitable balance between studying and time off. The most common reasons given for stimulant use were to maximize time, to increase motivation and to cope with memorizing. According to the interviews, there is a considerable discrepancy between subjective experiences and objective academic results achieved.
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Affiliation(s)
- Elisabeth Hildt
- Department of Philosophy, Johannes Gutenberg University of Mainz, Jakob Welder-Weg 18, D - 55099 Mainz, Germany.
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Madan CR. Augmented memory: a survey of the approaches to remembering more. Front Syst Neurosci 2014; 8:30. [PMID: 24624063 PMCID: PMC3939671 DOI: 10.3389/fnsys.2014.00030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 02/10/2014] [Indexed: 11/13/2022] Open
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Bodenlos JS, Malordy A, Noonan M, Mayrsohn A, Mistler B. Prescription Drug Attitudes Questionnaire: Development and Validation. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/psych.2014.514176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Maier LJ, Liechti ME, Herzig F, Schaub MP. To dope or not to dope: neuroenhancement with prescription drugs and drugs of abuse among Swiss university students. PLoS One 2013; 8:e77967. [PMID: 24236008 PMCID: PMC3827185 DOI: 10.1371/journal.pone.0077967] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 09/07/2013] [Indexed: 11/19/2022] Open
Abstract
Background Neuroenhancement is the use of substances by healthy subjects to enhance mood or cognitive function. The prevalence of neuroenhancement among Swiss university students is unknown. Investigating the prevalence of neuroenhancement among students is important to monitor problematic use and evaluate the necessity of prevention programs. Study aim To describe the prevalence of the use of prescription medications and drugs of abuse for neuroenhancement among Swiss university students. Method In this cross-sectional study, students at the University of Zurich, University of Basel, and Swiss Federal Institute of Technology Zurich were invited via e-mail to participate in an online survey. Results A total of 28,118 students were contacted, and 6,275 students completed the survey. Across all of the institutions, 13.8% of the respondents indicated that they had used prescription drugs (7.6%) or drugs of abuse including alcohol (7.8%) at least once specifically for neuroenhancement. The most frequently used prescription drugs for neuroenhancement were methylphenidate (4.1%), sedatives (2.7%), and beta-blockers (1.2%). Alcohol was used for this purpose by 5.6% of the participants, followed by cannabis (2.5%), amphetamines (0.4%), and cocaine (0.2%). Arguments for neuroenhancement included increased learning (66.2%), relaxation or sleep improvement (51.2%), reduced nervousness (39.1%), coping with performance pressure (34.9%), increased performance (32.2%), and experimentation (20%). Neuroenhancement was significantly more prevalent among more senior students, students who reported higher levels of stress, and students who had previously used illicit drugs. Although “soft enhancers”, including coffee, energy drinks, vitamins, and tonics, were used daily in the month prior to an exam, prescription drugs or drugs of abuse were used much less frequently. Conclusions A significant proportion of Swiss university students across most academic disciplines reported neuroenhancement with prescription drugs and drugs of abuse. However, these substances are rarely used on a daily basis and more sporadically used prior to exams.
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Affiliation(s)
- Larissa J. Maier
- Swiss Research Institute for Public Health and Addiction, Associated Institute at the University of Zurich and WHO Collaborating Centre, Zurich, Switzerland
- * E-mail:
| | - Matthias E. Liechti
- Division of Clinical Pharmacology & Toxicology, Department of Biomedicine and Department of Internal Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Fiona Herzig
- Division of Psychopathology and Clinical Intervention, University of Zurich, Zurich, Switzerland
| | - Michael P. Schaub
- Swiss Research Institute for Public Health and Addiction, Associated Institute at the University of Zurich and WHO Collaborating Centre, Zurich, Switzerland
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36
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Ilieva IP, Farah MJ. Enhancement stimulants: perceived motivational and cognitive advantages. Front Neurosci 2013; 7:198. [PMID: 24198755 PMCID: PMC3813924 DOI: 10.3389/fnins.2013.00198] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 10/10/2013] [Indexed: 11/13/2022] Open
Abstract
Psychostimulants like Adderall and Ritalin are widely used for cognitive enhancement by people without ADHD, although the empirical literature has shown little conclusive evidence for effectiveness in this population. This paper explores one potential explanation of this discrepancy: the possibility that the benefit from enhancement stimulants is at least in part motivational, rather than purely cognitive. We review relevant laboratory, survey, and interview research and present the results of a new survey of enhancement users with the goal of comparing perceived cognitive and motivational effects. These users perceived stimulant effects on motivationally-related factors, especially "energy" and "motivation," and reported motivational effects to be at least as pronounced as cognitive effects, including the effects on "attention."
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Affiliation(s)
- Irena P Ilieva
- Department of Psychology, Center for Neuroscience and Society, University of Pennsylvania Philadelphia, PA, USA
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37
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Farah MJ, Smith ME, Ilieva I, Hamilton RH. Cognitive enhancement. WILEY INTERDISCIPLINARY REVIEWS. COGNITIVE SCIENCE 2013; 5:95-103. [PMID: 26304298 DOI: 10.1002/wcs.1250] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 07/15/2013] [Accepted: 07/24/2013] [Indexed: 11/10/2022]
Abstract
Cognitive enhancement refers to the improvement of cognitive ability in normal healthy individuals. In this article, we focus on the use of pharmaceutical agents and brain stimulation for cognitive enhancement, reviewing the most common methods of pharmacologic and electronic cognitive enhancement, and the mechanisms by which they are believed to work, the effectiveness of these methods and their prevalence. We note the many gaps in our knowledge of these matters, including open questions about the size, reliability and nature of the enhancing effects, and we conclude with recommendations for further research. WIREs Cogn Sci 2014, 5:95-103. doi: 10.1002/wcs.1250 CONFLICT OF INTEREST: The authors have declared no conflicts of interest for this article. For further resources related to this article, please visit the WIREs website.
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Affiliation(s)
- Martha J Farah
- Center for Neuroscience & Society, University of Pennsylvania, Philadelphia, PA, USA
| | - M Elizabeth Smith
- Center for Neuroscience & Society, University of Pennsylvania, Philadelphia, PA, USA
| | - Irena Ilieva
- Center for Neuroscience & Society, University of Pennsylvania, Philadelphia, PA, USA
| | - Roy H Hamilton
- Center for Neuroscience & Society, University of Pennsylvania, Philadelphia, PA, USA
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Mazanov J, Dunn M, Connor J, Fielding ML. Substance use to enhance academic performance among Australian university students. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.peh.2013.08.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Franke AG, Bagusat C, Dietz P, Hoffmann I, Simon P, Ulrich R, Lieb K. Use of illicit and prescription drugs for cognitive or mood enhancement among surgeons. BMC Med 2013; 11:102. [PMID: 23570256 PMCID: PMC3635891 DOI: 10.1186/1741-7015-11-102] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Accepted: 03/08/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Surgeons are usually exposed to high workloads leading to fatigue and stress. This not only increases the likelihood of mistakes during surgery but also puts pressure on surgeons to use drugs to counteract fatigue, distress, concentration deficits, burnout or symptoms of depression. The prevalence of surgeons taking pharmacological cognitive enhancement (CE) or mood enhancement (ME) drugs has not been systematically assessed so far. METHODS Surgeons who attended five international conferences in 2011 were surveyed with an anonymous self-report questionnaire (AQ) regarding the use of prescription or illicit drugs for CE and ME and factors associated with their use. The Randomized Response Technique (RRT) was used in addition. The RRT guarantees a high degree of anonymity and confidentiality when a person is asked about stigmatizing issues, such as drug abuse. RESULTS A total of 3,306 questionnaires were distributed and 1,145 entered statistical analysis (response rate: 36.4%). According to the AQ, 8.9% of all surveyed surgeons confessed to having used a prescription or illicit drug exclusively for CE at least once during lifetime. As one would expect, the prevalence rate assessed by RRT was approximately 2.5-fold higher than that of the AQ (19.9%; 95% confidence interval (CI), 15.9% to 23.9%, N = 1,105). An even larger discrepancy between the RRT and AQ was observed for the use of antidepressants with a 6-fold higher prevalence (15.1%; 95% CI, 11.3% to 19.0%, N = 1,099) as compared to 2.4% with the AQ. Finally, logistic regression analysis revealed that pressure to perform at work (odds ratio (OR): 1.290; 95% CI, 1.000 to 1.666; P = 0.05) or in private life (OR: 1.266; 95% CI, 1.038 to 1.543; P = 0.02), and gross income (OR: 1.337; 95% CI, 1.091 to 1.640; P = 0.005), were positively associated with the use of drugs for CE or ME. CONCLUSIONS The use of illicit and prescription drugs for CE or ME is an underestimated phenomenon among surgeons which is generally attributable to high workload, perceived workload, and private stress. Such intake of drugs is associated with attempts to counteract fatigue and loss of concentration. However, drug use for CE may lead to addiction and to overestimation of one's own capabilities, which can put patients at risk. Coping strategies should be taught during medical education.
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Affiliation(s)
- Andreas G Franke
- Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Untere Zahlbacher Str. 8, Mainz 55131, Germany.
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