Neurocognitive, Autonomic, and Mood Effects of Adderall: A Pilot Study of Healthy College Students

ADHD and Academic Performance in College Students: A Systematic Review

OBJECTIVES

The present study performed a systematic review of the scientific literature that deals with the academic performance of university students with ADHD, collecting the research conducted between 2018 and 2024. Likewise, we aimed to know the factors that influence on academic performance and evaluate the tools used in the collection of ADHD symptoms and educational data.

METHODS

The electronic databases PubMed, PsycInfo, and Scopus were used to search studies using PRISMA guidelines. Quantitative studies selected had to discuss about academic performance in college students with ADHD. For each study, quality of evidence was examined using the Quality Assessment Tool of the National Heart Lung and Blood Institute.

RESULTS

Fifteen studies with good-fair quality were included in the review. These studies demonstrated that an ADHD diagnosis or significant ADHD symptoms are associated with lower academic performance in college students, particularly those with inattention symptoms. Additionally, factors such as executive functions, medication use, and study strategies also influence the academic performance of these students. The most commonly used instruments for the assessment of ADHD were the screening measures ADHD Self-Report Scale and the ADHD Rating Scale-Self Report Version. To assess academic performance half of the studies collected the Grade Point Average directly from university records, while in other studies, students were asked directly for their grades.

CONCLUSION

Overall, ADHD has a relevant impact on the academic performance of university students, but the evaluation methodology used has some differences with respect to child's evaluations procedures. Therefore, studies in this population must include not only self-reported symptomatology, but also assessments from clinicians specialized in adult ADHD.

Brain Glutamate Dynamics Predict Positive Agency in Healthy Women: Insights from Combined Application of Pharmacological Challenge, Comprehensive Affective Assessment, and Magnetic Resonance Spectroscopy

Contributions of brain glutamate (Glu) to conscious emotion are not well understood. Here, we evaluate the relationship of experimentally induced change in neocortical Glu (ΔGlu) and subjective states in well individuals, using combined application of pharmacological challenge, magnetic resonance spectroscopy (MRS), and comprehensive affective assessment. Drug challenge with d-amphetamine (AMP) (20 mg oral), methamphetamine (MA) (Desoxyn, 20 mg oral), and placebo (PBO) was conducted on three separate test days in a within-subjects double blind design. Proton MRS quantified neurometabolites in the right dorsal anterior cingulate cortex 140-150 min post-drug and PBO. Subjective states were assessed at half hour intervals over 5.5 h on each session, yielding 3792 responses per participant (91,008 responses overall, N = 24 participants), with self-reports reduced by principal components analysis (PCA). PCA produced a primary factor score of AMP- and MA-induced positive agency (ΔPA). MRS indicated drug-induced ΔGlu related positively to ΔPA (ΔGluMA r = +0.44, p < 0.05, N = 21), with large effects in females (ΔGluMA r = +0.52, p < 0.05; ΔGluAMP r = +0.61, p < 0.05, N = 11). Subjective states related to ΔGlu included rise in subjective stimulation, vigor, friendliness, elation, positive mood, positive affect (r's = +0.51 to +0.74, p < 0.05), and alleviation of anxiety in females (r = -0.61, p < 0.05, N = 11). These self-reports correlated with ΔGlu to the extent they loaded on ΔPA (r = 0.95 AMP, p = 5 × 10-10; r = 0.63 MA, p = 0.0015, N = 11), indicating the coherence of ΔGlu effects on emotional states. Timing data indicated Glu shaped positive emotion both concurrently and prospectively, with no relationship with pre-MRS emotion (ΔGluAMP r = +0.59 to +0.65, p's < 0.05; ΔGluMA r = +0.53, p < 0.05, N = 11). Together these findings indicate substantive, mechanistic contributions of neocortical Glu to positive agentic states in healthy individuals, which are most readily observed in women. The findings illustrate the promise of combined application of pharmacological challenge, comprehensive affective assessment, and MRS neuroimaging techniques in basic and clinical studies.

Expectancy for Adderall influences subjective mood and drug effects regardless of concurrent caffeine ingestion: A randomized controlled trial

RATIONALE

Nonmedical prescription stimulant use (NPS; use without a prescription or in ways other than prescribed) is common among college students. Despite the potential for negative consequences, students continue engaging in NPS for cognitive enhancement purposes, which may be maintained by expectancy and placebo effects.

OBJECTIVES

This study examined if a placebo administered under the guise of Adderall influenced subjective mood/drug effects and cognitive performance. Furthermore, this study examined if concurrent caffeine ingestion incrementally enhanced Adderall-related placebo effects.

METHODS

Undergraduate students with features that put them at elevated risk for NPS (N = 121) completed measures of mood and drug effects and cognitive assessments on two separate laboratory visits in this parallel randomized controlled trial. Visit 1 was a baseline control visit, on which no drug was expected or received. On visit 2, subjects were randomized to: (1) expect/receive no drug (control); (2) expect Adderall/receive placebo; or (3) expect Adderall/receive 200 mg caffeine.

RESULTS

There were several significant condition × visit interactions for subjective effects, including amphetamine effects, energy and efficiency effects, and feeling high. In most cases, participants who expected Adderall reported greater positive subjective effects on visit 2 compared to controls; however, there were generally not incremental enhancements for those ingesting caffeine compared to placebo. There were no significant effects for any cognitive tests.

CONCLUSIONS

Expectation for prescription stimulant effects influenced subjective outcomes in a sample of high-risk college students. These findings may inform expectancy challenge interventions to reduce NPS.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03648684.

Prescription Stimulant Misuse Among Nursing Students: A Systematic Review

ABSTRACT

Nonmedical prescription stimulants are used to reduce symptoms of inattention, impulsivity, and hyperactivity in children and adults with attention-deficit hyperactivity/disorder. They are Schedule II controlled substances because of their high potential for dependence, and individuals who misuse them without a valid prescription are subject to criminal charges. Stimulant medications are also associated with common side effects (e.g., insomnia) as well as more serious but less common side effects (e.g., arrhythmias). Despite the potential health and legal consequences, misuse of prescription stimulants has become a public health crisis on college campuses in the United States. Neurocognitive enhancement is the primary reason that college students report misusing prescription stimulants, despite no enhancement of cognitive functioning when taken by healthy adults. Nursing students may be at risk for misuse because of their high levels of academic and clinical demands and because many start misusing in nursing school. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the databases PubMed, Science Direct, EBSCOhost, and Academic OneFile were systematically searched to investigate the (a) percentage of prescription stimulant misuse studies that have included nursing students, (b) prevalence of prescription stimulant misuse among nursing students, (c) motivations for prescription stimulant misuse among nursing students, and (d) demographic factors associated with increased use among nursing students. Results revealed that of the 197 studies conducted within the past decade (2010-2021), only 1.02% (two) included nursing students. Future studies must investigate the prevalence and nature of prescription stimulant misuse among nursing students.

Anger, agency, risk and action: a neurobehavioral model with proof-of-concept in healthy young adults

Introduction

Anger can engender action by individuals and groups. It is thus important to understand anger's behavioral phenotypes and their underlying neural substrates. Here, we introduce a construct we term agentic anger, a negatively valenced internal state that motivates action to achieve risky goals. We evaluate our neurobehavioral model via testable hypotheses in two proof-of-concept studies.

Study 1 Methods

Study 1 used the Incentive Balloon Analogue Risk Task in a within-subjects, repeated measures design in 39 healthy volunteers to evaluate: (a) impact of blockade of reward on agentic anger, assessed by self-reports of negative activation (NA), (b) impact of achievement of reward on exuberance, assessed by self-reports of positive activation (PA), (c) the interrelationship of these valenced states, and (d) their relationship with personality.

Study 1 Results

Task-induced NA was positively correlated with task-induced PA, risk-taking on the task and trait Social Potency (SP), a measure of trait agency and reward sensitivity on the Multidimensional Personality Questionnaire Brief-Form.

Study 2 Methods

Study 2 assessed functional MRI response to stakes for risk-taking in healthy volunteers receiving 20 mg d-amphetamine in a double-blinded, placebo-controlled crossover design (N = 10 males), providing preliminary information on ventral striatal response to risky rewards during catecholamine activation.

Study 2 Results

Trait SP and task-induced PA were strongly positively related to catecholamine-facilitated BOLD response in the right nucleus accumbens, a brain region where DA prediction error signal shapes action value and selection. Participants' task-induced NA was strongly positively related with trait SP and task-induced PA, replicating the findings of Study 1.

Discussion

Together these results inform the phenomenology and neurobiology of agentic anger, which recruits incentive motivational circuitry and motivates personal action in response to goals that entail risk (defined as exposure to uncertainty, obstacles, potential harm, loss and/or financial, emotional, bodily, or moral peril). Neural mechanisms of agency, anger, exuberance, and risk-taking are discussed, with implications for personal and group action, decision-making, social justice, and behavior change.

Prescription Stimulants in College and Medical Students: A Narrative Review of Misuse, Cognitive Impact, and Adverse Effects

Stimulants are effective in treating attention-deficit/hyperactivity disorder (ADHD). Psychiatrist Charles Bradley first made this discovery in 1937 when he found that children treated with amphetamines showed improvements in school performance and behavior. Between 1995 and 2008, stimulants to treat ADHD increased six-fold among American adults and adolescents at an annual rate of 6.5%. Stimulants without a prescription, known as nonmedical use or misuse, have also increased. The highest rates of nonmedical prescription drug misuse in the United States are seen most notably in young adults between 18 and 25 years, based on data from the Substance Abuse and Mental Health Services Administration in 2021. Aside from undergraduate students, nonmedical prescription stimulant use is prevalent among medical students worldwide. A recent literature review reported the utilization of stimulants without a prescription in 970 out of 11,029 medical students. The percentages of medical students across the country misusing stimulants varied from 5.2% to 47.4%. Academic enhancement, reported in 50% to 89% of college students with stimulant misuse, is the most common reason for nonmedical stimulant use. With the increasing use of stimulants among adolescents and adults, it is unclear what long-term outcomes will be since little data are available that describe differences in how side effects are experienced for prescribed and non-prescribed users. The present narrative review focuses on these adverse effects in this population and the reasonings behind misuse and nonmedical use.

Effort–Reward Imbalance at Work and Prescription Drug Misuse—Prospective Evidence from Germany

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.

Human behavioral pharmacology of stimulant drugs: An update and narrative review

Stimulant use disorders present an enduring public health concern. Chronic stimulant use is associated with a range of health problems, with notable increases in stimulant overdose that disproportionately affect marginalized populations. With these persistent problems, it is important to understand the behavioral and pharmacological factors that contribute to stimulant use in humans. The purpose of this chapter is to provide an update and narrative review on recent human laboratory research that has evaluated the behavioral pharmacology of stimulant drugs. We focus on two prototypic stimulants: cocaine as a prototype monoamine reuptake inhibitor and d-amphetamine as a prototype monoamine releaser. As such, placebo controlled human laboratory studies that involved administration of doses of cocaine or d-amphetamine and were published in peer reviewed journals within the last 10 years (i.e., since 2011) are reviewed. Primary outcomes from these studies are subjective effects, reinforcing effects, cognitive/behavioral effects, and discriminative stimulus effects. Both cocaine and d-amphetamine produce classical stimulant-like behavioral effects (e.g., increase positive subjective effects, function as reinforcers), but there are notable gaps in the literature including understanding sex differences in response to stimulant drugs, cognitive-behavioral effects of stimulants, and influence of use history (e.g., relatively drug naïve vs drug experienced) on stimulant effects.

Outcomes and Predictors of Stimulant Misuse in College Students with and Without ADHD

In recent years, rates of prescription stimulant misuse have increased among young adults ages 18 to 25 along with increases in dispensing rates of these medications. Preliminary studies suggest that college students with Attention-Deficit Hyperactivity Disorder (ADHD) may be more likely to misuse their stimulant medication than their non-ADHD peers. Research is needed to further explore possible rates, correlates, and outcomes of prescription stimulant misuse among college students with and without ADHD. Data regarding study strategies, psychological functioning, stimulant misuse, and GPA were collected from students from universities within the US (N = 144), showing significantly higher rates of misuse among college students with ADHD. With depression and anxiety entered into the predictive model, inattentive symptoms were the only significant predictor of misuse in the full sample. The present findings have implications for academic interventions aimed at supporting the success of college students with and without ADHD and inform academic outcomes of prescription stimulant misuse.

Feigning Symptoms to Obtain Prescription Stimulants: A Vignette-Based Study on Its Conditions

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.

The Ethics of Motivational Neuro-Doping in Sport: Praiseworthiness and Prizeworthiness

Motivational enhancement in sport – a form of ‘neuro-doping’ – can help athletes attain greater achievements in sport. A key question is whether or not that athlete deserves that achievement. We distinguish three concepts – praiseworthiness (whether the athlete deserves praise), prizeworthiness (whether the athlete deserves the prize), and admiration (pure admiration at the performance) – which are closely related. However, in sport, they can come apart. The most praiseworthy athlete may not be the most prizeworthy, and so on. Using a model of praiseworthiness as costly commitment to a valuable end, and situating prizeworthiness within the boundaries of the sport, we argue that motivational enhancement in some cases can be compatible with desert.

Unhealthy parenting strategies: Situational (Dis-)Incentives, Machiavellian personality, and their interaction on misuse of ADHD medication for healthy children

Some parents engage in the potentially unhealthy and morally debateable parenting practice of giving prescription stimulant drugs to healthy children to boost their school and extracurricular performance. However, the parents' underlying reasoning remains unexamined. This web-based study (N_Respondents = 1360) simultaneously investigates eight experimentally-varied situational (dis-)incentives (e.g., financial gains and drug properties) within a factorial vignette survey (N_Vignettes = 256), Machiavellianism as a measured socially relevant personality trait, and possible interaction effects. Results show that approximately 40% of the described situations (N_Evaluations = 5440) provoked some willingness to medicate healthy children. Multilevel mixed-effect models revealed that this willingness was higher, for example, with increasing financial gains and weaker side effects. Machiavellians disclosed a higher willingness. They were more responsive to financial gains and threats (e.g., probable side effects). Respondents' sex, age, ethnicity, and experience with prescription drugs also had effects. Prevention measures might emphasize the dangers and limited potential of prescription drugs for healthy children.

The Relationships between Personal Values, Justifications, and Academic Cheating for Business vs. Non-Business Students

In this study we examine college cheating behaviors of business students compared to non-business students, and investigate possible antecedents to cheating in an effort to better understand why and when students cheat. We specifically examine power values; we found that they were positively related to academic cheating in our sample, and that choice of major (business or non-business) partially mediated the relationship between power values and cheating. We also considered the extent to which students provide justifications for their cheating, and found that business students were more likely to justify (rationalize) their cheating behaviors. Finally, we update the literature in terms of the ways students cheat. We assess newer forms of academic cheating, as increased accessibility to information via the Internet and smartphones may have changed the ways and ease with which students cheat – a particularly relevant topic currently, as many classes have moved online during the COVID-19 pandemic. In our study, cheating was especially prevalent when taking quizzes or tests or completing homework online. We found that only 10% of participants reported never engaging in any of the cheating behaviors we examined.

Unique considerations in the assessment of ADHD in college students

Evidence-based practice in psychology (EBPP) has long focused on treatment, but evidence-based psychological assessment (EBPA) is also crucial given the important role of accurate and reliable diagnostic practices in treatment planning. In terms of the diagnosis of attention-deficit/hyperactivity disorder (ADHD), EBPA practices are well-established for children, and more recently for adults, but for college students in particular there are special considerations that warrant attention. College students with symptoms of ADHD have some challenges that are unique, and thus the assessment and diagnosis of ADHD in these students is unique. The aim of this review is not to cover all EBPA strategies for diagnosing ADHD in emerging adult college students; rather, we will focus on the unique considerations at play in college ADHD assessment. These include (a) conceptual matters such as the appropriateness of the DSM-5 criteria for college students, the limitations of our understanding of ADHD this population because of a lack of diversity in research studies, and the issue of late-identified ADHD; and (b) practical matters, such as specific documentation needs, how to gather and interpret self- and other-report of symptoms, how to assess impairment, and alternate explanations for ADHD-like symptoms in college students.

Neuroenhancement: State of the Art and Future Perspectives

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.

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.

Stimulant Usage by Medical Students for Cognitive Enhancement: A Systematic Review

Stimulants have been used throughout human history for a variety of reasons. High levels of stress and the demanding nature of medical school make their usage among medical students particularly common. The most prevalent stimulant used by students is coffee, followed by tea and other forms of caffeine like sugary energy drinks. In addition, amphetamine-based medications for treating attention deficit hyperactivity disorder (ADHD) have been increasing in popularity, which many students take illicitly. Students report taking various forms of stimulants to promote cognitive enhancement, prolong wakefulness and retain focus for long periods of time. Moderate doses of caffeine and amphetamines would lead to enhanced alertness and concentration. However, large increases in dosage or frequency would lead to an increased risk of toxicity and adverse effects. The positive outcomes from stimulant consumption are often overshadowed by the negative side effects and incorrect dosage. Thus, it appears that usage of stimulants should be limited, in favor of a more sustainable approach to cognitive enhancement. This review analyzes the use of stimulants among the medical student community, consequences of misuse and discussed the healthy and organic approaches to lessen the stress and improve academic performance. This article also discusses the mechanisms of action, acceptable doses, additives, ingredients of stimulants commonly used by medical students for cognitive enhancement and the implications of long-term use as the stress of practicing medicine extends well beyond the medical school years.

Cognitive Enhancement: Unanswered Questions About Human Psychology and Social Behavior

Stimulant drugs, transcranial magnetic stimulation, brain-computer interfaces, and even genetic modifications are all discussed as forms of potential cognitive enhancement. Cognitive enhancement can be conceived as a benefit-seeking strategy used by healthy individuals to enhance cognitive abilities such as learning, memory, attention, or vigilance. This phenomenon is hotly debated in the public, professional, and scientific literature. Many of the statements favoring cognitive enhancement (e.g., related to greater productivity and autonomy) or opposing it (e.g., related to health-risks and social expectations) rely on claims about human welfare and human flourishing. But with real-world evidence from the social and psychological sciences often missing to support (or invalidate) these claims, the debate about cognitive enhancement is stalled. In this paper, we describe a set of crucial debated questions about psychological and social aspects of cognitive enhancement (e.g., intrinsic motivation, well-being) and explain why they are of fundamental importance to address in the cognitive enhancement debate and in future research. We propose studies targeting social and psychological outcomes associated with cognitive enhancers (e.g., stigmatization, burnout, mental well-being, work motivation). We also voice a call for scientific evidence, inclusive of but not limited to biological health outcomes, to thoroughly assess the impact of enhancement. This evidence is needed to engage in empirically informed policymaking, as well as to promote the mental and physical health of users and non-users of enhancement.

Why Parents Misuse Prescription Drugs to Enhance the Cognitive Performance of Healthy Children: The Influence of Peers and Social Media

The mechanisms affecting parents’ misuse of prescription stimulant drugs to boost healthy children’s school performance are hardly unknown. Using four web-based factorial vignette surveys (2×2 between-subjects design experiment), we investigated the willingness of U.S. parents with school-aged children to medicate a fictitious 13-year-old child whose grades had declined. We examined mechanisms of informational and normative social influence on their decision-making: others’ behavior ( NExperiment 1 = 359), others’ definitions ( NExperiment 2 = 326), social control ( NExperiment 3 = 325), and others’ experience ( NExperiment 4 = 313). In addition, we explored the moderating role of influential sources (close friends vs. social media). Parents were more willing to engage in said behavior when others reported engagement in this behavior or positive drug experiences, especially if both influences were transmitted via social media. Others’ definitions and social control had no effect. Thus, social media might be a channel for the prevention of pharmacological cognitive enhancement.

How effective are pharmaceuticals for cognitive enhancement in healthy adults? A series of meta-analyses of cognitive performance during acute administration of modafinil, methylphenidate and D-amphetamine

Modafinil, methyphenidate (MPH) and d-amphetamine (d-amph) are putative cognitive enhancers. However, efficacy of cognitive enhancement has yet to be fully established. We examined cognitive performance in healthy non-sleep-deprived adults following modafinil, MPH, or d-amph vs placebo in 3 meta-analyses, using subgroup analysis by cognitive domain; executive functions (updating, switching, inhibitory control, access to semantic/long term memory), spatial working memory, recall, selective attention, and sustained attention. We adhered to PRISMA. We identified k = 47 studies for analysis; k = 14 studies (64 effect sizes) for modafinil, k = 24 studies (47 effect sizes) for Methylphenidate, and k = 10 (27 effect sizes) for d-amph. There was an overall effect of modafinil (SMD=0.12, p=.01). Modafinil improved memory updating (SMD=0.28, p=.03). There was an overall effect of MPH (SMD=0.21, p=.0004) driven by improvements in recall (SMD=0.43, p=.0002), sustained attention (SMD=0.42, p=.0004), and inhibitory control (SMD=0.27, p=.03). There were no effects for d-amph. MPH and modafinil show enhancing effects in specific sub-domains of cognition. However, data with these stimulants is far from positive if we consider that effects are small, in experiments that do not accurately reflect their actual use in the wider population. There is a user perception that these drugs are effective cognitive enhancers, but this is not supported by the evidence so far.

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

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