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Working smart: the use of ‘cognitive enhancers’ by UK university students

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Abstract

Cognitive enhancers include a wide range of substances including prescription medication for attentional deficient disorders and pharmacological substances for cognitive augmentation. Students have recently been identified as the largest cohort of users. Most research on student use of cognitive enhancers has been undertaken in the United States. This study utilised a mixed methods sequential explanatory approach to investigate cognitive enhancer use among UK university students specifically to aid study. A bespoke online survey was distributed throughout the UK. The findings informed the development of a qualitative interview study comprising 15 participants. In total, 506 responses to the online survey were received from 54 UK institutions. Forty-six per cent of respondents reported using recreational drugs and 19% reported having used cognitive enhancers. Males were two and a half times more likely to use cognitive enhancers than females. Participants reported various motives for using cognitive enhancers, the most frequent being to meet the demands of coursework, to improve focus or maintain wakefulness. The qualitative findings revealed that cognitive enhancers are widely accessible and are used to enhance performance in terms of motivation, concentration and meeting academic deadlines. The findings of this study will be of interest to a wide range of services within Universities across the UK.

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... Studies among university students in Western Europe obtained results in a similar range. For example, lifetime prevalences for PN of 7.8% among Swiss (N = 6275) 13 , 3.2% among Norwegian (N = 9370) 14 , and 19.2% among British students (N = 506) 15 were reported. The same tendencies appear among German university students, as 12-month prevalence estimates between 11.9 16 and 20% 17 , assessed by indirect survey techniques, were reported. ...
... To conclude, empirical studies addressing PN among university students are heterogeneous regarding their methodology and results [13][14][15][16][17]40,41 . Moreover, there is a considerable lack of knowledge regarding potential factors that might predict PN and regarding the identification of potential study-related risk groups. ...
... Referring to the first research question, namely to assess the prevalence of PN among university students, the overall 12-month prevalence for PN was 10.4%. This prevalence is approximately in the middle of the reported prevalences for university students from western European countries [13][14][15][16][17]40 . As stated above, these differences among reported prevalences may be caused by various methodological aspects (e.g. ...
Article
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Aiming to develop and implement intervention strategies targeting pharmacological neuroenhancement (PN) among university students more specifically, we (1) assessed the prevalence of PN among German university students, (2) identified potential sociodemographic and study-related risk groups, and (3) investigated sociodemographic, psychological, study-related psychosocial, general psychosocial and health behavior related factors predicting the 12-month prevalence of PN. Therefore, a cross-sectional online survey was administered to students of the University of Mainz, Germany. A binary logistic regression with stepwise inclusion of the five variable groups was performed to predict PN. A total number of 4351 students out of 31,213 registered students (13.9%) participated in the survey, of which N = 3984 answered the question concerning PN. Of these, 10.4% had used one substance for PN at least once in the past 12 months. The regression analysis revealed 13 variables that were significantly related to the 12-month prevalence of PN. Specifically, the group of health behavior related variables showed the strongest relationship with PN. Therefore, an approach to the prevention of PN should be multifactorial so that it addresses social conditions, as well as education on substance use and healthy behaviors in terms of non-pharmacological strategies as alternatives of PN. The term "pharmacological neuroenhancement" (PN), also called "pharmacological cognitive enhancement", is generally defined as the use of illicit or prescription drugs by healthy individuals for cognitive-enhancing purposes 1-3 , such as enhancing alertness, attention, concentration, memory, and also mood 4,5. According to this definition, the so called soft neuroenhancers (e.g. energy drinks, caffeine tablets, ginkgo biloba) are not included. There are many inconsistencies and differences in the definition 6,7 , but a full discussion of these would go beyond the scope of this research.
... The use of cognitive enhancers among university students in the United Arab Emirates students from both the UK [36] and Iran [37]. This level of CE use seems to be at odds with previous suggestions [11] that students are resistant to using CEs. ...
... In line with previous findings [36,43] peer influence and the web were here reported as facilitating the students' uptake of CEs. Most users, but especially so males (e.g., 70% vs 40%) accessed their CEs from online sources, with the web having been previously described as the focus of drug acquisition activities [51][52][53]. ...
... In particular, B6 was more popular in females than in males (e.g., 22.5% vs 5.5%), whilst modafinil was more significantly reported in males (e.g., 48.4% vs 7.5%). In line with a recent study conducted in the UK [36], the intake of remaining CEs was not significantly different between the two groups. ...
Article
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Background: Cognitive enhancers (CE) are often used to improve memory, alertness and cognitive capacity. These products are commercially and pharmaceutically available. Due to high academic pressure, university students are at risk of CE misuse. However, data regarding this issue are limited, especially in the United Arab Emirates (UAE). Aims: To assess the prevalence of CE intake; evaluate students' knowledge of these substances; and identify student characteristics associated with CE usage. Method: A cross sectional study based on a validated online survey that was distributed using university-licensed software (Qualtrics) as a direct web link via email and social media to all Medical, Pharmacy, Dentistry, Nursing and Engineering students enrolled in six UAE universities. Associations between student characteristics and CE use were investigated using the chi-squared test and multiple logistic regression. Reasons for CE use, temporal patterns of use, details regarding purchase and types of CE used were compared by gender. Results: One quarter of students had used CEs. There was a clear difference between users and non-users in terms of gender (p<0.001). CE users were disproportionately represented by students from either UAE or other Arab countries (p<0.001), and by students of Medicine, followed by Pharmacy, Dentistry, and Engineering (p<0.001). CE use increased with year of study, reaching the highest level in the fourth year (p<0.001), which for most programmes is the final year. Modafinil was self-administered, especially in males, for concentration and alertness; B12 was typically taken by female students for academic performance and concentration; and high-dosage caffeine compounds were ingested to improve alertness levels. Use of the internet for both obtaining information and purchasing CEs was frequently reported. Multiple logistic regression analysis showed that gender, nationality, and year of study were associated with CE use among UAE university students. Conclusions: Universities need to address the prevalence of CE use amongst their students by providing effective support programs.
... A very well examined group with an increased risk for PN is the collective of university students. For example, a large study comparing the non-medical use of prescription stimulants between US college students and respondents of the same age not enrolled in college (N = 15,454), showed that college students used prescription stimulants more often (OR 1.28, 95% CI 1.05, 1.56) compared to non-students of the same age group 11 . Moreover, within a comprehensive review and meta-analysis, Benson et al. 12 reported 12-month prevalences for the use of prescription stimulants between 5% and 35% among college students in the US, demonstrating large heterogeneity in the range of these prevalence rates. ...
... Studies among university students in Western Europe obtained results in a similar range. For example, lifetime prevalences for PN of 7.8% among 6,275 Swiss students 13 , 3.2% among Norwegian students 14 , and 19.2% in a sample of students from the United Kingdom 15 were reported. The same tendencies appear among German university students, as lifetime prevalences of 4.6% 16 , and 12-month prevalence estimates between 11.9% 17 and 20% 18 were reported. ...
... To conclude, empirical studies addressing PN among university students are heterogenous regarding their methodology and results [13][14][15][16][17][18]41 . Moreover, there is a considerable lack of knowledge with regard to potential factors that might predict PN as well as to the identi cation of potential study-related risk groups. ...
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Aiming to develop and implement intervention strategies targeting pharmacological neuroenhancement (PN) among university students more specifically, we i) assessed the prevalence of PN among German university students, ii) identified potential sociodemographic and study-related risk groups, and iii), investigated sociodemographic, psychological, study-related psychosocial, general psychosocial and health behavior related factors predicting the 12-month prevalence of PN. Therefore, a cross-sectional online survey was administered to all students of the University of Mainz, Germany. A binary logistic regression with stepwise inclusion of the five variable groups was performed to predict PN. A total of N = 4,351 students participated in the survey of which N = 3,984 answered the question with regard to PN. Of these, 10.4% had used one substance for PN at least once in the past 12 months. The regression revealed 13 variables that were significantly related to the 12-month prevalence of PN. Specifically, the group of health behavior variables had the strongest influence on the explained variance of PN. Therefore, an approach to the prevention of PN should be multifactorial so that it addresses social conditions, as well as education on substance use and healthy behaviors in terms of non-pharmacological strategies as alternatives of PN.
... Inclusion criteria were quantitative (surveys) and qualitative (interviews) studies having been carried out among healthy students aged 18 years and older in HEIs. Articles were included if they related to a range of nine CEs (prescription CEs including amphetamine salt mixtures, methylphenidate, modafinil and piracetam; and non-prescription CEs including caffeine, cobalamin (vitamin B12), guarana, pyridoxine (vitamin B6) and vinpocetine), which were selected here because of their popularity among university students [4,7,22,26,30]. Studies written in English, from the year 2000 (i.e., from around the time when NPS started to emerge in drug scenarios) to 2020 were included in the study search. Regional/world drug reports (e.g., from the European Monitoring Centre for Drugs and Drug Addiction/EMCDDA and the United Nations Office for Drug and Crime/UNODC) were included here as well. ...
... Males were here identified as the most typical CE misusers [7,22,30,31,41,51,52,63,66,70,71,[73][74][75], with some studies reporting a male:female ratio of 3:1 [54]. In contrast with this, a Welsh study reported that female representation was slightly more than males [68]. ...
... Volkow and colleagues (2004) showed the effects of methylphenidate on motivation, which can affect academic performance whilst increasing cognitive ability and improving students' self-rated interest in a relatively dull mathematical task. A study reported that methylphenidate has one of the highest prescriptions rates, associated with an abundance of websites offering to sell and supply the drug without a prescription to UK users [30]. University students might be attracted to methylphenidate because of its alleged increase in attention and focusing levels [101]. ...
Article
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Introduction: Cognitive enhancers (CEs), also known as "smart drugs", "study aids" or "nootropics" are a cause of concern. Recent research studies investigated the use of CEs being taken as study aids by university students. This manuscript provides an overview of popular CEs, focusing on a range of drugs/substances (e.g., prescription CEs including amphetamine salt mixtures, methylphenidate, modafinil and piracetam; and non-prescription CEs including caffeine, cobalamin (vitamin B12), guarana, pyridoxine (vitamin B6) and vinpocetine) that have emerged as being misused. The diverted non-prescription use of these molecules and the related potential for dependence and/or addiction is being reported. It has been demonstrated that healthy students (i.e., those without any diagnosed mental disorders) are increasingly using drugs such as methylphenidate, a mixture of dextroamphetamine/amphetamine, and modafinil, for the purpose of increasing their alertness, concentration or memory. Aim: To investigate the level of knowledge, perception and impact of the use of a range of CEs within Higher Education Institutions. Methodology: A systematic review was conducted in adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Whilst 1400 studies were identified within this study through a variety of electronic databases (e.g., 520 through PubMed, 490 through Science Direct and 390 through Scopus), 48 papers were deemed relevant and were included in this review. Results: The most popular molecules identified here included the stimulant CEs, e.g., methylphenidate, modafinil, amphetamine salt mixtures and caffeine-related compounds; stimulant CEs' intake was more prevalent among males than females; drugs were largely obtained from friends and family, as well as via the Internet. It is therefore suggested that CEs are increasingly being used among healthy individuals, mainly students without any diagnosed cognitive disorders, to increase their alertness, concentration, or memory, in the belief that these CEs will improve their performance during examinations or when studying. The impact of stimulant CEs may include tolerance, dependence and/or somatic (e.g., cardiovascular; neurological) complications. Discussion: The availability of CEs for non-medical indications in different countries is influenced by a range of factors including legal, social and ethical factors. Considering the risk factors and motivations that encourage university students to use CE drugs, it is essential to raise awareness about CE-related harms, counteract myths regarding "safe" CE use and address cognitive enhancement in an early stage during education as a preventative public health measure.
... Female respondents in the present study were less inclined to believe that taking CEs for cognitive enhancement is safe for students. Another study reported that males were two and a half times more likely to use CEs than females (McDermott et al., 2021). ...
... It was reported in a study that a high number of primary care physicians have been asked to prescribe CE medicines by their patients, however, only a small proportion was fully informed about the potential of CE use (Franke et al., 2014). Another study reported that several respondents perceived advantages from CEs, more than half were conversant with the potential side effects, and almost 40% experienced some negative consequences (McDermott et al., 2021). Some individuals experienced significant detrimental effects on their physiological and psychological well-being, clearly contradicting prior research indicating that CEs are safe drugs. ...
Article
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Cognitive enhancers (CEs) encompass a wide range of drugs, including prescription medications for attention deficit disorders and pharmacological compounds for cognitive enhancement. It is well-documented that the students are the leading cohort of CEs users. Exploring how healthcare professionals perceive the use of CEs for academic accomplishments is significant to understand their encouragement of CE use. Hence, the purpose of the current study was to look at healthcare professionals' attitudes and perceived understanding about the usage of CEs in academic contexts. The study was a quantitative cross-sectional research design conducted in different healthcare and academic settings of Karachi. The respondents were approached either through social media platforms or the official email addresses of their working organizations. Data were collected through a web link of an online questionnaire that included four sections; inquiring about the respondents' demographics characteristics, their knowledge about CEs, their attitudes towards the use and impact of CEs, and their inclination to use a hypothetical prescription-only CE. The response rate of the study was 73.3%. The majority of the respondents negated to permit university students to using CEs for cognitive boost (n = 360, 67.1%), to concentrate (n = 406, 75.7%), to increase vigilance (n = 394, 73.5%) or to mitigate the effects of other medicines (n = 312, 58.2%). The pharmacists were more likely to refute that using CEs by the students is safe (pharmacists 10.8% vs. physicians 8.3%, p
... ´Optimizing´ the need for sleep, or the ability to concentrate, one can not only do things better and more effectively, but also faster. Empirical studies have shown that, for example, the (mis)-use of Ritalin or methylphenidate as a neuro-or cognitive enhancing substance has increased (McDermott et al., 2021). Ritalin is an amphetamine drug type that is typically prescribed as therapy to individuals with ADHD. ...
Article
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Against the backdrop of emerging medical technologies that promise transgression of temporal limits, this paper aims to show the importance that an individual lifetime’s finitude and fugacity have for the question of the good life. The paper’s first section examines how the passing of an individual’s finite lifetime can be experienced negatively, and thus cause “suffering from the passing of time.” The second section is based on a sociological analysis within the conceptual framework of individualization and capitalism, which characterizes many modern individualized and consumerist societies and explains how the described problem of time’s passage is particularly relevant today. The paper then proceeds to show and discuss how individuals employ various, primarily medical, enhancement-technologies like social egg freezing, anti-aging-medicine and physical- and neuro-enhancement in an attempt to overcome time’s passing. Finally, the paper seeks to explain why such attempts fail and, moreover, why it is exactly the awareness of time’s passing that can constitute a prerequisite for a good life.
... e results of students' measurements are stored in the database and processed by the intelligent analysis system to form analysis reports and mental health levels, which are fed back to students and stored in the database. At the same time, by logging in to the psychological teacher management subsystem, psychological teachers can timely view the students' evaluation results, pay attention to the students with serious test results, and make corresponding decisions [21]. Because people's psychological problems are complex, relying on the traditional decision support system to analyze the psychological scale with fuzzy logic can only reflect one side of the problem. ...
Article
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Paying attention to the mental health education of college students, optimizing the psychological quality of college students, and improving their mental health level are inevitable requirements of higher education facing the world. In recent years, the mental health education of college students has always been a hot issue in the education circle, which has attracted much attention. It is the main research purpose of this paper to correctly understand the problems existing in college students’ mental health education and to find reasonable countermeasures and approaches to solve these problems. This paper collects and organizes the dimension facts twice, conducts descriptive analysis, unbiased pattern t-test, chi-square test, variance evaluation, and SNK-q check on the legitimate data, and analyzes the change and impact of the mental health level of students with negative psychological symptoms after 2 years. We use machine learning methods to model and analyze susceptibility factors. Among the psychological susceptibility factors, the UPI scores of students with negative psychological symptoms with different levels of self-esteem, psychological resilience, depressive cognition, positive coping style, negative coping style, different family functions, and ability to perceive social support have significant differences. The mental health level of college students with negative psychological symptoms decreased after 2 years. The self-esteem stage decreased, and the psychological elasticity stage decreased; the longer the cognitive stage of depression, the worse the coping style; the more serious the impairment of family function, the lower the possibility of social support, the more likely it is to lead to psychological problems. After preprocessing the original data, the features of various types of information of the intelligent model are extracted. The test and data analysis results show that the improved recognition accuracy based on the intelligent model is 82.5%, which is higher than the traditional model, which proves the effectiveness and feasibility of the scheme. Using item or dimension data, the model established by machine learning method based on susceptibility factors can effectively predict the changes of mental health of college students with negative psychological symptoms after 2 years, and can effectively identify college students with psychological problems after 2 years.
... Furthermore, a considerable number of studies demonstrated the use of PN in the collective of university students. For example, as lifetime prevalence for PN, 7.8, 3.2, and 19.2% was reported among Swiss (10), Norwegian (11), and British (12) students. Using an indirect survey technique, Dietz et al. (13,14) described estimates for the 12-month prevalence of PN between 12 and 20% among university students from Austria and Germany. ...
Article
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Background According to the literature, the conditions of studying and living as well as the psychological, social and health behavior-related variables, which were strongly related to pharmacological neuroenhancement (PN) before the pandemic, significantly changed during the pandemic. For this reason, it is expected that the prevalence of PN among university students is higher during the pandemic compared to before the pandemic. Therefore, the present study aimed to investigate and compare the prevalence of PN among university students before and during the COVID-19-pandemic. Methods Three online surveys assessing the 12-month prevalence of PN were conducted among university students at the University of Mainz, Germany. The first survey took place in summer term 2019 (before the pandemic), the second in summer term 2020 (during the first German lockdown), and the third in summer term 2021 (after the second German lockdown). Pearson's chi-square test was used to test whether the 12-month prevalence of PN differed significantly between the three surveys. Results The 12-month prevalence of PN was 10.4% in 2019, 11.3% in 2020, and 8.0% in 2021. Chi-square tests revealed no statistical difference in the prevalence of PN between 2019 and 2020. Overall, the use of PN was lower in 2021 compared to 2019 ( p < 0.0001) as well as in comparison to 2020 ( p = 0.001). Only the use of cannabis slightly increased from 2019 to 2020 (7.1 vs. 8.3%) and decreased in 2021 (5.4%). At all three time points, cannabis was the most commonly used substance for the purpose of PN. Consequently, the results suggest that the prevalence of PN was highly intertwined with the prevalence of cannabis use for PN. Discussion The decrease in the prevalence of PN of around three percentage points in 2021 compared to the previous years was a surprising finding. It may be mainly due to the decrease in the prevalence of cannabis for the purpose of PN. However, the fairly high prevalence of PN of around 8% in 2021 is still an important finding that demonstrates that there is still an urgent need for prevention initiatives among university students to combat the use of PN.
... Between 2018 and 2019, Crime Survey for England and Wales (Home Office, 2019) reported that 6.2% of young people had used powder cocaine and 4.7% had used ecstasy/MDMA in the last year. These figures appear to increase substantially for university students with McDermott et al. (2020) [n= 506] reporting that 23.% of students in their survey had used powder cocaine and 25.5% had used ecstasy/MDMA in the last year. ...
Article
Purpose Research suggests that student drug use is substantially higher than that of the general population and while the UK Government’s current Drug Strategy emphasises the importance of PSHE in preventing young people from becoming drug users, there is a lack of research investigating the longer-term effectiveness of drug prevention education, and students’ views using qualitative methods. The purpose of this paper is to gain a holistic understanding into university students’ lived experiences of recreational class A drug taking and the drug education taught in English secondary schools. Design/methodology/approach Five interviews with university students were undertaken and thematically analysed using an ideographic case study approach alongside a qualitative content analysis of publicly available drug education resources and policy documents. Findings The normalisation of drug taking at university and social micro-pressures to assimilate group norms were key contributing factors to participants’ drug use. While the content of drug education in PSHE is grounded in theory, its implementation is not. Originality/value This study extends upon existing theories of normalisation of drug use at university through the concept of micro-pressures to offer an explanation of the process by which students assimilate group norms through the implicit threat of not fitting in.
... 16 Medicines may also be taken to improve performance, such as cognitive enhancers in academia. 17 Sometimes the psychoactive effect of OTC and POMs may only become apparent when taken via an alternative route, such as Buscopan (hyoscine N-butyl bromide), which when smoked produces hallucinations, and the antitussive dextromethorphan and loperamide (for diarrhoea) when used at significantly high doses, can have euphoric effects. [18][19][20] When being misused, formulations such as buprenorphine tablets may be crushed and administered by injection, 21 and fentanyl may be extracted from transdermal patches and administered by all routes of administration. ...
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Introduction There is a growing concern about the misuse of over the counter (OTC) and prescription only medication (POM) because of the impact on physical and mental health, drug interactions, overdoses and drug-related deaths. These medicines include opioid analgesics, anxiolytics such as pregabalin and diazepam and antidepressants. This protocol outlines how a systematic review will be undertaken (during June 2021), which aims to examine the literature on the pattern of OTC and POM misuse among adults who are accessing substance misuse treatment services. It will include the types of medication being taken, prevalence and demographic characteristics of people who access treatment services. Methods and analysis An electronic search will be conducted on the Cochrane, OVID Medline, Pubmed, Scopus and Web of Science databases as well as grey literature. Two independent reviewers will conduct the initial title and abstract screenings, using predetermined criteria for inclusion and exclusion. If selected for inclusion, full-text data extraction will be conducted using a pilot-tested data extraction form. A third reviewer will resolve disagreements if consensus cannot be reached. Quality and risk of bias assessment will be conducted for all included studies. A qualitative synthesis and summary of the data will be provided. If possible, a meta-analysis with heterogeneity calculation will be conducted; otherwise, Synthesis Without Meta-analysis will be undertaken for quantitative data. The reporting of this protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Ethics and dissemination Ethical approval is not required. Findings will be peer reviewed, published and shared verbally, electronically and in print, with interested clinicians and policymakers. PROSPERO registration number CRD42020135216.
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Objective The association between illicit substance use by third-level education students and their mental and physical health is well documented. The aim of this scoping review was to determine factors that contribute to student motivations to reduce or stop their use of illicit substances, and to elaborate on factors that may be pertinent for student-focused behaviour change interventions for substance use. Method We searched eight databases in March 2021 using search terms based on ‘students’, ‘illicit substance use’, and ‘motivations’. We identified 86 research articles that reported on third-level education students’ illicit substance use and included reasons or motives for their use. Results After full-text screening, three studies were eligible for inclusion in the qualitative synthesis. The majority of studies described motives for abstention but did not describe motivation for reducing or stopping current patterns of use of illicit substances. Conclusion Few studies have examined motivations of third-level education students to decrease or cease substance use. Promising avenues for research on motivations to change substance use behaviour include the social contextual factors, perceived effects on social relationships, and actions of friends and family to prompt contemplations of change.
Qualitative work with students who use prescription medicines for academic purposes is limited. Thus, a more nuanced understanding of tertiary students’ experiences is urgently needed. Our study – which draws on five semi-structured interviews with New Zealand university students, complemented with information from local newspapers, blog entries and discussion forums – reveals students’ motivations and perceived effects, their risk perceptions and provides insights into the circumstances enabling the engagement with prescription medicines for academic purposes. Students were influenced by peers and social norms; and ideas about identity, morality and fairness also played a role for engaging with cognitive enhancers. Students used high levels of stress and workload to justify their use but took individual responsibility for their practices. By taking responsibility in this way, rather than considering it as a product of their environment, they buy into the neoliberal university discourse. Unexpectedly, some participants were already receiving medically justified psychopharmacological treatment but extended and supplemented this with nonmedical use. Others considered their use as being for academic emergencies, and that their low level of use helped manage risks. Overall, students viewed pharmacological cognitive enhancement for improving academic performance as cautious, safe, and morally acceptable. We argue in this paper that a local understanding of students’ motivations, justifications and perceptions of pharmacological cognitive enhancement is required, to tailor policies and support systems better to their needs and behaviours.
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Introduction: Smart drugs are among the most common drugs used by students. It is estimated that they are second in incidence after cannabis. Although they are usually used for diseases such as attention deficit hyperactivity disorder (ADHD) and dementia, in most cases the use of smart drugs is illegal and without a prescription. Methodological issues: A systematic review was conducted according to PRISMA guidelines. SCOPUS, Medline (using PubMed as a search engine), Embase, Web of Sciences, and Google Scholar were used as search engines from January 1, 1980 to June 1, 2021 to evaluate the association between smart drugs and neuro-enhancement. A total of 4715 articles were collected. Of these, 295 duplicates were removed. A total of 4380 articles did not meet the inclusion criteria. In conclusion, 48 articles were included in the present systematic review. Results: Most of the studies were survey studies, 1 was a prospective longitudinal study, 1 was a cross-over study, and 1 was an experimental study in an animal model (rats). The largest group of consumers was school or university students. The most frequent reasons for using smart drugs were: better concentration, neuro enhancement, stress reduction, time optimization, increased wake time, increased free time, and curiosity. There are conflicting opinions, in fact, regarding their actual functioning and benefit, it is not known whether the benefits reported by consumers are due to the drugs, the placebo effect or a combination of these. The real prevalence is underestimated: it is important that the scientific community focus on this issue with further studies on animal models to validate their efficacy.
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Cognitive enhancement (CE) agents are those purported to improve or augment aspects of cognition such as working memory, creativity, and executive function in healthy individuals. CE by university students looking to improve their academic performance, particularly through the use of pharmacological agents (or nootropics), has become an area of increasing interest for researchers. However, studies on the prevalence of, and motivations behind, students’ CE use at Australian universities are limited. This study aimed to contribute a new sample of prevalence data, as well as corroborate previous qualitative research that has suggested that emotion-focused and avoidant coping styles may make students more susceptible to utilizing CE drugs. A sample of N=633 individuals was recruited to complete the “Cognitive Enhancement and Student Lifestyle Survey” online. The key questions of interest concerned students’ enhancement drug usage habits, usage motivations, and coping styles. Analyses found that 6.32% of students indicated lifetime use of prescription CE agents for the purposes of study-related enhancement. Furthermore, dysfunctional coping strategies were associated with an increased likelihood of both lifestyle and prescription CE drug use. Findings from this study refine current understandings of enhancement drug use in Australia and are contextualized in regard to potential avenues for on-campus health interventions and regulatory opportunities. In particular, helping students to maintain manageable stress levels through identifying less harmful coping strategies may prove useful.
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Pharmacological cognitive enhancement, using chemicals to change cellular processes in the brain in order to enhance one's cognitive capacities, is an often discussed phenomenon. The prevalence among Dutch university students is unknown. The study set out to achieve the following goals: (1) give an overview of different methods in order to assess the prevalence of use of prescription, illicit and lifestyle drugs for cognitive enhancement (2) investigate whether polydrug use and stress have a relationship with cognitive enhancement substance use (3) assessing opinions about cognitive enhancement prescription drug use. A nationwide survey was conducted among 1572 student respondents of all government supported Dutch universities. The most detailed level of analysis-use of specific substances without a prescription and with the intention of cognitive enhancement-shows that prescription drugs, illicit drugs and lifestyle drugs are respectively used by 1.7, 1.3, and 45.6% of the sample. The use of prescription drugs and illicit drugs is low compared to other countries. We have found evidence of polydrug use in relation to cognitive enhancement. A relation between stress and the use of lifestyle drugs for cognitive enhancement was observed. We report the findings of several operationalizations of cognitive enhancement drug use to enable comparison with a wider variety of previous and upcoming research. RESULTS of this first study among university students in the Netherlands revealed a low prevalence of cognitive enhancement drug use compared to other countries. Multiple explanations, such as a difference in awareness of pharmacological cognitive enhancement among students, accessibility of drugs in the student population and inclusion criteria of enhancement substances are discussed. We urge enhancement researchers to take the different operationalizations and their effects on the prevalence numbers into account.
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Use of 'smart drugs' among UK students is described in frequent media reports as a rapidly increasing phenomenon. This article reports findings from the first large-scale survey of pharmacological cognitive enhancement (PCE) among students in the UK and Ireland. Conducted from February to September 2012, a survey of a convenience sample of 877 students measured PCE prevalence, attitudes, sources, purposes and ethics. Descriptive and logistic regression statistical methods were used to analyse the data. Lifetime prevalence of PCE using modafinil, methylphenidate or Adderall was under 10%, while past regular and current PCE users of these substances made up between 0.3%-4% of the survey population. A substantial majority of students was unaware of and/or uninterested in PCE; however about one third of students were interested in PCE. PCE users were more likely to be male, British and older students; predictors of PCE use included awareness of other students using PCEs, ADHD symptomatology, ethical concerns, and alcohol and cannabis use. The survey addresses the need for better evidence about PCE prevalence and practices among university students in the UK. We recommend PCE-related strategies for universities based on the survey findings.
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Background: Pharmaceutical neuroenhancer consumption in college students is a rather unknown phenomenon in Europe and particularly in France, where surprisingly only one study was conducted in 1988. Aim: Our objective is to assess prevalence and motivations for licit (use inside medical indication) and illicit pharmaceutical neuroenhancer consumption (tablet form) in a non-selected French sample of Medicine and Pharmacology students. Subjects and methods: A validated questionnaire was send to French sample of Medicine and Pharmacology students using email. The questionnaire investigate motives for use of pharmaceutical licit (vitamin C and caffeine tablets) and illicit (methylphenidate, amphetamines, modafinil, piracetam). Results: Among 206 undergraduate students, 139 students (67.4%) declared to have consumed at least one cognitive enhancer in the past 12 months. Twelve students (8.6% of cognitive enhancers users and 5.8% of our total sample) used illicit pharmaceutical neuroenhancer. The motivations were first to improve their academic performances, second to improve their wakefulness/ vigilance, and third to improve their attention/concentration. Conclusions: Neuroenhancement is a widespread means of using pharmaceutical drugs in French as well as in US college campuses. Despites some limitations, these preliminary results highlight the need to boost the interest of professionals for the neuroenhancement issue in French and European students.
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PERSPECTIVES is a special feature included in this issue of Journal of Creativity in Mental Health that provides mental health professionals with an opportunity to discuss their positions on a variety of creativity-related topics. In this article, Dr. Mohamed shares his view of the ethical and prudential issues that arise from impairing creativity with psychostimulants. Dr. Ahmed Dahir Mohamed is a chartered psychologist member of the British Psychological Society. His Ph.D., which was awarded in 2013 by the Department of Psychiatry at the University of Cambridge, was in the area of cognitive enhancement. Using modafinil as a pharmacological probe, his work explored how drugs like modafinil, Adderall, and methylphenidate (Ritalin) affect cognitive and affective functions in healthy individuals with no psychiatric disorders. His work has been published in highly regarded academic journals including the International Journal of Neuropsychopharmacology, The American Journal of Bioethics: Neuroscience, The Journal of Ethics in Mental Health, and The British Journal of Counselling and Psychotherapy. Dr. Mohamed was the previous winner of the Nuffield Science Bursary Award for outstanding research in psychology and the Wellcome Trust Doctoral Neuroscience studentship award. In 2013, Dr. Mohamed became an Elected Life Academic Member of Clare Hall at the University of Cambridge. Dr. Mohamed is currently editing an Oxford University Press handbook entitled Rethinking Cognitive Enhancement: The Neuroscience and Ethics of Cognitive and Physical Enhancement. This article is based on an invited lecture given at the St. Cross Ethics Seminars at Oxford. Dr Mohamed was a visiting academic scholar at St. Cross College and a recognized DPhil student at the Oxford Centre for Neuroethics at the University of Oxford.
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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. To describe the prevalence of the use of prescription medications and drugs of abuse for neuroenhancement among Swiss university students. 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. 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. 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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There is currently little empirical information about attitudes towards cognitive enhancement - the use of pharmaceutical drugs to enhance normal brain functioning. It is claimed this behaviour most commonly occurs in students to aid studying. We undertook a qualitative assessment of attitudes towards cognitive enhancement by conducting 19 semi-structured interviews with Australian university students. Most students considered cognitive enhancement to be unacceptable, in part because they believed it to be unethical but there was a lack of consensus on whether it was similar or different to steroid use in sport. There was support for awareness campaigns and monitoring of cognitive enhancement use of pharmaceutical drugs. An understanding of student attitudes towards cognitive enhancement is important in formulating future policy.
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Should qualitative researchers be members of the population they are studying, or should they not? Although this issue has been explored within the context of qualitative research, it has generally been reserved for discussions of observation, field research, and ethnography. The authors expand that discussion and explore membership roles by illustrating the insider status of one author and the outsider status of the other when conducting research with specific parent groups. The strengths and challenges of conducting qualitative research from each membership status are examined. Rather than consider this issue from a dichotomous perspective, the authors explore the notion of the space between that allows researchers to occupy the position of both insider and outsider rather than insider or outsider.
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Ethnographic research on youth cultures, particularly at doctoral level, is often conducted by investigators with some degree of initial cultural proximity to the individuals or cultures under the microscope. Yet elaboration of the practical and epistemological implications of ‘insider research’ among such scholars has been somewhat limited. This article contributes to the development of such discussion through drawing together a range of previous writings and by drawing upon elements of the author's own experience of researching a contemporary youth subculture as a long-term participant of the grouping. In the face of theories emphasising the complexities of identity and the multiplicity of insider views, the paper argues for the continued use of the notion of insider research in a non-absolute sense. Subsequently, it is argued that researching youth cultures from such a position may offer significant potential advantages—in respect both of the research process and the types of understanding that might be generated. It is also suggested, however, that the realisation of such possible benefits and the avoidance of significant difficulties, requires a cautious and reflexive approach.
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Adderall is the most commonly abused prescription stimulant among college students. Social media provides a real-time avenue for monitoring public health, specifically for this population. This study explores discussion of Adderall on Twitter to identify variations in volume around college exam periods, differences across sets of colleges and universities, and commonly mentioned side effects and co-ingested substances. Public-facing Twitter status messages containing the term "Adderall" were monitored from November 2011 to May 2012. Tweets were examined for mention of side effects and other commonly abused substances. Tweets from likely students containing GPS data were identified with clusters of nearby colleges and universities for regional comparison. 213,633 tweets from 132,099 unique user accounts mentioned "Adderall." The number of Adderall tweets peaked during traditional college and university final exam periods. Rates of Adderall tweeters were highest among college and university clusters in the northeast and south regions of the United States. 27,473 (12.9%) mentioned an alternative motive (eg, study aid) in the same tweet. The most common substances mentioned with Adderall were alcohol (4.8%) and stimulants (4.7%), and the most common side effects were sleep deprivation (5.0%) and loss of appetite (2.6%). Twitter posts confirm the use of Adderall as a study aid among college students. Adderall discussions through social media such as Twitter may contribute to normative behavior regarding its abuse.
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Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology. In this paper, we argue that it offers an accessible and theoretically flexible approach to analysing qualitative data. We outline what thematic analysis is, locating it in relation to other qualitative analytic methods that search for themes or patterns, and in relation to different epistemological and ontological positions. We then provide clear guidelines to those wanting to start thematic analysis, or conduct it in a more deliberate and rigorous way, and consider potential pitfalls in conducting thematic analysis. Finally, we outline the disadvantages and advantages of thematic analysis. We conclude by advocating thematic analysis as a useful and flexible method for qualitative research in and beyond psychology.
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This online panel study (n(t)(1) = 5,882; n(t)(2) = 3,486 (randomly selected)) used multiple metrics to assess the prevalence of the nonmedical use of prescription medication for enhancing cognitive performance among German university students in 2010. Rare events logistic regression revealed that increased cognitive test anxiety increased the prevalence of medication use over various time windows. Negative binomial regression models showed that the higher the cognitive test anxiety, the higher the use frequencies were during the previous six months. The models controlled for expected side effects, risk attitudes, self-attributed competencies, prior medication use, sex, and age. We also discuss the study's implications.
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This study tested the hypothesis that college students' substance use problems would predict increases in skipping classes and declining academic performance, and that nonmedical use of prescription stimulants (NPS) for studying would occur in association with this decline. A cohort of 984 students in the College Life Study at a large public university in the US participated in a longitudinal prospective study. Interviewers assessed NPS; Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) cannabis and alcohol use disorders; and frequency of skipping class. Semester grade point average (GPA) was obtained from the university. Control variables were race, sex, family income, high school GPA, and self-reported attention deficit hyperactivity disorder diagnosis. Longitudinal growth curve modeling of four annual data waves estimated the associations among the rates of change of cannabis use disorder, percentage of classes skipped, and semester GPA. The associations between these trajectories and NPS for studying were then evaluated. A second structural model substituted alcohol use disorder for cannabis use disorder. More than one-third (38%) reported NPS for studying at least once by Year 4. Increases in skipping class were associated with both alcohol and cannabis use disorder, which were associated with declining GPA. The hypothesized relationships between these trajectories and NPS for studying were confirmed. These longitudinal findings suggest that escalation of substance use problems during college is related to increases in skipping class and to declining academic performance. NPS for studying is associated with academic difficulties. Although additional research is needed to investigate causal pathways, these results suggest that nonmedical users of prescription stimulants could benefit from a comprehensive drug and alcohol assessment to possibly mitigate future academic declines.
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Prescription stimulants are often used to treat attention deficit hyperactivity disorder (ADHD). Drugs like methylphenidate (Ritalin, Concerta), dextroamphetamine (Dexedrine), and dextroamphetamine-amphetamine (Adderall) help people with ADHD feel more focused. However, misuse of stimulants by ADHD and nonaffected individuals has dramatically increased over recent years based on students' misconceptions or simple lack of knowledge of associated risks. In this review, we discuss recent advances in the use and increasing misuse of prescription stimulants among high school and college students and athletes. Given the widespread belief that stimulants enhance performance, there are in fact only a few studies reporting the cognitive enhancing effects of stimulants in ADHD and nonaffected individuals. Student athletes should be apprised of the very serious consequences that can emerge when stimulants are used to improve sports performance. Moreover, misuse of stimulants is associated with dangers including psychosis, myocardial infarction, cardiomyopathy, and even sudden death. As ADHD medications are prescribed for long-term treatment, there is a need for long-term safety studies and education on the health risks associated with misuse is imperative.
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Introduction and aims: Recent, high profile articles in leading science journals have claimed that the enhancement use of prescription stimulants is a common practice among students worldwide. This study provides empirical data on Australian university students' perceptions of: (i) the prevalence of prescription stimulant use by their peers for cognitive enhancement; (ii) motivations for such use; (iii) efficacy; and (iv) its safety. Design and methods: Participants were 19 Australian university students with an average age of 24 who were recruited through emails lists, notice board posters and snowball sampling. Semi-structured interviews were conducted during 2010 and 2011, recordings transcribed and responses coded using thematic analysis. Results: Participants typically did not believe the use of stimulants for cognitive enhancement was common in Australia. Perceived motivations for use included: (i) 'getting ahead' to perform at high levels; (ii) 'keeping up' as a method of coping; and (iii) 'going out' so that an active social life could be maintained in the face of study demands. Australian students were generally sceptical about the potential benefits of stimulants for cognitive enhancement and they identified psychological dependence as a potential negative consequence. Discussion and conclusions: This study is an important first step in understanding the use of stimulants for cognitive enhancement in Australia, amid calls for more widespread use of cognitive enhancing drugs. It is important to conduct further studies of the extent of cognitive enhancement in Australia if we are to develop appropriate policy responses.
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The prospects of enhancing cognitive or motor functions using neuroscience in otherwise healthy individuals has attracted considerable attention and interest in neuroethics (Farah et al., Nature Reviews Neuroscience 5:421–425, 2004; Glannon Journal of Medical Ethics 32:74–78, 2006). The use of stimulants is one of the areas which has propelled the discussion on the potential for neuroscience to yield cognition-enhancing products. However, we have found in our review of the literature that the paradigms used to discuss the non-medical use of stimulant drugs prescribed for attention deficit/hyperactivity disorder (ADHD) vary considerably. In this brief communication, we identify three common paradigms—prescription drug abuse, cognitive enhancement, and lifestyle use of pharmaceuticals—and briefly highlight how divergences between paradigms create important “ethics blind spots”. KeywordsNeuroethics-Enhancement-Prescription drug misuse-Lifestyle drugs-Public health
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The use of prescription drugs to improve cognitive functioning in normal persons--neuroenhancement"--has gained recent attention from bioethicists and neuroscientists. Enthusiasts claim that the practice is widespread and increasing, and has many potential benefits; however recent evidence provides weak support for these claims. In this study we explored how the newsprint media portrays neuroenhancement. We conducted an empirical study of media reporting of neuroenhancement to explore: media portrayals of the prevalence of neuroenhancement; the types of evidence used by the media to support claims about its prevalence; and, the possible benefits and risks of neuroenhancement mentioned in these media articles. Using the Factiva database, we found 142 newspaper articles about the non-medical use prescription drugs for neuroenhancement for the period 2008-2010. We conducted a thematic content analysis of how articles portrayed the prevalence of neuroenhancement; what type of evidence they used in support; and, the potential benefits and risks/side-effects of neuroenhancement that were mentioned. 87% of media articles mentioned the prevalence of neuroenhancement, and 94% portrayed it as common, increasing or both. 66% referred to the academic literature to support these claims and 44% either named an author or a journal. 95% of articles mentioned at least one possible benefit of using prescription drugs for neuroenhancement, but only 58% mentioned any risks/side effects. 15% questioned the evidence for efficacy of prescription drugs to produce benefits to users. News media articles mentioned the possible benefits of using drugs for neuroenhancement more than the potential risks/side effects, and the main source for media claims that neuroenhancement is common and increasingly widespread has been reports from the academic literature that provide weak support for this claim. We urge journalists and researchers to be cautious in their portrayal of the non-medical use of drugs for neuroenhancement.
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With growing interest in online assessment of substance abuse behaviors, there is a need to formally evaluate the validity of the data gathered. The current investigation evaluated the reliability and validity of anonymous, online reports of young adults' marijuana use and related cognitions. Young adults age 18 to 25 who had smoked at least one cigarette in the past 30 days were recruited over 14 months to complete an anonymous online survey. Of 3,106 eligible cases, 1,617 (52%) completed the entire survey. Of those, 54% (n = 884) reported past-month marijuana use (65% male, 70% Caucasian, mean age was 20.4 years [SD = 2.0]). Prevalence of marijuana use was reported reliably across three similar items, and interitem correlations ranged from fair to excellent for measures of marijuana dependence symptoms and thoughts about marijuana use. Marijuana use frequency demonstrated good construct validity through expected correlations with marijuana use constructs, and nonsignificant correlations with thoughts about tobacco use. Marijuana frequency distinguished among stages of change for marijuana use and goals for use, but not among gender, ethnicity, or employment groups. Marijuana use and thoughts about use differed by stage of change in the hypothesized directions. Self-reported marijuana use and associated cognitions reported anonymously online from young adults are generally reliable and valid. Online assessments of substance use broaden the reach of addictions research. (PsycINFO Database Record (c) 2011 APA, all rights reserved).
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To investigate the possible association between untreated ADHD symptoms (as measured by the Adult ADHD Self-Report Scale) and persistent nonmedical use of prescription stimulants. Multinomial regression modeling was used to compare ADHD symptoms among three groups of college students enrolled in a longitudinal study over 4 years: (1) persistent nonmedical users of prescription stimulants, (2) persistent users of marijuana who did not use prescription stimulants nonmedically, and (3) consistent nonusers of drugs. ADHD symptoms were associated with being a persistent nonmedical user of prescription stimulants after adjustment for race/ethnicity, sex, socioeconomic status, and other illicit drug use. No associations were observed between ADHD symptoms and being a persistent marijuana user or nonuser. ADHD symptoms, and in particular inattention symptoms, appeared to be associated with nonmedical use of prescription stimulants.
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Modafinil, a novel wake-promoting agent, has been shown to have a similar clinical profile to that of conventional stimulants such as methylphenidate. We were therefore interested in assessing whether modafinil, with its unique pharmacological mode of action, might offer similar potential as a cognitive enhancer, without the side effects commonly experienced with amphetamine-like drugs. The main aim of this study was to evaluate the cognitive enhancing potential of this novel agent using a comprehensive battery of neuropsychological tests. Sixty healthy young adult male volunteers received either a single oral dose of placebo, or 100 mg or 200 mg modafinil prior to performing a variety of tasks designed to test memory and attention. A randomised double-blind, between-subjects design was used. Modafinil significantly enhanced performance on tests of digit span, visual pattern recognition memory, spatial planning and stop-signal reaction time. These performance improvements were complemented by a slowing in latency on three tests: delayed matching to sample, a decision-making task and the spatial planning task. Subjects reported feeling more alert, attentive and energetic on drug. The effects were not clearly dose dependent, except for those seen with the stop-signal paradigm. In contrast to previous findings with methylphenidate, there were no significant effects of drug on spatial memory span, spatial working memory, rapid visual information processing or attentional set-shifting. Additionally, no effects on paired associates learning were identified. These data indicate that modafinil selectively improves neuropsychological task performance. This improvement may be attributable to an enhanced ability to inhibit pre-potent responses. This effect appears to reduce impulsive responding, suggesting that modafinil may be of benefit in the treatment of attention deficit hyperactivity disorder.
Article
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.
Book
This book addresses the emerging field of neuromarketing, which, at its core, aims to better understand the impact of marketing stimuli by observing and interpreting human emotions. It includes contributions from leading researchers and practitioners, venturing beyond the tactics and strategies of neuromarketing to consider the ethical implications of applying powerful tools for data collection. The rationale behind neuromarketing is that human decision-making is not primarily a conscious process. Instead, there is increasing evidence that the willingness to buy products and services is an emotional process where the brain uses short cuts to accelerate the decision-making process. At the intersection of economics, neuroscience, consumer behavior, and cognitive psychology, neuromarketing focuses on which emotions are relevant in human decision-making, and uses this knowledge to make marketing more effective. The knowledge is applied in product design; enhancing promotions and advertising, pricing, professional services, and store design; and improving the consumer experience as a whole. The foundation for all of this activity is data gathering and analysis. Like many new processes and innovations, much of neuromarketing is operating far ahead of current governmental compliance and regulation and thus current practices are raising ethical issues. For example, facial recognition software, used to monitor and detect a wide range of micro-expressions, has been tested at several airports—under the guise of security and counterterrorism. To what extent is it acceptable to screen the entire population using these powerful and intrusive techniques without getting passengers’ consent? Citing numerous examples from the public and private sectors, the editors and contributing authors argue that while the United States has catalyzed technological advancements, European companies and governments are more progressive when it comes to defining ethical parameters and developing policies. This book details many of those efforts, and offers rational, constructive approaches to laying an ethical foundation for neuromarketing efforts.
Article
Today there is continued, and in some cases growing, availability of psychoactive substances, including treatments for mental health disorders such as cognitive enhancers, which can enhance or restore brain function, but also 'recreational' drugs such as novel psychoactive substances (NPS). The use of psychoactive drugs has both benefits and risks: whilst new drugs to treat cognitive symptoms in neuropsychiatric or neurodegenerative disorders could have great benefits for many patient groups, the increasing ease of accessibility to recreational NPS and the increasing lifestyle use of cognitive enhancers by healthy people means that the effective management of psychoactive substances will be an issue of increasing importance. Clearly, the potential benefits of cognitive enhancers are large and increasingly relevant, particularly as the population ages, and for this reason we should continue to devote resources to the development of cognitive enhancers as treatments for neurodegenerative diseases and psychiatric disorders, including Alzheimer's disease, attention deficit hyperactivity disorder (ADHD) and schizophrenia. However, the increasing use of cognitive enhancers by healthy individuals raises safety, ethical and regulatory concerns, which should not be ignored. Similarly, understanding the short- and long-term consequences of NPS use as well as better understanding the motivations and profiles of users could promote more effective prevention and harm reduction measures.
Chapter
The rapid advancement of technology raises ethical issues that need to be addressed in the near future. According to Kurzweil law, technology progresses at an exponential rate. Ethics, on the other hand, advances much slower and doesn’t keep pace with the number and complexity of issues brought by technology. Considering that technology’s speed of evolution won’t slow down because ethics can’t keep pace with it, we argue that all those ethical issues that are already present in the public space should be discussed and sorted out as soon. Otherwise, they will become deeper and generate even more problems. The chapter discusses at length about the cognitive and body enhancements, achieved through either medical or bionic implants, and the changes that these enhancements induce in our behavior. Computers and the internet are some of the greatest enhancers ever and they managed to change the attitude of the millennials and Generation Z towards ownership and work. Our goal was to raise questions regarding the challenge of ethical and moral principles and values by the rapid development of technology. We then argued that the future of research lies in the realm of technology and that neuromarketing, unlike traditional research, has predictive power thanks to the brain scans. It was not our intention to solve or find answers to any of those issues that we raised. For some of them, it might be too soon to draw a conclusion. And for the others, there are competent bodies that can enforce suitable measures.
Article
Introduction The use of drugs to improve cognitive performance (pharmacological enhancement) is a practice that increases in frequency, especially in individuals with a high degree of academic education, university students, and workforce with high responsibilities. Legal substances such as alcohol and caffeine, prescription drugs such as modafinil or methylphenidate and some illegal drugs such as amphetamines or cannabis are utilized to improve cognitive performance, maintain wakefulness, or induce sleep. Perception of risk is low in many cases. Internet has facilitated the illicit access to prescription drugs with astonishing ease. Objective and methods We want to exemplify through a clinical case, how the access to some of these substances through internet is very easy, and how, in this case, the use of Modafinil (drug indicated for narcolepsy) with the objective of maintaining academic performance aggravates symptoms of anxiety in a 22-year universitary patient. Results Exposition of clinical case in the poster. Conclusions The use of substances (“smart drugs”) presents risks for both physical and psychological health that sometimes are not perceived by the user. It is surprising that a highly educated individual has taken Modafinil without researching for a deep understanding of the side effects of the drug. Internet access of regulated substances that should only be prescribed by a physician to be used on very concrete symptoms is extremely easy. In the case of the Modafinil, it is possible to access its purchase by simply searching the words “purchase/buy Modafinil” in any internet browser.
Article
Cognitive enhancers (CE) such as methylphenidate, amphetamines and modafinil are becoming more commonly used in non-medical situations. This study explored the prevalence and motivations for CE use in a New Zealand university. Students from the Schools of Pharmacy, Nursing, Medicine, Law and Accounting at a university in New Zealand were invited to complete a paper-based questionnaire that elicited their views on the prevalence, reasons for use and attitudes towards use of CEs. Questionnaires were distributed at the end of a third-year lecture (August-October 2012). Reasons for use and attitudes towards use was measured using a 7-point Likert scale from strongly agree (1) to strongly disagree (7). Descriptive and prevalence statistics were calculated. Inferential statistics were generated to explore the overall associations between CE use and how the respondents had first learnt about CEs, and to investigate reasons for CE use. The response fraction was 88.6 % (442/499) and the prevalence of CE use was 6.6% (95% confidence interval 4.5-9.0). Commonly cited reasons for use were to get high [M = 4.43, standard deviation (SD) 2.36], experimentation (M = 4.17, SD 2.36), increase alertness (M = 3.55, SD 2.48), to help concentrate (M = 3.48, SD 2.42), to help stay awake (M = 3.20, SD 2.33), to help study (M = 3.10, SD 2.47) and to concentrate better while studying (M = 3.00, SD 2.43). Use of CEs was uncommon in contrast to the prevalence reported in the USA. The reasons for use also varied depending on which CE was used. Students who use CEs have differing attitudes towards their acceptability, which warrants further research about how these attitudes influence their use and attitudes towards academic performance. [Ram S(S), Hussainy S, Henning M, Jensen M, Russell B. Prevalence of cognitive enhancer use among New Zealand tertiary students. Drug Alcohol Rev 2015]. © 2015 Australasian Professional Society on Alcohol and other Drugs.
Article
Pharmacological "cognitive enhancement" (CE) is defined as the use of any psychoactive drug with the purpose of enhancing cognition, e.g. regarding attention, concentration or memory by healthy subjects. Substances commonly used as CE drugs can be categorized into three groups of drugs: (1) over-the-counter (OTC) drugs such as coffee, caffeinated drinks/energy drinks, caffeine tablets or Ginkgo biloba; (2) drugs being approved for the treatment of certain disorders and being misused for CE: drugs to treat attention-deficit/hyperactivity disorder (ADHD) such as the stimulants methylphenidate (MPH, e.g. Ritalin(®)) or amphetamines (AMPH, e.g. Attentin(®) or Adderall(®)), to treat sleep disorders such as modafinil or to treat Alzheimer's disease such as acetylcholinesterase inhibitors; (3) illicit drugs such as illicit AMPH, e.g. "speed", ecstasy, methamphetamine (crystal meth) or others. Evidence from randomized placebo-controlled trials shows that the abovementioned substances have limited pro-cognitive effects as demonstrated, e.g. regarding increased attention, increased cognitive speed or shortening of reaction times, but on the same time poses considerable safety risks on the consumers. Prevalence rates for the use of CE drugs among healthy subjects show a broad range from less than 1 % up to more than 20 %. The range in prevalence rates estimates results from several factors which are chosen differently in the available survey studies: type of subjects (students, pupils, special professions, etc.), degree of anonymity in the survey (online, face-to-face, etc.), definition of CE and substances used/misused for CE, which are assessed (OTC drugs, prescription, illicit drugs) as well as time periods of use (e.g. ever, during the past year/month/week, etc.). A clear and comprehensive picture of the drugs used for CE by healthy subjects and their adverse events and safety risks as well as comprehensive and comparable international data on the prevalence rates of CE among healthy subjects are of paramount importance for informing policy makers and healthcare professionals about CE.
Article
This research note reports the results of a comparison of face-to-face interviewing with telephone interviewing in a qualitative study. The study was designed to learn visitors’ and correctional officers’ perceptions of visiting county jail inmates. The original study design called for all face-to-face interviews, but the contingencies of fieldwork required an adaptation and half of the interviews were conducted by phone. Prior literature suggested that the interview modes might yield different results. However, comparison of the interview transcripts revealed no significant differences in the interviews. With some qualifications, we conclude that telephone interviews can be used productively in qualitative research.
Article
The technical potential of the Internet offers survey researchers a wide range of possibilities for web surveys in terms of questionnaire design; however, the abuse of technical facilities can detract respondents from cooperating rather than motivating them. Within the web survey methodology literature, many contributions can be found on how to write a ‘‘good’’ questionnaire. The outcomes are however scattered and researchers and practitioners may find it difficult to obtain an overall picture. The article reviews the latest empirical research on how questionnaire characteristics affect response rates. The article is divided into three main sections: an introduction where the various forms of nonresponse in web surveys are described; a second section presenting questionnaire features affecting nonresponse— general structure, length, disclosure of survey progress, visual presentation, interactivity, and question/response format—and a final section that summarizes the options in terms of questionnaire design and its implications for nonresponse rate.
Article
Stimulant use for academic performance is widespread among college students, but less is known about use among students obtaining advanced degrees. In this cross-sectional survey, we measured the prevalence and demographic correlates of prescription stimulant use among a sample of US medical students. The lifetime prevalence of stimulant use in this sample of 144 medical students was 20%, and prevalence of use during medical school was 15%. More white students (32%) than Asian students (7%) had used stimulants. Nine percent of respondents reported an attention-deficit/hyperactivity disorder (ADHD) diagnosis, and those diagnosed were more than 30 times more likely to have used stimulants compared with those without a diagnosis. Of those who had taken stimulants, 83% reported using them specifically for cognitive performance enhancement such as studying better and staying awake longer while on clinical duties. This study suggests a high prevalence of stimulant use among medical students compared with the general population. Personal experience with these medications as medical students could impact physician attitudes and prescribing patterns toward patients seeking help for ADHD-related symptoms.
Article
The purpose of this study was to give an overview whether German students regularly use stimulants for enhancing their academic performance. Reasons associated with the use of these substances were explored. Moreover, gender differences were analyzed. A cross-sectional survey study was performed analyzing a random sample of 1,053 students of different fields of study in Germany. Students were asked to complete an anonymous self-administered web-based survey containing questions on cognitive performance-enhancing substance use. We used statistical analyses, e.g. non-parametric tests to evaluate the data of our questionnaire. Among 1,053 students, 61 % responded to our questionnaire. The average age was M = 24.58; 635 participants were female and 418 were male students. Total 1-13 % of the participating students have taken prescription stimulants (e.g. modafinil) or illicit drugs (e.g. cannabis) at least once in their lifetime. The most common reasons for taking stimulants were to support concentration, to relax and to increase alertness. We found significant gender differences with regard to frequency and reason for using performance-enhancing substances. Our study results give an overview about the actual situation on frequency and reasons for taking performance-enhancing substances. Departments of Public Health should address this issue in national health debates and discussions. Based on our study findings health education programmes should be developed.
Article
To compare responses to personally sensitive questions, 352 undergraduates were randomly assigned to respond anonymously to a survey using one of three survey methods: pencil and paper mail-in, Internet survey, or an automated touch-tone telephone response system. The survey contained 68 brief Yes/No questions ranging from low to high sensitivity in 13 domains, such as general honesty, academic honesty, prejudice, illegal behavior, alcohol use, substance use, violence, and sexual behavior. We found no significant differences (p>0.05) in participants’ responses among these three media for any of the questions. This suggests that for some populations, under some circumstances, Internet and touch-tone telephone systems achieve the same results as traditional pencil and paper surveys.
Article
Use of prescription stimulants by normal healthy individuals to enhance cognition is said to be on the rise. Who is using these medications for cognitive enhancement, and how prevalent is this practice? Do prescription stimulants in fact enhance cognition for normal healthy people? We review the epidemiological and cognitive neuroscience literatures in search of answers to these questions. Epidemiological issues addressed include the prevalence of nonmedical stimulant use, user demographics, methods by which users obtain prescription stimulants, and motivations for use. Cognitive neuroscience issues addressed include the effects of prescription stimulants on learning and executive function, as well as the task and individual variables associated with these effects. Little is known about the prevalence of prescription stimulant use for cognitive enhancement outside of student populations. Among college students, estimates of use vary widely but, taken together, suggest that the practice is commonplace. The cognitive effects of stimulants on normal healthy people cannot yet be characterized definitively, despite the volume of research that has been carried out on these issues. Published evidence suggests that declarative memory can be improved by stimulants, with some evidence consistent with enhanced consolidation of memories. Effects on the executive functions of working memory and cognitive control are less reliable but have been found for at least some individuals on some tasks. In closing, we enumerate the many outstanding questions that remain to be addressed by future research and also identify obstacles facing this research.
Article
Quantitative methods were used to investigate the use of nonmedical attention-deficit/hyperactivity disorder (ADHD) stimulants by fraternity members. Three hundred thirty-three fraternity members at a large, public southeastern research university in the United States were surveyed in classes and at other campus locations. Once those with legal prescriptions for ADHD stimulants were removed (n = 26), the sample size was 307. Of the study participants, 55% (n = 170) reported the nonmedical use of ADHD stimulants. Use was significantly higher among upperclassmen, those living off campus, and those who regularly smoke marijuana. The vast majority of fraternity members (1) reported academic motives for use, (2) did not view ADHD stimulants as dangerous, and (3) procured stimulants from their friends. These results demonstrate a high rate of use of these drugs in a campus population. More studies on nonmedical users (and suppliers of users) are needed, as are educational interventions on university campuses, especially among members of fraternities.
Article
While Adderall has been available for the treatment of attention-deficit/hyperactivity disorder (ADHD) for several years, there are few controlled studies comparing it to methylphenidate. Fifty-eight children with ADHD (mean age 8.1 +/- 1.4 years) were randomly assigned to receive placebo, methylphenidate, or Adderall in a double-blind, parallel-group design for 3 weeks. Dosage was adjusted at the end of weeks 1 and 2 via an algorithm based on teacher and parent ratings. Final doses were 12.5 +/- 4.1 mg/day for Adderall and 25.2 +/- 13.1 mg/day for methylphenidate. Teacher and parent ratings, as well as the psychiatrist's Clinical Global Impression (CGI), were the final outcome measures at the end of week 3. Both medications were superior to placebo at reducing inattentive and oppositional symptoms in the classroom and on the CGI. Adderall produced significantly more improvements on teacher ratings and the CGI than methylphenidate, although the algorithm may have limited dosing in the methylphenidate group. Seventy percent of children in the Adderall group were given medication once a day, compared with 15% of the subjects receiving methylphenidate. Adderall compared favorably to methylphenidate, and the behavioral effects of Adderall appear to persist longer than those of methylphenidate after individual doses.
Article
Based on the her experiences of completing a doctoral study in which semi-structured interviews featured as the primary data collection method, Christine Dearnley offers a reflective insight into using semi-structured interviews as a method of data collection. The processes of reflection in, and on, the interview process are explored, and some of the ethical dilemmas that emerged during the study are reflected on. The practicalities of conducting semi-structured interviews are considered with a view to sharing new understandings of the process and its management.
Article
To explore the illicit use of specific prescription stimulants among college students and add to our understanding of reasons (motives) and routes of administration associated with illicit use of these drugs. A random sample of 4580 college students self-administered a Web-based survey. The survey contained a variety of items pertaining to the illicit use of prescription stimulants. An extensive list of prescription stimulants was provided, and students were asked to select all the specific prescription stimulants that they had used illicitly. Items were also included to assess the motives and routes of administration associated with illicit use of prescription stimulants. Lifetime and past-year prevalence rates for illicit use of prescription stimulants were 8.3% (382 students) and 5.9% (269 students), respectively. Approximately three fourths (75.8%) of the 269 past-year illicit users of prescription stimulants reported using an amphetamine-dextroamphetamine combination agent (e.g., Adderall) in the past year, and approximately one fourth (24.5%) reported using methylphenidate (e.g., Ritalin, Concerta, Metadate, Methylin). Past-year illicit use of prescription stimulants was more than 3 times more likely among Caucasians (odds ratio [OR] 3.1, 95% confidence interval [CI] 1.5-6.6) and Hispanics (OR 3.8, 95% CI 1.6-9.3) compared with African-Americans, and more than twice as likely among Caucasians (OR 2.1, 95% CI 1.3-3.4) and Hispanics (OR 2.6, 95% CI 1.4-5.1) compared with Asians. The most commonly reported motives for illicit use were to help with concentration (65.2%), help study (59.8%), and increase alertness (47.5%). Other motives included getting high (31.0%) and experimentation (29.9%). Nearly every illicit user (95.3%) reported oral administration, and 38.1% reported snorting prescription stimulants. Illicit use of amphetamine-dextroamphetamine is more prevalent than illicit use of methylphenidate formulations among college students.
Article
Recent studies have provided variable information on the frequency and context of diversion and the use of nonprescribed and prescribed stimulant medications in adolescent and young adult populations. The purpose of this systematic review of the literature is to evaluate the extent and characteristics of stimulant misuse and diversion in attention-deficit/hyperactivity disorder (ADHD) and non-ADHD individuals. We conducted a systematic review of the literature of available studies looking at misuse and diversion of prescription ADHD medications using misuse, diversion, stimulants, illicit use, and ADHD medications as key words for the search. We identified 21 studies representing 113,104 subjects. The studies reported rates of past year nonprescribed stimulant use to range from 5% to 9% in grade school- and high school-age children and 5% to 35% in college-age individuals. Lifetime rates of diversion ranged from 16% to 29% of students with stimulant prescriptions asked to give, sell, or trade their medications. Recent work suggests that whites, members of fraternities and sororities, individuals with lower grade point averages, use of immediate-release compared to extended-release preparations, and individuals who report ADHD symptoms are at highest risk for misusing and diverting stimulants. Reported reasons for use, misuse, and diversion of stimulants include to concentrate, improve alertness, "get high," or to experiment. The literature suggests that individuals both with and without ADHD misuse stimulant medications. Recent work has begun to document the context, motivation, and demographic profile of those most at risk for using, misusing, and diverting stimulants. The literature highlights the need to carefully monitor high-risk individuals for the use of nonprescribed stimulants and educate individuals with ADHD as to the pitfalls of the misuse and diversion of the stimulants.
Knowledge, Not Numbers: Qualitative Research and Impact in Sport, Exercise and Health
  • T Kay
Qualitative Research and Evaluation Methods. Thousand Oaks, CA: Sage
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Monitoring the future national survey results on drug use
  • L D Johnston
  • P M Malley
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  • R A Miech