A primary means for the augmentation of cognitive brain functions is "pharmacological cognitive enhancement" (PCE) The term usually refers to the off-label use of medical substances to improve mental performance in healthy individuals With the final aim to advance the normative debate taking place on that topic, several empirical studies have been conducted to assess the attitudes toward PCE in the public, ie, in groups outside of the academic debate In this review, we provide an overview of the 40 empirical studies published so far, reporting both their methodology and results Overall, we find that several concerns about the use of PCE are prevalent in the public These concerns largely match those discussed in the normative academic debate We present our findings structured around the three most common concerns: medical safety, coercion, and fairness Fairness is divided into three subthemes: equality of opportunity, honesty, and authenticity Attitudes regarding some concerns are coherent across studies (eg, coercion), whereas for others we find mixed results (eg, authenticity) Moreover, we find differences in how specific groups-such as users, nonusers, students, parents, and health care providers-perceive PCE: a coherent finding is that nonusers display more concerns regarding medical safety and fairness than users We discuss potential psychological explanations for these differences

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Attitudes toward pharmacological cognitive enhancement-a review.

Pharmacological cognitive enhancement among non-ADHD individuals-A cross-sectional study in 15 countries.

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

https://biblio.ugent.be/publication/7086173/file/8054440.pdf

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

(Mis)use of Prescribed Stimulants in the Medical Student Community: Motives and Behaviors: A Population-Based Cross-Sectional Study.

Background: There are reports that some university students are using prescription stimulants for non-medical ‘pharmaceutical cognitive enhancement (PCE)’ to improve alertness, focus, memory, and mood in an attempt to manage the demands of study at university. Purported demand for PCEs in academic contexts have been based on incomplete understandings of student motivations, and often based on untested assumptions about the context within which stimulants are used. They may represent attempts to cope with biopsychosocial stressors in university life by offsetting students’ inadequate coping responses, which in turn may affect their cognitive performance. This study aimed to identify (a) what strategies students adopted to cope with the stress of university life and, (b) to assess whether students who have used stimulants for PCE exhibit particular stress or coping patterns. Methods: We interviewed 38 university students (with and without PCE experience) about their experience of managing student life, specifically their educational values, study habits and achievement, stress management, getting assistance, competing activities and responsibilities, health habits, and cognitive enhancement practices. All interview transcripts were coded into themes and analysed. Results: Our thematic analysis revealed that, generally, self-rated coping ability decreased as students’ self-rated stress level increased. Students used emotion- and problem-focused coping for the most part and adjustment-focused coping to a lesser extent. Avoidance, an emotion-focused coping strategy, was the most common, followed by problem-focused coping strategies, the use of cognition on enhancing substances, and planning and monitoring of workload. PCE users predominantly used avoidant emotion-focused coping strategies until they no longer mitigated the distress of approaching deadlines resulting in the use of prescription stimulants as a substance-based problem-focused coping strategy. Conclusion: Our study suggests that students who choose coping responses that do not moderate stress, where possible, may cause themselves additional distress and avoid learning more effective coping responses. Helping students to understand stress and coping, and develop realistic stress appraisal techniques, may assist students in general to maintain manageable distress levels and functioning. Furthermore, assisting students who may be inclined to use prescription stimulants for cognitive enhancement may reduce possible drug-related harms.

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Australian University Students' Coping Strategies and Use of Pharmaceutical Stimulants as Cognitive Enhancers.

Use of substances to enhance academic performance among university students has prompted calls for evidence to inform education and public health policy. Little is known about this form of drug use by university students outside the US. A convenience sample of n= 1729 Australian university students across four universities responded to an exploratory on-line survey. Students were asked about their lifetime use of modafinil, prescription stimulants (e.g. methylphenidate), supplements (e.g. ginkgo biloba), illicit drugs (e.g. speed), relaxants (e.g. valium) and caffeine in relation to enhancing study performance. The results show that Australian students report using substances for study purposes at a higher lifetime rate than observed among US or German students. The main reasons for use were to improve focus and attention, and to stay awake. Use of substances to enhance study outcomes was correlated with faculty of study, attitude and use of other substances. These results point to the need to develop Australian evidence to guide policy or regulatory responses to student use of substances to enhance academic performance. © 2013 Elsevier Ltd.

Mai-Lee Fielding

Papers

Substance use to enhance academic performance among Australian university students