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Journal ArticleDOI

A Comparison of Attitudes Toward Cognitive Enhancement and Legalized Doping in Sport in a Community Sample of Australian Adults

05 Nov 2012-Ajob Primary Research (Taylor & Francis Group)-Vol. 3, Iss: 4, pp 81-86

AbstractBackground: This article compares public attitudes toward the use of prescription drugs for cognitive enhancement with the use of performance enhancing drugs in sport. We explore attitudes toward the acceptability of both practices; the extent to which familiarity with cognitive enhancement is related to its perceived acceptability; and relationships between the acceptability of cognitive enhancement and legalized doping in sport. Methods: A survey was administered through a computer-assisted telephone interviewing system to members of the Australian general public aged 18–101 years in the state of Queensland. Results: Of 1,265 participants, 7% agreed that cognitive enhancement is acceptable; 2.4% of the total sample said they had taken prescription drugs to enhance their concentration or alertness in the absence of a diagnosed disorder, and a further 8% said they knew someone who had done so. These participants were twice as likely to think cognitive enhancement was acceptable. Only 3.6% of participants ...

Summary (2 min read)

METHODS

  • The Queensland Social Survey Data collection occurred during July and August 2011 as part of the Queensland Social Survey (QSS), a large omnibus statewide survey of views of participants in households in the state of Queensland, Australia, also known as The Survey Instrument.
  • The QSS is administered through a CATI (computer-assisted telephone interviewing) system.
  • It includes questions from multiple research bodies and other organizations on a wide range of topics.
  • Next, the authors included two questions about attitudes toward cognitive enhancement and legalized sports doping.
  • Participants were asked to respond using the following response categories: (1) strongly agree; (2) agree; (3) slightly agree; (4) neither agree nor disagree; (5) slightly disagree; (6) disagree; (7) strongly disagree; (8) don't know.

Procedure

  • The target population for the telephone interview consisted of persons 18 years of age or older who at the time of the survey were living in a dwelling unit in Queensland and could be contacted by directdialed, land-based telephone service.
  • The sample was drawn from a telephone database of randomly generated numbers that had been selected using postcode parameters.
  • Known nonresidential and nonworking numbers were not included in the database.
  • Within each household, one eligible person was selected as the respondent for the interview.
  • All participants gave verbal informed consent to participate.

Analysis

  • Descriptive analyses gave overall rates of familiarity with the use of prescription drugs for cognitive enhancement; the overall rate of agreement with using prescription drugs for cognitive enhancement; and the overall rate of agreement with legalized doping.
  • Participant responses to Q1 were coded into two groups: "familiar" (they, or someone they know personally, have taken prescription drugs to enhance concentration or alertness) and "not familiar" (they had never taken prescription drugs to enhance concentration or alertness and didn't know anyone who had).
  • Participant responses to Q2 and Q3 were coded into four categories: agree, disagree, neutral, or don't know.
  • The authors used logistic regression to see what characteristics predicted agreement with the acceptability of using prescription drugs for cognitive enhancement.
  • The dependent variable was "agreement with the acceptability of using prescription drugs" (coded as disagree = 0; agree = 1).

Sample Characteristics

  • Acceptance of cognitive enhancement and use of performance-enhancing drugs Table 2 Predictive factors for acceptability of cognitive enhancement and legalized doping Familiarity With Cognitive Enhancement Familiarity with cognitive enhancement was low in the sample.
  • Age was also a significant predictor of familiarity, but education was not.
  • Roughly 21% of participants aged 18-34 either knew someone who had used prescription drugs to enhance alertness or concentration, or had done so themselves (6.2% of the 18-34 group had ever used).

Attitudes Toward Cognitive Enhancement

  • The logistic regression analysis examining factors predicting attitudes toward the acceptability of healthy people using prescription drugs to enhance their concentration or alertness was statistically significant (χ2(8, N = 1153) = 26.989, p < .001).
  • Attitudes Toward Legalized Doping Only 3.6% of participants (n = 45) agreed that people who play professional sport should be allowed to use performance-enhancing drugs if they wanted to (see Table 1 ).
  • Gender, age, and education were not significant predictors, but attitude toward the acceptability of cognitive enhancement was a statistically significant predictor.

DISCUSSIONJ

  • This is the first time public attitudes toward the two forms of enhancement have been assessed.
  • Even so, the vast majority of those who found cognitive enhancement acceptable did not support the use of PEDs.
  • There were low levels of direct or vicarious familiarity with cognitive enhancement-only 2.4% of participants claimed to have ever used prescription drugs in this way and a further 8% knew someone else who had done so.
  • The results of self-report surveys of drug use and attitudes may be subject to recall and response biases; however, these limitations are not unique to this survey and it is not clear that their results have been unduly affected.
  • Their survey generates one of the first sets of empirical data about public attitudes toward cognitive enhancement and legalized doping in sport.

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NHMRC Australia Fellowship 569738 award to Professor Wayne Hall 2009-2013 postprint
1
Partridge B., Lucke J., Hall W. A comparison of attitudes toward cognitive enhancement and
legalized doping in sport in a community sample of Australian adults. American Journal of Bioethics -
Primary Research 2012; 3: 81-86.
Abstract
Background: This article compares public attitudes toward the use of prescription drugs for cognitive
enhancement with the use of performance enhancing drugs in sport. We explore attitudes toward the
acceptability of both practices; the extent to which familiarity with cognitive enhancement is related
to its perceived acceptability; and relationships between the acceptability of cognitive enhancement
and legalized doping in sport. Methods: A survey was administered through a computer-assisted
telephone interviewing system to members of the Australian general public aged 18–101 years in the
state of Queensland. Results: Of 1,265 participants, 7% agreed that cognitive enhancement is
acceptable; 2.4% of the total sample said they had taken prescription drugs to enhance their
concentration or alertness in the absence of a diagnosed disorder, and a further 8% said they knew
someone who had done so. These participants were twice as likely to think cognitive enhancement
was acceptable. Only 3.6% of participants agreed that people who play professional sport should be
allowed to use performance-enhancing drugs if they wanted to. Participants who found cognitive
enhancement acceptable were 9.5 times more likely to agree with legalized doping. Conclusions:
Policies that facilitated the use of prescription drugs by healthy people for cognitive enhancement or
permitted performance-enhancing drugs in sport would be at odds with the attitudes of the vast
majority of our participants. Furthermore, our findings do not support media claims that the use of
prescription drugs for cognitive enhancement is widespread in all sectors of society.
Keywords
cognitive enhancement, doping, methylphenidate, neuroenhancement, performance-enhancing drugs,
public attitudes, public opinion
The archetypal example of nonmedical use of prescription drugs by healthy people for “cognitive
enhancement” is the university student who buys prescription stimulants (e.g., Ritalin or Adderall)
from a friend because she wants to improve her normal level of concentration or achievement while
studying (Greely et al. 2008). Such behavior has been compared to the use of performance-enhancing
drugs (PEDs) in sport. Similar concerns have been expressed about the two activities regarding: (1)
users gaining an unfair competitive advantage; (2) competitive pressure coercing nonusers to engage
in the practice; (3) the inauthenticity of drug-enhanced performances; (4) the potential benefits to the
“enhanced” individual; (5) the health risks of using prescription drugs for nonmedical purposes; and
(6) the effectiveness of the relevant regulatory systems in discouraging such use (see, e.g., Cakic
2009; Kayser et al. 2005; Kayser and Smith 2008; Lucke et al. 2011b; Partridge 2010).
The nonmedical use of prescription drugs by healthy people for cognitive enhancement and the use of
PEDs in sport are both prohibited behaviors. Since the inception of the World Anti-Doping Agency
(WADA) in 1999—globally formalizing a prohibitive stance toward the use of PEDs in sport—
expenditures on eradicating “doping” in sport (e.g., drug testing of athletes) have increased
enormously. Cognitive enhancement per se is not regulated explicitly, but in most developed countries
there is a prescription system for acquiring putatively enhancing drugs, such as methylphenidate,
dexamphetamine, and modafinil, none of which are indicated for “cognitive enhancement” in healthy
people, and it is illegal to use these drugs without a prescription. There are as yet no pre-exam drug
tests at universities, or threats of students being stripped of their degrees as a result of “academic
doping,” but in many U.S. states the nominal penalties for diverting these drugs and using them
without a prescription can be harsh. These penalties do not seem to be often enforced.

NHMRC Australia Fellowship 569738 award to Professor Wayne Hall 2009-2013 postprint
2
In the bioethics literature, cognitive enhancement has been compared to performance enhancement in
sport (e.g., Cakic 2009). However, there have been few empirical studies comparing public attitudes
toward each practice, and there are conflicting assumptions made in the literature about public
attitudes toward cognitive enhancement and sports doping that can be empirically tested. For instance,
antidoping campaigns typically rest on an assumption that the public condemns doping in sport, and
one recent survey of the Australian public found overwhelming support for strong sanctions against
athletes caught doping in sport, such as loss of sponsorship and prize money, and even criminal
convictions (Engelberg et al. 2012). However, sociologists have speculated that there actually exists a
“culture of enhancement” in many Western societies (Knorr Cetina 2005), and a number of
bioethicists have even recommended various degrees of “legalized doping” in sport, by allowing
athletes to use PEDs ((Kayser and Smith 2008; Kayser et al. 2005; Savulescu et al. 2004)). In arguing
for fewer restrictions on doping in sport, Kayser and Smith (2008) say:
Outside the sporting field, enhancement technologies like cosmetic surgery and eye surgery and use of
substances like caffeine, fluoxetine, modafinil, sildenafil, methylphenidate, and anti-ageing drugs are
an increasingly accepted social behaviour; this places zero tolerance for enhancement in sport at odds
with broader social values.
The existence of a culture of enhancement is often inferred from drug sales, but in the case of
cognitive enhancement several recent papers have shown the phenomenon is not as prevalent as
suggested by advocates in the popular media (Lucke et al. 2011a; Partridge et al. 2011). Importantly,
there are very few empirical studies in the literature that have explored whether the public accepts
either cognitive enhancement or sports doping and whether these attitudes are related. In his 2005
book Testosterone Dreams, John Hoberman links the two by suggesting that public attitudes toward
PEDs in sport may actually be a kind of referendum on other enhancements:
The question of how ordinary people feel about the doping practices of elite athletes is significant
because it indirectly addresses the status of all pharmacological enhancements in the modern world.
(Hoberman 2005)
Several recent editorials have called for investigations of public attitudes toward cognitive enhancers
to better inform policy discussions (Lucke 2012; Nadler and Reiner 2011). Nadler and Reiner (2011)
point out that many assumptions about the value of cognitive enhancement in the public's eyes lack
empirical support, and suggest that gathering such evidence is important not only for its predictive
value, but also for deciding what role “public opinion” should play in setting policies toward
cognitive enhancement. The lack of evidence on public attitudes contrasts with recent, high-profile
calls by bioethicists and others to adopt policies that could facilitate the use of drugs for cognitive
enhancement. In their Nature article, Greely and colleagues (2008) recommended allowing
pharmaceutical companies to market drugs to healthy people for the purposes of cognitive
enhancement, and proposed reevaluating legislation that prohibits the use of prescription drugs
without a prescription. These proposals assume that current restrictions on the use of prescription
drugs for cognitive enhancement may be at odds with public acceptance of cognitive enhancement
(and enhancement more generally). The American Academy of Neurology has recently defended the
ethical permissibility of prescribing drugs that are used to treat dementia, Alzheimer's disease, and
attention-deficit hyperactivity disorder (ADHD) to normally functioning people who want to enhance
their cognitive function (Larriviere et al. 2009). Yet it is not clear whether members of the public find
it acceptable for healthy people to use prescription drugs for cognitive enhancement. The same
appears to be true for legalized doping in sport.
This article reports the results of a survey of members of the Australian public that explored the
following key questions: 1. To what extent do members of the public find it acceptable for healthy
people to use prescription drugs for cognitive enhancement?

NHMRC Australia Fellowship 569738 award to Professor Wayne Hall 2009-2013 postprint
3
2. What is the level of personal or vicarious “familiarity” with cognitive enhancement among the
general public? That is, what proportion of people has used prescription drugs this way? What
proportion knows someone who has?
3. Is “familiarity” with cognitive enhancement related to attitudes toward its acceptability?
4. To what extent do members of the public believe that people who play professional sport should be
allowed to use performance-enhancing drugs if they choose to do so (legalized doping)?
5. How are attitudes toward the acceptability of cognitive enhancement related to attitudes toward
legalized sports doping?
METHODS
The Survey Instrument: The Queensland Social Survey
Data collection occurred during July and August 2011 as part of the Queensland Social Survey (QSS),
a large omnibus statewide survey of views of participants in households in the state of Queensland,
Australia. Ethical approval to conduct the study was obtained through Central Queensland University,
where the survey is based. The QSS is administered through a CATI (computer-assisted telephone
interviewing) system. It includes questions from multiple research bodies and other organizations on a
wide range of topics. Among the questions, we asked participants about their familiarity with people
who engaged in cognitive enhancement:
Q1: Have you, or someone you know personally, ever taken prescription drugs—not for a diagnosed
disorder—but to enhance your normal level of concentration or alertness?
Participants were asked to answer according to the following format: (1) YesI have; (2) Yes
someone I know personally has; (3) Yes—both myself and someone I know personally; (4) No; (5)
Don't know.
Next, we included two questions about attitudes toward cognitive enhancement and legalized sports
doping. Participants were asked the extent to which they agreed with the following statements:
Q2: It is acceptable for prescription drugs to be used by healthy people without a diagnosed disorder,
to enhance their normal level of concentration or alertness.
Q3: People who play professional sport should be allowed to use performance-enhancing drugs if they
want to.
Participants were asked to respond using the following response categories: (1) strongly agree; (2)
agree; (3) slightly agree; (4) neither agree nor disagree; (5) slightly disagree; (6) disagree; (7) strongly
disagree; (8) don't know.
Procedure
The target population for the telephone interview consisted of persons 18 years of age or older who at
the time of the survey were living in a dwelling unit in Queensland and could be contacted by direct-
dialed, land-based telephone service. The sample was drawn from a telephone database of randomly
generated numbers that had been selected using postcode parameters. Known nonresidential and
nonworking numbers were not included in the database. A smaller sample of randomly generated
mobile telephone numbers was also included. Within each household, one eligible person was
selected as the respondent for the interview. A respondent within each household was randomly
selected to ensure an equal proportion of male and female participants. All participants gave verbal
informed consent to participate.
Analysis
Descriptive analyses gave overall rates of familiarity with the use of prescription drugs for cognitive
enhancement; the overall rate of agreement with using prescription drugs for cognitive enhancement;
and the overall rate of agreement with legalized doping. Participant responses to Q1 were coded into
two groups: “familiar” (they, or someone they know personally, have taken prescription drugs to
enhance concentration or alertness) and “not familiar” (they had never taken prescription drugs to

NHMRC Australia Fellowship 569738 award to Professor Wayne Hall 2009-2013 postprint
4
enhance concentration or alertness and didn't know anyone who had). Participant responses to Q2 and
Q3 were coded into four categories: agree, disagree, neutral, or don't know.
We used logistic regression to examine participant characteristics that predict familiarity with
cognitive enhancement (not familiar = 0 (reference); familiar = 1). The predictor variables were (a)
gender (female = 0 (reference); male = 1); (b) age in years (1834 = 0 (reference); 35–44 = 1; 45–54 =
2; 55+ = 3); and (c) years of education (110 = 0 (reference); 11–12 = 1; 13–14 = 2; 15+ = 3).
We used logistic regression to see what characteristics predicted agreement with the acceptability of
using prescription drugs for cognitive enhancement. In this model, participants who responded “don't
know” or “neutral” were excluded. The dependent variable was “agreement with the acceptability of
using prescription drugs” (coded as disagree = 0; agree = 1). The predictor variables were: (a)
familiarity with those who have engaged in cognitive enhancement (not familiar = 0 (reference);
familiar = 1); (b) gender (male = 0 (reference); female = 1); (c) age in years (18–34 = 0 (reference);
35–44 = 1; 45–54 = 2; 55+ = 3); and (d) years of education (1–10 = 0 (reference); 11–12 = 1; 13–14 =
2; 15+ = 3).
We used the same method to examine predictors of attitudes toward legalized doping in sport (coded
as disagree = 0; agree = 1). The predictors were: (a) attitudes toward the acceptability of using
prescription drugs for cognitive enhancement (disagree = 0; agree = 1); (b) gender (male = 0
(reference); female = 1); (c) age in years (18–34 = 0 (reference); 35–44 = 1; 45–54 = 2; 55+ = 3); and
(d) years of education (1–10 = 0 (reference); 11–12 = 1; 1314 = 2;
15+ = 3).
RESULTS
Sample Characteristics
The sample comprised 1,265 Australian participants (633 males and 632 females) aged 18 years and
older (range 18–101; mean = 53.7 years). Those under 35 years of age comprised 13.9% of the
sample, those 35–54 comprised 35.1%, and those aged 55 and older 50.3%. The sample varied in the
number of years of education: 1–10 (24.3%), 11–12 (22.5%), 13–14 (10.9%), and 15+ (41.2%). The
response rate was 31.9%.
Table 1 Acceptance of cognitive enhancement and use of performance-enhancing drugs
Table 2 Predictive factors for acceptability of cognitive enhancement and legalized doping
Familiarity With Cognitive Enhancement
Familiarity with cognitive enhancement was low in the sample. Most participants (89.6%; n = 1134)
said that neither they nor anyone they knew had taken prescription drugs to enhance their
concentration or alertness. Only 1 in 10 participants (10.4%) were in the “familiar” group: 2.4% of the
total sample (n = 30) said they had taken prescription drugs to enhance their concentration or alertness
in the absence of a diagnosed disorder and a further 8% (n = 101) said they knew someone who had
done so. A logistic regression analysis (χ2(7, N = 1242) = 27.462, p < .001) showed that men were
approximately 1.5 times more likely than women to be in the “familiar” group. Age was also a
significant predictor of familiarity, but education was not. Roughly 21% of participants aged 18–34
either knew someone who had used prescription drugs to enhance alertness or concentration, or had
done so themselves (6.2% of the 18–34 group had ever used). Younger participants were 2.5 times
more likely to have used prescription drugs for cognitive enhancement or know someone who had
compared to those aged 35–44, 2.65 times more likely than those aged 45–54, and 2.97 times more
likely than those aged 55 and older.

NHMRC Australia Fellowship 569738 award to Professor Wayne Hall 2009-2013 postprint
5
Attitudes Toward Cognitive Enhancement
Only 7% of participants (n = 89) agreed that it is acceptable for healthy people without a diagnosed
disorder to use prescription drugs to enhance their concentration or alertness (Table 1). Eighty-five
percent (n = 1085) disagreed to any extent (42.7% disagreed “strongly” and 2.2% disagreed
“slightly”). Very few participants said they didn't know (4%; n = 51), or were neutral (3.2%; n = 40).
The logistic regression analysis examining factors predicting attitudes toward the acceptability of
healthy people using prescription drugs to enhance their concentration or alertness was statistically
significant (χ2(8, N = 1153) = 26.989, p < .001). It showed that those in the “familiar” group were
almost twice as likely as those in the “not familiar” group to agree that it was acceptable (Table 2).
Younger participants aged 18–34 were 3.2 times more likely than those aged 45–54 to find cognitive
enhancement acceptable and 2.7 times more likely than those aged 55 and older. Gender and level of
education were not statistically significant predictors.
Attitudes Toward Legalized Doping
Only 3.6% of participants (n = 45) agreed that people who play professional sport should be allowed
to use performance-enhancing drugs if they wanted to (see Table 1). Ninety-three percent (n = 1181)
of participants disagreed with legalized doping to any extent (65.9% disagreed “strongly” and 0.5%
disagreed “slightly”). Very few participants said they didn't know (1.3%; n = 17), or were neutral
(1.7%; n = 22).
The regression model predicting agreement with legalized doping was statistically significant (χ2(8, N
= 1135) = 41.737, p < .001). Gender, age, and education were not significant predictors, but attitude
toward the acceptability of cognitive enhancement was a statistically significant predictor.
Participants who said it was acceptable for healthy people to use prescription drugs for cognitive
enhancement were 9.5 times more likely to think that people who play professional sport should be
allowed to use performance-enhancing drugs if they wanted to (Table 2).
DISCUSSIONJ
Despite explicit analogies being drawn between the ethical and regulatory issues surrounding
cognitive enhancement and sports doping, this is the first time public attitudes toward the two forms
of enhancement have been assessed. The majority of our participants clearly believed it was
unacceptable for healthy people to use prescription drugs to improve their concentration or alertness.
They were even more disapproving of allowing professional athletes to use PEDs if they wanted to
(most disagreed “strongly”). Policies that facilitated the use of prescription drugs by healthy people
for cognitive enhancement (e.g., Greely et al. 2008) would be at odds with the attitudes of the vast
majority of our participants. Similarly, proposals to relax doping controls and permit the use of PEDs
in sport (e.g., Kayser et al. 2005; Kayser and Smith 2008; Savulescu et al. 2004s) would also appear
to be strongly opposed by the Queensland general public. These results provide new information
about the nature of the relationship between attitudes toward different forms of enhancement. Kayser
and Smith (2008) criticize what they see as hypocrisy in public support for “zero tolerance” toward
doping in sport while the use of drugs for cognitive enhancement is deemed a socially acceptable
behavior. Our results do not support the existence of contrasting attitudes. At least for this sample of
the Australian public, the use of drugs for cognitive enhancement was not acceptable (nor one that
was commonly engaged in), and nor was the prospect of legalized doping in sport.
Hoberman (2005) suggested that attitudes toward sports doping may be related to attitudes toward
pharmacological enhancement in general. Only a minority of our participants found cognitive
enhancement acceptable (7%), but they were 9.5 times more likely to agree that professional athletes
should be allowed to use PEDs if they wanted to. Even so, the vast majority of those who found
cognitive enhancement acceptable did not support the use of PEDs.

Citations
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Journal ArticleDOI
TL;DR: Overall, it is found that several concerns about the use of PCE are prevalent in the public, and a coherent finding is that nonusers display more concerns regarding medical safety and fairness than users.
Abstract: A primary means for the augmentation of cognitive brain functions is "pharmacological cognitive enhancement" (PCE) The term usually refers to the off-label use of medical substances to improve mental performance in healthy individuals With the final aim to advance the normative debate taking place on that topic, several empirical studies have been conducted to assess the attitudes toward PCE in the public, 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

98 citations


Cites background from "A Comparison of Attitudes Toward Co..."

  • ...…2012 Switzerland Physicians Stratified random sampling (profession, gender, years of training, language) Paper and pencil questionnaire 23.9% 379 Safety Partridge et al., 2012 Australia General public Random sampling Telephone interview 31.9% 1265 General Partridge et al., 2013 Australia…...

    [...]

  • ...…of PCE amongst 1265 members of the general public in Australia found that respondents who were familiar with PCE—either by using it themselves or by knowing somebody who used PCE—were twice as likely to find PCE acceptable than respondents who were not familiar with it (Partridge et al., 2012)....

    [...]

  • ...Authors Country Occupation of Sampling method Research Response Sample Concerns participants method rate size Aikins, 2011 USA University students Purposive sampling Semi-structured interview n/a 12 Safety, fairness Asscher and Schermer, 2013 The Netherlands General public Purposive sampling Focus groups n/a 37 Safety Ball and Wolbring, 2014 Canada Parents Purposive sampling Semi-structured interview n/a 12 Safety Banjo et al., 2010 USA and Canada Physicians Convenience sampling Web-based survey n/a 212 Safety, coercion, Fairness Bell et al., 2013 Australia University students Convenience sampling Interview n/a 19 Safety, coercion Bergström and Lynöe, 2008 Sweden General public Random sampling Paper and pencil questionnaire 52% 517 Safety Physicians 39% 108 Bossaer et al., 2013 USA University students All students at one university invited Web-based survey 59.9% 372 Safety, fairness Desantis and Hane, 2010 USA University students Convenience sampling Interview n/a 175 Safety Dodge et al., 2012 USA University students All students at one university invited Web-based survey 37% ±1200 Fairness Dubljević et al., 2013* Germany University students Three stage cluster sampling (universities, disciplines, students) Web-based survey First wave 53.5% 5882 Fairness Second wave 69.1% 3486 Eickenhorst et al., 2012 Germany University students Convenience sampling Web-based survey n/a 1218 Safety University graduates 106 European Citizens Panel, 2006 Belgium, Denmark, France, Germany, Greece, Hungary, Italy, the Netherlands, UK General public Stratified random sampling (age, profession, gender) Citizen’s deliberation n/a 126 Coercion Fitz et al., 2013 USA and Canada General public Convenience sampling, Amazon’s Mechanical Turk recruitment Web-based survey n/a 4011 Safety, coercion, fairness (Continued) Frontiers in Systems Neuroscience www.frontiersin.org April 2014 | Volume 8 | Article 53 | 3 Table 1 | Continued Authors Country Occupation of Sampling method Research Response Sample Concerns participants method rate size Forlini and Racine, 2009 Canada University students Purposive sampling Focus groups n/a 29 Coercion Parents 21 Health care providers 15 Forlini and Racine, 2012a Canada University students Purposive sampling Focus groups n/a 29 Safety, coercion, fairness Parents 21 Health care providers 15 Forlini and Racine, 2012b Canada University students Purposive sampling Focus groups n/a 29 Safety, fairness Parents 21 Health care providers 15 Franke et al., 2012a* Germany High school students All students at 12 public grammar and vocational schools, and students of three departments of one university invited Paper and pencil questionnaire 83% 1035 Safety, coercion, fairness University students 512 Franke et al., 2012b Germany University students Convenience sampling Interview n/a 22 Safety, coercion, fairness Franke et al., 2014 Germany Physicians All primary care physicians in one state invited Paper and pencil questionnaire 30.2% 832 Safety Hotze et al., 2011 USA Physicians Random sampling Paper and pencil questionnaire 46.6% 633 Fairness Judson and Langdon, 2009 USA University students All students at two colleges invited Paper and pencil questionnaire 10% 333 Safety Kudlow et al., 2013 Canada University students All medical students at one medical school invited Web-based survey 50% 326 Safety Maier et al., 2013 Switzerland University students All students at three educational institutions invited Web-based survey 22.3% 6275 Coercion Maslen et al., in press Germany University students Convenience sampling Paper and pencil questionnaire n/a 80 Coercion Mazanov et al., 2013 Australian University students Convenience sampling Web-based survey n/a 1729 General, fairness Ott and Biller-Andorno, 2013 Switzerland University students Convenience sampling Web-based survey and separate paper and pencil questionnaire n/a 1765 Safety, fairness (Continued) Frontiers in Systems Neuroscience www.frontiersin.org April 2014 | Volume 8 | Article 53 | 4 Table 1 | Continued Authors Country Occupation of Sampling method Research Response Sample Concerns participants method rate size Ott et al., 2012 Switzerland Physicians Stratified random sampling (profession, gender, years of training, language) Paper and pencil questionnaire 23.9% 379 Safety Partridge et al., 2012 Australia General public Random sampling Telephone interview 31.9% 1265 General Partridge et al., 2013 Australia University students Convenience sampling Interview n/a 19 Safety Riis et al., 2008 USA University students No information provided Web-based survey n/a 357 Fairness Sabini and Monterosso, 2005 USA University students Convenience sampling Paper and pencil questionnaire n/a 185 Fairness Santoni de Sio et al., in press United Kingdom University students Convenience sampling Paper and pencil questionnaire n/a 102 Safety, fairness Sattler et al., 2013a* Germany University students Three stage cluster sampling (universities, disciplines, students) Web-based survey 87.1% 1852 Safety, fairness (Sattler et al., 2013b)* Germany University teachers Three stage cluster sampling (universities, disciplines, students/teachers) Web-based survey 33.5% 1402 Safety University students 69.1% 3486 Sattler et al., 2014* Germany University students Three stage cluster sampling (universities, disciplines, students); only second time wave Web-based survey 69.1% 3486 Safety, coercion, fairness Sattler and Wiegel, 2013* Germany University students Three stage cluster sampling (universities, disciplines, students); only second time wave Web-based survey First wave 53.5% 5882 Safety Second wave 69.1% 3486 Scheske and Schnall, 2012 UK University students Convenience sampling, two studies - two samples Paper and pencil questionnaire n/a 50 Safety, fairness 306 Schildmann et al., 2013 Germany University students No information provided Survey n/a 1026 Coercion, fairness (Continued) Frontiers in Systems Neuroscience www.frontiersin.org April 2014 | Volume 8 | Article 53 | 5 Table 1 | Continued Authors Country Occupation of Sampling method Research Response Sample Concerns participants method rate size Schuijff and Brom, 2013 The Netherlands All Purposive sampling Focus groups n/a 38 Safety, coercion, fairness Sweeney, 2010 USA University students Convenience sampling Paper and pencil questionnaire n/a 100 Safety, fairness Convenience sampling and purposive sampling require no random selection of participants, whereas random sampling, stratified random sampling and cluster sampling do....

    [...]


Journal ArticleDOI
TL;DR: This study provides empirical data on Australian university students' perceptions of the prevalence of prescription stimulant use by their peers for cognitive enhancement; motivations for such use; efficacy; and its safety.
Abstract: 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. [Partridge B, Bell S, Lucke J, Hall W. Australian university students' attitudes towards the use of prescription stimulants as cognitive enhancers: Perceived patterns of use, efficacy and safety. Drug Alcohol Rev 2013;32:295-302]

57 citations



Journal ArticleDOI
TL;DR: The results show that Australian students report using substances for study purposes at a higher lifetime rate than observed among US or German students, and the main reasons for use were to improve focus and attention, and to stay awake.
Abstract: 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.

43 citations


Journal ArticleDOI
TL;DR: Students who choose coping responses that do not moderate stress where possible, may cause themselves additional distress and avoid learning more effective coping responses, and assisting students who may be inclined to use prescription stimulants for cognitive enhancement may reduce possible drug-related harms.
Abstract: 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.

41 citations


References
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Journal ArticleDOI
10 Dec 2008-Nature
TL;DR: Society must respond to the growing demand for cognitive enhancement by rejecting the idea that 'enhancement' is a dirty word, argue Henry Greely and colleagues.
Abstract: Society must respond to the growing demand for cognitive enhancement. That response must start by rejecting the idea that 'enhancement' is a dirty word, argue Henry Greely and colleagues.

725 citations


"A Comparison of Attitudes Toward Co..." refers background in this paper

  • ...…nonmedical use of prescription drugs by healthy people for “cognitive enhancement” is the university student who buys prescription stimulants (e.g., Ritalin or Adderall) from a friend because she wants to improve her normal level of concentration or achievement while studying (Greely et al. 2008)....

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  • ..., Ritalin or Adderall) from a friend because she wants to improve her normal level of concentration or achievement while studying (Greely et al. 2008)....

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  • ...Policies that facilitated the use of prescription drugs by healthy people for cognitive enhancement (e.g., Greely et al. 2008) would be at odds with the attitudes of the vast majority of our participants....

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Journal ArticleDOI
TL;DR: It is suggested that declarative memory can be improved by stimulants, with some evidence consistent with enhanced consolidation of memories, and the cognitive effects of stimulants on normal healthy people cannot yet be characterized definitively.
Abstract: 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.

389 citations


Journal ArticleDOI
TL;DR: The use of performance enhancing drugs in the modern Olympics is on record as early as the games of the third Olympiad, when Thomas Hicks won the marathon after receiving an injection of strychnine in the middle of the race.
Abstract: The legalisation of drugs in sport may be fairer and safer In 490 BC, the Persian Army landed on the plain of Marathon, 25 miles from Athens. The Athenians sent a messenger named Feidipides to Sparta to ask for help. He ran the 150 miles in two days. The Spartans were late. The Athenians attacked and, although outnumbered five to one, were victorious. Feidipides was sent to run back to Athens to report victory. On arrival, he screamed “We won” and dropped dead from exhaustion. The marathon was run in the first modern Olympics in 1896, and in many ways the athletic ideal of modern athletes is inspired by the myth of the marathon. Their ideal is superhuman performance, at any cost. The use of performance enhancing drugs in the modern Olympics is on record as early as the games of the third Olympiad, when Thomas Hicks won the marathon after receiving an injection of strychnine in the middle of the race.1 The first official ban on “stimulating substances” by a sporting organisation was introduced by the International Amateur Athletic Federation in 1928.2 Using drugs to cheat in sport is not new, but it is becoming more effective. In 1976, the East German swimming team won 11 out of 13 Olympic events, and later sued the government for giving them anabolic steroids.3 Yet despite the health risks, and despite the regulating bodies’ attempts to eliminate drugs from sport, the use of illegal substances is widely known to be rife. It hardly raises an eyebrow now when some famous athlete fails a dope test. In 1992, Vicky Rabinowicz interviewed small groups of athletes. She found that Olympic athletes, in general, believed that most successful athletes were using banned substances.4 Much of the writing on the use of …

298 citations


"A Comparison of Attitudes Toward Co..." refers background in this paper

  • ...The nonmedical use of prescription drugs by healthy people for cognitive enhancement and the use of PEDs in Brad Partridge has been awarded an NHMRC Training Fellowship....

    [...]

  • ...Younger participants were 2.5 times more likely to have used prescription drugs for cognitive enhancement or know someone who had compared to those aged 35–44, October–December, Volume 3, Number 4, 2012 ajob pr 83 Acceptable for healthy people to use prescription drugs for cognitive enhancement (CE) 1265 7.0 85.8 3.2 4.0 - Familiar with CE 131 13.0 79.4 4.6 3.1 - Unfamiliar with CE 1134 6.3 86.5 3.0 4.1 - Age 18–34 176 12.5 77.8 6.8 2.8 - Age 35–44 202 11.4 83.2 3.5 2.0 - Age 45–54 241 4.1 90.0 2.5 3.3 - Age 55+ 636 5.0 87.4 2.2 5.3 Acceptable for professional athletes to use PEDs if they want to 1265 3.6 93.4 1.7 1.3 - CE is acceptable 89 15.7 77.5 3.4 3.4 - CE is not acceptable 1085 2.0 96.9 1.0 0.1 Note....

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  • ...…there actually exists a “culture of enhancement” in many Western societies (Knorr Cetina 2005), and a number of bioethicists have even recommended various degrees of “legalized doping” in sport, by allowing athletes to use PEDs (Kayser and Smith 2008; Kayser et al. 2005; Savulescu et al. 2004)....

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  • ...Only a minority of our participants found cognitive enhancement acceptable (7%), but they were 9.5 times more likely to agree that professional athletes should be allowed to use PEDs if they wanted to....

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  • ...Since the inception of the World Anti-Doping Agency (WADA) in 1999—globally formalizing a prohibitive stance toward the use of PEDs in sport—expenditures on eradicating “doping” in sport (e.g., drug testing of athletes) have increased enormously....

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Journal ArticleDOI
TL;DR: The illicit use of stimulants for cognitive enhancement is significantly higher than non-medical use of prescription stimulants among pupils and students in Germany.
Abstract: Introduction The aim of this study was to assess for the first time the prevalence and factors associated with stimulant use exclusively for cognitive enhancement among pupils and university students in Germany. Methods A sample of 1 035 pupils (vocational and grammar schools) in small and big cities and 512 university students of 3 Departments (Medicine, Pharmacy, Economics) completed a questionnaire regarding knowledge and use of stimulants for cognitive enhancement and factors associated with their use. Results Lifetime prevalence for use of prescription stimulants (methylphenidate, amphetamines) for cognitive enhancement in pupils was 1.55% and in students 0.78%. Last-year and last-month prevalence rates were significantly lower. 2.42% of pupils and 2.93% of students reported lifetime illicit use of stimulants (amphetamines, cocaine, ecstasy) for cognitive enhancement with lower last-year and last-month rates. Prevalence was higher in male pupils, pupils from vocational schools and pupils with bad marks. Discussion The illicit use of stimulants for cognitive enhancement is significantly higher than non-medical use of prescription stimulants among pupils and students. Stimulant use is determined by gender, school type, and school marks. The potential risks associated with stimulant use require early awareness and intervention strategies.

211 citations


Additional excerpts

  • ...(Franke et al. 2011)....

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Journal ArticleDOI
Vince Cakic1
TL;DR: The ethical and pragmatic implications of nootropic use in academia are reviewed by drawing parallels with issues relevant to the drugs in sport debate by examining the use of methylphenidate, modafinil and piracetam among healthy students within academia.
Abstract: Reports in the popular press suggest that smart drugs or "nootropics" such as methylphenidate, modafinil and piracetam are increasingly being used by the healthy to augment cognitive ability. Although current nootropics offer only modest improvements in cognitive performance, it appears likely that more effective compounds will be developed in the future and that their off-label use will increase. One sphere in which the use of these drugs may be commonplace is by healthy students within academia. This article reviews the ethical and pragmatic implications of nootropic use in academia by drawing parallels with issues relevant to the drugs in sport debate. It is often argued that performance-enhancing drugs should be prohibited because they create an uneven playing field. However, this appears dubious given that "unfair" advantages are already ubiquitous and generally tolerated by society. There are concerns that widespread use will indirectly coerce non-users also to employ nootropics in order to remain competitive. However, to restrict the autonomy of all people for fear that it may influence the actions of some is untenable. The use of potentially harmful drugs for the purposes of enhancement rather than treatment is often seen as unjustified, and libertarian approaches generally champion the rights of the individual in deciding if these risks are acceptable. Finally, whether the prohibition of nootropics can be effectively enforced is doubtful. As nootropics use becomes widespread among students in the future, discussion of this issue will become more pressing in the years to come.

180 citations


"A Comparison of Attitudes Toward Co..." refers background in this paper

  • ...In the bioethics literature, cognitive enhancement has been compared to performance enhancement in sport (e.g., ajob pr 81 Cakic 2009)....

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  • ...…to the “enhanced” individual; (5) the health risks of using prescription drugs for nonmedical purposes; and (6) the effectiveness of the relevant regulatory systems in discouraging such use (see, e.g., Cakic 2009; Kayser et al. 2005; Kayser and Smith 2008; Lucke et al. 2011b; Partridge 2010)....

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Q1. What contributions have the authors mentioned in the paper "Nhmrc australia fellowship 569738 award to professor wayne hall 2009-2013 postprint" ?

This article compares public attitudes toward the use of prescription drugs for cognitive enhancement with the use of performance enhancing drugs in sport. Of 1,265 participants, 7 % agreed that cognitive enhancement is acceptable ; 2. 4 % of the total sample said they had taken prescription drugs to enhance their concentration or alertness in the absence of a diagnosed disorder, and a further 8 % said they knew someone who had done so. Furthermore, their findings do not support media claims that the use of prescription drugs for cognitive enhancement is widespread in all sectors of society.