The Debate about “Neuroenhancement”

Have you ever wanted to accomplish more than was humanly possible, given your current resources of time and energy? Have you wished you had a drug that could make superhuman accomplishments possible? Alex and Lucy are college students who had the same desire, and they found stimulant medications (Adderall for Alex, Provigil for Lucy) that seemed to fit the bill. It is important to point out that the students were taking these medications “off-label” to help them “do it all” (Lane, 2010, p.12). Neither Alex nor Lucy had a psychiatric diagnosis of attention deficit hyperactivity disorder or sleep disorder, nor a prescription for the drug that allegedly enhanced their performance. Neither had any concern about what they were doing. For example, Lucy asserted that “Taking a pill is no different to having a cup of coffee” (Lane, 2010, p. 13). Is it? As a mental health professional, what do you think? I think it is medication misuse. Studies show that non-medical use of prescription stimulants is an ever-increasing problem on college campuses in the United States (McCabe, Knight, Teter, & Wechsler, 2005). In a study of more than 10,000 college students, rates were as high as 25% at some schools. Users of the drugs were more likely to be white males who had lower grade point averages and belonged to fraternities (McCabe et al., 2005). After a spate of newspaper and magazine articles calling attention to the use/misuse of stimulant drugs for “neuroenhancement” by high school and college students, vigorous debate ensued among neuropsychologists, physicians, bioethicists, and educators (Lane, 2010). It is surprising to me that “neuroenhancement” has defenders such as Greely et al., (2008), who published a paper in Nature asserting that “mentally competent adults should be able to engage in cognitive enhancement using drugs” (p. 703). The authors, prominent professors at institutions such as Stanford and Harvard, suggest that the drugs will prove “increasingly useful for improved quality of life and extended work productivity” (p. 705). Another defender of neuroenhancers spoke of “customizing your brain” (cited in Lane, 2010, p. 13). In contrast, college professor Lane considers student use of nonprescribed stimulants “cheating” (p. 13). As a nurse, I immediately think of the potential for adverse outcomes of this drug misuse, such as dependence and side-effects. I remember disastrous results from the excessive dextroamphetamine use that we were seeing decades ago. Readers, are you seeing young people in your clinical practice who are misusing stimulants? Do they obtain the drugs by pilfering from the family medicine cabinet or by persuading their friends to “share”? Do they begin using “downers” when they are too stimulated? Is there any credible evidence that their performance on academic assignments is truly enhanced? I would welcome submissions of articles by psychiatric clinicians who are dealing with this issue. To their credit, Greely et al. (2008) did call for research on the impact of cognitive-enhancing drugs. Nurse researchers are well suited to contribute to this research. Nurses also have a role in educating their clients who take stimulants for legitimate reasons, given the frequency with which young people with prescribed stimulants are being approached by classmates to sell or give them away (54% as reported in McCabe et al., 2005). I am anxious to hear if the use of stimulants for neuroenhancement is prevalent in other countries, and if so, how psychiatric professionals in those countries view the issue. I await your articles or letters to the editor.