Getting Clever About Smart Drugs: A Few Remarks for Students, Parents and educators.

A spectre is haunting Britain - imported from America of course - the spectre of 'Smart Drugs'! Soon every university student in the country will be hooked on Adderall or Modafinil and cramming for exams until the cows come home, just like their overly ambitious counterparts across the Atlantic.

A spectre is haunting Britain - imported from America of course - the spectre of 'Smart Drugs'! Soon every university student in the country will be hooked on Adderall or Modafinil and cramming for exams until the cows come home, just like their overly ambitious counterparts across the Atlantic. Students and parents will be pleading with doctors for an ADHD or narcolepsy diagnosis so that they can be prescribed the latest psychostimulant. Creativity, critical thinking and Bildung be damned; the government has made it clear: it's a dog-eat-dog, brave new world out there and our kids just aren't cutting the mustard anymore. We need memorisation, skills and vocations, none of this artsy-fartsy, outdated, citizen-forming university education nonsense anymore (unless you're a deserving member of the upper classes). The government is of course also unflinchingly anti-drugs, but we needn't worry ourselves with that, this isn't 'opening the doors of perception' or some other fruity waste of time, these drugs are the fire in the gut, or rather the brain, of homo economicus.

Okay, none of this is really true, but there certainly seems to be a lot of hype surrounding the use of so-called 'smart drugs' for what's termed (in academic parlance) 'cognitive enhancement': pharmaceutical manipulation of the brain to improve cognitive capabilities of otherwise normally functioning individuals.

When I organised a public debate on the topic in January, I was inundated with interest from the media, and the local student newspaper soon demanded that the university where I work come up with a 'smart drug policy', despite lack of evidence that there was a problem or even much use amongst students. Reading some national newspapers you'd be forgiven for thinking think that use of Ritalin and Modafinil was already widespread amongst British students (no evidence of that), and that all of New York is on Adderall (my unscientific informal poll of professionals I know in New York revealed no such prevalence). Notwithstanding the hype, there are still a number of important issues surrounding 'smart drugs' or 'cognitive enhancement' that students, educators and parents should be thinking about.

The first thing is to figure out what we're talking about when we use the term 'smart drugs'. For the moment this means the off-label use of psychostimulants usually prescribed for conditions like Attention Deficit Hyperactivity Disorder (Ritalin, Adderall) or narcolepsy (Modafinil). An increase in ADHD diagnoses means a larger grey market for psychostimulants prescribed for the condition. This is certainly what has happened in the US. The lack of a clear aetiology for ADHD coupled with the drastic increase in prevalence has many in the psychological and psychiatric professions rightfully concerned, as psychostimulant use becomes more and more common amongst school-age Americans. In the future there will most likely be pharmaceuticals directly aimed at cognitive enhancement, but at the moment the drugs in question are being used off-label.

This is at the source of one of the two main worries: safety and fairness. The first is a legitimate concern, the second not. The psychostimulants that we hear most about Adderall, Ritalin, and Modafinil have all been shown to have potentially dangerous side effects, including dependence, and in some extreme cases even psychosis. This is cause for serious concern. But we have to be realistic and honest about the fact that students are not exactly a risk adverse group, many may be willing to take some chances if there is a real benefit. Moreover, universities have seemingly little issue with selling a more dangerous drug to students, often at highly discounted prices - alcohol. Saying the drugs are dangerous is not likely to be a huge deterrent to their use.

With good intentions, some universities have indicated that they would consider 'smart drug' use a form of cheating. Legally, this stacks up. The use of these pharmaceuticals without a prescription is illegal. Morally however, it's questionable whether there is any difference in taking a smart drug to gain an advantage and paying for extra tutoring, or seeking guidance from a nutritionist on a brain-friendly diet, both of which would probably be encouraged. In fact, the latter two, by being more expensive and probably making a bigger difference in performance than the pychostimulants in question are probably more unfair in a strict sense. So I think we can set the fairness issue aside.

But do they work? Experiments in laboratory conditions have shown negligible change in the cognitive performance of normally performing individuals. So why are students taking them? Some point to a placebo effect. There is probably some truth to this, but anecdotal evidence also points to some real world effects that are hard to measure in laboratory conditions, namely a boost in the feeling of motivation and the capacity to focus for longer periods. The ability to stay awake and lucid for longer than normal is also obviously a plus for many sleepy students. So rather than enhancing cognitive capacities themselves, what some people report is an ability to use their existing capacities better and longer.

It's this idea of motivation or focus 'in a can' that concerns me. Universities and schools in general are special parts of our societies. They are not just places where employment skills are learned or information memorised for future repetition. They are places where characters are formed, where the value of being able to muster motivation and focus in adverse conditions is learned. Substituting a pharmaceutical for the formation of these traits seems undesirable, regardless of the efficacy of the outcome.

Educational institutions are also places where students fall in love, not just with one another, but with ideas. As we all know, love involves daydreaming, letting the mind wander aimlessly, and chasing plenty of futile ends. The so-called 'smart drugs' available at the moment do not lend themselves favourably to these kinds of 'romantic' activities, but rather to narrowly focused cramming and memorisation, which has its place, but is a mere shadow of all that we call learning.

Finally, there the issue of a gradual medicalisation and 'technisation' of life, the idea that there is a technical or medical solution to challenges in all aspects of our lives. This last concern is linked (I think) to some of the controversy around the rise in ADHD diagnoses. These concerns make me a conservative in many regards. I think there is something worth holding on to in the way that we value effort and will power, but also daydreaming, creativity, and often futility in learning and education. We should think very carefully before potentially making changes to these aspects of institutionalised learning.

Bioethicist Ruud ter Meulen counsels not making too much fuss about drugs used by relatively few with little or no gain, but poorly defined risks. Prohibiting something often makes it more attractive. I agree, I'm also not sure what grounds could be used to prohibit the use of a new drug developed and approved specifically for 'cognitive enhancement'.

What can be done is for university policy to explicitly place emphasis on the character forming and 'romantic' aspects of education. And why not go as far as to tell students directly that any drug that might negatively impact these parts of the learning experience is not very smart at all.


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