This article examines the ambiguous relationship between treating illness and enhancing normalcy through the use of “cognitive enhancement” drugs. Although the literature on pharmacological neuro-enhancement generally differentiates between the “licit/therapeutic” and “illicit/enhancement” use of substances, in-depth interviews with 35 university students in the Netherlands and Lithuania—both with and without formal medical diagnoses of (mainly) Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder—reveal the fluidity of these categories. Our study of the perceptions and experiences of people who use such drugs further suggests a much broader range of substances, motives, and sought-after effects than are commonly acknowledged in the “cognitive enhancement” literature. We need a more inclusive and context-sensitive approach to study pharmacological neuro-enhancement, for instance, by approaching both licit and illicit drugs as tools or instruments.

The use of cognitive enhancement drugs (CEDs) among university students has raised widespread concerns about non-medical prescription drug use, safety, exam cheating, and study-related stress. While much of the empirical research to date has been conducted in the United States and Australia, this article examines perceptions and experiences of CED use among university students in the Netherlands and Lithuania. Our data come from two qualitative studies and one mixed-methods study and comprise 35 semi-structured interviews (20 in the Netherlands and 15 in Lithuania) and openended online survey responses from a convenience sample of 113 students in the Netherlands. Employing a crowded theory approach to interpret our qualitative data, we found most of our informants turned to CEDs to enhance their studying through better concentration and time management. Students used a broad range of pharmaceuticals (with and without a physician's prescription), recreational drugs, and nutritional supplements as cognitive enhancers, were generally well informed about the safety and efficacy of the substances they used, experienced both beneficial and adverse effects, and self-regulated their CED use to balance these effects, ensuring that their use remained moderate and thoughtful.