Beyond Treatment Versus Enhancement: A Qualitative Study of Pharmacological Neuro-Enhancement Among Dutch and Lithuanian University Students

Abstract

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.

Cognitive enhancement with licit and illicit stimulants in the Netherlands and Finland: what is the evidence?

“…Thus, what is included under the term “enhancement drugs” would require rethinking (Hupli et al , 2016), as prescription opioids are reportedly used in working life in Finland more than prescription stimulants (EHYT, 2017). Students in the Netherlands have also reported the use of several drugs for “cognitive enhancement”, from prescription to illicit and lifestyle drugs like nicotine (Hupli et al , 2016; 2019a; Schelle et al , 2015; Schermer, 2016). Therefore, research in this field needs to consider other drugs used for cognitive enhancement purposes beyond prescription stimulants.…”

“…Overestimations about prevalence and efficacy might generate more use as young people might consider their use as a norm (McCabe, 2008; Outram, 2010). It is, therefore, important that the discussion and research around PCE is based on empirical knowledge about their actual prevalence and user effects to avoid giving too optimistic visions of their potential to enhance human abilities (Schleim and Quednow, 2017; Hupli et al , 2016; 2019a; Partridge et al , 2011).…”

“…This seems to be the case among young users as well; a qualitative study combining 35 user reports from the Netherlands and Lithuania found out that ADHD-diagnosed students sometimes used other drugs for enhancement purposes and undiagnosed students were occasionally convinced that their use of Ritalin was due to medical necessity (Hupli et al , 2019a).…”

“…Academic literature on the topic is also presented when comparing research on cognitive enhancement drug use between the two countries. As PCE has not been researched in Finland, and cross-country research is scarce (Hupli et al , 2019a; Maier et al , 2018), this review provides one of the first empirical glimpses into the phenomena within the Finnish context while expanding the review of the Netherlands (Schermer, 2016). This comparison between the countries where the debates and practices of cognitive enhancement drug use seem to be at different stages is meant to stress the importance of context of drug use and policy (Duff, 2011).…”

Study drug use among university students in Western Australia: Results of a web survey and their policy and practice implications

“…Alternatively, even though we were explicit about including both non‐users and users of ‘study drugs’ it may have attracted a larger proportion of users. It is also possible that some of the respondents who were excluded from the prescription CE category as they had a valid prescription, may also be using the drug off‐label as a CE [37]. The results suggest that the use of prescription drugs as CEs is worthy of inclusion in representative studies of young Australians, and students in particular, and of consideration from a university policy and health service point of view.…”