One of the hottest topics in the bioethics world involves the use of cognitive enhancers—also known as “smart drugs”, “brain boosters”, and “nootropics”—to achieve elevated mental and physical performance. Some of the most intense enhancers are prescription pharmaceuticals, like Adderall and Ritalin, which are stimulants that have historically been used to treat attentional disorders such as ADHD. In addition to increasing concentration, many of these compounds have also been shown to drastically enhance mood, cognition, and creativity in those who are psychologically healthy. Whether these effects persist over the long-term is still a matter of heated debate, and unwanted side effects such as nervousness, insomnia, and psychological disturbances have been commonly reported.
Still, given the great advantages, we must ask ourselves whether the responsible use of performance enhancing stimulants by neurologically and psychologically healthy individuals is ethically acceptable at this time. Many rational people—including some respected, high profile scientists—believe that mentally competent adults should be able to choose to enhance their cognition with stimulants if they so please. At the same time, others are concerned that legalization would quickly lead to drug abuse and misuse. So the question is, do the positive attributes of stimulant-based cognitive enhancement outweigh the negatives?
As a cognitive neuroscientist who often relied on Adderall to complete critical assignments and tasks during my academic and research career, my experience may shed some light on the subject. My first encounter with Adderall was nothing short of a life-changing experience, and I imagine that I am not alone in this. Actually, “life-changing” is probably the perfect way to describe it, as the consequences of that initial act had effects on my future that still prevail today. Some were positive while others were negative, but all were equally illuminating.
My first time ingesting the innocuous-looking tiny orange tablet was in a university library just over a decade ago. Fearful of tampering with my brain, I was hesitant at first, but eventually my curiosity got the best of me. I had just learned about neurotransmitters in my undergraduate neurobiology course and was eager to experience what it felt like to alter their levels. Could a little pill that’s prescribed to young children noticeably boost my mood and ability to focus in an instant?
In no time I found myself in a deep state of concentration unlike any before. The textbook I was reading—which had previously seemed dry and meticulous—momentarily became an incredibly fascinating piece of literary work. I was learning about what was going on in my brain as it was happening, and I could vividly picture the cellular and molecular processes playing out in my mind like a Pixar film. When I finally lifted my head and looked around, I thought to myself, “I could realistically read every single book in this place with enough Adderall.” The next 8 hours spent glued to my books was an indication that this thought might be more than a fleeting stimulant-fueled fantasy. Who would have thought that studying could be a thrill? It was like someone had opened up an interstate for knowledge that led directly into my brain, providing free flow of information with no bottlenecks or restrictions.
Needless to say this wasn’t the last time I took Adderall. Use continued intermittently up until I was a neuroscience doctoral student conducting my own research on cognition, at which time I found a host of peer-reviewed articles that corroborated the details of my experiences. For example, a well-controlled study on the effects of Ritalin found increased accuracy on a variety of working memory tasks, while a meta-analysis—a type of study known for being statistically reliable—showed that Adderall strengthened performance on sustained attention and vigilance tasks. These results came as no surprise to me, as I myself had bore witness to them many times.
But soon I learned—as pointed out by the esteemed neuroscientist and neuroethicist Martha Farah—that ADHD drugs don’t actually boost IQ. They only increase motivation and perceived energy. Perhaps a better name for ‘smart drugs’ would be ‘productivity pills’. This point mattered little to me since the only thing I was concerned with was whether they could massively increase my capacity to get stuff done, which they most certainly did. Term papers, proposals, computer task programming—all would be completed despite the vast amounts of time I spent doing less scholarly things, like writing music with buddies and hanging out with my girlfriend. I knew that I had a secret weapon that allowed for all of it. I wasn’t physically addicted to Adderall because I never experienced any withdrawal symptoms or urges that were totally beyond my control. However, I was certainly psychologically addicted to the productivity it produced.
But it wasn’t long until I realized that the side effects reported by researchers and news specials were real and unavoidable. Anxiety, irritability, dry mouth, and insomnia were all present to some degree. At one especially busy time of the school year I had become so sleep deprived that my cognition grew much too sloppy to write or even think with any real precision, and my brain was on the verge of complete malfunction. For some time I was plagued by periodic states of mental disarray which put my academic career in serious jeopardy. This condition persisted until I found an insomnia medication that could correct the sleep-wake balance that had been severely damaged. It took months of ten-hour sleep nights, along with countless hours spent practicing mindfulness meditation, until I began to feel like my cognition had fully recovered. I’d learned my lesson, and was done with Adderall for good.
So after all this, do I believe that prescription stimulants and other ADHD medications should be legal and widely available to the general public? As surprising as it may sound given my story, I don’t have a clear answer to that. Adderall certainly got me through some major academic obstacles that I might not have survived otherwise. Eventually my health suffered because of it, but that was likely a result of excessive use and poor sleep habits. To be honest, I can’t say for sure that I’d be where I am had I not had access to the most popular prescription drug on U.S. college campuses during particular critical moments. I had the smarts to achieve, but I often lacked the discipline and focus, which was more directed towards creative ventures that did not directly relate to my professional goals.
The reality is that we live in a dog-eat-dog world with a cutthroat educational system and an exceedingly competitive job market. It seems certain that those who are able to convince their doctor of attention problems possess a highly unfair advantage, and it may just be time to even out the playing field. Stimulant-based cognitive enhancers might not just yield more productive students, but a more productive nation. Proper use could significantly elevate the performance of computer programmers, stock traders, CEOs, lawmakers, and scientists—thereby improving a country’s economy through pumping out a higher gross national product. If a foreign nation like China decides to supply their workforce with cognitive-enhancing stimulants for similar reasons, we may be forced to do the same to stay competitive in the global economy.
Furthermore, each of us knowingly takes risks for rewards all the time, like when we fly in airplanes, swim in the ocean, or play tackle football. At present there are many legal forms of enhancement that pose serious health risks to the individual but are widely accepted by society. Many pay money to enhance their physical appearance through cosmetic surgery to gain an edge in fields like modeling and acting (or life in general for that matter). This is 100% legal to all despite the fact that some procedures have been linked to ailments like loss of sensation, necrosis, and hematoma.
If we are in fact living in a “free society”, then perhaps informed, consenting adults should be able to make decisions that are based upon our own cost-benefit analyses—especially when the potential rewards outweigh the risks and no harm is being presented to others. To deny cognitive enhancers to all because of abuse by some would seem unfair to those who might use these drugs reasonably. Unfortunately, my story shows that reasonable use may be much harder to maintain than most account for.
We won’t arrive at the perfect solution to the legalization debate over night. Nevertheless, by conducting more research and sharing our intimate stories with the public, we will begin paving a path toward the responsible use of cognitive enhancers—for those with attentional or behavioral issues, and maybe also for those without.