Side Effects

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Using Meds for "Neuro-Enhancement"

Students are abusing prescription stimulants in large amounts

"Brain Gain," Margaret Talbot's troubling article in the latest issue of the New Yorker magazine, tackles a growing problem among undergraduate and high-school students: the abuse of prescription stimulants for scholarly gain. Talbot interviews a former Harvard student who regularly took Adderall off-label, without a diagnosis of ADHD, in hopes of ramping up his academic performance. Like hundreds of students across American campuses who adopt this practice, the student wasn't performing badly. He simply wanted to party a bit more than time and body permitted, and took Adderall in hopes that it would help him make up for lost time.

Rather than casting aspersions or trying to dismiss the issue, Talbot tries to understand what's driving it and why so many students think it's wise, expedient, or necessary to take prescription stimulants for conditions they know they haven't got, in hopes that doing so won't backfire.

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A number of bioethicists have chimed in on this issue, saying they don't in principle object to the phenomenon, which they prefer to call "neuroenhancing." And you can at least see their point, because our school systems and work environments are so competitive that it's difficult to keep an edge. Over whether to take meds for an extra boost, the bioethicists' line has become: "You can choose whether to compete or not."

I'm not so sure. Our culture expects us to be "up" and "on" at all hours. As one advocate of "selective" neuroenhancement put it, "I don't think we need to be turning up the crank another notch on how hard we work." We work hard enough as it is.

Those who favor neuroenhancement hit back with this rejoinder: Why hold on to "self-limiting" behaviors when popping a pill seems to extend such limits further than we could imagine? We can have "responsible use of cognitive-enhancing drugs by the healthy," writes Martha Farah in a recent issue of Nature. Even the British Medical Association appears to be taking this line: "Universal access to enhancing interventions would bring up the base-line of cognitive ability," the organization wrote recently, "which is generally seen to be a good thing."

True. But the argument has a coercive edge to it, because new norms and practices put a lot of pressure on a younger generation, in this case raising expectations about performance that are tied solely to medication rather than greater work, effort, or understanding. To what extent is that a real or lasting improvement, either in the student or in the generation she or he represents?

Those favoring neuroenhancers echo the line we used to hear about SSRI antidepressants (long before the FDA found it necessary to add black-box warnings to them because of concerns about suicide ideation): the drugs simply elevate our moods and give us freedom from angst: We can "customize" our brains just as we can "customize" ourselves. It's a lifestyle-improvement issue, apparently. And fatigue—like sadness—is just an unfortunate residue of our humanity that we can medicate away.

Talbot's piece usefully disabuses us of that fantasy. The essays the Harvard student would grind out on Adderall, he himself conceded, were far less precise and succinct than those he normally would write. Another person Talbot interviews puts it this way: "In the end, you're only as good as the ideas you've come up with."

Finally, Talbot asks whether taking an unneeded stimulant for an assignment could make one's thinking—and writing—less creative than otherwise: closer to a distinctly unromantic model of productivity than a truly well-conceived, well-executed exercise. The difference may not matter with one or two projects, but one wouldn't want that pattern repeated on a larger scale, especially if it leads to similar work being churned out unthinkingly across the nation.

To those taking prescription stimulants purely to get an edge over their peers, it's easy to voice the charge of cheating. A teacher myself, I don't like the thought of students self-medicating before an exam because they haven't adequately revised for it. I worry too about the unforeseen side effects of such medication, because the lists of them from Adderall and Ritalin (forms of amphetamine) are as easy to find on the Web as the medications themselves. Such side effects include extreme fatigue, loss of appetite, headaches, fever, and heartburn. There's also concern that the drugs are habit-forming.

When Adderall and Ritalin replace caffeine and NoDoz as ways of getting through finals week, there are clearly grounds for concern. The phenomenon of neuroenhancement is growing rapidly among undergraduates and high-school students—according to one study, as many as 35% of students on one campus had taken prescription stimulants they didn't need during the previous year.

The most powerful moment in Talbot's article comes near the end, when she sums up these issues and lets slip her personal feelings about them. "All this may be leading to a kind of society I'm not sure I want to live in: a society where we're even more overworked and driven by technology than we already are, and where we have to take drugs to keep up; a society where we give children academic steroids along with their daily vitamins."

Christopher Lane, the Pearce Miller Research Professor at Northwestern University, is the author most recently of Shyness: How Normal Behavior Became a Sickness.

Christopher Lane, Ph.D., teaches literature and intellectual history at Northwestern University and is the author of Shyness: How Normal Behavior Became a Sickness. more...

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