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How ‘Smart Drugs’ Enhance Us

If I only had a (better) brain.

The French Revolution was largely conceived in Parisian coffee houses such as Café Procope, where the radical journalist Jean-Paul Marat sipped java during his energetic diatribes and Robespierre's habitual consumption only increased his rebellious fervor. Voltaire reportedly guzzled over ten cups each day. Although they didn't know about caffeine at the time (it wasn't discovered until 1819, 30 years after the French Revolution), they certainly didn't overlook the stimulating effects of consuming a cup of perk. Some coffee-enthusiasts might suggest that imbibing the early-morning helper contributed to the monarchy's demise and the rise of the new Republic.

Our understanding of pharmacology has come a long way since the Reign of Terror. Recently, ‘smart drugs' have been touted as a remedy to an array of problems, from bad moods to failing economies. What have we gained with the advent of modern cognitive enhancers?

A cup of coffee is a far cry from the sophisticated stimulants used by many on a daily basis. For example, Adderall and Ritalin, prescribed for the treatment of Attention-Deficit Hyperactivity Disorder (ADHD), work by helping individuals focus their attention without being easily distracted. For a child diagnosed with ADHD, these drugs can greatly improve both behavior and school performance. Adderall, composed of mixed amphetamine salts, and Ritalin, an amphetamine derivative, are also two of the drugs most widely used by healthy adults as purported brain boosters. Surveys at some universities have shown that up to 35% of students have obtained these drugs for use as a study aid, though most of them do not have ADHD (ADHD affects only 3-4% of people). For students without prescriptions, they usually have little trouble acquiring Ritalin or Adderall from friends or schoolmates. Students with prescriptions sometimes even sell their unneeded doses.

Given the dramatic rise in use for studying, ethicists have debated whether cognitive-enhancing drugs are unfair. Those who take them may have an advantage on tests versus students who attempt to study using their wits alone. If taking drugs could provide a cognitive edge, you might expect that these students would outperform their classmates. Some wonder if parents might begin forcing their children to take smart-drugs in order to maintain competitive grades.

In order to address this issue, The College Life Study began periodically surveying university students a few years ago to better understand how health-related behaviors, including all varieties of drug use, affect school performance and career development. At a recent conference, Amelia Arria, the lead researcher, presented data about the use of Ritalin and Adderall as study drugs. The students who used these drugs more often also tended to skip more classes and smoke more pot. In terms of performance, they tended to have lower GPAs, in the 2.0-3.0 range, not higher ones. It seems, rather than as a tool to get ahead, students used stimulants while cramming to catch up for lost study time. Students earning As were mostly doing so by steady work throughout the semester, without the assistance of modern medicine.

Of course, this finding merits some caveats. Maybe the students using cognitive-enhancers did better than they would have otherwise. Just because most students (without ADHD) who use pharmacological aids don't perform better, some users may see a dramatic improvement. Nonetheless, so far it appears that Ritalin and Adderall offer the greatest assistance to the people they're prescribed to, those diagnosed with ADHD. As for the rest of students, Adderall may not be an unequivocal performance enhancer. The results of this study suggest that if a gap exists, the students who don't take study drugs are edging out those who do.

Arria reminds that evidence has been inconclusive so far about whether the enhancement for studying is real or perceived in healthy adults. In another study, students were given pills labeled either 'Ritalin' or 'placebo' and asked to take a mock SAT examination. The students given pills labeled 'Ritalin' reported feeling greater focus and mental clarity but their scores weren't any better--perhaps because the labels were misleading: both groups actually received a placebo.

A third common cognitive-enhancer, modafinil, first entered the market to help people with narcolepsy stay awake. A great deal of research has since looked at the potential benefits of modafinil for a variety of purposes. In healthy adults who are sleep-deprived, modafinil can improve mood, provide 10-12 hours of wakeful, focused productivity and improve cognition to a similar extent as caffeine, but without the jitteriness-and the effects last longer. After working overnight in the emergency room, doctors who took a single dose of modafinil kept their eyes open more easily than doctors who didn't take modafinil during morning lectures. However, they were just as weary on the drive home, and they had more difficulty falling asleep once they finally made it to bed. For patients with traumatic brain injury, major depressive disorder or schizophrenia, modafinil had a substantial effect on reducing fatigue, excessive sleepiness and depression, but it did not provide any benefit greater than placebo. For well-rested, healthy adults, the benefits remain controversial. While some studies have demonstrated that well-rested individuals can show modest improvement on memory tasks with modafinil, there may be a ceiling effect. High-functioning, healthy adults with adequate sleep may not receive any noticeable benefit because they are already performing optimally.

What is the difference between cognitive-enhancers like modafinil or Adderall and predecessors like caffeine? The chemical compounds differ, and they have unique mechanisms of action. Pharmaceutical packaging gives them elegance and refinement. Most people believe they'll work, so they offer at minimum a placebo effect. Even if, at heart, they're simply newer, prettier double-shots of espresso, there may still be some advantages to taking these drugs, such as longer-lasting effects and no jitteriness.

Do these drugs make you smarter? More likely, they allow you to productively use your pre-existing intelligence, even if you didn't get a great night of rest beforehand. After ingesting one of these pills, an average person won't suddenly discover a cure for cancer or write a symphony that would make Beethoven envious. If someone is seeking a miraculous transformation, they're better off booking a room at a Holiday Inn Express or going about it the old-fashioned way-by signing a deal with the devil.

In a December, 2008 article "Towards responsible use of cognitive-enhancing drugs by the healthy" in the journal Nature, Greely and colleagues argued that cognitive enhancers should be available, but that we need to consider the ethical dilemmas that may arise. After all, exercise improves cognitive performance, but we don't ban it from college campuses.

To see more of the work by Amelia Arria and her colleagues, see a description here. She presented her recent findings at the College for Problems of Drug Dependence in Reno, Nevada.

Raminder Kumar at the University of Chicago wrote a recent review of a wide range of research on modafinil.

Thanks to Audrey Nath for her suggestions.