How widespread is 'smart drug'
use in the wild?
'Figures published yesterday
show that soaring numbers of today’s scholars are
abusing prescribed drugs designed to boost
concentration in order to keep revising for hours on
end,' an article
on the Daily Telegraph's website
announced last summer. That would be news. Stories
about the prevalence of 'smart drugs' tend to be
heavy with anecdotes but light on data. They work by
suggestion.
And so it turned out once
again. The figures themselves were sound. They came
from the UK Care Quality Commission's annual report,
which noted that 657,000 methylphenidate packages
were prescribed in 2012, a rise of 56 per cent since
2007. If more tablets are passing over pharmacy
counters, the quantities potentially available for
diversion into non-medical use are growing. But this
tells us nothing about how much 'scholars' or others
are tapping into that potential. The Telegraph
article plugged the gaping empirical hole with the
assertion that under pressure to get top grades,
'students today will take anything they can get
their hands on.'
So, it's tempting to suggest,
will commentators writing about the prevalence of
'smart drugs' – journalists and journal authors
alike. This isn't just an instance of the media
making a mockery of what scientists tell them. The
message that comes across from what scientists and
other academics say about cognitive enhancers is
quite similar to the impression promoted by media
coverage: that yet another generation of young
people has started up a drug underground, which must
surely be intense and widespread even though it is
invisible.
Some scholars have argued that
it's actually the academics who have supplied the
media with the message. Researchers at the
University of Queensland
linked claims in media stories that 25% of US
university students use 'smart drugs' to a figure
which has been widely cited in bioethics articles.
It came from a
study of stimulant use – for whatever reasons,
not just cognitive enhancement – in which results
from one college indicated that one student in four
had used stimulants in the past year. Across all 119
colleges in the study, the rate was just 4.1%.
Equating stimulant use with
attempts at cognitive enhancement – despite the long
history of amphetamine use by young people for
excitement and pleasure – is a common weakness in
discussions of how extensive 'smart drug' use may
be. Another is reliance on self-selecting
respondents. The article that cropped up most often
in the media reports examined by the Queensland
researchers was one
from Nature, reporting the results of
a poll in which a fifth of respondents said they had
taken drugs to improve their focus, concentration or
memory. But surveys like these will tend to attract
those who have an interest in the matter, while
failing to detain those who don't. As another critical
commentary observed, a poll about Vermont
vacations wouldn't produce an accurate estimate of
the fraction of the population that takes its
vacations in Vermont.
In surveys that have inquired
about students' motives for taking stimulants,
concentration, attention and exams do loom large.
The numbers themselves may be modest, though. A study
in the German city of Mainz found that 1.5% of
school students and less than one per cent of
students had used prescription drugs to enhance
their cognition; between two and three per cent had
used illicit drugs (including cocaine and ecstasy as
well as amphetamines) to the same end.
Were these figures a full
disclosure, though? When the questions are
sensitive, people may not feel even an anonymous
questionnaire is anonymous enough. In a subsequent
study, the research group used a 'randomized
responses technique', a super-anonymization
procedure designed to encourage people to answer
sensitive questions honestly. Mainz students were
asked to think of a birthday, such as their own or
their mother's. If it was in the first third of the
month, the question they were to answer was whether
the date was in the first half of the year. If it
wasn't in the first third of the month, they were to
indicate whether they had used 'brain-doping'
substances in the past year. The researchers thus
did not know whether individual respondents had
answered the innocuous question or the sensitive
one, but they could work out the percentages for the
responses as a whole: 20% had said yes to
'brain-doping'.
They also used
the same procedure with surgeons attending
conferences in Germany, together with a conventional
anonymous questionnaire. Answering the
questionnaire, 8.9% owned up to having ever used
drugs to enhance their cognition. Under the
randomized procedure, the figure rose to almost 20%.
The difference between the
figures obtained under ordinary anonymity and
superanonymity illustrates the uncertainty, and the
unease, that clouds all efforts to gauge levels of
non-medical drug use. So does the response rate.
Although it looks as though randomization has
countered bias arising from reluctance to disclose
questionable behaviour, the results may not reflect
the experience of surgeons as a whole: 3300 were
approached but only 1100 responded, which might
suggest a 'Vermont vacation' effect.
Of those who answered the
questionnaire, three per cent recorded that they had
used drugs for cognitive enhancement in the past
year. Maybe the rate would have been twice as high,
like the lifetime figure, if the question had been
asked under the randomized procedure. But even three
per cent may count for a lot in a group of
professionals who hold people's lives in their hands
on a daily basis.