Perceptions of assisted cognitive and sport performance enhancement among university students in England
Introduction
There is a growing debate around the widespread use of drugs to enhance physical performance and cognitive capacity, including the use of prescription drugs beyond therapeutic use (Møldrup and Rie Hansen, 2006, Petersen et al., 2014, Smith and Farah, 2011). The pressure arising from the real or perceived need for performance excellence can lead to using artificial enhancement (McVeigh, Evans-Brown, & Bellis, 2012). Emerging evidence suggests that using “neuroenhancement” (a term utilised to define the use of prescription drugs to improve cognitive capacity) in the absence of any medical need is only the most recent addition to the already extensive array of drugs that enhance human performance or experience (Franke et al., 2013, Møldrup et al., 2003, Savulescu et al., 2011). Even though such “academic doping” is by no means new, the side effects arising from the unsupervised use of powerful new amphetamines, narcoleptics and analeptics present a significant threat to individual and public health. Given the prominent role of ethicality in models of athlete doping and anti-doping interventions (Miah, 2006), ethicality may prove a viable basis for interventions designed to control the health threat posed by misuse or abuse of substances to improve academic performance (Cakic, 2009, Outram and Racine, 2011). The current study therefore explores how university students construct the ethicality of using prescription drugs to enhance academic performance in relation to the ethicality of using substances to enhance performance in sport.
With the rise in university enrolments and increasing university tuition fees (Hübner, 2012), students in many post-industrial societies endure more pressure to perform well, aiming for high marks in response to the increased competitiveness of the graduate job market. These shifts in the academic environment have led to a reported rise according to frequent media reports, of “smart drug” use among students who wish to optimise academic performance (Forlini and Racine, 2009, Partridge et al., 2011). The evidence suggests that students use these substances to increase studying periods and levels of concentration, and decrease anxiety (DeSantis et al., 2008, Judson and Langdon, 2009, Rabiner et al., 2009). It has also been evidenced that students attempt to self-medicate the lack of sleep through these substances (Wolff & Brand, 2013). Neuroenhancement appears to be correlated with faculty of study, attitude and the use of other substances (Mazanov, Dunn, Connor, & Fielding, 2013).
Neuroenhancing drugs act on a variety of neurotransmitter systems and appear to be able to enhance cognition, mood and pro-social behaviour (De Jongh, Bolt, Schermer, & Olivier, 2008). Nonetheless, their efficacy in enhancing overall memory and intellectual performance is yet to be established, and side effects can be detrimental to the individual's health and psychological wellbeing (Farah, Smith, Ilieva, & Hamilton, 2014). Misuse or abuse of prescription medication can be very dangerous and is an ongoing challenge for public health. Inappropriate use of these compounds can impair cognitive function and cause substance dependency; the side effects of long-term use are not yet fully understood (Sahakian & Morein-Zamir, 2011).
Stimulants like Ritalin, a drug normally prescribed to attention deficit hyperactive disorder patients, are estimated to be used by 5–35% of the student population in the United States (DeSantis et al., 2008, Wilens et al., 2008). While a low prevalence of use (1.3%) was observed among German students (Franke et al., 2011), the same study reported 80% of participants stating that they would consider using these stimulants. Swiss university students had experience with neuroenhancement but only 4.1% reported methylphenidate (Ritalin) use, finding that a significant proportion of students felt neuroenhancement was acceptable as long as it served performance related (as opposed to “recreational”) goals (Maier, Liechti, Herzig, & Schaub, 2013). Neuroenhancer use has also been observed among Australian university students (Mazanov et al., 2013, Partridge et al., 2012), although these students were concerned about possible side effects and the drugs’ effectiveness in improving grades. In a study surveying UK students (Singh, Bard, & Jackson, 2014), less than 10% reported lifetime prevalence, but one third expressed an interest in experimenting with neuroenhancement. One university student newspaper has reported that 20.5% of a convenient sample of local students has used cognitive performance enhancing drugs, and 54% indicated that they would use stronger substances than coffee or energy drinks if such substances were available to them (Ibrahim, 2012). To date, no epidemiological study has comprehensively examined and compared prevalence rates.
Despite students’ willingness to try these stimulants (Forlini & Racine, 2009) is associated with the belief that they are not dangerous (De Santis et al., 2009), side and long term effects are still of concern (Forlini & Racine, 2012). Due to the strong contrast in responses (Sattler, Forlini, Racine, & Sauer, 2013) and the high variability in prevalence rates, more research is needed to understand these differences. Although the non-prescribed use of neuroenhancers is – in most cases – illegal and students are obtaining these drugs from the black market (Greely et al., 2008), no regulations exist regarding their use in academia (Coenen, Schuiff, & Smits, 2014). Conversely, in the sporting environment the use of performance enhancing drugs is strictly regulated by the World Anti-Doping Agency (WADA) which defines doping as contrary to fair play and to the virtues of sport. Despite the intensified effort to curb doping use in sport, a concerning level has been documented in and outside WADA auspices (e.g., Dimeo and Taylor, 2013, Pitsch and Emrich, 2012). Similar to neuroenhancement, doping in sport raises issues regarding functionality for performance enhancement and ethicality in competitive contexts.
General attitudes towards doping have been extensively researched (Sjöqvist et al., 2008, Stamm et al., 2008, Yager and O’Dea, 2014). The most commonly identified motives for taking performance enhancing substances are mainly related to external pressures (Bilard et al., 2011, Curry and Wagman, 1999, Pappa and Kennedy, 2013, Singhammer, 2013) and a desire to win (Baron et al., 2007, Lucidi et al., 2008). Taken together, available research suggests that doping is used as a way to cope with training and competition demands, as well as recover from injury quickly and more efficiently. In this sense, doping in the athletic domain could be seen as a means to cope with environmental demands, presenting similarities to students’ motivations related to using neuroenhancers. Athletes often acquire performance enhancing substances via the black market, thus the health risks of their conduct can be even more critical and unpredictable (Paoli & Donati, 2014).
Prevalence rates emerging across samples and methods (e.g., James et al., 2013, Mottram, 2005, Pitsch and Emrich, 2012) indicate higher rates of doping than official records of adverse analytical findings suggest (approximately 2%; WADA, 2013). Furthermore, the Athlete Biological Passport (ABP) has shown an estimated average of 14–19% blood dopers among track and field athletes (Sottas et al., 2011), suggesting a considerable discrepancy between doping prevalence rates based on direct evidence and the ABP. However, prevalence rates can only be interpreted in the contexts in which the information is obtained. Often, the target populations vary in sporting levels and investigations lack a uniformly accepted definition of what constitutes doping (Lentillon-Kaestner & Ohl, 2011).
Many athletes do not consider taking performance enhancers as deceitful and believe these are necessary to compete, regardless of health consequences (Curry and Wagman, 1999, Kayser and Broers, 2013, Morente-Sanchez and Zabala, 2013). Research on doping has often focused on attitudes of elite athletes and suggests that motivations tied to initiating or maintaining doping use are extremely diverse (Bloodworth and McNamee, 2010, Kirby et al., 2011, Lentillon-Kaestner and Carstairs, 2010, Overbye et al., 2013). Regarding stimulants in particular, it is suggested that athletes consider them as “performance enablers”, as they are required to maintain homeostasis during prolonged and intense training (Bilard et al., 2011). Athletes believe hard work alone is insufficient when competing against someone who is doping (Maycock & Howat, 2005). Considering the social and economic impact of the sports enterprise, doping and anti-doping attempts are to be considered a public issue (Kayser, Mauron, & Miah, 2007). Athletes are often confronted with a competitive environment which enables the functionality of doping, thus interventions based on morality and ethicality do not appear to successfully contain the phenomenon (Kayser and Broers, 2013, Petróczi, 2013a, Petróczi, 2013b).
Neuroenhancement is a relatively new phenomenon, and people may not have a ready-formed social representation unless they have personal experiences or have been in close contact with these drugs via friends and family. Research into cognitive enhancing drugs typically anchors the investigation to an established line of research, comparing it directly to illicit drugs (Svetlov, Kobeissy, & Gold, 2007) or doping (Bell et al., 2013, Dodge et al., 2012). These comparisons inevitably provide contextual valence, as exemplified by the use of terminology like “brain doping” (Dietz, Striegel, et al., 2013), “dope” (Maier et al., 2013), “smart drugs” or “viagra of the brain” (Lucke, Bell, Partridge, & Hall, 2011). Yet they are nonetheless relevant, as they provide insight on how representations from one drug domain may be transferred to others, both in scientific terms as by general social knowledge (Petróczi, Mazanov, & Naughton, 2011). These ready-made social representations can then directly influence drug use trajectories as well as the interventions and approaches aimed at reducing and controlling them.
In an attempt to investigate attitudes towards neuroenhancement through a comparison with doping in sport, Dodge et al. (2012) explored how individuals judge others who use enhancers in either the athletic or the academic sector by applying the zero-sum and non-zero sum paradigm (Goodman, 2010). Goodman (2010) defines zero sum tasks as either/or situations where there is a winner and one or many losers. Non-zero sum tasks on the other hand describe situations where success is independent from others’ performance. Through this differentiation Dodge et al. (2012) explain why their sample judged steroid use as more immoral: academic situations are primarily considered non-zero sum (e.g., an examination), while sporting competitions are seen as zero sum (e.g., a tournament). However, the wording of the scenarios differed importantly, as the term “effort” was mentioned only in the cognitive enhancer scenario, possibly leading participants to assume that the use of anabolic steroids required less or no effort (Dodge et al., 2012).
Although the goal to pursue can influence views of performance enhancing, Dodge et al.’s study (2012) still leaves issues unresolved. It is still possible to utilise neuroenhancement and doping for both zero-sum and non-zero tasks. Moral standards co-exist with other decision-making processes which may rationalise assisted performance enhancement as a functional adaptation (Petróczi, 2013a). Implicit attitudes can also be seen as key variables in predicting intentions, as they play an important role in determining subjective mental representations of these practices (De Houwer, 2006). Indirect reaction-time based attitude tests, such as the implicit association test, have been used to explore attitudes towards doping (Brand et al., 2014, Petróczi, 2013b) but no studies have yet used these instruments to explore attitudes relative to neuroenhancement. Previous research indicates that the general population takes a predominantly negative view of doping (Backhouse and McKenna, 2011, Solberg et al., 2010) while those from sporting contexts show a tendency to view performance enhancers as necessary (Mazanov et al., 2014, Pappa and Kennedy, 2013). Attitudes towards cognitive enhancers remain controversial and still poorly researched (Bostrom and Sandberg, 2009, Savulescu et al., 2011).
Neuroenhancement in academia and doping in sports may draw back on similar psychological representations based on the need to excel (Farah et al., 2014, Wolff and Brand, 2013). The drug instrumentalization theory (Müller & Schumann, 2011) explores non-addictive drug use through individuals’ expectations, where drug use represents a functional adaptation to modern environments based on previous learning mechanisms. In a similar manner, neuroenhancement may represent a functional means to achieve a highly valued end, or an instrument utilised as a coping strategy (Hildt et al., 2014, Ilieva and Farah, 2013, Wolff and Brand, 2013).
Section snippets
Aims
The aim of the present study was to explore university students’ implicit and explicit moral mental representations relative to neuroenhancement and doping in sports. Students’ attitudes were explored in a multidimensional manner. The scarcity of studies which explore attitudes towards neuroenhancement, as well as the public concern expressed on regulating their use, make this exploration vital and necessary.
A brief Implicit Association Test (b-IAT) (Sriram & Greenwald, 2009) served for the
Demographics
Ninety-eight students (mean age = 24 ± 5.98 years, 60.2% male) were recruited from universities in England. In the sample, 12.2% had no sporting experience, 31.6% practiced sports recreationally and 27.6% belonged to a local or university sports club, whereas 17.3% practiced sport at a semi-professional level, and 11.2% practiced sports at a professional level. The distinctions in sport involvement were based upon the level of financial support available, according to the information provided by
Psychometric properties of the brief PEAS and CEAA
Confirmatory factor analysis provided reassurance that the shortened version of the PEAS maintained a unidimensional structure with strong standardised regression weights (>0.64), and good model fit after allowing correlation between the error terms of items 2 and 8. Overall, the CFA results showed good fit (χ2 = 35.416, df = 19, p < 0.012; χ2 = 1.864, RMSEA = 0.094 (null model = 0.381), p of close fit < 0.071, CFI = 0.968, TLI = 0.939). The reliability coefficient of the PEAS-S was excellent (Cronbach alpha =
Discussion
In order to explore students’ moral attitudes and representations relative to neuroenhancement, three sets of assessments comparing this practice to sports doping were utilised. Both quantitative and qualitative data were considered in analysis, enabling a multidimensional investigation of participant attitudes. It should be noted that a significant proportion of participants declared to have close friends which used performance and neuroenhancing substances (19% and 13%, respectively). These
Conclusions
Data emerging from the study demonstrated that a significant number of students from English universities hold an instrumental view of performance enhancing drugs, which are seen as a legitimate means for achieving personal success. From the open responses it was clear that many participants believed neuroenhancers could be necessary to be competitive in the job market. While gaining unfair advantage was still considered unacceptable, the “instrumentalization” of these drugs emerged as a key
Acknowledgement
The project received no financial assistance.
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These authors contributed equally.