Tuesday, April 14, 2015

Adderall as a motivational enhancer

Prescription stimulant use is on the rise at college campuses, especially at elite schools where the pressure and demands can be overwhelming. Students have a variety of methods to handle the stresses of their studies, but the consumption of prescription stimulants, such as Adderall or Ritalin, has become more popular among healthy individuals. While this trend raises multiple important ethical issues, the interesting idea that prescription stimulants may be masking authentic versions of ourselves was the topic of the most recent Neuroethics in the News discussion. Facilitated by AJOB Neuroscience editorial intern Ryan Purcell and AJOB Neuroscience Editor John Banja, the discussion centered around a recently published article by Torben Kjaersgaard entitled “Enhancing Motivation by Use of Prescription Stimulants: The Ethics of Motivation Enhancement."1

                                                                from Smart Drug Smarts

The cognitive enhancement debate is not new; scholars have been considering the ethical dilemmas, such as equal access, safety, coercion, and cheating, of healthy individuals seeking enhancement via prescription drugs for almost a decade.2,3 There is also a debate surrounding whether or not current stimulants are even cognitive enhancers at all, which would render the discussion irrelevant.4,5 Kjaesrgaard doesn’t focus on any of these issues though, and instead presents the ethical dilemmas associated with motivational enhancement of drugs such as Adderall and modafinil. He argues that these stimulants are not eliciting performance enhancement, but instead performance maintenance and sometimes increased motivation for a task, and this can often be ethically problematic. While the future may hold cognitive enhancers that have the ability to increase a person’s capability to solve a task or make an individual “smarter,” current stimulants promote wakefulness, arousal, and stimulation. The invocation of these emotions is related to motivation, and Kjaersgaard argues that motivation enhancement is an important but “neglected subitem in the bioethical debate on cognitive enhancement.”1
 
 Motivation in this article is defined as a “broad set of affective states that influence whether a person will voluntarily use their cognitive ability in the performance of a task,” which comes from a paper by IIieva and Farah.3 Very few papers have reported on the reasons for consumption of prescription stimulants by healthy individuals, but the article alludes to a recent qualitative study published by Scott Vreko6 to show that students who take these stimulants are typically seeking to enhance their motivation and interest during an “Adderall” day spent studying in the library. Vrecko reported four experiential “feelings” that students experience when taking Adderall including feeling up, drivenness, interestedness, and enjoyment; feelings all related to motivation. Many of the students were unable to study unless taking the drug or felt they were more effective and interested when under the influence. It is possible that these students could be self-medicating depression or ADHD, and as problematic as that may be, what if these students are just lazy? (Kjaersgaard does note that many of the students only attribute their inability to study to factors related to school, suggesting depression is not an underlying factor). Is there really anything wrong with trying to become a more productive, studious person? If a boost in motivation is needed to study for a midterm or prepare a presentation at work, is there anything ethically fraught about seeking an external stimulant? Or, is intrinsic motivation somehow more meaningful than motivation induced by prescription stimulants? The answer, according to Kjaersgaard, is sometimes. 

Lack of motivation could be part of a much larger problem connected to the meaning, structure, and purpose in a person’s life. The constant use of prescription stimulants to get through four years of college or every task at work could signal feelings of alienation, and treating these feelings with pharmaceuticals is unethical.  A student who enjoys learning and finds it self-fulfilling, but needs to take Adderall to get through one class unrelated to his major is not participating in an unethical act because the one-time use does not change the course of his life or who he is. Most importantly, this student isn’t trying to escape from reality. However, Adderall is not helping the student that is trying to get through college as a biology major because his parents want him to go to medical school. In this instance, the student is on a path of becoming his least authentic self, a complex issue that should not be controlled with prescription stimulants. Continually using stimulants to overcome a lack of willpower means that “we risk losing touch with ourselves in some sense.”1 When we start to regard lack of motivation as a physiological problem, instead of a vice, we are losing an essential part of the human condition and we are perhaps only masking the most authentic version of ourselves. 

                                                               from DistanceAdvising

 This twist on the cognitive enhancement debate is interesting because for the first time we live in a society where the quest to become what you may consider your most authentic self is actually possible.  Serfs in the Middle Ages were not questioning whether or not serfdom was their actual calling, and classes were still starkly divided as late as the 19th century. Some have made the claim that we should take cognitive enhancers because we have an obligation to society to be the best, smartest, most productive versions of ourselves. But, do we instead have an individual obligation to become the most authentic, true version of ourselves? Is it even possible to find your most authentic self? And, as Dr. Banja pointed out with this Monty Python sketch, what if your true self is boring and dull? In this case the use of prescription stimulants may not be holding you back in the slightest.  

While it may be true that the fate of college students does not drastically depend on prescription stimulant use, perhaps rampant Adderall consumption is a chance to have a conversation regarding the collegiate atmosphere. In college and in life, we move at a faster pace than before and ubiquitous technology means that something or someone is constantly demanding attention. This can often make life seem overwhelming and challenging, but by accepting the occasional Adderall usage, are we ignoring other fundamental problems with our social structure? Maybe prescription stimulants are a solution for the vast majority of people that are unsatisfied with their jobs, especially if income is a priority over authenticity. But, does society suffer at all if every person is trying to be productive, but is sacrificing essential pieces of what makes us human to get there? 

References: 
(1)          Kj√¶rsgaard, T. Enhancing Motivation by Use of Prescription Stimulants: The Ethics of Motivation Enhancement. AJOB Neurosci. 2015, 6 (1), 4–10.
(2)          Chatterjee, A. Cosmetic Neurology: The Controversy over Enhancing Movement, Mentation, and Mood. Neurology 2004, 63 (6), 968–974.
(3)          Ilieva, I. P.; Farah, M. J. Enhancement Stimulants: Perceived Motivational and Cognitive Advantages. Front. Neurosci. 2013, 7.
(4)          Lucke, J. C.; Bell, S.; Partridge, B.; Hall, W. D. Deflating the Neuroenhancement Bubble. AJOB Neurosci. 2011, 2 (4), 38–43.
(5)          Smith, M. E.; Farah, M. J. Are Prescription Stimulants “Smart Pills”? The Epidemiology and Cognitive Neuroscience of Prescription Stimulant Use by Normal Healthy Individuals. Psychol. Bull. 2011, 137 (5), 717–741.
(6)          Vrecko, S. Just How Cognitive Is “Cognitive Enhancement”? On the Significance of Emotions in University Students’ Experiences with Study Drugs. AJOB Neurosci. 2013, 4 (1), 4–12.


Want to cite this post?

Strong, K. (2015). Adderall as a Motivational Enhancer. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2015/04/adderall-as-motivational-enhancer.html

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