Smart drugs are in the news lately. They are prescription drugs used for the treatment of medical/psychiatric conditions to include cognitive enhancement purposes. Common drugs include Adderall and Modafinil. Adderall is prescribed in the treatment of attention deficit hyperactivity disorder (ADHD) and narcolepsy. It also is used as an athletic performance and cognitive enhancer, and recreationally as an aphrodisiac and euphoriant. Adderall increases the activity of the neurotransmitters norepinephrine and dopamine in the brain. Other medications in this class include Ritalin, Concerta, and Focalin. Modafinil is a wakefulness-promoting agent used for treatment of narcolepsy, shift work sleep disorder, and excessive daytime sleepiness associated with obstructive sleep apnea. The mechanism of action is one whereby the drug acts as a selective, relatively weak, atypical dopamine reuptake inhibitor.
Such drugs have been discussed in television news pieces, in the Huffington Post, and most recently in an article by Carl Celestrom in the online Harvard Business Review (for May 20, 2016 titled "Like it or not, 'Smart Drugs' are coming to the office"). The use of the medications has been common in American universities for many years as students seek to improve concentration and stamina, particular when time for exam cramming. In his article, Celestrom noted that up to 20% of Ivy League college students already have tried such drugs. While not known at this time, it is likely that use is increasing in the professional and business world as the many pressures on employees demand increased concentration, stamina, and performance. Celestrom reported that the Financial Times has claimed that smart drugs are “becoming popular among city lawyers, bankers, and other professionals keen to gain a competitive advantage over colleagues.” In 2008, the magazine Nature asked its readers whether they use cognitive-enhancing drugs; of the 1,400 respondents, one in five responded yes.
Do the smart drugs work? There has been research from Harvard Medical School consistent with the conclusion that Modafinil has significant cognitive benefits for those who do not suffer from sleep deprivation. The drug improves patients' planning and decision making ability and has a positive effect on learning and creativity. Other research has shown that Modafinil helped sleep-deprived surgeons become better at planning, redirecting their attention, and being less impulsive when making decisions. The U.S. military has already started experimenting with Modafinil, including with controlled use for air force pilots.
When acquired prescriptively, the drugs are safe when used as monitored by a physician. However, when acquired through the internet, on the street, or through friends/acquaintances, there certainly can be risks. Using drugs like Adderall without a legitimate need for the medication or adequate medical monitoring can cause sudden changes in blood pressure, over exhausting the heart, and even death. So, at this time, nonprescriptive use can neither be encouraged nor endorsed.
However, as noted in the media, the drugs are not difficult to obtain. Modafinil has an annual global share of $700 million, with high estimated off-label use. ADHD medication sales (Ritalin, Adderrall, Concerta, Focalin) are growing rapidly, with annual revenues of $12.9 billion in 2015. Putting aside the use of the drugs prescriptively through clinics, hospitals, medical offices, etc., the HBR article raised several issues. Should such drugs be allowed in the universities and/or work places? Does it give an unfair advantage to some who can gain access to the drugs versus those who can not? Does the use in the work place increase the stress levels of an already stressed and frequently overworked work force? Perhaps the use of the smart drugs will help employees be more productive and efficient thereby facilitating their enhanced well being when out of work. As was mentioned in the HBR article, if you were the manager at a hospital, would you want your surgeon to be under the influence of these drugs, provided there was clear evidence that they improved his/her work performance? Or, if you were the CEO of an airline, would you prefer to have a pilot on drugs if it decreased the probability of accidents?
I am clear about one thing. No matter what benefits the smart drugs bring to cognitive enhancement, by themselves they will not improve low self esteem and/or a lifetime of negative beliefs. It is critical that individuals are able to attribute whatever success they have to their efforts and not outside forces such as medications and drugs. I have seen too many patients work hard in therapy only to attribute their improvement to their medications. Then when they do not have the medications they believe themselves incapable of functioning despite their therapy progress. However, in the business world, management will have to consider the ramifications and issues associated with such smart drug use in the work place.
For now, may all your thoughts be smart ones. Good luck on your journey.
Dr. Paul Longobardi
For information on these and related topics, please see my website at www.successandmindset.com.