A researcher who chooses to pull an “all-nighter” to meet a submission deadline might be tempted to use Ritalin to prolong concentration and vigilance. This use of psychoactive substances to enhance one’s cognitive functioning, without the medical indication to do so, is prevalent [1–4]. For this behavior the term neuroenhancement (NE) has been coined . NE is subject to ongoing debates in epidemiology and neuroethics. Issues of fairness and health have been emphasized in the light of a supposedly rising prevalence of NE among students . It is important not to add to an untimely and unrealistic “media hype” at this stage of research however . Most of the social science research published to date is aimed at describing NE prevalence and tends to neglect to ask why it might be prevalent. The representativeness of some epidemiological studies is at least questionable. Especially empirical studies on NE’s possible psychological roots are very scarce at the time.
This picture, including the extant problems with defining the phenomenon more consistently , is similar to what could be observed during the emerging years of social science research on doping in sport. Thus, one of the central claims of this article is that a projection of research strategies, fundamental assumptions, and underlying theories from the sporting domain may help to understand the psychology of NE.
Doping in sport is known to be associated with severe health consequences and in most competitive sports, it is seized with rigorous legal sanctions . Both, health consequences and legal restrictions are also discussed with respect to NE [10, 11]. Researchers have referred to a shared subjective “morality” of using performance enhancing substances in sport and everyday life . With regard to drug abuse in everyday life, drug instrumentalization theory  postulates that non-addictive drug use can be explained by the individual’s expectation, that substances will facilitate performance in previously learned behaviors [14, 15]. Similar arguments have been introduced to the doping literature . With regard to both domains, taking goal system theory  as an exemplary theoretical framework, the use of a performance enhancing substance represents a functional means to achieve a highly valued end. In the sporting domain, erythropoietin (EPO) is employed for improving one’s athletic endurance, making winning more probable. In the NE domain, methylphenidate (e.g., in Ritalin) can be used as a means to prolong concentration during learning sessions , thus facilitating the end of academic success. It is a worthwhile hypothesis that basic psychological representations of these two behaviors are therefore similar.
Attitudes are defined as the individual’s subjective evaluation of a person or object, and represent such a basic psychological representation . Attitudes have been shown to be amongst the strongest predictors for doping , and doping specific attitude scales have been shown to predict doping intentions and behavior . Attitudes are a promising target construct for NE researchers not only because they can predict behavior; but also because they might form before this behavior occurs. It is true that attitudes may also result from previous behavioral choices . However, to prevent a behavior from occurring, changing peoples’ attitudes has been shown to be one of the superordinate goals of preventative interventions in the doping domain . Our proposition is to measure NE attitudes with an adapted version (domain specific enhancement scale) of an internationally validated doping attitude scale therefore.
Another parallel between NE and doping in sport might be seen in the use of performance enhancing substances in order to cope with stress and anxiety. With regard to doping in sport, authors have proposed that athletes are more likely to use illicit substances if demands are high and they appraise their own resources as insufficient to cope with these demands . Alcohol is one substance, which is employed by students to reduce experienced pressure to perform . More recent exploratory studies have also found correlations between global psychological distress in college students and NE . One study even concludes that “some students take drugs to manage the current vast study demands (; p. 268)”. This study did not include measures to explicitly assess these demands however. It is a worthwhile hypothesis that diverse NE substances may be employed as coping means.
With respect to which substances might be regarded as being suitable as coping means, we argue for a behavioral definition of NE. From this viewpoint, NE aims at the enhancement or rebuilding of cognitive performance (means-to-end relation), thus representing one of the nine instrumentalization goals [13, 15] attributed to systematic non-addictive drug use (the others are: improved social interaction, facilitated sexual behavior, facilitated recovery from and coping with psychological stress, euphoria and hedonia, improved physical appearance and attractiveness, self-medication for mental problems, sensory curiosity and facilitating spiritual and religious activities). This behavioral viewpoint neither implies that the substance is a prescription drug or not (for problems with the substance-based definition of doping in sport see ), nor that it is effective (for the often overestimated expectations regarding typical NE substances see ), nor that it could not be used for resolving other annoying states (e.g., indulgence or boredom). Our behavioral viewpoint thus includes the first claim made by drug instrumentalization theory (substances are used as instruments) but does not necessarily imply the second one (substances increase performance through changes in mental states). The assumed functionality of the behavior is its key definitional aspect: If a person consumes a substance with the goal to improve cognitive performance, and if he or she assumes (subjectively expects) that this substance is able to improve his or her cognitive performance, this person is neuroenhancing. For example, caffeinated drinks (“energy drinks”) are consumed frequently among younger people [27, 28]. If such drinks are explicitly consumed to enhance cognitive performance they are means to an end; and therefore qualify as neuroenhancers. Epidemiological evidence on the use of such lifestyle neuroenhancers is widely lacking (for one exception see ).
While we focus on the assumed functionality of NE, it has to be noted that the actual effects of enhancing substances vary greatly between individuals . Enhancers have shown to be more effective in novel situations  and for participants with poor memory capacity  for example.
With regard to substances we propose three NE variants: lifestyle drug NE (e.g., high dosed caffeinated drinks), prescription drug NE (e.g., Methylphenidate) and illicit substance NE (e.g., Cocaine). For lifestyle drug NE, substances like coffee or caffeinated drinks, lifetime prevalence in students has been reported to be 53.2% and 39% respectively . Lifetime prevalence of prescription drug and illicit substance NE among US American students (University and College) have been found to range between 7 and 9% [6, 33, 34]. One recent study, which has employed a randomized response technique in order to better account for social sensitivity of the issue, suggests the one-year prevalence for prescription and illicit drug NE among German students to be as high as 20% .
The advantage of distinguishing between these three NE variants is (at least) twofold. Firstly it allows for a much more faceted view of the phenomenon, and its behavioral basis respectively. Secondly, it allows for describing multiple NE substance abuse. This is relevant, as lifestyle drug NE may pave the road for later prescription drug or illicit substance NE (similar to the behavioral gateway hypothesis in the doping in sport literature, ). A few studies in the doping domain have already investigated the (mental) relation of doping and recreational drugs [36–38] or nutritional supplements . The extant literature on NE has not drawn on this possible link as yet.
Based on these assumptions our empirical hypotheses are as follows:
Hypothesis 1 (multiple NE substance abuse): Use of lifestyle drug NE is associated with a higher probability of prescription drug and illicit substance NE.
Hypothesis 2 (domain specific enhancement attitude): Self-reported use of lifestyle, prescription drug and illicit substance NE can be predicted by a domain specific (i.e., NE) variant of a doping attitude scale.
Hypothesis 3 (NE and stress in school): Pressure to perform, test anxiety and overwhelming demands can be used to incrementally (over and above the effects of age and gender; see below) predict the three NE variants.