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Abstract
This research note provides an update from a 2013–2014 online survey examining attitudes and uptake of cognitive enhancement drugs among students at five Christian colleges. This study had two primary aims: (1) To assess whether one could measure the use of drugs for cognitive enhancement purposes in environments of heightened moral sensitivity—in this case, publicly identified evangelical Christian institutions of higher learning; and (2) to explore whether the subcultural normative sensitivity toward cognitive enhancement presumed within expressly Christian institutions might be reflected in student beliefs about the moral status of cognitive enhancement for academic purposes. The findings from this study have implications for student development offices in Christian institutions of higher education and suggest areas for future inquiry. Furthermore, this study also contributes to the literature on how social and religious beliefs and norms may or may not affect attitudes about the moral status of cognitive enhancement drug use and to the broader conversation of how such misuse can be addressed as a public health issue.
Keywords: Christian higher education, Christian identity, cognitive enhancement, prescription stimulant misuse
Editor’s Note:
This research note is based on a 2013–2014 multisite study completed by Susan Rouse and Michael Sleasman. Susan Rouse served as the Primary Investigator on the study as part of her graduate capstone for the Master of Arts in Bioethics program at Trinity Graduate School. Shortly after completing the data collection phase of the study, Dr. Rouse was diagnosed with an aggressive cancer, subsequently completing only preliminary data analysis before passing unexpectedly a few months later. Subsequent analysis was completed by the present team of authors along with supplemental research regarding the general enrollment data of participating institutions and community standard/honor code analysis to provide further context for the unique student population included within this study.
While the research team recognizes the data contained in this report is now a decade old, the specific student population examined in this study remains unique within the landscape of empirical analyses of attitudes and uptake of drugs for cognitive enhancement purposes among college students. The higher education context, particularly within Christian colleges and universities, has changed dramatically over this time, not least of which due to the radical ways the Covid-19 pandemic reshaped educational practices, course modalities and delivery formats, and student development work. Nonetheless, the present analysis serves as an important starting point for future research within this unique student population as well as to identify specific challenges to research methods and traditional recruitment strategies for research within Christian colleges and universities. As such, it is our hope that this research note will foster dialogue and awareness among student life staff and administrators within Christian colleges and universities regarding these cognitive enhancement practices and the challenges of studying such behavior.
Introduction
Numerous studies have shown that a meaningful proportion of students in higher education have used prescription stimulant drugs for cognitive enhancement (CE) purposes,[1] and researchers have produced a substantial body of literature describing the prevalence and risks of CE drug use in academic settings.[2] Furthermore, public health officials have reason to be concerned about the use of CE drugs, since reported prevalence suggests a widespread, potentially dangerous disposition toward the use of prescription drugs outside of the supervision of a physician.[3] Studies have explored domains such as attitudes toward CE drug use,[4] perceptions of prevalence (i.e., perceptions of the ubiquity of CE drug use),[5] and associations between CE drug use and other substance abuse (e.g., alcohol, illicit drugs, etc.).[6] Other studies have looked at predictors of drug use for CE, such as academic environment,[7] gender,[8] and social marginalization.[9]
While common cognitive enhancement drugs may have effective clinical uses (e.g., prescription stimulants are an effective treatment for attention deficit hyperactivity disorder [ADHD]), there is an emerging literature that calls into question the efficacy or actual usefulness of these medications for cognitive enhancement purposes, claiming nothing more than mere placebo effect.[10] For the purposes of this research update, we will set such considerations aside as interesting but not wholly relevant to our analysis of findings. While there is certainly value in determining the efficacy and safety of such misuse of these substances, regardless of such determinations the students themselves believe these to be cognitive enhancers even if in the end they are not effective at what is colloquially referred to as brain boosting.
The volume of literature exploring the use of stimulant drugs for CE among student populations in particular underscores the enormity of the problem and the general consensus of its detrimental potential for public health. There has been a steady growth in the relevant medical and bioethics literature since the late 1990s with a measurable uptick, nearly doubling previous publication levels, beginning around 2010 and peaking between 2017 and 2021.[11] Prevalence rates for non-medical/off-label use of drugs for CE reported at the time of the study in 2013 ranged from as low as 3%[12] to 35%,[13] with specific subpopulations such as members of fraternities reported as high as 55% lifetime use.[14] The majority of the existing research at the time suggested prevalence between 4%[15] to 8.1%[16] for non-medical/off-label use.[17] While earlier studies focused primarily on methylphenidate (Ritalin®) misuse, later studies typically included other ADHD drugs such as Adderall® and stimulants such as modafinil.
The studies of this period demonstrate consistent factors associated with higher rates of CE use: male, Caucasian, lower GPA, reside off-campus, and being a member of a fraternity.[18] By way of contrast, female students were generally more cautious both in their attitudes and uptake. Furthermore, while the vast majority of misuse of prescription stimulant drugs was for CE purposes, female students were more likely to use such drugs to lose weight than their male counterparts (18.2% vs. 3.2%).[19] Finally, male students were more likely to participate in CE drug use recreationally to get high, and uptake was also more likely to be associated with alcohol use and/or other drug misuse.[20]
While it is the case that the prevalence of CE drug use among college and university student populations has been studied generally, few, if any, studies have focused on the extent of the problem in narrower educational environments explicitly aligned with faith traditions that constitute distinct moral communities, nor have they explored the potential influence of the religious commitments—theological and ethical—of these communities on student attitudes and/or uptake.[21] For example, publicly identified evangelical Christian colleges and universities hold much more defined and restricted understandings of personhood and human dignity—most notably, but not exclusively, with respect to reproductive health—when compared with secular universities that aspire to pluralistic moral openness. Given these distinctives one might assume that the prevalence of CE use in these settings is lower than in secular educational settings, if not altogether absent, given the behavioral commitments that are incumbent on constituents of religious institutions. However, if CE drug use were to be identified in these communities, we must conclude either that the constituents of religious universities do not personally ascribe to the moral codes of their institutions, or (more likely) that the use of CE drugs in academic settings is increasingly viewed in broader society as morally unproblematic.
The present study conducted an online survey distributed among college students at five publicly identified evangelical Christian colleges and universities. The study had two aims. First, to pilot whether one could measure CE drug use in environments of heightened moral sensitivity—in this case, publicly identified evangelical Christian institutions of higher education. Second, the intention was to explore whether the subcultural normative sensitivity toward CE presumed within expressly Christian institutions might be reflected in student beliefs about the moral status of CE for academic purposes. Our findings have implications for student development offices in Christian institutions of higher education and suggest areas for future study. Furthermore, these findings also contribute to the literature on how social norms may or may not affect attitudes about the moral status of CE drug use and to the broader conversation of how CE drug use can be addressed as a public health issue.
Methods
Sample
Given our interest in exploring the use and attitudes among Christian college students and to identify any cultural distinctives about this student population, the study was designed to be administered within institutions of higher education with an explicit institutional Christian identity. As a result, the study sample comprised undergraduate students at five publicly identified evangelical Christian colleges and universities in the Fall 2013 semester. All five of the participating institutions were member institutions of the Council for Christian Colleges and Universities (CCCU). Furthermore, four of the institutions were members of the smaller Christian College Consortium.
At the time of the study in 2013, the CCCU required its member institutions to endorse a commitment to the “moral and spiritual formation of students” and impose a set of moral “community standards” upon their student bodies.[22] This is significant in that these institutions of higher education have a variety of distinctives, including institutional doctrinal or belief statements, and generally hold some form of honor code/life covenant/community standards of conduct/community agreements. Such honor codes generally include a variety of behavioral prescriptions and prohibitions against things such as alcohol use and sexual activity outside of marriage for students (and sometimes inclusive of faculty and staff). Many, but not all, of the CCCU member institutions include a statement about the use of illegal drugs or the broader illegal use/misuse/illicit use/abuse of drugs (sometimes specified as prescription drugs). In the case of this study all five schools addressed illegal drug use, but one of the institutional honor codes did not specifically reference the misuse of prescription drugs. While it is important to realize that the student constituencies of these institutions represent a greater diversity of beliefs regarding moral boundaries than the beliefs held by institutional leadership or reflected in their respective honor codes, it is a safe assumption that general institutional commitments are shared and exert a constraining social influence upon the student body as a religious sub-community.
Survey
In a 2012 commentary Jayne Lucke advocated for more focused research examining attitudes about CE use rather than establishing mere prevalence.[23] Such research, Lucke proposed, should address three questions: (1) Do attitudes toward CE vary and how is the practice framed? (2) How do attitudes influence behavior? (3) Are there cross-cultural differences in attitudes toward CE? [24] Responding to Lucke’s questions, the present study posed Christian college students as a cross-cultural phenomenon in contrast to the existing research literature examining student populations within largely secular, pluralistic institutional environments. This is particularly significant given the honor codes noted above that are common to Christian colleges and universities. Also, while the study was intended to establish some basic data on prevalence and diversion among Christian college students, it was primarily interested in exploring attitudes and whether Christian beliefs influenced decision-making and attitudes toward use.
In addition to Lucke’s three questions serving as a primary research prompt, the survey questions of the present study were based on surveys used in several previous studies.[25] The survey (41 possible questions) used conditional branching-logic to direct respondents to appropriate follow-up questions based on their answers to questions such as “Have you ever been diagnosed with ADHD?” or “Have you ever used ADHD medications without a prescription?”[26] Participants who admitted to taking ADHD medications without a prescription were asked additional questions about the specific types of medication used and the frequency of use. In addition to behavioral questions, the survey contained several attitudinal questions asked of all participants. For example, participants indicated agreement to statements such as “Taking ADHD medications without a prescription is immoral” and “ADHD medications should be available for those without ADHD, but only under the supervision of a physician.” Attitudinal statements assessed moral opinions via a 5-point Likert scale measuring agreement numbered from 1–5 (strongly disagree to strongly agree).
Data Collection and Analysis
Initially invitations were extended to thirteen institutions from within the CCCU to participate in the study. Despite endorsement by several senior (SVP and VP-level) student development administrators across multiple institutions, subsequent institutional processes led a majority of the institutions to decline participation. While the study had already received institutional review board (IRB) approval from both of the original research team members’ host institutions, each prospective site expressed varying degrees of concern with participation. The most commonly expressed concerns from respective institutional administrators involved: (1) how the survey results might reflect negatively on their institutions or introduce “potential liability” if results demonstrated high usage rates or revealed damaging information about the ethos of a particular institution; and/or (2) questions about students reporting activity that is illegal and/or in violation of community living standards. Ultimately, the research team was able to enlist the support of student development offices from five sites. Of the participating institutions, four required additional site-specific IRB approval within their respective institutions as a condition for their participation.
Due to the challenges experienced in the recruitment phase, research goals were adjusted with agreement not to report findings from individual institutions, maintaining institutional anonymity, and each institutional site was permitted to define a recruitment method that was amenable to their local IRB, administrative stakeholders, and student development personnel. Survey invitations were either emailed to students directly by Student Development staff or posted as a general announcement on the campus intranet, and students accessed the survey by a hyperlink to the survey. One institution sent the invitation to their entire student body, while others identified a representative sample to invite either by identifying select faculty, departments, or degree programs to distribute the survey. Surveys were available from October–December 2013.
Survey responses were collected using the web-based survey tool Qualtrics, and data were imported to JMP 14. Frequencies and percentages were generated for demographic, behavioral, and attitudinal variables. Chi-square tests or Fisher’s exact tests were performed for categorical demographic and hypothetical behavior variables.
Results
352 individuals responded to our survey invitation. Based on public enrollment figures for the participating students, we estimate that as many as 8,845 individuals may have been offered to participate in the study, although that figure is conservatively large since all but one institution offered students the participation link through a public intranet message board or only to a locally determined subset of their student body through email. As a result, approximately 4% of the total student population of the five participation institutions responded to the survey invitation. Table 1 provides sample demographics. 70.1% of respondents were female, and 86.3% were non-Hispanic white. These percentages generally reflect the gender, race, and ethnic distributions of the student populations of these institutions, with a slightly higher percentage of women (reported at approximately 58% for the aggregate student bodies) and minority participants (reported at approximately 22% for the aggregate student bodies) represented in the survey results. 82.9% of respondents professed to be born-again Christians. Religious affiliation was distributed across several Christian denominations, with greatest representation being “non-denominational” (38.3%) followed by Baptist (23.5%), and Evangelical Free (11.7%). Catholic, Orthodox, Methodist, Wesleyan, Presbyterian, Lutheran, and Episcopalian denominations were also represented. Additionally, the varied distribution methods led to significant oversampling of science majors (47.8%), reflecting a significant variance from the breakdown of enrollment within majors for CCCU institutions generally and for the participating institutions.
Table 1. Sample demographics
323 (91.2%) of survey respondents responded to the question about whether or not they had used ADHD medications without a prescription (29 individuals did not answer). Of respondents who answered this question, 38 (11.8%) answered affirmatively. 101 (29.4%) respondents reported knowledge of someone else using ADHD medications without a prescription. Table 2 compares users with those who identified as non-users across key demographic variables. More men identified as users than women (17.4% vs. 9.6%, p=0.049) and were older (p=0.023). White, non-Hispanic participants identified as users less than individuals identifying as other races (p=0.023). Finally, individuals who identified as “not born again” (i.e., not professing conversion to Christianity) more often identified as a user than those with a Christian profession of personal faith (27.3% vs. 8.7%, p<0.0001). Most of the users reported using these prescription stimulants in order to concentrate (59%), study more effectively (56%), stay awake longer (47%), and stay alert longer (38%). 9% of users reported CE use to lose weight. A significant percentage of users reported receiving such drugs from a friend or acquaintance for free (70% and 27% noncumulative respectively).
Table 2. Comparison of users and non-users of ADHD medications without a physician’s prescription across key demographic variables
Participants indicated their level of agreement to statements such as “Taking ADHD medications without a prescription is immoral” and “ADHD medications should be available for those without ADHD, but only under the supervision of a physician.” Table 3 compares self-reported users with non-users for each of these items and reports frequencies and percentages of participants who responded “strongly agree,” “agree,” or “neither agree nor disagree” to each item (i.e., lack of disagreement about intent to participate). All comparisons were statistically significant, with more users reporting approval of or ambivalence toward consumption of prescription medications for CE for various reasons if legal restrictions were hypothetically removed. Somewhat surprisingly, over 30% of non-users indicated approval of or ambivalence toward the use of cognitive enhancing drugs for studying purposes in the hypothetical absence of legal restrictions.
Table 3. Comparison of users and non-users of non-prescribed ADHD medications indicating ambivalence toward or moral approval of various ADHD medication uses
Discussion
As noted earlier, a significant body of literature has examined the use of prescription drugs for CE within academic settings. However, to our knowledge, this survey is the first to have looked at the use of prescription drugs for CE purposes by students in publicly identified evangelical Christian colleges and universities. The lack of published data focused narrowly on evangelical institutions of higher education is not surprising, since a relatively modest percentage of active students in the US attend publicly identified evangelical Christian schools.[27] Nonetheless, our findings accomplish two important empirical goals. First, our findings establish the fact that off-label use of prescription drugs for CE purposes indeed happens in evangelical Christian institutions, despite the commitments of these institutions to specific moral codes of conduct. Second, some students in evangelical Christian institutions may conflate the moral permissibility of using prescription drugs for CE with the legal status of consuming/diverting prescription medications for uses not intended by a prescribing physician. This potential conflation raises the question of whether the moral uncertainty surrounding drug use for CE is self-evident to constituents of institutions that champion their community standards and moral codes as critical to personal growth and belonging in an epistemic community.
Although our study was not designed to measure prevalence, a noteworthy percentage (11.8%) of respondents indicated use of prescription drugs for CE outside of the supervision of a physician. Of the majority of students who did not report personal use, almost one third indicated a degree of ambivalence toward or even approval of (strongly agree, agree, or neither agree nor disagree) the use of prescription drugs for academic purposes if doing so was legally permissible. It may be that the use of prescription drugs for academic purposes is not necessarily self-evidently problematic to students represented by our sample, despite the fact that several of the schools in our study explicitly censured the misuse of prescription drugs in their honor codes. The ubiquity of Starbucks and Red Bull in campus coffee shops and vending machines can reinforce the notion that academia endorses the use of pharmacological aids for academic work.[28] Caffeine use has long been an epidemiological concern, even as it retains its celebrated status as part of the scholar’s identity.[29]
In parallel to the empirical attention given to the prevalence of prescription drug use for CE more broadly in colleges and universities are ongoing normative conversations about the moral status of drug use for CE. From the standpoint of ethics, CE drug use in academic settings has become part of the larger ethical discourse around normative definitions of health, the demarcation of therapy and enhancement, and issues such as fairness, equality, academic integrity,[30] and human dignity.[31] Some have questioned the very notion that using drugs for CE could be morally problematic and have challenged the philosophical underpinnings of common objections to its use.[32] Some have suggested that concern about cognitive enhancing drugs has been overhyped and misrepresented.[33] Scholars such as Maslen and colleagues suspend normative judgment about the moral status of drug use for CE while issues of safety, efficacy, and uniform effect are forthcoming.[34]
We believe there is value in gaining an empirical understanding of how the normative beliefs of subcultures and communities might impact the prevalence of prescription drug misuse among its constituents.[35] At least two potential benefits are possible. First, empirical inquiry can inform the efforts of those who influence subcultures (i.e., the administration of publicly identified Christian institutions engaging in spiritual and moral formation alongside their educational missions) to align their beliefs with behavior. Second, empirical inquiry might show that some sentiments of normative subcultures could have utility in broader public health efforts. A possible analogue might be the normative concept of “natural,” which has had significant and sustained impact despite its pseudo-scientific quality.[36] Those charged with engaging public health concerns around prescription drug misuse should at least consider whether some of the normative themes from relatively obscure subcultures such as evangelical Christian institutions of higher education might have unanticipated salience to a much broader audience. For example, could appeals to themes such as “moral integrity” or “wholeness” strengthen existing public messages intended to curb the misuse of prescription drugs in secular settings?
To the extent that discouraging prescription drug misuse is consistent with the publicly stated norms of an institution, administrators and student development directors at evangelical Christian colleges and universities should examine their methods for discouraging its use among their student constituencies. Interventions aimed at aligning student behavior with institutional policies or stated positions should not be built around the presumption that the moral status of prescription drug use for CE is self-evident to their students. Further research could suggest whether appeals to the illegality of prescription drug misuse have utility in discouraging its use in Christian institutions. However, a preferred approach would be to include more robust education in the theological and philosophical pathways to normative Christian positions on CE beyond the mere policy and legal discussions. Christian institutions could use such opportunities to model the methods of their Christian subcultures in discovering and defining their subcultural ethics. CE could serve as a case study, a thought experiment that proceeds through a theologically informed ethical analysis and terminates in an institutional position statement or policy. Leaders of these institutions may also find it useful to draw more meaningful lines around the use of more respected substances such as caffeine and sustain a conversation about the role of a broad spectrum of human behaviors such as eating, drinking, rest, music, etc. in the work of study, personal growth, worship, and devotion. Such substantive discussion stemming initially in the discernment regarding uptake of certain enhancement “technologies” could serve as a venue for wisdom formation within a more wholistic educational context and foster deeper engagement with the ethical values and theological commitments of the respective Christian institution than the mere conformity to institutional policy and honor codes.
Limitations
The present study had two important limitations that should be noted. First, the recruitment methods (i.e., allowing participating institutions to locally determine distribution strategies) precluded the ability to ascertain a definitive response rate to the survey. As such, it is unknown whether respondents constituted a representative sample or whether the sample was influenced by self-selection bias that could have artificially inflated or deflated our measured ratio of users and non-users of prescription drugs for CE. For these reasons, we are cautious not to regard our findings as a measure of prevalence but instead as simple proof of concept that misuse of prescription drugs can be identified in publicly identified Christian academic environments. Importantly, it is quite likely that use was underreported in our data given the potential for students to underreport practices that are illegal and either implicitly or explicitly prohibited within their institution. Future studies could employ more rigorous methods to track invitation and response rates, analyze sample frames for non-response bias, and produce a more representative measure of prevalence in evangelical Christian institutions.
Secondly, each institution identified with a tradition of moral specificity that does not closely resemble that of its non-Christian peers. Each institution prohibited illicit drug use in their institutional codes of conduct. However, we did not, in this survey, assess the degree to which respondents endorsed the moral codes of conduct of their respective institutions. Future studies could look more closely at the degree to which student constituencies subscribe to the ethical norms envisioned by institutional leadership and faculty, as well as the ways in which these institutions communicate the commitments behind the institutional polices and honor codes. Furthermore, future studies could also seek ways to measure the impact of institutional ethos on individual moral decision-making. Such studies could also explore for predictors of prescription drug misuse among students in Christian institutions in an effort to identify effective interventions.
A further limitation regarding this present analysis is the age of the data. As noted earlier, the study represents a snapshot of Christian college campuses from ten years ago. While the present research team believes this data provides an important benchmark establishing evidence of uptake, it is also acknowledged that substantive changes have occurred in the campus life experience of Christian colleges and universities. As a result, the present analysis is offered as a historical snapshot pointing to the need for future attention. Beyond the limitations of the research sample, generational rise in mental health concerns, issues of resilience, continuing social impact of the Covid-19 pandemic, etc. further complicate any attempts to offer more generalizable conclusions from this study.
Conclusion
CE drug use in academic institutions continues to be an issue of great concern to stakeholders. Stakeholders in evangelical Christian institutions should not ignore the reality that CE drug use occurs even in situations where the social stigma for such behavior is presumed to be intact. Christian institutions should consider how to address the issue of CE behavior in a way that draws deeply and faithfully from the sources of moral authority that form the foundation for Christian ethics. It may be that what currently presents as a problem may provide a unique opportunity to educate tomorrow’s leaders in the exercise of ethical assessment and moral discernment. For the broader community, the data from this study presents a window into a culturally distinct subpopulation. When moral reservations about enhancement lose their foothold even in historically morally particular (even obscure) epistemic communities, we should ask whether such shifts are proxies for subtle tectonic movement of broader society’s shifting moral orientation.
References
[1] The literature establishing misuse among undergraduate and graduate students is extensive; for example see Charles Warnock, Carolyn Lauckner, and Lucy Ingram, “Exploratory Study of Indicators of Recent Nonmedical Prescription Stimulant Use Among College Students,” Journal of American College Health 71, no. 5 (2023): 1311–16, https://doi.org/10.1080/07448481.2021.1923506; Sylvia Wong, Courtney Stevens, Cindy Liu, and Justin Chen, “Prevalence and Correlates of Prescription Stimulant Misuse Among US College Students: Results From a National Survey,” The Journal of Clinical Psychiatry 84, no. 1 (2023): 22m14420, https://doi.org/10.4088/jcp.22m14420; Tess K. Drazdowski, “A Systematic Review of the Motivations for the Non-Medical Use of Prescription Drugs in Young Adults,” Drug and Alcohol Dependence 162 (2016): 3–25, https://doi.org/10.1016/j.drugalcdep.2016.01.011; Niloofar Bavarian, Brian Flay, Patricia Ketcham, and Ellen Smit, “The Illicit Use of Prescription Stimulants on College Campuses: A Theory-Guided Systematic Review,” Health Education and Behavior 42, no. 6 (2015): 719–29, https://doi.org/10.1177/1090198115580576; Lisa Weyandt, Marisa Marraccini, Bergljot Gudmundsdottir et al., “Misuse of Prescription Stimulants Among College Students: A Review of the Literature and Implications for Morphological and Cognitive Effects on Brain Functioning,” Experimental and Clinical Psychopharmacology 21, no. 5 (2013): 385 –407, https://doi.org/10.1037/a0034013; Timothy Wilens, Lenard Adler, Jill Adams et al., “Misuse and Diversion of Stimulants Prescribed for ADHD: A Systematic Review of the Literature,” Journal of the American Academy of Child and Adolescent Psychiatry 47, no. 1 (2008): 21–31, https://doi.org/10.1097/chi.0b013e31815a56f1.
[2] Again, this literature is extensive and global in its implications; see for example Sebastian Magnotti, Avery Beatty, Erek Bickford et al., “Prescription Stimulant Misuse Among Nursing Students: A Systematic Review,” Journal of Addictions Nursing 34, no. 3 (2023): 216–23, https://doi.org/10.1097/JAN.0000000000000539; Stephen Faraone, Anthony Rostain, C. Brendan Montano et al., “Systematic Review: Nonmedical Use of Prescription Stimulants: Risk Factors, Outcomes, and Risk Reduction Strategies,” Journal of the American Academy of Child & Adolescent Psychiatry 59, no. 1 (2020): 100–12, https://doi.org/10.1016/j.jaac.2019.06.012; Timothy Wilens and Tamar Arit Kaminski, “Prescription Stimulants: From Cognitive Enhancement to Misuse,” Pediatric Clinics of North America 66, no. 6 (2019): 1109–20, https://doi.org/10.1016/j.pcl.2019.08.006; Zachary A. Kirkpatrick and Carol J. Boyd, “Stimulant Use Among Undergraduate Nursing Students,” Journal of Addictions Nursing 29, no. 2 (2018): 84–9, https://doi.org/10.1097/jan.0000000000000219; James A. Ford and Corey Pomykacz, “Non-Medical Use of Prescription Stimulants: A Comparison of College Students and Their Same-Age Peers Who Do Not Attend College,” Journal of Psychoactive Drugs 48, no. 4 (2016): 253–60, https://doi.org/10.1080/02791072.2016.1213471; Aiste Lengvenyte, Roberta Strumila, and Jurgita Grikiniene, “Use of Cognitive Enhancers Among Medical Students in Lithuania,” Nordic Studies on Alcohol and Drugs 33, no. 2 (2016): 173–87, https://doi.org/10.1515/nsad-2016-0014; Sanyogita Ram, Safeera Hussainy, Marcus Henning et al., “Prevalence of Cognitive Enhancer Use Among New Zealand Tertiary Students,” Drug and Alcohol Review 35, no. 3 (2016): 345–51, https://doi.org/10.1111/dar.12294; Mark M. Silvestri and Christopher J. Correia, “Normative Influences on the Nonmedical Use of Prescription Stimulants Among College Students,” Psychology of Addictive Behaviors 30, no. 4 (2016): 516–21, https://doi.org/10.1037/adb0000182; Genevieve Verdi, Lisa L. Weyandt, and Brynheld Martinez Zavras, “Non-Medical Prescription Stimulant Use in Graduate Students: Relationship with Academic Self-Efficacy and Psychological Variables,” Journal of Attention Disorders 20, no 9 (2016): 741–53, https://doi.org/10.1177/1087054714529816; Bavarian et al., “The Illicit Use of Prescription Stimulants on College Campuses,” 719–29; Evangelia Liakoni, Michael Schaub, Larissa Maier et al., “The Use of Prescription Drugs, Recreational Drugs, and ‘Soft Enhancers’ for Cognitive Enhancement Among Swiss Secondary School Students,” PloS One 10, no. 10 (2015): e0141289, https://doi.org/10.1371/journal.pone.0141289.
Kimberly Schelle, Bas Olthof, Wesley Reintjes et al., “A Survey of Substance Use for Cognitive Enhancement by University Students in the Netherlands,” Frontiers in Systems Neuroscience 9 (2015): https://doi.org/10.3389/fnsys.2015.00010; Stéphane Deline, Stéphanie Baggio, Joseph Studer et al., “Use of Neuroenhancement Drugs: Prevalence, Frequency and Use Expectations in Switzerland,” International Journal of Environmental Research and Public Health 11, no. 3 (2014): 3032–45, https://pmc.ncbi.nlm.nih.gov/articles/PMC3987019/pdf/ijerph-11-03032.pdf; Niloofar Bavarian, Brian Flay, Patricia Ketcham, and Ellen Smit, “Illicit Use of Prescription Stimulants in a College Student Sample: A Theory-Guided Analysis,” Drug and Alcohol Dependence 132, no. 3 (2013): 665–73, https://pmc.ncbi.nlm.nih.gov/articles/PMC3770776/pdf/nihms-482599.pdf; John Bossaer, Jeffrey Gray, Stacy Miller et al., “The Use and Misuse of Prescription Stimulants as “Cognitive Enhancers” by Students at One Academic Health Sciences Center,” Academic Medicine 88, no. 7 (2013): 967–71, https://doi.org/10.1097/acm.0b013e318294fc7b; Larissa Maier, Matthias Liechti, Fiona Herzig, and Michael Schaub, “To Dope or Not to Dope: Neuroenhancement with Prescription Drugs and Drugs of Abuse Among Swiss University Students,” PloS One 8, 11, (2013): e77967, https://doi.org/10.1371/journal.pone.0077967; Jadon Webb, Mark Valasek, and Carol North, “Prevalence of Stimulant Use in a Sample of US Medical Students,” Annals of Clinical Psychiatry 25, no. 1 (2013): 27–32, https://doi.org/10.1177/104012371302500105; Andreas Franke, C. Bonertz, M. Christmann et al., “Non-Medical Use of Prescription Stimulants and Illicit Use of Stimulants for Cognitive Enhancement in Pupils and Students in Germany,” Pharmacopsychiatry 44, no. 2 (2011): 60–66, https://doi.org/10.1055/s-0030-1268417; Sean Esteban McCabe, “Misperceptions of Non-Medical Prescription Drug Use: A Web Survey of College Students,” Addictive Behaviors 33, no. 5 (2008): 713–24, https://pmc.ncbi.nlm.nih.gov/articles/PMC2741637/pdf/nihms44590.pdf; Emma Scotter and Julie Meaux, “Prescription Stimulant Misuse Among College Students,” Journal of Pediatric Nursing 23, no. 2 (2008): E21, https://doi.org/10.1016/j.pedn.2008.01.068.
Sean Esteban McCabe, Christian Teter, and Carol Boyd, “Medical Use, Illicit Use, and Diversion of Abusable Prescription Drugs,” Journal of American College Health 54, no. 5 (2006): 269–78, https://pmc.ncbi.nlm.nih.gov/articles/PMC1876754/pdf/nihms14394.pdf; Christian Teter, Sean Esteban McCabe, Kristy LaGrange et al., “Illicit Use of Specific Prescription Stimulants Among College Students: Prevalence, Motives, and Routes of Administration,” Pharmacotherapy 26, no. 10 (2006): 1501–10, https://pmc.ncbi.nlm.nih.gov/articles/PMC1794223/pdf/nihms14382.pdf; Sean Esteban McCabe, John R. Knight, Christian J. Teter, and Henry Wechsler, “Non-Medical Use of Prescription Stimulants Among US College Students: Prevalence and Correlates from a National Survey,” Addiction 100, no. 1 (2005): 96–106, https://doi.org/10.1111/j.1360-0443.2005.00944.x; and Sarah Lord, George Downs, Paul Furtaw et al., “Nonmedical Use of Prescription Opioids and Stimulants Among Student Pharmacists,” Journal of the American Pharmacists Association 49, no. 4 (2003): 519–28, https://doi.org/10.1331/japha.2009.08027.
[3] Silvestri and Correia, “Normative Influences on the Nonmedical Use of Prescription Stimulants Among College Students.”
[4] Magnotti et al., “Prescription Stimulant Misuse Among Nursing Students”; Alynna G. Summit and Nora E. Noel, “Assessing Motivations and Gender as Factors in College Students’ Views of Nonmedical Prescription Stimulant Use,” Journal of American College Health 71, no. 5 (2023): 1497–1503, https://doi.org/10.1080/07448481.2021.1942005; Andreas G. Franke, Sophie Lehmberg, and Michael Soyka, “Pharmacological Neuroenhancement: Teachers’ Knowledge and Attitudes-Results from a Survey Study Among Teachers in Germany,” Substance Abuse: Treatment, Prevention, and Policy 11, no. 1 (2016): https://doi.org/10.1186/s13011-016-0077-y; Silvestri and Correia, “Normative Influences on the Nonmedical Use of Prescription Stimulants Among College Students”; Cynthia Forlin, Jan Schildmann, Patrik Roser et al., “Knowledge, Experiences and Views of German University Students Toward Neuroenhancement: An Empirical-Ethical Analysis,” Neuroethics 8, no. 2 (2014): 83–92, https://doi.org/10.1007/s12152-014-9218-z; Brad Partridge, Stephanie Bell, Jayne Lucke, and Wayne Hall, “Australian University Students Attitudes Towards the Use of Prescription Stimulants as Cognitive Enhancers: Perceived Patterns of Use, Efficacy and Safety,” Drug and Alcohol Review 32, no. 3 (2013): 295–302, https://doi.org/10.1111/dar.12005; and Teter et al., “Illicit Use of Specific Prescription Stimulants Among College Students.”
[5] Magnotti et al., “Prescription Stimulant Misuse Among Nursing Students”; Laura Holt and Megan McCarthy, “Predictors of Prescription Stimulant Misuse in U.S. College Graduates,” Substance Use & Misuse 55, no. 4 (2020): 644–57, https://doi.org/10.1080/10826084.2019.1692867; Wilens and Kaminski, “Prescription Stimulants: From Cognitive Enhancement to Misuse”; and Partridge et al., “Australian University Students Attitudes Towards the Use of Prescription Stimulants as Cognitive Enhancers.”
[6] Holt and McCarthy, “Predictors of Prescription Stimulant Misuse in U.S. College Graduates”; Conrad Woolsey, Ronald Williams, Bert Jacobson et al., “Increased Energy Drink Use as a Predictor of Illicit Prescription Stimulant Use,” Substance Abuse 36, no. 4 (2015):413–19, https://doi.org/10.1080/08897077.2014.969470; Maier et al., “To Dope or Not to Dope”; Andreas Franke, Klaus Lieb, and Elisabeth Hildt, “What Users Think About the Differences Between Caffeine and Illicit/Prescription Stimulants for Cognitive Enhancement,” PloS One 7, no. 6 (2012): e40047, https://doi.org/10.1371/journal.pone.0040047; Andreas Franke, M. Christmann, C. Bonertz et al., “Use of Coffee, Caffeinated Drinks and Caffeine Tablets for Cognitive Enhancement in Pupils and Students in Germany,” Pharmacopsychiatry 44, no. 7 (2011): 331–38, https://doi.org/10.1055/s-0031-1286347; and Christian Teter, Sean Esteban McCabe, James Cranford et al. “Prevalence and Motives for Illicit Use of Prescription Stimulants in an Undergraduate Student Sample,” Journal of American College Health 53, no. 6 (2005): 253–62, https://doi.org/10.3200/JACH.53.6.253-262.
[7] Magnotti et al., “Prescription Stimulant Misuse Among Nursing Students”; Sara De Bruyn, Edwin Wouters, Koen Ponnet, and Guido Van Hal, “Popping Smart Pills in Medical School: Are Competition and Stress Associated with the Misuse of Prescription Stimulants Among Students?” Substance Use & Misuse 54, no. 7 (2019): 1191–1202, https://doi.org/10.1080/10826084.2019.1572190; Martha Boulton and Kathleen O’Connell, “Nursing Students’ Perceived Faculty Support, Stress, and Substance Misuse,” Journal of Nursing Education 56, no. 7 (2017): 404–11; Ford and Pomykacz, “Non-Medical Use of Prescription Stimulants,” 253–60, https://doi.org/10.3928/01484834-20170619-04; Charmaine Jensen, Cynthia Forlini, Brad Partridge, and Wayne Hall, “Australian University Students’ Coping Strategies and Use of Pharmaceutical Stimulants as Cognitive Enhancers,” Frontiers in Psychology 7 (2016): 277, https://doi.org/10.3389/fpsyg.2016.00277; Cynthia Forlini and Eric Racine, “Autonomy and Coercion in Academic ‘Cognitive Enhancement’ Using Methylphenidate: Perspectives of Key Stakeholders,” Neuroethics 2, no. 3 (2009): 163–77, https://doi.org/10.1007/s12152-009-9043-y; Amelia Arria and Eric Wish, “Nonmedical Use of Prescription Stimulants Among Students,” Pediatric Annals 35, no. 8 (2006): 565–71, https://pmc.ncbi.nlm.nih.gov/articles/PMC3168781/pdf/nihms-320291.pdf; and Sean Esteban McCabe, Christian Teter, and Carol Boyd, “Medical Use, Illicit Use and Diversion of Prescription Stimulant Medication,” Journal of Psychoactive Drugs 38, no. 1 (2006): 43–56, https://pmc.ncbi.nlm.nih.gov/articles/PMC1761861/pdf/nihms14390.pdf.
[8] McCabe et al., “Medical Use, Illicit Use and Diversion of Prescription Stimulant Medication.”
[9] Teter et al., “Illicit Use of Specific Prescription Stimulants Among College Students.”
[10] Lisa Weyandt, Tara White, Bergljot Gyda Gudmundsdottir et al., “Neurocognitive, Autonomic, and Mood Effects of Adderall: A Pilot Study of Healthy College Students,” Pharmacy 6, no. 3 (2018): 58, https://doi.org/10.3390/pharmacy6030058; Lisa Weyandt, Marisa Marracini, Bergljot Gyda Gudmundsdottir et al., “Misuse of Prescription Stimulants Among College Students: A Review of the Literature and Implications for Morphological and Cognitive Effects on Brain Functioning,” Experimental and Clinical Psychopharmacology 21, no. 5 (2013): 385–407, https://doi.org/10.1037/a0034013; Ameila Arria, Kevin O’Grady, Kimberly Caldeira et al., “Nonmedical Use of Prescription Stimulants and Analgesics: Associations with Social and Academic Behaviors Among College Students,” Journal of Drug Issues 38, no. 4 (2008): 1045–60, https://pmc.ncbi.nlm.nih.gov/articles/PMC2857807/pdf/nihms-65737.pdf.
[11] Searches of PubMed’s database using various search terms and parameters suggest that while literature continues to be published annually on this topic, it appears to have peaked in volume sometime between 2017 and 2021, with the 2020–2021 publication period yielding the largest consistent volume.
[12] Larry Kroutil, David Brunt, Mindy Herman-Stahl et al., “Nonmedical Use of Prescription Stimulants in the United States,” Drug and Alcohol Dependence 84, no. 2 (2006): 135–43, https://doi.org/10.1016/j.drugalcdep.2005.12.011; and Christian Teter, Sean Esteban McCabe, Carol Boyd, and Sally Guthrie, “Illicit Methylphenidate Use in an Undergraduate Student Sample: Prevalence and Risk Factors,” Pharmacology 23, no. 5 (2003): 609–17, https://doi.org/10.1016/j.drugalcdep.2005.12.011.
[13] K. Graff Low and A. E. Gendaszek, “Illicit Use of Psychostimulants Among College Students: A Preliminary Study,” Psychology, Health & Medicine 7, no. 3 (2002): 283–87, https://doi.org/10.1080/13548500220139386.
[14] Alan Desantis, Seth Noar, and Elizabeth M. Webb, “Speeding Through the Frat House: Nonmedical ADHD Stimulant Use in Fraternities,” Journal of Studies on Alcohol and Drugs 70, no. 6 (2009): 157–171, https://doi.org/10.2190/de.40.2.d.
[15] Scott Novak, Larry Kroutil, Rick Williams, and David Van Brunt, “The Nonmedical Use of Prescription ADHD Medications: Results from a National Internet Panel,” Substance Abuse Treatment, Prevention, and Policy 2, no. 32 (2007): https://doi.org/10.1186/1747-597X-2-32.
[16] McCabe et al., “Medical Use, Illicit Use and Diversion of Prescription Stimulant Medication.”
[17] While most of the studies at this time were based on single site student populations, a 2005 national multisite college student survey noted 7% non-medical lifetime use, 4% in the past 12 months, 2% in the last month as a comparative. McCabe et al., “Non-Medical Use of Prescription Stimulants Among US College Students,” 96–106. For an overview of the literature review for the study relevant to prevalence see Susan Rouse, “Cognitive Enhancement in Education: A Literature Review,” Dignitas 21, no. 3 (2014): 1, 9–12, https://www.cbhd.org/dignitas-articles/cognitive-enhancement-in-education-a-literature-review. While recent studies appear to indicate increasing rates of prevalence, a secondary analysis of a 2017 national survey of 40,645 undergraduate students suggested uptake remains around 8% of college students. Wong et al., “Prevalence and Correlates of Prescription Stimulant Misuse Among US College Students.
[18] Rouse, “Cognitive Enhancement in Education.”
[19] Teter et al., “Illicit Use of Specific Prescription Stimulants Among College Students.” See also Teter et al., “Prevalence and Motives for Illicit Use of Prescription Stimulants in an Undergraduate Student Sample,” 260; and Barbara Prudhomme White, Kathryn Becker-Blease, and Kathleen Grace-Bishop, “Stimulant Medication Use, Misuse and Abuse in an Undergraduate and Graduate Student Sample,” Journal of American College Health 54, no. 5 (2006): 261–68, https://doi.org/10.3200/jach.54.5.261-268. More recent studies suggest this gender uptake gap may have narrowed; see Abby Johnson Holm, Shelby Tuthill, Neelamberi Klein et al., “Compounding Privilege, Resilience, and Nonmedical Prescription Stimulant Use Among College Students,” Substance Use & Misuse 57, no. 12 (2022): 1751–60, https://pmc.ncbi.nlm.nih.gov/articles/PMC10851314/pdf/nihms-1836322.pdf. However, the increased female motive to use CE drugs to lose weight appears to continue; see Sheena Cruz, Stephanie Sumstine, Jocelyn Mendez, and Niloofar Bavarian, “Health-Compromising Practices of Undergraduate College Students: Examining Racial/Ethnic and Gender Differences in Characteristics of Prescription Stimulant Misuse,” Addiction Behaviors 68 (2017): 59–65, https://pmc.ncbi.nlm.nih.gov/articles/PMC5272829/pdf/nihms843809.pdf; and Elise Gibbs, Andrea Kass, Dawn Eichen et al., “ADHD-Specific Stimulant Misuse, Mood, Anxiety, and Stress in College-Age Women at High Risk for or with Eating Disorders,” Journal of American College Health 64, no. 4 (2016): 300–308, https://pmc.ncbi.nlm.nih.gov/articles/PMC4904716/pdf/nihms792022.pdf.
[20] Teter et al., “Prevalence and Motives for Illicit Use of Prescription Stimulants in an Undergraduate Student Sample,” 257. More recent studies suggest this association between CE misuse and risky alcohol and other drug misuse continues. Warnock et al., “Exploratory Study of Indicators of Recent Nonmedical Prescription Stimulant Use Among College Students”; and Nicole Fossos-Wong, Jason Kilmer, Alexander Sokolovsky et al., “Patterns, Consequences, and Motives in Simultaneous Use of Prescription Stimulant Medication with Alcohol and Marijuana, “ Substance Use & Misuse 56, no. 13 (2021): 1972–81, https://pmc.ncbi.nlm.nih.gov/articles/PMC8751539/pdf/nihms-1767388.pdf.
[21] A few studies have suggested the ways in which religiosity serves as a “protective factor for substance use behavior,” but have conducted these studies within contexts of religiously diverse student populations in public or private institutions that do not explicitly identify as a Christian college or university as described by the Council for Christian Colleges and Universities. In the context of cognitive enhancement misuse see: Wilma Figueroa, Kyle Yomogida, Jocelyne Mendez, and Niloofar Bavarian, “Prescription Stimulant Misuse Avoidance Self-Efficacy: Correlates and Moderation by Race/Ethnicity,” Journal of Ethnicity in Substance Abuse 19, no. 3 (2020): 479–89, https://pmc.ncbi.nlm.nih.gov/articles/PMC9592243/; and Andrew Galluci, Christine Hackman, and Amanda Wilkerson, “Examining the Relationship Between Religious Coping and the Misuse of Prescription Stimulants Among a Sample of Undergraduate Students,” Substance Use & Misuse 53, no. 9 (2018): 1571–79, https://doi.org/10.1080/10826084.2017.1416405. For literature examining religiosity as a protective factor against broader substance use, see Oscar S. Escobar and Ellen L. Vaughan, “Public Religiosity, Religious Importance, and Substance Use Among Latino Emerging Adults,” Substance Use & Misuse 49, no. 10 (2014): 1317–25, https://doi.org/10.3109/10826084.2014.901384; Fernanda Carolina Gomez, Arthur Guerra de Andrade, Rafael Izbicki et al., “Religion as a Protective Factor Against Drug Use Among Brazilian University Students: A National Survey,” Revista Brasileira de Psiquiatria 35, no. 1 (2013): 29–37, https://doi.org/10.1016/j.rbp.2012.05.010; Zila Van der Meer Sanchez, Lúcio Garcia De Oliveira, and Solange Aparecida Nappo, “Religiosity as a Protective Factor Against the Use of Drugs,” Substance Use & Misuse 43, no. 10 (2008): 1476–86, https://doi.org/10.1080/10826080802183288; and Aashir Nasim, Shawn Utsey, Rosalie Corona, and Faye Belgrade, “Religiosity, Refusal Efficacy, and Substance Use Among African-American Adolescents and Young Adults,” Journal of Ethnicity in Substance Abuse 5, no. 3 (2006): 29–49, https://doi.org/10.1300/j233v05n03_02.
[22] Council for Christian Colleges and Universities, https://www.cccu.org/; and Council for Christian Colleges and Universities, “Members and Affiliates,” https://www.cccu.org/members_and_affiliates.
[23] Jayne Lucke, “Empirical Research on Attitudes Toward Cognitive Enhancement Is Essential to Inform Policy and Practice Guidelines,” AJOB Primary Research 3, no. 1 (2012): 58–60, https://doi.org/10.1080/21507716.2011.645268.
[24] Lucke, “Empirical Research on Attitudes Toward Cognitive Enhancement Is Essential to Inform Policy and Practice Guidelines.”
[25] Stephanie Bell, Brad Partridge, Jayne Lucke, and Wayne Hall, “Australian University Students’ Attitudes Towards the Acceptability and Regulation of Pharmaceuticals to Improve Academic Performance,” Neuroethics 6, no. 1 (2013): 197–205; Alan DeSantis, Seth Noar, and Elizabeth Webb, “Speeding Through the Frat House: A Qualitative Exploration of Nonmedical ADHD Stimulant Use in Fraternities,” Journal of Drug Education 40, no. 2 (2010): 157–71, https://doi.org/10.2190/de.40.2.d; Kristina Hall, Melissa Irwin, Krista Bowman et al., “Illicit Use of Prescribed Stimulant Medication Among College Students,” Journal of American College Health 53, no. 4 (2005): 167–74, https://doi.org/10.3200/jach.53.4.167-174; Timothy Hotze, Kavita Shah, Emily Anderson, and Matthew Wynia, “‘Doctor, Would You Prescribe a Pill to Help Me . . . ?’ A National Survey of Physicians on Using Medicine for Human Enhancement,” The American Journal of Bioethics 11, no. 1 (2011): 3–13, https://doi.org/10.1080/15265161.2011.534957; and Novak et al., “The Nonmedical Use of Prescription ADHD Medications.”
[26] As a result of the conditional branching logic most response pathways resulted in 36–39 asked questions.
[27] The CCCU reports total global enrollment of member institutions at more than 525,000 at its 170+ member colleges and universities. “About: Our Work and Mission,” Council for Christian Colleges and Universities, accessed September 22, 2026, https://www.cccu.org/about/.
[28] Franke et al., “What Users Think About the Differences Between Caffeine and Illicit/Prescription Stimulants for Cognitive Enhancement.”
[29] Rowan P. Ogeil and James G. Phillips, “Commonly Used Stimulants: Sleep Problems, Dependence and Psychological Distress,” Drug And Alcohol Dependence 153 (2015): 145–51, https://doi.org/10.1016/j.drugalcdep.2015.05.036; Franke et al., “Use of Coffee, Caffeinated Drinks and Caffeine Tablets for Cognitive Enhancement in Pupils and Students in Germany”; Andreas Franke and Klaus Lieb, “Pharmacological Neuroenhancement and Brain Doping: Chances and Risks,” Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz 53, no. 8 (2010): 853–60, https://doi.org/10.1007/s00103-010-1105-0; Gilberto Fisone, Anders Borgkvist, and Alessandro Usiello, “Caffeine As a Psychomotor Stimulant: Mechanism of Action,” Cellular and Molecular Life Sciences 61, no. 7–8 (2004): 857–72, https://pmc.ncbi.nlm.nih.gov/articles/PMC11138593/pdf/018_2003_Article_3269.pdf; and John R. Hughes, Alison H. Oliveto, John E. Helzer et al., “Should Caffeine Abuse, Dependence, or Withdrawal Be Added to DSM-IV and ICD-10?” American Journal of Psychiatry 149, no. 1 (1992): 33–40, https://doi.org/10.1176/ajp.149.1.33.
[30] Kelsy Reisinger, Patricia Rutledge, and Sarah Conklin, “Study Drugs and Academic Integrity: The Role of Beliefs About an Academic Honor Code in the Prediction of Nonmedical Prescription Drug Use for Academic Enhancement,” Journal of College Student Development 57, no. 1 (2016): 65–78, https://doi.org/10.1353/csd.2016.0011; and Katrina Bramstedt, “Caffeine Use by Children: The Quest for Enhancement,” Substance Use and Misuse 42, no. 8 (2007): 1237–51, https://doi.org/10.1080/10826080701208962.
[31] Susan Rouse, “Cognitive Enhancement in Education: The State of the Issue,” Dignitas 20, no. 3 (2013): 6–11, https://www.cbhd.org/dignitas-articles/cognitive-enhancement-in-education-the-state-of-the-issue.
[32] Hannah Maslen, Nadira Faulmüller, and Julian Savulescu, “Pharmacological Cognitive Enhancement—How Neuroscientific Research Could Advance Ethical Debate,” Frontiers in Systems Neuroscience 8, no. 107 (2014): https://doi.org/10.3389/fnsys.2014.00107.
[33] Bradley Partridge, Stephanie Bell, Jayne Lucke et al., “Smart Drugs ‘as Common as Coffee’: Media Hype About Neuroenhancement,” PloS One 6, no. 11 (2011): e28416, https://doi.org/10.1371/journal.pone.0028416; Jayne C. Lucke, Stephanie Bell, Bradley Partridge, and Wayne D. Hall, “Deflating the Neuroenhancement Bubble,” AJOB Neuroscience 2, no. 4 (2011): 38–43, https://doi.org/10.1080/21507740.2011.611122; and Hazem Zohny, “The Myth of Cognitive Enhancement Drugs,” Neuroethics 8, no. 3 (2015): 257–69, https://doi.org/10.1007/s12152-015-9232-9.
[34] Maslen et al., “Pharmacological Cognitive Enhancement.”
[35] Silvestri and Correia, “Normative Influences on the Nonmedical Use of Prescription Stimulants Among College Students.”
[36] (Un)Natural: Ideas About Naturalness in Public and Political Debates About Science, Technology and Medicine: Analysis Paper (Nuffield Council on Bioethics, November 2015), https://cdn.nuffieldbioethics.org/wp-content/uploads/Naturalness-analysis-paper-1.pdf.
Acknowledgements: The 2013–2014 original study received partial funding from The Center for Bioethics & Human Dignity to assist in administering the online survey. Additionally, we acknowledge our indebtedness to Dr. Susan Rouse for initiating and conducting this research and express our profound sadness and condolences to her family and friends for her passing.
Supplemental Data Tables
Cite as: Joel Pacyna, Michael J. Sleasman, and Bryan A. Just, “Research Note: Cognitive Enhancement Attitudes and Uptake Among Christian College Students,” Ethics & Medicine 39, no. 2–3 (2023): Early Access.
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