I discuss a lot how the mere concept of cognitive enhancement has obvious appeal among college students. This makes prevention difficult when this concept is ubiquitous in the culture at large. This dissertation aims to understand the broader conversations surrounding academically oriented drug use, including behaviors, beliefs, and the cultural influences that shape student beliefs.
It deserves to be noted first that mental health, ADHD, prescription stimulants, marijuana ballot initiatives, FDA bans on Four Loko, and all of the other many drug-related issues mentioned throughout this dissertation are news. Medical advancements are of public interest, and pharmacological advancements are covered in medical journals and academic peer-reviewed publications before subsequent controversies (e.g., overmedicalization in America, an ADHD crisis, too much legal pot, etc.) raise the level of the discourse to where it becomes cover fodder for mainstream magazines and lead material for broadcast news.
In other words, cognitive enhancement is a known issue. Joe got the idea to try Adderall after reading the article “Brain Gain” in The New Yorker (Talbot, 2009); Patrick from the pilot study cited the seminal editorial in Nature as his inspiration to seek nootropes (Greeley et al., 2008). This proves that even responsibly written editorials or academic literature can inspire irresponsible—or at least illicit—drug use. Our culture is replete with other cautionary and tempting stories about human enhancement in film, literature, and television that are both high- and lowbrow.
We’ll start with the highbrow.
Aldous Huxley’s Brave New World is arguably the preeminent postmodern cautionary tale about the limits of human enhancement, but what’s most striking about the novel today is Huxley’s prescience, despite being first published in 1932, before genetics and Ritalin existed. The fictional panacea drug “soma” represented chemical escapism, but this was a cautionary tale. Just as Huxley’s utopian society takes markedly dystopian trajectory, the rampant therapeutic use of soma is revealed to be more of a great chemical pacifier and stultifier of the human condition rather than an agent for its progress (Huxley, 2006). This is the opposite of what nootropics are designed to do.
An earlier and perhaps more apt cautionary tale of human enhancement is Mary Shelly’s Frankenstein. There could arguably be no more fitting enhancement allegory than a classic about creation, where a man (Dr. Frankenstein, of course) creates a superior being (Shelly, 2000). Dr. Jekyll and Mr. Hyde also deals thematically with the consequences of a medically altered self (Stevenson, 1991). Science fiction as a literary and film genre has produced countless works that incorporate similar themes, and there is no possible way for this discussion to meaningfully catalog them all. The point is that human enhancement is not an uncommon plot premise.
Classic fictional takes on this enhancement narrative are usually not specific to illicit use of ADHD medications in educational settings. Thus the participants in this study, or students in general, are not likely to get the specific idea to use Adderall non-medically through classic literature and films. Contemporary popular culture however is different. Here’s where it gets lowbrow.
Over the course of this approximately four-year research period, people have graciously reported all kinds of pop-cultural references to Ritalin, collegiate drug use, and other related topics, whenever they occur. Though I cannot possibly comprehensively and exhaustively archive every “study drug” scene in television or film, or mention every episode of drug celebrity drug misbehavior occurring over nearly a half-decade, there are several worth noting.
When talking about prescription drug stigmas, participants often mentioned recently deceased celebrities. Posthumous Oscar-winning actor Heath Ledger was the most commonly cited example during the pilot phase of research, but students interviewed months later for this dissertation brought up Michael Jackson more often. In each of these cases, students discussed tragic celebrity overdoses to illustrate the realized harms of prescription drugs—but not specifically prescription stimulants. In most cases, these deaths were caused by prescription opiates, sedatives, or combinations thereof, but not stimulants. Frank, Kendall, and a few other participants felt that stimulants were less harmful and less negatively-stigmatized, but this study can’t conclude that all or most students will accurately discern the variable risks associated with different classes of prescription drugs.
In terms of penetrating youth demographics, MTV has been a cultural presence since I was born. The Emmy award-winning MTV series “True Life” has featured several mini-documentaries about alcohol, drug use, and college, including a 2003 episode “I’m on Adderall,” which chronicled the lives of three college students coping with varyingly severe non-medical prescription drug addictions (Sirulnick, 2003). And after 25 seasons of fairly regular alcohol and drug consumption on MTV’s groundbreaking reality show “The Real World,” recent casts have included individuals with prescription drug problems. Controversially, MTV adapted the BBC teenage drama “Skins,” in 2010, which featured liberal amounts of underage sex, lawlessness, and prescription drug abuse (Elsley & Brittain, 2011).
In the first season (2004) of the ABC network’s hit show “Desperate Housewives,” a key plot point featured one of its title housewives diverting Ritalin from her ADD-diagnosed children in order to clean the house, pick up her kids from soccer practice, and just to more expediently do general housewifery (Cherry, 2004). The raunchy and seminal Comedy Central animated satire “South Park” also took aim at ADD and Ritalin in an episode from its fourth season (Parker & Stone, 2000). As of this writing, the center of the popular culture universe seems to be orbiting around the speculation that actor Charlie Sheen might be on drugs.
In 2009 Middlebury College President Emeritus and Amethyst Initiative founder John McCardell appeared on the “Colbert Report” to discuss his campaign for higher education to reconsider the 21 year-old drinking age. The host, comedian/political satirist Stephen Colbert quipped “this is one of the things I worry about: if we have freshman in college drinking, that alcohol will mess up the Ritalin and Adderall they’re taking to study for their finals. And the Provigil.” (Hoskinson & Colbert, 2009).
Stimulant medications and prescription drugs have made inroads within contemporary popular music as well. The popular Grammy Award-winning Philadelphia-based jazz/hip-hop band “The Roots” seemed to make a daft commentary about the state of American education, juxtaposing the Columbine school shooting and overmedicalization in their 2006 song “False Media” where they sing: “America’s lost somewhere inside of Littleton / Eleven million children are on Ritalin.” (Trotter, 2006). And Ryan, a participant, cited mainstream rap/hip-hop mogul Lil’ Wayne’s song “I Feel Like Dying” where the rapper discusses “jumping off a mountain into a sea of Codeine” and “[feeling like] a prisoner locked up behind Xanax bars” (Carter, 2004).
Mental health also seems to be prevalent in popular culture. There are currently at least three reality shows about hoarding, a mental disorder listed in the DSM related to obsessive compulsive disorder. There are reality series’ about drug interventions and celebrities undergoing drug rehabilitation. Anecdotally, ADHD has become commonplace in our cultural lexicon; it is used often as an everyday adjective applicable to anybody rather than as a specified learning disorder affecting some, as in, “I’m totally ADHD right now.”
Then there are films. Gabe credited “Charlie Bartlett” for giving him the idea to try study drugs, which is a 2007 rated-R comedy satire about an affluent high school student who feigned various psychological disorders in order to receive a litany of medications that he could in turn trade to peers in-need for money and popularity (Poll, 2007). The film was a limited-release and not hugely successful commercially, but it was well received critically, and with regards to relevant issues surrounding doctor shopping and medication diversion, it is a great satire.
“Charlie Bartlett” is a cutting and surprisingly accurate lampoon of our therapy and prescription-happy culture, but its scenes involving drug diversion was more of a vehicle for other character-based plot points. Still, from the standpoint of somebody researching this exact topic, I could not have envisioned a more relevant or topical studio film. Then “Limitless” came out.
“Limitless” is an action-drama that was wide-released in early 2011, and it represents the ultimate manifestation of the modern “enhancement” dilemma (Burger, 2011). “Limitless” follows a struggling writer protagonist whose life changes completely when he discovers an experimental drug called “NZT.” The movie is of course fiction, bordering on science fiction, but it touches upon many of the same psychological issues experienced by students in this dissertation research (mainly dependence, withdrawal, extreme swings in perceived self-efficacy, etc.). “Limitless” is such a fitting modern allegory for the “Frankensteinian” cautions or Faustian pacts of human enhancement because its feature substance, NZT, represents the ultimate nootrope.
In “Limitless” NZT is introduced as a prototype designer drug concocted through a vague confluence between the pharmaceutical industry and underground street chemists. One dose lasts about a day, is worth $800, and it is awesome: on it, users can recall any information they’ve ever seen, instantly grasp complex concepts, harness complete creative control, and basically perform any mental function flawlessly and quickly. (Side effects of NZT include: awesomeness, violence, balling out of control, occasional prostitute murder, severe psychological dependence, withdrawal, crash like symptoms, sickness, and death. It may or may not also make you sort-of a ninja).
The relevant question asked in all of this is: are we the same people when we’re on drugs? We tell troubled addicts that they are not the same when they’re on drugs. This can be dear friends, family, or just people we know. Alcohol and drugs are a problem for them. And they know it’s a problem for them—neither they nor others want them to be on drugs because it’s a problem.
But therein lies the dilemma with enhancement. Outwardly, nobody knows if there’s a drug “problem” because the problem manifests in success with work, school, or relationships. Nobody cares if you’re the same person on drugs or not, because that person kicks ass. Only you know—or wonder—if you’re the same person on drugs. Maybe you even think you’re a better person on drugs.
This is probably a greater occupational concern for students, soldiers, and athletes who occupationally confront these competitive and career-determining pressures to medicate (or in soldiers’ case, life-determining).
Professional athletics remains one of the more prominent concurrent examples of enhancement being played out in the court of public opinion, especially major league baseball. As of this writing, Barry Bonds was charged with obstruction of justice in the federal case against his use of illegal performance enhancement drugs (undetectable steroids and HGH), and Roger Clemens has yet to resolve his considerable legal troubles against federal prosecutors. These are arguably two of the greatest players—Bonds as a hitter; Clemens a pitcher—in baseball history, and the specter of their probable drug use looms as a testament to the reach of enhancement’s appeal.
Baseball, like cycling and other sports, also has a rich tradition of amphetamine use. But with high profile steroid and HGH cases like Bonds and Clemens dominating the discourse, over a hundred professional baseball players quietly filed for “therapeutic exemption clauses” to the MLB’s less-heralded 2005 ban on amphetamines. In the season prior to this ban there were only 35 exemptions, of which 28 were for ADHD medications (Blum, 2008). In 2008, 103 of 111 exempt players were using ADHD medications. This can’t be coincidental, and yet relative to steroids, nobody really cares. Though different contexts, therapeutic exemption clauses and 504 plans undeniably present a similar type of opportunity for advantageous gamesmanship.
During a San Francisco Giants broadcast on August 13, 2010, a local network field reporter talked about Giants outfielder Andres Torres: “Andres Torres was a track star in Puerto Rico, and says it took him a while to develop as a hitter, but there's another reason why he got it going late: he was diagnosed with ADD in 2002, but didn't start taking medication until 2007 during his second stint with the Tigers organization,” (CSN, 2010). Looking at Torres’ career stats, his highest batting average prior to 2007 was .220 (168 at-bats in 59 games in 2003, which is not a lot), he then struggled in 2004, was subsequently demoted to play in the minor leagues for a couple years before returning to the major league (Detroit Tigers) in 2007, and then the Giants in 2009 where he batted .270. Last season he batted .284. Thus for guys like Torres, it’s possible Ritalin can make or save your career (Torres’ 2010 salary was $428,000; in 2011 it is $2.2 million; ESPN, 2011).
College students clearly feel similar competitive pressures to medicate, with many reporting successful outcomes. This begs the question of what exactly is “responsible” use when it comes to enhancement drugs?
 I’ve used several Time and Newsweek magazine covers featuring Ritalin, ADHD, and prescription drugs, and several TV news magazines have covered the issue as well, most recently 60 Minutes, with Katie Couric interviewing Alan DeSantis and several other researchers cited in this dissertation (Fager, 2010).
 Not to be confused with the opiate medication soma that is currently available on the market, though I suspect its etymology may come from Brave New World.
 Ironically, Huxley in real life became quite an advocate for the therapeutic and spiritual use of mescaline, chronicling his experiences with the drug in 1954’s The Doors of Perception (Elliott, 2003).
 Actress Brittany Murphy, musician “DJ AM”, and Comedian Greg Giraldo were also mentioned.
 Mainly presciption opiates, but alcohol and other illegal drugs are pretty constant. Please don’t ask me how I know this.
 The ensuing controversy had many advertisers abandoning MTV and the show.
 It received a 56% positive rating on Rotten Tomatoes as of April 27, 2011 (rottentomatoes.com, 2011).
 Serendipitously, I first caught wind of this development about a year ago, when my roommates got teamed up with Andrew Howard for 9 holes of golf at Griffith Park. (Howard played an Eastern European goon, arguably the movie's main bad guy). He told them about his current project at the time—a movie about a miracle brain drug that grants super cognitive powers and turns lives around. They came home and said “Dude, I think they’re making a movie about your dissertation …”
 The small pills are about the size of a 20mg tablet of methylphenidate, only translucent, resembling those clear plastic rubber tabs that you stick on the inside of IKEA desk drawers to keep them from slamming.
 This is the central thesis in Carl Elliott’s “Better Than Well,” cited in the Literature Review and throughout this dissertation (Elliott, 2003).
 But it’s not looking good for “The Rocket.”
 On April 8, 2011, Tampa Bay Rays outfielder Manny Ramirez announced his sudden retirement from baseball after his third positive test for banned substances. Ramirez was issued a 50-game suspension after his second positive test as a member of the Dodgers in 2009-10, and rather than receive the 100-game suspension for the failed third test, he retired. Sports critics widely speculated that Ramirez—widely regarded as one of the greatest right-handed hitters ever—has no chance to be voted into baseball’s Hall of Fame despite career statistics that would otherwise merit near-automatic induction (Stark, Rojas, & Padilla, 2011).
 Maybe not quite though. If the medical exemption clause was truly like 504-plans, then Andres Torres, Texas Rangers All-Star Ian Kinsler, and the over 100 other exempt players would be given four and a half strikes instead of three.
 Which is relatively good, or at least vastly improved from his early career numbers. Batting averages represent percentages of at-bats that are hits, thus a .284 means that Torres safely reached base 28.4 percent of his at-bats. Batting around or above .300 is statistically considered very good, potentially all-star worthy.
 And all you have to do is tell a doctor you can’t concentrate? Who wouldn't do that? (Footnote-footnote: I first wrote this piece of discussion as a blog entry in August focusing on Torres and Kinsler; serendipitously, both teams later reached the 2010 World Series, which the Giants won).