The Use and Impact of Cognitive Enhancers within Higher Education in the United Arab Emirates

Abstract

Introduction: Cognitive enhancers (CEs), also known as ‘smart drugs,’ ‘study aids’ or ‘nootropics’ are a cause of concern. Recent research studies investigated the use of CEs being taken as study aids by university students. Despite being illegal in most countries, the diverted non-prescription use of these molecules and the related potential for dependence and/or addiction is being reported. It has been demonstrated that healthy students (i.e. those without any diagnosed mental disorders) are increasingly using drugs such as methylphenidate, mixtures of dextroamphetamine/amphetamine, and modafinil, for the purpose of increasing their alertness, concentration or memory. These products are available on prescriptions and on the illicit market. Due to high academic pressure, university students are at risk of CE misuse. However, data regarding this issue are limited, especially in the United Arab Emirates (UAE). Aim: The current PhD thesis aimed to exploring the phenomenon of cognitive enhancers use among UAE University students. Methodology: Study 1. A systematic review was performed, in adherence with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Whilst 1,400 studies were identified within this review through a variety of electronic databases (e.g. 520 through PubMed, 490 through Science Direct and 390 through Scopus), 48 papers were deemed as relevant and were included in the review. Study 2. A cross sectional study based on a validated online survey that was distributed using university-licensed software (Qualtrics) as a direct web link via email and social media to all Medical, Pharmacy, Dentistry, Nursing and Engineering students enrolled in six UAE Universities. Associations between student characteristics and CE use were investigated using the Pearson’s Chi-squared test and Multiple logistic regression (MLR). Reasons for CE use, temporal patterns of use, details regarding purchase and types of CE used were compared by gender. Study 3. The study was a qualitative research design conducted in different academic settings of the UAE. Data were analysed thematically for the identification of themes and subthemes within the data using a coding protocol. Results: Study 1. The most popular molecules identified here included the stimulant CEs, e.g. methylphenidate, modafinil, amphetamine mixtures and caffeine-related compounds; stimulant CEs’ intake was more prevalent among males than females; drugs were largely obtained from friends and family, as well as via the Internet. Study 2. One quarter of students had used CEs. There was a clear difference between users and non-users in terms of gender (p<0.001). CE users were disproportionately represented by students from either UAE or other Arab countries (p<0.001), and by students of Medicine, followed by Pharmacy, Dentistry, and Engineering (p<0.001). CE use increased with year of study, reaching the highest level in the fourth year (p<0.001), which for most programmes is the final year. Modafinil was self-administered, especially in males, for concentration and alertness; B12 was typically taken by female students for academic performance and concentration; and high-dosage caffeine compounds were ingested to improve alertness levels. Use of the internet for both obtaining information and purchasing CEs was frequently reported. Multiple logistic regression analysis showed that gender, nationality, and year of study were associated with CE use among UAE university students. Study 3. The semi-structured interview transcripts were analysed. The study identified four main themes and 12 subthemes from students and three main themes and their five sub-themes from university faculty staffs. The qualitative findings revealed that CEs are accessible to enhance performance in terms of concentration, motivation and meeting academic deadlines. Discussion: It is suggested that CEs are increasingly being used among healthy individuals, mainly students without any diagnosed cognitive deficits, to increase their alertness, concentration, or memory, in the belief that these CEs will improve their performance during examinations or when studying. The impact of stimulant CEs may include tolerance, dependence and/or somatic (e.g. cardiovascular; neurological) complications. Conclusions: Universities need to address the prevalence of CE use amongst their students by providing effective support programs. The ethical concerns related to the use of these substances should be considered by universities against the legal restrictions related to their use.