Enhancing Motivation by Use of Prescription Stimulants: The Ethics of Motivation Enhancement

Abstract

Healthy individuals' use of prescription drugs taken with the intention to enhance performance in academia or at work and related ethical issues concerning cognitive enhancement have been widely discussed in the academic literature. Qualitative studies have shown that enhanced motivation is one of the most pronounced effects experienced by healthy individuals seeking to boost their academic performance by taking prescription drugs. But bioethicists dealing with the ethical issues of cognitive enhancement have so far neglected to offer ethical analyses paying special attention to the ethics of motivation enhancement. In this article I discuss ethical issues of motivation enhancement induced by currently available prescription drugs. I argue that medically enhanced motivation raises questions concerning the ethics of accomplishment and the value of human effort.

Keywords:

• bioethics
• cognitive enhancement
• neuroethics
• psychopharmacology
• attention deficit disorder/ADHD
• depression

Notes

1. The term “cognitive enhancement” most often refer to “pharmacological cognitive enhancement” in the bioethical literature. Other cognitive enhancement technologies (yet only in the experimental phase) include genetic modification, brain–computer interfaces, and transcranial magnetic stimulation.

2. This definition is used by Ilieva and Farah (2013).

3. Modafinil (often referred to by the brand name Provigil) is a medical substance used to treat people suffering from sleep disorders such as narcolepsy.

4. Furthermore, studies have shown that students taking prescription drugs generally get lower grades than their peers who do not use prescription drugs (Arria 2011).

5. See, for example, Quednow (2010), who calls the discussion a “phantom debate.” I believe there are other good reasons to discuss hypothetical questions of not yet available technologies. However, that is beyond the scope of this article.

6. As one of the reviewers made me aware of, this is an example discussed by Dubljevic (2012).

7. Adderall (brand name) is a substance consisting of mixed amphetamine salts approved to treat attention deficit hyperactivity disorder (ADHD) and the sleep disorder narcolepsy in the United States. Adderall is the most preferred substance among individuals using stimulants to increase productivity among American college students (DeSantis, Noar, and Webb 2010, 158). However, Adderall is not approved to treat ADHD in many European countries.

8. Vrecko interviewed 24 students attending an elite university on the East Coast of the United States

9. Some might question the validity of self-reports by individuals using Adderall to enhance their motivation. Terbeck (2013) has raised doubt about the validity of the self-reports from Vrecko's (2013) findings. However, given amphetamines’ physiological effects it is not surprising that Adderall induces increased motivation to a much larger extent than, for example, methylphenidate, as reported by the informants. Besides affecting dopamine and noradrenaline receptors in the central nervous system, amphetamine also affects serotonin, a neurotransmitter that affects mood. See Ranisch et al. (2013) for a more detailed explanation of the physiological effects of amphetamine.

10. Even though the informants from Vrecko's study do not seem to suffer from depression, I agree that people suffering from depression could be tempted to experience the effects of Adderall. Accordingly, I think that the assumption that some students are in fact using Adderall in order to treat a real depression is plausible.

11. For example, Flanigan (2013) has argued in favor of expanding use of Adderall for individuals not suffering from disorders.

12. The argument in Freedman (1998) is applied to the SSRI antidepressant Prozac. But the line of reasoning is perfectly applicable on medical motivation enhancement as well.