The relevance of pharmacological neuroenhancement for stress and resilience-A multistudy report.

Background: Pharmacological neuroenhancement (PNE) is discussed as coping strategy in academic and work-related contexts. Depending on the definition of PNE and sample population, different prevalence rates for various groups have been reported. In the three parts of the study, prevalence rates for work and student populations in Germany are detected and the reasons for PNE and possible causal associations between PNE, stress and resilience are investigated. Methods: In part 1 of the study, 152 occupational physicians (OPs) were surveyed about prevalence rates and reasons for PNE. In part 2 of the study, 1,077 German students reported on their PNE behavior. 704 students were then longitudinally considered to draw conclusions on causal associations between PNE, stress, and resilience. Results: The OPs' estimated prevalence rate of 10.9% in a working population is higher than the prevalence rate of 5.4% for prescription and illicit substances found in the student sample in part 2 of the study. The reason suspected by OPs to be most important for PNE with prescription drugs were performance pressure and long working hours. Using soft enhancers, such as caffeine, is most common with a prevalence rate of 76.8% in the student sample. Stress predicts a higher (ß = 0.179, p < 0.001) and resilience a lower use of PNE (ß = -0.13, p = 0.001). Resilience predicts a lower (ß = -0.35, p < 0.001) and PNE a higher level of stress (ß = 0.11, p < 0.001). Conclusion: OPs suspect a prevalence rate of 10.9% among the working population, while we found a prevalence rate of 5.4% among students. Caffeine is the most used substance for PNE, while the use of prescription and illicit substances remains low. Higher levels of stress and lower levels of resilience result in a higher use of PNE. Universities should therefore include the promotion of resilience and methods for dealing with study stress in health programs to reduce PNE.

Pharmacological Neuroenhancement, Perceived Stress, and Resilience in Spine Surgeons-A Cross-Sectional Survey.

BACKGROUND: Spine surgeons are usually exposed to high workload and demanding work conditions. Although the relationship between pharmacological neuroenhancement (PNE) and resilience (i.e., the ability to recover from stress), as well as perceived stress and resilience-enhancing factors, has been investigated in the general population, less is known about the impact of those factors in spine surgeons. This study aimed to close that gap by investigating the relationship between PNE use and resilience, perceived stress, or resilience-enhancing factors in spine surgeons. METHODS: We conducted a cross-sectional survey in a sample of 582 spine surgeons in German-speaking countries (Austria, Germany, and Switzerland). Potentially predictive variables as well as the use of PNE were assessed by self-report questionnaires. We conducted stepwise logistic regression with backward elimination to assess the relationship among PNE use, perceived stress, resilience, and resilience-enhancing factors. RESULTS: Lifetime prevalence for PNE use was 5.7%, with highest prevalence rates for antidepressants (2.6%). Each additional unit on the Perceived Stress Scale increased the risk for PNE use (odds ratio, 2.271; 95% confidence interval, 0.1.363-3.785; P = 0.002). No statistically significant results were found for the individual ability to recover from stress or resilience-enhancing factors. CONCLUSIONS: Spine surgeons with higher levels of stress seem to be more prone to nonmedical use of PNE. Tailored interventions may improve the ability to cope with high perceived stress and prevent the use of PNE. Further research should examine the efficacy of those interventions on the prevention of PNE in spine surgeons.

Pharmacological neuroenhancement and the ability to recover from stress - a representative cross-sectional survey among the German population.

BACKGROUND: Pharmacological neuroenhancement (PNE) refers to the use of psychoactive substances without doctor's prescription to enhance cognitive performance or to improve mood. Although some studies have reported that drugs for PNE are also being used to cope with stressful life situations, nothing is known about the relationship of PNE and resilience, i.e. the ability to recover from stress. This study aimed at investigating the relationship of PNE and resilience in the first representative population sample. METHODS: A cross-sectional survey in a representative sample of 1128 adults (age ≥ 18 yrs.) living in Germany was conducted. The use of PNE and related attitudes, perceptions and behaviours were assessed by structured interviews and self-report questionnaires. Stepwise logistic regression with backward elimination was conducted to identify potential risk factors for PNE use. RESULTS: Lifetime prevalence for the use of stimulating prescription drugs without medical indication was 4.3%, 10.2% for stimulating illicit drugs, 20.3% for mood modulating prescription drugs, and 23.4% for cannabis. Coping with stressful situations was more frequently reported as underlying motive for using stimulant or mood modulating prescription drugs than stimulating illicit drugs or cannabis. The individual perceived stress increased the risk of using stimulating prescription drugs (OR: 2.86; 95% Cl: 1.49-5.46) and the individual ability to recover from stress decreased the risk of using any substance for PNE and especially mood modulating prescription drugs (OR: .62; 95% Cl: .47-.81). CONCLUSIONS: The non-medical use of prescription drugs for PNE appears to be more prevalent in subjects who are less resilient to stress. Tailored resilience interventions that improve the ability to adapt to and recover from stressors may prevent the use of prescription medication for PNE. Further research should disentangle the association between psychological resilience and PNE as well as examine the efficacy of resilience interventions in the prevention of PNE.

Prevalence of and motives for pharmacological neuroenhancement in Switzerland--results from a national Internet panel.

AIMS: To estimate the prevalence of self-reported pharmacological neuroenhancement (PNE) with prescription or recreational drugs among the Swiss general population and correlates of PNE. DESIGN: A population-based cross-sectional study using a self-administered online survey. SETTING: A telephone-recruited highly representative internet panel in Switzerland. PARTICIPANTS: A total of 10,171 Swiss employees and students (unweighted n = 10,084) aged 15-74 years (mean age: 39.1 ± 13.3; 46.6% female). MEASUREMENTS: Self-reported life-time, past-year and past-month use of prescription or recreational drugs for PNE, motives for use and correlates of PNE, including socio-demographic, health and recreational drug use characteristics. FINDINGS: The life-time prevalence of PNE was 4.0% [95% confidence interval (CI) = 3.62, 4.38], and the past-year prevalence was 2.1% (95% CI = 1.82, 2.38). Life-time pharmacological mood enhancement (3.1%; 95% CI = 2.76, 3.44) was more prevalent than pharmacological cognitive enhancement (1.4%; 95% CI = 1.17, 1.63). Fifty-four participants reported both (0.5%; 95% CI = 0.36, 0.64). PNE was associated with studying rather than full-time [odds ratio (OR) = 0.35; 95% CI = 0.21, 0.57] or part-time employment (OR = 0.39; 95% CI = 0.23, 0.67), stress (OR = 1.51 95% CI = 1.31, 1.75), cocaine (OR = 2.40; 95% CI = 1.51, 3.82) and amphetamine use (OR = 2.44; CI 95% = 1.37, 4.33), diagnosis of a mental disorder (OR = 4.26; 95% CI = 3.14, 5.80), and perceived poor health (OR = 0.76; 95% CI = 0.64, 0.90). CONCLUSIONS: Taking prescription or recreational drugs for pharmacological neuroenhancement is rare among Swiss employees and students (4.0%). Pharmacological mood enhancement (3.1%) is more prevalent than direct pharmacological cognitive enhancement (1.4%).