Germany's largest representative study on "brain doping" published

The study has been published in the journal "Deviant Behavior" and emerged from the "Enhance" project, which Dr Sebastian Sattler from the Faculty of Sociology at Bielefeld University is leading together with Professor Guido Mehlkop from the Faculty of Economics, Law and Social Sciences at the University of Erfurt. The project is funded by the German Research Foundation (DFG). Previous studies were based on significantly fewer cases, often did not use representative samples or had ambiguous findings. Existing studies are also several years old. The Enhance study now provides solid, new data.

Caffeinated drinks far ahead, followed by dietary supplements and home remedies

The study recorded whether and how often the participants had used legal substances such as caffeine and caffeine tablets, dietary supplements and home remedies, prescription medication and illegal drugs to boost their mental performance in the past, without there being any medical reasons for doing so. The survey also asked about personal characteristics such as age, gender, educational background, employment status and income.

According to the survey, a total of seven out of ten respondents (69.9 per cent) had taken at least one of the performance-enhancing substances in the past twelve months – many of them also consumed more than one substance.

The most common were caffeinated drinks, which include energy drinks as well as coffee: 64.2 per cent of respondents stated that they had consumed these in the past twelve months with the express aim of boosting performance. Food supplements and home remedies such as ginkgo biloba were the second most frequently used (31.4 per cent). 3.7 per cent of respondents also stated that they were currently taking prescription medication without medical necessity (over their lifetime: 5.5 per cent), which corresponds to around 2.5 million users (lifetime: 3 million).

40 per cent can imagine taking medication to improve performance

"Of these people, almost one in three stated that they had used such drugs 40 times or more within a year," says Sattler, lead author of the study. Around 40 per cent of those surveyed do not fundamentally reject the future use of such performance-enhancing drugs. "This figure surprised us. There seems to be a great willingness to take performance-enhancing drugs for which there is no medical need."

In addition, 4.1 per cent of respondents stated that they had taken cannabis in the past twelve months, presumably to improve performance by reducing stress or to stimulate creativity. The use of other illegal substances, such as cocaine or amphetamine, was rather rare at 1.4 per cent in the twelve-month period.

The use of different substances varies across social groups. According to Sattler, it is interesting to note, for example, that men are more likely than women to use caffeine tablets and illegal drugs such as cocaine to boost their mental performance. There was also a greater prevalence of illegal drugs in urban compared to rural areas.

Link between age and consumption behaviour

Three age-specific trends in neuro-enhancer use are recognisable in the study:

• "To boost their performance, people aged 35 to 44 and younger were significantly more likely to consume caffeinated drinks and caffeine tablets than older people," said Professor Guido Mehlkop from the Faculty of Economics, Law and Social Sciences and the Institute for Planetary Health Behaviour at the University of Erfurt.
• Prescription drugs that were not medically necessary for performance enhancement were used the least by this age group, while younger and older people used them significantly more. "We wonder why," says Mehlkop. "In older people, it could be assumed that their mental performance is declining and they want to compensate for this in order to continue to fulfil the requirements of their job."
• Illegal substances, on the other hand, are mainly consumed by younger people up to the age of 34. After that, the likelihood of use is greatly reduced.

Use based on personal expectation despite sometimes thin evidence

According to Sattler, it is interesting that many people take substances even though it is unclear whether they really improve cognitive abilities such as concentration and memory. They act on the basis of subjective expectations and hope, for example because acquaintances tell them about it or they have read about it on social media - similar to homeopathy. In doing so, they risk side effects such as nausea, high blood pressure and sleep disorders. In some cases, taking the medicine also leads to overestimation.

According to co-author Professor Uwe Fuhr from the Centre for Pharmacology at Cologne University Hospital, there are indeed substances that also show effects in healthy people: "But drugs with the active ingredients modafinil or methylphenidate, which are prescribed for daytime sleepiness and attention deficit/hyperactivity disorder (ADHD), among other things, can support individual aspects of cognitive performance not only in people with such indications, but also in healthy people. However, not everything that is currently being prescribed has the desired effect."

Behaviour with many question marks

Mehlkop points out the legal, social and ethical implications that arise from the side effects of such performance-enhancing drugs. "There is the question of whether they create an unfair advantage, comparable to doping in sport," he says. In addition, people often expose themselves to unknown health risks when combining such substances.

According to Sattler, who is also a member of the Center for Uncertainty Studies (CeUS) at Bielefeld University, this raises the question of prevention: "How can working life and society be shaped to minimise the risks?" To this end, employers should create better working conditions, for example by reducing uncertainty through fixed-term contracts or curbing overtime. Guido Mehlkop suggests offering stress and resilience training in cooperation with health insurance companies. Healthier alternatives such as sport, meditation and restful sleep should also be better applied. One research question is whether such strategies can reduce substance use. Answers to this are expected at the Enhance Conference from 10 to 12 December at the Centre for Interdisciplinary Research (ZiF) at Bielefeld University.

Original publication:
Sebastian Sattler, Floris van Veen, Fabian Hasselhorn, Lobna El Tabei, Uwe Fuhr, Guido Mehlkop, Prevalence of Legal, Prescription, and Illegal Drugs Aiming at Cognitive Enhancement across Sociodemographic Groups in Germany. Deviant Behavior, https://doi.org/10.1080/01639625.2024.2334274, published on 18 April 2024, available in open access since 15 May 2024.

The journal Deviant Behavior is the only peer-reviewed scientific journal that deals exclusively with social deviance. The journal has an impact factor of 1.6 (2022).