At a party in a rambling, million-dollar Victorian mansion in Atlanta’s hip Inman Park neighborhood, artists and lawyers, musicians and businesspeople mingle, talk, and imbibe that eternally popular feel-good drug, alcohol. The slightly pungent scent of marijuana drifts in from a room off the kitchen, where joints are passed among a dozen people, some of them old enough to have been smoking marijuana as a recreational drug since the 1960s. Despite the fears of their worried parents in the hippie heyday, most of these folks have ended up successful; they say that they are using pot to unwind, de-stress, and be more sociable.
Later I join some friends and head to a nearby tavern. Here we are, four middle-aged professionals (a physician, a neurology technician, a computer executive, and a writer) having beers and burgers, when the conversation turns to travel—and to a certain drug. Everyone but me is knowledgeable and enthusiastic about this attention enhancer, which has become de rigueur for their far-flung travels abroad. Used routinely on trips that would normally leave people jet-lagged, the drug helps override weariness from disrupted circadian rhythms and broken sleep. The small pill, containing the compound modafinil and marketed as Provigil by the pharmaceutical company Cephalon, also makes my friends feel—perhaps actually be—more alert and focused when they return home. And taken in moderation, it doesn’t give them the jittery cardiac stimulation of amphetamines or, for that matter, too much caffeine.
Modafinil is the latest and most touted of a growing number of pharmaceuticals used to enhance cognition and mental performance in people without a diagnosis, disorder, or disease. The trend I observed on my party circuit has been documented in rigorous peer review: In a study published last year in Pharmacotherapy, researchers at the University of Maryland found that of 1,208 college students, 18 percent took ADHD medications like Ritalin and Adderall even though the drugs had not been prescribed. You might think the college students were taking stimulants mostly to party, but that is not what the researchers found. The students were taking the stimulants mainly to help with studying.
College students are not the only ones seeking that attention edge. According to an informal survey conducted by Nature last year, 20 percent of the more than 1,400 responding readers admitted to using cognition-enhancing prescription drugs for nonmedical reasons, mostly to “improve concentration.” Of those, some 50 percent said they did it daily or weekly. These were not just twentysomethings, either; nearly half of the respondents were over 35.
Drugs like modafinil, moreover, are just the leading edge of a growing trend. The potential for mind-boosting drugs and technologies has increased stunningly over the past decade as neuroscientists have unlocked the secrets of neuronal circuits, neurotransmitters, and specific molecular events triggering brain functions in three interconnected cognitive domains—attention, memory, and creativity. The resulting pharmaceutical products go by several names, including smart drugs, neuropharmaceuticals, or nootropics (from the Greek noos, for “mind,” and tropein, “going toward”). In applications where pharmaceuticals may not be viable, brain stimulation with magnetism and other mind-altering technologies are being studied instead.
Zack Lynch, executive director of the Neurotechnology Industry Organization and editor of Brain Waves, an industry blog, predicts these products will transform our future. “Neurotechnology holds the promise of not only changing people individually but accelerating economic growth for entire countries,” Lynch says. “Think of millions of workers in India or China cognitively enhanced with neuropharmaceuticals that boost productivity. Will the United States be able to place these drugs off-limits and compete?”
The Attention Edge
Pay attention to this paragraph and you are selectively concentrating on a task or idea while ignoring distractions like that dog barking down the street or your cell phone ringing. In a world of information overload and increasing multi-multitasking, you do not have to suffer from ADHD to have trouble focusing. You need no diagnosis to benefit from drugs that cut through the chaos and help you get things done.
Attention-focusing drugs, of course, have been here for years: Amphetamines, nicknamed “go pills,” were discovered in the late 19th century. By the 1940s these central nervous system stimulants were widely used to treat asthma and had become popular as “pep” and diet pills. They were embraced by members of the armed forces, especially pilots, who had to remain attentive to myriad tasks despite constant danger and fatigue. Rife with serious side effects, including hallucinations, anorexia, and heart problems, dextroamphetamine (trade name Dexedrine, better known as speed) is rarely used today by civilians. But the amphetamine mix Adderall and the amphetamine-related drug methylphenidate (Ritalin, Methylin, Concerta, among others) are commonly prescribed.
Exactly how these drugs work their magic remains unknown, but stimulants like Ritalin and modafinil influence the neurotransmitters dopamine and norepinephrine, which are essential for attention and memory skills. Both drugs inhibit reuptake, or reabsorption, of these neurotransmitters by neurons, thus prolonging their action. Modafinil also indirectly alters the action of glutamate, the main neurotransmitter used by neurons in the brain to send signals down the line. The center of action for all these drugs, says University of California at Davis psychiatrist Michael Minzenberg, is the prefrontal cortex, the part of the brain that is responsible for executive functions like sorting out conflicting thoughts, making choices, predicting events, and exerting social control.
Specializing in research on modafinil, Minzenberg has captured the drug in action through functional MRI (fMRI) scans, which map brain activity through changes in blood flow and oxygenation as subjects engage in particular mental processes. In one Minzenberg study, 21 healthy research subjects received either modafinil or a placebo on different days as they took a standardized test. Modafinil helped subjects perform significantly better on the task.
Researchers also saw the shift in prefrontal cortex activity right on the fMRI map. When an individual is not concentrating on a complex task, neurons in that part of the brain fire sporadically, constituting what Minzenberg calls the exploration mode. When the same person performs complex activities, the neurons shift into a state of heightened, coordinated activity, firing mostly in concert with the task at hand and orchestrating what Minzenberg terms the exploitation mode. “We found that modafinil shifts the brain into this exploitation mode, and so the study subjects performed better on tasks,” he says. “Now that we know how it works, we are hoping to develop better cognitive enhancers.”
Some of those enhancers may be revised versions of existing drugs. National Institutes of Health scientists have published several preliminary studies showing that nicotine—yes, the same chemical found in cigarettes—has the ability to focus attention. Minzenberg adds that there is some evidence that the brain’s canniboid receptors, the sites where marijuana has its effects, could also be manipulated to increase attention.
As scientists learn more about how the brain manages attention, drugs will become ever more powerful, nuanced, and precise. Neuroscientists Timothy Buschman and Earl Miller of the Massachusetts Institute of Technology, for instance, have found two types of attention in two separate regions of the brain. The prefrontal cortex is in charge of willful concentration; if you are studying for a test or writing a novel, the impetus and the orders come from there. But if there is a sudden, riveting event—the attack of a tiger or the scream of a child—it is the parietal cortex that is activated. The MIT scientists have learned that the two brain regions sustain concentration when the neurons emit pulses of electricity at specific rates—faster frequencies for the automatic processing of the parietal cortex, slower frequencies for the deliberate, intentional work of the prefrontal.
Theoretically, a spectrum of different drugs that modulate neural frequencies or target specific areas of the brain could fine-tune attention to suit the task at hand. “People may have different forms of ADHD. By tailoring drugs for these two different frequencies, we may be able to enhance attention for specific forms of the disorder,” Miller says. As for moderate use in normal people, he has no problem with the idea: “I would love to have drugs that enhance my cognition.” When the new products arrive, there may be different flavors for the surgeon, the fighter pilot, and the aspiring Ph.D.