Modafinil to boost academic performance: Effective, Addictive, Cheating?

Originally marketed as a wake-promoting agent, modafinil is a prescription drug that is said to boost cognition in healthy subjects. As such it’s use has spread amongst college students cramming for dreaded examinations. Anecdotal reports are of enhanced focus, clarity of thought and intellectual stamina; attractive properties for those hoping to secure a competitive edge for themselves.

But how do the pro-cognitive effects of modafinil stack up in proper scientific studies? Is modafinil addictive? And what ethical stance should be taken on the use of performance-enhancing agents in academic life?

Does modafinil enhance cognitive performance?

The first laboratory-based study of modafinil (single dose 100 or 200mg) in 2003 showed that it had clear pro-cognitive properties. Since then a further six studies have been in agreement, with performance enhancements in the domains of working memory, cognitive flexibility and planning.

A recent and elegant study carried out in Cambridge involving 64 healthy participants between the ages of 19-36 is illustrative [Muller et al 2012]. Participants were randomly allocated to receive modafinil (200mg) or placebo under experimental conditions, two hours ahead of a cognitive challenge. In addition to the usual measures of memory performance, task enjoyment was rated.

Performance in planning/problem solving under modafinil v placebo

The modafinil group achieved success with fewer choices in a task requiring cognitive planning. Performance enhancement was most apparent at the highest level of difficulty. Error bars are SEM.
From: Muller et al Neuropharmacology 64 (2013) 490-495.

The main findings were that the modafinil group out-performed the placebo group on tests of working memory, planning and pattern recognition memory. These improvements were more prominent as the cognitive tasks became more difficult.

And for the first time, it was shown that modafinil boosted enjoyment during the testing.

The authors postulated that the enjoyment could have arisen from the sense of satisfaction at task mastery or instead be the result of heightened motivation as a direct effect of the drug – surely now a topic for further study.

Is modafinil addictive?

The behavioural pharmacology of modafinil appears to stem from inhibition of the dopamine re-uptake transporter (DAT), akin to the mechanism of the classic [and addictive] stimulants, cocaine and amphetamine. However modafinil is a relatively weak inhibitor of DAT.

raclopride PET following modafinil

PET images of the human brain showing that compared to placebo, modafinil reduces raclopride binding in the striatum. The reduction in raclopride binding is indicative of dopamine release. Volkow et al (2009) JAMA 2009 301:1148-54

There are a number of behavioural differences between modafinil and the classical stimulants. Perhaps most notably, modafinil has a very low propensity for abuse (Wisor 2013). Indeed there was some hope that modafinil might actually constitute a treatment for cocaine/amphetamine addiction, but the findings to date in clinical trials have been disappointing.

Does the use of modafinil for exam revision constitute cheating?

Modafinil certainly confers a cognitive advantage, at least in the short term. And the downside in terms of addiction appears to be negligible, despite the pharmacological similarities of modafinil to ‘hard drugs’ such as cocaine and amphetamine.

The differences in cognitve performance under modafinil may be slight, and only apparent as the demands of the task increase. But isn’t this similar to the highest levels of sport, in which performance enhancing substances confer a critical edge as the competition reaches a climax.

The ethics of ‘smart drugs’ is complex [unlike the pharmacological questions above, which in contrast, can be settled by experiment, as well as reason]. One could argue that personal choice is all that matters. Surely the individual student should make their own judgement on whether to use, or abstain from, cognitive enhancers?  But is it only a personal matter? A decision to use smart drugs has a potential impact on the competition, the rest of the field. Is the use of modafinil, and the like, nothing other than cheating?