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      Stimulant abuse as a coping strategy—Forensic and criminal consequences of stimulant abuse for neuroenhancement

      systematic-review

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          Abstract

          Pharmacological neuroenhancement (PN) describes the use of divergent psychoactive substances to enhance mental performance (cognition) without medical need. This kind of substance abuse takes place predominantly in stressful situations. Users implicitly—or even explicitly—describe this kind of drug abuse to be a coping strategy. Regarding the decision making process whether to use PN drugs or not, users indicate that legal aspects to be decisive. However, the legal situation has been neglected so far. To elucidate the German legal situation, PN substances have to be divided into over-the-counter drugs, prescription drugs and illegal drugs. Amphetamines have the highest cognition-enhancing potential, followed by modafinil and caffeine-containing substances. It is pointed out that the use of both freely available and prescription PN substances and narcotics without medical indication have so far been largely exempt from punishment under German law. However, individuals (physicians, bus and truck drivers, etc.) taking PN substances may expose others at risk due to wrong decisions (driving or treatment), errors based on side effects of the used substances. Therefore, the protection of life and health of others could legitimize criminal regulation.

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          Towards responsible use of cognitive-enhancing drugs by the healthy.

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            Modafinil and methylphenidate for neuroenhancement in healthy individuals: A systematic review.

            The term neuroenhancement refers to improvement in the cognitive, emotional and motivational functions of healthy individuals through, inter alia, the use of drugs. Of known interventions, psychopharmacology provides readily available options, such as methylphenidate and modafinil. Both drugs are presumed to be in widespread use as cognitive enhancers for non-medical reasons. Based on a systematic review and meta-analysis we show that expectations regarding the effectiveness of these drugs exceed their actual effects, as has been demonstrated in single- or double-blind randomised controlled trials. Only studies with sufficient extractable data were included in the statistical analyses. For methylphenidate an improvement of memory was found, but no consistent evidence for other enhancing effects was uncovered. Modafinil on the other hand, was found to improve attention for well-rested individuals, while maintaining wakefulness, memory and executive functions to a significantly higher degree in sleep deprived individuals than did a placebo. However, repeated doses of modafinil were unable to prevent deterioration of cognitive performance over a longer period of sleep deprivation though maintaining wakefulness and possibly even inducing overconfidence in a person's own cognitive performance. Copyright 2010 Elsevier Ltd. All rights reserved.
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              Caffeine: Cognitive and Physical Performance Enhancer or Psychoactive Drug?

              Caffeine use is increasing worldwide. The underlying motivations are mainly concentration and memory enhancement and physical performance improvement. Coffee and caffeine-containing products affect the cardiovascular system, with their positive inotropic and chronotropic effects, and the central nervous system, with their locomotor activity stimulation and anxiogenic-like effects. Thus, it is of interest to examine whether these effects could be detrimental for health. Furthermore, caffeine abuse and dependence are becoming more and more common and can lead to caffeine intoxication, which puts individuals at risk for premature and unnatural death. The present review summarizes the main findings concerning caffeine’s mechanisms of action (focusing on adenosine antagonism, intracellular calcium mobilization, and phosphodiesterases inhibition), use, abuse, dependence, intoxication, and lethal effects. It also suggests that the concepts of toxic and lethal doses are relative, since doses below the toxic and/or lethal range may play a causal role in intoxication or death. This could be due to caffeine’s interaction with other substances or to the individuals' preexisting metabolism alterations or diseases.
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                Author and article information

                Contributors
                Journal
                Front Public Health
                Front Public Health
                Front. Public Health
                Frontiers in Public Health
                Frontiers Media S.A.
                2296-2565
                28 October 2022
                2022
                : 10
                : 1028654
                Affiliations
                [1] 1Institute for Criminal Law and Criminal Procedure Law, University of Cologne (UoC) , Cologne, Germany
                [2] 2Department of Psychiatry and Psychotherapy, Ludwig Maximilian University (LMU) , Munich, Germany
                [3] 3University of Applied Labour Sciences , Mannheim, Germany
                Author notes

                Edited by: Yuka Kotozaki, Iwate Medical University, Japan

                Reviewed by: Andreas Ihle, Université de Genève, Switzerland; Jolanta B. Zawilska, Medical University of Lodz, Poland

                *Correspondence: Martin P. Waßmer martin.wassmer@ 123456uni-koeln.de

                This article was submitted to Public Mental Health, a section of the journal Frontiers in Public Health

                Article
                10.3389/fpubh.2022.1028654
                9650539
                804f4af5-4d36-4c35-859f-38c70cbba156
                Copyright © 2022 Dominik, Waßmer, Soyka and Franke.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 26 August 2022
                : 12 October 2022
                Page count
                Figures: 2, Tables: 1, Equations: 0, References: 94, Pages: 12, Words: 9194
                Funding
                Funded by: Deutsche Forschungsgemeinschaft, doi 10.13039/501100001659;
                Categories
                Public Health
                Systematic Review

                cognitive enhancement,criminal law,punishment,stimulants,legal situation,fine,neuroenhancement

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