This
is the third of a multiple part series exploring Cosmetic
Psychopharmacology. It includes the text of Joe's thesis and will
culminate in a reanalysis and break down of the piece. Read Part One here.Part Two here Part Four here
By
Joe Chiarenzelli
Caffeine
Origin
Caffeine is commonly known as the substance that gives us
the pick up after a cup of coffee or tea. It has been used for thousands of
years. Many accounts of this drug are found in legends, normally associated
with beneficial overtones attributed to the drink and its effects on health.
The Chinese attribute its discovery to an ancient emperor 3000 years before the
Common Era (Evans 1992). However, caffeine is not localized to Asia since
Ethiopian legends also reference drinks containing caffeine, namely coffee.
Caffeine has traditionally been used in a liquid form by steeping various
plants (tea leaves and cocoa leaves) in boiling water and consuming the liquid.
Its use has continued until today, being added into popular soft drinks. It is
the most widely used drug in contemporary times (Lovett et al. 2005) and is
considered to have few social downsides as evidenced by its near universal
legality. Recent antioxidants discoveries, common compounds found in tea and
coffee, have illuminated beneficial effects of these beverages aside from
caffeine, which may be disassociated from the beneficial effects perceived from
the action of caffeine itself.
Cognitive effects
Most of us are
fairly familiar with the effects of Caffeine ingestion. Primarily it causes an
increase in alertness and an abatement of sleepiness (Horne 1996). This is
obviously one of the cosmetic effects of caffeine. Through ingestion caffeine
can supplant the natural circadian rhythm and allow an individual to extend
his/her period of wakefulness. The benefits of this are easy to see. For
example an individual working as a long haul trucker benefits immensely by
being able to use caffeine to stay awake while driving for extended periods of
times. This allows him to avoid potentially dangerous scenarios such as falling
asleep behind the wheel or driving while in a state of extreme tiredness.
However, this is not the only effect of caffeine on cognitive functioning.
A study by Lieberman et al. in 2002 on Navy seals
demonstrated that Caffeine also has beneficial effects on vigilance, learning,
memory, and mood state. This suggests that while the primary benefit of
caffeine is staving off sleepiness, it
also can be used to more generally
increase cognitive function. While the Navy seals are not by any means
unhealthy (in fact they are most likely one of the most healthy groups one
could study), they benefit from the administration of 200 mg of caffeine. What
this suggests is that individuals at peak health still gain an advantage from
caffeine ingestion, which enables them to better perform their duties. This is
a prime example of cosmetic psychopharmacology in action and demonstrates that
there is indeed a cognitive benefit to caffeine that is not present under
purely abstinent conditions.
Cultural and Moral Views
Caffeine, being the most widely
used psychoactive compound, has no real restrictions or strong moral opposition
globally. The Mormon Church and other religions encourage abstinence from
caffeine, but this abstinence extends to all
psychoactive compounds in general. Many cultures have a long historical
connection with various caffeinated beverages notably China and Japan. In
general, most people do not view caffeine as a problem drug even though it is
addictive.
Cocaine
Origin
Cocaine is found in the Coca plant of South America. It
has had a long, rich history with both
negative and positive aspects. Originally and still today, various native
tribes chew(ed) Coca leaves along the range of the Andes Mountains. Spanish
Conquistadors who took control of the region initially decried Coca leaves, but
upon discovery that the locals were correct about the beneficial effects, taxed
the plant (Freye and Levy 2009). Many workers in mines along the Andes range
still chew the leaf while working, allowing them to work for longer periods at
increased pace (Freye and Levy 2009). German chemist Friedrich Gaedcke isolated
the cocaine alkaloid in 1855, which created the white powder commonly thought of
today. This extraction technique allowed pure cocaine, which did not require
chewing for ingestion. Cocaine then gained widespread use in medicine. Because
of its anesthetic properties it could be used topically in various surgeries,
gaining a long history of use in dental practices but also in other
applications (Musto 1991).
Cocaine found another use in the wine Vin Mariani, which
contained cocaine dissolved in ethanol. This was widely popular, with various
other beverages also adding cocaine as an ingredient. Sigmund Freud published a
work entitled Uber Coca which lauded the effects of cocaine. However, cocaine
was not long declared universally beneficial. America prohibited the sale and
distribution of Cocaine with the Harrison Narcotics Tax Act and later listed it
as a controlled substance in the 1970 Controlled Substances Act. Currently
cocaine is illegal in the United States and has a large black market revolving
around its distribution. The use of crack cocaine, which can be smoked,
increased its addictive potential and caused large- scale addiction in impoverished communities.
Cognitive Effects
Due to
cocaine's illegal status in most developed countries, it is difficult to judge
its potential cognitive benefits . However, anecdote does provide some insight.
For instance, as mentioned before, the tribes along the Andes use coca leaves
very frequently in their everyday work to give them added endurance and focus.
This suggests that, much like caffeine, cocaine has the potential to increase
wakefulness and focus. One important difference between these two stimulants
however is the addictive potential of cocaine. While coca leaves are chewed by
indigenous tribes, the leaves are not pure cocaine and this means that the
dosage on average is lower than what an individual consuming cocaine usually
ingests. Also, cocaine works directly on dopamine, a neurotransmitter that has
reinforcing effects (it promotes the repetition of a behavior), meaning that it
quite easily causes addiction in individuals exposed to it (Dackisa and Gold
1985). Due to the illicit nature of cocaine it can also be adulterated in ways
that can cause harm to an individual.
Cultural and Moral Views
In the United
States cocaine is often demonized as a very powerful negative influence on
society. It is a powerfully addictive
drug and has a strong association with delinquency. Crack cocaine, the
smokeable form, is often abused in lower income neighborhoods and, because of
this, has become largely associated with gang violence and its associated evils
(Elliot et al 1998). However there are other segments of the population who use
cocaine too. As far back as 1915, the New York Timeshad reported on cocaine use by traders
on Wall Street and in a 1973 article referred to it as a "chic
refreshment" (TIME). Outside the United States, there are both positive
and negative connotations with cocaine use, but as of yet, no one has stopped
the indigenous tribes of the Andes from using the coca leaf for their benefit.
Nicotine
Origin
Nicotine is another commonly used legal psychostimulant.
It comes from the tobacco plant and also has been used by Native Americans in
religious ceremonies for a long time. It was named after Jean Nicot de
Villemain of France. It was first isolated from the tobacco plant by German
chemists Posselt and Reiman (Henningfeild and Zeller 2006). It can be chewed,
smoked, or administered topically. It is currently the leading cause of
preventable death worldwide, with the Surgeon General in 1967 claiming that it is the main cause of lung cancer. Opinion has long
been divided about nicotine.
Cognitive effects
Nicotine, like
cocaine and caffeine, is a stimulant. It promotes wakefulness much like other stimulants.
Nicotine also has been shown in multiple studies to increase attention and
memory, both long and short term (Rezvani and Levin 2001). However there is
much debate over these benefits. Several studies have shown that nicotine users
have a lower attention and memory baseline when not under the influence of
nicotine. Upon administration of nicotine however there is an increase in
attention and memory. However on naive nicotine users (those previously
unexposed), there is also an attendant increase in attention and memory
suggesting that nicotine does have a cognitive enhancing effect. The difficulty
with nicotine is establishing whether users use because they have a lower
baseline capacity or if they use because nicotine has lowered their baseline capacity.
Cultural and Moral Views
Due to nicotine’s widespread use there are many different
opinions on its use. Some contend that it allows them to focus and relax more
easily while others contend that its use is detrimental. An important
distinction needs to be made in regards to nicotine’s effects in and of
themselves and the effects of the route of administration. Nicotine itself is
not carcinogenic, however the additives applied to it are. Nicotine does have
negative effects on cardiovascular health. Another important problem with
nicotine use is secondhand smoke. Many studies have found that the negative
effects of smoking extend not only to the individual but also to those who inhale the smoke due to
proximity. This means that individuals who do not smoke have detrimental
effects by being in close proximity to individuals who do (Zhu 2003). While
this may not be a major problem for adults who can move away from smoke, it is
import for those who live in the same household and cannot remove themselves from
the situation, namely children. This issue has inspired many countries to ban
smoking in public areas and indoors aside from in one's own home. There are
large scale global efforts to decrease the use
of products containing nicotine due to their
highly addictive nature. Many smokers themselves hope to cease use but are
incapable of doing so due to the addictive properties of the substance. And
there have been large lawsuits tied to companies that distribute nicotine
containing products because of their perceived use of misinformation and
advertising to encourage use.
Alcohol
Origin
Alcohol is
another widespread and commonly used psychoactive agent, different from
cocaine, caffeine, and nicotine because it is a depressant. Alcoholic beverages
have been consumed since prehistoric time (Roach 2005). Until 1796, alcohol was limited to alcohol water mixtures but
Johann Tobias Lowitz was able to obtain ethanol through activated charcoal
filtration. The use of alcohol is widely legal although there are many laws
that establish a minimum age for the purchase and consumption of alcohol. Many
religions use alcohol, notably the Christian use of wine in the sacrament.
Alcohol also serves as a social lubricant, meaning many countries have a social
setting around which alcohol consumption is typical and used for increased
ability of social interaction.
Cognitive effects
Although
ethanol is a depressant it has been shown to increase memory consolidation
(Tyson and Schirmuly 2003). However the intellectual effects are of minor
importance in a study of the reasons why it is used cosmetically. Primarily
alcohol is used for its properties as a "social lubricant,"
essentially a means of lowering inhibition for an increased ability to
socialize. This presents itself by decreasing self-consciousness and increasing
the likelihood of approaching others. The effects of these alterations are
evidenced by an increase in promiscuity associated with the use of alcohol.
Obviously this increase in promiscuity demonstrates an evolutionary incentive
to consume alcohol in an effort to pass on one's genes. Aside from this
cosmetic increase in social openness alcohol greatly reduces mental capacity.
Cultural and Moral Views
Interestingly
alcohol’s effects are also influenced by expectations, which vary by culture.
For instance, not all cultures expect alcohol to behave as a social lubricant
and, in accordance with this, those society's individuals do not exhibit
disinhibition upon intoxication. This is also true of aggressiveness associated
with alcohol along with sexual arousal. Many religions, including Islam and
some Christian sects, mandate complete abstinence from alcohol. Others use
alcohol in religious ceremonies or are permissive of their use. Generally,
cultures that allow the use of alcohol look at extreme alcohol use as negative
while finding no problem with moderate alcohol use. There have been periods of
alcohol prohibition in the United States where an outright ban was placed on
all alcoholic beverages. These varied opinions on alcohol have led to many
moral disagreements over alcohol that continues to today, with no real
consensus on its morality.
Selective Serotonin
Reuptake Inhibitors (SSRIs)
Origin
Selective
Serotonin Reuptake Inhibitors are a class of drug which had their inception in
1967. Dissatisfied with MAOIs and Tricyclic
antidepressants, which caused severe adverse side effects, SSRIs were developed
to function on the sertonergic system instead of the noradrengergic system, the
target of tricyclic antidepressants. These drugs quickly gained widespread use
throughout the 80s and 90s as a result of massive marketing campaigns and
clinicians preferring the less severe side effects. Currently antidepressants
are the most common prescription in the United States, making up a multibillion
dollar marketplace for drugs of this kind.
Cognitive effects
SSRIs have very
subtle effects that occur over a significant time scale for effects to occur
(Eison and Mullins 1996). Currently they are being contested as large-scale
meta-analyses show little difference in mild to moderate cases of depression
between SSRIs and placebo (Kirsch 1998) (Rief 2009). On a very small scale,
SSRIs strengthen serotonergic signals by preventing the reuptake of serotonin
at the synapse. This means that signals which are normally too weak because of
the absence of adequate serotonin have a higher chance of coming through
because the serotonin remains at the site of action for a longer time. The
exact mechanism of the reduction in anxiety and depressive thoughts is unknown,
however it is postulated that it may be because of an increase in cells of the
hippocampus, which has been noted in animal models (Santarelli 2003).
Cultural and Moral Views
The SSRIs are a topic of great contention in current
times. There widespread use raises questions of over prescription and pressure
from drug companies. However, they do provide a large scale model of cosmetic
use as the rates of clinical depression do not match up with the rates of
prescription of SSRIs. They are often a subject of cultural interest, spawning
several books, films, and art that touch on the use of Prozac or other SSRIs.
Also important is their general lack of drug seeking behavior although there
can be withdrawal symptoms associated with discontinuation.
Modafinil
Origin
Modafinil was
synthesized in the late 1970s by the French Pharmaceutical company Lafon. It
gained acceptance as a drug for use in Narcolepsy, shift work sleep disorder,
and excessive daytime sleepiness due to sleep apnea. It is also used off label
for many other disorders but interestingly is
sanctioned in Maryland for use by law enforcement and paramedics. They are
allowed, in times of high risk or extended law enforcement operations to use
doses of 200mg of Modafinil once a day to increase alertness and allow workers
to maintain activity for a long period of time. There is much interest in its
cosmetic use, because several high profile athletes use it as a doping agent
which prompted a petition of the FDA for over the counter sale [OTC].
Cognitive effects
Modafinil's
mechanisms of action are very unclear, but they do not work the exact same way
as amphetamines even though they share similar pharmacodynamic features. The
drug increases levels of monoamines and histamines. Modafinil has been found to
significantly enhance performance on digit span, visual pattern recognition,
spatial planning and stop signal reaction time (Turner 2003). Also latency was
decreased in delayed matching to a sample, decision-making and spatial planning
(Turner 2003). This means it took less time for test subjects to perform tasks
involving decision making and spatial reasoning. When asked to self-report
patients expressed that they felt alert attentive and energetic when using the
drug (Turner 2003).
Cultural and Moral views
Modafinil is not a widely known drug and correspondingly
has very little in the way of cultural significance. However, the military
approves its use for fighter pilots and other armed personnel suggesting that
its use is found to be acceptable in these professional ranks. Also, astronauts
use Modafinil for mental augmentation and to give them a semblance of a sleep
wake cycle in space, where the natural biorhythms of the earth do not apply due
to the lack of clear sunrise and sunset. These various uses suggest that in
terms of morality there are no common critiques of its use from the layman's
perspective.
Methylphenidate
Origin
Methylphenidate
(commonly known as Ritalin) was first synthesized in 1944. Beginning in the 1960s it was used to treat attention deficit hyperactivity disorder
(ADHD). It rose to prominence in the 1990s as the diagnoses of ADHD was better
understood and accepted as a condition in the medical community. It is approved
for use in ADHD, postural orthostatic tachycardia syndrome and narcolepsy and
is prescribed off label for lethargy, depression, neural insult, obesity, and
other disorders to a lesser degree.
Cognitive effects
Methylphenidate
is a psychostimulant and has the typical effect profile of such a drug. It
works by increasing the release of dopamine and norepinephrine through
preventing reuptake. The drug has been found to increase performance on spatial
tests, planning, and working memory (Elliot 1997). It also increases alertness
and wakefulness.
Cultural and Moral views
Due to methylphenidate's similarity to cocaine and
amphetamines it has a high potential for abuse and addiction, this causes
controversy over its use. There is a great deal of concern over its use by
college students as a cosmetic agent for studying or remaining awake longer.
This is a drug that has had a great deal of ethical discussion over its use,
citing its efficacy as a mental augmentative agent and also its potential for
adverse and addictive effects. Ritalin is unavailable without prescription and
is considered a schedule II substance in the United States, the same status as
cocaine.
Adderall
Origin
Adderall is a
mix of amphetamine salts that was introduced in 1996 by Shire Pharmaceuticals. It contains dectroamphetamine and a racemic
mixture of amphetamine salts. It is approved for use in ADHD and nacrcolepsy
patients and is used off label for some cases of depression and obesity.
Cognitive Effects
Like amphetamines and methylphenidate, Adderall is a
stimulant and has the associated effects of increased wakefulness. Adderall has
been found to enhance performance on convergent thinking tasks only and having
a two tiered effect, enhancement for low performing individuals and negative or
no effect on high performing individuals (Farah 2009). Adderall is also thought
to increase attentiveness.
Cultural and Moral views
Much like methylphenidate Adderall is used commonly on
college campuses to increase energy, stay awake, and increase focus. Its use
has been banned by different athletic organizations, most significantly the
NFL. Because it is an amphetamine, its
use carries with it a large potential for abuse and addiction. Generally the
drug is thought to be acceptable for use in patients with the proper medical
indications but is considered dangerous and immoral for use in healthy
individuals.
Modern Use of Cosmetic
Psychopharmaceuticals
While currently
being of indeterminate moral standing the use of cosmetic psychopharmaceuticals
is widespread in the developed world and on the rise. This is of importance to
note because it demonstrates some real world truths about the current state of
the legal status of psychopharmaceuticals. Because purchase and use of cosmetic
psychopharmaceuticals is illegal, at least for those which require
prescriptions for use or are illegal to possess, dosing is self-prescribed by
individuals hoping to gain a benefit through pharmacological means. This means
that there is no oversight to the use of psychopharmaceuticals for purposes of
enhancement (outside of the law) or patients are feigning symptoms to gain
access to these prescriptions and are using the drug in dosages suited for
curative effects and not for augmentative effects (within the law). Even though
the curative effects and the augmentative effects may have a similar dose range
this isn't certain. Also, with self-dosing, there is a high chance of
developing addiction to the compound being used. However, even though these
risks are fairly obvious to people who use augmentative psychopharmaceuticals,
this does not dissuade college students or professionals from off label use of
these compounds. These same issues arise with self-administered use of the
legal compounds alcohol, caffeine, and nicotine along with the illegal cocaine
use because there is, again, no medical oversight.
Who Uses Cosmetic
Psychopharmaceuticals?
In the Western
world there seems to be an obvious pattern in those who use cosmetic
psychopharmaceuticals for enhancement. In the US 6.9% -16.2% of college students have reported using
psychostimulants for studying. For individuals between the ages of 12 to 18
years old, 2.4% of students have used psychostimulants for studying. These statistics
illustrate the attraction of using cosmetic enhancement as a tool to improve
performance of school work. By using these compounds,
students are able to work longer, faster, and with greater attentiveness
allowing for a minimization of time spent on work while allowing more time for
other desirable activities or more work in general.
Professional scientists and intellectuals have prevalent rates of psychopharmaceutical use
is too. A poll put online by the journal Nature asking scientists to respond
about their use of psychopharmaceutical enhancement showed that 1 in 5 scientists used compounds for nonmedical purposes. Of those who did
utilize pyschopharmaceutical compounds, 62 percent used Ritalin while 44 percent used Modafinil.
Some notable historical intellectuals and leaders have
also utilized psychoactive compounds for their beneficial effects on the
intellect and work rate. Freud was a vehement supporter of the use of cocaine
and used it himself quite frequently. He also wrote a book proselytizing the
benefits of the use of cocaine entitled Uber Coca. Jean-Paul Sartre used
an over the counter medication called Corydrane that contained aspirin and
amphetamine, which purportedly enabled him to write for 8 to 10 hours a day at
the height of his activity. He also was a heavy smoker, around 2 packs per day.
Adolf Hitler also utilized cosmetic psychopharmaceuticals being administered
caffeine, amphetamines, methamphetamine, and cocaine by his personal doctor
Theodor Morell.
Summation
From this point on we will be using the previous
information to craft how we should ethically engage these pyschopharmaceutical
agents. To reiterate, keep in mind the following points.
To
be mentally ill is to be functionally (in the sense of being able to work and
provide for oneself) and interpersonally impaired members of society. This
leaves out those who can interpersonally and functionally operate in society,
but are not up to the level that they want themselves to be. These are the
individuals with health as opposed to Health.
When
we are discussing augmentary methods we are dealing with situations in which
someone cannot be classified as unhealthy but they hope to be better than they
currently are. This is opposed to curative methods that take someone from a
state of illness to a state of health or Health. While augmentary methods run
afoul of creating a legitimate ontological distinction between the two states,
the field of psychiatry is founded on a pragmatic basis and this allows us to
draw a pragmatic distinction between health and Health.
It
is important to remember that when we are discussing the moral permissibility
of using certain pharmaceutical agents to enhance ourselves, we are not discussing the legal permissibility.
While legality applies to a specific spatiotemporal location, morality aspires
to transcend this barrier and give a prescriptive explanation of how we should
act.
We
must also remember the drugs that have been described and note their
differences and similarities. This shows the wide breadth of both use and
effects of cosmetic psychopharmaceuticals. This breadth shows how variant the
situation between a given individual and a certain chemical can be. It also
reminds us that while these compounds all fall under the category of drugs;
they do not necessarily have common features.
Finally
we must note the long history of psychopharmaceutical enhancement in human
society. This is important to remember because it suggests that there is a
common human urge to enhance one’s self through pharmaceutical means. This is
found in our contemporary culture in both the professional and educational
arenas.
No comments:
Post a Comment