Department of Psychiatry, Florida International University.
Psychol Bull. 2011 Sep;137(5):742-8. doi: 10.1037/a0024898.
Smith and Farah (2011) presented a scholarly review of critical areas related to their intriguing title "Are Prescription Stimulants 'Smart Pills'?" We contend that they accomplished the main goal of the article, to get the facts straight about possible cognitive enhancement via the nonmedical use of stimulant drugs by individuals without a diagnosis of attention-deficit/hyperactivity disorder (ADHD). At the same time, they justified their main conclusions that (a) individuals are seeking and engaging in nonmedical use of stimulant drugs with the expectations of cognitive enhancement despite uncertainty whether such expectations are valid and (b) on some tasks, there are small average benefits of nonmedical use, but the overall pattern is not clear (e.g., small beneficial effects across most individuals or large beneficial effects only in a few individuals, both of which result in small average effects). We offer comments in 3 areas to amplify key topics mentioned but not emphasized by Smith and Farah: (a) characterization of the cognitive effects of medical use of stimulants to contrast with the cognitive effects of nonmedical use; (b) justification of medical use of stimulants by placement on a normally distributed dimension of behavior rather than categorical diagnosis of ADHD, which varies widely across countries; and (c) evaluation of the potential risks of nonmedical use to individuals and to society (e.g., the likelihood of addiction to stimulant drugs in a small minority of the population) rather than just the potential benefits of cognitive enhancement.
史密斯和法雷（2011 年）对与他们引人入胜的标题“处方兴奋剂是‘聪明药’吗？”相关的关键领域进行了学术综述。我们认为，他们实现了这篇文章的主要目标，即澄清通过非医疗用途使用兴奋剂药物对没有注意力缺陷/多动障碍（ADHD）诊断的个体进行可能的认知增强的事实。同时，他们证明了他们的主要结论是合理的，即（a）个体寻求并从事非医疗用途的兴奋剂药物使用，期望获得认知增强，尽管对这些期望是否有效存在不确定性，（b）在某些任务上，非医疗用途有较小的平均收益，但总体模式不明确（例如，大多数个体有较小的有益效果，或只有少数个体有较大的有益效果，这两种情况都会导致较小的平均效果）。我们在 3 个领域提供了评论，以放大史密斯和法雷未强调但提到的关键主题：（a）描述医疗用途兴奋剂对认知的影响，以与非医疗用途对认知的影响形成对比；（b）通过放置在行为正态分布维度上而不是通过 ADHD 的分类诊断来证明兴奋剂的医疗用途，这在各国之间差异很大；（c）评估非医疗用途对个体和社会的潜在风险（例如，少数人群中对兴奋剂药物成瘾的可能性），而不仅仅是认知增强的潜在益处。
