A paper published in the Journal of Psychoactive Drugs has given extra support to the power
of placebo.
It found that giving someone placebo, if it was said to be a prescription stimulant like
Adderall, could make people self-report improvements in cognition.
This sort of finding exemplifies something that's becoming well understood.
Namely, that a person's expectancies impact not only what a real drug does, but can make
a placebo seem like it's doing something.
I think results of this sort need to be kept in mind when people are experimenting with
alleged cognitive enhancers, whether they're nootropics or LSD microdoses.
The background for this paper is that the non-medical use of prescription stimulants
has become popular among undergrads and graduate students.
They often believe stimulants can improve performance, which contributes to higher use
rates.
In the US, it's estimated 12 to 20% of university-level students have used these drugs at some point.
Although people may think their performance will improve, the results are often mixed
or negative in actual studies.
At this point we still don't have much evidence that amphetamine or methylphenidate significantly
improves performance in healthy, non-sleep deprived people.
People with ADHD do consistently receive benefits, yet some papers have found the same drugs
in healthy people can't do a whole lot.
It's possible some benefits exist, but probably not to the degree people think.
A key part of this paper was looking at the impact of positive expectancies on the effects
of a placebo.
We don't fully know how placebo effects will change based upon preconceived notions.
But there's reason to think a placebo can feel like a stimulant, depressant, or another
kind of substance depending on what's expected.
166 participants enrolled in the study, with 86 entering the experimental group, and 80
acting as a non-experimental control group.
These individuals were undergraduate students with a mean age of 19 years old and an average
GPA of 3.45.
Experimental participants were asked to pick a "dose" of alleged Ritalin, Adderall, or
Focalin.
74% chose Adderall, which probably indicates a greater familiarity with that drug's alleged
positive effects.
But, keep in mind, everyone ultimately received placebo.
They only thought they were getting a prescription stimulant.
To measure performance, four neuropsychological tests were employed: the d2 Test of Attention,
the PASAT (which measures information processing), a Passage Comprehension test, and Digit Span
tests to look at short-term memory.
They were also given subjective tests of typical positive and negative stimulant symptoms.
On the positive side were changes in alertness, focus, and motivation.
While the negatives included things like dry mouth, dehydration, and shakiness.
The experimental group had no significant positive changes in performance.
Rather, those who thought they received a stimulant actually had a potential decline
in performance on the PASAT.
So, at least in this paper, a placebo stimulant couldn't improve actual cognitive performance.
But that's a bit different from what the users reported.
Those who received the placebo stimulant reported significant improvements in alertness, focus,
and positive mood.
While the control group experienced the opposite.
And there was no change between groups in terms of physical symptoms like dry mouth
and shakiness.
The second part of this paper involved looking for correlations between performance, subjective
performance, and expectancies.
A large portion of the sample had positive performance-related ideas about stimulants.
For example, they felt they could improve focus, improve attention, and sometimes contribute
to higher grades.
Despite those feelings, higher positive expectancies didn't mediate any true neuropsychological
benefit.
One of the only correlations was actually between negative expectancies (i.e. about
addiction or health issues) and Passage Comprehension.
Experimental participants with higher negative expectancy scores showed improved performance.
Whether this is a true finding and what the mechanisms may be aren't known.
In summary, if you give someone a placebo and tell them it's a stimulant, you can make
them think they're under the influence of a cognitive enhancer.
And you could even make them feel better overall.
Positive expectancies may not actually improve performance, at least according to this paper,
but they can mediate self-reported benefits.
This sort of research needs to be taken to heart by self-experimenters.
Legitimate cognitive enhancers may exist, but I'm inclined to think a lot of the anecdotal
reports are heavily tainted by placebo and expectancy.
The authors of the paper felt it was surprising task performance didn't improve due to positive
expectancies.
"Despite self-reported subjective improvements in focus, alertness, and pleasant mood in
the placebo group, participants did not perform better across task administrations overall.
This substantiates prior research indicating that students' beliefs that stimulant medications
are cognitive enhancers are likely misconstrued."
The authors concluded by suggesting college administrators begin telling students about
these findings in order to reduce expectancies and perhaps the use of stimulants by students.
If there's another thing I'm inclined to believe, it's that we probably won't see much of an
effect from anti-Adderall public information campaigns.
If you have any questions, feel free to put them in the comments.
You can also email me with questions.
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