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The Use of Pharmacologic Cognitive Enhancers in Competitive Chess

Franke, Andreas G.; Dietz, Pavel; Ranft, Karla; Balló, Harald; Simon, Perikles; Lieb, Klaus

doi: 10.1097/EDE.0000000000000737
Letters

Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany, University of Neubrandenburg, University of Applied Sciences, Department of Social Work and Education, Neubrandenburg, Germany

Institute of Sport Science, University of Graz, Graz, Austria, Department of Sports Medicine, Rehabilitation and Disease Prevention, Faculty of Social Science, Media and Sports, Johannes Gutenberg-University Mainz, Mainz, Germany

Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany

Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany, Internistisch-Onkologische Gemeinschaftspraxis, Offenbach am Main, Germany

Department of Sports Medicine, Rehabilitation and Disease Prevention, Faculty of Social Science, Media and Sports, Johannes Gutenberg-University Mainz, Mainz, Germany

Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany, German Resilience Center, University Medical Center Mainz, Mainz, Germany., klaus.lieb@unimedizin-mainz.de

Supported by intramural funds of the Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Germany.

The authors report no conflicts of interest.

Supplemental digital content is available through direct URL citations in the HTML and PDF versions of this article (www.epidem.com).

Data availability: The dataset and computing code can be obtained from the corresponding author by sending him an e-mail.

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To the Editor:

Pharmacologic cognitive enhancement is defined as the use of pharmacologic substances by healthy subjects without any medical indication with the aim to enhance cognitive abilities.1,2 In a recent study, we have shown for the first time that modafinil and methylphenidate may have enhancing effects in chess-playing performance.3 In this study, we investigated how prevalent stimulant use is in tournament chess players.

One paper-and-pencil survey as well as one online survey on substance use were conducted in 2012/2013. The paper-and-pencil survey was conducted among a representative and random sample of 7,314 of 67,981 adult members of the German Chess Federation (DSB). The online survey with the same contents was conducted between January and April 2013 among all adult members of the DSB. After an introduction into the topic, demographic data, chess-playing history including ELO/Deutsche Wertungszahl (DWZ) number, which reflects the strength of tournament chess players, willingness to use and past use of freely available substances, prescription drugs and illicit drugs for chess playing enhancement purposes were assessed. In both surveys, use was asked (a) directly with an anonymous questionnaire and (b) indirectly for the group of freely available substances and prescription/illicit drugs by the randomized response technique. The latter guarantees complete anonymity for the respondents and reveals more precise estimates for sensitive questions.4 The study was approved by the responsible ethics committee (Mainz; 837.351.10(7360)).

A total of 1,421 paper-and-pencil questionnaires were filled in and returned (response rate 22.9%), and 1,322 online questionnaires adding up to a total of 2,743 questionnaires. Mean age of all respondents was 47.5 ± 17.0 years; 94% were male. Most of the subjects were not convinced of the chess play enhancing effects of drugs, e.g., only 42 (1.5%) and 319 (11.6%) believed that it is possible to do so with modafinil or methylphenidate, respectively. A total of 2,023 subjects (73.8%) stated that they would never take any drugs with the aim to increase chess-play performance, and of the remaining ones the majority (n = 484; 17.7%) would consider using freely available substances and a minority prescription drugs (n = 50; 1.8%) or illicit drugs (n = 20; 0.7%). Four (0.2%) and 11 (0.6%) subjects reported having used modafinil or methylphenidate, respectively, to enhance chess performance at least once (eTable; http://links.lww.com/EDE/B259). Summing up, 1,007 subjects (44.5%) had at least once during lifetime used any freely available substance for chess competitions, and 64 (3.5%) any prescription or illicit drug. The number of users of prescription and illicit drugs was 4.5 times (15.9% vs. 3.5%) and for freely available substances 2 times higher (34.6% vs. 17.7%) when asked with online questioning compared with paper-and-pencil questionnaire. For all participants, the randomized response technique led to an estimated prevalence of 25% of chess players who had used freely available substances to enhance chess performance and 8.9% for the use of prescription or illicit drugs, whereas the anonymous questionnaire revealed 44.5% and 3.5%, respectively (Table). It has to be mentioned that the results may be biased for the following reasons: (a) while the randomized response technique received up to 98% (2,420/2,473) response to the sensitive item, the response to this item by anonymous questionnaire was 73% (1,823/2,473) leading to around one fourth of potential item-nonresponders by direct questioning and (b) the mean age of the participants who filled in the online survey was 9.6 years lower than the age of the participants who filled in the paper-and-pencil survey (potential selection bias). Because the announcement for the online survey was published on the webpages of several DSB regional associations and in chess online panels (e.g., chessbase.com) as well as in print magazines (Schachmagazin64, Rochade, Schwalbe, Kaissiber), it was not possible to determine the response rate for the online survey.

TABLE

TABLE

Our overall conclusion is that the online survey and the randomized response technique reveal higher prevalence rates for the use of prescription or illicit drugs to increase chess-play performance compared with paper-and-pencil surveys and anonymous questionnaires. Using anonymous questionnaires, 3.5% of the surveyed chess players admitted having used at least one prescription or illicit drug at least once to increase chess-play performance. Since anonymous questionnaires sent by mail have a low level of perceived anonymity and may lead to underestimation, we also used an online survey and the randomized response technique connected to both anonymous questionnaire and online survey to assess the dark figure of substance use in chess. These questionnaires revealed in total 2.5 times higher prevalence rates (8.9%) than conventional anonymous questionnaires. Although this is considerably lower than the estimated dark figure for doping in international elite sports (14–39%),5 we nevertheless believe that substance use in chess is a phenomenon that needs further attention. Apart from risks of side effects and development of addiction in individuals who use such drugs1 and ethical issues arising from their use,6 brain doping during chess play is threatening the principle of fair play. Our data, therefore, contribute to a newly emerging discussion on doping in chess and other competitive settings related to high cognitive functioning and encourage the regular use of doping controls in chess competitions.

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ACKNOWLEDGMENTS

The authors want to thank the German Chess Federation (Deutscher Schachbund, DSB) and all participating subjects for cooperation. None of the pharmacologic substances discussed in this manuscript is labeled for the use of cognitive enhancement in competitive chess. Many of them are on the prohibited list of the World Anti-Doping Agency (WADA).

Andreas G. Franke

Department of Psychiatry and Psychotherapy

University Medical Center Mainz

Mainz, Germany

University of Neubrandenburg

University of Applied Sciences

Department of Social Work and Education

Neubrandenburg, Germany

Pavel Dietz

Institute of Sport Science

University of Graz

Graz, Austria

Department of Sports Medicine

Rehabilitation and Disease Prevention

Faculty of Social Science, Media and Sports

Johannes Gutenberg-University Mainz

Mainz, Germany

Karla Ranft

Department of Psychiatry and Psychotherapy

University Medical Center Mainz

Mainz, Germany

Harald Balló

Department of Psychiatry and Psychotherapy

University Medical Center Mainz

Mainz, Germany

Internistisch-Onkologische

Gemeinschaftspraxis

Offenbach am Main, Germany

Perikles Simon

Department of Sports Medicine

Rehabilitation and Disease Prevention

Faculty of Social Science, Media and Sports

Johannes Gutenberg-University Mainz

Mainz, Germany

Klaus Lieb

Department of Psychiatry and Psychotherapy

University Medical Center Mainz

Mainz, Germany

German Resilience Center

University Medical Center Mainz

Mainz, Germany.

klaus.lieb@unimedizin-mainz.de

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REFERENCES

1. Franke AG, Bagusat C, Rust S, Engel A, Lieb K. Substances used and prevalence rates of pharmacological cognitive enhancement among healthy subjects. Eur Arch Psychiatry Clin Neurosci. 2014;264(suppl 1):S83–S90.
2. Greely H, Sahakian B, Harris J, et al. Towards responsible use of cognitive-enhancing drugs by the healthy. Nature. 2008;456:702–705.
3. Franke AG, Gränsmark P, Agricola A, et al. Methylphenidate, modafinil, and caffeine for cognitive enhancement in chess: A double-blind, randomised controlled trial. Eur Neuropsychopharmacol. 2017;27:248–260.
4. Dietz P, Striegel H, Franke AG, Lieb K, Simon P, Ulrich R. Randomized response estimates for the 12-month prevalence of cognitive-enhancing drug use in university students. Pharmacotherapy. 2013;33:44–50.
5. de Hon O, Kuipers H, van Bottenburg M. Prevalence of doping use in elite sports: a review of numbers and methods. Sports Med. 2015;45:57–69.
6. Forlini C, Hall W, Maxwell B, et al. Navigating the enhancement landscape. Ethical issues in research on cognitive enhancers for healthy individuals. EMBO Rep. 2013;14:123–128.

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