Predictors of Psychoactive and Nootropic Substance Use Among Romanian University Healthcare Students: The Interplay Between Academic Anxiety and Educational Advancement

Background: The use of cognitive enhancers (CEs) is becoming increasingly widespread among students, especially in health fields, with significant implications for both academic performance and student well-being. The aim of the study was to investigate the use of CEs among healthcare university students in relationship with stimulant intake, academic progression, and academic anxiety. Material and Methods: The cross-sectional study included 402 students enrolled in medical studies (general medicine, pharmacy, dentistry, and physiotherapy). Socio-demographic characteristics, health-related and academic data, lifestyle behaviors, and the consumption of different CEs were collected. The Academic Anxiety Scale was used to evaluate university students’ perceived stressors that contribute to academic anxiety. Data processing analysis was performed using IBM Statistical Package for Social Sciences. Results: The frequency of cognitive compound intake exhibits a positive correlation with the consumption of group B vitamins (r = 0.170, p = 0.001), tea (r = 0.158, p = 0.003), and coffee (r = 0.113, p = 0.031). Lecithin and Ginkgo biloba were significant independent predictors (p < 0.05) of enhanced alertness, memory, and academic performance. The only significant independent predictor of cardiovascular events (palpitations, tachycardia) is caffeine consumption, which increases the risk by nearly three times (OR = 2.96; p = 0.001). In terms of addictive risk, drinking caffeine raises the likelihood of being addicted by 4.78 times (p = 0.014). It has been demonstrated that the probability of using synthetic nootropics (piracetam/cerebrolysin) increases by 1.86 times (OR = 1.86, p = 0.021) as university education progresses (nN= 335). Academic anxiety had a mean score of 23.27 ± 7.38. Unemployed students exhibit markedly elevated anxiety levels compared to employed students. Respondents who justify the use of stimulants by feeling stressed or overwhelmed present the highest levels of academic distress, in contrast to those who use them to combat fatigue or out of curiosity. A large majority (95.0%) do not consider use of CEs as a form of cheating on examinations, and 88.9% are against its prohibition. Conclusions: The findings of this study highlight that many university students in the healthcare field use cognitive stimulants during periods of intellectual overload, with more than 40% of participants utilizing CEs daily or weekly in periods of academic stress. Overload schedule, academic stress, the knowledge about their positive effects, and psychosocial contexts influence consumption.