Drugs Aren’t A Moral Category
Are drugs good?
This question doesn’t really make sense. Yet Western society answers with a firm “NO”.
I have ADHD and have a prescription for Methylphenidate (MPH). Often I don’t feel like taking it. Shouldn’t I be able to just do the right things? I can just decide to be productive. Right? Needing a drug to function feels like a flaw in who I am.
I also have sleep apnea. That means I stop breathing at night, which makes the CO2 concentration in my blood rise until I wake up. This has quite bad health implications if untreated. However, I have a CPAP which is a device that constantly blows air in my mouth during sleep to prevent the airway from collapsing.
Shouldn’t I be able to just breathe correctly? Can I just decide to not stop breathing right? Needing a CPAP device to function feels like a flaw in who I am.
No it doesn’t! I never had an aversion to using this medical device.
I think I had a flawed model. This isn’t about “drugs are good” VS “drugs are bad”. This is about manipulating reality. The real question is: What mental states do you want, and what tools get you there?
Your calculation needs to take into account all the physiological and psychological short and longerm consequences of taking this compound, and how these consequences change based on what dose you take, and how often you take it. But if that all checks out, if that drug makes you more of who you want to be, then take it. Not because drugs are good, but because it’s the best thing to do at a more fundamental level.
Drugs can be abused. You can grind and snort immediate-release MPH. In the UK—if you are old—and come in with a hipfracture, they’ll give you diamorphin (aka heroin). It’s possible to drink away your sorrows.
But this isn’t what happens when I take MPH. MPH gives me the ability to make decisions, or rather to propagate a decision through my brain. Without MPH, I can think “I should stop watching YouTube, I am just wasting my time” but it’s extremely hard to decide to stop, in the sense that I change my policy such that I actually stop. With MPH it’s easy to turn my thoughts into a policy change.
Even as my brain thinks time and time again about that great movie that would be really fun if I rewatch it now, it’s still easy to decline each time. Without MPH I’ll just give in after less than 30 alluring thoughts.
“Are drugs good?” is too broad. It tries to answer whether taking MPH is good in general. MPH makes it easy to just keep going. I’m often so engrossed in whatever I am doing that taking a step back and considering if what I am doing is really the best thing I could do isn’t natural.
So “Is MPH good?” doesn’t make sense as a question either. It depends on the situation. For me it’s probably a good baseline to take it. But doing more experimentation with dosing, taking days off, or even taking half a day off seems useful.
The general point is: Don’t use moral reasoning (i.e. “is X good”) for thinking about drugs. Use consequentialist reasoning.
I feel like I need to say this because culture is quite powerful. In the past I have considered myself pro-drug. As we have seen, this position doesn’t really make sense (as it tries to be an answer to a nonsensical question). But even so, some part of my subconscious was still disappointed in myself for not being able to just decide not to have ADHD. And this seemed actively harmful.
I agree it’s probably good to not use moral reasoning, but the reason people have deontological rules around drugs is because it’s hard to trust our own consequentialist reasoning. Something like “don’t do (non-prescribed) drugs ” also a simple rule that’s much more low effort to follow and may well be worth the cost-benefit analysis.
This generalizes quite a bit: Simple moral strictures should very rarely be the first or second consideration in your life-optimization decisions. They certainly CAN be tiebreakers when it’s a relatively close call.
For the specific, I don’t actually know anyone who thinks all drugs are automatically bad. I do know people who sloganize this way, but when pressed they tone it down to recreational and self-prescribed palliative drugs are bad. Prescribed drugs (and, depending on the vigor of your counterpart in the discussion quasi-legal off-brand uses for a specific reason) are generally well accepted.
Neither pro-drug nor anti-drug are coherent positions—there’s just too much variance across drugs and patients to have any simple rule.
Separately, the topics of mental health and neurodivergence are not well-formed in our culture(s). That deserves a discussion very distinct from drugs generally.
In the past I would have said when ask: “obviously not all drugs are bad” without being pressed. But when it comes to moment to moment decision making I would have subconsciously weight things such that not taking drugs is better. That is the pernicious thing. It’s not about what people say when pressed. It’s about how they make decisions moment to moment.
It seems that I used moral strictures subconsciously, while my stated position was almost be the opposite of these strictures. And both are—like you said—didn’t really make sense.
A bias against drugs is very different from “drugs are always bad”. It’s very reasonable to say “I’d prefer not to mess with my body via fairly blunt chemical intervention, but there are lots of exceptions for specific cases where the risk is worth it”.
Not taking drugs IS better, in the median case of a drug being offered to you. It’s just that the variance is wide—sometimes it’d be extremely bad (say, narcotics before a road-trip), sometimes it’s quite good (antibiotics when you have pneumonia). Often it’s less clear, and having a default position against this kind of intervention is probably OK.
With a stark exception for caffeine (maybe more like an exception from the category ‘drugs’ than the generalization ‘drugs are bad’).
This phrasing suggests that you actually know all the physiological and psychological short and longterm consequences of taking this compound. In reality, in most cases you don’t know all the consequences.
You generally want the positive consequences to be strong enough to balance the risk you are taking with unknown undesired effects of drugs.
Can confirm that cultural messaging around drugs made me delay useful mental health treatment.
(Some) left straw-view: Meds are a way for The System to enslave you and destroy your creativity/individuality/humanity.
(Some) libertarian straw-view: You’re a strong smart Galt-like ubermensch already, why would you need drugs as a crutch?
Conservative depressingly-common view: All this is fake, mental health is fake, you’re just a whiny pussy who can’t handle real life, bootstrap yourself.
All these views intersected into a rarely-explicit “I don’t need medicine for my brain!” that hampered my life trajectory.
Then again, drug effects can have complex interactions with one’s thinking, so who knows? Maybe I would’ve been more productive in high school and gotten into a better college… and then proceeded to work on the wrong things! (This is what some rationalists think happened with rats/EA as a whole, or OpenPhil, or therabouts something something moderation vs extremism yadda yadda)