drugs for the competent

A bunch of scientists have written a commentary in Nature arguing that mentally competent adults should be able to use what have been referred to “brain doping” drugs (Adderall, Ritalin, etc) at will, for cognitive enhancement. The idea is responsible use, of course, and of course I’m for it in theory. (For me this falls into the same category as my firm pro-choice stand: anyone who can soundly judge what they’re doing should be able to do what they consider needful or desired with their own body. And face all consequences arising from their decisions.)

Three things worry me. First, where’s the line of mental competency? This isn’t a new question, and I don’t pretend to have an answer, but it’s relevant here. Second, even assuming competency, what about sound judgment? (Ah, but here’s where their responsibility begins, and nobody should stand in their way.) And connectedly, what about physical addiction to stimulants of various sorts? This ties into both competency and sound judgment. But also, successful navigation of the addiction bit heavily depends on education, and that’s what I see as lacking.

So, we need, must have education on this topic that goes along with the freedom to experiment with one’s own brain and body chemistry. And allowing people to do so at will involves implicit acceptance of some incidence of drug addiction. But just as alcoholism is no reason to reinstate Prohibition, addiction to drugs — prescription and otherwise — is no reason to restrict those drugs.

Of course, there are drugs whose addictiveness is so overwhelming that I wouldn’t particularly want those available without a prescription. But, having seen people around me take Adderall and the like for some years, some of them getting addicted, some — not, I think cognitive-enhancing drugs aren’t physically addictive enough to worry. We just need to make sure to get information to people, enough of it that they can make their own informed decisions.

(Edited to add: But I do wish people would stop calling them brain doping drugs. That puts a derisive spin on what isn’t an inherently bad practice.)

6 Responses to “drugs for the competent”

  1. laurenhat Says:

    The need for more research and education about non-ADD (or non-narcoleptic, in the case of Provigil) people using cognitive-enhancing drugs was one of the important points of the article. I think we really need to do a much better job researching and educating about the effects of drug use in general (I think much of the harm, though not all, from drug use and abuse comes from people not having enough real information about risks and responsible levels of usage; it’s all just scare tactics). But especially if people are going to start using these drugs in a way similar to caffeine, it’s going to be important that they understand the consequences.

    Another important point in thinking about this (which the Nature article also made) is how unfair it will be if these drugs help people substantially at their job or studies, but are only available to the richer segment of the population. I don’t know if that would be the case. But I don’t feel that bad about people relying on coffee to get through the day sometimes; it’s just not that expensive. Something that cost a lot more, though, would bring up interesting ethics issues.

    (I don’t believe that these drugs generally do substantially increase cognitive abilities, but they can be really useful in cases where you have to learn a great deal under time pressure, for instance, and/or get by on little sleep — especially at exam time, or when grant-writing deadlines occur, or similar competitive circumstances.)

  2. dillweed Says:

    agreeeed. i read that article yesterday and was thinking something similar to what you wrote. (just not as eloquent or organized)

    .. and your WP site is pretty.

    “Let’s think the unthinkable, let’s do the undoable, let’s prepare to grapple with the ineffable itself, and see if we may not eff it after all.”

  3. maga Says:

    My main concern is the threshold-technology thing: once a certain proportion of people do it, everybody else has to do it or lose their job.

    Or: if everybody else in your physically demanding job is throwing down painkillers to cope, then your bosses’ response to complaints is always going to be ‘so take some more painkillers’.

  4. vika Says:

    Maga: totally. And it’s not just that everyone else is compelled to do the performance enhancement, there’s also habituation. Which is the point you implicitly make in the second paragraph. OTOH, all of this can also be applied to caffeine. How many people start taking it (in whatever form) just to keep up at work?

    Lauren: I’ve thought about the economic inequity, in fact the title of this post was originally “drugs for the competent (and rich)”. But then I called the pharmacy I shop at, and thirty 10mg pills of non-XR Adderall (well, its generic equivalent) are $42.99. That’s less than $1.50 per pill, and so is comparable to the price of even cheap coffee. A cheapo cup is, what, 70-80 cents? And a pill of amphetamine salts would last longer than a cup of coffee. So I’m not actually sure that the economic-disparity argument flies, and am pleasantly surprised by that.

    Dill: Yay, thanks! :)

  5. vicka Says:

    (reposted from lj for the sake of dialogue rather than thinking aloud….)

    count me in on the side of legal enhancement, but with outside medical supervision.

    i know a few too many people who think they’re “enhanced”, whose performance has, imho, degraded in so many other ways that it’s overall a loss. and it’s very, very hard to judge this kind of thing for yourself. so i’m in favor of the experimentation, but also in favor of appropriate oversight and reality check.

    and fwiw i could care less about the addictive aspects — if you have access to your substance, it’s really just not a major life issue, as gabillions of smokers can attest. (they may object to their addictions for other reasons, like health effects, but it’s not typically the addiction per se….)

  6. vika Says:

    Vicka – a reality check is a great thing, for sure, though there seems to be a fine line between that and a more controlling practice, and the increased restriction is more common. (“This drug is only to be used in these situations, because we’ve decided so, and we could let you use it, but you don’t fall under any existing protocols so, um, no.” Nothing to do with the actual effect of the drug, or explaining to a patient exactly why they shouldn’t experiment; just a strong discouragement of “drug-seeking” behavior for scheduled substances. Given that people experiment with nicotine, alcohol and many other drugs routinely, and given how much of the animal kingdom experiments with altering its consciousness, that seems like a political stance and a control issue the more I look at it. I don’t know how to effectively draw a line between all of this and useful oversight. Cultures change slowly.

    I disagree about addiction, though. It is a major life issue when you’re addicted to something, anything, but don’t want to be. The wide availability of that substance at best doesn’t help, and at worst undermines any resolve you might have to get un-addicted. Quitting nicotine has been hell for me, and I don’t take it for granted that I’m rid of it for good.

    Health effects, well, what else is there? Smoking cigarettes, when I have, has made me feel terrible some time after, or sometimes right after, and that’s both a health effect and a physical sensation I do not want. I get angry and annoyed at the addiction itself; it makes me feel powerless sometimes, and it’s frustrating to spend so much energy on this… thing that’s glommed on to me and isn’t letting go. I’ve heard similar sentiments from other addicts, mostly in relation to nicotine and caffeine.