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.