1.20 Supplements, substances and nootropics

"I don't do drugs. I am drugs."

Salvador Dali

One of the interesting things about modern humankind is that we seem to be hell-bent on altering our minds whenever we can. There is plenty of evidence of the use of substances in prehistoric societies.

It is unlikely that we are suddenly going to stop this well-established habit but we are, at least, in a position to offer improved advice on the potential effects and any potential harms from using various substances. You might have just read our separate chapter on caffeine, given its strong association with writing.

Supplements, vitamins and more

My view is that there is very little evidence that vitamins and other supplements make any substantial difference to outcomes in healthy people. And the important bit to stress here is healthy people.

If you are well and not suffering from any particular diseases or other disorders, the chance that taking some kind of vitamin or other supplementation will improve your health is very slim. There’s little evidence to suggest benefit. There are a few rare exceptions, for example, the use of folic acid in women before they conceive and in early pregnancy can prevent a certain type of birth defect. (Even that could be argued as correcting a deficiency.)

As ever, the problem with evidence is that it aggregates and averages effects across the entire population. This always leaves scope for individuals to claim astonishing effects and it is entirely possible that this could be the case. I wouldn't deny that, but my own opinion is that when it comes to making decisions about whether or not to take supplements, I would rather follow the evidence than hope I was an outlier.

Cannabis

There is a continual and popular movement to reduce the barriers to access of cannabis. It is now widely available in several US states for use as a medication.

Cannabis comes from the cannabis sativa plant and is available as leaf or resin. It is then usually smoked, though it can be taken orally. The primary psychoactive ingredient is tetrahydrocannabinol, and it can result in general relaxation and, to a mild degree, euphoria. It has often been associated with people who want deep thinking and it has sometimes been a drug associated with creativity.

Of course, the relaxation effect is often associated with the ‘stoner’ stereotype as well. They are not renowned as good role models for the productive writer. Tetrahydrocannabinol has been shown to actually be fairly useful at reducing some symptoms associated with anxiety, and the relaxation effects have been exploited by people who have chronic pain and muscle spasms.

One of the difficulties with cannabis is that while it has beneficial effects, it certainly has some harmful effects as well. That's the same as any drug, any medication, commercially produced or illicit. Taking a substance is always going to be a balance of the harmful effects versus the beneficial effects. In recent times some different strains of cannabis have been cultivated. Some of these are known as ‘skunk,’ and there have been concerns that these are potentially more harmful.

Cannabis and smoking

If you do use cannabis, there are a few concerns I would want to tell you about.

The first is that smoking is bad for your health. Surprise, surprise! And the problem with smoking cannabis is that it tends to be smoked in a slightly different and more harmful way. People generally smoke it without a filter, take deeper drags and hold the smoke in the lungs for longer. They also smoke it right down to the roach, where the smoke is hotter and more damaging to the airways. This is a quite different pattern of smoking to normal cigarettes and has been shown to be substantially more damaging to the lungs and airways.

It is possibly to take cannabis in other ways that don’t involve tobacco. Using a vaporizer is the obvious one, and it can also be eaten in some forms. There is also rising interest in cannabis oil which contains cannabidiol and doesn’t have the psychoactive effects of tetrahydrocannabinol.

Cannabis and psychosis

Another major concern is related to mental health. While some people who use cannabis get some benefit from its anti-anxiety properties, there have been worries about possible problems with it damaging memory and cognition.

There have been a lot of studies looking at the association between cannabis and psychosis. It is difficult to unpick causation and association. People will often turn to cannabis when they get distressing mental health symptoms because they feel better when they take it. Working out whether people are smoking more cannabis to self-medicate or whether it is causing the problem is tricky.

Overall, the balance of evidence is tilting toward cannabis being a cause of psychosis in susceptible individuals, and this includes adolescents. Younger people are still developing and their brains seem to be particularly vulnerable to this effect from cannabis.

For all that, the argument often thrown back is that cannabis is less dangerous than alcohol. Fair point. But the harms of alcohol are extraordinarily well documented and researched, while cannabis remains an unknown quantity in many respects. There are potential benefits and there are potential harms. As legalization spreads, hopefully there will be more studies.

Educate yourself. And go carefully.

Cognitive enhancement and nootropics

A nootropic is defined as "a substance that enhances cognition and memory and facilitates learning."

Most writers have used caffeine for a boost, so few people can claim no interest in this. Self-styled psychonauts have launched themselves into personal experiments with all manner of drugs to reach elevated states of consciousness.

Steven Kotler and Jamie Wheal’s book, Stealing Fire, has documented some of the exploits of people in places like California’s Silicon Valley as they have pushed these boundaries.

Microdosing hallucinogens and modafinil

Most people will have heard of magic mushrooms and LSD (lysergic acid diethylamide). Magic mushrooms have the active ingredient psilocybin and the peyote cactus plant produces mescaline. LSD, psilocybin and mescaline are psychedelic drugs that cause people to hallucinate and experience an altered perception of the world around them.

The idea of microdosing has risen to prominence with reports that entrepreneurs in Silicon Valley have been using these substances to enhance creativity. By taking smaller doses, perhaps a tenth of the usual dose, there have been reports that they don’t cause the ‘trips,’ the hallucinations, but instead heighten awareness and creativity.

There has been renewed interest in the use of small doses of hallucinogens to treat addictions and other mental health problems like obsessive compulsive disorder and depression. The studies so far have been tiny, little more than pilots that offer some promise.

Probably the best nootropic, or at least the one with some kind of decent evidence, is not a hallucinogen. Modafinil has been popular for years, and a review published in 2015 put together the results of several trials and found there were benefits to planning and decision-making, memory, and creativity. Side effects seem to have been largely trivial, with little evidence of significant harm. In general it is only available on prescription and the USA has stricter legislation around it that restricts its availability.

Weighing the risks versus the benefits

There are risks around the use of nootropics. Access has become easier through the internet and sites like the Silk Road on the Dark Web have provided an online marketplace for all manner of substances. Nootropics provide a tempting shortcut to increased productivity. Who wouldn’t like to be a bit smarter and more creative?

By the standards of modern medicine, the studies and evidence around their use is relatively weak and unsubstantiated. In most countries the use of these substances is carefully controlled and you may be breaking the law in accessing them. Whatever your feelings about the liberalization of drug laws, the current situation means that access to these drugs can be problematic, and there is a huge quality control problem. There is no guarantee that the medications you obtain will have reliable dosages in them, and contamination and adulteration are real risks in an unregulated market.

It’s worth highlighting that there are plenty of cognitive enhancers out there that have a good evidence base: physical activity, education, mindfulness, social engagement, and quality sleep all have proven benefits without some of the unknowns of the new nootropics.

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