A rationalist's guide to psychoactive drugs

post by Skatche · 2011-02-10T01:01:16.712Z · LW · GW · Legacy · 48 comments

Contents

  Introduction
  Supplements and Neurotransmitters
  Stimulants
  Nootropics
  Psychedelics and "recreational" drugs
  Conclusion
None
48 comments

This is a first draft.  Over the next few days I'll add citations and that sort of thing, but I'm posting it as-is in order to solicit feedback.  Also, I wasn't able to find any specific policy regarding mention of illicit substances, so I'm going to assume this is okay, but if not please let me know.

Disclaimer: This is a work of postmodern fiction about two irredeemable junkies named Alice and Bob and their cat Fido.  The views contained herein are not medical or legal advice, they are not my views, and they are not the views of LessWrong.com or any of its members.  In fact they are not views at all: they are transnarrative flows in alterity-space, or that's what my lit prof tells me.  I do not condone any illegal activity whatsoever, except jaywalking.

Introduction

Today, says Alice, I'm going to talk to you about drugs.  I'll be covering several nutritional supplements, some stimulants and nootropics, and - as some of you have probably guessed - I'll also be talking briefly about recreational drugs, particularly psychedelics.  Now, I don't have any sense of what the popular perception is of drugs around here, but I presume that at least some of you will be a little put off at the suggestion of recreational drug use.  If that is how you feel, please bear with me.  To partake or not partake of prohibited substances is a choice that must be made individually, and for many the payoffs may not be worth the risks; but I hope to convince you that, at least for some people, responsible drug use is a very reasonable and beneficial activity.

Well, hold on, says Bob - who takes a permissive but detached view of these things - hold on, now.  It may be true (as cursory research will show) that drug use is far less dangerous than it's made out to be, and it may be true that some people get a lot of enjoyment out of them.  But if you value knowledge and reason over hedonic pleasure, it seems better to cut them out entirely.  After all, it's your brain on the line if anything goes wrong!

As a matter of fact, says Alice, drugs are good for more than just hedonism.  First of all, they give you a handle on your own neurochemistry.  It's unlikely that your brain is optimally tuned for the things you want to accomplish, so if you can tweak it the right way, you might be able to improve your functioning.  In extreme cases, you might have chronic imbalances leading to depression, mania, etc., in which case you'll probably want to talk to a doctor about medication; but the ability to use drugs to change yourself goes well beyond this.  For example, judicious use of MDMA can help you retrain your social reflexes and become more outgoing and sociable.  Having this handle also allows you to begin to experimentally correlate your subjective experience with the physical processes to which they correspond, and by carefully observing more unusual states of consciousness, you broaden your understanding of the mind and how it operates.  Lastly, psychedelics can sometimes help you understand things differently or more deeply.  I've often found my mathematical ability improved by moderate doses of LSD, for example.  So, even for someone concerned primarily with rationality and the accumulation and application of knowledge, drugs are at least worth considering.

And what of the risks? says Bob.

I was getting to that, says Alice.  There will always be a risk/benefit tradeoff, but the risks can be minimized through careful and responsible use:

With that out of the way, continues Alice, let's start simple: what is a drug?  For our purposes, we'll say a drug is any substance consumed for reasons other than its nutritive value or the sensory experience of consumption.  We'll specifically be focusing on psychoactive drugs, which are consumed for their effects on the mind.  Note that just about anything you eat or drink is potentially a psychoactive drug, and you may not have to turn to outlandish synthetic compounds to alter your neurochemistry.  For example: after three years of vegetarianism, I gradually began to develop chronic anxiety, with occasional panic attacks.  It plateaued at a (barely) manageable level, so I never ended up seeking medical help; it took two years before I thought to try eating meat again.  When I finally did, the anxiety immediately vanished and has not returned.  So, for me, meat is a psychoactive drug.  In fact, let's talk about nutritional supplements first.

Supplements and Neurotransmitters

The first group of drugs we're going to be looking at are neurotransmitters, and their chemical precursors, which can be found at health food stores.  First, there are 5-HTP and tryptophan, which are serotonin precursors.  There is some evidence that these can help treat depression, improve quality of sleep, and improve your mood, but since you need to take it for a few days before you start to notice the effect, it might be hard to tell if this is actually doing anything for you.

Next, consider phenylalanine, an amino acid which serves as a precursor to dopamine, norepinephrine and adrenaline.  Phenylalanine is first metabolized into tyrosine, which is also available as a dietary supplement.  Research seems to suggest that these are mainly effective only for people under conditions of physical, emotional or mental stress, and don't do much for the general population.  I've found that, in fact, L-phenylalanine has a noticeable uplifting effect on my mood within a short time of taking it; but maybe this just says something about how much stress I'm under.

Lastly, there's GABA, a neurotransmitter which has an inhibitory effect on the dopamine system and certain other neurotransmitters.  In short, this will calm you down right quick, which makes it useful for dealing with intense and uncontrollable emotions - anxiety, grief, rage, etc.  I find that, for this purpose, theanine is even better: it promotes GABA production and alpha brainwave activity, and also seems to increase dopamine levels.  Its calming effect is very similar to that of GABA, but I find it much less likely to leave me feeling tired and out of it: if anything, it seems to have a mildly stimulating effect.  As an added bonus, theanine appears to boost the immune system.  Theanine synergizes well with caffeine, which we'll cover shortly.

All of the above - 5-HTP, tryptophan, phenylalanine, tyrosine, theanine and GABA - are not only useful for regulating your mood, but also for learning what your neurochemistry feels like from the inside.  I found it edifying to take fairly large doses of 5-HTP (or phenylalanine, etc.) every day for a couple weeks, stop for a few weeks, go back on for a couple weeks, stop, etc. - all the while noting changes in my mood and perception.  In that respect, melatonin tablets can be added to this list: they're not really going to make you a more effective rationalist, but they will teach you what melatonin does to your cognition.  Melatonin will also be useful if you're taking stimulants, which might otherwise interfere with your sleep patterns.

It is also worth mentioning that vitamin deficiencies (or excesses) can have a significant impact on mood and cognitive functioning.  I recommend taking multivitamins; this need not be a daily regimen if you have a healthy diet, just kind of take them when you remember to.  Women should look for multivitamins with iron, and men should look for those without.

Stimulants

Next, let's talk about stimulants, starting with caffeine - by far the most popular, although by no means the most effective.  Caffeine works by blocking the activity of adenosine, an inhibitory neurotransmitter that plays a role in sleep and drowsiness.  As a result, neural activity goes up, accompanied by a kick to the sympathetic nervous system and an increase in blood sugar levels.  Taken on a fairly regular daily schedule, caffeine seems to improve my attention, motivation and energy level.  In the long term, there appear to be health benefits from drinking coffee in this way: in addition to its stimulating effects, it appears to help prevent heart disease, Alzheimer's disease and Parkinson's disease, among others.  For all-nighters, though, caffeine is an inferior choice: although it suffices to keep you up and running, it doesn't seem to do much to mitigate the cognitive effects of sleep deprivation.  Also, as increasing amounts are consumed, a variety of unpleasant side-effects begin to appear, including tremors, heart palpitations, anxiety, diarrhea, and dehydration.  It should also be noted that caffeine builds tolerance, and the withdrawal is rather unpleasant.  Despite this, it seems to make sense to take coffee every day in moderation, unless you are especially sensitive to its negative effects.

Caffeine can also be had in tea (green tea, in particular, also contains theanine, as we discussed), in chocolate, preferably dark (chocolate also contains a number of other psychoactive alkaloids, including phenylalanine and theobromine), in caffeine pills and in energy drinks.  It is perhaps worth mentioning that I find that the energy drinks and energy shots containing other medicinal ingredients (phenylalanine, taurine, B vitamins, etc.) really do seem to be slightly better, minimizing the unpleasant side effects and smoothing out the crash.  Still, I try to avoid these because of the sugar and/or artificial sweetener content.  It is unclear exactly what effect each of these other medicinal ingredients has individually, if any at all, so you should also be warned that you are probably buying some nonsense along with your actually mind-altering compounds.

Next are amphetamines, which act on the serotonin, norepinephrine and especially dopamine systems, causing increased focus, improved cognitive ability, and elevated energy levels.  They also mitigate some of the effects of sleep deprivation, although your cognitive performance will still suffer.  While amphetamines can greatly improve your productivity if used correctly, they can also easily do the opposite, because it's just as easy to hyperfocus on video games as it is to hyperfocus on neural network algorithms.  Body tics and bad habits can also get strongly reinforced, since your reward systems are getting pummelled by dopamine.  Basically, if you're doing amphetamines, keep your akrasia-fighting systems on high alert (fortunately this, too, will be aided by the amphetamines).  Another downside to amphetamines is that they're quite addictive; take them either in fixed quantities on a regular schedule (if you have a prescription) or else in occasional bursts of no more than a few days, and in moderate quantities.

Beside addiction, a lot of the danger from amphetamines comes from failing to eat and sleep, if you're taking them for more than a day or two.  Amphetamines are strong appetite suppressants, and of course they keep you awake, so you'll need to force yourself to eat three square meals a day and get to sleep at a reasonable hour.  Sleep is especially important because the longer you stay up, the more amphetamines you have to take to stay awake; if your dose gets high enough, and if you're badly enough sleep deprived, you put yourself at risk of amphetamine psychosis, which is about as much fun as it sounds like.

There are a number of prescription amphetamines on the market, and these are generally to be preferred to street speed, due to their purity and lack of adulterants.  It's not terribly hard to get diagnosed with ADD/ADHD, so this can be above-the-board.  Dexedrine is pure dextroamphetamine, while Adderall is a mix of dextroamphetamine and racemic salts (which contain a 50%/50% split between dextro- and levoamphetamine).  The difference between the two stereoisomers is complicated, and your best bet is to experiment to see which works best for you, but a rule of thumb is that Adderall has more "kick" at lower doses, while Dexedrine is stronger at higher doses.  Methamphetamine, you may be surprised to learn, is also prescribed for ADHD, although much more rarely.  Meth is stronger, longer-lasting, and significantly more addictive, than amphetamine.  It is also more neurotoxic.  I would recommend exercising extreme caution around this one, or else avoiding it entirely, unless you actually have severe ADHD and this is the only thing that works for you.  Lastly, there is a prodrug for dextroamphetamine that just came on the market, called Vyvanse (lisdexamphetamine).  This has a much slower onset, since it has to be metabolized into dextroamphetamine, and therefore has significantly less addiction potential.

Ritalin works similarly to amphetamines; apparently it tends to produce less euphoria.  Ephedrine is chemically similar to amphetamines, but works primarily by increasing the activity of noradrenaline; it has the advantage of being legally available without a prescription.  I mention these only in passing because I don't have much experience with them; if you want to contribute some information about them, please comment!

I also want to briefly mention MDPV (methylenedioxypyrovalerone), an experimental stimulant still legally available in the U.S. and in Canada (sold online as a research chemical or, sometimes, as "envigorating bath salts").  This one acts as a dopamine and norepinephrine reuptake inhibitor, producing a state reminiscent of that caused by amphetamines.  It has a quick onset and short lifetime (3-5 hours), which makes it well-suited to accomplishing quick chores.  However, there are a number of nasty side effects reported, and it seems to have some addictive potential.  Looking at the evidence, it appears that most of the people reporting this sort of thing were insufflating larger doses; so taken orally and in moderation, this one can still be reasonably safe.  But there's very little out there that's peer-reviewed, so take a look at some trip reports and proceed with caution.

All of this probably makes it sound like stimulants are, at best, not far off from a zero-sum game: they may benefit cognitive performance, but they come with side effects and addictive potential and a nasty crash when you come off them.  Well, good news: we'll be considering Modafinil next, which some are calling the perfect stimulant.  Modafinil is sold by prescription only, but its prodrug, Adrafinil, can be purchased online.  I've taken the latter on a number of occasions, and have been quite impressed with the results.  Adrafinil promotes a state of wakefulness and energy, but without the "edge" that comes with amphetamine use.  Even under conditions of sleep deprivation it has a significant positive effect on cognitive functioning, memory retention, focus and motivation.  It has no significant crash, produces no tolerance, and seems to have very little addictive potential.  You can even sleep on Adrafinil, if you wish; this is a significant advantage over all of the other stimulants we've discussed, since if you take dexedrine at 9PM and finish your work at 1AM, you're still effectively committed to staying up all night.  Adrafinil also seems to have a positive effect on mood; lastly, there are signs it can be used both to prevent and to treat some of the effects of aging on energy level and cognitive ability.

Modafinil and Adrafinil are not perfectly safe, though.  They put a fairly heavy load on the liver and kidneys if taken daily, and should therefore be taken only occasionally, unless as part of medically-supervised treatment.  There are also occasional side effects to watch out for, most notably skin infections.

Nootropics

Nootropics are still a very new and experimental class of drugs.  Many purported nootropics give negative or inconclusive results in clinical tests, and many of them have not been tested at all, or very little: more specifically, most of the research has focused around using nootropics to treat neural disorders and injuries, or to mitigate the effects of aging, with very little focus on young and healthy individuals.  This does not mean, however, that they do nothing beneficial; it only means that you'll have to do some careful experimentation to determine how they effect you, if at all.  For our purposes, I'll only be covering some of the more popular and (most importantly) well-studied nootropic drugs.

We'll start with piracetam.  The research on piracetam shows positive effects in the prevention and treatment of aphasia, dementia, epilepsy and hypoxic injury, but says almost nothing about its effect on healthy individuals.  The general consensus among those who take it daily is that it seems to do something, though it's hard to put a finger on.  One friend of mine suggests that it seems to subtly improve the general flow of cognition, making memories and good ideas more available.  One significant effect that piracetam seems to have is general potentiation of other drugs, especially stimulants and psychedelics, so if you incorporate piracetam into your daily regimen, you should be extra-careful about trying new drugs.

Another "smart drug" is DHEA, an endogenous chemical with a variety of functions, including inhibition of cortisol.  The research shows that it has anti-depressant effects, and seems to improve cognitive functioning under stressful conditions.  It also seems to improve episodic memory in young men, but has no such effect in elderly people.  You'll note I said "young men", not "young people": the effects of DHEA appear to be asymmetric with respect to gender.  In particular, higher levels of endogenous DHEA are correlated with longer lifespan in men, but there is no such correlation in women.

On the life extention angle, another nootropic worth considering is Selegiline, which appears to be available for purchase online, although technically it's not supposed to be sold to anyone without a prescription (possession, on the other hand, is legal).  Selegiline is an MAO-B inhibitor, commonly used to treat Parkinson's, depression and dementia.  Even for someone without these conditions, Selegiline produces cognitive benefits similar to those of Adrafinil, and there are reports that long-term use might tend to increase your lifespan.  Looking at the evidence, I am inclined to take such claims seriously.  Since it targets MAO-B specifically, Selegiline is less dangerous than nonspecific MAOIs.  However, at higher doses, Selegiline to lose its specificity and inhibit MAO-A also.  Women on oral contraception should be especially careful, as birth control pills appear to increase Selegiline's bioavailability, so that MAO-A inhibition may kick in at lower doses.  At any rate, use caution with this one, and take lower-than-usual doses of other substances, including foods containing tyrosine and other potentially dangerous monoamines (e.g. chocolate, cheese, wine).

Some other less common nootropics with effects similar to those of the above include Vinpocetine and Hydergine, which function as neuroprotectives and might also improve cognitive functioning.  I haven't tried these, and available research is slim, so I can't say much.  Beyond the nootropics we've discussed, the field begins to look a little grim.  For example, the jury seems to be out on ginkgo biloba: some clinical trials failed to demonstrate any measurable effect on memory or cognition, and others appeared to show short-term benefits.  It gets worse, though, than merely ambiguous research.  For example, DMAE, once marketed as a life-extension agent, may actually shorten your lifespan.  Other nootropics have turned out to be severely toxic, such as Fipexide, which appears to cause liver failure with prolonged use.  At any rate, your best bet is probably to stick with established and well-studied drugs; there are whole communities out there perfectly willing to put themselves on the line testing new contenders, and I feel it's best to leave that up to them.

Psychedelics and "recreational" drugs

Now, says Alice, for psychedelics.  We should begin with some general remarks.  First of all, these are contraindicated for anyone with a family history or predisposition to psychotic disorders.  More generally, set and setting (mental state and external circumstances, respectively) are extremely important to having a positive experience.  Psychedelics have been described as "nonspecific amplifiers of experience", which means that if you're having a bad day, acid will probably make it worse.  Ideally, your first trip should be in a place where you feel safe and inspired, with a few people you trust and who are experienced and knowledgeable about the drug you're taking.  You'll probably want to have art books, sketchbooks, good music and someplace comfy to lie or sit.

Your provisos and warnings are all well and good, says Bob, but what do psychedelics actually do?

It's... hard to describe, says Alice, in the same way that the colour red is hard to describe, but I'll give it a shot; just keep in mind this is an incomplete description.  First there are the visual effects.  These aren't hallucinations, in the sense that you'll recognize them as being effects of the drug.  With your eyes open, you'll tend to see colours intensified and altered, and your brain will be having a field day reinterpreting interesting textures (cf. pareidolia and form constants); with your eyes closed, you'll see animated geometric patterns, tessellations, visions, and all kinds of surprisingly interesting stuff.  Depictions in popular culture of psychedelic experiences are notoriously bad, but this movie does a reasonably good job.  In addition to visual alterations (which can teach you a lot about the functioning of your visual cortex) you might also experience changes in auditory and tactile sensation, as well as synaesthetic crossover between senses.

Even more interesting than the sensory changes are the cognitive effects.  It turns out that your sense of a coherent self can be overridden, and you may experience a blurring of the boundary between you and everything else.  You may have strange, spontaneous ideas or insights; to some extent this is because the peculiarity of the experience forces you to reexamine tacit assumptions hidden deep in your reality model; these assumptions do not always turn out to be wrong, but it's good to be aware of them and to understand them more deeply.  You may also become unusually aware of pathologies in your lifestyle and relationships, and with practice you may be better able to articulate those pathologies, than you are normally.  Ideas that come to you while high must be carefully examined and tested while sober, of course, but my experience has been that many of them turn out to be genuinely good ideas, and some have even led to significant improvements in my functional relationship to the world.

LSD, in particular, seems well-suited to understanding technical fields, including math and physics.  Unlike mushrooms, acid does not significantly impair my ability to read and understand mathematical texts, and the heightened ability to flex my visual cortex allows me to see difficult and abstract constructions quite vividly, as well as to understand on an intuitive level how they work.  Mushrooms, conversely, are more likely to present me (somewhat forcefully) with ideas I might never have otherwise considered.  These two are the most popular psychedelics, and the two experiences bear a definite family resemblance.  LSD is calmer, and easier to control and direct, but it lasts up to twice as long as mushrooms - twelve hours is common.  Mushrooms tend to be more emotionally intense: usually this means euphoria and lots of giggling, but occasionally you might be overcome by grief or anger, especially if you're already feeling that way before you dose.

I'm not going to say much about cannabis, because while the experience is certainly interesting, it's probably not going to help most of you think better (there are some, mind you, who actually function better with THC in their systems; Carl Sagan, for example, was a notorious pothead).  One reason you might want to take cannabis anyway is that it can serve as a gentle introduction to psychedelia - but be warned that some people, even those who generally enjoy psychedelics, have consistently bad reactions to THC.  Proceed with caution.  Another reason to take cannabis is for life extension purposes; there's good evidence that THC helps prevent certain kinds of cancer.  If you're taking it for health reasons, though, you probably want to use a vapourizer or eat it instead of smoking it.  Also note that, at least for some particularly susceptible people, cannabis can be addictive.  Again, if you have reason to believe you're prone to substance abuse, you might want to give this one a skip.

Another controlled substance to consider is MDMA.  MDMA has a variety of neurochemical effects: it inhibits dopamine and norepinephrine reuptake, actually reverses the serotonin reuptake pump, and also seems to increase levels of oxytocin, the "trust hormone".  So, you feel a sense of love, joy, wellbeing, safety, etc.  You'll also get many of the same stimulant effects as methamphetamine, albeit milder.  I mention MDMA because in my experience, if you already have a decent idea of how social interactions are supposed to work but still have trouble getting over your anxiety, this can help you teach yourself to be more socially confident, if taken in the appropriate environment (hint: do this around other people on MDMA).  The surge of oxytocin makes you temporarily fearless about approaching strangers, and also cushions the blow if things go badly, while the increased dopamine activity strongly reinforces behaviours leading to successful interactions.  This learned confidence persists into the sober state.  MDMA is also useful for confronting emotionally difficult issues - indeed, it was used for psychotherapy before it became popular recreationally and was banned - but I'll leave that to you to research on your own.

Some warnings about MDMA.  First of all, most "Ecstasy" contains adulterants (commonly caffeine and methamphetamine and sometimes PCP, among others), and sometimes contains no MDMA at all.  As a general rule, avoid pressed pills; pure MDMA most commonly comes in crystal form.  If you don't have a reliable source, you might want to skip MDMA entirely.  Also note that MDMA commonly causes hangovers, although these can be mitigated by taking 5-HTP.

Lastly, although all the drugs I've mentioned in this section are controlled, you might actually be able to experience very similar altered states legally.  Alex and Ann Shulgin, the research chemist and psychotherapist (respectively) who first popularized MDMA, also came up with literally hundreds of other psychoactive compounds, many of which are still legal outside America and can be purchased online from so-called "research chemical" companies (the U.S. has the Analogues Act, which automatically makes illegal any chemical broadly similar to any other illegal chemical, but Canada, among other countries, has not shared this dismal fate).  For example, instead of MDMA, you might consider AMT, a tryptamine with similar and in some ways better effects.  Another research chemical, 4-ACO-DMT, is actually metabolized into psilocin, as is psilocybin, and so the trip is almost identical to that of mushrooms.  The downside to all this is that research chemicals are generally sold only in larger quantities, so if you don't want to drop a couple hundred dollars on something you may not enjoy, this may not be your best bet.  There's also the fact that these are not as well-understood as more popular psychedelics, which makes them riskier, although these risks can be minimized by using caution and moderation.

Conclusion

As we've seen, says Alice with a smirk, you too can alter your neurochemistry for fun and profit - but this must be done responsibly.  Although I've tried to give a sense of the dangers alongside the benefits, this post is really only meant to serve as a broad introduction.  If you're thinking of actually trying any of the drugs I've mentioned, it's important that you do some in-depth research, and a proper cost-benefit analysis.  But with a little practice, you too can expand your mind.

48 comments

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comment by jimmy · 2011-02-11T20:28:48.968Z · LW(p) · GW(p)

Here's an unorganized list of interesting things I've learned about drugs over the years.

  • Anti-drug people cried wolf way past the point where you should stop listening to them.

  • Even the worst drugs that legitimately screw people up do so because those people are taking them in ridiculously stupid ways. These drugs can often be useful tools to have when used responsibly.

  • Addiction, as far as I can tell, can be prevented just by using a little forethought, precommitments, and outside view: "This drug might be too fun, so I wont do it again for at least a month, no matter what. Longer if it turns out to be more temping than predicted", and "Is this the kind of thing that addicts do before becoming addicted? (and that non addicts don't)"

  • Some foods do produce strong enough mental changes to notice (if you're paying attention). Butter and MCT oil both improve my brain function. The effect is different from the 'racetam family. For example, when playing guitar, my fingers aren't sped up, but they do play new songs as if I'm more familiar with them.

  • GHB is in all ways a better version of alcohol. Therapeutic index, long term toxicity, clear headedness, shorter duration of action, no hangover, higher sleep quality, possibly even less addictive, and causes numerically fewer date rapes (:P). It's a shame that this hasn't replaced alcohol. EDIT: Might not be so non toxic https://en.wikipedia.org/wiki/Gamma-Hydroxybutyric_acid#Neurotoxicity

  • Marijuana makes SWIM feel mentally impaired and makes it harder to put sentences together, but has also led to his fastest arithmetic time since Alexei came out with his lifetracking app. The average of times was not improved, however.

  • It is possible to sleep on modafinil, but even if you stay up late on it, you can wake up at a normal time the next day and feel good. Modafinil makes all of SWIM feel energetic except for facial muscles.

  • Threshold doses of mushrooms taken before bedtime seem to make SWIM wake up in an exceptionally good mood and feeling exceptionally well rested, regardless of whether the mushrooms helped him get to sleep earlier or if they kept him up very late by making him be productive.

  • My hand wavy model for psychedelics is that they change your thinking in ways that make it easier to move through thought/belief/identity space than normal, but with no strong bias in any direction. Most people (especially in therapeutic environments) tend to find positive paths, but it's possible to walk down the wrong path too. Learn to navigate.

  • My other hand wavy psychedelics model (for describing the experiences themselves, rather than the effect of them) is that they turn up the signal from many different parts of your brain. For example, it cranks up the volume for pattern matching algorithms and interest/curiosity- sometimes to the point of noticing patterns that you've never noticed before, and sometimes to the point of seeing patterns that don't exist at all. It also tends to make you see things as if its the first time seeing them. For example, despite knowing for his whole life that ageing is bad, 50ug of LSD made SWIM see old people 'for the first time' and get a deeper appreciation for "Aging SUCKS, and the world is insane for ignoring it!". Mechanisms like this can make it easier to take ideas seriously (which makes it easier to make lasting changes ^^^).

  • Psychedelics are much less scary and less dangerous than most people assume. Starting with low doses and proper set and setting, people rarely freak out, and the main damage it causes when it happens is to turn people away from psychedelics. There is next to no physiological danger.

  • Psychedelics aren't a whole new level more intense than marijuana. SWIM has had his two most intense and scary experiences after taking one hit of marijuana even though he has taken a fairly high dose of LSD and has taken low dose psychedelics more times than he can list. His only close friend to have had a scary experience had it on marijuana and wasn't scared on LSD.

Replies from: achiral, wedrifid, hg00, rastilin
comment by achiral · 2011-11-01T14:22:56.017Z · LW(p) · GW(p)

I realize it isn't typical to resurrect dead threads, but since I was searching for threads on LW about psychoactives I decided to go ahead.

Regarding the last bullet point:

I agree that cannabis can be frighteningly strong, of course. Even the renowned Alexander Shulgin, creator and consumer of many novel tryptamines and phenethylamines, doesn't react well to weed(see Pihkal).

I also agree with the second to last bullet point, as a generalization.

However, I felt that must address this, in case curious readers dig this thread up: Warning Psychedelics can absolutely be a whole new level more intense than marijuana. Please be careful with and respectful of all psychedelics, especially those used in conjunction with MAOIs and smoked tryptamines.

These drugs can be absurdly powerful and weird. It's all too easy to be unexpectedly plunged into a whir of terror, forget that one has consumed a drug, feel as though one is dying, perceive oneself to be tortured for eternity, perceive oneself to be poisoned, perceive demonic entities, and all the while perhaps be experiencing physical symptoms like vomiting and screaming/crying.

Psychedelics, as typically used by recreationally motivated Westerners(ie your typical LSD or whatever dose), are fairly easy to manage. In no way does this mean that all modes and forms of psychedelic drug use are 1) anywhere near as safe psychologically 2) anywhere near as easy to manage/undergo/guide 3) anywhere near as limited in the broad range of both positive and negative effects.

comment by wedrifid · 2013-09-08T08:46:10.774Z · LW(p) · GW(p)

GHB is in all ways a better version of alcohol. Therapeutic index, long term toxicity, clear headedness, shorter duration of action, no hangover, higher sleep quality, possibly even less addictive, and causes numerically fewer date rapes (:P). It's a shame that this hasn't replaced alcohol.

What? This is wrong. GHB has a excessively steep dose-response curve and a terrible theraputic index. Enough so that GHB was the example the lecturer used in my pharmacology class when explaining what the theraputic index is and the risks of a bad one. It's about 2, which means that double the dose that gets you high can kill you. He went on to give details about the later stages of the synthesis of the end product (typically done a step or two closer to the final dealer) and how varying practices can lead to a variability in the delivered dose greater in magnitude than the theraputic index. This is bad.

My past self seems to have voted up the parent. I can only hope that is because he didn't read through fully. While most of the claims are true, the one that is wrong is a belief that gets people killed.

Replies from: jimmy
comment by jimmy · 2013-09-08T17:48:29.676Z · LW(p) · GW(p)

You have a cite for the LD50? Erowid gives 2000mg/kg for male rats and 1650mg/kg for female rats, and a strong dose of up to four grams for a human. I haven't seen any LD50 data for humans, but have read about people taking well over the normal dose, passing out, and waking up fine. It does seem to imply a therapeutic index well over two, and the comparison was made to alcohol which has a quite low one itself. Lethal BAC is around 0.4 and up to 0.2 is pretty common.

Mixing GHB with alcohol is a big no-no though, and does get people killed.

Replies from: wedrifid
comment by wedrifid · 2013-09-09T06:46:46.871Z · LW(p) · GW(p)

You have a cite for the LD50?

Pardon me. Cntrl-C failure. The link in the grandparent was supposed to be to the source but I evidently copied the wrong tab. In any case the measure was likely based on rats---there doesn't seem to be good data for humans. It also seems that the more 'official' (in social authority not academic authority) a source is the worse the drug is made to appear.

Further investigation brought up a few things worth mentioning:

  • The cause of death from GHB overdose is respiratory failure from CNS depression. If respiratory support is supplied the lethal dose (from whatever critical thing fails next) is several times higher. This suggests increased expected valueof having a sober friend who knows Expired Air Resuscitation and the emergency services number relative to other drugs of abuse.
  • Many of the deaths that are attributed to "GHB overdose" can (allegedly) actually be better attributed to a different cause of death (including the GHB and alcohol cocktail mentioned).
  • More 'official' sources suggest a lower LD50 than less official sources. In this case 'official' refers to social authority and not academic authority and there is good cause to doubt the credibility of sources for which writing a high LD50 could get the author fired by some moralizer with power.
comment by hg00 · 2013-09-08T08:17:37.312Z · LW(p) · GW(p)

GHB is in all ways a better version of alcohol. Therapeutic index, long term toxicity

https://en.wikipedia.org/wiki/Gamma-Hydroxybutyric_acid#Neurotoxicity seems at least slightly scarier than what I've read about alcohol... but I'm far from a neuroscientist.

Replies from: jimmy
comment by jimmy · 2013-09-08T18:11:18.760Z · LW(p) · GW(p)

Agreed, and edited. Thanks!

When I originally looked into it, those studies weren't around, and I missed them when they came up :(

comment by rastilin · 2011-04-11T11:11:19.783Z · LW(p) · GW(p)

MCT oil.. that's stuff like coconut oil right? I would never even have considered trying something like that, thanks.

Replies from: jimmy
comment by jimmy · 2011-04-11T23:48:51.503Z · LW(p) · GW(p)

It's a big component of coconut oil, but you can buy it by itself.

comment by CronoDAS · 2011-02-10T06:20:04.068Z · LW(p) · GW(p)

There's also this David Pearce essay.

comment by RobinZ · 2011-02-11T18:11:30.001Z · LW(p) · GW(p)

Disclaimer: This is a work of postmodern fiction about two irredeemable junkies named Alice and Bob and their cat Fido. The views contained herein are not medical or legal advice, they are not my views, and they are not the views of LessWrong.com or any of its members. In fact they are not views at all: they are transnarrative flows in alterity-space, or that's what my lit prof tells me. I do not condone any illegal activity whatsoever, except jaywalking.

Added to personal quotefile.

comment by wedrifid · 2011-02-11T03:25:28.707Z · LW(p) · GW(p)

At any rate, use caution with this one, and take lower-than-usual doses of other substances, including foods containing tyrosine and other potentially dangerous monoamines (e.g. chocolate, cheese, wine).

Just elaborating here on interactions with selegiline (which is a drug I highly recommend, by the way). The active ingredient in chocolate that interacts with the MOAI in selegiline is phenylalanine. The same amino acid discussed earlier that serves as a precursor to dopamine, norepinephrine and adrenaline. It's what people refer to when they talk about chocolate's "happy hormone".

Normally phenylalanine is fairly mild. Take a whole bunch and you may notice a boost in mood - particularly if stress has depleted your reserves. Even then it doesn't last long. But with selegiline in the system it is a whole different ball game. The combo can be abused to give a euphoric high with an amount of phenylalanine you quite possibly wouldn't even have noticed. The combo has also been used as a depression treatment. But either way selegiline + phenylalanine is powerful stuff. To the extent that I am surprised that people bother with illegal party drugs when this stuff is legal.

(Above notes aside I am not particularly warning against selegiline + chocolate. There isn't that much phenylalanine in the stuff that you're going to get high. :P)

Oh, and another thing. Selegiline is an irreversible MOAI-B. That means that when it deactivates the monoamine oxidase that molecule is deactivated for good. Basically, this means that the primary effect of selegiline operates over the timescale of about a month, not hours. It takes a while for the effects to build up and even longer for them to disappear completely. This is in stark contrast to most other things that give a stimulating effect. So don't go about swallowing 500mg of phenylalanine a week after you stopped selegiline and be surprised when you hit the roof. ;)

Replies from: wallowinmaya
comment by David Althaus (wallowinmaya) · 2013-06-03T15:28:30.917Z · LW(p) · GW(p)

Are you sure you mean phenylalanine and not phenylethylamine?

For me, the combo selegiline + 500 mg phenylalanine (or even 1000 mg) doesn't produce any noticeable effects. OTOH, selegiline + 500 mg phenylethylamine is really powerful stuff. On a par with the strongest illegal stimulants.

Replies from: wedrifid
comment by wedrifid · 2013-06-03T16:02:37.935Z · LW(p) · GW(p)

Are you sure you mean phenylalanine and not phenylethylamine?

Thankyou, I mean the latter.

comment by SeventhNadir · 2011-02-13T10:34:46.283Z · LW(p) · GW(p)

You've skipped over nicotine. While I've never smoked and could not recommend it (for many reasons) I do use nicotine patches for increased focus and productivity. Nicotine carries a lot of negative associations because of their link to cigarettes but a lot of the dangers of cigarette smoking are actually related to things other than the nicotine itself. The chemicals in a cigarette are quite toxic and cigarette smoke is harmful to the lungs. The fact that cigarettes co-administer MAOI's and have a powerful behavioural trigger that reinforces addiction makes me consider nicotine patches to probably have a low potential for addiction. On the stimulant angle, I also prefer the extended release stimulants, a slower release profile is much less spiky, and lends itself to a smoother experience, less tolerance and less anxiety.

Replies from: gwern
comment by gwern · 2012-04-12T00:00:19.104Z · LW(p) · GW(p)

Further reading: http://www.gwern.net/Nicotine

comment by [deleted] · 2011-02-10T22:47:01.062Z · LW(p) · GW(p)

One thing I would point out here and that is that it's a really really bad idea to take multiple serotonin precursors, or to mix serotonin precursors and high doses of caffeine. Serotonin syndrome ( http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004531 ) can sneak up on you quickly and is not fun.

Replies from: wedrifid, Skatche
comment by wedrifid · 2011-02-11T02:58:55.986Z · LW(p) · GW(p)

Serotonin is the thing to be careful with if you are messing around with your neurotransmitters. Serotonin Syndrome is bad. That said, it isn't multiple serotonin precursors that are a problem. You can mix 5HTP and and Tryptophan and you still haven't done anything more than add to the pool of precursors - not much different from simply taking more of one or the other. It is a whole different ball game when you mix an SSRI with tryptophan, each unit of tryptophan is multiplied in potency.

The real problem comes when you introduce monoamine oxidase inhibitors, MOAI-A, in particular is the one that messes with the breakdown of serotonin. If you mix a MOAI-A with an SSRI you are in for a world of hurt. Even mixing MOAI-A with precursors isn't a good idea. Especially since a lot of our serotonin (and so monoamine oxidase) is actually located in the gut, not the brain. Here you are putting a bunch of serotonin precursor right into the digestive system, the same system you have made nearly incapable of disposing of serotonin efficiently. People on old style MOAIs have specific dietary instructions that they need to follow to avoid this kind of problem.

Replies from: None
comment by [deleted] · 2011-02-11T08:53:37.767Z · LW(p) · GW(p)

Good point - I didn't express myself very well (was quite tired when I commented). However, my point about caffeine stands though - and in fact is true for all amphetamine-like stimulants. They all increase production of serotonin, which when combined with an increased level of serotonin precursors can be far from pretty.

comment by Skatche · 2011-02-11T01:48:25.514Z · LW(p) · GW(p)

Thanks for the heads up; has this happened to you? What did you take, and were you on anything else at the time?

Replies from: None
comment by [deleted] · 2011-02-11T08:50:23.918Z · LW(p) · GW(p)

I believe so - I was never officially diagnosed, but became extremely ill and became better pretty much instantly on withdrawal of the 5-HTP. The symptoms matched those of serotonin syndrome, so I believe I had it - if I did, I was very lucky, as it can be fatal. I was taking, at the time, two over-the-counter 5-HTP supplements per day (can't remember the dosage, but they were fairly standard ones), but I was combining it with a lot of coffee - maybe ten, fifteen cups a day? - and that can have a synergetic effect when combined with serotonin precursors, as caffeine acts on the serotonergetic system.

Replies from: wedrifid
comment by wedrifid · 2011-02-11T09:50:19.921Z · LW(p) · GW(p)

That is a lot of caffeine! Are you still on that much?

Replies from: None
comment by [deleted] · 2011-02-11T11:27:47.945Z · LW(p) · GW(p)

No - at the time I was being paid by the hour, and not a very high wage, so I was working 13-and-a-half hour days. These days I limit myself to four cups a day maximum (three at weekends) and I don't take any 5-HTP (I do take melatonin though).

comment by Costanza · 2011-02-10T02:44:46.416Z · LW(p) · GW(p)

Surprised to see no reference to methylphenidate/Ritalin.

I approve of this kind of post, supportive of illegality though it may be. Cheers, mate!

P.S.

On further reflection, I'm not in favor of illegality as such. We're never going to have perfect laws, but those of us who live in liberal democracies should almost always follow the rules, even when the rules are sort of stupid. But the so-called war on drugs in America has become thoroughly ridiculous. Especially when those drugs may be performance enhancing. </ ranty afterthought>

Replies from: Skatche
comment by Skatche · 2011-02-10T03:52:17.527Z · LW(p) · GW(p)

Look again: Alice mentions Ritalin in the Stimulants section, after the amphetamines, but only briefly because she doesn't know much about it. If you'd like to contribute what you know and/or have experienced, it would be greatly appreciated. :)

Replies from: Costanza
comment by Costanza · 2011-02-10T12:19:31.211Z · LW(p) · GW(p)

Indeed, it is there. I must have mistyped when I tried to search. Thanks.

comment by [deleted] · 2011-02-13T17:51:16.764Z · LW(p) · GW(p)

Eve likes your story, but she has something to say about psychedelics. She's not nearly as enamoured of LSD as you are. Eve thinks acid is like a Newton tablet: it was getting at something important, but the implementation was tremendously clunky, and these days it may be a sort of curiosity piece but there are better options for anybody looking to get real (neural) work done.

Eve recommends 2CB. A person under the influence of 2CB isn't nearly as "impaired" as a person tripping on acid: you can have relatively normal conversations with people who are not tripping. 2CB also appears to be much safer than LSD, showing none of the potential for overdose or for long-term damage, and it only lasts 5-6 hours. And being on 2CB is really interesting for the same reasons indicated in the original story--it allows the mind to look at itself. It also has mild empathogenic qualities, making it sort of like an "MDMA lite" for those who want a milder version of the experience.

comment by Multiheaded · 2012-04-12T05:34:58.027Z · LW(p) · GW(p)

Nothing about DXM? Daymn shame. I'll write something up. It's definitely a recreational drug first, but I've found that it's very good for a few specific purposes in daily life. First, in all doses it impairs short-term memory but at the same time reduces boredom and increases focus on whatever you might be doing - whether it's writing a paper or picking lint from your socks. Therefore, be cautious if you want to power through a demanding task with it; get working first, make sure there are no distractions, then take your cough syrup or however you're getting it[1]. Time is going to fly by and you'll get a job done with little cost to your willpower. (I also used the boredom-alleviating effect to get through a 12-hour shift when I was working at a store, on a few occasions.)
The second notable effect, for me, is the rush of confidence, the increase in empathy (and interest in people you're talking to), moderate disinhibition and, generally, a feeling of being charming and charismatic - I don't know to what extent that last one is objective or whether it's an illusion, but I've definitely had several amazingly successful conversations while on the "2nd plateau". However, using that much to socialize could be perilous if whoever you're talking to is looking for signs of intoxication. I've only been called out once, and they thought I was drunk, not high (prompting me to reflect on the insane hypocrisy of most drug bashers). Still, take care. By the way, while the stuff has little in the way of hangover (you might feel numb and sleepy... or, if you timed your doses right, it can be a rather pleasant afterglow) and no long-term absistence syndrome (as it doesn't form a physical dependency), there can be less frequent reactions depending on the individual - and the composition of whatever medicine you've been taking that contains the stuff. I sometime get rather unpleasant bowel disruption, and then I have to use a small dose of codeine to put it out.

(to be cont.)

[1] There are generally only a few DXM-containing cough medicines for sale in any country; AFAIK there's only token regulation of them everywhere, unlike opiate-containing drugs. Your country's drug scene has long figured out which ones are acceptable to use in higher dosages, and which ones contain harmful stuff or cause side effects; read some forums to see what's best to buy.

comment by Hul-Gil · 2011-05-14T02:13:00.667Z · LW(p) · GW(p)

Why nothing about opioids?

Some quick facts about opioids, including heroin. I have written up a version of this with sources if so desired.

0.) Opioids cause feelings of well-being and euphoria, and usually some sedation (though some can be stimulating). They do not generally cause mental impairment, unless enough are taken to cause one to nod off. Negative side-effects are rare at low doses, but increase as dose does, and can include nausea and constipation.

1.) Most opioids - again, including heroin - are not toxic in any manner*. (Meperidine is a notable exception.) One could be on morphine, for instance, one's entire life, and not suffer ill health effects beyond constipation (usually easily fixed with magnesium).

2.) Opioids are very addictive. No qualifiers here.

3.) Heroin addicts are usually so unhealthy because of drug prohibition, not because of the drug itself. Some of the things heroin is cut with are dangerous in combination with it (like quinine), or just plain dangerous; its manufacture is illegal and there is no quality control; and it is expensive, so addicts engage in behaviors like injection or theft.

4.) Opioid withdrawal will not kill you, and opioids are usually fairly hard to overdose on accidentally. Most heroin "overdoses" are actually due either to what is thought to be a contaminant in the heroin, or due to mixing drugs to make a limited supply of heroin last longer (see #3).

*I have read an article stating they can cause dopaminergic toxicity, which is what rewires your brain to require opioids after using them for a long time. As far as I know, this is reversible, however.

I have a theory that most opioid addicts are actually self-medicating for psychological pain. Opioids been found to be efficacious in the treatment of depression and anxiety, but concerns over addiction prevent them from being marketed for these uses. I find this odd, because benzodiazepines are used for psychiatric purposes, but are also (less, admittedly) addictive, and their withdrawal symptoms are much worse.

Replies from: Will_Newsome, gwern, inblankets, Eugine_Nier
comment by Will_Newsome · 2013-06-14T10:48:54.866Z · LW(p) · GW(p)

I've known a few people who have died from "heroin" overdose. So even if heroin doesn't tend to kill in itself, "heroin" is still quite dangerous.

comment by gwern · 2012-04-12T00:02:56.746Z · LW(p) · GW(p)

3.) Heroin addicts are usually so unhealthy because of drug prohibition, not because of the drug itself. Some of the things heroin is cut with are dangerous in combination with it (like quinine), or just plain dangerous; its manufacture is illegal and there is no quality control; and it is expensive, so addicts engage in behaviors like injection or theft.

From reading about heroin, isn't a lot of the danger from the acids involved in synthesizing onto the original morphine the 2 acetyl groups, leftover in the final powder?

Replies from: Hul-Gil
comment by Hul-Gil · 2012-04-12T05:33:18.652Z · LW(p) · GW(p)

I don't think so - acetic anhydride is really the only other reagent involved in the step we're considering, and an excess wouldn't be harmful in any way... except, possibly, making the product a bit uncomfortable to ingest, if too much acetic acid was left over. (An excess of acetic anhydride is commonly used so as to make sure all the morphine reacts; any excess will become acetic acid - i.e., vinegar - as well.) It's common for a little to be left over, giving heroin its characteristic (vinegar-y) smell, but I don't think it's dangerous.

So I'd say that there's no danger here... but lack of quality control in general is definitely a big problem indeed.

Replies from: inblankets
comment by inblankets · 2013-02-24T16:03:28.446Z · LW(p) · GW(p)

I don't know about other cities, but I've used heroin in NYC off and on for almost 5 years, and I can safely say that, although I attempted to control for nutrition etc., I almost always had some deleterious effects on my skin etc. from (presumably) additives, even using "pure" stuff. If you're taking something in intravenously, very pure is not pure enough.

Replies from: inblankets
comment by inblankets · 2013-02-24T16:05:09.723Z · LW(p) · GW(p)

It's definitely not as dangerous as people act like, though. You can control dose if you're careful and it's not instantly addictive or anything like that. I actually was badly physically addicted and although withdrawal is the most uncomfortable thing I've ever felt, it's doable.

comment by inblankets · 2013-02-24T16:08:33.568Z · LW(p) · GW(p)

Injection is not just because of pricing. It's not that expensive-- $/effect is greater than many other opioids. Addiction behavior is known to manifest around drugs that have quick onset, quick fade of effect, and an intense peak. Injection yields this. Also snorting it will tear up your nose, possibly because you haven't filtered it yet (which virtually everyone does before IVing).

comment by Eugine_Nier · 2013-06-15T05:55:18.210Z · LW(p) · GW(p)

Heroin addicts are usually so unhealthy because of drug prohibition, not because of the drug itself.

I'm not convinced this is true. Heroin was certainly causing social problems back in the days when it was still legal, i.e., the reason a movement started to ban it in the first place.

comment by zslastman · 2012-12-31T13:22:14.404Z · LW(p) · GW(p)

Is there a good resource anywhere for finding what psychoactive chemicals are legal in a given country?

Replies from: gwern
comment by gwern · 2012-12-31T15:46:06.860Z · LW(p) · GW(p)

The best I know of is Erowid and Wikipedia, but they tend to specialize in per-drug lookup rather than per-country (so it's easy to look up whether marijuana is legal in the US, but not so easy to look up 'everything legal in the US').

comment by InquilineKea · 2011-02-20T08:52:52.219Z · LW(p) · GW(p)

One thing to add about Ritalin: It isn't neurotoxic, unlike the amphetamines. The details are a lot more complicated, but they're nicely summarized here

Anyways, here's another guide to nootropics

comment by Broggly · 2011-02-15T02:57:12.574Z · LW(p) · GW(p)

As someone who actually does have ADD, I'd like to point out that if you take amphetamines often you need to pay more attention to dental hygene. Amphetamines inhibit saliva production (presumably this has something to do with its effects on appetite) which can promote cavities if you skip brushing your teeth. Since it can give you dry mouth, maybe a good way to ensure you eat is to make a nice soup so you'll eat it when you feel thirsty? If that doesn't work (I've never needed to try it) then maybe drinking milk instead of water could be good since at least you get some nutrition out of it (although being South Australian I do come from a culture where iced coffee is supposedly more popular than coca cola)

comment by jfm · 2011-02-10T14:16:03.735Z · LW(p) · GW(p)

I have taken ephedrine (in the form of ephedra tea) for nasal decongestion and increased focus. In my experience, it worked about as well for increased focus as caffeine (in the form of coffee) does, but caused more heart racing and jitters.

comment by MonsterDK · 2013-01-19T20:56:13.862Z · LW(p) · GW(p)

Very interesting, thank you for the article.

comment by knb · 2011-02-10T03:02:42.716Z · LW(p) · GW(p)

I take ephedrine, adrafanil, and (prescription) amphetamine sometimes (not together). I have used Ephedrine for appetite suppression and for increased focus, and I found it works very well for both purposes. However, I also had an experience where I felt like my heart was pounding (even though I wasn't active at the time). I'm not sure if ephedrine was the cause, though. It may have just been placebo effect since I was aware ephedrine can exacerbate heart problems.

I've also tried piracetam. If there was any effect, it was extremely small. Probably placebo.

comment by [deleted] · 2015-07-02T01:24:47.131Z · LW(p) · GW(p)

sd

comment by nazgulnarsil · 2011-02-13T00:45:41.636Z · LW(p) · GW(p)

AFAIK multivitamins have no effect/slightly negative effects in clinical studies. If you need a basic multivitamin you need to fix your diet ASAP and not rely on a pill.

Replies from: blindey
comment by blindey · 2015-02-18T13:11:09.807Z · LW(p) · GW(p)

Indeed. I had heard that as well, though I don't know the validity of it. What I have seen, however, is dangerously low/high amounts of whatever is said to be in the vitamins.

http://www.salon.com/2015/02/03/walmart_target_walgreens_gnc_accused_of_selling_scam_herbal_supplements/

In any event, just be careful about the amount of any particular vitamin you get. Excess vitamin A is a lot different than excess vitamin C (In the harmful dosages, and its effects of course) LD50 for Vitamin C is 11900mg/kg LD50 for Vitamin A is 1510mg/kg

comment by pontifex · 2011-02-10T23:35:27.819Z · LW(p) · GW(p)

As an added bonus, theanine appears to boost the immune system.

Not sure that's merely a "bonus": there's a lot of literature suggesting a link between immune system activity and affective states, and if we take the somatic marker hypothesis seriously this is likely where the real action is.

e.g. http://dx.doi.org/10.1016/j.biopsycho.2006.06.006