Meta-Illness and Extra-Diegetic Disease in RPGs

This is a tangent on my meta-narcotics post and only really half, or the start of, a mad, little idea. Sickness, illness - having your character contract and deal with a disease in a game is rarely very exciting from a mechanical or roleplay perspective. It could be... much goofier. Having your character take one-off or cumulative stat damage is dull and forgettable, we could make it more engaging and present in everyday play - we could make it META. So;

A disease is made of three different components; a symptom, one or more triggers and an effect. I will show this with the following example: 

--

Oh no! The adventurer, Gorto Gold-Groveler, has contracted Dungeon Lung! Now Gorto's player (not Gorto the character) must pretend to wheeze before they try to speak to an NPC. Each time Gorto's player does not wheeze or forgets to do so, Gorto will lose 1 HP permanently until his sickness is cured. When cured, Gorto will regain any lost HP. If uncured, Dungeon Lung becomes progressively worse and soon Gorto's player will have to pretend to wheeze whenever they make an ability check. The Dungeon Lung may even progress to a final stage, where the player must wheeze if they are making Gorto do anything other than lay prone. If another player tries to remind Gorto's player to wheeze whenever there is a trigger, that player has opened themselves to risk of contagion and must make a save against becoming infected with Dungeon Lung themselves. 

--

Does that make sense? While the symptom, trigger(s) and effect can be remixed and swapped out entirely, the core of the idea is - the illness's symptom must be performed the afflicted player whenever a trigger is encountered during play, if not, the afflicted character suffers from the disease's effect. This way, disease becomes more interactive and present for the afflicted player and the rest of the table. With this method, a disease has no other effects than when those caused by a trigger - either the player acting out the illness's symptom or forgetting to do so and suffering an effect. For me, it simply simulates the experiences and feel of actually being unwell - and it is funny and a little gross. Be weird, try it.

The Failed Careers of Tetragrammatown - or - Failed Careers as Worldbuilding

Failed Careers are great. PC's get a random failed career at character creation along with the items someone of that career would have possessed. It doesn't need to be said that they are wonderful mediums for implied world-building that immediately involve and inform players in and about the world.  

When making failed career tables, I try to keep two things in mind. First, I try to make the careers so specific that a player can immediately grasp the concept - take ownership of, or define the career themselves. The world, however weird should be understandable and implied only, if a concept is too weird, prepscriptive or requires too much meta-knowledge to understand it shouldn't be available as a failed career for your players. Secondly, the weapon and item need to be interesting. It's ok to play fast and loose with the definition of 'weapon' and 'item' - especially if it's something a player wouldn't pick for their character off of an equipment list or something that isn't even on a equipment list. Interesting can mean strangely useful, something that produces new or odd situations - something that can be used for more than its intended purpose or even provides a narrative, character or adventure hook. You can fit a lot of flavour into the [name], [weapon], [item] format.  

While demographically unsound, failed career tables can make for useful encounter tables. I like an exploding d4 to determine numbers of an encountered career. 

Below is an example failed career list for a city called Tetragrammatown. Read it and you will get a good feel for the setting via failed careers only. 

UPDATE: I've been using this table for one-shot episodic play and slowly over the last year or so this table has expanded along with the setting itself. I think it started as a d66 table, then d68, then d88 and know a full d100. It's been really useful for supporting and expanding the setting and it's feel and has grown to reflect the play that has taken place. It's been a lot of fun. The 

Failed Careers of Tetragrammatown

Roll 1d100 to determine your character's backstory. The format is; [Failed Career/Backstory Name], [Weapon], [Item(s)]

1. Whipping-Boy, whip, a wooden sign listing the ways you've been a naught boy/girl.
2. Trench-Brother, sharpened shovel (as axe), permanently muddy military uniform.
3. Dare-to-Die Duelist, pistol with no bullets, black coat with white 'duel me' painted on it.
4. Riot Police, tear-gas grenade, plastic see-through shield.
5. Reluctant Zealot, cat o' nine tails, prescription rage-juice.
6. Living-Book, tattooing needle, an entire book tattooed onto body.
7. Satirist/Polemicist, razor sharp wit (0 damage), head and arms locked in a pillory/stocks.
8. Faerie-Realm Polluter, oil drum full of chemical by-products, map of local fairy rings.
9. Elf-Hater, elf-basher (as club), 'hate' and 'elfs' tattooed on knuckles.
10. Puddle-Prophet, lead rod, electric pouring crucible.
11. Vehicularist, a pike (to prod people out of your way), a slow and primitive iron car.
12. Amateur Aeronaut, a helmet with a big spike on the top, a heavy wood and canvas gliding-suit.
13. Natural Philosopher, poisonous bug/plant/element (single use), specialist's tools.
14. Gruel-Giver, heavy ladle, keg of gruel (20 rations).
15. Noir Detective, twin knuckle-dusters, chainmail-lined trenchcoat (+2 AC)
16. Gladiatorial Vampire-Baiter, wooden stake gauntlets, wooden plate armour painted with crucifixes (+3 AC).
17. Veteran-Brother, beam-rifle in a locked box (no key), a pocketful of medals.
18. Clerical Assassin (official), crucifix with concealed dagger, mitre hat with pistol stitched inside.
19. Clerical Assassin (unofficial), poisoned needle, shabby imitation vestments.
20. Most-Wanted Warlock, pet anaconda, edgy eldritch tattoos.
21. Ratman Exterminator, rat-poison, vicious tunnel dog.
22. Puritan-Procuress, spanking-paddle, trunk of spare puritan clothing.
23. Puritan-Bothering Pacifist Revolutionary, fruity trombone, book of jokes.
24. Dissolute Paladin, bejewelled knightly longsword, plastic bag full of laughing gas canisters and naughty printing-press pamphlets.
25. Demon-Fumigator, hand-pump sprayer, holy-water.
26. Rocket Smuggler, pocket-rocket, fistful of solid rocket-fuel.
27. Prostitute Gangster, switchblade, fish-net stockings.
28. Old-Town Rioter, bag of bricks, knitted balaclava.
29. Wicked Noble, thumbscrew, flamboyant feather hat.
30. Atomic Fisherman, glowing harpoon, radioactive fish.
31. One Man Speakeasy, blinding bath-tub gin, backpack distillery.
32. Involuntary Rocket Tester, molten weathervane, exhaust-blackened parachute.
33. Paramilitary Goon, percussion cap rifle, camouflage tunic and cap (camouflage gives stealth bonus in matching environment).
34. Political Congregant, swagger stick, a pamphlet listing the benefits of the new ideology you've invented.
35. Industrial Congregant, huge and consecrated spanner (as a mildly holy, two-handed club), sackcloth gasmask.
36. Itinerant Explosives Workman, big shard of shrapnel (as dagger), huge hand-cranked iron bomb that explodes instantly after three cranks.
37. Agrarian Congregant, ploughshare, emergency ploughshare weaponization kit and manual.
38. Book-Burner, single-use spray canister of napalm, slightly singed book (rolled randomly).
39. Creature-Collector, Cattle prod (target saves vs paralysis or becomes slowed and loses 1pt of hp), vicious and toothsome creature in a small cage strapped to your back.
40. Penal Legionary, metal-pipe arquebus with 2 shots, black and white striped fatigues.
41. Quadruple Agent, garotte, d4+1 fake identity papers
42. Scientific Congregant, two vials of unstable chemicals, badly repaired spectacles.
43. Latest Technology Inquisitor, electric cattle prod (target saves Vs paralysis or becomes slowed and loses 1pt of hp), EZ-lite bonfire with portable stake.
44. Authoritarian Thug, heavy hobnail jackboots for stamping, an imposing black uniform.
45. Industrialiser, single-use glue gun, furnace-powered engine (to glue onto something).
46. Morality Play Thespian, false metal god marionette (as flail), black renaissance theatrical costume and morph-suit.
47. Satellite-Botherer, laser pointer, tinfoil hat.
48. Indentured Window-Washer, 100-foot pole, bucket of caustic soaps.
49. Self-Abusing Flagellant (get it?), stinging-nettle cat o’ nine tails, medieval smut.
50. Computational Congregant, soldering iron, huge and humming electronic calculator carried on the back.
51. Hypno-Pressganger, hose with bricks in the feet, a paper spinning black and white spiral on a stick.
52. Sixteenth-Story Man, clawed gloves, 500 feet of rope
53. Clerical Congregant, spiked processional cross, aspergillum of holy water.
54. Out-Of-Town Gangster, a crude weapon wrapped in barbed wire, helmet with your gang's motif.
55. Expeditionary Brother, long-rifle, wearable waterproof black bivvy-onesie
56. Radicalised Protester, disposable rocket launcher with 1 HEAT round, placard
57. Gutter Groveller, sharpened spoon, tattered blanket
58. Fugitive, pocket pistol, roll a second failed career- gain their items - this is your cover identity or why you are wanted
59. Puritan Black Ops, silenced caplock pistol, perfectly boring disguise with belt-buckle-balaclava in the back-pocket.
60. Proxy Doxy, concealable single-use blackpowder SMG, pre-contact licence
61. Reconstruction Congregant, wrecking bar, hardened cement-stained overalls and shroud, (+2 AC)
62. Assembly-Line Congregant, a handful of screws and bolts, stimulant pills (roll a second failed career, this was your second job)
63. Folk Hero, ancient acid-stained longsword, soot-covered white stallion.  
64. Overworked Peon, roll twice and take both failed careers.
65. Psalm Singer, you needed no weapon, entire bible memorized.
66. Gunpowder Cultist, dodgy hand-gonne (crits you on a critical failure), singed robe
67. Corporate Stooge, long-arm stapler, demotivational poster
68. Corporate Enforcer, concealable whip-sword belt with factory logo belt-buckle, factory branded sunglasses 
69. Proto-CEO, a pistol next to a half empty bottle of gin in a desk drawer somewhere, a big cigar
70. Lone Gunman (for hire), scoped takedown arquebus in a case, keys to a fancy apartment 
71. Theocratic Commando, your choice of any pre-1830 firearm, your specific faith's paramilitary uniform. 
72. Warmachine Welder, Blowtorch, d4+1 armour plates.
73. Chain-Ganger, rusty pickaxe, a convict you remain chained to by the ankle.
74. Factory 'Hand', a fistful of nuts and bolts you pulled from industrial machinery, d4+1 severed fingers that you keep in a jar (if 5 is rolled you can have a hook hand)
75. Alleywayman, two flintlock pistols, masked ratman accomplice/occasional steed
76. Soldier of the Sex Worker's Battalion of Death, any historical pre-1815 personal weapon of your choosing, an imperious black military uniform with silver crucifix
77. Dragoon Brother, prototype lever-action rifle (breaks irreparably on a roll of 1 damage), cloned horse
78. Dogmatic Vigilante, a small non-lethal weapon of your choosing, thematic dress-up, roll a second career for your unassuming alter ego.
79. Motorbike Knight, lance, crude poison/goblin powered motorbike
80. Deforestation Congregant, crude poison-powered chainsaw, sharpened grappling hook and chain
81. Cull Girl, your choice of any historical sword type, skimpy bloodstained clothing 
82. Snake Handling Acolyte, two snakes with woozifying venom (if swung as a weapon will die), vial of anti-venom 
83. Law Brother, hand-gonne truncheon, insta-pillory kit (flatpack, probably takes 10 minutes to assemble)
84. Logistics Congregant, multitool, iron dolly 
85. Snail Farmer, snail hammer, very large snail
86. Boschian Hell Muralist, large paint encrusted palette knife, rejected proposal sketch of Hell
87. Goblin Smasher, really big rock, a glass jar of green slurry
88. Keeper of Cursed Books, attack book on chain (d6 reach weapon, knows only to bite) random book - cursed (flipped information as if from evil alternate dimension)
89. Tragedian, fencing foil, sad mask with dark and dramatic cape
90. Exorcist, heavy chain and padlock, demonic voice in the back of your head
91. 'The Free Press' (hahahaha), crutch, a black eye and a broken leg in cast +1 additional broken limb of your choice.
92. Polluted River Pirate, acid stained cutlass, NBC resistant coracle
93. Bunker Buster, d4+1 stinky sticks of sweaty tnt (d6 impact explosive), a crowbar with flint and steel keyring
94. Conscript Brother, pike, iron puritan hat shaped helmet 
95. Landlord's Retainer, fancy looking musket (tiny calibre, d4 damage), tabard with landlord's symbol (and/or face) on it
96. God-playing Scientist - Biologist (or) Engineer, mostly dead human arm (or) haywire automaton arm, reanimated head that babbles madness (or) schizophrenic AI skull.
97. Slum-Knight, length of pipe with crossguard, corrugated steel armour
98. Anarchic Bomb-Thrower, 2 grenades, get-away mule robed in a punk caparison.
99. Weapons Maintenance Congregant, large vat of atramental lubricant, ballistic-weave NBC suit and sackcloth gasmask.  
100. Underworked Punk, roll two careers, this is your parent's stuff that you’ve borrowed.

Meta-Narcotics - Experimental Rules for Extra-Diegetic Drugs in RPGs

Psychoactive drugs alter mental states. The players themselves represent their character’s minds, so logically, drugs must alter the behaviour of the players. 

This is achieved by getting very meta, player-facing, extra-diegetic or even paratextual with the effects and mechanics of the drugs - certainly one of those terms is accurate. In affecting the player in this way we are in essence altering the mind of the player-character in the fiction - creating an effect on the fiction of the game by holding the player themselves to rules, strictures and behaviours that exist outside of the game world. In this post you will find some meta-effects for the three aspects of psychoactive substances most relevant to roleplaying games - what the drug's benefits are, the drug’s side effects and how the drug’s particular high is ended.

The meta-gameplay effects I have listed are far from exhaustive; expand on them, use them to add meta-elements to pre-existing drugs in your campaign world or use the effects to create entirely new and weird meta substances for your players to partake of. All effects were written with standard OSR style games in mind. At the end of this post are rules for gaining addictions and the effects of addiction on a character. Additionally and very importantly, all of these effects are standalone and can be used in any context, be it traps, spells, weird dungeon effects, a monster’s special ability, odd class features - anything.

Tonally and aesthetically, this post appears quite serious, in actuality having players affected by their character’s drug use in ways listed below can be rather humorous. These extra-gameplay effects are not well suited for online play, though I am sure one could create an online variant quite easily. Thanks to Thomas of Everythings the Meta-Magician for suggesting some effects, check out his blog and feel free to suggest more meta-effects you might think of in the comments. 

An important note, the 'you' in the following lists refers to the player acting in the real world, not their character. You (the player) must abide with the narcotic’s effects at all times. In a blurring of the lines between player and character, the player’s character is assumed to be acting strangely in obviously peculiar ways in accordance with the narcotic’s effects and the player's own odd behaviour. 

Creating a Meta-Narcotic:

Creating your own extra-diagetic drug is quite easy. First choose a method by which the high is ended, a beneficial effect and a side-effect. Lists for these effects can be found below in this post. Carefully consider how these effects might interact with each other. Once happy with the three effects, name the drug, give it an addiction rating and provide it with a in-universe description.  For example:

Name: Dodona’s Eye, 1 dram

Description:

Dodona’s Eye, a colossal liquid loop found spinning a great distance into the continent’s core. It’s precious waters once used sparingly, intravitreally imbibed by Hermitian mystics to glimpse the universe’s unseen truths, it has since been devastated by far-travelling camel-riders who caravan the oracular fluid to hedonistic princes of wealthy cities. Imbibers enter fleeting and teary-eyed trances, their bodies becoming numb and ungainly, and through bleary eyes they see strange and terrible, epiphanous dreams.         

Ending the High:

Corneal Reflex: The high ends when you blink or otherwise close your eyes.

Beneficial Effect:

Precognition. You can look at the DM's notes for an unmolested but limited amount of time.

Side Effect:

Gross-Motor Malfunctions. You can only use the fingers on your non-dominant hand (no thumbs) for the duration of the high and must limp using your non-dominant foot when walking.

Addictiveness:

Negligible

(These effects play quite well with each other. The drug will affect a player thusly - the player may look at the DM's notes for as long as they can keep their eyes open while awkwardly paging through the notes using their non-dominant hand)

Ending the High:

Rather than a drug lasting for however many units of in-game time or even a non-diegetic 'session', meta-narcotics only end when certain extra-roleplaying requirements have been fulfilled. These can result in very controlled on uncontrollable durations as well as highs of random or interminable lengths. Once a high ends, that meta-narcotic's benefits and side-effects also end. 

• Corneal Reflex: The high ends when you blink or otherwise close your eyes.
• Tussal Expulsion: When you cough, voluntarily or involuntarily.
• Exhalation: The narcotic lasts for as long as you can hold your breath. 
• Isolation: when you cannot see or hear any other real-world human being. 
• Jubilation: when you laugh.
• Exsanguination: When you put your own blood on your character sheet. 
• Immolation: When your character sheet is exposed to flame.
• Ablution: When you next go to the toilet. 
• Balneotherapy: When you next bathe or shower.
• Klazomania: When you scream or shout.
• Saccharphagy: When you eat sugar.
• Hematophagy: When you taste blood.
• Somesthetic Shock: When you pull out one of your own eyelashes or any other hair. 
• Dilution: When you eat or drink anything.
• Detoxification: When you drink a full glass of drink in one go.
• Insolation: When you are directly exposed to the sun's rays. Not through a window. 
• Perspiration: When you have sweat on your brow. 
• Medication: When you next swallow a pill or otherwise take medicine. 
• Meditative Retreat: You must play as a different character for a session. 
• Precisely Timed Dosage: The high ends at the turn of the next real-world hour. For example, if you make your character take the drug at 10.35 (your time) the drug will affect you for 25 minutes, wearing off precisely at 11.00. The length of time that passes for your character is irrelevant. 
• Number Fixation: You must keep a running total of all your rolls, recording each die roll on your character sheet. When your total reaches a set number the drug wears off. 20-30 times the total of the game system's standard die is recommended, so a total of 400-600 for a d20 system is needed to end the high. 
• Brain Imps: DM writes the name of a reasonably standard monster (such as a creature from the monster manual or a very common monster from the campaign) and keeps it a secret from you but shows the note to all other players. You must guess the creature for the drug to wear off. You can only ask yes or no questions. 
• Focus: When you build a dice tower using all 7 polyhedral dice. 
• Somnolence: When you sleep.

Beneficial Effects:

Why take the drug? Effects guaranteed to be more interesting than +2 strength, -2 wisdom.   

• Precognition: You can look at the DM's notes for an unmolested but limited amount of time or at any point as long as the DM cannot see you doing so. 
• Physical Previsualisation: If you the player perform a comparable act to the one your character is about to perform gain a +4 to that roll. IE jump a distance if you character is about to leap a chasm, lift a heavy object when your character is about to do the same, sufficiently strike a living thing with an implement when your character is about to make an attack, etc.
• Healing Enzymes: Lick your character sheet to heal your character, 1 hp for a little lick, d4 if licking from top to bottom. This works on other's characters sheets (if everyone is ok with that).
• Psycho-Survival Instinct: Avoid character death by ripping your character sheet in half at the moment the DM pronounces your character's death. You have to repair your character sheet manually and your character is out of action until the sheet is repaired. 
• Oracular Superego Scarring: Rip off piece of your character sheet write a question on it, pass the piece to DM. The DM will write an accurate answer on the same piece of character sheet you asked the question on. The bigger the piece the longer/more legible the answer. The DM will not discuss or clarify anything about what they have written.
• Hyperphagic Delectation: heal 1 HP for each and every food item that you consume in real life, so a whole apple, an entire packet of crisps.
• Machine-Elf Communication: DM will send you cryptic messages about the campaign via GIFs, songs and pre-existing memes via your phone or computer. The DM can do this for as long as the drug is in effect, even and especially outside of session time. You cannot directly reference the character or form of these strange messages but can vaguely describe them to your fellow players.
• Confidence Instability: Build a dice tower using a standard set of 7 polyhedral dice, the height of the dice tower +12 is your new armour class. If the tower falls your AC collapses to 5. If your character takes damage the DM knocks your tower over. 
• En Bloc Blackout: Your character can gain experience from sessions you don't attend. Your character will suffer from each and every misfortune and depredation possible in that given session, such as mutating if there is a pool of mutagenic sludge. The DM decides whether to run your PC as a stuporous NPC or just to keep them in the background. The other players should be encouraged to suggest things that could happen but your PC cannot die. 
• Joviality: DM has to get you a beer or a bar of chocolate.
• Psychedelic Mind Tunnel: This effect works on two or more people that take the same batch of drug at the same time, including NPCs. You and your fellow imbibers can send messages to each other's characters (regardless of where the characters are in the game world) if both players completely crawl under the gaming table to talk. If talking to an NPC both you and the DM must crawl under the table.
• Emotional Vampirism*: You must complete an act of emotional-vampiric feeding to gain a +1 to all rolls. The DM selects one of the following feeding behaviours and tells it to you in secret. Once the mission is complete, you will gain your +1 to rolls and the DM will pick another feeding behaviour for you to complete and so on until the high ends. The +1's are cumulative. Here are 20 example feeding behaviours:   
• 1. Make another player yawn.
• 2. Get a player tell you about a dream they had.
• 3. Get another player hit you (playfully or not)
• 4. Have a player insult you.
• 5. Have a player compliment you.
• 6. Make another player groan.
• 7. Have a player ask you if you are crying. 
• 8. Get a specific player to give you 3 high fives. 
• 9. Have a player tell you a joke.
• 10. Purposefully get a quote wrong and have a player correct you. 
• 11. Get a player to finish one of your sentences.  
• 12. Get a player to argue about which way north is.  
• 13. Pretend you have something in your eye and get another player to check. 
• 14. Get a player to attempt to touch their nose with their tongue. 
• 15. Balance several items and have a player knock them over. 
• 16. Make up and repeatedly use a word until a player asks you what it means.  
• 17. Have a player take a selfie with you. they must use their own phone. 
• 18. Pretend to be too weak to perform a everyday task and have another player do it for you.
• 19. Try to get another player to chant something with you. 
• 20. Make up a wild-sounding rule and have another player check the rulebook for it.  
• Distracted Mood Swings: Find a competitive sports match either online or on a television. Preferably taking place concurrently to your gaming sessions. If none can be found the DM will find a random pre-recorded match. You must pick a team/player. Whenever your player/team scores a point/goal/touchdown/strike you gain 50xp and can instantly succeed in any one die roll. If the match concludes before the end of your trip find another competitive sport, whenever the opposing team score lose 50xp. The DM can disallow any sport if it is unsuitable for this extra-gameplay effect.

Side Effects:

All drugs have adverse or inconvenient effects. How do this drug's side-effects manifest? Player's must be wary of their chosen drug’s side-effects, failure to follow them may result in a Psychological Break, the rules for which follow this section of the post.    

• Auditory Hallucinations: You must continue playing with ear or headphones on that are playing sounds/music of the DM's choosing at a comfortable volume. 
• Confusion: Your vision is obscured by the DM, such as having a thin scarf veiled over your eyes.
• Brain-Needling: You must poke a hole in your character sheet for each hit point your character loses.
• Paranoia: You cannot talk to anyone outside of your gaming group during session time. This effect works better if you play in public or semi-public places.
• Yes-Man Syndrome: You must agree with (but not necessarily do) whatever anyone says or asks of you. You cannot suggest alternative ideas or other courses of action.  
• Oppositional Defiance Disorder: You must disagree with whatever anyone says or asks of you. You can only be obstinate and must suggest alternative ideas or other courses of action, even after others may have agreed with a plan you might have suggested. 
• Autophobia: You cannot look directly at your character sheet. It can only be looked at via some medium such as the camera of your phone, a mirror or through the glass of your drink. 
• Gross-Motor Malfunctions: You can only use the fingers on your non-dominant hand (no thumbs) for the duration of the drug and must limp using your non-dominant foot when walking. 
• Nervous Creative Energy: You must be constantly drawing and doodling, your pen or pencil must never leave the paper or stop mark-making. 
• Infantilism. Must play under the table or otherwise on the floor.  
• Depersonalisation: You must leave the room and can only continue play via speaker-phone or by talking loudly. Other players must perform that player’s dice rolls and keep note of changes to their character sheet, ie HP. 
• Heightened Proprioception: You must adopt the general stance of your character. If your character is knocked prone, you must lay down, when the character is standing or crouching the player must do the same. 
• Autocannibalism: Rip off little bits of your character sheet before announcing what your character does or says. 
• Arithmomania: You must pick a number between 1-6, whenever you, the player, see this number all can can do is sit saying the number over and over again until another player removes the number for you. Try not to pick a number on your character sheet, if you pick 1 the 1 in 16 does not count toward your paralysis.
• Histrionic Personality Disorder: You must be the first to answer any question the DM asks.
• Nervous Tic: You must lightly slap your cheek or your head as many times as the number of sides of the dice you are about to roll - d8 = eight slaps. You must slap yourself the correct number of times before every dice roll. A d100 might be too much of a strain for you.
• Obsessive compulsive: You must tap your knuckles on the table as many times as the number of sides of the dice you are about to roll - d10 = 10 slaps. You must slap yourself the correct number of times before every dice roll.
• Hemophobic Hand Washing: You must wash your hands after every combat encounter. 
• Diffidence: You can only talk by whispering into your fellow player's ears. 

Psychological Breaks:

When a narcotic is taken by a player explain the effects of the drug, having the player write the details of the drug on a separate piece of paper. Explain that this piece of paper is used to represent the player character's mental state or brain. Whenever they, the player, break one of the drug's meta-rules or side-effects, tear a rip into the paper. For example, when a Paranoid player talks to someone outside of the group, they will have to add a rip their character's brain. When the paper has been ripped three times a mental break or freak-out occurs and the player’s character loses a level as if level-drained. This penalty is serious and must be for the drug-user, DM and fellow players to willingly follow along with the drug’s effects. 

Meta-Addiction Test

Each type of drug has a different capacity for addictiveness. In keeping with the meta nature of these rules, we won't be making a saving throw to test against addiction but an actual throw. The DM will ask the player to toss a coin into or onto a designated thing from a specific distance. The size of the target and the thrower's distance from said target is determined by the DM based on the drug's addiction rating. Upon being asked to make the throw, the player can make arguments for or against their character's resilience to addiction - high constitution score, good saves, backstory, racial factors such as poison resistance, class abilities, etc. Ultimately the DM decides whether these arguments affect any particular effect on the test - allowing the thrower to move closer, give multiple throws, substituting the target or even the thrower. If the throw is a success, the character has avoided addiction - if the coin misses, the character has become addicted. The same mechanic is used to test for breaking an addiction once a character has become addicted.    

Effects of Addiction:

While addicted to a substance, characters cannot access the experience points that they accumulate while adventuring and they can only ‘unlock’ those points to level up by taking the drug to which they are addicted. Once the character has built up a backlog of XP large enough to level up, they cease accumulating XP until unblock those addiction-trapped points and actually level up. You need to take as many doses of the drug as the level you are trying to attain, these doses do not need to be taken in one go. 

*Most of the Emotional Vampirism feeding behaviours come from the party game Don't Get Got

This concept started life a very long time ago, inspired by James Young's Cleric Rework and was originally going to be about mechanizing different forms of madness. Meta and extra-gameplay features in ttrpgs appeal to me at the moment and may yet provide some more ideas of  reasonable interest. The effects and ideas in this post could be applied to many, many different things. *EDIT* such as Disease.