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Bahji A, Crockford D, Brasch J, Schutz C, Buckley L, Danilewitz M, Dubreucq S, Mak M, George TP. Training in Substance use Disorders, Part 1: Overview of Clinical Practice Recommendations. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:428-456. [PMID: 38613369 PMCID: PMC11107443 DOI: 10.1177/07067437241231128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Affiliation(s)
- Anees Bahji
- Clinical Assistant Professor, Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - David Crockford
- Clinical Professor, University of Calgary, Cumming School of Medicine, Department of Psychiatry, Calgary, AB, Canada; Hotchkiss Brain Institute & Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, AB, Canada
| | - Jennifer Brasch
- Associate Professor, Department of Psychiatry & Behavioural Neurosciences, Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada; Lead, Addiction Psychiatry, St. Joseph's Healthcare, Hamilton, ON, Canada; Past-President, Canadian Society of Addiction Medicine, Calgary, AB, Canada
| | - Christian Schutz
- Professor, Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; Research Lead Adult Mental Health and Substance Use, Provincial Health Service Authority, Vancouver, BC, Canada
| | - Leslie Buckley
- Associate Professor, Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Marlon Danilewitz
- Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Associate Medical Director, General Psychiatry, Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada
| | - Simon Dubreucq
- Psychiatrist, Department of Addiction Medicine, CHUM, Montreal, QC, Canada; Assistant Professor, Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
| | - Michael Mak
- Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Adjunct Assistant Professor, Department of Medicine, McMaster University, Hamilton, ON, Canada; Adjunct Research Professor, Department of Psychiatry, Western University, London, ON, Canada
| | - Tony P George
- Professor, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Viña SM. Religion, Psychedelics, Risky Behavior, and Violence. J Psychoactive Drugs 2024:1-12. [PMID: 38660976 DOI: 10.1080/02791072.2024.2346132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/20/2024] [Indexed: 04/26/2024]
Abstract
Research has found that psychedelic use is associated with positive behavioral changes, however research has yet to explore the relationship between socio-cultural conditions on this relationship. This paper intends to fill this gap by testing the effects of religious participation and beliefs on the relationship between psychedelic use and behaviors. This study examines the relationship between Lifetime Classic Psychedelic Use (LCPU), different aspects of religion (such as salience and attendance), and the likelihood of committing a violent assault. The analysis uses pooled data from the National Survey of Drug Use and Health (NSDUH) from 2015 to 2019, with a sample size of 282,768. Binary logistic regression models conducted in Stata 17 reveal that LCPU and religion (salience and influence) are independently associated with reduced violence. Additionally, two-way interactions indicate that the association between risky behavior and violence is smaller among individuals with high levels of religious salience. Furthermore, a three-way interaction suggests that the association between risky behavior and violence is smaller for those who have used psychedelics, with the largest effect observed among individuals with high religious salience. These results show that religious factors can influence the relationship between psychedelic use and behaviors, with both attendance and salience operating simultaneously.
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Affiliation(s)
- Sean M Viña
- The University of the Incarnate Word, Department of Sociology, San Antonio, Texas, USA
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Tap SC. The potential of 5-methoxy-N,N-dimethyltryptamine in the treatment of alcohol use disorder: A first look at therapeutic mechanisms of action. Addict Biol 2024; 29:e13386. [PMID: 38600715 PMCID: PMC11007263 DOI: 10.1111/adb.13386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/24/2023] [Accepted: 02/13/2024] [Indexed: 04/12/2024]
Abstract
Alcohol use disorder (AUD) remains one of the most prevalent psychiatric disorders worldwide with high economic costs. Current treatment options show modest efficacy and relapse rates are high. Furthermore, there are increases in the treatment gap and few new medications have been approved in the past 20 years. Recently, psychedelic-assisted therapy with psilocybin and lysergic acid diethylamide has garnered significant attention in the treatment of AUD. Yet, they require significant amounts of therapist input due to prolonged subjective effects (~4-12 h) leading to high costs and impeding implementation. Accordingly, there is an increasing interest in the rapid and short-acting psychedelic 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT). This paper offers a first look at potential therapeutic mechanisms for AUD by reviewing the current literature on 5-MeO-DMT. Primarily, 5-MeO-DMT is able to induce mystical experiences and ego-dissolution together with increases in psychological flexibility and mindfulness. This could decrease AUD symptoms through the alleviation of psychiatric mood-related comorbidities consistent with the negative reinforcement and self-medication paradigms. In addition, preliminary evidence indicates that 5-MeO-DMT modulates neural oscillations that might subserve ego-dissolution (increases in gamma), psychological flexibility and mindfulness (increases in theta), and the reorganization of executive control networks (increases in coherence across frequencies) that could improve emotion regulation and inhibition. Finally, animal studies show that 5-MeO-DMT is characterized by neuroplasticity, anti-inflammation, 5-HT2A receptor agonism, and downregulation of metabotropic glutamate receptor 5 with clinical implications for AUD and psychiatric mood-related comorbidities. The paper concludes with several recommendations for future research to establish the purported therapeutic mechanisms of action.
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Affiliation(s)
- Stephan C. Tap
- Department of PsychiatryGroningen University Medical CenterGroningenThe Netherlands
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Viña SM. Diminished psychedelic returns on distress: Marital status and household size. PLoS One 2024; 19:e0293675. [PMID: 38451885 PMCID: PMC10919602 DOI: 10.1371/journal.pone.0293675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 10/18/2023] [Indexed: 03/09/2024] Open
Abstract
Although the use of psychedelics to impact health has seen growth, little research has tested the effects of culture conditions on the relationship. More specifically, how does marital status and family size affect the relationship between psychedelics and health? This study tests the relationship between Lifetime Classic Psychedelic Use (LCPU), marital status, and household size (number of people living in a household) on levels of psychological distress in the past 30 days. This project uses pooled data from the National Survey of Drug Use and Health (NSDUH) (2010 to 2018) (N = 674,521). The Final sample size is determined by the dependent variable, psychological distress in the past month (n = 158,633). The analysis includes a series of nested logistic regression models conducted in Stata 17. Results indicate that LCPU is independently associated with better health, but the association between LCPU and health varies across levels of household size. Larger households are associated with higher levels of distress, which are then exacerbated among psychedelics users. Furthermore, three-way interactions reveal that the negative association between household size and distress gets larger among psychedelic users who are married, divorced, and widowed. Overall, results suggest that household size negatively impacts the association between LCPU and health, with those who are married, divorced, and widowed experiencing the worst outcomes.
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Affiliation(s)
- Sean M. Viña
- Department of Sociology, The University of the Incarnate Word, San Antonio, Texas, United States of America
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Yaden DB, Berghella AP, Hendricks PS, Yaden ME, Levine M, Rohde JS, Nayak S, Johnson MW, Garcia-Romeu A. IUPHAR-review: The integration of classic psychedelics into current substance use disorder treatment models. Pharmacol Res 2024; 199:106998. [PMID: 38029805 DOI: 10.1016/j.phrs.2023.106998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 12/01/2023]
Abstract
Substance use disorders (SUDs) have an enormous impact on public health. With classic psychedelic-assisted therapies showing initial promise in treating multiple SUDs, it is possible that these treatments will become legally available options for patients with SUDs in the future. This article highlights how classic psychedelic-assisted therapies might be integrated into current clinical practice. We first describe contemporary evidence-based treatments for SUDs and highlight how classic psychedelic-assisted therapies might fit within each treatment. We suggest that classic psychedelic-assisted therapies can be integrated into most mainstream evidence-based SUD treatments that are currently used in clinical settings, indicating broad compatibility of classic psychedelics with contemporary SUD treatment paradigms.
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Affiliation(s)
- David B Yaden
- Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA.
| | - Andrea P Berghella
- Thomas Jefferson University MD/PhD Program, Sidney Kimmel Medical College and Jefferson College of Life Sciences, Philadelphia, USA
| | - Peter S Hendricks
- School of Public Health, The University of Alabama at Birmingham, Birmingham, USA
| | - Mary E Yaden
- Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Michael Levine
- Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Julia S Rohde
- Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Sandeep Nayak
- Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Matthew W Johnson
- Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Albert Garcia-Romeu
- Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
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Thal SB, Baker P, Marinis J, Wieberneit M, Sharbanee JM, Bruno R, Skeffington PM, Bright SJ. Therapeutic frameworks in integration sessions in substance-assisted psychotherapy: A systematised review. Clin Psychol Psychother 2023. [PMID: 38148518 DOI: 10.1002/cpp.2945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/07/2023] [Accepted: 11/24/2023] [Indexed: 12/28/2023]
Abstract
Serotonergic psychedelics and related substances have been explored as potential adjuncts in substance-assisted psychotherapy (SAPT) for treating various disorders. SAPT can be divided into three phases: preparation, administration and integration. Integration is commonly defined as the comprehension and effective application of insights from psychedelic experiences into everyday life. However, there is limited research regarding the most appropriate therapeutic approach during SAPT. In this article, we discuss the current evidence for different therapeutic frameworks for integration sessions when serotonergic psychedelics and entactogens are used as adjuncts to psychotherapy. We conducted a systematised review of the literature following PRISMA guidelines and searched PsycINFO, MEDLINE and Cochrane Library databases. The final synthesis included 75 clinical trials, mixed-methods investigations, treatment manuals, study protocols, quasi-experiments, qualitative investigations, descriptive studies, opinion papers, reviews, books and book chapters, published until 11 November 2022. The effects that various therapeutic approaches for integration sessions have on therapeutic outcomes have not been investigated by means of rigorous research. Most of the available evidence we retrieved was not supported by empirical data, thus limiting any conclusive statements regarding appropriate therapeutic frameworks for integration sessions for SAPT. Current clinical studies have used a range of therapeutic frameworks with the majority drawing from the humanistic-experiential tradition. While integration is regarded as crucial for the safe application of SAPT, there is currently an insufficient evidence base to suggest that any type of therapy is effective for guiding integration sessions. A systematic investigation of different therapeutic frameworks for integration and additional therapy-related factors is needed.
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Affiliation(s)
- Sascha B Thal
- Curtin School of Population Health, Curtin University, Bentley, Western Australia, Australia
- School of Psychology, College of Health & Education, Murdoch University, Murdoch, Western Australia, Australia
| | - Paris Baker
- School of Medicine (Psychology), University of Tasmania, Hobart, Tasmania, Australia
| | - Jonathon Marinis
- Orygen Youth Health, University of Melbourne, Parkville, Victoria, Australia
| | - Michelle Wieberneit
- Law School, University of Western Australia, Crawley, Western Australia, Australia
| | - Jason M Sharbanee
- Enable Institute, Discipline of Psychology, Curtin School of Population Health, Curtin University, Bentley, Western Australia, Australia
| | - Raimundo Bruno
- School of Medicine (Psychology), University of Tasmania, Hobart, Tasmania, Australia
| | - Petra M Skeffington
- School of Psychology, College of Health & Education, Murdoch University, Murdoch, Western Australia, Australia
| | - Stephen J Bright
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Psychedelic Research in Science and Medicine (PRISM), Balwyn North, Victoria, Australia
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Viña SM, Stephens AL. Psychedelics and workplace harm. Front Psychiatry 2023; 14:1186541. [PMID: 37398579 PMCID: PMC10311554 DOI: 10.3389/fpsyt.2023.1186541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/23/2023] [Indexed: 07/04/2023] Open
Abstract
This study aims to understand the relationship between Lifetime Classic Psychedelic Use (LCPU), employment status, and weekly work hours on levels of psychological distress. The data used for this analysis is pooled from the National Survey of Drug Use and Health (NSDUH) from 2008-2019 and includes a sample size of 484,732 individuals. The findings suggest that LCPU and being employed are independently associated with better health. Additionally, the results indicate that psychedelic use is associated with lower distress for those who are employed, volunteer, retired, or permanently disabled. However, those who are unemployed, full-time students, or homemakers may experience higher levels of distress with psychedelic use. Interestingly, the analysis also suggests that those who use psychedelics are working longer hours per week before experiencing an increase in stress. Overall, the study suggests that psychedelics are not likely to have a negative impact on employment outcomes.
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Heinsbroek JA, Giannotti G, Bonilla J, Olson DE, Peters J. Tabernanthalog Reduces Motivation for Heroin and Alcohol in a Polydrug Use Model. PSYCHEDELIC MEDICINE (NEW ROCHELLE, N.Y.) 2023; 1:111-119. [PMID: 37360328 PMCID: PMC10286262 DOI: 10.1089/psymed.2023.0009] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Background The potential use of psychedelic drugs as therapeutics for neuropsychiatric disorders has been limited by their hallucinogenic properties. To overcome this limitation, we developed and characterized tabernanthalog (TBG), a novel analogue of the indole alkaloids ibogaine and 5-methoxy-N,N-dimethyltryptamine with reduced cardiac arrhythmogenic risk and a lack of classical psychedelic drugs-induced sensory alterations. We previously demonstrated that TBG has therapeutic efficacy in a preclinical model of opioid use disorder (OUD) in rats and in a binge model of alcohol drinking in mice. Alcohol is commonly co-used in ∼35-50% of individuals with OUD, and yet, preclinical models that recapitulate this comorbidity are lacking. Methodology Here we employed a polydrug model of heroin and alcohol couse to screen the therapeutic efficacy of TBG on metrics of both opioid and alcohol seeking. We first exposed rats to alcohol (or control sucrose-fade solution) in the home-cage (HC), using a two-bottle binge protocol, over a period of 1 month. Rats were then split into two groups that underwent self-administration training for either intravenous heroin or oral alcohol, so that we could assess the impact of HC alcohol exposure on the self-administration of each substance separately. Thereafter, rats began self-administering both heroin and alcohol in the same sessions. Finally, we tested the effects of TBG on break points for heroin and alcohol in a progressive ratio test, where the number of lever presses required to obtain a single reward increased exponentially. Results and Conclusion TBG effectively reduced motivation for heroin and alcohol in this test, indicating its efficacy is preserved in animals with a history of heroin and alcohol polydrug use.
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Affiliation(s)
- Jasper A Heinsbroek
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Giuseppe Giannotti
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Integrative Physiology and Neuroscience, Washington State University, Pullman, Washington, USA
| | - Joel Bonilla
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - David E Olson
- Department of Chemistry, University of California, Davis, Davis, California, USA
- Department of Biochemistry and Molecular Medicine, School of Medicine, University of California, Davis, Sacramento, California, USA
- Center for Neuroscience, University of California, Davis, Davis, California, USA
- Institute for Psychedelics and Neurotherapeutics, University of California, Davis, Davis, California, USA
| | - Jamie Peters
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Pharmacology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Dawood Hristova JJ, Pérez-Jover V. Psychotherapy with Psilocybin for Depression: Systematic Review. Behav Sci (Basel) 2023; 13:bs13040297. [PMID: 37102811 PMCID: PMC10135952 DOI: 10.3390/bs13040297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/22/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
Depression is a common mental health issue that affects 280 million people in the world with a high mortality rate, as well as being a leading cause of disability. Psychopharmacological therapies with psychedelics, particularly those with psilocybin, are showing promising potential for the treatment of depression, among other conditions. Some of their benefits include a rapid and exponential improvement in depressive symptoms and an increased sense of well-being that can last for months after the treatment, as well as a greater development of introspective capacity. The aim of this project was to provide experimental evidence about therapeutic procedures along with psilocybin for the treatment of major depressive disorder. The project highlights eight studies that examined this condition. Some of them dealt with treatment-resistant depression while others dealt with depression due to a life-threatening disease such as cancer. These publications affirm the efficiency of the psilocybin therapy for depression, with only one or two doses in conjunction with psychological support during the process.
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Brett J, Knock E, Korthuis PT, Liknaitzky P, Murnane KS, Nicholas CR, Patterson JC, Stauffer CS. Exploring psilocybin-assisted psychotherapy in the treatment of methamphetamine use disorder. Front Psychiatry 2023; 14:1123424. [PMID: 36998623 PMCID: PMC10043240 DOI: 10.3389/fpsyt.2023.1123424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
Methamphetamine use disorder is a chronic relapsing condition associated with substantial mental, physical, and social harms and increasing rates of mortality. Contingency management and psychotherapy interventions are the mainstays of treatment but are modestly effective with high relapse rates, while pharmacological treatments have shown little to no efficacy. Psilocybin-assisted psychotherapy is emerging as a promising treatment for a range of difficult-to-treat conditions, including substance use disorders; however, no studies have yet been published looking at psilocybin-assisted psychotherapy in the treatment of methamphetamine use disorder. Here we review the rationale for psilocybin-assisted psychotherapy as a potential treatment for this indication, and describe practical considerations based on our early experience designing and implementing four separate clinical trials of psilocybin-assisted psychotherapy for methamphetamine use disorder.
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Affiliation(s)
- Jonathan Brett
- Department of Clinical Pharmacology, St. Vincent’s Hospital, Sydney, NSW, Australia
- School of Population Health, Medicines Intelligence Centre of Research Excellence, University of New South Wales, Sydney, NSW, Australia
| | - Elizabeth Knock
- Alcohol and Drug Service, St. Vincent’s Hospital, Sydney, NSW, Australia
| | - P. Todd Korthuis
- Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Paul Liknaitzky
- Department of Psychiatry, School of Clinical Sciences, Monash University, Caulfield, VIC, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Caulfield, VIC, Australia
| | - Kevin S. Murnane
- Louisiana Addiction Research Center, Department of Pharmacology, Toxicology & Neuroscience, Shreveport, LA, United States
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health, Shreveport, LA, United States
| | - Christopher R. Nicholas
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, WI, United States
| | - James C. Patterson
- Louisiana Addiction Research Center, Department of Pharmacology, Toxicology & Neuroscience, Shreveport, LA, United States
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health, Shreveport, LA, United States
| | - Christopher S. Stauffer
- Department of Mental Health, Veterans Affairs Portland Health Care System, Portland, OR, United States
- Social Neuroscience and Psychotherapy Lab, Department of Psychiatry, Oregon Health and Science University, Portland, OR, United States
- *Correspondence: Christopher S. Stauffer,
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Pedicini M, Cordner ZA. Utility of preclinical models in the study of psilocybin - A comprehensive review. Neurosci Biobehav Rev 2023; 146:105046. [PMID: 36646257 DOI: 10.1016/j.neubiorev.2023.105046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/06/2023] [Accepted: 01/12/2023] [Indexed: 01/15/2023]
Abstract
Interest in the therapeutic potential of psilocybin across a broad range of neuropsychiatric disorders is rapidly expanding. Despite promising clinical data and tremendous public enthusiasm, complimentary basic and translational studies - which are critical for advancing our understanding of psilocybin's biological effects and promoting innovation - have been relatively few. As with all work involving the study of complex neuropsychopharmacology, the search for deeper understanding of biological mechanisms, and the need for nuanced behavioral analyses in the context of both normal and diseased states, the roles for preclinical models are clear. A systematic search of the literature identified 57 articles involving the study of psilocybin in preclinical rodent models. A comprehensive review and thematic analysis identified 4 broad areas of investigation - pharmacology, toxicity, effects on disease models, and molecular mechanisms - with pharmacology studies accounting for the majority. Though these papers represent a still remarkably small body of literature, several important conclusions can already be drawn, and several areas of high priority for future work can be identified.
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Affiliation(s)
- Megan Pedicini
- The Johns Hopkins University School of Medicine, Department of Psychiatry & Behavioral Sciences, Baltimore, MD 21287, USA.
| | - Zachary A Cordner
- The Johns Hopkins University School of Medicine, Department of Psychiatry & Behavioral Sciences, Baltimore, MD 21287, USA.
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12
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Stauffer CS, Brown MR, Adams D, Cassity M, Sevelius J. MDMA-assisted psychotherapy; Inclusion of transgender and gender diverse people in the frontiers of PTSD treatment trials. Front Psychiatry 2022; 13:932605. [PMID: 36299539 PMCID: PMC9589439 DOI: 10.3389/fpsyt.2022.932605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Transgender and gender diverse (TGD) people experience stigma, discrimination, trauma, and post-traumatic stress disorder (PTSD) at higher rates compared to the general population; however, TGD people have been underrepresented in PTSD research. Clinical trials of 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy demonstrate promising safety and efficacy for the treatment of PTSD. Issues related to equitable access, power imbalances in the therapeutic relationship, and vulnerable states of consciousness occasioned by MDMA are magnified when working with people affected by structural vulnerabilities and health disparities, and community engagement in research planning and implementation is essential. To inform the inclusion and safety of TGD people in future MDMA-assisted psychotherapy research, the aims of the current study were to: characterize TGD experiences with trauma-related mental health care, assess openness of TGD people to participate in experimental PTSD research, and to gather specific feedback on protocol design for conducting MDMA-assisted psychotherapy with TGD people. Materials and methods We conducted three virtual focus group discussions (FGDs) with 5-6 participants each (N = 17). Eligible TGD participants had a history of receiving trauma-related mental health care. Each FGD was facilitated by two licensed clinicians who identified as TGD. Qualitative data analysis was conducted via an iterative process of identification of recurrent patterns and themes. Results We have identified several key issues TGD people face when seeking and engaging in trauma-related mental health care, including barriers to receiving adequate gender-affirming and trauma-informed mental health care and frustration with providers lacking cultural humility. Suggested amendments to MDMA-assisted psychotherapy protocols include: routine collection of trans-inclusive gender identity data, implementing an explicit gender-affirming treatment approach, ensuring a culturally safe setting, and diversifying co-therapy dyads. Discussion The inclusion of TGD voices in early conversations about emerging experimental PTSD interventions promotes equitable access, in the context of health and healthcare disparities, and helps researchers understand the needs of the community and tailor research to meet those needs. Through an ongoing conversation with the TGD community, we aim to incorporate a gender-affirming approach into existing research protocols and inform future applications of MDMA-assisted psychotherapy in addressing the effects of minority stress and boosting resilience.
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Affiliation(s)
- Christopher S Stauffer
- Social Neuroscience and Psychotherapy Lab, Oregon Health and Science Institute, Department of Psychiatry, Portland, OR, United States
- Portland VA Health Care System, Department of Mental Health, Portland, OR, United States
| | - Melanie R Brown
- School of Public Health, Oregon Health and Science University-Portland State University, Portland, OR, United States
| | - Dee Adams
- Center for Public Health and Human Rights, Department of Epidemiology, John Hopkins University, Baltimore, MD, United States
| | - Marca Cassity
- Social Neuroscience and Psychotherapy Lab, Oregon Health and Science Institute, Department of Psychiatry, Portland, OR, United States
- Portland VA Health Care System, Department of Mental Health, Portland, OR, United States
| | - Jae Sevelius
- Center of Excellence for Transgender Health, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
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13
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Bergeria CL, Strain EC. Opioid Use Disorder: Pernicious and Persistent. Am J Psychiatry 2022; 179:708-714. [PMID: 36181330 DOI: 10.1176/appi.ajp.20220699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Cecilia L Bergeria
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore
| | - Eric C Strain
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore
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14
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Barnett BS, Weleff J. Psychedelics in the Treatment of Substance Use Disorders. Psychiatr Ann 2022. [DOI: 10.3928/00485713-20220804-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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15
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Frymann T, Whitney S, Yaden DB, Lipson J. The Psychedelic Integration Scales: Tools for Measuring Psychedelic Integration Behaviors and Experiences. Front Psychol 2022; 13:863247. [PMID: 35677137 PMCID: PMC9168432 DOI: 10.3389/fpsyg.2022.863247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/04/2022] [Indexed: 11/23/2022] Open
Abstract
In this study, we describe the development and initial validation of two psychometric scales for measuring psychedelic integration. Psychedelic integration refers to the post-acute period of time following psychedelic drug administration. We created the Integration Engagement Scale (IES) to capture positive behavioral engagement with integration and the Experienced Integration Scale (EIS) to capture internal aspects of feeling integrated. These scales were developed to measure post-acute psychedelic administration dynamics in order to inform the creation of enhanced integration support and to help refine a general conceptual understanding of the construct of psychedelic integration. The scales are brief and face valid instruments designed for practical use in applied and research settings. Scale items were generated and refined using the Iterative Process Model of scale development, with input from psychedelics experts and clinicians. Content validity, internal structure, and reliability were assessed via expert surveys, content validity analysis, cognitive interviewing, convergent validity analysis, exploratory factor analysis, and confirmatory factor analysis. The data indicates the scales are valid and reliable measurements of the behavioral and experiential forms of Psychedelic Integration.
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Affiliation(s)
- Tomas Frymann
- Psychology and Spirituality Lab, Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, United States
| | - Sophie Whitney
- Depth and Clinical Psychology, Pacifica Graduate University, Carpinteria, CA, United States
| | - David B Yaden
- Department of Psychiatry and Behavioral Sciences, Center for Psychedelic and Consciousness Research, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Joshua Lipson
- Psychology and Spirituality Lab, Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, United States
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Yaden DB, Earp D, Graziosi M, Friedman-Wheeler D, Luoma JB, Johnson MW. Psychedelics and Psychotherapy: Cognitive-Behavioral Approaches as Default. Front Psychol 2022; 13:873279. [PMID: 35677124 PMCID: PMC9169963 DOI: 10.3389/fpsyg.2022.873279] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
The acute subjective effects of psychedelics are responsive to users' expectations and surroundings (i.e., "set and setting"). Accordingly, a great deal of thought has gone into designing the psychosocial context of psychedelic administration in clinical settings. But what theoretical paradigms inform these considerations about set and setting? Here, we describe several historical, sociological influences on current psychedelic administration in mainstream European and American clinical research settings, including: indigenous practices, new age spirituality from the 1960s, psychodynamic/psychoanalytic approaches, and cognitive-behavioral approaches. We consider each of these paradigms and determine that cognitive-behavioral therapies, including newer branches such as acceptance and commitment therapy (ACT), have the strongest rationale for psychedelic-assisted psychotherapy going forward. Our primary reasons for advocating for cognitive-behavioral approaches include, (1) they avoid issues of cultural insensitivity, (2) they make minimal speculative assumptions about the nature of the mind and reality, (3) they have the largest base of empirical support for their safety and effectiveness outside of psychedelic therapy. We then propose several concepts from cognitive-behavioral therapies such as CBT, DBT, and ACT that can usefully inform the preparation, session, and integration phases of psychedelic psychotherapy. Overall, while there are many sources from which psychedelic psychotherapy could draw, we argue that current gold-standard, evidence-based psychotherapeutic paradigms provide the best starting point in terms of safety and efficacy.
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Affiliation(s)
- David B. Yaden
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Dylan Earp
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Marianna Graziosi
- Department of Clinical Psychology, Hofstra University, Hempstead, NY, United States
| | - Dara Friedman-Wheeler
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jason B. Luoma
- Portland Psychotherapy Clinic, Research, and Training Center, Portland, OR, United States
| | - Matthew W. Johnson
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Henner RL, Keshavan MS, Hill KP. Review of potential psychedelic treatments for PTSD. J Neurol Sci 2022; 439:120302. [DOI: 10.1016/j.jns.2022.120302] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 04/27/2022] [Accepted: 05/24/2022] [Indexed: 12/20/2022]
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Kang M, Mackay L, Christie D, Callon C, Argento E. Can psychedelic-assisted psychotherapy play a role in enhancing motivation to change in addiction treatment settings? JOURNAL OF PSYCHEDELIC STUDIES 2022. [DOI: 10.1556/2054.2022.00190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract
Despite growing availability of several evidence-based approaches in the treatment of substance use disorders, existing pharmacotherapy and psychosocial interventions continue to have significant limitations, such as low treatment retention rates and high rates of relapse. There is a need to develop new strategies and models to address these limitations and target underlying psychosocial drivers of addiction, such as motivation to change – a crucial factor in achieving positive addiction treatment outcomes. Re-emerging clinical evidence and literature signal the promise of psychedelic-assisted psychotherapies as being novel, adjunctive treatments for a range of mental health and substance use disorders, encouraging further research. However, there remains a lack of formally validated metrics to evaluate recovery capital and motivation, limiting interpretation of the growing psychedelic literature. This commentary describes the current state of this line of investigation and potential impact of psychedelic-assisted psychotherapy on enhancing motivation to change in addiction treatment, and the need for validated metrics to evaluate recovery motivation and capital to assess the potential for psychedelic-assisted psychotherapies to elicit positive, lasting changes in substance use behaviors among those seeking treatment.
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Affiliation(s)
- Mark Kang
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Lindsay Mackay
- Department of Medicine, University of British Columbia, Vancouver, Canada
- BC Centre on Substance Use, Vancouver, Canada
| | - Devon Christie
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Cody Callon
- BC Centre on Substance Use, Vancouver, Canada
| | - Elena Argento
- Department of Medicine, University of British Columbia, Vancouver, Canada
- BC Centre on Substance Use, Vancouver, Canada
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The Potential of Psychedelics for End of Life and Palliative Care. Curr Top Behav Neurosci 2021; 56:169-184. [PMID: 34958455 DOI: 10.1007/7854_2021_278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
End of life and palliative care has improved in recent decades but the psychopharmacological options available to clinicians and patients in these contexts remain limited. In particular, psychological factors such as depression, existential distress, and well-being remain challenging to address with current medications. Here, we review recent research on the use of psychedelics in clinical settings with a particular focus on patients with life-threatening diagnoses. We propose that psychedelics may provide clinicians with an additional psychopharmacological treatment in the context of end of life and palliative care.
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