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Substance Use Disorder

Psilocybin against tobacco addiction

February 7, 2022 / Mushrooms / Psilocybin, Substance Use Disorder / By

A positive treatment perspective for one of the current most persistent and deadliest addictions comes from a psilocybin-assisted smoking cessation study carried out at the Johns Hopkins University School of Medicine in Maryland, USA [2].

The form of treatment consisted of up to three psilocybin sessions additional to cognitive behavioral therapy. Twelve out of fifteen participants (80%) succeeded in quitting their habit after this treatment for a minimum of six months [3]. Participants experienced an increased faith to effectively deal with the addiction, a heightened spiritual awareness and an uplifted state of overall well-being. An interesting finding was that, although three participants didn’t succeed in quitting, this group turned out smoking less cigarettes a day six months after the beginning of the treatment.

Because of the study design lacking a control group, it is not (yet) possible to solely ascribe the therapeutic effect of the treatment to the characteristics of psilocybin. Nevertheless, these results promise a better treatment perspective for psilocybin combined with cognitive behavioral therapy than for regular treatment options. The success rate in this study being 80%, compared to 25% to 34% when treated with buproprion or varenicline respectively [4], or compared to around 50% when treated with a combination of bupropion, nicotine replacement, and intensive cognitive behavioral therapy [5][6]. More scientific studies would be necessary in order to understand the full potential of treating smoking addiction with psilocybin or other pharmacons that have their mechanism of action on the 5-HT2A-receptor.

The idea of using psychedelics to fight addiction is nothing new. In the 50s and 60s there were a lot of research projects focusing on the therapeutic potential of these compounds. The interested reader might want to take a look at a meta-analysis by Teri Krebs (2012), which, based on six of these studies, concluded that the treatment of alcoholism using LSD seemed to be very effective.

[1] World Health Organization (2011)
[2] Johnson, Garcia-Romeu, Cosimano, & Griffiths (2014)
[3] The notion should be considered that several participants indicated to have a relapse period between the last psilocybin session and six month follow-up, but that they were able to correct it themselves and continued as non-smokers until follow-up.
[4] Gonzales et al., 2014; Jorenby et al., 2014
[5] Hall et al., 2009; Killen et al., 2008
[6] Success rates are based on 7 day point prevalence abstinence measures of smoking behavior. Gathered by self-report and urine- and breath analyzes.

References
Gonzales, D., Rennard, S. I., Nides, M., Oncken, C., Azoulay, S., Billing, C. B., … Reeves, K. R. (2014). Varenicline, an ␣ 4 ␤ 2 Nicotinic Acetylcholine Receptor Partial Agonist, vs Sustained-Release Bupropion and Placebo for Smoking Cessation, 296(1), 47–55.
Hall, S. M., Humfleet, G. L., Muñoz, R. F., et al. (2009). Extended treatment of older cigarette smokers. Addiction, 104, 1043-1052
Johnson, M. W., Garcia-Romeu, A., Cosimano, M. P., & Griffiths, R. R. (2014). Pilot study of the 5-HT2AR agonist psilocybin in the treatment of tobacco addiction. Journal of Psychopharmacology (Oxford, England), (September). doi:10.1177/0269881114548296
Jorenby, D. E., Hays, J. T., Rigotti, N. A., Azoulay, S., Watsky, E. J., Williams, K. E., … Reeves, K. R. (2014). Efficacy of Varenicline, an α4β2 Nicotinic Acetylcholine Receptor Partial Agonist, vs Placebo or Sustained-Release Bupropion for Smoking CessationA Randomized Controlled Trial. JAMA, 296, 56-63.
Killen, J. D., Fortmann, S. P., Schatzberg, A. F., et al. (2008). Extended cognitive behavior therapy for cigarette smoking cessation. Addiction, 103, 1381-1390.
Krebs, T. S., & Johansen, P.-Ø. (2012). Lysergic acid diethylamide (LSD) for alcoholism: meta-analysis of randomized controlled trials. Journal of Psychopharmacology (Oxford, England), 26(7), 994–1002. doi:10.1177/0269881112439253[/fusion_builder_column][/fusion_builder_row][/fusion_builder_container]

Pilot study of the 5-HT2AR agonist psilocybin in the treatment of tobacco addiction

September 11, 2014 / Mushrooms / Psilocybin, Papers, Psychology, Publications, Substance Use Disorder / By / , , ,

Abstract

Despite suggestive early findings on the therapeutic use of hallucinogens in the treatment of substance use disorders, rigorous follow-up has not been conducted. To determine the safety and feasibility of psilocybin as an adjunct to tobacco smoking cessation treatment we conducted an open-label pilot study administering moderate (20 mg/70 kg) and high (30 mg/70 kg) doses of psilocybin within a structured 15-week smoking cessation treatment protocol. Participants were 15 psychiatrically healthy nicotine-dependent smokers (10 males; mean age of 51 years), with a mean of six previous lifetime quit attempts, and smoking a mean of 19 cigarettes per day for a mean of 31 years at intake. Biomarkers assessing smoking status, and self-report measures of smoking behavior demonstrated that 12 of 15 participants (80%) showed seven-day point prevalence abstinence at 6-month follow-up. The observed smoking cessation rate substantially exceeds rates commonly reported for other behavioral and/or pharmacological therapies (typically <35%). Although the open-label design does not allow for definitive conclusions regarding the efficacy of psilocybin, these findings suggest psilocybin may be a potentially efficacious adjunct to current smoking cessation treatment models. The present study illustrates a framework for future research on the efficacy and mechanisms of hallucinogen-facilitated treatment of addiction.

Johnson, M. W., Garcia-Romeu, A., Cosimano, M. P., & Griffiths, R. R. (2014). Pilot study of the 5-HT2AR agonist psilocybin in the treatment of tobacco addiction. Journal of Psychopharmacology, 28(11), 983-992. http://dx.doi.org/10.1177/0269881114548296
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Examining the psychological mechanisms of psilocybin-assisted smoking cessation treatment: A pilot study

July 1, 2014 / Mushrooms / Psilocybin, Papers, Psychology, Publications, Substance Use Disorder / By / , ,

Abstract

Anthropological evidence and early experimental studies suggest that structured administration of 5-HT2A agonist hallucinogens (e.g., LSD, psilocybin) may have potential in treating addictions, including alcoholism and opioid dependence. Psilocybin administration has been recently linked to persisting effects including personality change (i.e., increased NEO Openness), mood enhancement, and behavior change. The association between mood, personality, and addiction has been well documented, and suggests that psilocybin may be useful in the treatment of addiction.

Garcia-Romeu, A. P., Johnson, M. W., & Griffiths, R. R. (2014). Examining the psychological mechanisms of psilocybin-assisted smoking cessation treatment: A pilot study. Drug & Alcohol Dependence, 140, e66. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.200
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Therapeutic Effects of Ritual Ayahuasca Use in the Treatment of Substance Dependence—Qualitative Results

March 11, 2014 / Ayahuasca, Biology & Ethnobotany, Neuroscience, Papers, Psychology, Publications, Substance Use Disorder / By / ,

Abstract

This qualitative empirical study explores the ritual use of ayahuasca in the treatment of addictions. Ayahuasca is an Amazonian psychedelic plant compound created from an admixture of the vine Banisteriopsis caapi and the bush Psychotria viridis. The study included interviews with 13 therapists who apply ayahuasca professionally in the treatment of addictions (four indigenous healers and nine Western mental health professionals with university degrees), two expert researchers, and 14 individuals who had undergone ayahuasca-assisted therapy for addictions in diverse contexts in South America. The study provides empirically based hypotheses on therapeutic mechanisms of ayahuasca in substance dependence treatment. Findings indicate that ayahuasca can serve as a valuable therapeutic tool that, in carefully structured settings, can catalyze neurobiological and psychological processes that support recovery from substance dependencies and the prevention of relapse. Treatment outcomes, however, can be influenced by a number of variables that are explained in this study. In addition, issues related to ritual transfer and strategies for minimizing undesired side-effects are discussed.

Loizaga-Velder, A., & Verres, R. (2014). Therapeutic Effects of Ritual Ayahuasca Use in the Treatment of Substance Dependence—Qualitative Results. Journal of Psychoactive Drugs, 46(1), 63–72. http://dx.doi.org/10.1080/02791072.2013.873157
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Why Psychiatry Needs Psychedelics and Psychedelics Need Psychiatry

March 11, 2014 / Anxiety Disorders / PTSD, Depressive Disorders, LSD, MDMA, Mushrooms / Psilocybin, Papers, Psychology, Publications, Substance Use Disorder / By /

Abstract

Without researching psychedelic drugs for medical therapy, psychiatry is turning its back on a group of compounds that could have great potential. Without the validation of the medical profession, the psychedelic drugs, and those who take them off-license, remain archaic sentiments of the past, with the users maligned as recreational drug abusers and subject to continued negative opinion. These two disparate groups—psychiatrists and recreational psychedelic drug users—are united by their shared recognition of the healing potential of these compounds. A resolution of this conflict is essential for the future of psychiatric medicine and psychedelic culture alike. Progression will come from professionals working in the field adapting to fit a conservative paradigm. In this way, they can provide the public with important treatments and also raise the profile of expanded consciousness in mainstream society.

Sessa, B. (2014). Why Psychiatry Needs Psychedelics and Psychedelics Need Psychiatry. Journal of Psychoactive Drugs, 46(1), 57–62. http://dx.doi.org/10.1080/02791072.2014.877322
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The Heffter Research Institute: Past and Hopeful Future

March 11, 2014 / Anxiety Disorders / PTSD, Mushrooms / Psilocybin, Papers, Publications, Substance Use Disorder / By /

Abstract

This essay describes the founding of the Heffter Research Institute in 1993 and its development up to the present. The Institute is the only scientific research organization dedicated to scientific research into the medical value of psychedelics, and it has particularly focused on the use of psilocybin. The first clinical treatment study was of the value of psilocybin in obsessive-compulsive disorder. Next was a UCLA study of psilocybin to treat end-of-life distress in end-stage cancer patients. While that study was ongoing, a trial was started at Johns Hopkins University (JHU) to study the efficacy of psilocybin in treating anxiety and depression resulting from a cancer diagnosis. Following the successful completion of the UCLA project, a larger study was started at New York University, which is near completion. A pilot study of the value of psilocybin in treating alcoholism at the University of New Mexico also is nearing completion, with a larger two-site study being planned. Other studies underway involve the use of psilocybin in a smoking cessation program and a study of the effects of psilocybin in long-term meditators, both at JHU. The institute is now planning for a Phase 3 clinical trial of psilocybin to treat distress in end-stage cancer patients.

Nichols, D. E. (2014). The Heffter Research Institute: Past and Hopeful Future. Journal of Psychoactive Drugs, 46(1), 20–26. http://dx.doi.org/10.1080/02791072.2014.873688
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Indigenous healing practice: ayahuasca. Opening a discussion

March 1, 2014 / Ayahuasca, Papers, Psychology, Publications, Substance Use Disorder / By / ,

Abstract

This essay frames an invitation to pastoral counselors and pastoral theologians to examine connections and perhaps interactions between themselves and traditional shamanic healers who use ayahuasca in their healing ceremonies. Indigenous people in South America have used ayahuasca for centuries, and the ritual has become common among the mestizo populations in urban areas of the Amazon, particularly as a curing ritual for drug addiction (Dobkin de Rios, 1970; Moir, 1998). Like peyote in the United States (Calabrese, 1997) ayahuasca use amongst the indigenous people of the Amazon is a form of cultural psychiatry. A review of the literature reveals very little commentary or discussion of shamanic practice in Pastoral Counseling (Pastoral Theology). The scant literature identifies an antithetical relationship at best. The current authors wonder about the possibility of to including shamanic practices in the context of pastoral counseling? This essay seeks to provide some basic information about the ritual use of ayahuasca and to offer a rationale for pastoral counselors to engage in a dialogue about its utility.

Prue, R., & Voss, R. W. (2014). Indigenous healing practice: ayahuasca. Opening a discussion. Journal of Pastoral Care & Counseling, 68(1), 1-13. 10.1177/154230501406800106
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Therapeutic infusions of ketamine: Do the psychoactive effects matter?

February 18, 2014 / Ketamine, Neuroscience, Papers, Psychiatry & Medicine, Psychology, Publications, Substance Use Disorder / By / , , , , ,

Abstract

Background

Sub-anesthetic ketamine infusions may benefit a variety of psychiatric disorders, including addiction. Though ketamine engenders transient alterations in consciousness, it is not known whether these alterations influence efficacy. This analysis evaluates the mystical-type effects of ketamine, which may have therapeutic potential according to prior research, and assesses whether these effects mediate improvements in dependence-related deficits, 24 h postinfusion.

Methods

Eight cocaine dependent individuals completed this double-blind, randomized, inpatient study. Three counter-balanced infusions separated by 48 h were received: lorazepam (2 mg) and two doses of ketamine (0.41 mg/kg and 0.71 mg/kg, with the former dose always preceding the latter). Infusions were followed within 15 min by measures of dissociation (Clinician Administered Dissociative Symptoms Scale: CADSS) and mystical-type effects (adapted from Hood’s Mysticism Scale: HMS). At baseline and 24 h postinfusion, participants underwent assessments of motivation to stop cocaine (University of Rhode Island Change Assessment) and cue-induced craving (by visual analogue scale for cocaine craving during cue exposure).

Results

Ketamine led to significantly greater acute mystical-type effects (by HMS) relative to the active control lorazepam; ketamine 0.71 mg/kg was associated with significantly higher HMS scores than was the 0.41 mg/kg dose. HMS score, but not CADSS score, was found to mediate the effect of ketamine on motivation to quit cocaine 24 h postinfusion.

Conclusions

These findings suggest that psychological mechanisms may be involved in some of the anti-addiction benefits resulting from ketamine. Future research can evaluate whether the psychoactive effects of ketamine influence improvements in larger samples.

Dakwar, E., Anerella, C., Hart, C. L., Levin, F. R., Mathew, S. J., & Nunes, E. V. (2014). Therapeutic infusions of ketamine: Do the psychoactive effects matter?. Drug and alcohol dependence, 136, 153-157. http://dx.doi.org/10.1016/j.drugalcdep.2013.12.019

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Hallucinogen use predicts reduced recidivism among substance-involved offenders under community corrections supervision

January 2, 2014 / LSD, Mushrooms / Psilocybin, Papers, Psychology, Publications, Substance Use Disorder / By / , , , ,

Abstract

Hallucinogen-based interventions may benefit substance use populations, but contemporary data informing the impact of hallucinogens on addictive behavior are scarce. Given that many individuals in the criminal justice system engage in problematic patterns of substance use, hallucinogen treatments also may benefit criminal justice populations. However, the relationship between hallucinogen use and criminal recidivism is unknown. In this longitudinal study, we examined the relationship between naturalistic hallucinogen use and recidivism among individuals under community corrections supervision with a history of substance involvement (n=25,622). We found that hallucinogen use predicted a reduced likelihood of supervision failure (e.g. noncompliance with legal requirements including alcohol and other drug use) while controlling for an array of potential confounding factors (odds ratio (OR)=0.60 (0.46, 0.79)). Our results suggest that hallucinogens may promote alcohol and other drug abstinence and prosocial behavior in a population with high rates of recidivism.

Hendricks, P. S., Clark, C. B., Johnson, M. W., Fontaine, K. R. & Cropsey, K. L. (2014). Hallucinogen use predicts reduced recidivism among substance-involved offenders under community corrections supervision. Journal of Psychopharmacology, 28(1), 62-66. http://dx.doi.org/10.1177/0269881113513851
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Peyote as Medicin: an Examination of Therapeutic Factors that Contribute to Healing

January 1, 2014 / Anthropology & Sociology, Biology & Ethnobotany, Mescaline / Cacti, Papers, Publications, Substance Use Disorder / By /

Abstract

The therapeutic value of particular “hallucinogenic” plants is recognized by various cultures throughout the globe, with evidence suggesting that the medical and ritual use of these plants may date back several millennia in some instances. Peyote, a psychoactive cactus, is considered a medicine by many Native Americans, and has been hailed as a cure for alcoholism despite having no “scientifically” accepted medical use. The notion that hallucinogenic compounds may have therapeutic applications, however, is increasingly supported by scientific research. Despite the heavy focus of allopathic medicine on pharmacology, the therapeutic value of peyote must be understood in holistic terms. By uniting Gordon Claridge’s work on the Total Drug Effect with the work of Daniel E. Moerman and Wayne B. Jonas on the Meaning Response, and with Toksoz Karasu’s Agents of Therapeutic Change, a therapeutic model emerges that can explain how the symbolic, ritual, and community components of the peyote ceremony combine with peyote’s distinctive pharmacological properties to produce a unique and efficacious healing experience.

Ayahuasca-Liane, D., & Peyote-Kaktus, D. (2014). Zeitschrift für Medizinethnologie• Journal of Medical Anthropology. Curare, 37(2014), 3.
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