Dark loops: contagion effects, consistency and chemosocial matrices in psychedelic-assisted therapy trials

What happens when an emerging programme of medical research overlaps with a surging social movement? In this article we draw on the anthropological term ‘chemosociality’ to describe forms of sociality born of shared chemical exposure. Psychedelic administration in the context of recent clinical trials appears to have been particularly chemosocial in nature. We argue that one consequence is that psychedelic-assisted therapy (PAT) clinical research trials tend to breach key assumptions underlying the logic of causal inference used to establish efficacy. We propose the concept of dark loops to describe forms of sociality variously emerging from, and impacting participant experiences in, PAT trials. These dark loops are not recorded, let alone incorporated into the causal pathways in the interpretation of psychedelic trial data to date. We end with three positions which researchers might adopt in response to these issues: chemosocial minimisation where research is designed to attenuate or eliminate the effects of dark loops in trials; chemosocial description where dark loops (and their impacts) are openly and candidly documented and chemosocial valorisation where dark loops are hypothesised to contribute to trial outcomes and actively drawn upon for positive effect. Our goal is to fold in an appreciation of how the increasingly-discussed hype surrounding psychedelic research and therapeutics continues to shape the phenomena under study in complex ways, even as trials become larger and more rigorous in their design

Physical activity interventions for young people with increased risk of problematic substance use: a systematic review including different intervention formats

Objective: This systematic review investigates physical activity (PA) interventions for (1) reducing substance use and associated outcomes, (2) increasing physical activity, and (3) improving mental health in young people aged 12–25 years at increased risk for problematic substance use. Method: Four databases (PsycINFO, CINAHL, SPORTDiscus, and Medline) and grey literature, including hand searches, were searched (2021–2022). Non-randomized controlled or randomized controlled trials of a) multimodal or unimodal, short or long-term physical activity interventions in young people at increased risk of problematic substance use that b) investigated substance use outcomes were included. PA and mental health outcomes were explored where possible. Results: Sixty-one percent of the studies (k = 17/28) reported a significant improvement in outcomes related to tobacco (e.g., abstinence, cravings, withdrawal symptoms, smoking pattern), alcohol (e.g., quantity, frequency), or other substance use (e.g., frequency, quantity, recent use). Eight studies reported an increase in PA participation; two reported a beneficial effect on depression symptoms. The certainty of the evidence, i.e., the confidence in the reported effect estimates, was downgraded based on the risk of bias assessment. Findings should therefore be interpreted cautiously. Conclusions: A range of physical activity intervention formats and modalities may decrease substance use and associated outcomes and increase physical activity participation among people at risk for problematic substance use. Future research is warranted to better establish efficacy and investigate the effectiveness of implementing physical activity as part of treatment for substance use in young people

Behaviour change techniques in physical activity-focused interventions for young people at risk of problematic substance use: a systematic review and meta-analysis.

Aim This systematic review investigates behaviour change techniques in interventions promoting physical activity for young people aged 12-25 years at heightened risk of problematic substance use, and the effect of these techniques on physical activity participation and substance use outcomes. Methods Four databases (PsycINFO, CINAHL, SPORTDiscus and Medline) were searched between November 2020 and November 2022 for randomized and non-randomized controlled studies according to inclusion criteria. Meta-analyses were calculated using weighted, standardized averages of effect sizes (Hedges' g). Results Twenty-eight studies were included, 14 studies in the meta-analysis (intervention n = 1328; control n = 845). Reported BCTs included behavioural instructions, social comparison and goal setting. There was a significant effect of behaviour change techniques on combined substance use outcomes, such as cravings and consumption, for interventions reporting multiple behaviour change techniques (g = -0.33, p < .001, 95% CI [-0.50,-0.16]) or one single behaviour change technique (g = -1.84, p < .001, 95% CI [-2.89,-0.8]). Limitations include unexplained variance and limited reporting of relevant behaviour change technique data in the included studies. Conclusion The results indicate that using behaviour change techniques in interventions that promote physical activity for young people has an effect on substance use. Further research needs to be completed comparing the impact of the number and type of behaviour change technique, and improved reporting of intervention content is required

Psychedelic-Assisted Psychotherapy, Patient Vulnerability and Abuses of Power

Recent high-profile findings supporting the possible efficacy of psychedelic-assisted psychotherapy (Psy-AP) for indications including treatment-resistant depression and post-traumatic stress disorder make it increasingly likely that these treatments will become more widely available. While social and popular media discussions have highlighted interpersonal risks associated with Psy-AP, within psychiatry there has been little focus on this issue. In this viewpoint, we argue that while abuse of power unarguably happens in psychotherapeutic relationships more broadly, there are factors rendering Psy-AP modalities particularly vulnerable to such issues, while also presenting obstacles to reporting. Mainstream psychiatric institutions have a key role to play in increasing awareness of interpersonal risks in Psy-AP and developing protocols consistent with accepted standards of clinical care to manage them

A systematic review and meta-analysis of health, functional, and cognitive outcomes in young people who use methamphetamine

Methamphetamine use typically starts in adolescence or young adulthood, and early onset is associated with poor outcomes. However, health, functional, and cognitive outcomes associated with methamphetamine use in young people are poorly understood. Therefore, the aim of this systematic review and meta-analysis was to comprehensively assess the evidence on health, functional, and cognitive outcomes in young people (10-25 years-old) who use methamphetamine. Sixty-six studies were identified, investigating a range of outcomes. Meta-analysis revealed a strong association between conduct disorder and methamphetamine use in youth. Young people who use methamphetamine were also more likely to be involved in the justice system and to perpetrate violence against others than those who did not. Educational problems were also consistently associated with youth methamphetamine use. The most consistently impaired cognitive domain was inhibitory control. Key limitations in the current literature were identified, including heterogenous measurement of exposure and outcomes, lack of adequate controls, and limited causal evidence. Associations identified in the present review will be informative for the development of future research and treatments

Does Boredom Increase Impulsive Choice in People Who Use Cocaine?

Background: Impulsive choice – the tendency to choose immediate over larger delayed rewards – is associated with both cocaine use and relapse. Little is known about the influence of transient states on impulsive choice in people who use cocaine (PWUC). This study investigated the direct effects of induced boredom on impulsive choice (i.e., temporal discounting) in PWUC relative to well-matched community controls. Methods: In a mixed within-between subject design, 41 PWUC (≥1x cocaine use in past 3 months; 7 females) and 38 demographically-matched controls (5 females) underwent two experimental conditions in counterbalanced order. Temporal discounting was assessed immediately after a standardized boredom induction task (peg-turning) and a self-selected video watched for the same duration (non-boredom). Subjective mood state and perceived task characteristics were assessed at baseline, during experimental manipulations, and after the choice task. Results: PWUC and controls were demographically well-matched and similar in reported drugs use other than cocaine, except for recent cigarette and alcohol use (PWUC&gt;controls). As expected, peg-turning increased boredom in the sample overall, with higher boredom reported during peg-turning than the video (p&lt;.001, η2p=.20). Participants overall exhibited greater impulsive choice after boredom than non-boredom (p=.028, η2p=.07), with no preferential effects in PWUC (p&gt;.05, BF01=2.9). Conclusion: Experimentally-induced boredom increased state impulsivity irrespective of cocaine use status, suggesting a broad link between boredom and impulsive choice. This is the first study to show that transient boredom directly increases impulsive choice. Data support a viable laboratory method to further parse the effects of boredom on impulsive choice

Smoked cannabis reduces peak cocaine plasma levels and subjective effects in a controlled drug administration study of polysubstance use in men

BackgroundDespite the high prevalence of polysubstance use, outcomes and potential risks associated with common drug combinations are not well characterized. Many individuals who use cocaine also use cannabis, yet little is known about how interactions between the two drugs might contribute to continued co-use.MethodsThe aim of this double-blind, placebo-controlled study was to determine the physiological and subjective effects of smoked cannabis with smoked cocaine, to identify variables that may contribute to the continued use of this drug combination. Healthy, non-treatment seeking volunteers who reported smoking both cocaine and cannabis (N&nbsp;=&nbsp;9, all males) completed a 13-day inpatient protocol. On session days, cannabis [0.0 or 5.6 % tetrahydrocannabinol (THC)] was administered 28&nbsp;min prior to cocaine (0, 12, or 25&nbsp;mg). Dependent measures included pharmacokinetic assessment of THC and cocaine and their respective metabolites, in addition to subjective and cardiovascular effects.ResultsActive cannabis (5.6 % THC) increased plasma levels of THC and the metabolite 11-nor-9-carboxy-Δ9-THC (THCCOOH), as well as subjective ratings of cannabis effects and heart rate relative to inactive cannabis. Cocaine dose-dependently increased plasma cocaine and metabolites and subjective ratings of cocaine effects. Active cannabis pre-treatment decreased plasma levels of cocaine and metabolites. Furthermore, active cannabis attenuated cocaine-related reductions in 'Hunger' and 'Calm.'ConclusionsCannabis pre-treatment altered the subjective experience of smoked cocaine and reduced peak plasma levels of cocaine. Future studies should explore additional doses of each drug and whether these changes also impact cocaine's reinforcing effects