Ayahuasca’s ‘afterglow’: improved mindfulness and cognitive flexibility in ayahuasca drinkers

Rationale: There is a growing body of evidence demonstrating the therapeutic potential of ayahuasca for treating depression and anxiety. However, the mechanisms of action involved in ayahuasca’s therapeutic effects are unclear. Mindfulness and cognitive flexibility may be two possible psychological mechanisms. Like other classic psychedelics, ayahuasca also leads to an 'afterglow' effect of improved subjective wellbeing that persists after the acute effects have subsided. This period may offer a window of increased therapeutic potential. Objective: to explore changes in mindfulness and cognitive flexibility before, and within 24 hours after ayahuasca use. Methods: Forty-eight participants (54% female) were assessed on measures of mindfulness (Five Facets Mindfulness Questionnaire, FFMQ), decentering (Experiences Questionnaire, EQ) and cognitive flexibility (Cognitive Flexibility Scale, CFS), and completed the Stroop and Wisconsin Picture Card Sorting Task (WPCST) before drinking ayahuasca, and again within 24-hours. Results: Mindfulness (FFMQ total scores and four of the five mindfulness facets; Observe, Describe, Act with Awareness and Non-reactivity) and decentering (EQ) significantly increased in the 24 hours after ayahuasca use. Cognitive flexibility (CFS and WPCST) significantly improved in the 24 hours after ayahuasca use. Changes in both mindfulness and cognitive flexibility were not influenced by prior ayahuasca use. Conclusions: The present study supports ayahuasca’s ability to enhance mindfulness and further reports changes in cognitive flexibility in the 'afterglow' period occur, suggesting both could be possible psychological mechanisms concerning the psychotherapeutic effects of ayahuasca. Given psychological gains occurred regardless of prior ayahuasca use suggests potentially therapeutic effects for both naïve and experienced ayahuasca drinkers

Problematic and non-problematic ecstasy (MDMA) usage : cognitive and psychopathological aspects

This research thesis aimed to explore the apparent dichotomy of ecstasy (MDMA) users who report cognitive and psychopathological problems which they attribute to their use of this drug ("problematic" users), and those who report no adverse ecstasy-related effects ("nonproblematic" users). In the first study, possible psychological sequalae linked to past ecstasy use were assessed in problematic and non-problematic ecstasy users using the modified Brief Symptom Inventory, aspects of the Rivermead Behavioural Memory Test, Tower of London and Auditory Verbal Learning Task. Problematic ecstasy users displayed higher psychopathological symptoms and a small number of selective cognitive deficits compared to non-problematic ecstasy users and polydrug controls. However, problematic ecstasy use did not appear to be related to patterns of ecstasy use or polydrug use. Using the same assessment measures, a case study based on a heavy problematic ecstasy user (RW), who had been abstinent for seven years, was presented. RW displayed cognitive deficits and extensive psychological problems suggesting that heavy ecstasy consumption may be associated with irreversible problems. The persistence of possible psychological and cognitive problems was further investigated in the second group study, using the same battery of tests. However no significant differences in cognitive and psychopathological performances were found between polydrug controls, current and ex-ecstasy users. It is argued that impairments in performance were possibly masked by poor cognitive performance in polydrug controls. The validity of the polydrug control group was addressed (in the third study) by assessing 20 drug-naive participants on the same measures. The introduction of a drug-naive control group only suggested that problematic and non-problematic ecstasy users were exhibiting more errors on the Tower of London task compared to polydrug and drug-naive controls. The final study assessed psychopathological symptoms in problematic and non-problematic ecstasy users relative to drug-naive and polydrug controls, and explored factors which may be integral in the development of problematic ecstasy use, including certain pre-existing factors. Users were assessed on the BSI and Locus of Control scale. Pre-existing psychiatric histories, the intensity of ecstasy dosing and the role of polydrug use in relation to ecstasy use, appeared to contribute in higher psychopathological symptoms in problematic ecstasy users. Together these studies suggest that only self-reported problematic ecstasy users consistently display cognitive and psychopathological problems. For these vulnerable individuals the intensity of ecstasy use, patterns of other drug use and pre-existing psychiatric histories are thought to contribute to the development of these problems

A multi-centre cluster randomised controlled trial evaluating the effectiveness of e-cigarettes compared with usual care for smoking cessation when offered to smokers accessing homeless services: methodological challenges and experiences of collaboration.

Around 80% of people experiencing homelessness smoke. E-cigarettes (ECs) are an effective quitting aid, but they have not been widely tested in this population. Project SCeTcH aims to evaluate the offer of an EC or usual care (UC) to smokers accessing homeless centres. A multi-centre two-arm cluster randomised controlled trial (RCT), including 32 homeless centres across Great Britain (480 participants). Randomisation includes either an EC with weekly allocations of e-liquid for 4-weeks or UC comprising very brief advice and signposting to a stop smoking service. After year 1, 27 centres and 240 participants have been recruited and retention rates at 4- and 24- weeks are 67% and 70% respectively. Challenges include working with multiple centres with different structures, provision, and client needs; reconciling risk of bias with the practicalities of working in this sector; the ongoing impact of Covid; changing models of care and practice; and juggling the needs of different collaborators researchers and health and social care organisations This is the first cluster RCT to assign smokers experiencing homelessness to an EC and UC intervention to measure smoking abstinence and risky smoking practices. Running trials in this population requires the need to understand the realistic needs of these individuals and services, and to work pragmatically and flexibly within the remit of the trial protocol. Ultimately, if effective, the results will be used to inform the larger scale implementation of supporting homeless centres to aid smoking cessation

The electronic-cigarette: effects on desire to smoke, withdrawal symptoms and cognition

Electronic cigarettes (e-cigarettes) are battery operated devices that deliver nicotine via inhaled vapour. Few studies have evaluated acute effects on craving and mood, and none have explored effects on cognition. This study aimed to explore the effects of the White Super e-cigarette on desire to smoke, nicotine withdrawal symptoms, attention and working memory. Eighty-six smokers were randomly allocated to either: 18mg nicotine e-cigarette (nicotine), 0mg e-cigarette (placebo), or just hold the e-cigarette (just hold) conditions. Participants rated their desire to smoke and withdrawal symptoms at baseline (T1), and five (T2) and twenty (T3) minutes after using the e-cigarette ad libitum for five minutes. A subset of participants completed the Letter Cancellation and Brown-Peterson Working Memory Tasks. After 20 minutes, compared with the just hold group, desire to smoke and some aspects of nicotine withdrawal were significantly reduced in the nicotine and placebo group; the nicotine e-cigarette was superior to placebo in males but not in females. The nicotine e-cigarette also improved working memory performance compared with placebo at the longer interference intervals. There was no effect of nicotine on Letter Cancellation performance. To conclude, the White Super e-cigarette alleviated desire to smoke and withdrawal symptoms 20 minutes after use although the nicotine content was more important for males. This study also demonstrated for the first time that the nicotine e-cigarette can enhance working memory performance. Further evaluation of the cognitive effects of the e-cigarette and its efficacy as a cessation tool is merited

Nicotine absorption from e-cigarettes over 12 months

Background Research indicates that, over time, exclusive e-cigarette users (vapers) gradually reduce the nicotine concentration in their e-liquid and transition to more sophisticated devices. Alongside this, consumption of e-liquid increases and constant cotinine levels are maintained. Aims We aimed to confirm these observations in 27 experienced vapers tested at baseline and 12 months later, by measuring nicotine absorption (via salivary levels of the nicotine metabolite cotinine; ng/mL), nicotine concentrations in e-liquid (mg/mL), volume of e-liquid consumed (mL per day), device types and flavours used, both at baseline and 12 months. Results Vapers reduced both their nicotine concentrations in e-liquid over 12 months (from 13.83 mg/mL at baseline to 9.91 at follow up) but significantly increased their e-liquid consumption (from 4.44 to 6.84 mL). No significant changes in salivary cotinine concentrations (370.88 ng/mL at baseline and 415.78 ng/mL at follow up) were observed. There was an increase in sub-ohming (using an atomiser coil with resistance of <1 Ω with increased power) at 12 months, and in the use of fruit flavoured e-liquids. Conclusions Our sample of experienced vapers reduced the concentration of nicotine in their e-liquid over time, but maintained their nicotine intake possibly through self-titration via more intensive puffing. Findings suggest there may be little benefit in reducing nicotine e-liquid concentration since this appears to result in higher e-liquid consumption which may incur both a financial and health cost. Gaining an understanding of underlying reasons for lowering e-liquid concentration would be a useful line of empirical enquiry

Smoking amongst adults experiencing homelessness: a systematic review of prevalence rates, interventions and the barriers and facilitators to quitting and staying quit

Background To date, there has been no review of the research evidence examining smoking cessation among homeless adults. The current review aimed to: (i) estimate smoking prevalence in homeless populations; (ii) explore the efficacy of smoking cessation and smoking reduction interventions for homeless individuals; and (iii) describe the barriers and facilitators to smoking cessation and smoking reduction. Method Systematic review of peer-reviewed research. Data sources included electronic academic databases. Search terms: ‘smoking’ AND ‘homeless’ AND ‘tobacco’, including adult (18+ years) smokers accessing homeless support services. Results Fifty-three studies met the inclusion criteria (n = 46 USA). Data could not be meta-analysed due to large methodological inconsistencies and the lack of randomised controlled trials. Smoking prevalence ranged from 57% to 82%. Although there was no clear evidence on which cessation methods work best, layered approaches with additions to usual care seemed to offer modest enhancements in quit rates. Key barriers to cessation exist around the priority of smoking, beliefs around negative impact on mental health and substance use, and environmental influences. Conclusions Homeless smokers will benefit from layered interventions which support many of their competing needs. To best understand what works, future recommendations include the need for consensus on the reporting of cessation outcomes

Toward an ontology of tobacco, nicotine and vaping products.

Ontologies are ways of representing information that improve clarity and the ability to connect different data sources. This paper proposes an initial version of an ontology of tobacco, nicotine and vaping products with the aim of reducing ambiguity and confusion in the field. Terms related to tobacco, nicotine and vaping products were identified in the research literature and their usage characterised. Basic Formal Ontology was used as a unifying upper-level ontology to describe the domain, and classes with definitions and labels were developed linking them to this ontology. Labels, definitions and properties were reviewed and revised in an iterative manner until a coherent set of classes was agreed by the authors. Overlapping, but distinct classes were developed: 'tobacco-containing product', 'nicotine-containing product' and 'vaping device'. Subclasses of tobacco-containing products are 'combustible tobacco-containing product', 'heated tobacco product' and 'smokeless tobacco-containing product'. Subclasses of combustible tobacco-containing product include 'cigar', 'cigarillo', 'bidi' and 'cigarette' with further subclasses including 'manufactured cigarette'. Manufactured cigarettes have properties that include 'machine-smoked nicotine yield' and 'machine-smoked tar yield'. Subclasses of smokeless tobacco product include 'nasal snuff', 'chewing tobacco product', and 'oral snuff' with its subclass 'snus'. Subclasses of nicotine-containing product include 'nicotine lozenge' and 'nicotine transdermal patch'. Subclasses of vaping device included 'electronic vaping device' with a further subclass, 'e-cigarette'. E-cigarettes have evolved with a complex range of properties including atomiser resistance, battery power, properties of consumables including e-liquid nicotine concentration and flavourings, and the ontology characterises classes of product accordingly. Use of an ontology of tobacco, nicotine and vaping products should help reduce ambiguity and confusion in tobacco control research and practice. [Abstract copyright: © 2022 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.