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Abstract

Psychedelic compounds hold promise for alleviating human suffering. Initial trials of psychedelic-assisted treatments have established feasibility and safety, generating calls for replications. Meanwhile, social and medical sciences have drawn criticism due to perceptions of replication failures and varying public trust in empiricism. Data suggest that researchers and the public frequently misunderstand some of the statistical issues associated with replication, potentially leading to unrealistic expectations of treatment effects. Promoting discourse on what constitutes sufficient replication is especially warranted considering the ongoing progression of multi-site phase II and III clinical trials. Here, we review recent and classic work on prediction intervals and power analysis to reveal that trials of psychedelic-assisted therapy that emphasize statistical significance will likely include failures to replicate, especially if sample sizes do not increase dramatically. The field and the public should expect some failed replication attempts based on sampling variability alone. Continued emphasis on statistical significance will require markedly larger samples than those used in clinical trials to date, necessitating substantially greater resources. An alternative approach focused on prediction intervals has distinct advantages. We focus on a recent trial of MDMA-assisted therapy for PTSD to show that, based on prediction intervals, reasonable replications are well within reach. A lack of attention to these statistical issues could unnecessarily prompt widespread dismissal of these therapies before the intervention receives adequate investigation and a fair assessment. In contrast, realistic expectations and appropriate planning could help ensure that these treatments receive the opportunity to help those most in need.

Open access
Journal of Psychedelic Studies
Authors:
Thais Guimarães Bourscheid
,
Leonardo Corrêa Cardoso
,
Marcelo Henrique Nascimento Santana
,
Letícia Cimó de Oliveira
,
Fernanda Ziegler Reginato
,
Michel Mansur Machado
, and
André Valle de Bairros

Abstract

Snuff is a fine aromatic powder composed of dried and thin leaves combined with tobacco, roots, peels, and seeds. Its use for indigenous religious purposes has appeared since pre-Columbian period in various localities of American continent. Practice is considered sacred in indigenous culture and suffered from trivialization of consumption due to influence of colonizers, which triggered subsequent industrialization of this complex for commercial purposes. Commercial snuff is essentially made from industrialized tobacco without addition of other medicinal plants and without therapeutic or spiritual purposes beyond its indiscriminate and inappropriate use, causing health risks. Therefore, this study aimed to make a review on snuff in Brazilian culture and a tour of a local community. In shamanism, plants are used as access vehicles to other religions of cosmos and its inhabitants, from where experts dialogue, bring songs, news, omens, and acquire new knowledge. The plants used in shamanic composition of snuff vary with the locality of indigenous villages in America and are essential ingredients of this interaction between humans and non-humans, a special mediator of intersubjective interactions. Several studies show the use and meaning of Erythroxylum coca used in different communities of the Amazon, besides Chacrona and Mariri, popular names of plants used in manufacture of Ayahuasca drink by doctrine Santo Daime. Because of this, it is essential to establish differences between recreational snuff and shamanic and their effects on body as well as studies on use of shamanic snuff should be directed according to their applications and plants employed by communities.

Open access
Journal of Behavioral Addictions
Authors:
Bastien Perrot
,
Jean-Benoit Hardouin
,
Elsa Thiabaud
,
Anaïs Saillard
,
Marie Grall-Bronnec
, and
Gaëlle Challet-Bouju

Abstract

Background and aims

Gambling disorder is characterized by problematic gambling behavior that causes significant problems and distress. This study aimed to develop and validate a predictive model for screening online problem gamblers based on players' account data.

Methods

Two random samples of French online gamblers in skill-based (poker, horse race betting and sports betting, n = 8,172) and pure chance games (scratch games and lotteries, n = 5,404) answered an online survey and gambling tracking data were retrospectively collected for the participants. The survey included age and gender, gambling habits, and the Problem Gambling Severity Index (PGSI). We used machine learning algorithms to predict the PGSI categories with gambling tracking data. We internally validated the prediction models in a leave-out sample.

Results

When predicting gambling problems binary based on each PGSI threshold (1 for low-risk gambling, 5 for moderate-risk gambling and 8 for problem gambling), the predictive performances were good for the model for skill-based games (AUROCs from 0.72 to 0.82), but moderate for the model for pure chance games (AUROCs from 0.63 to 0.76, with wide confidence intervals) due to the lower frequency of problem gambling in this sample. When predicting the four PGSI categories altogether, performances were good for identifying extreme categories (non-problem and problem gamblers) but poorer for intermediate categories (low-risk and moderate-risk gamblers), whatever the type of game.

Conclusions

We developed an algorithm for screening online problem gamblers, excluding online casino gamblers, that could enable the setting of prevention measures for the most vulnerable gamblers.

Open access
Journal of Behavioral Addictions
Authors:
Jakob Jonsson
,
David C. Hodgins
,
Axel Lyckberg
,
Shawn Currie
,
Matthew M. Young
,
Ståle Pallesen
, and
Per Carlbring

Abstract

Background and aims

Lower-risk recommendations for avoiding gambling harm have been developed as a primary prevention measure, using self-reported prevalence survey data. The aim of this study was to conduct similar analyses using gambling company player data.

Methods

The sample (N = 35,753) were Norsk Tipping website customers. Gambling indicators were frequency, expenditure, duration, number of gambling formats and wager. Harm indicators (financial. social, emotional, harms in two or more areas) were derived from the GamTest self-assessment instrument. Receiver operating characteristics (ROC) curves were performed separately for each of the five gambling indicators for each of the four harm indicators.

Results

ROC areas under the curve were between 0.55 and 0.68. Suggested monthly lower-risk limits were less than 8.7 days, expenditure less than 54 €, duration less than 72–83 min, number of gambling formats less than 3 and wager less than 118–140€. Most risk curves showed a rather stable harm level up to a certain point, from which the increase in harm was fairly linear.

Discussion

The suggested lower-risk limits in the present study are higher than limits based on prevalence studies. There was a significant number of gamblers (5–10%) experiencing harm at gambling levels well below the suggested cut-offs and the risk increase at certain consumption levels.

Conclusions

Risk of harm occurs at all levels of gambling involvement within the specific gambling commercial environment assessed in an increasingly available gambling market where most people gamble in multiple commercial environments, minimizing harm is important for all customers.

Open access

Another failure of the latent disease model? The case of compulsive sexual behavior disorder •

Commentary to the debate: “Behavioral addictions in the ICD-11”

Journal of Behavioral Addictions
Authors:
Nicholas C. Borgogna
and
Stephen L. Aita

Abstract

Recent debates have evolved regarding the classification/conceptualization of compulsive sexual behavior disorder (CSBD). Conclusions regarding an agreed upon CSBD model are hindered by reliance on the latent disease model. Competing biological-based frameworks are moving forward to replace latent disease classification more broadly but have been met with limited success. We suggest that CSBD researchers move towards developing dimensional, transtheoretical, process-based models. We further suggest additional research, particularly mixed methods and longitudinal studies. Finally, we request that federal funding bodies take a more active role in supporting CSBD research.

Open access

Abstract

Background and aims

Despite promising findings indicating the therapeutic potential of psychedelic experience across a variety of domains, the mechanisms and factors affecting its efficacy remain unclear. The present paper explores this by focusing on two psychedelic states which have been suggested as therapeutically significant in past literature: ego-dissolution and connectedness. The aim of the study is to investigate the impact of ego-dissolution and connectedness on the therapeutic effects of the psychedelic experience.

Methods

The investigation was carried out as a mixed methods systematic review, with the data from four databases analysed thematically and results presented through narrative synthesis.

Results

The analysis and synthesis of findings from 15 unique studies (n = 2,182) indicated that both ego-dissolution and connectedness are associated with a higher chance of improvement following a psychedelic experience. However, there seem to be differences in the way the two experiences affect individuals psychologically. Ego-dissolution appears to trigger psychological change but does not typically exceed the psychedelic experience in its duration, while connectedness can be more sustained and is associated with several positive, potentially therapeutic feelings.

Conclusions

Moreover, the findings of this review have implications for further theory-building about the mechanisms which enable therapeutic effects in psychedelic experience. This in turn might lead to improved models for psychedelic therapy practice. Emphasis on ego-dissolution during the preparation phase and on connectedness during integration is one suggestion presented here, alongside overarching implications for the mental health debate and general practice.

Open access
Journal of Behavioral Addictions
Authors:
Hongsheng Xie
,
Feifei Zhang
,
Yuan Cao
,
Xipeng Long
,
Baolin Wu
,
Qiyong Gong
, and
Zhiyun Jia

Abstract

Background and aims

Perfectionism is correlated with the occurrence of exercise dependence. We aim to reveal the role of functional connectivity (FC) between gray matter (GM) and white matter (WM) networks in the association between perfectionism and exercise dependence.

Methods

In this cross-sectional study, one hundred ten participants with exercise dependence underwent behavioral evaluation and resting-state functional magnetic resonance imaging. Perfectionism and exercise dependence were quantified using the Frost Multidimensional Perfectionism Scale (FMPS) and Exercise Dependence Scale (EDS). We used a K-means clustering algorithm to identify functional GM and WM networks and obtained the FCs of the GM-GM, GM-WM, and WM-WM networks. Partial correlation and mediation analyses were performed to explore the relationships among FCs, FMPS, and EDS.

Results

We identified ten stable GM networks and nine WM networks. Of these, FCs existed between the corona radiata network (WM1) and default mode network (DMN, GM8), WM1 network and WM DMN (WM4), WM1 network and midbrain WM network (WM7), and WM4 network and inferior longitudinal fasciculus network (WM9). The WM1-GM8 and WM1-WM4 FCs were positively correlated with the EDS and negative FMPS. The mediating effects of the WM1-GM8 and WM1-WM4 FCs were established in the association between the negative dimensional FMPS and EDS.

Discussion and Conclusions

The WM1 network anatomically linked the subregions within the GM8 and WM4 networks, and WM1-GM8 and WM1-WM4 FCs mediated the association between negative dimensional FMPS and EDS. These findings indicated that DMN function might be involved in the increased risks of exercise dependence promoted by negative perfectionism.

Open access
Journal of Behavioral Addictions
Authors:
Florent Wyckmans
,
Nilosmita Banerjee
,
Mélanie Saeremans
,
Ross Otto
,
Charles Kornreich
,
Laetitia Vanderijst
,
Damien Gruson
,
Vincenzo Carbone
,
Antoine Bechara
,
Tony Buchanan
, and
Xavier Noël

Abstract

Background and aims

Experiencing acute stress is common in behavioral addictions such as gambling disorder. Additionally, like most substance-induced addictions, aberrant decision-making wherein a reactive habit-induced response (conceptualized as a Model-free [MF] in reinforcement learning) suppresses a flexible goal-directed response (conceptualized as a Model-based [MB]) is also common in gambling disorder. In the current study we investigated the influence of acute stress on the balance between habitual response and the goal-directed system.

Methods

A sample of N = 116 problem gamblers (PG) and healthy controls (HC) performed an acute stress task – the Socially Evaluated Cold pressure task (SECPT) – or a control task. Self-reported stress and salivary cortisol were collected as measures of acute stress. Following the SECPT, participants performed the Two-Step Markov Task to account for the relative contribution of MB and MF strategies. Additionally, verbal working memory and IQ measures were collected to account for their mediating effects on the orchestration between MB/MF and the impact of stress.

Results

Both groups had comparable baseline and stress-induced cortisol response to the SECPT. Non-stressed PG displayed lower MB learning than HC. MANOVA and regression analyses showed a deleterious effect of stress-induced cortisol response on the orchestration between MB and MF learning in HC but not in PG. These effects remained when controlling for working memory and IQ.

Discussion and Conclusions

We found an abnormal pattern of modulation of stress on the orchestration between MB and MF learning among PG. Several interpretations and future research directions are discussed.

Open access
Journal of Behavioral Addictions
Authors:
Hannah Schmidt
,
Dominique Brandt
,
Christian Meyer
,
Anja Bischof
,
Gallus Bischof
,
Anika Trachte
,
Bettina Besser
,
Svenja Orlowski
,
Samantha Schlossarek
,
Stefan Borgwardt
, and
Hans-Jürgen Rumpf

Abstract

Background

Adolescents and young adults (AYA) have an increased risk for Internet use disorders (IUD) compared to older individuals that may lead to functional impairments in daily life. To date, evidence-based brief interventions are lacking. This study aimed to test the efficacy of a low-threshold counseling approach based on Motivational Interviewing (MI) in a vocational school setting.

Methods

Of 8.230 vocational students (age M=20.56, SD=4.68; 51.85% female) being proactively screened for IUD, 937 with positive screenings took part in telephone-based diagnostic interviews. IUD were assessed in line with the criteria of the Internet Gaming Disorder in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Readiness to change, self-efficacy, and impairments in daily life were additionally assessed with standardized screening instruments. Participants fulfilling at least two IUD criteria were randomized to the intervention group (n=240, up to three MI-based counseling sessions via telephone) or the control group (n=257, information brochure on responsible Internet use). Follow-up interviews were conducted after five and ten months. The primary outcome was the reduction of IUD criteria. Secondary outcomes were improvements of readiness/ self-efficacy to change and the reduction of daily impairments. Data were analyzed with Intention-to-Treat (ITT) and complier average causal effect (CACE) analyses.

Results

Overall, 153 (63.75%) individuals assigned to the intervention group participated at least in one counseling session (=compliers). Both groups reduced the number of IUD criteria over time. In ITT analyses, however, we did not find intervention effects for primary and secondary outcomes. Bayes statistics were inconclusive. Based on low participation rates in the intervention group, explorative CACE analyses were conducted to compare compliers in the intervention group to potential compliers in the control group. Again, we did not find intervention effects apart from improvements in self-efficacy after five months.

Discussion

Telephone-based counseling seems not appropriate to address AYA at risk for IUD. Low participation rates in the intervention group caused underpowered analyses. Besides, dealing with the own Internet use during intensive assessments and receiving an information brochure led to behavioral changes also in the control group. Since the efficacy of brief interventions under the condition of higher participation rates cannot be fully ruled out, further research is required by taking the implications of this study into account.

Open access
Journal of Psychedelic Studies
Authors:
Chelsea Radakovic
,
Ratko Radakovic
,
Guy Peryer
, and
Jo-Anne Geere

Abstract

Background and aims

The benefits of classic serotonergic psychedelics (e.g. psilocybin, LSD, DMT, ayahuasca) are becoming more widely known with the resurgence in research in the past decade. Furthermore, the benefits of mindfulness are well documented. However, no systematic reviews have examined linkage of mindfulness and psychedelics use. The aim of this systematic review is to explore the link between psychedelics and characteristics of mindfulness.

Methods

We conducted a systematic search across multiple databases, inclusive of grey literature and backwards/forward-citation tracking, on the 18 January 2021. The search strategy included terms relating to mindfulness and psychedelics, with no restriction on clinical or non-clinical conditions. Study quality was assessed. An exploratory random-effects meta-analysis was conducted on pre-post mindfulness data relative to psychedelic ingestion.

Results

Of 1805 studies screened, 13 were included in the systematic review. There was substantial variability in participant characteristics, psychedelic administration method and measurement of mindfulness. The ingestion of psychedelics is associated with an increase in mindfulness, specifically relating to domains of acceptance, which encompasses non-judgement of inner experience and non-reactivity. The meta-analysis of a subset of studies (N = 6) showed small effects overall relative to ayahuasca ingestion, increasing mindfulness facets of non-judgement of inner experience and non-reactivity, as well as acting with awareness.

Conclusions

Further methodologically robust research is needed to elucidate the relationship between psychedelics and mindfulness. However, mindfulness and specific facets relating to acceptance have been shown to increase following ingestion of psychedelics in a number of studies.

Open access