Abstract
Background and Aims
This study sought to identify patterns of psychedelic use among American psychiatrists, to compare the demographic variables across categories of social proximity and personal use, and to determine how these categories influenced psychiatrists' attitudes towards drugs and people who use drugs.
Methods
Respondents (N = 180; mean age = 48.4 [SD = 16.2]; male = 65.5%; trainees = 24.1%) were recruited via email lists/listservs and personal networks (snowball sampling).
Results
Approximately one-third (32.8%) of psychiatrists reported Personal Connection (i.e., history of personal use and social connection) to psychedelics. Psychiatrists with Personal Connection to psychedelics were more likely to be younger (p = 0.006, ηp2 = 0.057) and have fewer years of practice (p = 0.008, ηp2 = 0.058). Almost all (92%) of those with No Connection to psychedelics were out of training, compared with only 8% of those in training. Those with Personal and Social Connection to psychedelics were more likely to disagree: that using illegal drugs is morally wrong (p < 0.001, ηp2 = 0.28), that illegal drug users should go to prison (p < 0.001, ηp2 = 0.15), are weak minded (p < 0.001, ηp2 = 0.10), have no future (p < 0.001, ηp2 = 0.12), are not well educated (F(2.0, 170) = 7.38. p < 0.001, ηp2 = 0.08), are dishonest (p < 0.001, ηp2 = 0.10), and that illegal drug users ‘make me angry’ (p < 0.001, ηp2 = 0.10).
Conclusions
Personal and social connection to psychedelics is associated with decreased stigma towards drug use and people who use drugs. Future research should examine whether proximity to psychedelic use impacts other factors (e.g., empathy, therapeutic alliance) involved in psychiatry training and practice.
Introduction
The global prevalence of illegal substance use among adults is 5.8% with an estimated 39.5 million people worldwide who have a substance use disorder (SUD) (World Drug Report, 2023). Most individuals diagnosed with SUD do not seek or have access to treatment (Substance Abuse and Mental Health Services Administration, 2022), and those who do engage in treatment are more likely to drop out prematurely (Lappan, Brown, & Hendricks, 2020), to leave treatment against medical advice (Ti & Ti, 2015), and to receive suboptimal screening and management of their SUD (van Boekel, Brouwers, van Weeghel, & Garretsen, 2013). Individuals with SUD often delay or avoid seeking necessary medical care due to fear of stigma (Biancarelli et al., 2019) contributing to higher rates of morbidity and mortality from co-morbid diseases (Lewer, Tweed, Aldridge, & Morley, 2019). Indeed, negative attitudes among health care professionals towards patients who use drugs are prevalent (van Boekel et al., 2013), and patients often report stigma as a primary reason for drop out and lack of engagement with medical services (Farhoudian et al., 2022).
Despite the evidence showing that drug use stigma negatively effects treatment seeking and engagement among those with SUD, no formal intervention is particularly effective in reducing stigma among healthcare providers (Hooker et al., 2023; Livingston, Milne, Fang, & Amari, 2012). One intervention featuring a narrative from the perspective of a patient with SUD resulted in a minimal (15%) reduction in stigma (Kennedy-Hendricks et al., 2022). Another study which used a stigma-reduction online training tool among primary care physicians showed no improvement in stigma after intervention (Hooker et al., 2023). Despite these findings, there is evidence that social proximity or lived experience of stigmatized conditions can positively influence attitudes and beliefs (Corrigan, Markowitz, Watson, Rowan, & Kubiak, 2003). For example, addiction specialists report less stigma than generalists towards people who use drugs (van Boekel et al., 2013), and providers with more personal and social exposure to people with SUD also report decreased stigma (May, Warltier, & Pagel, 2002; Palamar, Kiang, & Halkitis, 2011). Data on the effects of personal drug use on stigma are mixed, with some studies showing decreased stigma in those who endorsed recent drug use (May et al., 2002; Palamar et al., 2011) and others showing increased stigma towards people who use drugs (Adlaf, Hamilton, Wu, & Noh, 2009), and increased self-stigma (Luoma et al., 2007; Schomerus et al., 2011), among those with recent drug use. For example, self-endorsed marijuana use has been associated with higher levels of stigma towards people with SUDs (Adlaf et al., 2009). Thus, it seems possible that social proximity and personal use of specific drugs may have unique effects on overall attitudes towards drugs and people who use them.
Psychedelic drugs are unique as they have been viewed as illicit drugs of abuse yet are characterized by an ability to engender deeply meaningful, psychologically insightful, and mystical-type experiences, particularly when taken in supportive settings (Reiff & Widge, 2020). Classic psychedelics (e.g., psilocybin, lysergic acid diethylamide (LSD), N,N-dimethyltryptamine (DMT), ayahuasca, mescaline) have also shown promise for the treatment of various mental health conditions (Reiff & Widge, 2020), have relatively low potential for abuse (Johnson, Griffiths, Hendricks, & Henningfield, 2018), and have shown potential in the treatment of SUD in clinical trials and naturalistic settings (Zafar et al., 2023). Psychedelics may also enhance empathy and prosocial attitudes. For example, two doses of psilocybin, when combined with meditation or spiritual practice, produced enduring, trait level increases in prosocial attitudes and behaviors in healthy individuals (Griffiths et al., 2018). LSD has been shown to produce positive changes in social attitudes up to one year following administration (Schmid & Liechti, 2018), and psychedelics have been shown to enhance emotional empathy (Preller & Vollenweider, 2019) and feelings of connectedness (Kettner et al., 2021). Psychedelics have also been linked to enhanced psychological flexibility, leading to improvements in mental health (Davis, Barrett, & Griffiths, 2020), and reappraisals of long-held beliefs and assumptions (Weiss, Wingert, Erritzoe, & Campbell, 2023).
Given these changes, it has been suggested that psychedelics might enhance the effectiveness of health care providers by strengthening the therapeutic alliance between therapists and patients (Murphy et al., 2022), increasing empathic concern, improving resilience, and preventing burnout (Herrmann et al., 2023). Two clinical trials evaluating psilocybin-assisted therapy (PAT) for the treatment of burnout and traumatic stress in healthcare providers are underway (IRB_00152312, n.d.; NCT05163496). Furthermore, increases in empathy have been linked to reduced stigma towards people who use drugs (Clinton & Pollini, 2021) and people with mental illness (Hecht, Kloß, & Bartsch, 2022). It is possible that psychedelics may influence stigma towards people who use drugs both directly, through personal psychedelic experience, and indirectly, through personal use or social proximity to use, but no studies exploring this question have been conducted. Therefore, we aimed to assess whether psychiatrists' connection to psychedelic use influenced their attitudes towards drugs and people who use drugs, as measured by the Drug Use Stigmatization Scale (DUSS). Additionally, we aimed to examine whether psychiatrists' connection to psychedelics influenced their assessments of the safety, therapeutic, and abuse potentials of four controlled substances under the Controlled Substances Act (CSA) (psilocybin, methamphetamine, ketamine, alprazolam) and alcohol. To address Aim 1, we compared participant attitudes of drug use stigma between three groups: 1) psychiatrists with no personal use or social proximity (i.e., friends/relatives who had used psychedelics) to psychedelic use (No Connection), 2) psychiatrists with social proximity to but no personal use of psychedelics (Social Connection), and 3) those with personal use and social proximity to psychedelic use (Personal Connection). These three groups were also used to examine Aim 2, in which we compared respondents' ratings of safety, therapeutic value, and abuse potential of alcohol, psilocybin, methamphetamine, ketamine, and alprazolam.
Methods
Ethical considerations
This study comprises a secondary data analysis of previously unpublished data from a study exploring the attitudes and beliefs about national drug policy among psychiatrists in the US (Levin et al., 2022). The study was deemed exempt by the Institutional Review Board. Participation in the survey was anonymous. However, respondents had the option to enter a raffle for a chance to win one of 14, $100 gift cards and one of 30, $50 gift cards. If someone chose to enter the raffle, then they were asked to provide their name and email address, which were provided and stored separately from survey responses. All survey questions pertained to past use of psychedelics, with no assessment of current use.
Respondents and procedure
We recruited a national convenience sample of psychiatrists in the US. Recruitment occurred via two psychiatrist emailing lists purchased from marketing companies, email listservs from the American Psychiatric Association, and snowball sampling from April to May 2021. Potential respondents received an email which contained information about the study, the inclusion criteria (i.e., board certified psychiatrists or psychiatry residents in the US who can read, write, and speak English fluently), and a secure link to the online survey where they could read more about the study. Respondents were then presented with a consent form and, once completed, they could begin the survey. Respondents were required to complete the survey in one sitting for their data to be stored and used. Overall, 282 people clicked a link and were presented with the consent document. All respondents passed the bot detection and relevant fraud detection indices in Qualtrics. Of these, 185 consented to participate, however 5 respondents were excluded because they did not complete the remaining questionnaires. Of the remaining 180 respondents, there were 6 who reported personal use of psychedelics without any social proximity. Given the small number of people in this group, these respondents were removed from our analysis, resulting in a final sample of 174 psychiatrists.
Measures
The survey included items assessing demographics and background information (e.g., age, sex, gender, education, religion, professional training, and work history). Respondents were asked if they had ever had an experience with psychedelics in the past (yes/no), and if they had any friends or relatives with an experience with psychedelics (yes/no). Respondents were also asked to complete the Drug Use Stigmatization Scale (DUSS) (Palamar et al., 2011). Respondents reported their level of agreement (from 1 = “Strongly disagree” to 5 = “Strongly agree”) with a list of negative characterizations about drug use and people who use drugs (e.g., “Illegal drug users are weak-minded”, “Most illegal drug users are not well educated”). Finally, respondents were asked to rate alcohol, psilocybin, ketamine, methamphetamine, and alprazolam in terms of their safety (from −3 = “extremely unsafe” to +3 = “extremely safe”), abuse potential (from 0 = “no abuse potential” to 4 = “very strong abuse potential”), and therapeutic potential (from 0 = “no therapeutic potential” to 4 = “very strong therapeutic potential”). Drugs were presented with their generic and brand names (when relevant) throughout the survey but are referred to by their generic names throughout this paper.
Data analyses
Based on their responses to questions about connection to psychedelic use, respondents were grouped into one of three categories: 1) psychiatrists with no personal use and no friends/relatives who had used psychedelics (No Connection; NC), 2) psychiatrists with friends/relatives who had used psychedelics but no personal use (Social Connection; SC), and 3) those with personal use and friends/relatives who had used psychedelics (Personal Connection; PC). Next, we calculated summary statistics of all demographic characteristics, and compared demographic characteristics as a function of group using a series of chi-square (sex, region of residence, residency/fellowship training status, whether they use psychotherapy in practice) and one-way ANOVAs (age, years in practice). Post-hoc tests of mean wise comparisons (ANOVAs) and z-tests of comparing proportions (chi-square), with Bonferroni corrections, were used to explore specific group differences. Next, using a series of one-way ANOVAs, we examined whether ratings of drug use stigma differed as a function of group. Finally, using a series of one-way ANOVAs, we examined whether psychiatrists' ratings of safety, abuse potential, and therapeutic potential of psilocybin, methamphetamine, ketamine, alprazolam, and alcohol) differed as a function of group. Post-hoc tests of mean wise comparisons were used to explore specific mean differences. A p-value of 0.05 was used to determine statistical significance, and effect sizes (Phi for chi-square and eta-squared for ANOVA) were used to interpret strength of differences in each analysis. Analyses were performed using SPSS v 28.
Results
Participant characteristics
As Table 1 shows, 32.8% of respondents reported PC to psychedelics, 24.1% reported SC, and 43.1% reported NC. Respondents were middle aged (M = 48.4) and most were male (65.5%), with an average of 16.1 years (SD = 15.3) of psychiatry practice. A small proportion of respondents were trainees (24.1%), either in residency or fellowship, and 44.4% had completed some fellowship training. The sample was geographically diverse, with similar proportions from the South (26.2%), West (25.6%), Midwest (27.3%), and Northeast (20.9%).
Demographic characteristics in the sample and comparison of demographic characteristics as a function of social proximity to psychedelics use (i.e., personal connection, social connection, and no connection)
| Characteristic | Total Sample M or % | Social Proximity | F or X2 | Effect Size | Post-hoc | ||||||
| SD | NC M or % | SD | SC M or % | SD | PC M or % | SD | |||||
| Social Proximity | 100% | 43.1% | 24.1% | 32.8% | |||||||
| Age | 48.4 | 16.2 | 52.5 | 15.6 | 43.0 | 13.6 | 47.1 | 17.5 | 5.2** | 0.06^^ | NC > SC |
| Sex: | 7.92* | 0.21^^^ | |||||||||
| Male | 65.5% | 65.3% | 50.0% | 77.2% | PC > SC | ||||||
| Female | 34.5% | 34.7% | 50.0% | 22.8% | SC > PC | ||||||
| Region Residing: | 4.18 | 0.16^^^ | |||||||||
| South | 26.2% | 28.8% | 21.4% | 26.3% | |||||||
| West | 25.6% | 27.4% | 19.0% | 28.1% | |||||||
| Midwest | 27.3% | 21.9% | 38.1% | 26.3% | |||||||
| Northeast | 20.9% | 21.9% | 21.4% | 19.3% | |||||||
| Years practicing as psychiatrist | 16.1 | 15.3 | 20.2 | 15.7 | 11.5 | 12.5 | 14.3 | 15.6 | 5.31** | 0.06^ | NC > SC |
| In Residency or Fellowship Training: | 19.1*** | 0.33^^^ | |||||||||
| Yes | 24.1% | 8.0% | 33.3% | 38.6% | SC = PC > NC | ||||||
| No | 75.9% | 92.0% | 66.7% | 61.4% | NC > SC = PC | ||||||
| Completed Psychiatry Fellowship (total) | 4.75 | 0.17^^^ | |||||||||
| Yes | 41.4% | 48.0% | 45.2% | 29.8% | |||||||
| No | 58.6% | 52.0% | 54.8% | 70.2% | |||||||
| Utilizes Psychotherapy in Practice | 6.39* | 0.19^^^ | |||||||||
| Yes | 77.0% | 68.0% | 81.0% | 86.0% | NS | ||||||
| No | 23.0% | 32.0% | 19.0% | 14.0% | NS | ||||||
*p < 0.05, **p < 0.01, ***p < 0.001.
^ small, ^^ medium, ^^^ large.
Note. NC = No Connection; SC = Social Connection; PC = Personal Connection; M = Mean; SD = Standard Deviation.
As Table 1 also shows, there were significant differences in mean age of respondents as a function of group, F(2.0, 171) = 5.211, p = 0.006, ηp2 = 0.057. Post-hoc tests of mean pairwise comparisons revealed that respondents with NC were likely to be older (M = 52.5, SD = 15.6) compared to those with SC (M = 43.0, SD = 13.6, p = 0.006). Connection to psychedelics differed significantly in terms of the number of years of practice F(2.0, 171) = 5.285, p = 0.006, ηp2 = 0.058, with psychiatrists with more years of practice more likely to have NC (p = 0.008, ηp2 = 0.058). A greater proportion of respondents in training endorsed PC and SC (33.3%) or SC (38.6%) than the proportion of those with NC (8%) (X2 (2, N = 174) = 19.1, p < 0.001, Φ = 0.331). Additionally, a greater proportion of respondents with NC had completed training (92%) compared to those with PC (66.7%) and SC (61.4%), and a greater proportion of those with PC were male (77.2%) as compared to the proportion of males in the group with SC (50%) (X2 (2, N = 174) = 7.91, p = 0.019, Φ = 0.213). Conversely, the proportion of females in the group with SC (50%) was greater than that comprising the group with PC (23%).
Comparison of responses to Drug Use Stigmatization Scale as a function of connection to psychedelic use
There were significant differences as a function of connection in levels of agreement/disagreement with the following items on the DUSS: using illegal drugs is morally wrong (F(2.0, 170) = 32.9, p < 0.001, ηp2 = 0.28), illegal drug users should go to prison (F(2.0, 170) = 14.5, p < 0.001, ηp2 = 0.15), are weak minded (F(2.0, 170) = 9.9, p < 0.001, ηp2 = 0.10), have no future (F(2.0, 170) = 11.2, p < 0.001, ηp2 = 0.12), are not well educated (F(2.0, 170) = 7.38. p < 0.001, ηp2 = 0.08), are dishonest (F(2.0, 170) = 9.68, p < 0.001, ηp2 = 0.10), and that illegal drug users ‘make me angry’ (F(2.0, 170) = 9.29, p < 0.001, ηp2 = 0.10). As Table 2 shows, post-hoc tests of mean pairwise comparisons revealed that psychiatrists with PC and SC were more likely to disagree with each of the above statements as compared to those with NC. With regard to the statement ‘illegal drug use is morally wrong’, all three groups were significantly different from one another, with psychiatrists with PC reporting higher mean levels of disagreement (M = −1.70, SD = 0.57) than both those with SC (M = −1.20, SD = 0.93; p = 0.034) and those with NC (M = −0.35, SD = 1.20; p < 0.001).
Comparison of responses to Drug Use Stigmatization Scale as a function of social proximity to psychedelic use (i.e., personal connection, social connection, and no connection)
| Question | NC M | SD | SC M | SD | PC M | SD | F | Effect size | Post-hoc |
| Using illegal drugs is morally wrong | −0.35 | 1.20 | −1.20 | 0.93 | −1.70 | 0.57 | 32.9*** | 0.279 ^^^ | NC > SC > PC |
| Illegal drug users should go to prison | −1.15 | 0.87 | −1.63 | 0.70 | −1.79 | 0.45 | 14.5*** | 0.146 ^^^ | NC > SC = PC |
| Illegal drug users are weak-minded | −1.15 | 0.88 | −1.66 | 0.69 | −1.67 | 0.61 | 9.91*** | 0.104 ^^ | NC > SC = PC |
| Illegal drug users have no future | −1.20 | 0.82 | −1.63 | 0.70 | −1.75 | 0.51 | 11.3*** | 0.117 ^^ | NC > SC = PC |
| Most illegal drug users are not well educated | −0.96 | 0.99 | −1.49 | 0.87 | −1.46 | 0.66 | 7.38*** | 0.08 ^^ | NC > SC = PC |
| Illegal drug users are dishonest | −0.59 | 1.04 | −1.24 | 0.99 | −1.26 | 0.92 | 9.68*** | 0.102 ^^ | NC > SC = PC |
| Illegal drug users make me angry | −0.80 | 1.10 | −1.32 | 0.82 | −1.47 | 0.76 | 9.29*** | 0.099 ^^ | NC > SC = PC |
Range of scores are −3 (definitely not) to +3 (definitely).
*p < 0.05, **p < 0.01, ***p < 0.001.
^ small, ^^ medium, ^^^ large.
Note. NC = No Connection; SC = Social Connection; PC = Personal Connection; M = Mean; SD = Standard Deviation.
Comparison of ratings of safety, abuse potential, and therapeutic potential of drugs as a function of social proximity to psychedelic use
There were significant differences in ratings of safety (F(2.0, 171) = 39.1, p < 0.001, ηp2 = 0.31), abuse potential (F(2.0, 171) = 26.4, p < 0.001, ηp2 = 0.24), and therapeutic potential (F(2.0, 171) = 41.0, p < 0.001, ηp2 = 0.33) of psilocybin as a function of group, wherein psychiatrists with PC were more likely to rate psilocybin as safer (M = 1.68, SD = 0.97), having lower abuse potential (M = 1.12, SD = 0.73), and having greater therapeutic potential (M = 3.16, SD = 0.84) than those with SC (Safety: M = 0.40, SD = 1.42; Abuse: M = 1.79, SD = 0.84; Therapeutic: M = 2.19, SD = 0.55) and those with NC (Safety: M = −0.40, SD = 1.53; Abuse: M = 2.24, SD = 0.98; Therapeutic: M = 1.88, SD = 0.91). There were also significant differences as a function of group in ratings of abuse (F(2.0, 171) = 3.13, p = 0.046, ηp2 = 0.035) and therapeutic potential (F(2.0, 171) = 2.64, p = 0.029, ηp2 = 0.041) of alprazolam, wherein psychiatrists with PC were more likely to rate alprazolam as having a higher abuse potential (PC: M = 3.39, SD = 0.59; SC: M = 3.57, SD = 0.59) than those with NC (M = 3.27, SD = 0.68). Additionally, respondents with PC (M = 1.95, SD = 0.77), as well as those with NC (M = 2.24, SD = 0.90), were more likely to rate alprazolam as having a higher therapeutic potential than those with SC (M = 1.83, SD = 0.88) (Table 3).
Comparison of ratings of safety, abuse potential, and therapeutic potential as a function of social proximity to psychedelic use (i.e., personal connection, social connection, and no connection)
| Item | NC M | SD | SC M | SD | PC M | SD | F | Effect Size | Post-hoc |
| Psilocybin | |||||||||
| Safetya | −0.40 | 1.53 | 0.40 | 1.42 | 1.68 | 0.97 | 39.1*** | 0.31^^^ | PC > SC > NC |
| Abuse Potentialb | 2.24 | 0.98 | 1.79 | 0.84 | 1.12 | 0.73 | 26.4*** | 0.24^^^ | NC > SC > PC |
| Therapeutic Potentialc | 1.88 | 0.91 | 2.19 | 0.55 | 3.16 | 0.84 | 41.1*** | 0.32^^^ | PC > SC > NC |
| Methamphetamine | |||||||||
| Safety | −0.40 | 1.63 | −0.81 | 1.61 | −0.84 | 1.67 | 1.45 | 0.02^ | NS |
| Abuse Potential | 3.28 | 0.75 | 3.38 | 0.62 | 3.39 | 0.70 | 0.47 | 0.01 | NS |
| Therapeutic potential | 1.83 | 0.94 | 1.55 | 1.15 | 1.60 | 0.96 | 1.37 | 0.02^ | NS |
| Ketamine | |||||||||
| Safety | 0.65 | 1.34 | 0.57 | 1.33 | 0.93 | 1.25 | 1.08 | 0.01^ | NS |
| Abuse Potential | 2.34 | 0.80 | 2.40 | 0.80 | 2.21 | 0.77 | 0.80 | 0.01 | NS |
| Therapeutic potential | 2.55 | 0.72 | 2.64 | 0.79 | 2.79 | 0.90 | 1.49 | 0.02^ | NS |
| Xanax | |||||||||
| Safety | −0.21 | 1.55 | −0.79 | 1.35 | −0.63 | 1.46 | 2.39 | 0.03^ | NS |
| Abuse Potential | 3.27 | 0.68 | 3.57 | 0.59 | 3.39 | 0.59 | 3.13* | 0.04^ | PC = SC > NC |
| Therapeutic potential | 2.24 | 0.90 | 1.83 | 0.88 | 1.95 | 0.77 | 3.63* | 0.04^ | PC = NC > SC |
| Alcohol | |||||||||
| Safety | −0.63 | 1.58 | −0.62 | 1.45 | −0.77 | 1.54 | 0.17 | 0.00 | NS |
| Abuse Potential | 3.35 | 0.67 | 3.36 | 0.69 | 3.35 | 0.58 | 0.00 | 0.00 | NS |
| Therapeutic potential | 0.56 | 0.76 | 0.57 | 0.67 | 0.79 | 0.62 | 2.03 | 0.02^ | NS |
*p < 0.05, **p < 0.01, ***p < 0.001.
^ small, ^^ medium, ^^^ large.
a Range of scores are −3 (extremely unsafe) to +3 (extremely safe).
b Range of scores are 0 (no abuse potential) to 4 (very strong abuse potential).
c Range of scores are 0 (no therapeutic potential) to 4 (very strong therapeutic potential).
Note. NC = No Connection; SC = Social Connection; PC = Personal Connection; M = Mean; SD = Standard Deviation.
Discussion
This is the first study to explore the relationship between psychiatrists' connection to psychedelics and their attitudes towards drugs and people who use drugs. Overall, we found that psychiatrists with a PC and SC to psychedelics scored significantly lower on the DUSS, indicating that connection to psychedelic use is associated with less stigma towards drugs and people who use drugs. These findings are congruent with general evidence that knowledge of, and experience with, stigmatized conditions/behaviors can positively influence attitudes and beliefs about these conditions/behaviors (Corrigan et al., 2003). For example, addiction specialists and providers with more personal and social exposure to people with SUDs, tend to hold less stigma than generalists towards people who use drugs (May et al., 2002; Palamar et al., 2011; van Boekel et al., 2013).
Another possible explanation for the findings of reduced stigma is that psychedelic use generates more permissive attitudes or reinforces already favorable opinions towards drugs. Contrary to this, we found that psychiatrists' direct ratings of five drugs of abuse were mostly congruent with the generally accepted scientific and clinical evidence related to those drugs. Specifically, despite PC and SC being associated with more favorable attitudes towards psilocybin's safety, abuse, and therapeutic potential, this connection did not result in different attitudes towards alcohol, methamphetamine, or ketamine, all three of which have demonstrated higher overall risk compared to psilocybin (Nutt, King, Saulsbury, & Blakemore, 2007). Furthermore, in the case of alprazolam, respondents with less connection to psychedelic use endorsed more permissive and favorable attitudes, rating alprazolam as having a lower abuse potential than those with more connection to psychedelic use, despite recent FDA updates to the Boxed Warning describing the risks of abuse, misuse, addiction, physical dependence, and withdrawal (U.S. Food & Drug Administration, 2020).
Personal drug use does not always predict less stigmatizing attitudes towards drugs and people who use drugs. For example, people who use marijuana regularly have been shown to hold more stigmatizing attitudes towards people who use other drugs (Adlaf et al., 2009), while alcohol use is associated with higher degrees of self-stigma (Luoma et al., 2007; Schomerus et al., 2011). This provides further credence to the possibility that psychedelics may uniquely engender increased empathy and decreased stigma towards drugs and people who use drugs. Thus, further investigation is warranted regarding drug use, both prescribed and illicit, among healthcare professionals and the effect upon their levels of drug use stigma. Future studies could examine the relationship between reduced drug stigma and proximity to drugs with other prosocial variables such as empathy and altruism.
In our study, 56.9% of psychiatrists reported either PC or SC to psychedelics, with 32.8% reporting a history of personal use. This is considerably higher than estimates of lifetime prevalence of psychedelic use in the general US adult population (∼10%) (Shalit, Rehm, & Lev-Ran, 2019) and may represent a growing interest in the therapeutic uses of psychedelics in psychiatric practice. A higher proportion of individuals with PC and/or SC to psychedelics were male and were younger compared to those with NC, suggesting that demographic traits may play a role in attitudes and behaviors related to psychedelic use. Enactment of national and international drug policies in the 1970s were an important watershed event that globally halted the initial surge of psychedelic research during the 1950s and 1960s (Reiff & Widge, 2020). Younger psychiatrists who are currently in training or are recent graduates have been educated during a period characterized by two notable developments: the revival of psychedelic research and increasing efforts to decriminalize psychedelics and marijuana (Chiu, Hall, Chan, Hides, & Leung, 2022). This convergence of historical factors merits scholarly attention as it continues to significantly influence the educational landscape for emerging psychiatrists.
Along these lines, 92% of those with NC to psychedelics reported that they were no longer in psychiatric training whereas only 8% of that group was psychiatry trainees. This coincides with the emergence of psychedelic interest groups among resident physicians in psychiatry training programs practice (e.g., Yale Psychedelic Science Group, Stanford Psychedelic Science Group) suggesting that social exposure to psychedelics may be contributing to the growing professional interest in psychedelics amongst trainees. Additionally, recent research (Lebedev et al., 2023) suggests a relationship between psychedelic use and non-conformist thinking styles. Interestingly, among the various substances examined, only alcohol was negatively associated with non-conformist thinking. Further, psychedelics have been shown to alter deeply rooted metaphysical beliefs, including those related to meaning, purpose, and the nature of consciousness (Nayak, Singh, Yaden, & Griffiths, 2023). An interesting avenue of further study would be to examine whether these alterations in thinking styles and beliefs influence professional training, or attitudes towards traditional approaches, within psychiatry and other medical specialties.
Prior studies have demonstrated that individual demographic traits influence opinions on marijuana legalization among the general US population, including generation (i.e. Baby Boomers), age, education, region, race, political party, and religion (Chiu et al., 2022). However, in our study, region was not associated with levels of drug-related stigma, and a recent survey study demonstrated that demographic variables, including age, sex, and level of training, did not have a significant effect on medical student attitudes towards psychedelics (Li, Fong, Hagen, & Tabaac, 2023). These discrepancies suggest the need for further study of the factors influencing professional opinions on drug use.
Limitations
This study is limited by the absence of demographic data related to ethnicity/race and gender. This limits our ability to analyze the influence of these variables on respondents' attitudes towards people who use drugs. Additionally, we inquired about positive experiences with psychedelics in the context of friends and relatives. This focused approach, while valuable for exploring the potential therapeutic benefits and positive aspects of psychedelic use within personal networks, may exclude accounts of negative or adverse experiences, which might also influence attitudes and beliefs about people who use drugs.
Conclusion
This study found that a close to 60% of US psychiatrists reported a personal or social connection to psychedelics, with one-third reporting a history of personal use (PC). Greater connection to psychedelic use was associated with decreased stigma towards drug use and people who use drugs, and with more positive views of psilocybin as a therapeutic agent, but not with more positive attitudes towards other drugs. Further, PC was associated with the greatest decreases in stigma and with the highest ratings of the therapeutic potential of psilocybin. Together, these findings suggest that psychedelic use and psychedelics may be uniquely associated with decreases in stigmatizing beliefs, engendering more positive views of people who use drugs. Future research should investigate the effects of a renewed interest in psychedelic science, and of personal psychedelic use, on attitudes and beliefs in psychiatry training and practice.
Disclosures
AKD is a board member of Source Research Foundation, and an associate editor for the Journal of Psychedelic Studies.
Acknowledgements
Funding for the study was provided by the Drug Enforcement and Policy Center, Moritz College of Law, The Ohio State University. AKD is also supported by funding from Tim Ferriss, Matt Mullenweg, Craig Nerenberg, Blake Mycoskie, the Steven and Alexandra Cohen Foundation. AKD and AWL are supported by the Center for Psychedelic Drug Research and Education in the College of Social Work at Ohio State University, funded by anonymous private donors. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
References
Adlaf, E. M., Hamilton, H. A., Wu, F., & Noh, S. (2009). Adolescent stigma towards drug addiction: Effects of age and drug use behaviour. Addictive Behaviors, 34(4), 360–364. https://doi.org/10.1016/j.addbeh.2008.11.012.
Biancarelli, D. L., Biello, K. B., Childs, E., Drainoni, M., Salhaney, P., Edeza, A., … Bazzi, A. R. (2019). Strategies used by people who inject drugs to avoid stigma in healthcare settings. Drug and Alcohol Dependence, 198, 80–86. https://doi.org/10.1016/j.drugalcdep.2019.01.037.
Chiu, V., Hall, W., Chan, G., Hides, L., & Leung, J. (2022). A systematic review of trends in US attitudes toward cannabis legalization. Substance Use & Misuse, 57(7), 1052–1061. https://doi.org/10.1080/10826084.2022.2063893.
Clinton, A. J., & Pollini, R. A. (2021). Using positive empathy interventions to reduce stigma toward people who inject drugs. Frontiers in Psychology, 12. https://www.frontiersin.org/articles/10.3389/fpsyg.2021.616729.
Corrigan, P., Markowitz, F. E., Watson, A., Rowan, D., & Kubiak, M. A. (2003). An attribution model of public discrimination towards persons with mental illness. Journal of Health and Social Behavior, 44(2), 162–179.
Davis, A. K., Barrett, F. S., & Griffiths, R. R. (2020). Psychological flexibility mediates the relations between acute psychedelic effects and subjective decreases in depression and anxiety. Journal of Contextual Behavioral Science, 15, 39–45. https://doi.org/10.1016/j.jcbs.2019.11.004.
Farhoudian, A., Razaghi, E., Hooshyari, Z., Noroozi, A., Pilevari, A., Mokri, A., … Malekinejad, M. (2022). Barriers and facilitators to substance use disorder treatment: An overview of systematic reviews. Substance Abuse: Research and Treatment, 16, 11782218221118462. https://doi.org/10.1177/11782218221118462.
Griffiths, R. R., Johnson, M. W., Richards, W. A., Richards, B. D., Jesse, R., MacLean, K. A., … Klinedinst, M. A. (2018). Psilocybin-occasioned mystical-type experience in combination with meditation and other spiritual practices produces enduring positive changes in psychological functioning and in trait measures of prosocial attitudes and behaviors. Journal of Psychopharmacology (Oxford, England), 32(1), 49–69. https://doi.org/10.1177/0269881117731279.
Hecht, M., Kloß, A., & Bartsch, A. (2022). Stopping the stigma. How empathy and reflectiveness can help reduce mental health stigma. Media Psychology, 25(3), 367–386. https://doi.org/10.1080/15213269.2021.1963991.
Herrmann, Z., Levin, A. W., Cole, S. P., Slabaugh, S., Barnett, B., Penn, A., … Jain, S. (2023). Psychedelic use among psychiatric medication prescribers: Effects on well-being, depression, anxiety, and associations with patterns of use, Reported harms, and transformative mental States. Psychedelic Medicine. https://doi.org/10.1089/psymed.2023.0030.
Hooker, S. A., Crain, A. L., LaFrance, A. B., Kane, S., Fokuo, J. K., Bart, G., & Rossom, R. C. (2023). A randomized controlled trial of an intervention to reduce stigma toward people with opioid use disorder among primary care clinicians. Addiction Science & Clinical Practice, 18, 10. https://doi.org/10.1186/s13722-023-00366-1.
IRB_00152312 (n.d.). Retrieved November 16, 2023, from https://rpa.utah.edu/study-locator/trial_detail.php?trial_id=IRB_00152312.
Johnson, M. W., Griffiths, R. R., Hendricks, P. S., & Henningfield, J. E. (2018). The abuse potential of medical psilocybin according to the 8 factors of the Controlled Substances Act. Neuropharmacology, 142, 143–166. https://doi.org/10.1016/j.neuropharm.2018.05.012.
Kennedy-Hendricks, A., McGinty, E. E., Summers, A., Krenn, S., Fingerhood, M. I., & Barry, C. L. (2022). Effect of exposure to visual campaigns and narrative vignettes on addiction stigma among health care professionals: A randomized clinical trial. JAMA Network Open, 5(2), e2146971. https://doi.org/10.1001/jamanetworkopen.2021.46971.
Kettner, H., Rosas, F. E., Timmermann, C., Kärtner, L., Carhart-Harris, R. L., & Roseman, L. (2021). Psychedelic communitas: Intersubjective experience during psychedelic group sessions predicts enduring changes in psychological wellbeing and social connectedness. Frontiers in Pharmacology, 12. https://www.frontiersin.org/articles/10.3389/fphar.2021.623985.
Lappan, S. N., Brown, A. W., & Hendricks, P. S. (2020). Dropout rates of in-person psychosocial substance use disorder treatments: A systematic review and meta-analysis. Addiction, 115(2), 201–217. https://doi.org/10.1111/add.14793.
Lebedev, A. V., Acar, K., Horntvedt, O., Cabrera, A. E., Simonsson, O., Osika, W., … Petrovic, P. (2023). Alternative beliefs in psychedelic drug users. Scientific Reports, 13(1), 16432. https://doi.org/10.1038/s41598-023-42444-z.
Levin, A., Nagib, P. B., Deiparine, S., Gao, T., Mitchell, J., & Davis, A. K. (2022 Oct 1). Inconsistencies between national drug policy and professional beliefs about psychoactive drugs among psychiatrists in the United States. International Journal of Drug Policy, 108, 103816.
Lewer, D., Tweed, E. J., Aldridge, R. W., & Morley, K. I. (2019). Causes of hospital admission and mortality among 6683 people who use heroin: A cohort study comparing relative and absolute risks. Drug and Alcohol Dependence, 204, 107525. https://doi.org/10.1016/j.drugalcdep.2019.06.027.
Li, I., Fong, R., Hagen, M., & Tabaac, B. (2023). Medical student attitudes and perceptions of psychedelic-assisted therapies. Frontiers in Psychiatry, 14, 1190507. https://doi.org/10.3389/fpsyt.2023.1190507.
Livingston, J. D., Milne, T., Fang, M. L., & Amari, E. (2012). The effectiveness of interventions for reducing stigma related to substance use disorders: A systematic review. Addiction (Abingdon, England), 107(1), 39–50. https://doi.org/10.1111/j.1360-0443.2011.03601.x.
Luoma, J. B., Twohig, M. P., Waltz, T., Hayes, S. C., Roget, N., Padilla, M., & Fisher, G. (2007). An investigation of stigma in individuals receiving treatment for substance abuse. Addictive Behaviors, 32(7), 1331–1346. https://doi.org/10.1016/j.addbeh.2006.09.008.
May, J. A., Warltier, D. C., & Pagel, P. S. (2002). Attitudes of anesthesiologists about addiction and its treatment: A survey of Illinois and Wisconsin members of the American society of anesthesiologists. Journal of Clinical Anesthesia, 14(4), 284–289. https://doi.org/10.1016/S0952-8180(02)00359-8.
Murphy, R., Kettner, H., Zeifman, R., Giribaldi, B., Kartner, L., Martell, J., … Carhart-Harris, R. (2022). Therapeutic alliance and rapport modulate responses to psilocybin assisted therapy for depression. Frontiers in Pharmacology, 12. https://www.frontiersin.org/articles/10.3389/fphar.2021.788155.
National Library of Medicine (NCT05163496). A randomized, placebo-controlled Trial of psychedelic-assisted psychotherapy with single dose Psilocybin for frontline clinicians experiencing COVID-related Symptoms of Depression and burnout (Clinical Trial Registration NCT05163496). clinicaltrials.gov. https://clinicaltrials.gov/ct2/show/NCT05163496.
Nayak, S. M., Singh, M., Yaden, D. B., & Griffiths, R. R. (2023). Belief changes associated with psychedelic use. Journal of Psychopharmacology, 37(1), 80–92. https://doi.org/10.1177/02698811221131989.
Nutt, D., King, L. A., Saulsbury, W., & Blakemore, C. (2007). Development of a rational scale to assess the harm of drugs of potential misuse. The Lancet, 369(9566), 1047–1053. https://doi.org/10.1016/S0140-6736(07)60464-4.
Palamar, J. J., Kiang, M. V., & Halkitis, P. N. (2011). Development and psychometric evaluation of scales that assess stigma associated with illicit drug users. Substance Use and Misuse, 46(12), 1457–1467. https://doi.org/10.3109/10826084.2011.596606.
Preller, K. H., & Vollenweider, F. X. (2019). Modulation of social cognition via hallucinogens and “entactogens”. Frontiers in Psychiatry, 10. https://www.frontiersin.org/articles/10.3389/fpsyt.2019.00881.
Reiff, C. M., & Widge, A. S. (2020). Psychedelics and psychedelic-assisted psychotherapy. The American Journal of Psychiatry, 20.
Schmid, Y., & Liechti, M. E. (2018). Long-lasting subjective effects of LSD in normal subjects. Psychopharmacology, 235(2), 535–545. https://doi.org/10.1007/s00213-017-4733-3.
Schomerus, G., Corrigan, P. W., Klauer, T., Kuwert, P., Freyberger, H. J., & Lucht, M. (2011). Self-stigma in alcohol dependence: Consequences for drinking-refusal self-efficacy. Drug and Alcohol Dependence, 114(1), 12–17. https://doi.org/10.1016/j.drugalcdep.2010.08.013.
Shalit, N., Rehm, J., & Lev-Ran, S. (2019). Epidemiology of hallucinogen use in the U.S. results from the National epidemiologic survey on alcohol and related conditions III. Addictive Behaviors, 89, 35–43. https://doi.org/10.1016/j.addbeh.2018.09.020.
Substance Abuse and Mental Health Services Administration (2022). Key substance use and mental health indicators in the United States: Results from the 2021 national survey on drug use and health. PEP22-07-01-005 NSDUH.
Ti, L., & Ti, L. (2015). Leaving the hospital against medical advice among people who use illicit drugs: A systematic review. American Journal of Public Health, 105(12), e53–e59. https://doi.org/10.2105/AJPH.2015.302885.
U.S. Food & Drug Administration (2020). FDA drug safety communication.
van Boekel, L. C., Brouwers, E. P. M., van Weeghel, J., & Garretsen, H. F. L. (2013). Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: Systematic review. Drug and Alcohol Dependence, 131(1–2), 23–35. https://doi.org/10.1016/j.drugalcdep.2013.02.018.
Weiss, B., Wingert, A., Erritzoe, D., & Campbell, W. K. (2023). Prevalence and therapeutic impact of adverse life event reexperiencing under ceremonial ayahuasca. Scientific Reports, 13(1), 1. https://doi.org/10.1038/s41598-023-36184-3.
World Drug Report (2023). United Nations: Office on drugs and crime. www.unodc.org/unodc/en/data-and-analysis/world-drug-report-2023.html.
Zafar, R., Siegel, M., Harding, R., Barba, T., Agnorelli, C., Suseelan, S., … Erritzoe, D. (2023). Psychedelic therapy in the treatment of addiction: The past, present and future. Frontiers in Psychiatry, 14. https://www.frontiersin.org/articles/10.3389/fpsyt.2023.118374.
