Effects of in vivo NRT sampling on smoking abstinence and NRT adherence: A randomized clinical trial.

BACKGROUND: Nicotine replacement therapy (NRT) is an effective treatment but is associated with poor adherence during smoking cessation attempts. This study aimed to determine if In Vivo Sampling, an experiential intervention that includes sampling of NRT in-session, increases NRT adherence and smoking abstinence compared to standard smoking cessation behavioral counseling. METHODS: Eligible participants were under community corrections supervision and smoked five or more cigarettes per day for the past year. Participants were randomly assigned to receive either In Vivo Sampling or standard smoking cessation behavioral counseling. Both interventions involved four 30-minute sessions and received 12 weeks of combination NRT. Self-reported NRT adherence, quit attempts, and carbon monoxide (CO)-verified smoking cessation were measured at one, three-, and six-months post-intervention. RESULTS: From 2017-2022, 515 participants were enrolled and randomized. The In Vivo Sampling group had significantly greater mean adherence to patch and lozenge NRT regimens (71 % vs. 60 %, OR: 1.63, 95 % CI: 1.36-1.96, p<.001). The In Vivo group had a significantly higher likelihood of quit attempts across time (61 % vs. 53 %, OR: 1.4, 95 % CI: 1.05-1.87, p=.021). Groups did not significantly differ on the percent of participants who had quit smoking at 6 months post-intervention (17 % In Vivo Sampling vs. 13 % standard counseling, OR: 1.43, p=.24). CONCLUSION: In Vivo Sampling demonstrated better NRT adherence and quit attempts but similar cessation rates to standard behavioral counseling. The In Vivo Sampling intervention represents a novel approach that increased behaviors typically associated with successful cessation over standard behavioral counseling.

Psilocybin-assisted therapy and HIV-related shame.

As a proposed mediator between stigma-related stressors and negative mental health outcomes, HIV-related shame has been predictive of increased rates of substance use and difficulties adhering to antiretroviral treatment among people with HIV. These downstream manifestations have ultimately impeded progress toward national goals to End the HIV Epidemic, in part due to limited success of conventional psychotherapies in addressing HIV-related shame. In a pilot clinical trial (N = 12), receipt of psilocybin-assisted group therapy was associated with a large pre-post decrease in HIV-related shame as measured by the HIV and Abuse Related Shame Inventory, with a median (IQR) change of - 5.5 (- 6.5, - 3.5) points from baseline to 3-months follow-up (Z = - 2.6, p = 0.009, r = - 0.75). A paradoxical exacerbation of sexual abuse-related shame experienced by two participants following receipt of psilocybin raises critical questions regarding the use of psilocybin therapy among patients with trauma. These preliminary findings carry potential significance for the future of HIV care.

Impact of Nicotine Replacement Therapy Sampling on Cessation-Related Processes.

OBJECTIVES: Smoking prevalence remains high among low-income smokers. Understanding processes (eg, withdrawal, craving, motivation) in early smoking cessation is crucially important for designing effective interventions for this population. METHODS: This is a secondary analysis of a novel, in-session sampling intervention (ie, In Vivo) as compared with standard care behavioral smoking cessation counseling (SC) among community-dwelling low-income smokers (n = 83). This analysis examined the effect of 5 in-session sampling interventions on cessation-related processes and perceived advantages or disadvantages of nicotine replacement therapy (NRT) products over time using daily diaries. RESULTS: The In Vivo treatment had an early positive impact in terms of decreasing withdrawal symptoms and cravings, and increasing perceived advantages to NRT, with moderate to large effect sizes. Results also showed that the treatment effectively reduced withdrawal symptoms and cravings in-session, with small-to-medium and medium-to-large effect sizes, respectively. In-session reduction of withdrawal symptoms and cravings did not occur for the SC group, with the exception of decreased withdrawal symptoms occurring during week 4. The In Vivo treatment did not impact quit goal, desire to quit, abstinence self-efficacy, perceived difficulty in quitting, motivational engagement, or perceived disadvantages to NRT. The In Vivo group reported less daily cigarette use relative to the SC group, in addition to reporting less cigarette use on days they reported greater combination NRT use. CONCLUSIONS: There is preliminary support for this In Vivo treatment over SC in reducing withdrawal, craving, and the number of cigarettes smoked per day, as well as promoting perceived advantages of NRT among low-income smokers.

Psychedelic Microdosing among Young Adults from Southern California.

Despite common depictions in the media, there is little scientific evidence on microdosing psychedelic drugs. We assessed awareness, prevalence, and dosing practices of microdosing psychedelic drugs among young adults 18-22 years old from Southern California (2018-2019). We examined whether sociodemographic factors, personality traits, mental health, or other substance use behaviors were correlated with having ever microdosed. Among 2,396 participants, 293 (12%) had heard of microdosing and 74 (3%) ever microdosed. Among those who had heard of microdosing, 79% correctly defined microdosing as taking an amount of a psychedelic much lower than a standard dose, whereas 15% misperceived microdosing as a standard psychedelic dose. Psilocybin was the most common drug ever microdosed (70%), followed by lysergic acid diethylamide (LSD, 57%). Among those who ever microdosed, ~18% reported using psychoactive doses far higher than would be generally considered a microdose. White race, male/masculine gender identity, bisexual identity, past 6-month other drug use, greater attention deficit/hyperactivity disorder symptoms, mindfulness, and sensation-seeking were positively associated with having ever microdosed in multivariable models. Young adult microdosing merits further attention from scientific and public health professionals to help prevent misperceptions and potential adverse consequences as well as explore its potential therapeutic applications.

Longitudinal associations between psychedelic use and psychotic symptoms in the United States and the United Kingdom.

It has long been speculated that psychedelic use could provoke the onset of psychosis, but there is little evidence to support this conjecture. Using a longitudinal research design with samples representative of the US and UK adult populations with regard to sex, age, and ethnicity (n = 9732), we investigated associations between psychedelic use and change in the number of psychotic symptoms during the two-month study period. In covariate-adjusted regression models, psychedelic use during the study period was not associated with a change in the number of psychotic symptoms unless it interacted with a personal or family history of bipolar disorder, in which case the number of symptoms increased, or with a personal (but not family) history of psychotic disorders, in which case the number of symptoms decreased. Taken together, these findings indicate that psychedelic use may affect psychotic symptoms in individuals with a personal or family history of certain disorders characterized by psychotic symptomatology.

Longitudinal associations between psychedelic use and meditation practices in the United States and the United Kingdom.

BACKGROUND: Previous research has proposed that there may be potential synergies between psychedelic and meditation interventions, but there are still knowledge gaps that merit further investigation. METHODS: Using a longitudinal observational research design with samples representative of the US and UK adult population with regard to sex, age, and ethnicity (N = 9732), we investigated potential associations between self-reported psychedelic use and meditation practice. RESULTS: The follow-up survey was completed by 7667 respondents (79% retention rate), with 100 respondents reporting psychedelic use during the 2-month study period (1.3% of follow-up respondents). In covariate-adjusted regression models, psychedelic use during the study period was associated with greater increases in the number of days of mindfulness meditation practice in the past week (B = 0.40, p = 0.004). Among those who reported psychedelic use during the study period, covariate-adjusted regression models revealed that the subjective experience of insight during respondents' most intense psychedelic experience in that period was also associated with greater increases in the number of days of mindfulness and loving-kindness or compassion meditation practice in the past week (B = 0.42, p = 0.021; B = 0.38, p = 0.017). Notably, more days of loving-kindness or compassion meditation practice in the past week at baseline was associated with less severe subjective feelings of death or dying during respondents' most intense psychedelic experience in the study period (B = -0.29, p = 0.037). CONCLUSIONS: Psychedelic use might lead to greater engagement with meditation practices such as mindfulness meditation, while meditation practices such as loving-kindness or compassion medication might buffer against certain challenging experiences associated with psychedelic use.

IUPHAR-review: The integration of classic psychedelics into current substance use disorder treatment models.

Substance use disorders (SUDs) have an enormous impact on public health. With classic psychedelic-assisted therapies showing initial promise in treating multiple SUDs, it is possible that these treatments will become legally available options for patients with SUDs in the future. This article highlights how classic psychedelic-assisted therapies might be integrated into current clinical practice. We first describe contemporary evidence-based treatments for SUDs and highlight how classic psychedelic-assisted therapies might fit within each treatment. We suggest that classic psychedelic-assisted therapies can be integrated into most mainstream evidence-based SUD treatments that are currently used in clinical settings, indicating broad compatibility of classic psychedelics with contemporary SUD treatment paradigms.

Longitudinal associations between psychedelic use and unusual visual experiences in the United States and the United Kingdom.

BACKGROUND: Whereas findings from case reports and cross-sectional studies suggest that naturalistic psychedelic use may be associated with unusual visual experiences that occur after the acute pharmacological effects have subsided, such findings need to be replicated in longitudinal studies to better understand potential cause-and-effect relationships. AIMS: To investigate longitudinal associations between naturalistic psychedelic use and unusual visual experiences. METHODS: Using a longitudinal observational research design with samples representative of the US and UK adult populations with regard to sex, age, and ethnicity (N = 9732), we investigated the relationship between psychedelic use during the 2-month study period and changes in past-week unusual visual experiences. RESULTS: The follow-up survey was completed by 79% of respondents (n = 7667), with 100 respondents reporting psychedelic use during the 2-month study period (1.3% of those who responded at follow-up). In covariate-adjusted regression models, the results showed that, as hypothesized, psychedelic use during the 2-month study period was associated with greater increases in unusual visual experiences. Notably, there was an interaction between lifetime psychedelic use and psychedelic use during the study period on unusual visual experiences such that those who used psychedelics for the first time reported greater increases in unusual visual experiences. CONCLUSIONS: Psychedelic use may elicit unusual visual experiences that occur after the acute pharmacological effects have subsided, especially among those who have not used psychedelics previously. Future longitudinal studies are warranted to further elucidate these relationships.

5-MeO-DMT: An atypical psychedelic with unique pharmacology, phenomenology & risk?

5-MeO-DMT is a tryptamine being developed as a potential antidepressant that may display a distinct therapeutic mechanism due to its unique pharmacology and subjective effects compared to typical psychedelics. In this article, we parallel the relatively distinct phenomenology and behavioral effects of the acute and post-acute effects of 5-MeO-DMT to those induced by epileptiform activity, particularly in instances within epileptogenic zones of the temporal lobes. This is done by reviewing aberrant 5-HT1A receptor functioning in epilepsy, noting that 5-MeO-DMT has notable 5-HT1A receptor agonist properties-and then comparing the acute behavioral and subjective effects induced by 5-MeO-DMT to those that occur in seizures. It might be that 5-MeO-DMT's therapeutic mechanism is partly mediated by evoking temporary epileptiform activity, suggesting a similarity to electroconvulsive therapy. It is also noted that "reactivations," the sudden re-experiencing of drug effects common after 5-MeO-DMT but not after typical psychedelics, may suggest that 5-MeO-DMT produces recurrent epileptiform activity. Overall, this review indicates that further evaluation of 5-MeO-DMT's unique mechanisms in research settings and among naturalistic users are warranted.