A Qualitative Analysis of First-Hand Accounts of Diphenhydramine Misuse Available on YouTube.

Deliriants are the least studied class of hallucinogens and display noticeable subjective effects, including dysphoria, hallucinations, and substantial alterations in thought. High doses of diphenhydramine (DPH), an over-the-counter antihistamine medication, can produce deliriant effects due to secondary anticholinergic activity. We sought to characterize the subjective experiences produced by DPH misuse to better understand deliriants more broadly and the context under which DPH misuse occurs. To conduct our analysis, 32 first-hand accounts of DPH misuse publicly available in YouTube videos were analyzed using inductive thematic analysis. Video makers discussed alterations in most sensory modalities, confusion, and a tendency for strongly unpleasant experiences. Occasionally, video makers reported positive effects, although these were rare and often overshadowed by negative aspects of the experience. Video makers frequently warned against misusing DPH, and these individuals occasionally reported adverse post-acute effects. Despite the prevalence of adverse experiences, patterns of repeated misuse were sometimes discussed. Motives for misusing DPH, when mentioned, included accessibility, affordability, and legality. Overall, findings suggest DPH misuse can produce substantial psychoactive effects that are often distressing and share some phenomenological overlap with experiences produced by psychosis.

Perceptions of safety, subjective effects, and beliefs about the clinical utility of lysergic acid diethylamide in healthy participants within a novel intervention paradigm: Qualitative results from a proof-of-concept study.

BACKGROUND: Classic psychedelics show promise in the treatment of mental health conditions; however, more scalable intervention protocols are needed to maximize access to these novel therapeutics. In this proof-of-concept study, perceptions of safety, subjective effects, and beliefs about the clinical utility of lysergic acid diethylamide (LSD) were evaluated among healthy participants (N = 31) administered 50 to 100 µg LSD in a treatment paradigm conceptualized as more scalable than traditional approaches to administering classic psychedelics. METHODS: Semi-structured interviews assessed participants' expectations, experience, and thoughts on the safety and efficacy of the study design. These interviews were transcribed for thematic analysis relating to perceptions of safety, subjective effects, and beliefs about the clinical utility of LSD. RESULTS: Most participants felt safe throughout the study, with a minority reporting concerns related to having a challenging experience that diminished over time. Participants attributed their feelings of safety to the study structure and support of their attendants, which allowed them to "let go" and immerse themselves in the experience without pre-occupation. Furthermore, participants reported transcendent, mystical-type experiences characteristic of classic psychedelics, with almost half highlighting the prominent role played by music during the acute period of drug action. Finally, participants endorsed support for the clinical utility of LSD in controlled environments, expressing the belief that LSD is safe and has the potential to help others. CONCLUSION: Findings provide preliminary support for the feasibility of this scalable interventional paradigm and set the stage for future critical research with clinical populations.

Understanding Barriers and Facilitators to the Uptake of Best Practices for the Treatment of Co-Occurring Chronic Pain and Opioid Use Disorder.

Objective: Patients with a combination of chronic pain and opioid use disorder have unique needs and may present a challenge for clinicians and health care systems. The objective of the present study was to use qualitative methods to explore factors influencing the uptake of best practices for co-occurring chronic pain and opioid use disorder in order to inform a quantitative survey assessing primary care provider capacity to appropriately treat this dual diagnosis. Methods: Guided by the Consolidated Framework for Implementation Research (CFIR), semi-structured qualitative interviews were conducted with 11 primary care providers (PCPs) to inform the development of a questionnaire. Interviews were audio-recorded and transcribed verbatim. Fifteen comments from an open-ended question on the questionnaire were added to the analyses as they described factors that were not elucidated in the interviews. Barriers and facilitators were identified and categorized using the CFIR codebook. Results: The most frequently described barriers were cost and inadequate access to appropriate treatments, external policies, and available resources (e.g., risk assessment tools). The most frequently described facilitators were the presence of a network or team, patient-specific needs, and the learning climate. Knowledge and beliefs were frequently described as both barriers and facilitators. Conclusions: While substantial funding has been allocated to initiatives aimed at increasing PCP capacity to treat this population, numerous barriers to adopting appropriate practices still exist. Future research should focus on developing and testing implementation strategies that leverage the facilitators and overcome the barriers illustrated here to improve the uptake of evidence-based recommendations for the treatment of co-occurring chronic pain and opioid use disorder.

Development and validation of the Capacity to Treat Chronic Pain and Opioid Use Disorder (CAP-POD) questionnaire.

Background: Patients with co-occurring chronic pain and opioid use disorder (OUD) have unique needs that may present challenges for clinicians and health care systems. Primary care providers' (PCPs) capacity to deliver high quality, research-informed care for this population is unknown. The objective of this study was to develop and test a questionnaire of factors influencing PCP capacity to treat co-occurring chronic pain and OUD. Methods: Capacity to Treat Co-Occurring Chronic Pain and Opioid Use Disorder (CAP-POD) questionnaire items were developed over a 2-year process including literature review, semi-structured interviews, and expert panel review. In 2018, a national sample of 509 PCPs was recruited through email to complete a questionnaire including the initial 44-item draft CAP-POD questionnaire. CAP-POD items were analyzed for dimensionality, inter-item reliability, and construct validity. Results: Principal component analysis resulted in a 22-item questionnaire. Twelve more items were removed for parsimony, resulting in a final 10-item questionnaire with the following 4 scales: (1) Motivation to Treat patients with chronic pain and OUD (α = .87), (2) Trust in Evidence (α = .87), (3) Assessing Risk (α = .82), and (4) Patient Access to therapies (α = .79). These scales were associated with evidence-based practice attitudes, knowledge of pain management, and self-reported behavioral adherence to best practice recommendations. Conclusion: We developed a brief, 10-item questionnaire that assesses factors influencing the capacity of PCPs to implement best practice recommendations for the treatment of co-occurring chronic pain and OUD. The questionnaire demonstrated good reliability and initial evidence of validity, and may prove useful in future research as well as clinical settings. Plain language abstract: Patients with co-occurring chronic pain and opioid use disorder (OUD) have unique needs that may present challenges for clinicians and health care systems. Primary care providers' (PCPs) ability to deliver high quality, research-informed care for this population is unknown. There are no validated instruments to assess factors influencing PCP capacity to implement best practices for treating these patients. The objective of this study was to develop and test a questionnaire of factors influencing PCP capacity to treat co-occurring chronic pain and OUD. We recruited 509 PCPs to participate in an online questionnaire that included 44 potential items that assess PCP capacity. Analyses resulted in a 10-item questionnaire that assesses factors influencing capacity to implement best practice recommendations for the treatment of co-occurring chronic pain and OUD. PCPs reported moderately high confidence in the strength and quality of evidence for best practices, and in their ability to identify patients at risk. However, PCPs reported low motivation to treat co-occurring chronic pain and OUD, and perceived patients' access to relevant services as suboptimal, highlighting two areas that should be targeted with tailored implementation strategies. The 10-item Capacity to Treat Chronic Pain and Opioid Use Disorder (CAP-POD) questionnaire can be used for two purposes: (1) to assess factors influencing PCP capacity before implementation and identify areas that may require improvement for implementation and (2) to evaluate implementation interventions aimed at increasing PCP capacity to treat this population.

Narrative identity, rationality, and microdosing classic psychedelics.

BACKGROUND: Microdosing involves ingesting a small dose of a classic psychedelic (e.g., LSD and psilocybin) at regular intervals for prolonged periods. The practice is said to reduce anxiety, improve mood, and offer several creative and practical benefits to users. Using the narrative identity theoretical framework, our aim was to explore the experiences of those who microdosed classic psychedelics. Specifically, we sought to understand how and why they began microdosing and how they made sense of their actions in the context of their conventional lives. METHODS: To understand the experiences of those who microdose classic psychedelics, we rely on data collected from semi-structured interviews with 30 people who had microdosed. RESULTS: Participants saw themselves as conventional citizens who microdosed for rational and instrumental purposes. They emphasized the rationality of microdosing by discussing (1) the practicality of their procurement and administration processes, (2) the connection between their microdosing practice and their general awareness in health and wellness, and (3) the benefits of the practice. CONCLUSION: Participants described their microdosing in the context of embracing traditional middle-class values. This created social distance between themselves and those who use drugs recreationally. While people who use drugs recreationally typically construct boundaries by distancing themselves from symbolic others (i.e., "crackheads," "meth heads," "junkies"), microdosers constructed boundaries by emphasizing connections to conventional citizens who embrace middle-class values. This connection to conventional citizens allows them to normalize their drug use and facilitates persistence.

Harm Reduction Strategies and Disinhibitors Among Women Who Use Heroin.

People who use illicit drugs face significant physical risks in the acquisition, use, and aftermath of their use. This is particularly the case among those who use heroin in view of recent spikes in heroin-associated overdoses, injuries, and deaths. Using a restrictive deterrence framework, we identify the risks that women associate with chronic heroin use and the ways they seek to manage those risks. We also examine psychological and physiological disinhibitors that contribute to women reducing use of risk reduction strategies. We find from the narratives that nearly all of the women initially engaged in specific strategies to manage risk; however, as they continued using the drug, they began to abandon even the simplest of measures. Our findings shed light on the limitations of harm reduction strategies and inform the theoretical tradition of restrictive deterrence and the importance of disinhibitors.

Symbolic perceptions of methamphetamine: Differentiating between ice and shake.

BACKGROUND: Although public perceptions of methamphetamine (meth) consider all forms of the drug as the same, this is not true among those who use it. Our aim is to examine how those who use meth perceive two forms of meth (ice and shake) using the theoretical framework of symbolic boundaries. METHODS: We rely on data collected from a photo-ethnography with people who use methamphetamine in rural Alabama. The ethnography consisted of formal interviews (with 52 participants), informal observations, and photography. RESULTS: Participants had a strong preference for ice (49 of 52 preferred ice over shake). In discussing why they prefer ice they point to the various short- and long-term health problems associated with shake. This distinction allowed them to create symbolic definitions of shake as being dirty due to impure chemicals and its users as desperate. CONCLUSION: We argue that this symbolic differentiation of the two forms allows users to frame themselves as rational users (i.e., they avoid the unsafe form of meth) and shape use patterns and prevalence, with shake being used infrequently and often intravenously.

The relationships of classic psychedelic use with criminal behavior in the United States adult population.

Criminal behavior exacts a large toll on society and is resistant to intervention. Some evidence suggests classic psychedelics may inhibit criminal behavior, but the extent of these effects has not been comprehensively explored. In this study, we tested the relationships of classic psychedelic use and psilocybin use per se with criminal behavior among over 480,000 United States adult respondents pooled from the last 13 available years of the National Survey on Drug Use and Health (2002 through 2014) while controlling for numerous covariates. Lifetime classic psychedelic use was associated with a reduced odds of past year larceny/theft (aOR = 0.73 (0.65-0.83)), past year assault (aOR = 0.88 (0.80-0.97)), past year arrest for a property crime (aOR = 0.78 (0.65-0.95)), and past year arrest for a violent crime (aOR = 0.82 (0.70-0.97)). In contrast, lifetime illicit use of other drugs was, by and large, associated with an increased odds of these outcomes. Lifetime classic psychedelic use, like lifetime illicit use of almost all other substances, was associated with an increased odds of past year drug distribution. Results were consistent with a protective effect of psilocybin for antisocial criminal behavior. These findings contribute to a compelling rationale for the initiation of clinical research with classic psychedelics, including psilocybin, in forensic settings.

Creating visual differences: Methamphetamine users perceptions of anti-meth campaigns.

BACKGROUND: Because of increased law enforcement and subsequent media attention, methamphetamine users appear in the public's imagination as diseased, zombie-like White trash. We explore methamphetamine users' perceptions about whether the images, people, and situations in anti-methamphetamine campaigns reflect their own lives and experiences using meth. METHODS: To explore these perceptions, we used photo-elicitation interviews with 47 people who used methamphetamine (30 former and 17 active). Specifically, we presented participants with images from the Faces of Meth and the Montana Meth Project campaigns to stimulate discussion. RESULTS: We found that participants believed these ads did not reflect their personal experiences and consequently were ineffective at curtailing their own methamphetamine use. They believed that the ads represented a certain type of methamphetamine user, particularly those they defined as dysfunctional users. They created symbolic boundaries between themselves and those portrayed in the ads to show how they differed, which allowed them to believe that the ads were not relevant to their experiences. CONCLUSIONS: Findings suggest that there are unintended consequences to inauthentic/dramatic imagery. Participants did not believe they were like those in the ads-thus saw no reason to quit or seek help. Consequently, overly stigmatizing portraits of users may act as barriers to desistence. The findings have implications for designing anti-methamphetamine campaigns.

Alcohol and violence in nightlife and party settings: A qualitative study.

INTRODUCTION AND AIMS: In 'binge drinking' cultures, there is a strong association between alcohol consumption and violence. At the same time, several studies suggest that this link is cultural and contextual. We explore the role of alcohol in incidents of violence in nightlife settings. DESIGN AND METHODS: We used qualitative interviews with 104 Norwegians (52 men and 52 women, mean age 25 years) who binge drink and party in nightlife settings. RESULTS: Alcohol both sparks and constrains violence in these contexts. When participants use alcohol, they expect conflicts to occur and blame alcohol intoxication for such behaviour. The packed settings of nightlife and parties combined with the effects of alcohol can induce violence through personal affronts, heightened emotions and jealousy. At the same time, nightlife settings constrain violence. That is, binge drinkers excuse misbehaviour when it is attributed to alcohol. In addition, audiences in these setting often go to great lengths to stop fights. Combined, these factors help explain why violence occurs and why it usually does not escalate. DISCUSSION AND CONCLUSIONS: The association between alcohol and violence can be understood by more closely examining the cultural and situational context where the events occur. This link is not primarily related to the psychopharmacological properties of alcohol, but rather it is associated with situational factors and cultural norms regarding how to behave while intoxicated. Strategies aiming at reducing violence in nightlife should take such factors into consideration. [Pedersen W, Copes H, Sandberg S. Alcohol and violence in nightlife and party settings: A qualitative study. Drug Alcohol Rev 2016;35:557-563].

Examining the relationship between religiosity and self-control as predictors of prison deviance.

The relationship between religiosity and crime has been the subject of much empirical debate and testing over the past 40 years. Some investigators have argued that observed relationships between religion and crime may be spurious because of self-control, arousal, or social control factors. The present study offers the first investigation of religiosity, self-control, and deviant behavior in the prison context. We use survey data from a sample of 208 recently paroled male inmates to test the impact of religiosity and self-control on prison deviance. The results indicate that two of the three measures of religiosity may be spurious predictors of prison deviance after accounting for self-control. Participation in religious services is the only measure of religiosity to significantly reduce the incidence of prison deviance when controlling for demographic factors, criminal history, and self-control. We conclude with implications for future studies of religiosity, self-control, and deviance in the prison context.

Examining the Relationship Between Religiosity and Self-Control as Predictors of Prison Deviance.

The relationship between religiosity and crime has been the subject of much empirical debate and testing over the past 40 years. Some investigators have argued that observed relationships between religion and crime may be spurious because of self-control, arousal, or social control factors. The present study offers the first investigation of religiosity, self-control, and deviant behavior in the prison context. We use survey data from a sample of 208 recently paroled male inmates to test the impact of religiosity and self-control on prison deviance. The results indicate that two of the three measures of religiosity may be spurious predictors of prison deviance after accounting fovr self-control. Participation in religious services is the only measure of religiosity to significantly reduce the incidence of prison deviance when controlling for demographic factors, criminal history, and self-control. We conclude with implications for future studies of religiosity, self-control, and deviance in the prison context.

"Keepin' my mind right": identity maintenance and religious social support in the prison context.

It is not uncommon for inmates to experience religious conversions in prison. These conversions allow inmates to portray themselves in a prosocial light and help them to establish a sense of control in their current lives, regardless of their past. Despite the value of these conversions, maintaining a new outlook of one's self is remarkably difficult. Using semistructured interviews with 63 inmates who had undergone a religious conversion, the authors examine the process that they engaged in to keep these new senses of self. The narratives suggest that they relied on various social support mechanisms to keep themselves focused and inspired. Specifically, they stressed the importance of connecting with positive others in formal and informal settings, sharing their stories with those in need, and reflecting on their daily choices. It is through these strategies that inmates keep the inspiration and focus to "keep their minds right."

The effects of criminal justice contact on employment stability for white-collar and street-level offenders.

Criminologists increasingly have studied the effects of criminal justice contact on a broad range of offenders' adult outcomes. However, virtually all of this research focuses exclusively on street-level offenders. With the use of a unique data set that includes street-level and white-collar offenders, we investigated the odds of regaining steady employment following criminal justice contact by offender type. Specifically, we investigated the effects of age of onset, number of prior arrests, total time sentenced, timing of first arrest, and timing of first incarceration on employment stability for both types of offenders, while controlling for family background factors, race, educational attainment, and age. Overall, we found that white-collar offenders are better able to rebound following contact with the criminal justice system. However, when the accrue multiple arrests and are arrested or incarcerated before the age of 24, white-collar offenders face the same obstacles to employment stability as their street-level counterparts.