[HN Gopher] Psilocybin-Assisted Psychotherapy vs. Placebo in Tre...
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Psilocybin-Assisted Psychotherapy vs. Placebo in Treatment of
Alcohol Disorder
Author : pseudolus
Score : 37 points
Date : 2022-08-24 20:40 UTC (2 hours ago)
(HTM) web link (jamanetwork.com)
(TXT) w3m dump (jamanetwork.com)
| unstatusthequo wrote:
| TLDR; "Percentage of heavy drinking days during the 32-week
| double-blind period was 9.7% for the psilocybin group and 23.6%
| for the diphenhydramine group, a mean difference of 13.9%"
| loeg wrote:
| As phren0logy points out, the study was essentially unblinded.
| So it's probably worth clarifying that in a TLDR, or at least
| removing the explicit "double-blind" claim.
| phren0logy wrote:
| The comparison condition was psilocybin or diphenhydramine
| (Benadryl), and both groups got addiction counseling.
|
| >Participants correctly guessed their treatment assignment in
| 93.6% of the first sessions, reporting a mean (SD) certainty of
| 88.5% (23.2%). In the second session, 94.7% guessed correctly,
| and mean (SD) certainty was 90.6% (21.5%). Study therapists
| correctly guessed treatment 92.4% of the time for first sessions
| and 97.4% for second sessions, and their mean (SD) certainties
| were 92.8% (16.3%) and 95.4% (2.9%), respectively.
|
| This is not a criticism, as these trials are very hard to blind,
| but as you can see in hindsight they could as well have not
| bothered with blinding at all. So we need to interpret this as a
| randomized but unblinded trial.
|
| The researchers are well aware of this, and I suspect it will
| inform the next steps of their research.
|
| >Several limitations of the study warrant discussion. First,
| diphenhydramine was ineffective in maintaining the blind after
| drug administration, so biased expectancies could have influenced
| results. Control medications such as methylphenidate,42 niacin,2
| and low-dose psilocybin1 likewise did not adequately maintain
| blinding in past psilocybin trials, so this issue remains a
| challenge for clinical research on psychedelics.
| radicaldreamer wrote:
| It's going to be incredibly hard to blind a study on
| psychedelics due to their unique and powerful effects... the
| best might be some sort of VR experience with a dissociative to
| mimic a psychedelic experience, but even that seems unlikely to
| be an effective control.
| TylerE wrote:
| Especially when dealing with addiction. In other contexts, a
| fairly strong sedative is frequently used as the control,
| which is going to be a lot less subtle.
| hn_throwaway_99 wrote:
| Yeah, this was what I was thinking as well, but I think
| researchers should just accept that blinding is fundamentally
| impossible in studies like this:
|
| 1. With a high dose of shrooms, you're definitely going to know
| whether you were tripping or not.
|
| 2. If they can find another agent that mimics the effect of
| tripping, well then it's not really a placebo anymore.
| brian_c wrote:
| Netflix's _How to Change Your Mind_ (based on a book with same
| name, I believe) has been a nice digestible look at psychedelics'
| uses in various therapies, now and in the past, if you're
| interested in that kinda thing.
|
| (And, off-topic, but the scrollbar on the left here is
| interesting. Looks like it's a LTR block overflowing a RTL block.
| I don't think I like it, but, interesting!)
| dimal wrote:
| A historical counterfactual I've often wondered about is, what
| would have happened if Timothy Leary didn't exist? Prior to
| psychedelics going counterculture, there was a lot of evidence
| that they could help with alcoholism and other disorders. But
| then he went all "tune in, turn on, drop out", threw acid
| parties, and then psychedelics got tangled up with counterculture
| ideas instead of psychology, and we got the drug war instead.
| Maybe that was all inevitable, but maybe it wasn't?
| mistrial9 wrote:
| it is possible that there were widespread uses of psychedelics
| in multiple earlier civilizations, but those social systems
| either did not last themselves or were defeated in wars and
| erased. Some of the vigorous rhetoric about "pagans" in the
| middle ages Europe for example.. psychoactive substances are
| not new
| radicaldreamer wrote:
| The primary thing that happened is the rise and power of the
| catholic church, which saw the "direct" spiritual experience
| offered by psilocybin mushrooms and other psychedelic plants
| as a direct threat to their gatekeeping role and violently
| stamped out knowledge and use of such substances.
|
| Similarly, the moral panic about psychedelics was because it
| threatened vested business and corporate interests (and the
| economic war with communism), especially when slogans such as
| "Turn on, tune in, drop out" because associated with them.
| xupybd wrote:
| Drug use has been seen as witchcraft withing Christianity
| from the beginning of Christianity.
| https://www.massbible.org/exploring-the-bible/ask-a-
| prof/ans...
| numtel wrote:
| Alternatively, see John Allegro's (one of the people who
| worked on deciphering the Dead Sea scrolls) The Sacred
| Mushroom and the Cross which posits that Jesus actually
| was a mushroom.
| mistrial9 wrote:
| well.. so lets be broader here.. I listened to "Guns, Germs
| and Steel" on audiotape and that book gives great examples
| of innate advantages to the peoples in Europe, about grains
| and farm animals and a few other things.. that were
| multiplied over time for advantage.. However, they do not
| talk about the particular collection of psychoactive
| substances in that part of the world -- they occur all over
| the globe. But some of the drugs used in Europe were pretty
| awful actually. I imagine that taken badly, some fairly
| awful results could happen over time.. see the Baba-yaga
| group of stories, or just plain old bad health outcomes..
|
| So yes it is easy to fault the Church of Rome and others
| like it, but also there is benefit in gentler means of
| enlightenment.. is that not the higher evolutionary goal?
| Having more powerful black-metal shows or whatever, is not
| fertile and not productive over time.. Whereas the focus of
| the Church of Rome now is the family, stability and
| arguably forming the social strength to make strong
| military. There are other groups to pick on that way, not
| exclusive to the Church of Rome.
|
| I go out of my way to explain this because I also have
| Catholic-or-not conflicts in my own family tree.. so it is
| a real issue, for sure. I will also add that schizophrenia
| is a real and serious condition, and could be ignorantly
| connected to some strong drugs. Sadly, marijuana is now
| linked to schizophrenia in a small percentage of the
| population that is prone to that.. So .. more research
| needed.
| mbesto wrote:
| Whatever drug the anti-war crowd was going to use was going to
| get banned by Nixon.
|
| _"You understand what I'm saying? We knew we couldn't make it
| illegal to be either against the war or black, but by getting
| the public to associate the hippies with marijuana and blacks
| with heroin. And then criminalizing both heavily, we could
| disrupt those communities," Ehrlichman said. "We could arrest
| their leaders. raid their homes, break up their meetings, and
| vilify them night after night on the evening news. Did we know
| we were lying about the drugs? Of course we did."_
|
| - Nixon domestic policy chief John Ehrlichman
| lettergram wrote:
| Take the same mentality and apply it to the politics today;
| gets interesting. What's being vilified? What are the
| associates that may or may not be factual? Everything is
| propaganda
| Alex3917 wrote:
| The reason they were banned from Harvard is (allegedly) mainly
| because the researchers were having sex with the undergrads,
| not because Leary was telling kids to drop out. IIRC it was
| Andrew Weil who wrote the article about it in the crimson.
| bamboozled wrote:
| What's more mind boggling to me is Americans driving around
| with freedom written on our big ol trucks but we're not legally
| allowed to take...a mushroom. The cognitive dissonance is huge.
| geraldwhen wrote:
| A destroying angel is a mushroom and eating it is suicide,
| which is illegal I think everywhere in America.
|
| Just because something grows in nature does not mean it is
| safe or must be tolerated.
| sweetheart wrote:
| We both know that the above poster wasn't trying to make
| the point that mushrooms are intrinsically innocuous. It's
| obvious from context which mushroom they're talking about.
| Your comment serves only to make discussing the original
| point harder, and erodes everyone's ability to have an
| interesting conversation by adding inconsequential fluff to
| the thread.
| SQueeeeeL wrote:
| Damn, this is some peak hackernews vibes. Bringing up
| eating poison as a way to deflect from thinking too hard
| about the contradiction of America's cultural meme of
| intense individual freedom against extremely restrictive
| governments policies against psychedelic consumption
| pengaru wrote:
| Didn't Ken Kesey and the Merry Pranksters cause more trouble in
| this vein than Leary?
| kallistisoft wrote:
| I find that effective dosage is the most surprising aspect of
| this study
|
| >Interventions Study medications were psilocybin, 25 mg/70 kg, vs
| diphenhydramine, 50 mg (first session), and psilocybin, 25-40
| mg/70 kg, vs diphenhydramine, 50-100 mg (second session).
| Psychotherapy included motivational enhancement therapy and
| cognitive behavioral therapy.
|
| 25mg is an extremely small dose! Much smaller than most micro-
| dose regiments at 0.5g
| ThePowerOfFuet wrote:
| Are you perchance going by weight of dried fruit?
| hn_throwaway_99 wrote:
| No, 0.5g is the weight of a dried mushroom for microdosing.
|
| From another article I read:
|
| > Common varieties such as Psilocybe cubensis and Psilocybe
| semilanceata contain around 6 -10mg of psilocybin per gram of
| dried mushrooms
|
| So a 25mg dose of psilocybin is on the order of 2.5 - 4 grams
| of dried mushrooms, which is a hefty amount.
| juancampa wrote:
| They are measuring how much psilocybin (the compound) while
| people normally measure how much dry mushrooms by weight
| eklitzke wrote:
| 25mg is not a small dose if you're actually measuring the
| psilocybin rather than the dried weight of the mushroom fruit.
| The exact psilocybin weight ratio depends on the strain of
| mushroom, but typically dried P. Cubensis is about 1%
| psilocybin by weight. This means that 25mg of psilocybin
| roughly corresponds to 2.5g of dried shrooms.
| cwkoss wrote:
| 0.5g is a dry weight dosage of the whole mushroom bodies. 0.5g
| of dry mushroom contains ~7.5-50mg of psilocybin/psilocin.
| wearigo wrote:
| This comment is wrong. The study is reporting dosages for pure
| psilocybin. The number your referring to (0.5g) is for common
| psilocybe cubensis mushrooms.
|
| If we assume that "standard" cubensis contains 0.06%
| psilocybin:
|
| https://www.leafly.com/learn/psychedelics/how-to-dose-mushro...
|
| Then one gram contains 6mg, so if we want to take 25mg of
| psilocybin we will need to ingest ~4.17g of cubes. Which is
| pretty much your standard therapeutic dose.
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