[HN Gopher] Psilocybin-Assisted Psychotherapy vs. Placebo in Tre... ___________________________________________________________________ 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. ___________________________________________________________________ (page generated 2022-08-24 23:00 UTC)