The Brief Addiction Science Information Source (BASIS)

The STASH Vol. 3(6) - Sufferin’ Succulents!? Lack of Residual Psychological Effects from Peyote Use

Peyote is a small, spineless cactus containing the hallucinogen mescaline. The Native American Church (NAC) expects members to abstain from any drug or alcohol use except peyote, which is taken only during religious ceremonies (Stewart, 1987). This circumstance creates a unique opportunity to study the psychological effects of long-term peyote use, without confounding effects from additional drug use. This week’s STASH reviews just such a study conducted on a sample of Navajo Native Americans.

Halpern, Sherwood, Hudson, Yurgelun-Todd, and Pope (2005) recruited 61 Navajo NAC members with a history of extensive ritual use of peyote (i.e., ingested peyote at least 100 times) and 79 Navajos who report minimal use of peyote, alcohol or other substance use. Researchers excluded people with a history of psychological disorders or head injury, those who self-reported illicit substance use other than peyote, and people with other markers of severe illness. Researchers use multiple linear regression to adjust for age and gender so they could properly compare the peyote users to the control group on non-users. Table 1 presents the comparison for measures from the Rand Mental Health Inventory.

   

There were no differences between study groups on demographic characteristics. The mean age of all study participants was approximately 30 years, and the majority of study participants were female and middle class. More than half of the sample had a high school education or less. Of the people contacted for the peyote and control groups, 12% did not meet inclusion criteria. The peyote group evidenced significantly more general positive affect and psychological well-being than the control group. For none of the measures were the peyote users less mentally healthy than the control group.

This study has some limitations. First, retrospective self-report of drug use is subject to self-presentation biases. For example, some participants might have underreported prior drug or alcohol use for fear of legal sanctions. Second, the peyote users belonged to a religious community and the control group did not. Therefore the increase in metal health of the peyote group might have been due to the effects of belonging to such a community. Furthermore, members of the community who might have experienced negative psychological effects from peyote might have been more likely to stop using it or not to enroll in the study; thus, these people were not included in the experimental group Also, all study participants were recruited with the assistance of a Navajo case finder so they might not be representative of this Navajo community. Third, because of the unique cultural characteristics of this sample, researchers cannot generalize study findings to other populations of peyote users or users of other types of hallucinogens (e.g., LSD).

Despite these limitations, this study demonstrates an absence of any peyote-related adverse psychological effects among a sample of Navajo Native Americans who were taking the drug within the context of religious ceremony.

What do you think?  Let us know.  Comments can be addressed to Leslie Bosworth.

References

Halpern, J. H., Sherwood, A. R., Hudson, J. I., Yurgelun-Todd, D., & Pope, H. G. (2005). The psychological and cognitive effects of long-term peyote use among Native Americans. Biological Psychiatry, 58, 624-631.

Stewart, O. (1987). Peyote religion: A history. Tulsa: University of Oklahoma Press.

Op-Ed/Editorials - Gambling and the Law®: The U.S. Gets An “F” From The WTO

The United States has failed again in trying to overturn the ruling that it is discriminating against Antigua’s Internet gambling.  Worse, by failing to admit defeat, the Department of Justice has now turned a minor legal problem, limited to the issue of interstate horseracing, into a major headache for the U.S. on all aspects of remote wagering, including purely intrastate betting on horseracing, dogracing, sports, jai alai and maybe even poker.

I would have given a law student a grade of “D” if he or she had done what the D.O.J. did.  And that’s only because I do not like to fail anyone.

Imagine a student turning in a paper containing a very weak argument.  The professor gives the paper a poor grade and explains why the argument won’t work.  The professor then gives the next assignment:  Explain what changes your client now has to make in the way it does business to comply with the law. 

The student now takes a year to answer.  And, instead of stating what changes have to be made, the student says that the client is now in complete compliance, because it deserved to win. 

This is what the D.O.J. did.

It is hard to conceive of a lawyer making the same losing arguments – again – in front of the same judges.

The original decision, April 2005, was not that bad for the U.S.  The W.T.O. had ruled that the U.S. had indeed (accidentally) agreed to let in all forms of gambling when it signed the General Agreement on Trade in Services (GATS) treaty.  But, the U.S. won on the argument that it had to outlaw people betting from their homes and offices because it has reasonable fears that remote gaming will bring in crime and corrupt the morals of America.

The only thing the U.S. lost on was the minor issue of interstate horseracing.  Congress had amended the Interstate Horseracing Act (“IHA”) in December 2000 to expressly allow individuals to bet on horseraces from their homes by phone or computer, so long as the bets were legal in the states where they were made and accepted.

The D.O.J. had raised the rather unique legal argument that the IHA did not mean what it said.  Besides being factually questionable, given the large, established cross-border betting industries involving horse races, the argument was legal nonsense.  And the W.T.O. politely said so.

The W.T.O. held that the express language of the IHA allowed cross-border betting between states of the U.S., but not with foreign nations.  The W.T.O. ordered the U.S. to change its laws.

The remedy was simple: Change the Interstate Horseracing Act into an International Horseracing Act. 
Instead Congress did nothing. 

So, of course the U.S. lost, again.  But taking ridiculous positions can lead to more than losing a case.  It can tempt a decision-maker to reexamine the entire record, to find more things wrong.

By failing to quickly comply with the W.T.O.’s original decision, the D.O.J. allowed time for Antigua to find ways to bring in all the intrastate gambling that is allowed in the U.S.  Even the D.O.J. had to admit that the Wire Act did not prohibit remote wagering that took place entirely within one state.  Antigua showed that 18 states allow people to bet from their homes, not only on horseraces, but also on dograces, sports (in Nevada) and jai alai.

Amending the IHA to include foreign licensed OTBs might not now be enough.  The only legally safe position would be to outlaw all intrastate as well as interstate betting.  But the horseracing industry is not going to let this happen.

So, the U.S. is going to have to pay off Antigua.  It will probably be cash.  Fortunately, Antigua is small, so if will be only a few tens or hundreds of millions of dollars.

But what happens if the next complaint in the W.T.O. is filed by the European Union?

© Copyright 2007.  Professor I Nelson Rose is recognized as one of the world’s leading experts on gambling law.  His latest books, Internet Gaming Law and Gaming Law: Cases and Materials, are available through his website,  www.GamblingAndTheLaw.com.

Addiction & the Humanities Vol. 3(6)- Vodka & Lighter Fluid: Russian Mortality Rates on the Rocks?

Russia is famous for ballet, Romanovs, Dostoevsky, and communism among many other things. Many people think Russian vodka is the best in the world.  However, this particular cultural strength also might be associated with a high rate of alcoholism and alcohol-related deaths. For example, research indicates that nearly half of all deaths among men 25-54 in an average Russian city were related to hazardous drinking behavior (Leon et al., 2007). This week’s Addiction and the Humanities examines a related phenomenon: surrogate alcohol consumption in Russia (McKee et al., 2005).

In Russia, the consumption of surrogate alcohols (i.e., products not sold legally for consumption), such as medicinal compounds, samogon (i.e., home-produced spirits), and aftershave is somewhat common. One study indicated that the prevalence of past year surrogate alcohol consumption in an average Russian city was 7.3% (McKee et al., 2005). Among the most common surrogates are aftershave, lighter fluid, samogon, and medicine. Many surrogates contain a lethal ethanol content, which if watered down produces more for your ruble; but, if ingested undiluted, these substances can be very harmful.  In addition, home-made spirits contain unhealthy levels of toxic alcohols whose effects are not known.

                     

People might consume surrogate alcohol for a variety of reasons. Researchers (McKee et al., 2005) suggest that one reason some Russians might do so is because of regional packaging. In Russia, surrogate alcohol often comes in 250-ml bottles that look similar to bottles used for beverage alcohol. In the West, similar products typically are available only in 30- or 50-ml bottles (McKee et al., 2005).  The surrogate products do not face administrative scrutiny or alcohol taxation rates; however, their large containers suggest that they might be marketed for consumption (McKee et al., 2005).  This hypothesis makes sense; however, it is necessary to test this hypothesis using empirical methods. One way to do this might be to compare packaging and surrogate alcohol consumption in several countries. However, confounding variables, such as cultural and individual differences as well as marketing intentions, could make it very difficult to establish causality.

There is scant research related to this topic, despite the need for empirical examination.  For example, it is not clear whether surrogate consumption rates in Russia are higher than those of other countries or if they indicate typical rates found across cultures. Cheaper cost and unregulated alcohol content, along with their colorful containers, might make surrogate alcohol use appealing. Future research should examine the relative contribution of each of these factors to the decision to consume surrogate alcohol. Additional research and increased public health awareness can help uncover the extent of surrogate alcohol use in Russia and the dangers that societal customs might unintentionally support.

What do you think? Comments can be addressed to Erinn Walsh.

References

Drogvan Genuine Russian Vodka. (2007).   Retrieved 28 June, 2007, from http://blueplanetspirits.trustpast.alibaba.com

Leon, D. A., Saburova, L., Tomkins, S., Andreev, E., Kiryanov, N., McKee, M., et al. (2007). Hazardous alcohol drinking and premature mortality in Russia: a population based case-control study. Lancet, 369, 2001-2009.

McKee, M., Suzcs, S., Sarvary, A., Adany, R., Kiryanov, N., Saburova, L., et al. (2005). The Composition of Surrogate Alcohols Consumed in Russia. Alcoholism: Clinical and Experimental Research, 29(10), 1884-1888.

Troynoi. (2007).   Retrieved 28 June, 2007, from http://www.englishrussia.com

ASHES Vol. 3(6) - Nicotine Gum, Patches, and Lozenges: Do They Work for Real-World Smokers?

Clinicians have identified nicotine replacement therapy (NRT), such as nicotine gum, patches, and lozenges, as one of the most cost-effective, life-preserving interventions available to medical science (National Institute for Clinical Excellence, 2002; Silagy, 2004). However, many smokers might use NRT sub-optimally, leading to a lower level of efficacy outside of clinical trials.  This week’s ASHES reports on a multinational cohort study testing the effectiveness of NRT as a smoking cessation tool in the ‘real world’.

West & Zhou (2007) used the Internet to recruit participants who smoked five or more cigarettes per day, were 35 to 65 years old, and intended to quit.  Researchers sent an email invitation to complete a 25-minute online survey three and six months after participants initiated a quit attempt (West et al, 2006). This follow-up measure assessed continuous abstinence since the previous assessment, methods used to quit, and nicotine dependence. 

Of the 1561 smokers from five countries who had made a quit attempt, 1089 (69.8%) were followed three and six months later.  Of these, 344 (31.6%) used NRT and 745 (68.4%) did not.  The success rate of those using NRT was 7.8%, and of those not using NRT was 4.0%.  The odds of achieving six months of abstinence, adjusted for nicotine dependence, among those using NRT were 2.2 times higher than those not using NRT.

Limitations of the study include the fact that the sample was recruited using the Internet. Individuals seeking smoking information on the Internet might not be representative of ‘real world’ smokers attempting to quit.  Self-reported quit rates could be another source of bias, but there is no reason to assume it would contribute to a difference in success rates as a function of NRT use versus non-NRT use.   

Table 1:  Advice for the Effective Use of Nicotine Replacement Therapies (adapted from Kozlowski et al (2007))

This study supports the findings of clinical trials suggesting that NRT use is associated with improved chances of long-term abstinence when used by smokers attempting to quit in the ‘real world’.  To ensure the effectiveness of NRT, these medications should be used properly; Table 1 provides information about correct NRT use.  Further research should be conducted to determine if certain nicotine replacement therapies are more effective than others.

What do you think? Comments can be addressed to Andrew Boudreau.

References

Kozlowski, L., Giovino, G., Edwards, B., DiFranza, J., Foulds, J., Hurt, R., et al. (2007). Advice on using over-the-counter nicotine replacement therapy - patch, gum, or lozenge - to quit smoking. Addictive Behaviors.

National Institute for Clinical Excellence. (2002). National Institute for Clinical Excellence Technology Appraisal Guidance No. 38 Nicotine replacement therapy (NRT) and bupropion for smoking cessation.

Silagy, C., Lancaster T, Stead L, Mant D, & Fowler G. (2004). Nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews, 3.

West, R., Gilsenan, A., Coste, F., Zhou, X., Brouard, R., Nonnemaker, J, et al. (2006). The ATTEMPT cohort: a multi-national longitudinal study of predictors, patterns and consequences of smoking cessation; introduction and evaluation of internet recruitment data collection methods. Addiction, 101(9), 1352-1361.

West, R., Zhou, X. . (2007). Is nicotine replacement therapy for smoking cessation effective in the "real world"?  Findings from a prospective multinational cohort study. Thorax Online First.

The DRAM Vol. 3(6) Unlocking the mind: Study uncovers a possible neural pathway to explain how talk therapy works.

There are various forms of therapy, but for many people help revolves around talking over past experiences.  Researchers are working to uncover the mechanisms by which talk therapy operates.  Recently, Lieberman et al. (2007) utilized functional Magnetic Resonance Imaging (fMRI), to examine how affect labeling (i.e., putting feelings to words) diminishes activity in areas of the brain associated with emotional response.

Thirty subjects completed 10 trials each of 6 experimental tasks: (a) labeling emotional facial expressions; (b) matching emotional facial expressions; (c) observing emotional facial expressions; (d) labeling the gender of facial images; (e) matching the gender of facial images; and (f) matching shapes (see Figure 1).  Researchers used fMRI to scan participants’ brains as they completed each of the tasks.  The authors suggested that if affect labeling diminishes emotional reactivity to negative stimuli, the fMRI should reveal reduced activity in the amygdala .

FIGURE 1: A display of the 6 types of stimuli used in the experiment.

 

Engaging in affect labeling, the combination of observing an emotional stimulus and labeling the emotion (i.e., stimulus a), significantly reduced amygdala activity compared to the separate tasks of observing without labeling (stimulus c) or labeling a non-emotional stimulus (stimulus d).  Additional analyses revealed a plausible neural mechanism, showing that activity in the right ventrolateral prefrontal cortex (RVLPFC), mediated by the medial prefrontal cortex (MPFC), might have dampened the amygdala activity. 

This study illustrates the dampening effect that affect labeling has on affective activity in the limbic system.  The study also provides some early insight into one aspect of how talk therapy might act on the brain to help decrease emotional distress.  Future studies could benefit from observing the effect on the amygdala and the larger limbic system produced by having people experience and verbalize their reaction to negative emotional images.  It also might be helpful to observe activity in the limbic system while participants undergo psychotherapy to see what effect therapy has on the limbic system.  Evaluating treatment is an important part of the process.  Advances in technology might contribute to a better understanding of the effectiveness of various forms of treatment for those suffering from mental illness.

What do you think? Comments on this article can be addressed to John Kleschinsky.

References

Gerrig, R. J. Z., Philip G. (2002). Psychology and life (16th ed.). Boston: Allyn and Bacon.
Lieberman, M. D., Eisenberger, Naomi I., Crockett, Molly J., Tom, Sabrina M., Pfeifer, Jennifer H.,   Way, Baldwin M. (2007). Putting feelings into words:  Affect labeling disrupts amygdala activity in response to affective stimuli. Psychological Science, 18(5), 421-427.