Showing papers in "Journal of Psychoactive Drugs in 2005"

Drug tourism or spiritual healing? Ayahuasca seekers in Amazonia.

Abstract: This research addresses the question of whether Westerners who seek traditional spiritual medicine known as ayahuasca can be best characterized as "drug tourists" or as people pursuing spiritual and therapeutic opportunities. Participants in an ayahuasca retreat in Amazonia were interviewed regarding their motivations for participation and the benefits they felt that they received. These findings from the interviews were organized to reveal common motivations and benefits. Contrary to the characterization as "drug tourists", the principal motivations can be characterized as: seeking spiritual relations and personal spiritual development; emotional healing; and the development of personal self-awareness, including contact with a sacred nature, God, spirits and plant and natural energies produced by the ayahuasca. The motivation and perceived benefits both point to transpersonal concerns, with the principal perceived benefits involving increased self awareness, insights and access to deeper levels of the self that enhanced personal development and the higher self, providing personal direction in life.

Seeking Safety plus Exposure Therapy: an outcome study on dual diagnosis men.

Abstract: This study arose out of a prominent clinical need: effective treatment for comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD) in civilian men. This dual diagnosis is estimated to occur in up to 38% of men in substance abuse treatment, and generally portends a more severe clinical course than SUD alone. Clinical issues include self-harm, suicidality, perpetration of violence against others, and HIV risk behaviors. This study appears to be the first outcome trial to address a sample of civilian men with PTSD and SUD using manualized psychosocial treatment. It evaluates a novel combination treatment, Seeking Safety plus Exposure Therapy-Revised. The former is a coping skills treatment designed for PTSD and SUD; the latter is an adaptation of Foa's exposure therapy, modified for PTSD and SUD. In this small sample (n = 5) outpatient pilot trial, patients with current PTSD and current SUD were offered 30 sessions over five months, with the option to select how much of each type of treatment they preferred. Outcome results showed significant improvements in drug use; family/social functioning; trauma symptoms; anxiety; dissociation; sexuality; hostility; overall functioning; meaningfulness; and feelings and thoughts related to safety. Trends indicating improvement on 11 other outcome variables were also found. Treatment attendance, satisfaction, and alliance were extremely high. The need for further evaluation using more rigorous methodology is discussed.

Altered states of consciousness and short-term psychological after-effects induced by the first time ritual use of ayahuasca in an urban context in Brazil.

Abstract: This report describes psychological assessments of the first time ritual use of ayahuasca in the religious groups Uniao do Vegetal and Santo Daime. Nineteen subjects who tried the beverage in Santo Daime rituals and nine subjects who tried it in Uniao do Vegetal rituals were evaluated one to four days before their first ayahuasca experience in life and one to two weeks after this experience. Semistructured interviews and a structured psychiatric scale were used in the first evaluation to elicit set variables concerning attitudes towards the ayahuasca experience and to elicit mental health status. Mental health status was reassessed in the second evaluation, which also included a semistructured interview concerning the phenomenology of altered states of consciousness (ASCs). Predominantly positive expectancies concerning the ayahuasca experience were the most prominent findings concerning set variables. Visual phenomena, numinousness, peacefulness, insights and a distressing reaction were the most salient ASC experiences. A significant reduction of the intensity of minor psychiatric symptoms occurred in the Santo Daime group after the hallucinogen experience. Subjects in both groups reported behavioral changes towards assertiveness, serenity and vivacity/joy. The set and setting hypothesis, suggestibility processes, as well as the supposed unique effects of ayahuasca are used in discussing these findings.

Report on psychoactive drug use among adolescents using ayahuasca within a religious context

Abstract: Ritual use of ayahuasca within the context of the Brazilian ayahuasca churches often starts during late childhood or early adolescence. Premature access to psychoactive drugs may represent a risk factor for drug misuse. Conversely, religious affiliation seems to play a protective role in terms of substance abuse. The objective of this study was to describe patterns of drug use in a sample of adolescents using ayahuasca within a religious setting. Forty-one adolescents from a Brazilian ayahuasca sect were compared with 43 adolescents who never drank ayahuasca. No significant differences were identified in terms of lifetime substance consumption. Throughout the previous year period, ayahuasca adolescents used less alcohol (46.31%) than the comparison group (74.4%). Recent use of alcohol was also more frequent among the latter group (65.1%) than among ayahuasca drinkers (32.5%). Although not statistically significant, slight differences in terms of patterns of drug use were definitely observed among groups. Despite their early exposure to a hallucinogenic substance, adolescents using ayahuasca in a controlled setting were mostly comparable to controls except for a considerably smaller proportion of alcohol users. Religious affiliation may have played a central role as a possible protective factor for alcohol use. Thus, ayahuasca seems to be a relatively safe substance as far as drug misuse is concerned.

Ayahuasca in adolescence: a preliminary psychiatric assessment.

Abstract: Ayahuasca is believed to be harmless for those (including adolescents) drinking it within a religious setting. Nevertheless controlled studies on the mental/ psychiatric status of ritual hallucinogenic ayahuasca concoction consumers are still lacking. In this study, 40 adolescents from a Brazilian ayahuasca sect were compared with 40 controls matched on sex, age, and educational background for psychiatric symptomatology. Screening scales for depression, anxiety, alcohol consumption patterns (abuse), attentional problems, and body dysmorphic disorders were used. It was found that, compared to controls, considerable lower frequencies of positive scoring for anxiety, body dismorphism, and attentional problems were detected among ayahuasca-using adolescents despite overall similar psychopathological profiles displayed by both study groups. Low frequencies of psychiatric symptoms detected among adolescents consuming ayahuasca within a religious context may reflect a protective effect due to their religious affiliation. However further studies on the possible interference of other variables in the outcome are necessary.

Phytochemical analyses of Banisteriopsis caapi and Psychotria viridis.

Abstract: A total of 32 Banisteriopsis caapi samples and 36 samples of Psychotria viridis were carefully collected from different plants on the same day from 22 sites throughout Brazil for phytochemical analyses. A broad range in alkaloid distribution was observed in both sample sets. All B. caapi samples had detectable amounts of harmine, harmaline and tetrahydroharmine (THH), while some samples of P. viridis had little or no detectable levels of N,N-dimethyltryptamine (DMT). Leaves of P. viridis were also collected from one plant and analyzed for DMT throughout a 24-hour cycle.

HIV prevalence and correlates of receptive needle sharing among injection drug users in the Mexican-U.s. border city of Tijuana.

Abstract: Injection drug use is a growing but understudied problem in Tijuana, a city situated on the northwestern Mexico-U.S border. The authors studied factors associated with receptive needle sharing in an effort to inform prevention activities. In 2003, street-recruited injection drug users (IDUs) in Tijuana underwent interviews on injection risk behaviors and rapid HIV antibody tests. Logistic regression was used to identify correlates of receptive needle sharing at the last injection episode. Of 402 IDUs, 87.6% were male; the median age was 34. HIV prevalence was 4.01% (95%CI: 2.29–6.51). One third reported receptive needle sharing at last injection. Factors independently associated with receptive needle sharing were years living in Tijuana (Adjusted Odds Ratio [AdjOR]= 0.97 per year, 95% CI: 0.96–0.99), being bisexual/homosexual (AdjOR=2.12; 95% CI: 1.30 – 3.44), unemployed (AdjOR=2.5; 95% CI: 1.52–4.10), never having an HIV test (AOR: 4.02; 95% CI: 2.44–6.60), having friends who placed importance o...

Correlates of initiation of injection drug use among young drug users in Baltimore, Maryland: the need for early intervention.

Abstract: This article examines individual and social factors associated with initiation of illicit drug injection, with a focus on racial differences. Data were derived from across-sectional survey of young injection and noninjection drug users in Baltimore, Maryland. Participants were aged 15 to 30 and had initiated use of heroin, cocaine, and/or crack within the prior five years. Bivariate and multivariate logistic regression models were used to identify correlates of injection initiation. Of 579 drug users, 73% were injectors, 56% were male, and 41% were African American. In a multivariate model controlling for age, correlates of injection initiation were: being an African American male [Adjusted Odds Ratio (AOR): 0.08; 95% Confidence Interval (CI): 0.04, 0.17] or female (AOR = 0.12; 95%CI: 0.06, 0.27) compared to being a White male; younger age of first use of alcohol, marijuana, or inhalants (AOR=0.73; 95%CI: 0.65, 0.82); shorter time between first use of alcohol, marijuana, or inhalants and first use of heroin, crack, or cocaine (per year decrease, AOR=0.63, 95%CI: 0.40, 0.87); parental drug use (AOR=0.54, 95%CI: 0.32, 0.92); seeing someone inject prior to injection, AOR=1.96, 95%CI: 1.01, 3.50); and crack smoking (AOR=1.77, 95%CI: 1.07, 2.99). Early drug use patterns and drug exposure factors are associated with initiation injection. Interventions are needed that target noninjection drug users to prevent transition to injection drug use.

Sexual risk behaviors and substance use among alcohol abusing HIV-positive men who have sex with men.

Abstract: An ethnically diverse sample (79.0% men of color) of HIV seropositive (HIV+) men who have sex with men (MSM) with alcohol use disorders from the New York City metropolitan area was recruited from a variety of settings frequented by such men. Data were collected using quantitative assessments and calendar based techniques at the baseline assessment of a longitudinal study assessing the relationship between alcohol and substance use and sexual risk behaviors as well as alcohol use and HIV disease progression. Data were selected on a sample of 253 HIV+ MSM (mean age = 38.55, SD = 6.73). Of these, the majority of participants (80.2%, n=203) reported engaging in sexual behaviors with casual partners. In terms of sexual behaviors that put partners at greatest risk for HIV transmission, unprotected anal insertive intercourse was most likely to occur with unknown status casual partners (46.8%, n=95) than with either HIV negative casual partners (19.2%, n=39) or with HIV+ casual partners (40.8%, n=83). Further, bivariate analyses indicated significant relationships between the use of several substances and sexual behaviors that put partners at greatest risk for HIV transmission, as well as a significant positive relationship between drinks per drinking day and viral load.

Bringing ayahuasca to the clinical research laboratory.

Abstract: Since the winter of 1999, the authors and their research team have been conducting clinical studies involving the administration of ayahuasca to healthy volunteers. The rationale for conducting this kind of research is twofold. First, the growing interest of many individuals for traditional indigenous practices involving the ingestion of natural psychotropic drugs such as ayahuasca demands the systematic study of their pharmacological profiles in the target species, i.e., human beings. The complex nature of ayahuasca brews combining a large number of pharmacologically active compounds requires that research be carried out to establish the safety and overall pharmacological profile of these products. Second, the authors believe that the study of psychedelics in general calls for renewed attention. Although the molecular and electrophysiological level effects of these drugs are relatively well characterized, current knowledge of the mechanisms by which these compounds modify the higher order cognitive processes in the way they do is still incomplete, to say the least. The present article describes the development of the research effort carried out at the Autonomous University of Barcelona, commenting on several methodological aspects and reviewing the basic clinical findings. It also describes the research currently underway in our laboratory, and briefly comments on two new studies we plan to undertake in order to further our knowledge of the pharmacology of ayahuasca.

Various alkaloid profiles in decoctions of Banisteriopsis caapi.

Abstract: Twenty nine decoctions of Banisteriopsis caapi from four different sources and one specimen of B caapi paste were analyzed for N,N-dimethyltryptamine (DMT), tetrahydroharmine (THH), harmaline and harmine Other plants were also used in the preparation of these products, typically Psychotria viridis, which provides DMT There were considerable variations in alkaloid profiles, both within and between sample sources DMT was not detected in all samples Additional THH may be formed from both harmine and harmaline during the preparation of these products The alkaloid composition of one decoction sample did not change significantly after standing at room temperature for 80 days, but the initial acidic pH was neutralized by natural fermentation after 50 days

Ayahuasca in Adolescence: A Neuropsychological Assessment

Abstract: The purpose of the study was to evaluate neuropsychologically adolescents who use ayahuasca in a religious context. A battery of neuropsychological tests was administered to adolescents who use ayahuasca. These subjects were compared to a matched control group of adolescents who did not use ayahuasca. The controls were matched with regards to sex, age, and education. The neuropsychological battery included tests of speeded attention, visual search, sequencing, psychomotor speed, verbal and visual abilities, memory, and mental flexibility. The statistical results for subjects from matched controls on neuropsychological measures were computed using independent t-tests. Overall, statistical findings suggested that there was no significant difference between the two groups on neuropsychological measures. Even though, the data overall supports that there was not a difference between ayahuasca users and matched controls on neuropsychological measures, further studies are necessary to support these findings.

Antiquity of Coca-Leaf Chewing in the South Central Andes: A 3,000 Year Archaeological Record of Coca-Leaf Chewing from Northern Chile

Abstract: Carbon- 14 (14C) dating from mummies o f the Alto Ramirez culture confirms that coca leaf chewing was an incipient practice among members of a population that peopled the valleys and coastal areas of Northern Chile by 3,000 years before the present (yr.B.P.). Out of eleven bodies from the burial site of Pisagua-7 (PSG-7, S 19° 35′, W 70° 13′) that were analyzed, two samples tested positive. Mummy 725-A C2 (dated 3,090 to 2,850 rwo sigma calibrated 14C years before the present) was shown to have a cocaine value of 13.3 nanograms/10 milligrams of sample (ng/10mg), and mummy 741 (2,890 to 2,760 two sigma cal yr B.P), a 5.6 ng/10mg value.

EEG Gamma Coherence and Other Correlates of Subjective Reports During Ayahuasca Experiences

Abstract: The current study examined QEEG power and coherence of ayahuasca experiences with two experienced participants in a Brazilian jungle setting. An exploratory case series design was adopted for naturalistic field research. EEGs recorded during visual imagery was compared to eyes-closed baselines. The most important findings were increases in global EEG coherence in the 36-44 Hz and 50-64 Hz frequency bands for both subjects. Widely distributed cortical hyper-coherence seems reasonable given the intense synesthesia during ayahuasca experiences. Other findings include increased modal EEG alpha frequency and global power decreases across the cortex in most frequency bands, which concur with the EEG of psychedelics literature. Exploratory analysis revealed the usefulness of analyzing single Hz bins over the standard wide-band analysis. The discovery-oriented naturalistic approach developed for this study resulted in potentially important findings. We believe that finding increases in global gamma coherence during peak psychedelic experiences might contribute to the discussion of binding theory. Also, in light of recent research with gamma coherence during advanced meditative conditions, our findings might further the comparison of shamanic psychedelic practices with meditation.

Using motivational interviewing to promote HIV testing at an American Indian substance abuse treatment facility.

Abstract: Alcohol and drug use are associated with increased risk of HIV/AIDS. American Indians and Alaska Natives (AI/AN) have high rates of alcohol and other drug use, as well as a high incidence of unsafe sex behaviors and injection drug use practices. Indicators of AI/AN HIV risks involving sexual activity include high rates of STDs, such as gonorrhea, chlamydia, and syphilis. Despite these facts, the prevalence of HIV infection among AI/AN is not well known. The present study is part of a HRSA-funded SPNS HIV/AIDS health initiative, one goal of which is to increase the number of HIV-positive individuals who know their HIV status. To meet the goal of the SPNS project, patients in an inpatient alcohol and drug treatment center were provided with an HIV prevention educational presentation followed by one-on-one HIV counseling. Motivational interviewing was used in the counseling sessions to aid participants in recognizing their risk status and making a decision to be HIV tested. Results show that of the 134 who agreed to one-on-one HIV counseling and 105 (78%) returned for their results.

Culturally appropriate HIV/AIDS and substance abuse prevention programs for urban Native youth.

Abstract: This article will examine HIV/AIDS and substance abuse prevention for urban Native youth in Oakland, California. It will highlight the Native American Health Center's Youth Services programs. These programs incorporate solutions based on a traditional value system rooted in Native culture and consisting of youth empowerment, leadership training, prevention activities, traditional cultural activities and wellness and life skills education. They aim to reduce HIV/AIDS and substance abuse risk for American Indian/Alaska Native (AI/AN) youth through structured, community-based interventions. The Youth Services Program's events, such as the Seventh Native American Generation and the Gathering of Native Americans, offer effective and culturally relevant ways of teaching youth about American Indian/Alaska Native history, intergenerational trauma, and traditional Native culture. Satisfaction surveys gathered from these youth provide invaluable data on the positive effects of these prevention efforts. The need for culturally relevant and culturally appropriate HIV/AIDS and substance abuse prevention programs for urban AI/AN youth is apparent. These prevention efforts must be creatively integrated into the multidimensional and complex social structures of Native American youth.

Prevalence of substance use among white and American Indian young adolescents in a Northern Plains state.

Abstract: This article documents the prevalence of self-reported substance use among White and American Indian adolescents enrolled in seventh grade (ages 12 through 13) in 1997 in a Northern Plains state. Data were collected by self-administered questionnaire preceding adolescents' participation in a randomized field trial of Project Alert, a seventh and eighth grade substance use prevention curriculum. Rates of lifetime and past-month use of cigarettes and marijuana were higher among American Indians than among Whites of the same gender. American Indian girls exceeded American Indian boys as well as White girls and White boys on lifetime and past-month use of cigarettes and marijuana as well as alcohol and inhalants; differences on cigarette and inhalant use reached statistical significance. These findings add to the sparse literature on substance use among adolescents as young as 12 through 13 years old and underscore the importance of examining gender-specific substance use patterns early in adolescence.

Native women, violence, substance abuse and HIV risk.

Abstract: Violence has become a critical public health issue in the United States. It has had a particularly devastating impact on the health and well being of Native American women and children. The relationship between aggression and substance use is an intrinsic one: Native women often bear the brunt of violence in drinking situations, which places them and their children at extremely high risk for physical and sexual abuse. In urban environments, many Native American women find themselves in adult relationships that mirror the abuse they experienced and witnessed as children or adolescents. Not only does violence often occur while substances are being used, but conversely, substance use is a frequent consequence of sexual abuse. Clearly, the mental health repercussions of physical or sexual abuse are often severe. Trauma is associated not only with psychological distress, but also with risky behavior and social role impairment. Traumatized women engaging in substance abuse and unsafe sex are at high risk for contracting HIV/AIDS. This article explores the intersection of substance abuse, sexual and physical abuse, and increased HIV risk among urban Native American women in the San Francisco Bay Area.

A combined cognitive and behavioral intervention for cocaine-using methadone clients.

Abstract: Treating cocaine use by opiate-dependent clients in methadone programs is a well-documented challenge. Both behavioral (contingency management) and cognitive (relapse prevention) interventions have shown promise in helping engage these clients in treatment. In this study, the effectiveness of combining contingency management with a cocaine-specific relapse prevention counseling module was examined. Sixty-one cocaine-using methadone clients were randomly assigned to one of four treatment conditions to participate in the eight-week intervention and eight-week follow-up period. Using analysis of variance (ANOVA), differences in cocaine use and treatment retention were examined. Contingency management was significantly related to reductions in cocaine use and the counseling module was positively related to six-month retention rates. Both interventions were associated with positive treatment response but the effects were reflected in different behavioral outcomes.

Holistic Native network: integrated HIV/AIDS, substance abuse, and mental health services for Native Americans in San Francisco.

Abstract: The Holistic Native Network provides a model for integrated HIV/AIDS, substance abuse and mental health services in a cultural context. Funded in 2002 by a grant from the Health Resources and Services Administration (HRSA) Special Projects of National Significance (SPNS) initiative. the Holistic Native Network is a collaboration of the Native American Health Center and Friendship House Association of American Indians, two community-based organizations with facilities in San Francisco and Oakland. Substance abuse and mental health services are integrated into primary HIV/AIDS medical care. San Francisco has the largest population of Native Americans with HIV/AIDS in the country. Since its inception. 45 Native Americans with HIV/AIDS have been enrolled in the Holistic Native Network. These clients were surveyed upon admission and at three months in treatment. The results indicated positive changes in quality of life. The success of this program lies in the way that culture and community is included...

An integral approach to substance abuse.

Abstract: There is a pressing need in the substance abuse field for more comprehensive models of etiology and treatment that address the complex issues of addiction, including the biological, social, cultural, spiritual and developmental needs of individuals and groups. This article presents a theoretical framework for an integral approach to substance abuse that expands on the existing biopsychosocial model. One contribution of the model is an integrated approach to spirituality from a cross-cultural perspective. This integral approach examines substance abuse etiology and treatment from a four-quadrant perspective adapted from the work of Ken Wilber, and incorporates concepts from integrative medicine and transpersonal psychology/psychiatry. Implications of the model are explored.

Fast and slow metabolizers of Hoasca.

Abstract: Harmine, a major alkaloid in ayahuasca (hoasca), is a selective and reversible inhibitor of the enzyme monoamine oxidase-A (MAO-A). It is also a selective inhibitor of the human cytochrome P450 isozyme 2D6 (CYP 2D6), which metabolizes harmine to a more hydrophilic derivative for eventual excretion. CYP 2D6 exhibits a wide range of polymorphisms in human populations, and variations in this enzymatic activity could account for differences in effects between individuals who use hoasca. This report broadly describes two subgroups of CYP 2D6 phenotypes—i.e., fast and slow metabolizers of harmine—in 14 experienced male members of the Uniāo do Vegetal (UDV) who received a standardized dosage of hoasca. To compensate for metabolic variations in their normal religious practice, the administered dose of hoasca is always determined by the presiding mestre, who is responsible for deciding the actual amount for each individual. This age-old method compensates for metabolic variations between individuals and v...

Can drug design inhibit abuse

Abstract: A recent federal report indicates that prescription drug abuse is now the second leading category of illicit drug use, following marijuana use. Control strategies typically focus on reducing the diversion of prescription drugs from legitimate sources. The proliferation of unregulated Internet sources, however, has rendered control strategies less effective. This study examines a new approach that focuses on reducing abusability through the use of abuse-resistant drug designs. Drugs with and without such designs are compared and abuse levels assessed using multiple sources. In every instance, drugs employing abuse-resistant designs were found to have significantly lower levels of abuse than comparator drugs without such designs.

Acupuncture and spirituality-focused group therapy for the treatment of HIV-positive drug users: a preliminary study.

Abstract: In this study, 40 HIV-seropositive, cocaine abusing, methadone maintained drug users were randomized to either the standard five-needle National Acupuncture Detoxification Association (NADA) protocol or to a reduced, escalating dose (one to three needle) protocol. In addition to receiving their assigned acupuncture treatments, the last 15 patients also received a spirituality-focused group therapy intervention. Acupuncture treatments were offered five days per week for eight weeks. Urine samples were collected twice weekly and were analyzed for the presence of cocaine and heroin. Depression and anxiety were assessed pre- and post-treatment. Results showed no difference between the two acupuncture conditions on the number of weeks in which urine samples tested negative for illicit opiate and cocaine use. However, patients who received the spirituality-focused group therapy in addition to their assigned acupuncture treatment were abstinent from heroin and cocaine for significantly longer, and had greater reductions in depression and anxiety than did those patients not receiving spirituality-focused psychotherapy. These preliminary findings suggest that acupuncture and a spirituality-focused psychotherapy may be a synergistic combination worthwhile investigating in larger scale, controlled studies.

Substance use disorder characteristics and externalizing problems among inpatient adolescent smokers.

Abstract: Attention deficit hyperactivity disorder (ADHD) and/or conduct disorder (CD) have been found to be associated with substance use disorders and cigarette smoking among adolescents. However, studies have often failed to explore these relationships among females from a dimensional perspective, taking into account comorbidity between ADHD and CD symptomatology, and examining ADHD symptom subtypes (i.e., inattention and hyperactivity/impulsivity) separately as they relate to substance involvement and smoking characteristics. This study takes each of the above into consideration when examining the relationship between externalizing symptomatology and substance involvement characteristics in a sample of 191 (62.3% female, mean age = 15.4 years) inpatient adolescent smokers. The results of this study suggest that ADHD and CD symptoms may be related to different types of substance use characteristics. CD symptoms were associated with early onset of substance involvement and ADHD symptoms were related to alcohol and marijuana frequency. ADHD inattention symptoms, but not hyperactivity/impulsivity symptoms, were associated with marijuana and nicotine dependence. Lastly, significant interactions suggested that ADHD symptoms among boys and CD symptoms among girls were related to frequency of any type of substance use prior to inpatient hospitalization. The results of this study point to potentially important clinical implications such as tailoring prevention and intervention efforts according to type of externalizing symptomatology and gender.

Ayahuasca in Adolescence: Qualitative Results

Abstract: Qualitative research was conducted in Brazil among 28 ayahuasca-consuming adolescents members of the Uniao do Vegetal Church, and 28 adolescents who never used ayahuasca. They were compared on a number of qualitative variables, including vignettes measuring moral and ethical concerns. Psychocultural studies utilizing co-occurences of variables in the realm of qualitative studies are useful in understanding and complementing quantitative studies also conducted among this population. Qualitative data show that the teens in the Uniao do Vegetal religion appear to be healthy, thoughtful, considerate and bonded to their families and religious peers. This study examines the modern use of a powerful hallucinogenic compound within a legal religious context, and the youth who participated in these ayahuasca religious ceremonies (usually with parents and other family members) appeared not to differ from their nonayahuasca-using peers. This study helps to elucidate the full range of effects of plant hallucinogenic use within a socially-sanctioned, elder-facilitated and structured religious context.

Seven year follow-up of smoking cessation with smokeless tobacco.

Abstract: This study evaluated the tobacco use status of 63 subjects seven years after enrollment in a single-intervention smoking cessation study employing smokeless tobacco (SLT) as a nicotine substitute. Information about tobacco use and cessation attempts was obtained in interviews. The duration of follow-up and of smoke-free periods were derived from the date of the subject's enrollment and were expressed as person-years (p-y). Because the study focused on the use of SLT for smoking cessation, subjects who used SLT to quit were invited to return for verification (less than 10 parts per million of carbon monoxide in expired air). Follow-up was completed on 62 of 63 original subjects, classified according to tobacco use status at the end of the initial study. Of the 16 subjects who had quit smoking using SLT at one year, 12 were smoke-free at seven years. For all 16 subjects there was 106 p-y of follow-up, 97 (92%) of which were smoke-free. Of six subjects who had quit smoking at one year by a means other than SLT, four were smoke-free at seven years. This entire group had 42 p-y of follow-up, 34 (81%) of which were smoke-free. Of the 41 subjects who were smoking at one year, 12 had quit smoking by the seven-year mark, three of these subjects by using SLT. Total follow-up for this group was 284 p-y, of which 26 (9%) were smoke-free. Although the study is small, the long-term success rate of this pilot trial compares favorably with other cessation studies.

The combined effects of treatment intensity, self-help groups and patient attributes on drinking outcomes.

Abstract: Better understanding of the diverse factors that predict alcoholism treatment outcomes is essential to improving treatment strategies. Patients accepted for treatment at a multimodality program were interviewed and followed-up at three months and one year after admission. The study tested a set of hypotheses relating to the effects on drinking outcomes of treatment modality, modality matching, treatment retention, aftercare, self-help group participation and patient attributes at admission. Drinking frequency diminished substantially between baseline and the two follow-ups. Outcomes for inpatient were better than for outpatient treatment in bivariate analysis, but outcomes for these modalities were equal after adjusting for the effect of patient-treatment mismatching. Aftercare treatment, time in treatment for outpatients, community 12-Step group participation, and several patient attributes such as motivation for change and psychiatric severity significantly predicted drinking outcomes at one or both follow-ups. Clinical implications of the results are discussed.

Interview with Guillermo Arrévalo, a Shipibo Urban Shaman, by Roger Rumrrill

Abstract: Roger Rumrrill, a journalist headquartered in Lima, Peru who is a noted expert on the Peruvian Amazon, interviewed Guillermo Arrevalo, a Shipibo urban shaman in Pucallpa, who utilizes ayahuasca in curing rituals. Sr. Arrevalo comments on the phenomenon known as drug tourism, where urban men and women provide tours for foreigners, for a price, to experience drug-induced mystical experiences in urban settings like lquitos and Pucallpa, Peru, as well as in Brazil, Bolivia and Ecuador. Arrevalo distinguishes between folkloric shamanism and touristic practices which are currently in vogue and, in his opinion, are the result of people trying to resolve personal problems. Arrevalo sees a spiritual and psychological crisis in Europe and North American society. The Shipibo shaman laments the misuse of toxic plants as additives to the ayahuasca potion and the damage that these plants cause to the unsuspecting tourist who doesn't really get his money's worth from shamans without experience, people who are l...

A Retrospective Chart Review Comparing Tiagabine and Benzodiazepines for the Treatment of Alcohol Withdrawal

Abstract: Although benzodiazepines are the standard of care in the treatment of alcohol withdrawal, several studies have suggested that anticonvulsants may be equally effective at alleviating alcohol withdrawal symptoms and may pose less of a risk of causing rebound of symptoms which could contribute to relapse. This report compares treatment outcomes for patients (N = 13) treated for alcohol withdrawal with either the anticonvulsant tiagabine or the benzodiazepines oxazepam and lorazepam. The Clinical Institute Withdrawal Assessment for Alcohol-revised (CIWA-Ar) was utilized to gauge alcohol withdrawal symptoms over the course of the study. When possible, follow-up data was obtained on alcohol use post-treatment. Both benzodiazepines and tiagabine appeared to reduce CIWA-Ar scores at about the same magnitude. There was a trend for tiagabine patients to have less postdetoxification drinking (Fisher exact test, p = 0.12). The reduction in alcohol withdrawal symptoms and decreased tendency to relapse observe...