INTRODUCTION:The tobacco industry has incorporated strategies like greenwashing (i.e. a marketing tactic that utilizes false or unverified claims to mislead consumers about a business's environmental practices and impact) within cigarette advertisements. Despite regulation to limit greenwashing, research found continued employment of greenwashing tactics. Understanding the magnitude and extent of greenwashing strategies used by the industry is helpful given the emergence of these alternative tactics and the association between greenwashing advertising and consumer inaccurate risk perceptions. METHODS:We conducted a descriptive content analysis of 2102 cigarette ads that ran January 2019-December 2023 in the US and identified 487 ads (23.2%) that had at least one greenwashing feature. We further characterized the nature of the greenwashing tactics present via text, imagery, or audio cues in the ads, using a developed codebook. Ads were independently double-coded, with discrepancies reconciled by team deliberation. RESULTS:Over 90% of the sample of ads came from 4 brands: Hestia, Natural American Spirit, Winston and Marlboro. Social media were predominant for ad identification. Hestia ads predominantly featured the descriptors 'naked' (74.6%) and 'wild' (63.9%), and flora imagery (67.3%). Natural American Spirit ads frequently used descriptors such as 'different' (50.9%) and 'simple' (41.1%), and over half (58.9%) featured flora imagery. Winston ads used the term 'tobacco and water' (45.0%) and depicted the great outdoors (47.0%). Marlboro ads commonly used great outdoors imagery (92.7%) and eco-related sweepstakes (41.5%). CONCLUSIONS:Greenwashing continues to be used in cigarette advertising, including the use of tactics associated with inaccurate modified risk perceptions. If further studies strengthen the evidence, regulations to limit greenwashing in tobacco advertising may be justified.

Few studies have examined perceptions of psilocybin for use in a mental health context. In two studies involving independent samples (total N = 1,102), we examined the intentions to use psilocybin in a mental health context in relation to psychotherapy, psychiatric medication, and natural versus synthetic options. We also examined potential predictors of the intentions to use psilocybin. In Study 1, we found that participants had significantly lower intentions to use psilocybin in a mental health context versus psychotherapy and traditional psychiatric medications. We also found that males reported being more open to using psilocybin as compared to females whereas females reported being more open than males to using psychotherapy. Finally, psilocybin use intentions were negatively associated with age, and positively associated with mindfulness, narcissism, and current self-reported depression. In Study 2, we found that participants had stronger intentions to use a natural version of psilocybin isolated from mushrooms as compared to an identical synthetic version or a synthetic psilocybin analog that elicits the same biological effects (i.e. the three types of psilocybin or psilocybin-like compounds currently of interest). Overall, these studies provide novel insights into the factors that might influence psilocybin use in a mental health context if FDA-approved.

Importance: Cocaine use disorder is a serious public health problem and no medications have been proven effective for its treatment. Objective: To evaluate psilocybin in the treatment of cocaine use disorder. It was hypothesized that psilocybin, compared with placebo, would yield a higher percentage of cocaine abstinent days, a greater likelihood of complete abstinence from cocaine, and a greater latency to first cocaine lapse through 180 days after end of treatment. Design, Setting, and Participants: Randomized, quadruple-blind, placebo-controlled clinical trial at a major medical research center in the Deep South of the US. Participants were individuals with cocaine use disorder who were motivated to quit and without significant comorbidities, recruited between May 2015 and August 2023 with data collection completed in May 2024. Interventions: Participants were randomized (1:1) to receive a single oral dose of psilocybin (25 mg per 70 kg of body weight) or active placebo (100 mg diphenhydramine). All participants received manualized psychotherapy that incorporated cognitive-behavioral treatment approximately 1 month before and 1 month after an all-day investigational drug treatment session. Main Outcomes and Measures: Percentage of cocaine abstinent days, rates of complete cocaine abstinence, and time to first cocaine lapse through 180 days after end of treatment, assessed by timeline followback interview and confirmed with urinalysis. Hypotheses were formulated before data collection and analyses followed intention-to-treat principles. Results: Of the 40 participants, 33 (82.5%) were men, the median (IQR) age was 50.0 (43.8-56.0) years, 33 (82.5%) were Black, and 7 (17.5%) were White. Most participants had lower socioeconomic status, with 26 participants (65%) having an annual income of $20 000 or less. Four participants were lost to follow-up, resulting in 36 participants who completed assessments through 180 days after end of treatment. Psilocybin recipients had a higher percentage of cocaine abstinent days (β = 28.95; 95% CI, 18.22-39.67; P < .001), greater likelihood of complete cocaine abstinence (odds ratio, 18.37; 95% CI, 1.92-2468.17; P = .007), and a reduced risk of cocaine lapse over time (hazard ratio, 0.28; 95% CI, 0.13-0.60; P = .001) than active placebo recipients. No serious adverse events occurred. Conclusions and Relevance: In this randomized clinical trial, psilocybin appeared to be safe and efficacious for treating cocaine use disorder among individuals from underrepresented and vulnerable populations. Further research is warranted to replicate and expand these findings. Trial Registration: ClinicalTrials.gov Identifier: NCT02037126.

QuestionWhat tobacco smoking cessation rates does psilocybin, an experimental treatment, yield compared with nicotine patch, an established treatment, with individuals in both groups receiving standardized cognitive behavioral therapy?FindingsIn this pilot randomized clinical trial, 42 participants randomized to receive psilocybin had more than 6 times greater odds of prolonged smoking abstinence 6 months after treatment than 40 participants who received the nicotine patch.MeaningThese results suggest that psilocybin holds potential in the treatment of tobacco use disorder and, along with other psychedelics, should be investigated further for tobacco and other substance use disorders. This pilot randomized clinical trial compares prolonged smoking abstinence rates in smokers receiving psilocybin with those receiving the nicotine patch with both groups receiving manualized smoking cessation cognitive behavioral therapy. ImportanceAnnual tobacco-related death estimates are 480 000 in the US and 8 million worldwide, surpassing mortality for other abused substances. Most smoking cessation interventions result in modest long-term success.ObjectiveTo compare prolonged smoking abstinence rates in smokers receiving psilocybin plus cognitive behavioral therapy (CBT) with those receiving the nicotine patch plus CBT.Design, Setting, and ParticipantsIn this pilot randomized clinical trial, participants and investigators were unblinded to treatment condition, including an optional crossover after completion of the primary end point. Data were collected from psychiatrically healthy adult smokers from January 20, 2015, to May 8, 2023, at the Johns Hopkins Bayview Medical Center, an academic medical center and teaching hospital in Baltimore, Maryland.InterventionThe trial randomized cigarette smokers to receive either 1 high dose (30 mg/70 kg) of psilocybin or initiate 8 to 10 weeks of US Food and Drug Administration-approved nicotine patch treatment on the target quit date. Both groups received a 13-week manualized CBT program for smoking cessation.Main Outcomes and MeasuresBiochemically verified prolonged smoking abstinence (primary) and 7-day point prevalence abstinence (secondary) at 6 months after the target quit date were compared between groups using intention-to-treat analysis.ResultsA total of 82 psychiatrically healthy adult smokers (mean [SD] age, 47.6 [12.0] years; 49 [59.8%] male) participated in the study, with 68 (82.9%) completing the 6-month follow-up. At 6-month follow-up, 17 participants receiving psilocybin (40.5%) exhibited biochemically verified prolonged abstinence compared with 4 participants using the nicotine patch (10.0%) (odds ratio, 6.12; 95% CI, 1.99-23.26; P = .003), and 22 participants receiving psilocybin (52.4%) exhibited biochemically verified 7-day point prevalence abstinence compared with 10 participants using the nicotine patch (25.0%) (odds ratio, 3.30; 95% CI, 1.32-8.70; P = .01). No serious adverse events were attributed to psilocybin or nicotine patch.Conclusions and RelevanceIn this pilot randomized clinical trial, 1 dose of psilocybin with manualized CBT significantly increased long-term abstinence compared with nicotine patch treatment with CBT. Psilocybin abstinence rates were higher than typical treatments, suggesting promise for tobacco smoking cessation.Trial RegistrationClinicalTrials.gov Identifier: NCT01943994

Importance:Annual tobacco-related death estimates are 480 000 in the US and 8 million worldwide, surpassing mortality for other abused substances. Most smoking cessation interventions result in modest long-term success. Objective:To compare prolonged smoking abstinence rates in smokers receiving psilocybin plus cognitive behavioral therapy (CBT) with those receiving the nicotine patch plus CBT. Design, Setting, and Participants:In this pilot randomized clinical trial, participants and investigators were unblinded to treatment condition, including an optional crossover after completion of the primary end point. Data were collected from psychiatrically healthy adult smokers from January 20, 2015, to May 8, 2023, at the Johns Hopkins Bayview Medical Center, an academic medical center and teaching hospital in Baltimore, Maryland. Intervention:The trial randomized cigarette smokers to receive either 1 high dose (30 mg/70 kg) of psilocybin or initiate 8 to 10 weeks of US Food and Drug Administration-approved nicotine patch treatment on the target quit date. Both groups received a 13-week manualized CBT program for smoking cessation. Main Outcomes and Measures:Biochemically verified prolonged smoking abstinence (primary) and 7-day point prevalence abstinence (secondary) at 6 months after the target quit date were compared between groups using intention-to-treat analysis. Results:A total of 82 psychiatrically healthy adult smokers (mean [SD] age, 47.6 [12.0] years; 49 [59.8%] male) participated in the study, with 68 (82.9%) completing the 6-month follow-up. At 6-month follow-up, 17 participants receiving psilocybin (40.5%) exhibited biochemically verified prolonged abstinence compared with 4 participants using the nicotine patch (10.0%) (odds ratio, 6.12; 95% CI, 1.99-23.26; P = .003), and 22 participants receiving psilocybin (52.4%) exhibited biochemically verified 7-day point prevalence abstinence compared with 10 participants using the nicotine patch (25.0%) (odds ratio, 3.30; 95% CI, 1.32-8.70; P = .01). No serious adverse events were attributed to psilocybin or nicotine patch. Conclusions and Relevance:In this pilot randomized clinical trial, 1 dose of psilocybin with manualized CBT significantly increased long-term abstinence compared with nicotine patch treatment with CBT. Psilocybin abstinence rates were higher than typical treatments, suggesting promise for tobacco smoking cessation. Trial Registration:ClinicalTrials.gov Identifier: NCT01943994.

Importance:Cocaine use disorder is a serious public health problem and no medications have been proven effective for its treatment. Objective:To evaluate psilocybin in the treatment of cocaine use disorder. It was hypothesized that psilocybin, compared with placebo, would yield a higher percentage of cocaine abstinent days, a greater likelihood of complete abstinence from cocaine, and a greater latency to first cocaine lapse through 180 days after end of treatment. Design, Setting, and Participants:Randomized, quadruple-blind, placebo-controlled clinical trial at a major medical research center in the Deep South of the US. Participants were individuals with cocaine use disorder who were motivated to quit and without significant comorbidities, recruited between May 2015 and August 2023 with data collection completed in May 2024. Interventions:Participants were randomized (1:1) to receive a single oral dose of psilocybin (25 mg per 70 kg of body weight) or active placebo (100 mg diphenhydramine). All participants received manualized psychotherapy that incorporated cognitive-behavioral treatment approximately 1 month before and 1 month after an all-day investigational drug treatment session. Main Outcomes and Measures:Percentage of cocaine abstinent days, rates of complete cocaine abstinence, and time to first cocaine lapse through 180 days after end of treatment, assessed by timeline followback interview and confirmed with urinalysis. Hypotheses were formulated before data collection and analyses followed intention-to-treat principles. Results:Of the 40 participants, 33 (82.5%) were men, the median (IQR) age was 50.0 (43.8-56.0) years, 33 (82.5%) were Black, and 7 (17.5%) were White. Most participants had lower socioeconomic status, with 26 participants (65%) having an annual income of $20 000 or less. Four participants were lost to follow-up, resulting in 36 participants who completed assessments through 180 days after end of treatment. Psilocybin recipients had a higher percentage of cocaine abstinent days (β = 28.95; 95% CI, 18.22-39.67; P < .001), greater likelihood of complete cocaine abstinence (odds ratio, 18.37; 95% CI, 1.92-2468.17; P = .007), and a reduced risk of cocaine lapse over time (hazard ratio, 0.28; 95% CI, 0.13-0.60; P = .001) than active placebo recipients. No serious adverse events occurred. Conclusions and Relevance:In this randomized clinical trial, psilocybin appeared to be safe and efficacious for treating cocaine use disorder among individuals from underrepresented and vulnerable populations. Further research is warranted to replicate and expand these findings. Trial Registration:ClinicalTrials.gov Identifier: NCT02037126.

Greenwashing tactics involve advertising products as ecofriendly and/or natural, which may reduce perceived health risk. We tested the effect of greenwashing advertising tactics on cigarette demand, puff topography, and perceived health risk. Young adults (N = 31) who smoke cigarettes completed a within-subject experiment involving two topography and seven operant demand sessions. Participants were exposed to advertising for novel cigarette "brands." One brand was advertised using greenwashing tactics, whereas the other brand included matched control tactics. Unknown to participants, both conditions used the same commercial cigarette brand. During topography sessions, participants smoked cigarettes ad lib and puff topography data were collected. During demand sessions, cigarettes were concurrently available at varying prices. No significant differences were observed for puff-topography measures (dz values < 0.28). Participants demonstrated a preference for the cigarettes advertised using greenwashing tactics when concurrently available at the same low price with more puffs earned (dz = 0.44) and a greater proportion of total puffs smoked (dz = 0.55). Both brands acted as substitutes for each other, with substitution not reliably differing by brand. These findings indicate that greenwashing advertising tactics may increase the relative reinforcing effects of cigarettes particularly when available at prices similar to those for standard cigarettes, findings that should be considered by regulatory authorities.

INTRODUCTION:Interest in therapeutic applications of psychedelics has recently resurged. Mystical-type and challenging experiences that are elicited by psychedelics are commonly assessed using the 30-item Mystical Experience Questionnaire (MEQ-30) and the 26-item Challenging Experience Questionnaire (CEQ), respectively. The brief 4-item MEQ (MEQ-4) and 7-item CEQ (CEQ-7) may reduce respondent burden, but Japanese versions have not yet been developed. This study developed Japanese versions of the MEQ-4 and CEQ-7. METHODS:In translating the MEQ-4 and CEQ-7, our procedures were informed by the recommendations of the "Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures: Report of the ISPOR Task Force for Translation and Cultural Adaptation." Separately, experts in psychedelics reviewed semantic nuances and the naturalness and appropriateness of the Japanese wording. Cognitive debriefing was not conducted because recruiting an appropriate Japanese-speaking sample with psychedelic experience was not feasible. RESULTS:The final, approved back-translated versions of the MEQ-4 and CEQ-7 were developed, and the authorized Japanese versions of the MEQ-4 and CEQ-7 were established. CONCLUSIONS:In the present study, Japanese versions of the MEQ-4 and CEQ-7 were developed, enabling more rapid and efficient assessments of mystical and challenging experiences among Japanese speakers. Future studies should evaluate their comprehensibility, interpretability, cultural appropriateness, reliability, and validity in Japanese-speaking samples.

This analytic essay reviews the transition from unidimensional relative reinforcing efficacy to multidimensional behavioral economic demand analysis in drug reinforcement, focusing on tobacco science. It synthesizes operant laboratory studies in human smokers that use operant demand curve analysis. Reviewed studies used single- and concurrent-commodity sessions in which participants performed operant responses to earn the self-administration of controlled cigarettes puffs, and other commodities included money, and self-administration of denicotinized cigarette puffs, reduced-nicotine cigarette puffs, and nicotine gum. Unlike traditional measures purporting to assess relative reinforcing efficacy, demand curves showed multidimensional reinforcement. Operant demand studies resulted in findings relevant to tobacco science, therapeutics, and regulation. Despite greater demand for money at lower prices, cigarette puffs showed greater resistance to increasing prices. Denicotinized cigarette puffs were more effective substitutes (than nicotine gum) for nicotine-containing cigarettes. Reduced-nicotine and full-nicotine experimental cigarette exposure yielded modest, non-dose-dependent demand reductions. Greenwashing tactics increased demand intensity at low prices, enhancing unconstrained preference. Behavioral economic demand analysis offers a superior framework for understanding and assessing reinforcement over the concept of relative reinforcing efficacy. These findings underscore demand analysis as a versatile tool for investigating abuse liability, therapeutics, and tobacco regulatory science.

Introduction: The classic psychedelic psilocybin has attracted special interest across clinical and non-clinical settings as a potential tool for mental health. However, despite increasing attention to challenging psychedelic experiences, few studies have explored the relevance of emotionally painful, shame-related processes with psychedelic use. Methods: This prospective, longitudinal study involved sequential, automated, web-based surveys that collected data from 679 adults planning to use psilocybin in naturalistic settings at timepoints before and after psilocybin use. State and trait shame and feelings of guilt were collected using validated measures and assessed alongside other measurements of psychological health. Results: Participants were primarily college-educated, White individuals residing in the United States with a prior history of psilocybin use; mean age = 38.9-41 years. Most users (89.7%) described their experience of psilocybin as positive, though acute feelings of shame or guilt were commonly reported (i.e., 68.2% of users) and difficult to predict. Ratings of participant ability to constructively work through these feelings predicted wellbeing 2-4 weeks after psilocybin use. Psilocybin on average produced a small but significant decrease in trait shame that was maintained 2-3 months after use (Cohen’s dz = 0.37; adjusted p <0.001). Trait shame increased in a notable minority (29.8%) of participants. Discussion: The experience of self-conscious emotions with psychedelics has been explored minimally, but further study in this area may have far-reaching implications for psychological health. The activation of shame-related experiences with psychedelics may pose a unique and context-dependent learning condition for both therapeutic and detrimental forms of shame-related memory reconsolidation.

INTRODUCTION:The tobacco industry has a long history of circumventing regulations to present their products, inaccurately, as less harmful. Greenwashing (portraying a product as natural/eco-friendly) is increasingly used by tobacco companies and may mislead consumers to believe that certain cigarettes are less harmful than others. This study assesses the effect of some common greenwashing tactics on consumer product perceptions. AIMS AND METHODS:We conducted an online experiment with 1504 participants ages 18-29, randomized to view a cigarette ad manipulated for presence-absence of a combination of four different greenwashing techniques: greenwashed ad text, greenwashed ad imagery, recycled paper ad background, and image of greenwashed cigarette pack. Participants rated perceived absolute harm, relative harm to other cigarettes, absolute addictiveness, relative addictiveness, and relative nicotine content. RESULTS:Participants who viewed ads containing greenwashed text were more likely to have inaccurate perceptions about absolute harm (AOR = 1.72), relative harm (AOR = 3.92), relative addictiveness (AOR = 2.93), and nicotine content (AOR = 2.08). Participants who viewed ads containing greenwashed imagery were more likely to have inaccurate perceptions of relative harm (AOR = 1.55), absolute addictiveness (AOR = 1.72), relative addictiveness (AOR = 1.60), and nicotine content (AOR = 1.48). Forty-two percent of those who saw an ad with all greenwashed features believed the product was less harmful than other cigarettes versus 2% of those who saw an ad without greenwashed features. CONCLUSIONS:We found that greenwashed text and imagery produced inaccurate risk perceptions. More active U.S. Food & Drug Administration (FDA) enforcement against such greenwashing and new FDA rulemaking to prohibit unnecessary imagery in tobacco advertising and establish plain packaging requirements would help protect consumers and public health. IMPLICATIONS:These findings provide evidence that greenwashing tactics used by the tobacco industry increase inaccurate product risk perceptions. These tactics could be a way for the industry to make implicit modified risk claims, despite applicable U.S. Family Smoking Prevention and Tobacco Control Act prohibitions. Findings from this study support the need for prohibitions on these tactics, and the potential for such prohibitions to help protect public health.

Delay discounting describes an organism's sensitivity to delayed consequences. The advent of hyperboloid discounting models introduced the s discounting parameter, a fitted metric that reduces residual variance when working with human subjects. Mathematically, discounting s allows for a nonlinear relation between consequence (A) and delay (D) and could be conceptually accounted for as a psychophysical scalar that describes subjective differences in the rate of time passage. This study offers a proof-of-concept examination of hyperboloid s in relation to participant time-based experiences. A crowdsourced sample of adults (N = 211) completed tasks measuring time estimation (i.e., reporting how much time passed during a distractor task) and temporal distance estimation (i.e., reporting how temporally distant a delay feels). Participants generally underestimated durations in the time estimation task, where income and completion of a preceding day-framed discounting task (versus date-framed), but not Myerson and Green's s (b = -0.19), and modestly Rachlin's s (b = 0.82), exhibited a statistically significant relation with time estimation accuracy. Similarly, participant age and delay framing, but not hyperboloid s, exhibited a statistically significant relation with temporal distance estimation discrepancies. Broadly, data suggest that s may not be accounting for differences in time estimation as measured in this sample. At most, the modest effect observed for Rachlin's s suggests limited conceptual value, meriting further consideration of the metric's account of subject-level differences.

Introduction: Ketamine has garnered attention for its rapid efficacy in alleviating depressive symptoms in treatment-resistant depression, offering a novel mechanism as a non-monoaminergic agent. Despite its potential, limited research has explored mental health professionals’ perspectives on its use. This study assesses the attitudes, knowledge, and concerns of Portuguese psychiatrists and psychologists regarding the clinical application of ketamine in treatment-resistant depression. Methods: A cross-sectional survey study was conducted from June 2022 to January 2024 among Portuguese psychiatrists and psychologists. The anonymous online questionnaire assessed perceptions of ketamine’s therapeutic utility, risks, and knowledge sources. Statistical analyses examined subgroup differences by age, sex, profession, and prior psychedelic use. Results: Among 156 participants (mean age = 37.2; 68.6% female), 53.8% were psychologists, and 46.2% were psychiatrists or trainees in Psychiatry. Only 35.9% reported substantial knowledge of ketamine’s therapeutic potential, while 59% were open to integrating it clinically. The majority expressed interest in training, though 73% raised concerns about inadequate professional training. Significant differences emerged, with psychiatrists reporting higher knowledge levels and openness to ketamine compared to psychologists, while younger professionals showed greater interest in training and usage. Conclusion: There was a favorable attitude toward ketamine use among Portuguese psychiatrists and psychologists, yet substantial educational gaps remain. Customized training addressing age, sex, and professional background is essential for safe and effective clinical integration of ketamine in treatment-resistant depression. Further studies should focus on longitudinal outcomes of ketamine treatment under standardized protocols to ensure efficacy and safety in clinical practice.

INTRODUCTION:The purchase task procedure offers a rapid data collection method for evaluating drug value in contexts for which drug self-administration is practically or ethically limited. This study addresses a methodological concern with purchase task use-the correspondence between hypothetical and real commodity valuation-by testing the say-do and hypothetical-incentivized correspondence of the task for tobacco demand across varied tobacco products. AIMS AND METHODS:Participants (N = 24; 50% female) completed study sessions characterized by changing cigarette product characteristics. During each session, participants sampled a cigarette varying in blinded nicotine content and nicotine expectancy and completed hypothetical and incentivized purchase tasks for that product. The incentivized task prompted participants to report the number of session cigarettes they would purchase for a within-session self-administration period while the hypothetical task evaluated simulated purchases of cigarette packs for a typical smoking week. Measures of correspondence were evaluated across purchase task metrics. RESULTS:Across conditions, purchasing and self-administration in the incentivized purchase task and self-administration period showed a strong positive correlation (r = .70, p < .001). Average correlations for each metric between task types ranged from r = .43 [Omax] to r = .55 [breakpoint]. Linear mixed-effects modeling revealed statistically significant predictive relations between hypothetical and incentivized task metrics for Q0 (p < .001), ⍺ (p < .001), intensity (p < .001), Omax (p = .04), Pmax (p = .01), and breakpoint (p < .001). CONCLUSIONS:Data uphold the correspondence between hypothetical and incentivized task responding in the context of familiar and novel cigarette products. Broadly, data provide continued support for the purchase task method as a reliable and ecologically valid method of assessing reinforcer valuation. IMPLICATIONS:A limited body of research precludes conclusions regarding the say-do correspondence of simulated purchase tasks. This study examines correspondence across a hypothetical task prompting participants to report tobacco valuation in units of packs and an incentivized task prompting participants to report single cigarette consumption for use during a within-session self-administration period. The task correspondence observed in this study supports the continued use of behavioral economic simulated purchase tasks for application in difficult-to-study contexts.

IntroductionSubstance use disorders are often associated with impairments in cognitive and behavioral processes. Methamphetamine use disorder (MUD), in particular, has been linked to such differences, though it remains unclear whether response inhibition (the inability to withhold prepotent responses), risk taking, or other constructs play more prominent roles. Understanding the specific contributions of these constructs is essential for tailoring interventions and improving outcomes for individuals with MUD. This study aimed to investigate both subdomains of impulsivity in individuals recently abstinent from methamphetamine.MethodsParticipants with MUD (n=29) recruited from 30-day residential treatment programs and age-matched controls (n =27) completed the Iowa Gambling Task (IGT) and Balloon Analogue Risk Task (BART) to assess risk taking and delay sensitivity, and the Stroop Color and Word Task (SCWT) and Stop Signal Task (SST) to assess response inhibition. Two-way multivariate analyses of covariance (MANCOVAs) were performed to determine group differences.ResultsAnalyses revealed no significant group differences in IGT net score (p=0.62) and BART average pumps (p=0.45). Conversely, significant differences emerged in as evidenced by longer stop signal reaction times (p < 0.01) and lower SCWT accuracy (p=0.03) in the MUD group compared to age-matched controls.DiscussionThese findings suggest that methamphetamine use disorder is associated with specific cognitive and behavioral abnormalities. Targeting these constructs in treatment may improve outcomes for individuals recovering from MUD.

Introduction: Serotonergic psychedelics, serotonin 2A receptor agonists such as psilocybin that can result in substantially altered states of consciousness, are used in recreational and research settings. The safety of psychedelic experiences in research settings is supported by controlled physical environments, presence of clinical and medical staff to address emergent issues, screening for personal and family history of potential contraindications, and psychoeducational preparation with psychological support. Research settings typically provide psychoeducation to participants verbally and in writing (e.g., informed consent), and such documents and conversations can provide safety-related information-but may also introduce a wide range of expectancies. Such expectancies might involve the specific character of the acute subjective effects of psychedelics, possible side effects, and anticipated outcomes.Methods: To better understand the content of this psychoeducation, we gathered study materials from many psilocybin studies conducted in the past two decades in healthy and therapeutic populations. We conducted a reflexive thematic analysis to better understand these documents.Results: While these documents varied substantially between studies, we identified themes intended to lower levels of risk and optimize therapeutic effects from psychedelic treatments. The most frequently coded themes related to (1) biological and physical safety, (2) psychological safety and well-being, (3) aspects of setting, and (4) potential for expectancies. Prioritizing biological and psychological safety was evident in the materials from all sites. Furthermore, we identify potential contributors to expectancy unrelated to safety and suggest that these extrapharmacological elements be studied systematically in future research.Conclusions: Ideally, future research should strive to maximize safety while attempting to minimize extraneous expectancies.

The current chapter presents the literature evaluating the effects of classic psychedelic treatments on five substance use disorders: alcohol, tobacco, opioid, stimulant, and cannabis. Most work on psychedelics and substance use disorders was conducted for alcohol use disorder. A range of classic psychedelics (LSD, psilocybin, and ayahuasca) appear to be beneficial for facilitating both reduced drinking and abstinence. Small clinical trials have also shown promising initial results for both tobacco and opioid use disorders. In contrast, no trials have yet been conducted for stimulant and cannabis use disorders. Furthermore, the majority of studies described are naturalistic observational studies or correlational survey data. However, if such observational studies reflect causal therapeutic potential, these studies, combined with clinical trials, suggest potential broad transdiagnostic efficacy of psychedelics across multiple addictive drugs. The transdiagnostic effects of psychedelics are likely due to a combination of biological and psychological factors. Biologically, psychedelics appear to ameliorate deficits in brain areas involved in reward and emotional processing, which may reduce the risk of relapse. Psychologically, the insights gained during a psychedelic experience may reinforce personal motivations for sobriety and support subsequent behavior change. Overall, more work is needed to better characterize the potential benefits and limitations of psychedelic treatment for substance use disorders.

This Viewpoint discusses the need to better understand potential risks associated with psychedelic and 3,4-methylenedioxymethamphetamine (MDMA) use to ensure safe and ethical practice and identifies 4 key research goals.

BACKGROUND:Current FDA plans include proposed nicotine reduction mandates by the end of 2023. Most research on reduced nicotine cigarettes has been dose-blinded, while a mandate would be known to the public. Few laboratory studies have examined specifically how low nicotine content labeling impacts behavioral response. The purpose of this within-subject, balanced-placebo, human laboratory study was to evaluate the main and interactive effects of nicotine dose expectancy and dose reduction on cigarette reinforcement, withdrawal alleviation, and puff topography. METHODS:Participants who smoke daily (N=21; 9 female) completed one practice and four experimental sessions in which expectancy (labeled "average" versus "very low" nicotine) and nicotine dose (0.80mg versus 0.03mg yield) were manipulated. Participants in acute withdrawal sampled experimental cigarettes followed by withdrawal alleviation and puff topography measures. Cigarette demand was measured using an incentivized purchase task. Analyses evaluated main and interactive effects of expectancy and nicotine dose. RESULTS:Nicotine dose manipulation produced expected physiological effects (e.g., heart rate increases) and both reduced nicotine dose and expectation manipulations reduced perceived nicotine content. Expectation of reduced nicotine alone or in combination with reduced nicotine dose did not alter demand, withdrawal alleviation, or topography. Effective withdrawal alleviation was observed in all conditions. CONCLUSIONS:These data inform nicotine regulation policy by suggesting limited compensatory harms caused by reduced nicotine expectations. The minimal acute effects of reduced nicotine expectancy or exposure on demand suggests that reduced nicotine standards are likely to generate their greatest public health benefit through the slowing of newly initiating cigarette smoking.