Fortieth Anniversary Edition

Table of Contents

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Volume 40, Number 3

September 2008

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Editors’ Introduction - David E. Smith, M.D.; Terry Chambers, B.A. & Richard B. Seymour, M.A   View this article

MDMA-Assisted Psychotherapy Using Low Doses in a Small Sample of Women with Chronic Posttraumatic Stress Disorder — José Carlos Bouso, B.Sc.; Rick Doblin, Ph.D.; Magí Farré, M.D., Ph.D.; Miguel Ángel Alcázar, Ph.D. & Gregorio Gómez-Jarabo, Ph.D. 

Young Adult Ecstasy Users and Multiple Sexual Partners: Understanding the Factors Underlying this HIV Risk Practice — Claire E. Sterk, Ph.D.; Hugh Klein, Ph.D. & Kirk W. Elifson, Ph.D. 

Gamma Hydroxybutyrate: An Ethnographic Study of Recreational Use and Abuse  —Steven J. Lee, M.D. & Petros Levounis, M.D., M.A.

The Phenomenon of Drug Craving — Jeffrey L. Fortuna, Dr.P.H. & David A. Smelson, Psy.D.

Hypothesizing that Marijuana Smokers are at a Significantly Lower Risk of Carcinogenicity Relative to Tobacco-Non-Marijuana Smokers: Evidenced Based on Statistical Reevaluation of Current Literature — Amanda L.C. Chen, Ph.D. Thomas J.H. Chen, Ph.D.; Eric R. Braverman, M.D.; Vanessa Acuri, B.S.; Mallory Kerner; Michael Varshavskiy; Dasha Braverman, P.A.; William B. Downs, B.Sc.; Seth H. Blum, B.A.; Kimberly Cassel & Kenneth Blum, Ph.D. 

Heroin Users in Cape Town, South Africa: Injecting Practices, HIV-Related Risk Behaviors, and Other Health Consequences — Andreas Plüddemann, M.A.; Charles D.H. Parry, Ph.D.; Alan J. Flisher, Ph.D. & Esmé Jordaan, M.Sc.

Including the Siblings of Youth Substance Abusers in a Parent-Focused Intervention:  A Pilot Test of the Best Plus Program — John H. Bamberg, M.A.; John W. Toumbourou, Ph.D. & Richard Marks, R.N.

Newsmaking on Drugs: A Qualitative Study with Journalism Professionals — Fabio C. Mastroianni, M.Sc. & Ana Regina Noto, Ph.D.

Reassessing the Cultural and Psychopharmacological Significance of Banisteriopsis caapi:  Preparation, Classification and Use Among the Piaroa of Southern Venezuela — Robin Rodd, Ph.D.

SHORT COMMUNICATIONS

Availability and Characteristics of Betel Products in the U.S. — Melissa Blank, Ph.D.; Laxmikant Deshpande, Ph.D. & Robert L. Balster, Ph.D.

Substance Use in a Sample of Medical Patients — Jamshid Ahmadi, M.D.; Leila Benrazavi, M.D.; Mohammadali Babaeebeigi, M.D.; Ahmad Ghanizadeh, M.D.; Mohammadjavad Ghanizadeh M.D & Saxby Pridmore, M.D.

COVER ART — Buddhagirl by Chuck Whelon (www.whelon.com), with thanks to Janie Lucas for the original drawing

Abstracts

MDMA-Assisted Psychotherapy Using Low Doses in a Small Sample of Women with Chronic Posttraumatic Stress Disorder — José Carlos Bouso, B.Sc.; Rick Doblin, Ph.D.; Magí Farré, M.D., Ph.D.; Miguel Ángel Alcázar, Ph.D. & Gregorio Gómez-Jarabo, Ph.D.

Abstract—The purpose of this study was to investigate the safety of different doses of MDMA-assisted psychotherapy administered in a psychotherapeutic setting to women with chronic PTSD secondary to a sexual assault, and also to obtain preliminary data regarding efficacy. Although this study was originally planned to include 29 subjects, political pressures led to the closing of the study before it could be finished, at which time only six subjects had been treated. Preliminary results from those six subjects are presented here. We found that low doses of MDMA (between 50 and 75 mg) were both psychologically and physiologically safe for all the subjects. Future studies in larger samples and using larger doses are needed in order to further clarify the safety and efficacy of MDMA in the clinical setting in subjects with PTSD.

Keywords—MDMA, MDMA psychotherapy, posttraumatic stress disorder, PTSD, safety

Young Adult Ecstasy Users and Multiple Sexual Partners: Understanding the Factors Underlying this HIV Risk Practice — Claire E. Sterk, Ph.D.; Hugh Klein, Ph.D. & Kirk W. Elifson, Ph.D.

Abstract—The purposes of this study are to (1) examine the extent to which young adult Ecstasy users recently reported having had multiple sex partners and (2) identify the factors predictive of engaging in this behavior. Potential predictors included demographic characteristics, background and experiences measures, childhood maltreatment experiences, substance use variables, and measures assessing psychological/psychosocial functioning. This research is based on a sample of 283 young adult recurrent users of the drug, Ecstasy. Study participants were recruited in Atlanta, Georgia between August 2002 and August 2004 using a targeted sampling and ethnographic mapping approach. Interviews took approximately two hours to complete.  Nearly one-third of the study participants had more than one sex partner during the preceding month, and sexual protection rates tended to be low. Multivariate logistic regression analysis revealed seven predictors associated with an increased likelihood of having multiple sex partners: (1) being nonwhite, (2) knowing someone who was HIV-positive, (3) younger age of first sexual experience, (4) using Ecstasy for its touch-enhancing qualities, (5) higher self-esteem, (6) handling disagreements more dysfunctionally, and (7) not being involved in a romantic relationship. The HIV prevention- and intervention-related implications of these findings are discussed.

Keywords—drug users/abusers, Ecstasy users, HIV/AIDS, multiple sex partners, predictors, substance use/abuse

Gamma Hydroxybutyrate: An Ethnographic Study of Recreational Use and Abuse  —Steven J. Lee, M.D. & Petros Levounis, M.D., M.A.

Abstract—Gamma hydroxybutyrate (GHB) is a psychoactive substance with complex neurophysiological activity and significant potential for abuse, addiction, and dangerous toxicity. In this study, a semistructured interview was administered to 17 subjects to investigate GHB use, including: manner of use; setting; positive and negative consequences; other drug history; and sexual practices. Respondents were overwhelmingly male, but otherwise had a broad demographic background. Settings varied from nightclubs to private use at home. There was significant variability in the drug obtained, which subjects found problematic because of the narrow therapeutic window and ease of accidental overdose. Common positive experiences included increased sexual desire, decreased sexual inhibitions, and decreased anxiety. Common negative consequences included oversedation, loss of consciousness, motor incoordination, and mental confusion. Nine subjects reported that they would use GHB again, some despite severe negative consequences. Although most subjects reported negative experiences, only three felt their use was problematic, and none sought treatment for GHB abuse or addiction. Subjects were highly drug-experienced, most commonly using MDMA, ketamine, cocaine, alcohol, and methamphetamine. Some reported that GHB could cause poor decision making in sexual situations. This effect has significant ramifications for issues such as date rape and control of sexually transmitted diseases, such as HIV.

Keywords—club drugs, gamma hydroxybutyrate, GHB, sodium oxybate

The Phenomenon of Drug Craving — Jeffrey L. Fortuna, Dr.P.H. & David A. Smelson, Psy.D.

Abstract—The phenomenology of drug craving has become the focus of much research within addictive disorders because of the belief that desire plays a role in maintaining the addiction. Many of the studies have focused on the activation of neural pathways, particularly within the dopamine system in response to specific events or stimuli. While many of these studies have focused on a particular drug of choice, little has been done across addictive disorders. This article will present and review phenomena that induce drug craving, as well as delineate precise neural pathways which are activated during craving and specific neurobiological markers which are associated with an increased risk for drug craving and other forms of addictive behavior.

Keywords—amygdala, anterior cingulate, blue cone, cue-induced, dopamine-2, electroretinogram 

Hypothesizing that Marijuana Smokers are at a Significantly Lower Risk of Carcinogenicity Relative to Tobacco-Non-Marijuana Smokers: Evidenced Based on Statistical Reevaluation of Current Literature — Amanda L.C. Chen, Ph.D. Thomas J.H. Chen, Ph.D.; Eric R. Braverman, M.D.; Vanessa Acuri, B.S.; Mallory Kerner; Michael Varshavskiy; Dasha Braverman, P.A.; William B. Downs, B.Sc.; Seth H. Blum, B.A.; Kimberly Cassel & Kenneth Blum, Ph.D. 

Abstract—A hypothetical link between marijuana smoking and cancer has been established based on a number of misleading assumptions. However, recent studies tend to suggest, if anything, an inverse association between marijuana use and cancers. To test the hypothesis that marijuana smoking significantly lowers the risk of developing cancer in humans, we analyzed published data from a prospective cohort study on cancer incidence among nonsmokers (NS), marijuana-only smokers (MS), tobacco-only smokers (TS), and marijuana and tobacco smokers (MTS). Using the log linear model to calculate the probability of developing each cancer form as a function of the interaction between marijuana and tobacco smoking, as well as functions of marijuana and tobacco smoking main effects whereby chi square statistics were calculated for the interaction and main effect estimates, we found that in all cases tested there was a significantly lower risk for MS compared to TS. Male and female TS had a greater probability of developing lung cancer (r = 0.72) than did MS (r = 0.02). Males and females TS had a greater probability of developing lung cancer (r = 0.72) compared with NS (r = 0.05). Males and female MTS had a slightly higher probability of developing lung cancer (r = 0.73) than did MS (r = 0.07). This difference was statistically significant: c² = 30.51, p < .00001, with a correlation coefficient of -0.75, Z = -7.84, p < .05. Male and female MTS had a lower probability of developing lung cancer (0.23) than did TS (0.77). This difference was statistically significant: c² = 71.61, p = .00003, with a correlation coefficient of0 .61, Z = 5.06, p < .05.

Heroin Users in Cape Town, South Africa: Injecting Practices, HIV-Related Risk Behaviors, and Other Health Consequences — Andreas Plüddemann, M.A.; Charles D.H. Parry, Ph.D.; Alan J. Flisher, Ph.D. & Esmé Jordaan, M.Sc.
Abstract — UN reports point to a steady increase in heroin use in a number of African countries, including South Africa. South Africa also has one of the highest HIV infection prevalence rates in the world. Given the link between intravenous heroin use and HIV transmission, this study aimed to investigate HIV-related risk behaviors among heroin users in the city. A snowballing or chain referral sampling technique was used to find 239 heroin users in Cape Town who were interviewed using a structured questionnaire. Overall, 24% of all the participants reported that they had injected heroin in the past 30 days and 89% of these had shared a needle at least once during that period. Condom use was irregular among the survey participants. Three percent stated that they were HIV positive. Heroin use has become a major concern in Cape Town and may still be increasing. While injecting use still appears to be fairly limited, this has the potential to change. Further debate is required regarding the introduction of harm reduction approaches that have been found to be effective elsewhere.
Keywords—harm reduction, heroin, HIV, injecting, South Africa

Including the Siblings of Youth Substance Abusers in a Parent-Focused Intervention:  A Pilot Test of the Best Plus Program — John H. Bamberg, M.A.; John W. Toumbourou, Ph.D. & Richard Marks, R.N.

Abstract—Substance use is common among young people and can escalate into significant problems for affected individuals and their families. Family responses can influence the course of youth substance use and its consequences for family members, including parents and siblings. Family-level interventions developed to date have neglected the important role that siblings can play. This article describes a pilot test of an intervention designed to assist parents and siblings affected by youth substance use and related problems. The BEST Plus intervention consisting of professionally-led, multifamily groups sequenced over eight sessions is described with reference to the intended therapeutic processes. Professionally observed and self-reported changes for family participants including siblings suggested that the program had a beneficial therapeutic impact. This evaluation of early impacts suggests the BEST Plus program offers a promising means of assisting families to respond to substance use problems in young people.

Keywords—family therapy, youth substance use

Newsmaking on Drugs: A Qualitative Study with Journalism Professionals — Fabio C. Mastroianni, M.Sc. & Ana Regina Noto, Ph.D.

Abstract—Drugs are a frequent subject in the news media. Despite the existence of an important dynamic interplay between the print media, public opinion, and public policies, studies on these relationships are still scarce regarding the drug issue. The objective of this study is to understand the newsmaking process regarding drugs from the vantage point of Brazilian journalism professionals. Using qualitative research, semistructured interviews were conducted among an intentional sample of 22 professionals who write news stories and articles about drugs in nationwide news media. Interviewees mentioned illegality and crime as the main factors leading to the production of stories and articles. They claimed that by instilling fear among readers, newspapers and magazines tend to increase their audiences and/or sales. Most interviewees considered the coverage of drugs in Brazil as weak. Main problems reported include lack of knowledge on the subject, and not enough time to prepare the stories. It was concluded that the newsmaking process regarding drugs undergoes a series of interferences that compromise the content of the stories, therefore social strategies are needed in order to improve the quality of the material published in Brazil.

Keywords—Brazilian print media, journalism, psychotropic drugs, qualitative research

Reassessing the Cultural and Psychopharmacological Significance of Banisteriopsis caapi:  Preparation, Classification and Use Among the Piaroa of Southern Venezuela — Robin Rodd, Ph.D.

Abstract—Recent attention to the monoamine oxidase inhibiting properties of Banisteriopsis caapi’s harmala alkaloids has precluded a balanced assessment of B. caapi’s overall significance to indigenous South American societies. Relatively little attention has been paid to the cultural contexts, local meanings and patterns of use of B. caapi among snuff-using societies, such as the Piaroa, who do not prepare decoctions containing N,N-dimethyltryptamine (DMT) admixtures. This article reviews the psychopharmacological literature on B. caapi in light of recent ethnographic work conducted among the Piaroa of southern Venezuela. Piaroa shamans use only B. caapi’s cambium, identify at least five distinct varieties of B. caapi, and emphasise the plant’s importance for heightening empathy. Some Piaroa people also attribute a range of extra-shamanic uses to B. caapi, including as a stimulant and hunting aid. In light of the psychopharmacological complexity of harmala alkaloids, and ethnographic evidence for a wide range of B. caapi uses, future research should reconsider B. caapi’s cultural heritage and psychopharmacological potential as a stimulant and antidepressant-like substance.

Keywords—ayahuasca, Banisteriopsis caapi, ß-carbolines, Piaroa yopo

SHORT COMMUNICATIONS

Availability and Characteristics of Betel Products in the U.S. — Melissa Blank, Ph.D.; Laxmikant Deshpande, Ph.D. & Robert L. Balster, Ph.D.

Abstract—Betel use involves oral placement of shards of areca nut (Areca catechu palm seed containing the cholinergic agonist arecoline) wrapped with slaked lime in a betel leaf (Piper betle plant) or various chopped or powdered products containing areca nut and/or parts of the betel plant. Additives to this mixture include catechu (areca palm extract), spices/sweeteners (e.g., saccharin, cloves), and/or tobacco. Betel use is most common in Asia and East India; however, little is known about the availability and characteristics of these products outside of this region. Thus, a representative sample of betel products and additives was purchased in the Richmond, Virginia area. Five venues were visited between March and May, 2006. Products successfully purchased were those containing betel alone (seven), betel/tobacco (three), tobacco alone (four), and additives (four). Most betel products listed ingredients on the packaging, though some did not explicitly distinguish between those with versus without tobacco. Importantly, seven of seven betel alone and one of three betel/tobacco products omitted any health-related warnings. All products were inexpensive and relatively obtainable in the groceries visited. More research is warranted in order to accurately estimate product emergence into the U.S. and other world markets, and the consequent impact on public health.

Keywords—areca, betel nut, gutka, paan, tobacco

Substance Use in a Sample of Medical Patients —Jamshid Ahmadi, M.D.; Leila Benrazavi, M.D.; Mohammadali Babaeebeigi, M.D.; Ahmad Ghanizadeh, M.D.; Mohammadjavad Ghanizadeh M.D & Saxby Pridmore, M.D.

Abstract—The purpose of the current study was to assess the rate of substance use in patients with medical diseases who were admitted to different wards at Shiraz hospitals affiliated to the Shiraz University of Medical Sciences. Data were gathered from 600 randomly selected patients by a structured interview that included DSM-IV criteria for substance dependency. The mean ages for men and women were 45.8 and 44.7 years, respectively. In this group, 76.7% of the men and 83.7% of the women were married. The majority (29%) of the patients were current nicotine users, and 7.2% were opium users; none used cocaine or LSD. The reported reasons for initial use of substance(s), in order of frequencies, were enjoyment, modeling and release of tension; for current users the reasons were habit, enjoyment and need. Substance use, especially cigarettes, was found to be common among patients. Cultural attitudes toward substance use were thought to affect the type and amount of use. These findings can be considered when planning preventive programs.

Keywords—medical patients, substance use