The secret life of maladaptive daydreaming
Daydreaming can be a pleasant pastime, but people who suffer from maladaptive daydreaming are trapped by their fantasies.
21 January, 2021
Credit: Wikimedia Commons
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<p>James Thurber's short story "The Secret Life of Walter Mitty" follows its mild-mannered protagonist through another mundane day of thankless chores. But Mitty is a daydreamer. He spices up his humdrum existence—and, thankfully, the story itself—through fantasies. Real-world events cause Mitty to imagine he's an ace hydroplane pilot, a brilliant surgeon, and an assassin on trial.</p><p>Thurber's character fits many readers like a driving glove because, as science has discovered, we all have a little Walter Mitty in us.</p><p><a href="https://science.sciencemag.org/content/330/6006/932" target="_blank">Research suggests</a> that <a href="https://bigthink.com/ideafeed/why-daydreaming-is-a-virtue" target="_self">our minds wander</a> close to 50 percent of the time, and we use these mental getaways to imagine our lives in all manner of fun and fanciful scenarios. We fantasize about the perfect meet-cute, or starting an exciting new career, or what we'd do with superpowers, or unbridled sexual encounters. <a href="https://bigthink.com/sex-relationships/fantasizing-about-sex" target="_self">Mostly it's sex</a>. </p><p>And despite admonishments from our Victorian-styled teachers and supervisors, <a href="https://www.psychologytoday.com/us/blog/supersurvivors/201712/why-daydreaming-is-good-us" target="_blank" rel="noopener noreferrer">a mind in the clouds</a> comes associated with a bevy of cognitive benefits. These include <a href="https://bigthink.com/videos/scott-barry-kaufman-on-intelligence-and-imagination" target="_self">greater creativity</a>, improved productivity, better problem-solving, and progress toward goals. Daydreaming is, in short, <a href="https://bigthink.com/ideafeed/why-daydreaming-is-a-virtue" target="_self">a virtue</a>. </p><p>Except when it isn't, and here the darker undertones of Thurber's story come into play. It's hinted that Mitty may not be enjoying playful escapism but suffering from an uncontrollable urge to disassociate from his life, his responsibilities, and his relationships. Today, psychologists are researching whether such a Mittyesque existence may be the result of a new disorder known as maladaptive daydreaming.</p>
Maladaptive daydreaming
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNTUwMjgyMy9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY0OTUxNzc3Nn0.yVIUGnZl6VnJhfevESkBpb1TEvwKrHcLtobwNJV55HI/img.jpg?width=1245&coordinates=0%2C63%2C0%2C63&height=700" id="713cf" class="rm-shortcode" data-rm-shortcode-id="e2d24a66284b3aa58ad16b66c135dc9d" data-rm-shortcode-name="rebelmouse-image" data-width="1245" data-height="700" />One maladaptive dreamer spent hours a day dreaming he was a powerful man who could solve the world's problems.
Credit: Pixabay
<p>Daydreaming is an indulgence of the mind and imagination, one provided courtesy of the <a href="https://www.sciencedirect.com/topics/neuroscience/default-mode-network#:~:text=The%20default%20mode%20network%20(DMN,and%20Exercise%20Psychology%20Research%2C%202016" target="_blank">default mode network</a>, a network of interacting brain regions that is active even when the conscious mind is not. But like so many of life's indulgences—wine, steak dinners, video games, and even <a href="https://www.healthline.com/health-news/why-too-much-exercise-can-be-bad-042514" target="_blank">exercise</a>—too much daydreaming can be harmful to our well-being. When daydreaming crosses that threshold, it can be considered maladaptive.</p><p>This disorder was first identified by <a href="https://haifa.academia.edu/EliSomer" target="_blank">Eli Somer</a>, a professor of clinical psychology at the University of Haifa, School of Social Work, in <a href="https://link.springer.com/article/10.1023/A:1020597026919" target="_blank" rel="noopener noreferrer">a 2002 paper</a>. That paper looked to six patients in a trauma center whose daydreaming habits replaced human interactions or interfered with their standard life functions, such as going to school or holding down a job. </p><p>Since then, other case studies have looked at <a href="https://www.healthline.com/health/mental-health/maladaptive-daydreaming#:~:text=Maladaptive%20daydreaming%20is%20a%20psychiatric,life%20events%20trigger%20day%20dreams." target="_blank" rel="noopener noreferrer">maladaptive daydreamers</a> and compiled a list of potential symptoms. These include vivid, richly-detailed daydreams; abnormally long daydreaming sessions; daydreams triggered by real-life events; daydreaming sessions that interrupt sleep; and repetitive motions or whisperings while daydreaming. On average, one study reported, maladaptive daydreamers spend <a href="https://bigthink.com/bps-research-digest/people-with-maladaptive-daydreaming-spend-an-average-of-four-hours-a-day-lost-in-their-imagination" target="_self">four hours a day</a> housed in their imaginations.</p><p>"This is not like rehearsing a conversation that you might have with a boss," <a href="https://www.cnn.com/2016/12/30/health/maladaptive-daydreaming-feature/index.html" target="_blank" rel="noopener noreferrer">Somer told CNN</a>. "This is fanciful, weaving of stories. It produces an intense sense of presence."</p><p>While such symptoms are common, though not comprehensive or guaranteed, how maladaptive daydreams manifest are naturally individual to the dreamers. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6426361/" target="_blank" rel="noopener noreferrer">In one case study</a>, researchers analyzed the diary of a man codenamed "Peter." Peter described investing as many as 14 hours a day online. The news and images he happened upon would trigger related fantasies. For example, he may envision himself as a multimillionaire genius who could prevent bad news from occurring or self-insert himself into the power fantasies of superhero movies or police procedurals for hours at a time.</p><p>"When I felt this pain as a child, I started imagining how things could be different. I created stories which never happened. To suppress that pain I would hug my pillow or quilt, thinking I was being comforted by someone else," Peter wrote.</p><p>In an interview with CNN, Cordellia Rose described her maladaptive daydreaming like a drug and noted that her daydreams developed into intricate storylines that could last for years. These stories proved so distracted that she was unable to complete everyday tasks such as driving lessons.</p><p>"You get hooked on it, because it can be like an action movie in your head that's so gripping that you cannot turn off," Rose told CNN. "This [condition] needs to be public, because these are people suffering, and badly."</p><p>To be clear, maladaptive dreaming is not a <a href="https://www.webmd.com/schizophrenia/guide/what-is-psychosis#1" target="_blank" rel="noopener noreferrer">psychotic disorder</a> like schizophrenia. Daydreamers such as Peter and Rose are aware that their fantasies are as unreal as they may be unrealistic. Because of this, many maladaptive dreamers understand the difficulties they face and the real-life losses they have endured for the sake of their fantasies. </p>More research needed
<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="6fdb8ca5dcc87c58b441d9c7cd766f35"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/vI7b4_-MA8g?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>Researchers don't have a <a href="https://www.medicalnewstoday.com/articles/319400" target="_blank" rel="noopener noreferrer">standard diagnosis or treatment for maladaptive daydreaming</a> because they aren't yet sure it's a unique psychological condition. Maladaptive daydreaming has not been included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition—blessedly abbreviated as the DMS-5—the definitive book on mental disorders. To date, there isn't enough evidence to determine if maladaptive daydreaming is a separate condition or a manifestation of an already listed disorder.</p><p>Somer has developed a <a href="https://www.sciencedirect.com/science/article/abs/pii/S1053810015300611" target="_blank" rel="noopener noreferrer">14-point scale</a> to help people determine whether they are experiencing maladaptive-daydreaming symptoms, but the results only indicate whether an individual should seek help. They provide no formal diagnosis.</p><p>Also, maladaptive daydreaming is often expressed alongside other conditions, such as anxiety disorders, <a href="https://www.psychiatryadvisor.com/home/topics/anxiety/ptsd-trauma-and-stressor-related/high-prevalence-of-maladaptive-daydreaming-among-patients-with-dissociative-disorders/" target="_blank" rel="noopener noreferrer">dissociative disorders</a>, attention deficit disorders, and obsessive-compulsive disorders. And the researchers of Peter's case study noticed a striking similarity between his condition and those with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3164585/" target="_blank" rel="noopener noreferrer">behavioral addition response</a>—including analogous responses with preoccupation, mood modification, tolerance, and withdrawal. It may be that maladaptive daydreaming is an expression of these, or other, disorders.</p><p>It's worth noting that similar empirical hurdles exist for other well-known, though not formalized, disorders. Orthorexia, sex addiction, misophonia, internet addiction, and parental alienation syndrome are all <a href="https://www.verywellmind.com/whats-missing-from-the-dsm-4145344#:~:text=This%20diagnosis%20covered%20patients%20who,%22%20or%20%22unspecified%20disorder.%22" target="_blank" rel="noopener noreferrer">likewise absent from the DSM-5</a>. For maladaptive daydreaming and these other conditions, it's simply a case of more evidence and research needed before a determination can be made.</p>A growing understanding of maladaptive daydreaming
<p>The question of labeling is a tricky one—not only from a medical point-of-view but also a prosocial one. Some people find having a recognized condition validating; they feel it promotes social acceptance and makes seeking treatment easier. Others find such labels stigmatizing and restricting.</p><p>But the question of how to label something is an academic one. It isn't to say that the experience doesn't exist. It does, and whether maladaptive daydreaming ultimately enters the DSM-5 or not, awareness is growing. <a href="https://daydreamresearch.wixsite.com/md-research/links" target="_blank">Online communities</a> now exist to give support and spread awareness. And regardless of a condition's presence in the medical literature, if symptoms disrupt work, school, or social lives, help should be sought.</p><p>Thanks to the efforts of psychologists and the community, maladaptive daydreaming, unlike Thurber's literary creation, is no longer "inscrutable to the last." And those who suffer it are no longer relegated to a firing-squad of their own mind but can find they help the need.</p>
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Chemists modify hallucinogen to treat depression and addiction
A new study explores the therapeutic potential of the psychedelic drug ibogaine, which has been used in Africa for centuries.
10 December, 2020
Credit: David S. Soriano / Wikimedia Commons
- For decades, people have reported that the psychedelic drug ibogaine seems to rid addicts of their cravings for drugs.
- In a new study, researchers created a variant of ibogaine that's less toxic and doesn't cause hallucinations.
- The results showed that the variant seemed to significantly lower depression and drug relapse rates in tests on mice.
<p>A new study suggests a modified version of the psychedelic drug ibogaine could help treat addiction and depression. </p><p>Although the ibogaine variant has yet to be tested on humans, rodents who were treated with it showed decreased symptoms of depression and significantly fewer drug relapses, especially for opioids. </p><p>What's also encouraging is that the variant is far less toxic and hallucinogenic than ibogaine, meaning it has the potential to become a more widespread treatment than its psychedelic relative. </p><p>First, what's ibogaine?</p><p>Ibogaine is a uniquely powerful psychedelic drug that produces hallucinations and other effects that can last 24 hours. It's the active compound in the iboga plant, which has been used for medicinal and religious purposes in West Africa for centuries. The drug is central to the Bwiti spiritual discipline, practiced by Bantu peoples in Gabon. </p><p>In the 19th century, French Christian missionaries sought to rid the Bantu of their religious practices, causing some of the Bantu tribespeople to flee deep into the jungle, where they encountered Pygmies. The Pygmies showed igoba to the Bantu, who later incorporated it into Bwiti initiation rites.</p><p>Despite its religious applications, ibogaine is neurotoxic and can cause irregular heartbeat. At high doses, the substance can be lethal. </p><p>But it's also thought to have a unique therapeutic effect: For decades, people have reported that ibogaine seems to significantly—and in some cases, completely—rid addicts of cravings for drugs.</p><p>How? One hypothesis is that psychedelics like ibogaine help the brain grow more dendritic spines, which promote communication between neurons. This strengthened communication may benefit addicts, who often show decreased synaptic connections in the prefrontal cortex.</p>
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDk0NDgzMS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY2NDM1MTI0N30.nTZ-_XcHStKyN8vWUVrDp709FBCzktTYBaLtE1SxKg0/img.jpg?width=980" id="b1397" class="rm-shortcode" data-rm-shortcode-id="6e0a2533eca7abf67f4ee0ced2403daf" data-rm-shortcode-name="rebelmouse-image" alt="iboga" data-width="2683" data-height="2015" />
Tabernanthe iboga bark powder
Credit: Kgjerstad / Wikimedia Commons
<p>To explore ibogaine's potential as an addiction treatment, the researchers behind the recent study, published in the journal <a href="https://www.nature.com/articles/s41586-020-3008-z" target="_blank">Nature</a>, aimed to create safer, less toxic analogues of the drug. </p><p>The team created an ibogaine variant that, like ibogaine, had an element called a tetrahydroazepine ring, which seems to be involved in promoting the growth of dendritic spines. This variant—a compound called tabernanthalog (TBG)—was less toxic and less hallucinogenic.<br></p><p>Experiments on mice suggested TBG has antidepressant and anti-addiction potential. </p><p>One test showed that mice subjected to a series of stressors showed less depression symptoms after one treatment, effects similar to ketamine, another psychedelic drug. More surprising was a test on opioid addiction: TBG seemed to virtually eliminate relapses in mice who had become addicted to heroin. This anti-addictive effect lasted about two weeks.</p>Therapeutic potential
<p>The researchers suspect TBG might be able to treat multiple conditions simultaneously.</p><p style="margin-left: 20px;">"We've been focused on treating one psychiatric disease at a time, but we know that these illnesses overlap," David Olson, assistant professor of chemistry at UC Davis and senior author on the paper, told <a href="https://www.ucdavis.edu/news/new-compound-related-psychedelic-ibogaine-could-treat-addiction-depression/" target="_blank">UC Davis News</a>. "It's unbelievable how little we know about them." "It might be possible to treat multiple diseases with the same drug."</p><p>But before drugs like TBG could be used to treat addiction or depression in humans, more research will be needed to better understand the drug, its safety and whether its therapeutic effects extend beyond rodents. Another interesting question, though not explored by the study, is whether the psychedelic properties of ibogaine possess therapeutic benefits; by removing the trip aspect, would users be missing out?</p>The psychedelic aspect
<p>Maybe. Psychedelic experiences are mysterious and highly subjective, with some people reporting terrifying and negative trips, while others gain useful insights. Here's one account of a positive experience posted on <a href="https://erowid.org/experiences/exp.php?ID=58716" target="_blank">Erowid</a>:</p><p style="margin-left: 20px;">"[1 hour 20 minutes after ingestion] I am having an intense communion with a spirit in the shape of a purple-colored, brain-shaped cloud of vapor, which shows me the interconnection of myself and all things in the universe. It must sound comical to read it in words, but it was the most profound and beautiful experience in my life."</p><p style="margin-left: 20px;">"[7 hours after ingestion] [...] something interesting has started happening in my brain. I feel as if there is a distinct second consciousness inside me, and I can carry on internal conversations with it, asking questions, receiving answers. The other consciousness seems extremely wise, I sense it is another part of me that has never been encumbered by fears or doubts [...]"</p>To be sure, you can also find reports of ibogaine making people sick, being too powerful or <a href="https://erowid.org/experiences/exp.php?ID=94015" target="_blank">not being worth the money</a> to experiment with it at a treatment center. But regardless of the psychedelic properties, the new study adds to the <a href="https://bigthink.com/mind-brain/psychedelic-therapy" target="_self">renaissance of research exploring how psychedelics can help treat mental health conditions</a>.
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Psilocybin rapidly promotes neuroplasticity in the brains of rats
The compound found in "magic mushrooms" has significant and fast-acting impact on the brains of rats.
17 November, 2020
Credit: kichigin19/ Adobe Stock
- Psilocybin and psilocin are chemical compounds found in "magic mushrooms."
- A recent study published in the Journal of Psychopharmacology found very interesting results when psilocybin was administered to rats to research the potential impact the chemical could have on the human brain.
- Several studies have suggested that psilocybin could be a treatment for depression.
<p><a href="https://journals.sagepub.com/doi/abs/10.1177/0269881120959614" rel="noopener noreferrer" target="_blank">A recent study</a> published in the Journal of Psychopharmacology found very interesting results when psilocybin was administered to rats to research the potential impact the chemical could have on the human brain.</p><p>Psilocybin increases the expression of several genes related to neuroplasticity in the brain of rats after just one dose.</p><p><strong>What is psilocybin? </strong></p><p><a href="https://www.drugs.com/illicit/psilocybin.html" rel="noopener noreferrer" target="_blank">Psilocybin</a> and psilocin are chemical compounds found in "magic mushrooms." These are typically obtained from certain types of dried or fresh mushrooms found in places such as Mexico and South America. These compounds have a similar structure to lysergic acid diethylamide (LSD) and are often abused for their hallucinogenic and euphoric effects. </p><p><strong>What is neuroplasticity? </strong></p><p>Neuroplasticity is the ability of neural networks in the brain to change through both growth and reorganization, and the above increases/decreases of certain genes provoked by psilocybin is a form of neuroplasticity that happens in response to even small doses of psilocybin (magic mushrooms)</p><ul class="ee-ul"></ul>
The study: magic mushrooms and the prefrontal cortex/hippocampus of rats
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDc4MzI1OS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY3MDQ4ODMwN30.VecgmOyJFizN7u5d5AhYbSlsGXNE6xtpgRof2FV9g7o/img.jpg?width=1245&coordinates=0%2C299%2C0%2C299&height=700" id="45bbc" class="rm-shortcode" data-rm-shortcode-id="f87bcf6bacfca976a5bbcb028e790ee9" data-rm-shortcode-name="rebelmouse-image" alt="mushrooms growing on log in a forest psilocybin magic mushrooms study" data-width="1245" data-height="700" />Psilocybin increases the expression of several genes related to neuroplasticity in the brain of rats after just one dose.
Photo by bukhta79 on Adobe Stock
<p>The study examined the acute effects of a single dose (0.5-20mg/kg) of psilocybin on the brain of rats. In total, 45 genes and 8 reference genes were assessed using real-time quantitative polymerase chain reaction. The corresponding protein levels of the three most commonly regulated genes were then assessed using Western blotting.<br></p><p><strong>In the prefrontal cortex, the drug increased the expression of the following:</strong></p><ul><li><a href="https://www.genecards.org/cgi-bin/carddisp.pl?gene=CEBPB" target="_blank">CEBPB</a> (protein-coding gene)</li><li><a href="https://www.sciencedirect.com/topics/neuroscience/c-fos" target="_blank">c-Fos</a> (a proto-oncogene)</li><li><a href="https://www.frontiersin.org/articles/10.3389/fimmu.2019.01446/full" target="_blank" rel="noopener noreferrer">DUSP-1</a> (protein-coding gene)</li><li><a href="https://www.pnas.org/content/98/20/11042" target="_blank" rel="noopener noreferrer">FOSB</a> (protein-coding gene) </li><li><a href="https://www.genecards.org/cgi-bin/carddisp.pl?gene=JUNB" target="_blank" rel="noopener noreferrer">JunB</a> (protein-coding gene)</li><li><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4282558/" target="_blank" rel="noopener noreferrer">IkBa</a> (inhibitor gene)</li><li><a href="https://www.genecards.org/cgi-bin/carddisp.pl?gene=NR4A1" target="_blank" rel="noopener noreferrer">Nr4a1</a> (growth factor gene) </li><li><a href="https://www.jwatch.org/jp201012060000001/2010/12/06/p11-protein-and-depression" target="_blank" rel="noopener noreferrer">P11</a> (protein)</li><li><a href="https://molecularbrain.biomedcentral.com/articles/10.1186/s13041-019-0520-x" target="_blank" rel="noopener noreferrer">Psd95</a> (protein) </li><li><a href="https://www.ncbi.nlm.nih.gov/gene/6446" target="_blank" rel="noopener noreferrer">SGK1</a> (protein-coding gene)</li></ul><p>The drug also decreased the expression of <a href="https://www.genecards.org/cgi-bin/carddisp.pl?gene=CLK1" target="_blank" rel="noopener noreferrer">CLK1</a>, an enzyme that, in humans, is encoded by the CLK1 gene. </p><p><strong>In the hippocampus, psilocybin strongly increased the expression of: </strong></p><ul><li><a href="https://www.phosphosite.org/uniprotAccAction?id=Q8TBH0" target="_blank" rel="noopener noreferrer">Arrdc2</a> (protein) </li><li><a href="https://www.frontiersin.org/articles/10.3389/fimmu.2019.01446/full" target="_blank" rel="noopener noreferrer">DUSP-1</a> (protein-coding gene)</li><li><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4282558/" target="_blank" rel="noopener noreferrer">IkBa</a> (inhibitor gene)</li><li><a href="https://www.ncbi.nlm.nih.gov/gene/6446" target="_blank" rel="noopener noreferrer">SGK1</a> (protein-coding gene)</li></ul><p>The drug also decreased the expression of <a href="https://www.nih.gov/news-events/news-releases/memory-gene-goes-viral#:~:text=The%20neuronal%20gene%20Arc%20encodes,that%20mediates%20intercellular%20RNA%20transfer." target="_blank" rel="noopener noreferrer">ARC</a> (neuronal gene encoder), <a href="https://www.genecards.org/cgi-bin/carddisp.pl?gene=CLK1" target="_blank" rel="noopener noreferrer">CLK1</a>, <a href="https://www.genecards.org/cgi-bin/carddisp.pl?gene=EGR2" target="_blank" rel="noopener noreferrer">EGR2 </a>(protein-coding), and <a href="https://www.genecards.org/cgi-bin/carddisp.pl?gene=PTGS2" target="_blank" rel="noopener noreferrer">PTGS2</a> (protein-coding). The protein levels of certain genes (IkBa, DUSP1, and SGK1) showed only partial agreement with transcriptional patterns, which stresses the importance of assessing downstream translation with these kinds of rapid gene responses.</p><p><strong>What does this mean? </strong></p><p>This study demonstrates that psilocybin not only includes gene expression that's heavily related to neuroplasticity, but it does so as a very rapid response to the chemical. The results were biased towards the prefrontal cortex compared to the hippocampus, but the findings of this study provide undeniable evidence for the rapid plasticity-promoting effects of psilocybin. </p>Can magic mushrooms treat depression?
<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="44a65f388fea7701426102fac072709e"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/pxuaYPff-14?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>Several studies (including <a href="https://www.nature.com/articles/s41598-017-13282-7" target="_blank">this one from 2017</a>) have suggested that <a href="https://bigthink.com/scotty-hendricks/a-new-study-finds-a-psychedelic-treatment-for-depression-with-a-side-of-mushrooms" target="_self">psilocybin could be a treatment for depression</a>. In this study, 19 patients were given two incrementally larger doses of psilocybin administered one week apart. MRI scans were taken of the brains of patients before and after the doses were administered. The results of the study showed that the chemical reduced and then increased the amount of blood flow to (and thus changing the activity levels of) different regions of the brain, some of which are associated with depressive symptoms.</p><p>The patients of this study also self-reported improved mood spikes lasting for up to five weeks after the ingestion of psilocybin. The patients even explained that they felt as though their brains had been "reset" or "rebooted" - this effect being known (in unscientific settings) as the "afterglow" of psilocybin use. </p><p><strong>Psychedelic drugs (like psilocybin) may hold untold potential in treating not only depression but anxiety and addiction, as well.</strong> </p><p>While researchers are still pursuing how psychedelics like psilocybin could be beneficial to human brains, there are some theories surrounding how psychedelics could help in addiction therapies. </p><p>"People will often report a changed relationship in observing themselves. I think this is much like what we refer to as mindfulness: someone's ability to view their own motivations and behaviour from a more detached and less judgemental perspective," said Matthew Johnson, a professor of psychology at Johns-Hopkins University who is <a href="https://www.vice.com/en/article/bmvdnm/how-psychedelic-drugs-psilocybin-lsd-could-help-treat-addiction" target="_blank" rel="noopener noreferrer">testing psilocybin in a trial aimed at nicotine addiction.</a></p>
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Should we pay ex-drug users to help them get clean?
What is more important, that a treatment helps keep people healthy or that it meshes with our morals?
06 November, 2020
Credit: /.lkmlPixabay
- A novel treatment aims to help former drug users by paying them to stay clean.
- Some moral objections to the idea of paying people to not use drugs help keep the program underused.
- Many other treatment methods face similar issues.
<p> Addiction is a terrible thing, and there is a lot of it to be found these days. In addition to the ongoing opioid epidemic, an increase in overdose deaths, likely related to COVID-19 lockdowns, is being <a href="https://www.npr.org/sections/coronavirus-live-updates/2020/08/13/901627189/u-s-sees-deadly-drug-overdose-spike-during-pandemic" rel="noopener noreferrer" target="_blank">reported</a>. While opioid addictions and the pain they cause tend to get the most attention in the news, other drugs are also being used at high rates in some areas. Among them are stimulants such as meth. <br> <br> Despite the tremendous length of time humanity has been dealing with addictive substances, we're still not great at actually finding solutions to it. Many treatment programs use a variety of methods of limited effectiveness alongside ones with better track records. However, a rarely used but well-supported program offers a remarkably effective solution to addiction with a straightforward method: paying former drug users to stay clean. It is currently getting increasing amounts of attention. </p>
Kind of surprising it took us this long to try that idea.
<iframe width="730" height="430" src="https://www.youtube.com/embed/HLwUi7r7_T8" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe><p> The idea of positive reinforcement to encourage good behavior is familiar to most people. Using a technique dubbed "c<a href="https://en.wikipedia.org/wiki/Contingency_management" target="_blank" rel="noopener noreferrer">ontingency management</a>," these programs apply the concept in a new way. When someone undergoing treatment attends enough meetings and appointments or goes a particular length of time without relapsing, they are given <a href="https://drugabuse.com/contingency-management/" target="_blank" rel="noopener noreferrer">rewards</a>, often in the form of <u><a href="https://www.nytimes.com/2020/10/27/health/meth-addiction-treatment.html" target="_blank" rel="noopener noreferrer">money</a></u>.</p><p>How this is done differs by program; some just hand out cash prizes, others give out coupons, a few hand out tokens. Many don't offer a consistent amount, and some use systems where cash prizes are mixed with other rewards on a random basis. Despite these variations, the principle remains the same: good behavior that moves somebody towards their goal is rewarded. </p><p> The idea has been extensively studied and found to be very effective, more so than many other procedures frequently used in addiction treatment. It is also very effective when used in conjunction with other <a href="https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1002715&type=printable" target="_blank" rel="noopener noreferrer">therapies</a>. While most of the studies of contingency management appear to focus on its use against <a href="https://pubmed.ncbi.nlm.nih.gov/17907865/" target="_blank" rel="noopener noreferrer">stimulant addiction,</a> studies on its effectiveness against alcohol abuse also <a href="https://pubs.niaaa.nih.gov/publications/arh23-2/122-127.pdf" target="_blank" rel="noopener noreferrer">exist</a>. <br> <br> However, you can probably already see the difficulties of spreading the program; the idea of giving people cash for staying off drugs can be a hard sell. Most of the internet pages that explain the idea mention that no study has found people spend the money particularly irresponsibly, suggesting that the notion that they would is widespread. </p><p> A recent <a href="https://www.nytimes.com/2020/10/27/health/meth-addiction-treatment.html" target="_blank" rel="noopener noreferrer">New York Times article</a> on the subject included the coordinator of a treatment program voicing his concern that this very thing could happen. The same article pointed out that these programs might also, technically, be illegal. Many insurance companies won't pay for treatments that utilize this method. </p><p>This is a shame, as the benefits of this method are beyond doubt.<br></p>The moral questions of treating addiction
<iframe width="730" height="430" src="https://www.youtube.com/embed/HWrbUwNGoWc" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe><p> As you might expect, this isn't the only area where moral considerations crash into what is proven to help people beat their addictions or be healthier people. </p><p>The idea of government-backed needle <a href="https://www.cdc.gov/ssp/syringe-services-programs-faq.html" target="_blank" rel="noopener noreferrer">exchanges</a>, where people in need of needles for what are often illegal purposes can get a clean one despite why they may need it, goes back to a Dutch program in the 1980s. It has a long history of doing what it sets out to do in terms of keeping dirty, disease-causing needles, off the streets. </p><p> Proponents of these programs cite evidence that they reduce the instances of diseases (such as AIDS) often spread by dirty needles, they provide easier access to social services for those who need them most, and they are generally agreed to improve the condition of people struggling with addiction. <strong><br> <br> </strong>Despite this data, many people still oppose the idea on the grounds that providing needs or a space to use them amounts to an endorsement <a href="https://khn.org/news/conservative-indiana-adopted-needle-exchanges-but-still-faces-local-resistance/" target="_blank" rel="noopener noreferrer">of their use</a>. <br> <br> Limited studies suggest therapies incorporating LSD have shown promise in treating <a href="https://www.cbsnews.com/news/lsd-should-be-considered-for-alcoholism-treatment-study-says/" target="_blank" rel="noopener noreferrer">alcoholism</a>. While the lack of extensive research on the use of psychedelics in this area is enough to prevent a pilot program from coming to a town near you, the objections to treating alcohol addiction with powerful hallucinogens also make it unlikely. </p><p> A similar problem exists with specific treatments currently used to help those recovering from opioid addiction. Methadone, an opioid drug, is used to prevent withdrawal symptoms in patients battling an addiction to make it easier for them to stay off illicitly acquired drugs. These programs are strongly supported by studies demonstrating their <a href="https://researchonline.lshtm.ac.uk/id/eprint/5044/1/5044.pdf" target="_blank" rel="noopener noreferrer">effectiveness</a>. </p><p> Despite this, some still object to the idea of using one painkiller to wean people off <a href="https://www.careinnovations.org/wp-content/uploads/MATOpioidOvercomingObjections.pdf" target="_blank" rel="noopener noreferrer">another</a>. </p><p> Drug addiction is a painful thing. Humanity still isn't great at dealing with it. While the evidence in favor of contingency management and various other treatments is increasingly robust, their usage is limited by several factors, including moralizing. If we will end up using this treatment to help end addiction in our communities or shun it in favor of moral purity currently remains unknown. </p>
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FDA requires new addiction warning on benzodiazepines
There has been a dramatic increase in abuse and misuse.
09 October, 2020
Credit: LMWH / Shutterstock
- Benzodiazepine usage has increased in 2020 due to the pandemic.
- The FDA is requiring new label warnings due to increased abuse and misuse of benzos.
- Drugs like Valium and Xanax are approved for short-term use only, yet many are on them for years and even decades.
<p>There have been many troubling consequences of the pandemic: massive rates of unemployment, government gridlock over whether to provide further stimulus, an inability to see family members or travel, over 213,000 deaths in America, and increasing rates of anxiety and depression. </p><p>Early into quarantine rates of alcohol consumption also rose—unsurprising, given how much more time people were spending at home. Living alone was one factor, yet so was living with a partner who regularly drinks. In an interesting analysis, one European agency found <a href="https://www.emcdda.europa.eu/system/files/publications/13130/EMCDDA-Trendspotter-Covid-19-Wave-2_1.pdf" target="_blank">decreased usage of stimulants</a> like cocaine and MDMA in wastewater, which matches self-reported claims. Without late-night parties, people began tranquilizing instead of getting hyped up. </p><p>Speaking of tranquilization, rates of benzodiazepine (such as Valium and Xanax) use are <a href="https://massivesci.com/articles/covid-19-coronavirus-reactional-drug-use/" target="_blank" rel="noopener noreferrer">also increasing</a> in both the U.S. and UK. While antidepressants and anti-anxiety medications are only approved for short-term use, the uptick in prescription rates, as well as illicit use, is troubling. With no sanctioned tapering protocols available, the potential for long-term abuse—and chronic side effects—means we're in dangerous territory with drugs that we really know little about.</p><p>This news comes on the heels of an <a href="https://www.fda.gov/drugs/drug-safety-and-availability/fda-requiring-boxed-warning-updated-improve-safe-use-benzodiazepine-drug-class" target="_blank">FDA announcement</a> that benzodiazepine manufacturers will be required to update label packaging to reflect the potential for abuse and addiction. This includes brand names like Xanax, Klonopin, Librium, Valium, and Ativan. </p>
Benzodiazepine Dependence and Withdrawal - How To Avoid This
<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="5d7bbe438225de9f24d0ac75dc3710e2"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/qKpz91hYkvU?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>Since the early '50s, tranquilizer and sedative abuse has been a common yet under-discussed phenomenon in American society. The first blockbuster drug was Miltown. In 1955, meprobamate, a derivative of the short-acting mephenesin, was brought to market. Discovered by Czechoslovakian pharmacologist Frank Berger while developing a penicillin preservative, he noticed mephenesin calmed rats without knocking them out. In 1950, Berger moved from the UK to Cranbury, New Jersey where he developed meprobamate alongside chemist Bernard John Ludwig. By 1957, a billion pills of this drug, now called Miltown, were being produced.</p><p>Then the fire went out. In the sixties, Miltown was reclassified as a sedative. The manufacturers were sued for monopolizing the tranquilizer market. Doctors eventually recognized the risks outweighed the benefits. Miltown addicts flooded treatment centers. Instead of understanding the risks tranquilizers pose, pharmaceutical manufacturers simply shifted focus to other drugs, such as benzodiazepines, antipsychotics, SSRIs, and SNRIs.</p><p>Every decade, more problems arise with these pills. While short-term efficacy is clinically proven (especially when coupled with psychotherapy), underlying risks have long been known and little discussed. As Dr. Harshal Kirane, medical director of Wellbridge Addiction Treatment and Research, <a href="https://abcnews.go.com/Health/popular-anti-anxiety-medications-highly-addictive-fda-warning/story?id=73295488" target="_blank">recently said</a> after the FDA announcement, </p><p style="margin-left: 20px;">"Benzodiazepines will not be the next big epidemic. They have been a 'silent' epidemic for decades, intensifying consequences from the current opioid epidemic."</p><p>The FDA's decision is based on growing evidence that benzos are prescribed more frequently and for longer durations than they're approved for. This has led to increasing cases of abuse and misuse. </p><img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDQ5MDQ0MC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY3Mzg3NDIzN30.uL7TQioKg8QJHLDNRV69AVAdJgmmr1JbXqmLemqP_Bs/img.jpg?width=1245&coordinates=0%2C135%2C0%2C135&height=700" id="215d2" class="rm-shortcode" data-rm-shortcode-id="336303f55fc2bec4e6cfb759afe2b045" data-rm-shortcode-name="rebelmouse-image" alt="overturned pill bottle" data-width="1245" data-height="700" />
Credit: Tomas Nevesely / Shutterstock
<p>As journalist Robert Whitaker <a href="https://bigthink.com/mind-brain/antidepressants-dangers" target="_self">told Big Think</a> earlier this year, drug approval regulations are looser than many assume. Drug manufacturers, which often sponsor clinical trials for their own drugs, only have to show efficacy over placebo—how much efficacy doesn't matter. If a company doesn't like the result, they can throw out the data and never report it. Then there's chronic use.</p><p style="margin-left: 20px;">"We also don't measure long-term exposure. If you look at Xanax, it doesn't show any efficacy after about four weeks. If you're taking it on a daily basis, you really should get off it. But all sorts of people have been on it for two years, three years, five years, 10 years. We don't have a mechanism for assessing what happens to people on these drugs for that amount of time."</p><p>In fact, the original Xanax trial was for 14 weeks. At the end, the drug was under-performing the placebo. Instead of submitting that data, the company only reported the four-week data. As of 2017, Xanax was the <a href="https://clincalc.com/DrugStats/Top300Drugs.aspx" target="_blank">21st most-prescribed drug</a> in the country, with nearly 26 million prescriptions written, even though it only shows efficacy for about a month. </p><p>Psychiatrist Bechoy Abdelmalak <a href="https://abcnews.go.com/Health/popular-anti-anxiety-medications-highly-addictive-fda-warning/story?id=73295488" target="_blank" rel="noopener noreferrer">explains</a> the road to addiction: </p><p style="margin-left: 20px;">"When you start taking these drugs, the response is very positive so it becomes hard for patients to discontinue them. So patients often take them for many years and, with chronic use, the risk of side effects increases, especially in the elderly."</p><p>Overall, roughly 92 million prescriptions for benzodiazepines were dispensed in America in 2019, with an estimated 50 percent of patients taking them for two months or longer (according to 2018 data). </p><p>A label warning is a step in the right direction, but given the increasing amounts of mental health troubles in 2020, we need more protections. The only winner right now is the <a href="https://time.com/4900248/antidepressants-depression-more-common/" target="_blank">$17 billion antidepressant industry</a> and the <a href="https://www.goodrx.com/blog/depression-and-anxiety-prescriptions-are-climbing-nationwide/" target="_blank">burgeoning anti-anxiety market</a>. That money is made on our suffering. From the looks of it, these drugs are creating more problems than they're solving, and we're all paying the price. </p><p>--</p><p><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank">Twitter</a> and <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank" rel="noopener noreferrer">Facebook</a>. His new book is</em> "<em><a href="https://www.amazon.com/gp/product/B08KRVMP2M?pf_rd_r=MDJW43337675SZ0X00FH&pf_rd_p=edaba0ee-c2fe-4124-9f5d-b31d6b1bfbee" target="_blank">Hero's Dose: The Case For Psychedelics in Ritual and Therapy</a>."</em></p>
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