Substance Abuse Treatment Prevention and Policy
January 12, 2006
Sara Smucker Barnwell, Mitch Earleywine, Rand R. Wilcox
69 citations
Daily cannabis use does not impair motivation, and its impact on subjective wellbeing is small. A large sample of 487 people, comparing those who used cannabis daily with those who had never used it, found no differences in motivation using standard or robust statistical methods. A small difference in subjective wellbeing was detected only with robust methods, but this was largely accounted for by medical users reporting health problems, suggesting illness rather than cannabis use lowered wellbeing. All statistical tests failed to reach significance at the p = .05 level, indicating no reliable effects.
Addiction
November 1, 2001
Mitch Earleywine
57 citations
Koro, a panic reaction involving the sensation of penile retraction, has been observed in some cannabis users in India but was thought to be culturally specific. This study examined whether cannabis-induced Koro occurs in Americans. Among over 70 men who reported negative reactions to cannabis, three Caucasian men aged 22–26 spontaneously described Koro symptoms after smoking marijuana. All three cases occurred after the men had heard about cannabis-induced Koro and used the drug in a novel setting or atypical way. Two had body dysmorphia, which may have contributed. All three reduced cannabis use after the experience. Koro is not limited to Eastern cultures, and factors such as prior knowledge, heightened panic settings, and poor body image may interact to trigger symptoms.
Journal of Humanistic Psychology
April 2, 2022
Mitch Earleywine, Fiona Low, Carmen Lau et al.
47 citations
Integration therapy, a key part of psychedelic-assisted treatment, helps people make sense of their psychedelic experiences after the drug's effects wear off. In interviews with 30 integration therapists, 19 themes emerged reliably. Therapists commonly defined integration as a bridge between the psychedelic experience and daily life, expressed concern about nonresponsive clients, and worried about the commercialization of psychedelic psychotherapy. They viewed integration as a process that starts before substance use, never ends, makes sense of the experience, creates behavioral change, is personalized, and makes the individual whole. Many also discussed client resistance, unrealistic expectations, power differentials, the need for connections to other providers, and self-care. The findings may help standardize integration therapy and inform future research.
Journal of Psychoactive Drugs
September 30, 2019
Maha N. Mian, Brianna R. Altman, Mitch Earleywine
47 citations
Ayahuasca, a plant-based hallucinogen used as a spiritual medicine in South America, has shown antidepressant effects in at least one placebo-controlled trial, but the mechanisms remain unclear. A survey of 152 individuals examined changes in depressive symptoms, behavioral activation, and mindfulness after an Ayahuasca experience. Mindfulness was strongly linked to reduced depression severity, but behavioral activation—engaging in rewarding activities—was a stronger predictor of improvement. Changes in behavioral activation likely serve as a mechanism underlying Ayahuasca's antidepressant effects, suggesting future clinical trials could benefit from tracking behavioral activation.
Journal of Psychopharmacology
March 28, 2021
Mitch Earleywine, Luna F. Ueno, Maha N. Mian et al.
36 citations
High doses of cannabis can produce subjective effects similar to those of the psychedelic psilocybin, but at a lower rate. In a survey, 17–19% of cannabis users reported a “breakthrough” experience, compared to 59% in psilocybin clinical trials. Heavier cannabis users reported lower scores. These effects may parallel the therapeutic benefits seen with psilocybin, suggesting potential for cannabis-assisted psychotherapy.
Journal of Psychoactive Drugs
March 23, 2022
Mitch Earleywine, Fiona Low, Brianna R. Altman et al.
31 citations
People with depressive symptoms consider it somewhat important that guides in psilocybin-assisted therapy have personally used psilocybin. In a survey of over 800 MTurk respondents with depressive symptoms, ratings for the importance of a guide who had used psilocybin exceeded the "somewhat important" level (50 on a 0–100 scale) and were higher than ratings for other guide qualities and for a cognitive behavioral therapist who shared demographics, had depression experience, or received personal therapy. People of color and those with prior therapy gave even higher importance ratings. Participants listed similar desired qualities—proper training and empathy—for both psilocybin guides and CBT therapists. The findings suggest that guides who have used psilocybin and inform clients might enhance therapy's antidepressant effects for some clients.
American Journal of Psychiatry
January 1, 2024
Mitch Earleywine, Joseph de Leo, Dinesh Bhayana et al.
23 citations
No Summary
Journal of psychoactive drugs
January 1, 2023
Zachary Herrmann, Mitch Earleywine, Joseph De Leo et al.
19 citations
Subjective responses to psychedelic drugs, such as mystical experiences and oceanic boundlessness, often correlate with therapeutic improvements in conditions like treatment-resistant depression, end-of-life anxiety, and substance use disorders. Measuring these responses is challenging; several scales show good reliability and factor structure, but samples are often small and self-selected. This review examines the psychometric properties of widely used scales and their links to treatment outcomes. Challenging experiences, psychological insight, and emotional breakthroughs also show promise, though replication is needed. A collaborative approach to data collection on subjective reactions in therapeutic settings could help predict improvement across conditions.
Journal of Psychoactive Drugs
July 29, 2019
Stacey Farmer, Melissa N. Slavin, Mallory Loflin et al.
16 citations
Cannabis remains the most frequently used illicit drug in the United States, and as legal status has changed, more people use edibles. Among 172 individuals who reported an uncomfortable experience with edible cannabis, 62.9% found the experience at least somewhat meaningful, and 95.2% reported no medical problems. The most common non-medical problem was going to bed early or lying down (75.8%). Most participants (69.2%) said dose was the key contributor to the negative experience. Those who rated the experience as more aversive were less likely to use edibles again, and longer duration of the aversive experience correlated with higher aversiveness. Despite discomfort, the vast majority used edibles again and reported no significant problems.
Psychedelic Medicine
August 18, 2023
Philip Kamilar-Britt, Elana B. Gordis, Mitch Earleywine
15 citations
The therapeutic alliance—the cooperative connection between clients and providers—is a strong predictor of outcomes across many forms of psychotherapy, but its role in psychedelic-assisted therapy (PAT) has been largely overlooked. Only two publications directly address the alliance in PAT, despite years of recommendations emphasizing it. Adding alliance measures to PAT trials is low-cost and feasible, and clinicians can improve the alliance through simple behaviors like respecting patient autonomy, listening, and addressing practical concerns. Greater focus on the alliance could clarify how PAT works and boost its effectiveness, potentially reducing human suffering more efficiently.
Journal of Psychoactive Drugs
June 21, 2023
Fiona Low, Mitch Earleywine
15 citations
Grief can become problematic or impairing, and while treatments for prolonged grief disorder exist, they have room for improvement. In a survey of 363 recreational psychedelic users who had experienced a bereavement, retrospective reports showed improvements in grief symptoms after the psychedelic experience, with a large effect size. Emotional breakthroughs during the experience were linked to greater symptom improvement, whereas challenging experiences were associated with less improvement. These findings suggest that psychedelic-assisted therapy could be a promising alternative for treating grief symptoms.
Psychedelic medicine (New Rochelle, N.Y.)
June 1, 2024
Ryan Yermus, John Bottos, Nathan Bryson et al.
13 citations
Ketamine-assisted psychotherapy (KAP) produces sustained reductions in anxiety, depression, and PTSD symptoms lasting up to 5 months after the last session. In a retrospective study of adults with treatment-resistant major depressive disorder, generalized anxiety disorder, or PTSD who received KAP across 11 North American clinics, large treatment effects were detected at 3 months (Cohen's d = 0.75-0.86) and sustained at 6 months (d = 0.61-0.73). Case reductions ranged from 39% to 41% at 3 months and 29% to 37% at 6 months. However, high attrition rates (82% at 3 months, 95% at 6 months) may limit validity of the results.
Journal of Psychedelic Studies
June 1, 2020
Mitch Earleywine, Joseph De Leo
12 citations
Antidepressant medications alone help only one in four patients and rarely outperform placebos, while psychotherapies yield better outcomes and combining both helps only 65% of clients who complete treatment. Psychedelics may improve depression through mechanisms overlapping with psychotherapy and some novel ones, suggesting their combination could work very well. Subjective experiences during psychedelic sessions correlate with improvement, so guiding clients to focus on targeted thoughts and feelings could enhance outcomes. Clinical trials of psychedelic-assisted, empirically supported treatment with guided sessions are needed, including preparatory, administration, integration, and follow-up components for maximum impact.
Cannabis
July 11, 2022
Mitch Earleywine, Maha N Mian, Brianna R Altman et al.
11 citations
People who use cannabis expect that a cannabis-assisted psychotherapy session, modeled on psychedelic-assisted psychotherapy, would reduce depression. Over 500 participants in each of two studies imagined such a session and reported expected antidepressant effects. Expected reductions in depression were linked to anticipated psychedelic-like subjective experiences, such as mystical-type feelings, and also to expected changes in dysfunctional attitudes—a separate pathway that resembles how cognitive therapy works. These findings support calls for clinical trials of cannabis-assisted psychotherapy and indicate that users anticipate it would work through mechanisms similar to both psychedelics and cognitive therapy.
Addiction
April 22, 2005
B Mirken, Mitch Earleywine
10 citations
A critique of a New Zealand cohort study on cannabis and psychosis argues that the study's use of ten items from the Symptom Checklist 90 to assess psychosis is flawed because the items focus heavily on paranoid ideation, which is a known acute effect of marijuana intoxication. The authors did not ask respondents to distinguish feelings while intoxicated from those at other times, nor did they consider that paranoid feelings may be a rational reaction for people using an illegal, socially frowned-upon substance. The daily user group reported an average of less than two symptoms each, raising questions about whether the findings reflect mental illness or normal reactions to intoxication and social context.
Journal of Psychopharmacology
December 4, 2023
Maha N. Mian, Brianna R. Altman, Fiona Low et al.
8 citations
A new 32-item scale, the Protective Strategies for Psychedelics Scale (PSPS), measures strategies people use to reduce harm when taking psychedelics. Two factors emerged: long-term preparation (mood, setting, scheduling) and short-term preparation (social context, health, other substances). The scale showed excellent reliability and was strongly correlated with existing protective behavior scales for cannabis and alcohol, and moderately with lifetime psychedelic use. The authors call for further validation in diverse samples.
Journal of Psychoactive Drugs
August 3, 2017
Mallory Loflin, Mitch Earleywine, Stacey Farmer et al.
7 citations
Telling people they are consuming a cannabis-infused edible can produce feelings of intoxication even when the product contains no active drug. In a study of 20 participants who were given a placebo lollipop but told it contained a high dose of THC, measures of cannabis intoxication and negative mood showed significant changes over 60 minutes, while positive mood and a general intoxication measure did not. This provides preliminary evidence that the placebo effect extends to edible cannabis products, which have a delayed onset of effect.
Journal of Psychedelic Studies
March 5, 2024
Mitch Earleywine, Alyssa B. Oliva, Joseph A. de Leo et al.
6 citations
Internal Family Systems (IFS) therapy, which views the mind as composed of multiple subpersonalities or 'parts' shaped by trauma, has gained popularity, particularly in psychedelic-assisted treatments. However, outcome data for applying IFS to post-traumatic stress disorder are limited, and its theoretical assumptions are difficult to test. The model's appeal highlights a problem with how empirically supported treatments are perceived. Ethical recommendations for presenting IFS include providing detailed psychoeducation about evidence-based treatments, being candid about the experimental nature of alternatives, monitoring progress, and watching for harm. Drawing on IFS's appealing features to improve perceptions of validated treatments may attract more clients and reduce dropout while awaiting empirical evidence.
Journal of psychopharmacology (Oxford, England)
January 1, 2025
Henry A MacConnel, Mitch Earleywine, Steven Radowitz
5 citations
Intravenous ketamine administered in a supportive environment with preparation, intention-setting, integration sessions, eye shades, and evocative music—paralleling psychedelic therapy—was associated with large reductions in PTSD symptoms. In a retrospective sample of 117 outpatients, mean PCL-5 scores dropped from 52.54 to 28.78, with 75% showing clinically meaningful improvement and 62% suggesting remission. No serious adverse events occurred, and concomitant psychotherapy was a significant moderator. The findings suggest that environmental factors may account for variation in previous ketamine studies and that this approach may be a promising option for PTSD unresponsive to other treatments.
Psychedelic Med (New Rochelle)
September 4, 2024
Mitch Earleywine, Samantha G. Gomez
5 citations
The text argues that small, accumulating therapist effects pose a challenge to determining whether personal psychedelic experience is essential for effective psychedelic therapists. It suggests that therapist competence and skills, including personal experience, may influence patient outcomes, but the evidence is limited by the difficulty of isolating these effects in small studies. The authors indicate that while personal experience might be beneficial, it is not definitively proven as essential, and more research is needed to understand its role in therapeutic success.
Journal of Humanistic Psychology
September 22, 2023
Mitch Earleywine, Maha N. Mian, Joseph A. de Leo
5 citations
Expectations about psychedelics are understudied despite their powerful subjective effects. In over 500 people who have used psilocybin, expectancies about antidepressant effects correlated with specific subjective experiences—mystical experiences, ego dissolution, and emotional breakthrough—that previous work linked to depression improvement. Current depressive symptoms, ego dissolution, and emotional breakthrough each predicted unique variance in expected antidepressant effects, but mystical experience expectancies did not. Demographic factors and general hallucinogen involvement showed only weak correlations. These findings suggest that psilocybin users hold relevant expectancies about subjective and antidepressant effects, which could influence treatment outcomes and deserve monitoring in clinical trials.
Psychiatric Annals
September 1, 2022
Mitch Earleywine, Zachary Herrmann
5 citations
Serotonergic psychedelics such as psilocybin, LSD, and ayahuasca, when paired with supportive therapy, have reduced end-of-life anxiety in cancer patients, treatment-resistant depression, alcohol dependence, social anxiety in autistic adults, and nicotine dependence. MDMA-assisted therapy improves PTSD symptoms. Meta-analyses show promising effect sizes, but concerns remain about brief follow-ups, small samples, and poorly understood mechanisms. Generalization to the public is premature, and the proliferation of specialized clinics is not yet justified. Continued coordinated trials and judicious application are recommended, with realistic expectations that replication may yield smaller effects.
Journal of Psychoactive Drugs
January 3, 2022
Brianna R. Altman, Mitch Earleywine, Joseph De Leo
4 citations
People with depressive symptoms view cognitive-behavioral therapy (CBT) as more credible than psilocybin-assisted therapy (PAT). In a study of 803 adults recruited from Amazon's MTurk, participants read descriptions of each therapy and rated their credibility. Those with prior therapy experience rated CBT higher than those without. Men and individuals who had used hallucinogens rated PAT more favorably than women and non-users. Other demographic and clinical factors explained little of the variation in credibility ratings. The findings suggest that potential clients are cautious about PAT, and researchers and clinicians should consider patients' treatment beliefs as possible predictors of outcomes.
Journal of Psychedelic Studies
March 12, 2020
Brianna R. Altman, Maha N. Mian, Mitch Earleywine
4 citations
Ayahuasca users expect its effects to differ from those of other hallucinogens like LSD or psilocybin in several ways, including stronger positive connections to nature and other people, more dramatic or terrifying thoughts, greater variability of effects, and distinct physical reactions. Among 139 experienced users surveyed online, intentions to use ayahuasca again increased when they expected positive connections but decreased when they expected physical reactions. One version of a scale measuring the novelty of ayahuasca effects predicted a preference for ayahuasca over other hallucinogens, while another version did not, indicating a need for further research. Understanding these expectancies may help guide choices among hallucinogens for therapeutic use.
J Psychoactive Drugs
October 30, 2024
Mitch Earleywine, Genevieve S. Falabella, Alyssa B. Oliva et al.
3 citations
This study examined how acute psychedelic experiences relate to changes in dysfunctional attitudes and subsequent improvements in wellbeing. Participants who underwent psychedelic sessions showed reductions in dysfunctional attitudes, such as rigid negative beliefs, in the post-acute period. These changes were associated with increased wellbeing, suggesting that shifts in cognitive patterns may mediate the therapeutic benefits of psychedelics. The findings indicate that the acute psychedelic reaction can trigger lasting psychological changes that contribute to enhanced wellbeing.