Stephen J Bright

What can we say about substance use? Dominant discourses and narratives emergent from Australian media

Discourses are conceptualised as context-specific frameworks that constrain what can be presented as rational when considering psychoactive substances. Given the implications of this for Australian policy debate and development, research and health promotion, an integrative analysis explored the nature of the dominant discourses as they pertain to substance use. Newspaper articles spanning a 12-month period (April 2005–2006) were analysed with the analysis triangulated with visual media and newspapers from 5-years prior. We conclude that within Australia, psychoactive substance use is framed within the dominant discourses of medicine, morality, law, economics, politics and popular culture. The linguistic landscape circumscribed by each discourse is described and the power dynamics underpinning the maintenance of the discourses considered, with each discursive framework shown to delineate unique subject positions that define the numerous individuals concerned with substance use issues (e.g. substance users, politicians, medical experts, etc.).

NBOMe - a very different kettle of fish . . .

NBOMe — a very different kettle of fish . . . TO THE EDITOR: We are concerned that recent media reports about a 17-year-old Sydney boy who died after allegedly consuming 25Bor 25I-NBOMe might lead to an increase in the incidence of NBOMe toxicity among patients presenting to emergency departments. NBOMe was reported to be available online for as little as

Development of an Australian version of the Alcohol-Related Problems Survey: A comprehensive computerised screening tool for older adults

1.50 per tablet.1 The subsequent media interest is likely to have increased public awareness of the availability of the NBOMe series of drugs; and increased awareness of psychoactive substances through media reporting is associated with their increased initial uptake.2 It is possible that the increased awareness of this cheap LSD (lysergic acid diethylamide)-like drug will prompt some individuals to buy NBOMe tablets and sell them as LSD in order to make a significant profit. The NBOMe series are analogues of the 2C series of psychedelic phenethylamine drugs that include an N-methoxybenzyl (hence, “NBOMe”) substituent that has significant effects on their pharmacological activity. NBOMe drugs have been characterised in in-vitro receptor studies as remarkably potent agonists of the 5-HT2A and 5-HT2C receptors, 3

Australia should be initiating a psychedelic research program: What are the barriers?:

The Alcohol‐Related Problems Survey (ARPS) reliably classifies drinking as non‐hazardous, hazardous or harmful using scoring algorithms that consider quantity and frequency of alcohol use alone and in combination with health conditions, medication‐use and functional status. Because it has been developed using a 14‐g US standard drink, it is not valid in Australia where a standard drink contains 10 g of ethanol.

Psychometric Properties of the Locus of Control of Behaviour Scale (LCBS) among Australians Seeking Alcohol and Other Drug (AOD) Treatment

Australian & New Zealand Journal of Psychiatry, 50(11) A recent review in Pharmacological Reviews highlights that over the last decade, a renaissance has occurred in psychedelic drug research in North America and Europe as investigators at Johns Hopkins School of Medicine, University of California, Los Angeles (UCLA), New York University and Imperial College London have embarked on studies that could be paradigm-changing for psychiatry (Nichols, 2016). These developments overturn a 30-year embargo on psychedelic research that followed political reactions to the 1960s counter-culture movement in the United States and elsewhere, as disgraced Harvard Professor Timothy Leary told the world to take psychedelics to ‘turn on, tune in and drop out’. Promising research was halted, not for lack of theoretical interest and clinical applications but due to political pressure (Nutt et al., 2013). Serotonin was discovered in the course of understanding the mechanism of action of lysergic acid diethylamide (LSD), while clinical research by psychiatrists showed the drug’s promise for treatment of depression, anxiety, psychosomatic disorders, autism, alcohol dependence, existential angst among the dying and in reducing criminal recidivism (Grinspoon and Bakalar, 1979). The neologism ‘psychedelic’ was coined by psychiatrist Humphry Osmond in correspondence with Aldous Huxley. From its Greek roots, psychedelic means ‘mind-manifesting’, describing the profound, unique effects on human conscious experience elicited by these drugs. Naturally occurring psychedelics have been ingested safely by humans from premodern times for diverse medicinal, social and spiritual purposes (Nichols, 2016), some of which—notably ayahuasca in South America, peyote in North America and ibogaine in West Africa—have survived within their traditional contexts into contemporary times. LSD, undoubtedly the most widely recognized psychedelic compound, was discovered by Albert Hofmann when he resurrected his research into the effects of ergot derivatives on uterine contractions and accidentally ingested a small dose. This soon led to his self-experimentation with the drug, experiences he described as extraordinary (Hofmann and Ott, 2013). In 1947, the first research paper was published on LSD in the Swiss Archives of Neurology and Psychiatry. Hofmann remained interested in psychedelic research until his death; interviewed shortly before his 100th birthday in 2006, he called LSD ‘medicine for the soul’ and expressed his deep frustration at its prohibition, even demonization, worldwide (Hofmann and Ott, 2013). The current renaissance in psychedelic research in North America and Europe demonstrates that science can come before politics. The methodological flaws oft-cited in critiques of the first wave of clinical research largely have been overcome (Nichols, 2016). Randomized controlled trials (RCTs) at Johns Hopkins, in which an active placebo (methylphenidate) was utilized in efforts to address issues of double blinding, found that psilocybin can occasion spiritual and transcendental experiences that elicit longterm positive changes in personality. Multiple open-label and RCTs are now complete, with more in progress, that aim to study the capacity of psychedelic medicines such as psilocybin and LSD to reduce anxiety in patients suffering from advanced-stage cancer (Nichols, 2016). The results thus far have shown that the use of a psychedelic medicine on just one or two occasions within the context of a psychotherapeutic program of preparation and integration leads to a reduction in anxiety and depressive symptoms, sustained 6 months post-intervention. Research over many years has also indicated that psychedelics can be effective adjuncts in treating substance use disorders. Recently, an open-label trial of psilocybin-assisted psychotherapy for the treatment of tobacco addiction showed much higher rates of abstinence at 6 months follow-up Australia should be initiating a psychedelic research program: What are the barriers?

Development of Australia's first older adult-specific early intervention for alcohol-related harm: Feasibility and proof of concept

Despite a paucity of studies evaluating the psychometric properties of the Locus of Control of Behaviour Scale (LCBS), it continues to be widely used in behavioural research. The present study sought to redress this gap in the literature. The 17‐item LCBS was administered to 373 Australians attending Alcohol and Other Drug (AOD) treatment agencies in the northern metropolitan region of Perth. Confirmatory factor analyses were conducted in order to determine which of several plausible measurement models provided the best fit for the data. A unidimensional model, recommended by the authors of the LCBS, and a two‐dimensional (Internal Locus of Control vs External Locus of Control) model provided poor fits. Other multidimensional models, differing only in the dimensionality of the externality factor, were also tested. A multidimensional model consisting of an Internal Locus of Control factor and four component External Locus of Control factors provided the best fit; however, the fit is probably best described as “reasonable” rather than “good.” A subsequent exploratory factor analysis using parallel analysis indicated a cohesive internality factor; however, the externality factor showed a tendency to fragment into smaller components. Results were discussed in terms of the problematic externality factor.

Should addiction researchers be interested in psychedelic science?: MDMA therapy for substance use disorders

The rate of older Australians at risk of experiencing alcohol‐related harm increased by 31% over the past 10 years, yet there are no Australian age‐specific early interventions. We describe the development of Australias first age‐specific early intervention protocol.

Evaluation of Australia’s first older adult-specific early intervention for reducing alcohol-related harm

As recently noted by Strauss, Bright and Williams [1], while much of the Western world has been experiencing a renaissance in research into ‘psychedelic science’ over the past decade [2], there has been no such research conducted in Australia. In Europe and the USA, studies have been conducted into lysergic acid diethylamide (LSD) that have improved our understanding of brain function [3] and reduced existential anxiety associated with dying [4], while psilocybin-assisted psychotherapy has shown promise as an intervention for treatment of refractory depression [5]. Psilocybin-assisted therapy has also been shown to reduce depression and anxiety among people with end-stage cancer [6], with two recent RandomisedControlled Trials (RCT) showing significant improvements in quality of life [7,8]. In collaboration with the researchers involved in this research, the Heffter Institute is in discussions with the US Food and Drug Administration (FDA) about commencing Phase III multisite trials. Meanwhile, 3,4-methylenedioxymethamphetamine (MDMA) is proving efficacious as an adjunct to psychotherapy in the treatment of post-traumatic stress disorder (PTSD) [9–12]. This new research is occurring at prestigious institutions such as New York University, University of California, Los Angeles, Johns Hopkins University and Imperial College London, following a 30 year embargo on psychedelic research that commenced when President Nixon declared his ‘War on Drugs’. We believe that addiction researchers worldwide should be interested in these developments, for several reasons. First, there are indications that psychedelicassisted therapies might be effective in improving success rates in the treatment of substance use disorders. It is hypothesised that the mechanism of action might involve mystical states that have been shown to be reliably produced in an RCT of psilocybin [13]; the personal significance of these effects was maintained at 14 month follow up [14], including positive changes in personality [15]. The neurological basis of these effects is proposed to be a reduction of blood flow in the default mode network [3]. In an open-label trial of 15 people examining psilocybin-assisted psychotherapy for the treatment of tobacco addiction, 80% of participants remained abstinent at 6 month follow up [16]. In contrast, an RCT of varenicline [17], the most efficacious pharmacotherapy for smoking cessation [18], found that only 25.5% of participants were abstinent at 12 months. This team at Johns Hopkins University has just published the results of a survey of 358 people who reported that psychedelic drugs had helped them quit smoking and 74% had abstained for more than 2 years [19]. Consequently, this team is initiating an RCT of psilocybin-assisted psychotherapy for smoking cessation involving 40 participants [20].Meanwhile, a proof-of-concept study has found that treatment of alcohol dependence with psilocybin-assisted psychotherapy yielded similarly impressive effects [21]. This team at New York University is now undertaking an RCT of 180 people that includes functional magnetic resonance imaging scanning [22]. Second, while it is not considered a prototypical psychedelic, new research is showing that MDMA holds great promise in curing treatment-refractory PTSD [9]. This is significant because many people who develop substance use disorders have a history of psychological trauma [23,24]. Within the Australian Treatment Outcomes Study, 41% of people receiving treatment for heroin dependence met criteria for PTSD [25]. Some have suggested that the rates of trauma among people with substance use disorders may be even higher than first thought. Among a sample of 423 Dutch people with a range of substance use disorders, Gielen et al. [26] found 46.2% whose primary drug of choice was alcohol met the criteria for PTSD. MDMA was used in psychotherapy in the 1970s and early 1980s as a safe adjunct to couples counselling and to address psychological trauma, prior to its emerging popularity as a recreational drug. The first clinical study reporting on the therapeutic effects of MDMA was published in 1986 by Greer and Tolbert [27]. Described accurately as an ‘empathogen’ or ‘entactogen’, the compound has the unique properties of establishing empathy with clinical staff while concurrently creating an emotional openness in the client that allows him or her to reprocess the traumatic event/s within the window of tolerance, without fear or shame [9]. MDMA appears to function as a catalyst for the psychotherapeutic process and is described by Sessa

Development of the Australian Dominant Drug Discourses Scale

The aim of the present case study was to evaluate the service-wide implementation of Australias first older adult-specific early intervention called Older Wiser Lifestyles (OWL). OWL was designed to reduce alcohol consumption and alcohol-related harm among people identified as being at risk. OWL used the Australian Alcohol-Related Problems Survey (A-ARPS) to classify peoples drinking patterns as non-hazardous, hazardous or harmful. Participants of the present study were aged ≥60 years and consumed alcohol in the past month, although they did not require treatment for dependence. The Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) was used as a composite measure of alcohol consumption. Data were collected before intervention and 3 and 6 months after intervention. In all, 140 clients were screened and attended at least one appointment (54% male; mean (± s.d.) age 72.8±7.6 years). Generalised estimating equation (GEE) examined the correlations between the intervention groups, time point and outcomes of interest. At 6 months, significant reductions were observed in A-ARPS classification (P=0.001) and AUDIT-C scores (P=0.001) among all clients, regardless of the number of sessions or intervention group. These preliminary findings warrant a randomised clinical trial of the intervention. Until this is completed, Australian health care providers should still consider the early intervention to reduce the risk of alcohol consumption among older adults.

Psychometric properties of the Locus of Control of Behaviour Scale (LCBS) among Australian substance users.

There are a limited number of dominant discourses available to frame drug use within Australia. These dominant discourses play an important role in policy debate and development, and also drug use behaviour. We describe the development of a psychometric instrument that is hypothesised to measure the degree to which individuals internalise dominant drug discourses. Sixty items were developed to reflect six dominant discourses of drug use. A substantive validity analysis was conducted. The highest loading items were included in a 27-item measure that was administered to 370 people seeking substance use treatment in Perth, Western Australia. In addition, participants completed the Locus of Control of Behaviour Scale. Confirmatory Factor Analysis tested the fit of a predicted six factor model, in addition to three other plausible models. The best fitting model was the predicted model. Internal locus of control was correlated with medical and legal discourse. The Dominant Drug Discourses Scale appears to measure internalisation of six dominant discourses. The tool has utility in research examining policy development and drug use behaviours. To establish the construct validity of the tool and better understand the constructs being measured, further research is required.