Today in Japan psychoactive drugs are widely prescribed for various psychiatric disorders including so-called ‘functional’ disorders. They are undoubtedly effective in relieving various psychological and behavioral symptoms. However, Japan has yet to address some basic questions: (1) uncertainty concerning the cause of various psychiatric functional disorders; (2) unknown factors that affect the function of psychotropic drugs in patients; (3) the difficulty in obtaining objective data concerning the effects of these medications * both on the brain and the (...) psychological symptoms (behavior); and most importantly, (4) due to both the behavioral and organic (brain and CNS) effects of psychoactive drugs, the difficulty in evaluating the risk/benefit ratio between the behavioral (primary) effect and the organic (side) effect. In addition, there are bioethical problems, since these uncertainties tend to permit too broad a range of intention and too many modes of intervention in (a) prescribing and (b) taking psychoactive drugs on the part of therapists and patients, respectively. Though the increased risk of the inappropriate use of these drugs – the non-therapeutic uses, and their over-prescription – has been indicated in other industrialized countries, it has not yet been fully recognized and adequately discussed in Japan. Moreover, it is necessary to establish a sound basis for the ‘somato-psychic’ evaluation of these effects in the context of the physician-patient relationship, including the patient's family and even the broader society. Keywords: bioethics, pharmacological treatment, primary and secondary effects, psychiatric-functional disorders, risk/benefit ratio CiteULike Connotea Del.icio.us What's this? (shrink)

The “hijacking” and “drug instrumentalization” models of psychoactive drug use predict opposite outcomes in terms of adaptive behavior and fitness benefits. Which is the range of applicability of each model? To answer this question, we need more data than those reported by studies focusing on medical, psychiatric, and legal problems in addicted users. An evolutionary analysis requires a much wider focus.

Most people who are regular consumers of psychoactive drugs are not drug addicts, nor will they ever become addicts. In neurobiological theories, non-addictive drug consumption is acknowledged only as a “necessary” prerequisite for addiction, but not as a stable and widespread behavior in its own right. This target article proposes a new neurobiological framework theory for non-addictive psychoactive drug consumption, introducing the concept of “drug instrumentalization.” Psychoactive drugs are consumed for their effects on mental states. (...) Humans are able to learn that mental states can be changed on purpose by drugs, in order to facilitate other, non-drug-related behaviors. We discuss specific “instrumentalization goals” and outline neurobiological mechanisms of how major classes of psychoactive drugs change mental states and serve non-drug-related behaviors. We argue that drug instrumentalization behavior may provide a functional adaptation to modern environments based on a historical selection for learning mechanisms that allow the dynamic modification of consummatory behavior. It is assumed that in order to effectively instrumentalize psychoactive drugs, the establishment of and retrieval from a drug memory is required. Here, we propose a new classification of different drug memory subtypes and discuss how they interact during drug instrumentalization learning and retrieval. Understanding the everyday utility and the learning mechanisms of non-addictive psychotropic drug use may help to prevent abuse and the transition to drug addiction in the future. (shrink)

Psychoactive drugs are being prescribed to millions of Americans at an increasing rate. In many cases these drugs are necessary in order to overcome debilitating emotional problems. Yet in other instances, these drugs are used to supplant, not supplement, interpersonal therapy. The process of overcoming emotional obstacles by introspection and the attainment of self knowledge is gradually being eroded via the gratuitous use of psychoactive medication in order to rapidly attain a release from the common (...) problems that life inevitably presents us with. In this paper, I argue that Kant’s formula of humanity, which maintains that persons ought never to treat others or themselves soley as a means to an end, proscribes this. Moreover, Kant argues that we have an imperfect duty of self development, and I argue that we fail to adhere to such a duty whenever we seek to evade the process of introspection and self knowledge in favour of the expedient results that drugs may provide us with as we attempt to overcome the emotional hurdles in our lives. (shrink)

This article examines neuroleptics in relation to the histories of biopsychiatry and neoliberalism in the United States. Drawing from Foucault's concept of biopower, I contend that neuroleptics are socially constructed as a mechanism to address underlying biological illnesses in order to achieve neoliberal subjectivity for mad/disabled people. I then argue this biopsychiatric and neoliberal construct dominates services with the expressed goal of creating people who self‐govern their own drug consumption. This, however, contrasts with accounts that depict intersubjective balancing acts between (...) treatment providers and mad/disabled people, who must incorporate the various effects of psychoactive drugs beyond measures of rehabilitation. In doing so, I advocate for new lines of psychological inquiry that critically examine the structural determinants of poverty and the underlying constructions of citizenship and wellness. (shrink)

An exploration into the reciprocity between Nietzsche's drug use and his philosophy.

The newly proposed framework for non-addictive psychoactive substances postulated by Müller & Schumann (M&S) provides an interesting and plausible explanation for non-addictive drug use. However, with specific reference to the relevant behavioral addiction literature, this commentary argues that the model may unexpectedly hold utility not only for non-addictive use of drugs, but also for non-addictive use of other potentially addictive behaviors.

Proposing a change to the view on psychoactive drug use in non-addicts touches a sensitive issue because of its potential implications to addiction prevention, therapeutic practice, and drug policy. Commentators raised nine questions that ranged from clarifications, suggested extensions of the model to supporting data previously not regarded, to assumptions on the implications of the model. Here, we take up the suggestions of the commentators to expand the model to behavioral addictions, discuss additional instrumentalization goals, and review the evidence (...) from laboratory animal studies on drug instrumentalization. We consider further the role of sociocultural factors and individual development in the establishment in drug instrumentalization and addiction. Finally, we clarify which implications we think this model may have. We conclude that drug instrumentalization theory can be further applied to other behaviors but will require a sensitive debate when used for drug and addiction policy that directly affects prevention and treatment. (shrink)

In this Handbook, philosophers from around the world address the metaphysics, epistemology, and value of psychoactive (mind-altering) drug use. In so doing, they attempt to answer questions such as: What does the fact of drug-induced mind-altering experiences tell us about natures of the mind, free will, and God? What does it tell us about what, and how, we can know? Are drug-induced mind-altering experiences valuable, morally, aesthetically, or otherwise? Is the acquisition of drug-induced mind-altering experiences ever immoral? Should the (...) acquisition of drug-induced mind-altering experiences ever be legally prohibited? The Handbook gives an overview of the current research, and sets the stage for future directions in philosophical thought relating to psychoactive drug use. (shrink)

This chapter examines the states of consciousness induced by hallucinogens or psychedelic drugs in the framework of a general model of altered states of consciousness. According to the general model of ASCs, the content of a state of consciousness is a function of the internal set and external setting, regardless of the catalyst or trigger, which might be a drug, hypnotic induction, shock, rhythmic sounds, music, and so forth. Altered states of consciousness, whether induced by drugs or other (...) means, differ energetically on the dimensions of arousal versus sedation, pleasure versus pain, and expansion versus contraction. It is argued that the classical hallucinogenic or psychedelic drugs are consciousness-expanding and therefore opposite in effect to drugs such as the opiates, alcohol, cocaine, and amphetamines, all of which can lead to addicted, fixated, contracted states of consciousness. Drugs, such as the stimulants and depressants in moderate dosages, which affect primarily the dimensions of arousal and pleasure—pain, without significant expansion of consciousness, are referred to as psychoactive. The implications for applications in psychotherapy are also discussed. (shrink)

In recent years, a debate has emerged on whether bodily sensations are typically accompanied by a sense of body ownership, namely a distinctive experience of one's body or body part as one's own. Realists about the sense of body ownership heavily rely on evidence from experimentally-induced bodily illusions (e.g., the rubber hand illusion) and pathological disownership syndromes (e.g. somatoparaphrenia). In this chapter, I will introduce novel evidence regarding body disownership syndromes induced by psychoactive drugs rather than pathological conditions, (...) and discuss its relevance to the debate on the sense of body ownership. (shrink)

Science has needed a dispassionate valuation of psychoactive drugs, but a motivational analysis should be conducted with respect to long-term reward rather than reproductive fitness. Because of hyperbolic overvaluation of short-term rewards, an individual's valuation depends on the time she forms it and the times she will revisit it, sometimes making her best long-term interest lie in total abstinence.

Two meta-analyses of pharmacological research are presented, demonstrating that psychoactive drugs have consistent effects on EEG and sleep outside of their effects on REM sleep, and demonstrating that drugs other than those affecting sleep neurotransmitter systems and REM sleep can also alter reported nightmare occurrence. These data suggest that the neurobiology data terrain outside activation-synthesis may include sleep and dream electrophysiology, cognitive reports of dreaming, effects of alterations in consciousness on dreaming, immunology and host defense, and clinical (...) therapies for sleep disorders. (shrink)

The aesthetics of tea, in some practices, seems to focus on appreciating the mental effects of tea — the altered states of mind. Wine aesthetics, on the other hand, seems to actively exclude any inebriative effects. Wine experts are supposed to spit, in order to avoid inebriation when they judge wine. Why? The answer, I suggest, lies deep in several key suppositions in the traditional model of aesthetic experience: that aesthetic experience needs to be accurate of its object, and that (...) it needs to be inseparable from the particular details of its object. But, I argue, that model is not really incompatible with an aesthetics of drugs. The problematic presupposition is that the aesthetics of drugs is either an aesthetics of the world, as experienced while drugged, or an aesthetics of the physical substance itself. The aesthetics of some drugs, such as LSD, will turn out, instead, to be a self-reflective aesthetics — one in which the primary object of appreciation is the alteration of one’s own cognitive faculties. This can be valuable as a humbling aesthetic vision, of one’s own cognitive fragility. But the aesthetics of gastronomical drugs, such as wine and tea, will turn out to be even more complicated. Gastronomical drugs demand that we bridge the inwardly-focused aesthetics of inebriation and an outwardly focused gastronomical aesthetics. They open the door to the possibility of an aesthetic reconciliation between our capacity to get onto the world, and our fears about the fragility of that capacity. (shrink)

Recent research offers good reason to think that various psychedelic drugs—including psilocybin, ayahuasca, ketamine, MDMA, and LSD—may have significant therapeutic potential in the treatment of various mental health conditions, including post-traumatic stress disorder, depression, existential distress, and addiction. Although the use of psychoactive drugs, such as Diazepam or Ritalin, is well established, psychedelics arguably represent a therapeutic step change. As experiential therapies, their value would seem to lie in the subjective experiences they induce. As it is the (...) only way for trainee psychedelic therapists to fully understand their subjective effects, some have suggested that firsthand experience of psychedelics should form part of training programs. We question this notion. First, we consider whether the epistemic benefits offered by drug-induced psychedelic experience are as unique as is supposed. We then reflect on the value it might have in regard to the training of psychedelic therapists. We conclude that, absent stronger evidence of the contribution drug-induced experiences make to the training of psychedelic therapists, requiring trainees to take psychedelic drugs does not seem ethically legitimate. However, given the potential for epistemic benefit cannot be entirely ruled out, permitting trainees who wish to gain first-hand experience of psychedelics may be permissible. (shrink)

Why are people interested in money? Specifically, what could be the biological basis for the extraordinary incentive and reinforcing power of money, which seems to be unique to the human species? We identify two ways in which a commodity which is of no biological significance in itself can become a strong motivator. The first is if it is used as a tool, and by a metaphorical extension this is often applied to money: it is used instrumentally, in order to obtain (...) biologically relevant incentives. Second, substances can be strong motivators because they imitate the action of natural incentives but do not produce the fitness gains for which those incentives are instinctively sought. The classic examples of this process are psychoactive drugs, but we argue that the drug concept can also be extended metaphorically to provide an account of money motivation. From a review of theoretical and empirical literature about money, we conclude that (i) there are a number of phenomena that cannot be accounted for by a pure Tool Theory of money motivation; (ii) supplementing Tool Theory with a Drug Theory enables the anomalous phenomena to be explained; and (iii) the human instincts that, according to a Drug Theory, money parasitizes include trading (derived from reciprocal altruism) and object play. (Published Online April 5 2006) Key Words: economic behaviour; evolutionary psychology; giving; incentive; money; motivation; play; reciprocal altruism. (shrink)

Drug phenomenon is relatively new in our country; it became relevant only in the ninth decade of the last century. A new phenomenon or a process is usually dynamic in the initial stages and only later does it acquire features of stability and the main trends that have become prominent several years ago remain unchanged. The author shows the data of drugs crime and other indicators and the aspects of their perspectives. In the article, a question about drug crimes (...) in Lithuania is considered in all aspects. The author maintains that the rapid emergence of many new non‑controlled psychoactive substances represents an increasing challenge for current models of drug control. (shrink)

Presently, women receive two-thirds of the prescriptions for psychotropic drugs and Canadian studies have shown that, at any one time, 15–20% of women are taking the drugs. The authors suggest that this difference in prescription rates to men and women is rooted in the unrecognized stresses of women's traditional role and the pervasive sentiment that women who deviate from, or complain about, their traditional role as wife, mother, sex object and self-sacrificing nurturer must be sick. Thus a rationale (...) for the prescription of psychoactive drugs to women has grown up within the framework of the ideology surrounding the institution of the family, and both reflects and reinforces traditional stereotypes about women's status and role. (shrink)

In this paper, I present and criticize several historical arguments in favour of prohibition and criminalization of illicit psychoactive substances. I consider several versions of Charles Brent’s argument from drug harms and an argument from addiction based on Kantian view on autonomy. My criticism will mainly rely on empirical evidence on drugs, drug use, and addiction. I think that in light of this evidence, all of the arguments lose their cogency or can be refuted altogether. Moreover, the evidence (...) reveals an inconsistency in the international drug law framework. In conclusion, I therefore provide a general argument challenging the legitimacy of the existing distinction between licit and illicit drugs based on the inconsistency. (shrink)

The delightful anthology compiled by Roberts on Psychoactive Sacramentals presents two dozen essays on the use of psychoactive substances as sacraments. The contributions in PS are varied. Their authors include scientists engaged in the study of psychoactive substances and of altered states of consciousness, theologians and students of religion, clergymen and practitioners of Asian meditative practices, psychologists and other mental health professionals, educators, and policy makers. Some of the authors are first of the line veterans who were (...) personally involved in the making of the psychedelic movement about half a century ago. The contributions themselves include reflections on the very notion of entheogen, personal accounts of the use of psychoactive substances, firsthand accounts of important moments in the modern history of entheogenic research , discussions of the use of entheogens in different cultures, ancient and contemporary, reflections about the use and abuse of psychoactive substances in western society, discussion of their potential application in psychotherapy, examination of the religious and spiritual import of entheogens, practical recommendations, a juridical analysis and even a poem. Special praise is due to the series of questions for further study and reflection listed in the last item in the collection, that of the editor himself; not only are these thought provoking, they also offer a most instructive and insightful systematic typology for topics of research and reflection in the field at hand. All told, PS presents a valuable source of information, analysis, opinion and wise guidance for all - scientists, religious mentors, clinicians, policy makers and lay persons - interested in psychoactive substances. In fact, I wish persons who regard these substances as evil and menacing drugs would have a look at this book as well; perhaps it would make them see things in a different perspective. (shrink)

In our recent article, together with more than 60 of our colleagues, we outlined a proposal for drug policy reform consisting of four specific yet interrelated strategies: (1) de jure decriminalization of all psychoactive substances currently deemed illicit for personal use or possession (so-called “recreational” drugs), accompanied by harm reduction policies and initiatives akin to the Portugal model; (2) expunging criminal convictions for nonviolent offenses pertaining to the use or possession of small quantities of such drugs (and (...) releasing those serving time for these offenses), while delivering retroactive ameliorative relief; (3) the ultimate legalization and careful regulation of currently illicit drugs; and (4) the delivery of a new “Marshall Plan” focused on community-building initiatives, expanded harm reduction programs, and social and health care support efforts (Earp et al. 2021). We were gratified to see so many thoughtful commentaries on our proposal, and we respond to them in part in this reply. (shrink)

Recreational Drugs European Network (ReDNet) project aims to use the Psychonaut Web Mapping Project database (Psychonaut Web Mapping Group, 2009) containing novel psychoactive compounds usually not mentioned in the scientific literature and thus unknown to clinicians as a unique source of information. The database will be used to develop an integrated ICT prevention approach targeted at vulnerable individuals and focused on novel synthetic and herbal compounds and combinations. Particular care will be taken in keeping the health professionals working (...) directly with young people showing problematic behaviors regularly updated in terms of novel compounds and combinations as well. A user-friendly project website will be developed aimed primarily at delivering the information/prevention approaches, but will also be a way of communicating with project partners and relevant stakeholders (e.g. thematic forum facilities, instant messages, blogs, video chat, wikiblog, newsletters distributed via mailing list). The website will support various ICT prevention tools, including an SMS alert service. Different areas and sections will be aimed specifically at the different target groups. -/- . (shrink)

Philosophical and empirical research on bodily awareness has mostly focused so far on bodily disorders – such as anorexia nervosa, somatoparaphrenia, or xenomelia (body integrity dysphoria) – and bodily illusions induced in an experimental setting – such as the rubber hand illusion, or the thermal grid illusion. Studying these conditions can be illuminating to investigate a broad range of issues about the nature, function, and etiology of bodily experience. However, a number of psychoactive compounds can also induce a remarkably (...) wide variety of bodily effects that have received little attention despite their relevance to these issues. Some of these effects are similar to those associated with bodily disorders or experimental bodily illusions, while others appear to be unique. The purpose of this chapter is to provide an overview of these lesser known bodily effects of psychoactive compounds, and outline some ways in which they can bear on recent debates regarding bodily awareness and bodily ownership. (shrink)

We are unlikely to stop seeking pleasure, as this would prejudice our health and well-being. Yet many psychoactive substances providing pleasure are outlawed as illicit recreational drugs, despite the fact that only some of them are addictive to some people. Efforts to redress their prohibition, or to reform legislation so that penalties are proportionate to harm have largely failed. Yet, if choices over seeking pleasure are ethical insofar as they avoid harm to oneself or others, public health strategies (...) should foster ethical choice by moving beyond current risk management practices embodied in the harm reduction movement. The neuroscience of pleasure has much to offer neuroethics and public health strategies. Distinguishing between ‘wanting’ and ‘liking’ fosters new understandings of addiction. These hold promise for directing the search for pharmacotherapies which prevent addiction and relapse or disrupt associated neuromechanisms. They could inform new research into creating lawful psychoactive substances which give us pleasure without provoking addiction. As the health and well being of human and other animals rests upon the experience of pleasure, this would be an ethical objective within public health strategy. Were ethical and neurobiological obstacles to ending addiction to be overcome, problems associated with excessive consumption, the lure of unlawful psychoactive substances and the paucity of lawful means to achieve pleasurable altered states would remain. Non-addictive designer drugs, which reliably provided lawful access to pleasures and altered states, would ameliorate these public health concerns insofar as they fostered citizens’ informed, ethical choices according to a neurobiological taxonomy of pleasures. (shrink)

In “Racial Justice Requires Ending the War on Drugs,” Earp and colleagues argue that the personal use or possession of all currently illicit psychoactive substances should be immediately decriminal...

The self is a common yet unclear theme in addiction studies. William James's model of self provides a framework to explore the experience of self. His model details the subjective and objective constituents, the sense of self‐continuity through time, and the ephemeral and plural nature of the changing self. This exploration yields insights into the self that can be usefully applied to subjective experiences with psychoactive drugs of addiction. Results of this application add depth to the common understanding (...) of self in addiction, acknowledge the importance of feelings and choice in the sense of self created in addiction experiences, and affirm the values salient to these interior experiences in addiction. These results suggest meaning derived from those values, and provide important background knowledge for the nurse interacting with these clients. (shrink)

Herbert, Michael The World Health Organization and the UN reports indicate the need of an integrated approach to tackle the dependence on legal psychoactive substances, such as tobacco and alcohol, as well as illegal ones. The effective clinical and societal responses to the existence of substance misuse are discussed, suggesting that realistic, timely investment, influenced by the best scientific evidence indicating what works, for whom, under what circumstances, and an increased degree of collaboration within and between governments and their (...) agencies are essential. (shrink)

Each year, millions of individuals in the United States are treated for a variety of serious medical conditions with prescription drugs whose therapeutic benefits are well known. The vast majority of these medications are used to treat medical and psychiatric illnesses. Generally, they are used as prescribed, and contribute to a better quality of life for persons suffering from debilitating or life-threatening disorders.The fact that a small portion of these medications is diverted by those who seek their psychoactive (...) effects raises the important policy issue: how to make drugs easily available for medical use while limiting access for purposes of abuse.Such a responsibility poses challenges very different from those of the so-called “war” on illicit drugs, because this control must be achieved without impeding patients’ access to medical care. A rational public policy would attempt to achieve a balance between the need to minimize abuse and the need to provide relief. (shrink)

This article explores morality and credibility struggles in connection to two officially sanctioned public Swedish experiments launched in the late 1960s to investigate the (ab)use of alcohol and illicit drugs, especially in relation to young people, and the subsequent decisions to terminate the experiments and research. We argue that these 1960s struggles on how to analyze the effects of increased availability of psychoactive substances must be understood in the light of a simultaneous development of modern (social) science studies. (...) The public display of conflicting expert views on how to investigate and interpret questions of alcohol and drugs in modern society played out in concordance with the growth of social science alcohol and drug research and expertise. The article focuses on the 1960s, a decade that was characterized by profound transformations in Swedish society. In so doing, the article contributes from the perspective of history to debates on the nexus between knowledge production and policy in modern societies. (shrink)

:The available treatments for disorders affecting large segments of the population are often costly, complex, and only marginally effective, and many have numerous side effects. These disorders include dementias, debilitating neurological disorders, the multiple types of drug addiction, and the spectrum of mental health disorders.Preliminary studies have shown that a variety of psychedelic and similar U.S. Drug Enforcement Administration Schedule I drugs may offer better treatment options than those that currently exist and pose potentially the same or even less (...) risk than do legal psychoactive and nonpsychoactive substances. The pharmaceutical industry and academia, however, have largely avoided this avenue of research.Fairness to the affected populations demands that these drugs be adequately studied and, if they or their congeners are shown to be effective, made available with the proper caveats, instructions, and protections that other potentially abused medications receive. These substances may prove to relieve patients’ struggles with less effective treatments and decrease mortality from nontreatment of some conditions. (shrink)

In this chapter, Rob Lovering defends the legalization of recreational drug use by way of two types of argument: direct and indirect. His direct arguments for the legalization of recreational drug use—what he calls the “Prudential Goods Argument” and the “Right to Bodily Autonomy Argument”—involve providing reasons for accepting the view that recreational drug use ought to be legal. And his indirect argument for the legalization of recreational drug use—what he calls the “No Good Reason Argument”—involves providing reasons for rejecting (...) the view (and arguments thereof) that recreational drug use ought to be illegal. Since each of the two direct arguments contains a premise 11 Introduction whose successful defense requires delving into reasons for thinking that recreational drug use ought to be illegal and, with them, the No Good Reason Argument, he spends a little more time developing and discussing the latter argument than he does either of the former arguments. (shrink)

In this chapter, Rob Lovering provides some possible answers to the question of whether God—understood as an omniscient, omnipotent, omnibenevolent, spiritual, personal deity who created the universe—knows what it’s like to undergo a positive, psychoactive, drug-induced experience; or, as he puts it for short, whether God knows what it’s like to get high. For either God knows what it’s like to get high or he does not and, in any case, interesting metaphysical, epistemological, and value theoretical questions arise. Lovering (...) concludes that, collectively, the possible answers he provides to the question of whether God knows what it’s like to get high generate an intriguing (and paradoxical) conclusion: It is hard to see how God could know what it’s like to get high, but it is also hard to see how he could not know what it’s like to get high. (shrink)

I argue that harm reduction programs should be extended to include psychedelic drugs. I reach this conclusion by first defining harm reduction and discussing arguments in favor of harm reduction for drug use in general. I offer defenses of harm reduction for drug use on the basis of consequentialism, Kantianism/deontology, and virtue ethics. I then apply this reasoning to harm reduction for psychedelic drugs, while also arguing that these programs are easier to defend than harm reduction for other, (...) harder drugs and that these programs could be easily implemented. (shrink)

In many Western jurisdictions cannabis, unlike most other psychoactive drugs, cannot be prescribed to patients even in cases where medical professionals believe that it would ease the patient’s pain or anxiety. The reasons for this prohibition are mostly ideological, although medical and moral arguments have been formulated to support it. In this paper, it is argued that freedom, properly understood, provides a sound ethical reason to allow the use of cannabis in medicine. Scientific facts, appeals to harm and (...) autonomy, and considerations of symbolic value cannot consistently justify prohibitions. (shrink)

This paper examines the culture, the dynamics and the financial underpinnings that determine how medical research is being conducted on children in the United States. Children have increasingly become the subject of experiments that offer them no potential direct benefit but expose them to risks of harm and pain. A wide range of such experiments will be examined, including a lethal heartburn drug test, the experimental insertion of a pacemaker, an invasive insulin infusion experiment, and a fenfluramine "violence prediction" experiment. (...) Emphasis, however, is given to psychoactive drug tests because of the inherent ethical and diagnostic problems involved in the absence of any objective, verifiable diagnostic tool. Effort is made to provide readers comprehensive reference sources to evidence-based reports about the serious risks these drugs pose for adults and children so that the reader may judge whether the benefits (if any) outweigh the risks for children. The first ethical issue raised by these experiments is: did the severity of illness in these children justify their exposure to short and long-term risks? The ethics of the experiments will be evaluated by referring to existing codes of medical research ethics-the Nuremberg Code, the Declaration of Helsinki, and the federal Code of Regulations. The thirteen cases presented will demonstrate that children are being used in ever more speculative experiments, often in the absence of a therapeutic intent, but a significant chance for causing harm and / or discomfort. Some of the experiments were designed to explore the mechanisms of pathology and pharmacological interventions, or the response of neurological brain receptors to chemical provocation ("challenge"). Others were designed to test the safety or efficacy of new drugs, even to test these drugs on healthy children who were hypothesized to be "at risk." Children and adolescents have been subjected to "forced dose titration" experiments that induced a spectrum of severe adverse effects, including insomnia, extreme restlessness, agitation, (akathisia) and self-injurious behavior. FDA reports show that suicide is a significant issue in psychotropic drug trials-in pediatric trials the problem is even greater. The paper aims to demonstrate how the enactment of the Better Pharmaceuticals for Children Act (incorporated into the Food and Drug Administration Modernization Act, FDAMA), set in motion a radical shift in public policy by providing huge financial incentives to pharmaceutical companies to test new or patented drugs in children. Federal policy shifted from one aimed at protecting children by setting limits on permissible research risks, to a policy aimed at broadening the inclusion of children as test subjects. It will be shown how the FDA and the Department of Health and Human Services lifted regulatory restrictions to permit research involving greater than minimal risk to be conducted on healthy children, claiming that all children are potentially "at risk" of a future condition. Children were in this way deprived of regulatory protections. An argument will be made that the approval of nontherapeutic, harmful experiments-such as exposure of toddlers to lead poison-under the current gate keeping system raises serious doubts about the sustainability of institutional review boards (IRBs) as protectors of human research subjects. Children, who are precluded from exercising the adult human's right to informed consent, are being exploited as commodities for commercial ends. It is the position of the author that nothing less than the enactment of a federal law mandating a radical overhaul of the current research review system, with independent checks and balances, will provide children the legal protections they need. Ten specific recommendations are offered to protect children from harmful experiments. (shrink)

ABSTRACT Chemsex is a phenomenon in which typically gay, bisexual, trans, queer, and/or related communities of men take psychoactive drugs while having sex, often without a condom. The practice can lead to increased rates of HIV transmission, sexual assault, and in extreme cases murder. GBTQ+ men are already a stigmatised group so those who engage in chemsex face multiple stigmas. This study examines the ways that two types of media report on chemsex while negotiating these stigmas. We take (...) a large data set of newspaper articles written for the general British public and a smaller data set of magazines aimed at GBTQ+ men to examine how chemsex is represented in the media. We find that the mainstream press focus on extreme criminal cases involving chemsex, while the media aimed at GBTQ+ men focus on counselling services and discuss chemsex in relation to gay culture. Chemsex is unlikely to go away, and so we address how information about it is conveyed in different media and call for more research in this area. (shrink)

This afterword extends and refines the arguments presented in Cohen and Jacobs . The main point made by the authors is that the antidepressant randomized controlled trial world is a make-believe world in which researchers act as if a bona fide medical experiment is being conducted. From the assumed existence of the “disorder” and the assumed homogeneity of the treatment groups, through the validity of rating scales and the meaning of their scores, to the presentations of researchers’ ratings as the (...) genuine outcome of interest — all aspects of such trials are make-believe. The continued acceptance of randomized controlled trials as appropriate mechanisms to ascertain the actual effects of psychoactive drugs on human beings in distress confirms that researchers are inextricably dependent on large-scale organizational and financial interests that require the sustained production of make-believe results about psychoactive drugs. (shrink)

This article examines the historical construction of depression over about a hundred years, employing the social life of methods as an explanatory framework. Specifically, it considers how emerging methodologies in the measurement of psychological constructs contributed to changes in epistemological approaches to mental illness and created the conditions of possibility for major shifts in the construction of depression. While depression was once seen as a feature of psychotic personality, measurement technologies made it possible for it to be reconstructed as changeable (...) and treatable. Different types of scaling techniques (Likert versus dichotomous scales) enabled the separation of depressive personality from reactive depression, paving the way for measuring the severity and intensity of emotions. Techniques to test sensitivity to change provided a means of demonstrating the efficacy of new psychoactive drug treatments. Later, more advanced techniques of precision scaling enabled the management of a new measurement problem, clinician unreliability, associated with the growing number of professionals involved in mental health care. Through statistical management of unreliability, the construct of depression has dramatically reduced over this period from hundreds of questionnaire items to potentially just two. Exploring the history of depression through this lens produces an alternative narrative to those that have emerged as a result of medicalisation and the actions of individuals and pressure groups. (shrink)

The aim of this research was to describe the dependence between the need for and sense of belonging and symptoms of depression vs. one’s capacity to cope effectively. Using path analysis of our data, we found direct patterns, in which both depression symptoms and life satisfaction depend to a considerable degree on the sense of belonging. The belonging need influences, in a direct way, the coping focused on the search for social support. Undertaking active techniques of coping, including confrontation with (...) a stressful situation and its negative controlling impact, depends on having a high level of the sense of belonging. In contrast, individuals who cope by means of taking psychoactive drugs show the symptoms of depression. (shrink)

In this paper, we examine the case of psychedelic medicine for Alzheimer’s disease and related dementias (AD/ADRD). These “mind-altering” drugs are not currently offered as treatments to persons with AD/ADRD, though there is growing interest in their use to treat underlying causes and associated psychiatric symptoms. We present a research agenda for examining the ethics of psychedelic medicine and research involving persons living with AD/ADRD, and offer preliminary analyses of six ethical issues: the impact of psychedelics on autonomy and (...) consent; the impact of “ego dissolution” on persons experiencing a pathology of self; how psychedelics might impact caregiving; the potential exploitation of patient desperation; institutional review boards’ orientation to psychedelic research; and methods to mitigate inequity. These ethical issues are magnified for AD/ADRD but bear broader relevance to psychedelic medicine and research in other clinical populations. (shrink)

In 1938, doctors Eric Guttmann and Walter Maclay, two psychiatrists based at the Maudsley Hospital in London, administered the hallucinogenic drug mescaline to a group of artists, asking the participants to record their experiences visually. These artists included the painter Julian Trevelyan, who was associated with the British surrealist movement at this time. Published as ‘Mescaline hallucinations in artists’, the research took place at a crucial time for psychiatry, as the discipline was beginning to edge its way into the scientific (...) arena. Newly established, the Maudsley Hospital received Jewish émigrés from Germany to join its ranks. Sponsored by the Rockefeller Foundation, this group of psychiatrists brought with them an enthusiasm for psychoactive drugs and visual media in the scientific study of psychopathological states. In this case, Guttmann and Maclay enlisted the help of surrealist artists, who were harnessing hallucinogens for their own revolutionary aims. Looking behind the images, particularly how they were produced and their legacy today, tells a story of how these groups cooperated, and how their overlapping ecologies of knowledge and experience coincided in these remarkable inscriptions. (shrink)

If one believes that the brain is, in some as yet unspecified way, the organ of mind and behaviour, then all human behaviour has a neurobiological basis. Neuroscience research over the past several decades has provided more specific reasons for believing that many addictive phenomena have a neurobiological basis. The major psychoactive drugs of dependence have been shown to act on neurotransmitter systems in the brain (Nutt 1997; Koob 2000); common neurochemical mechanisms underlie many of the rewarding effects (...) of these drugs and the phenomena of tolerance and withdrawal symptoms (Hyman & Malenka 2001; Koob 2000), and there is evidence for a genetic vulnerability to addiction (Nestler 2001; Uhl 1999) that is mediated by genes that regulate the metabolism of psychoactive drugs and the brain neurotransmitter systems on which they act (Uhl 1999). (shrink)

In light of the recent focus in bioethics on questions of deliberate moral enhancement through the use of psychoactive drugs, Levy et al. (2014) argue that the more pressing issue may be the incidental effect that prescription drugs could already be having on moral agency. Although concerns have focused on the possibility of altering moral psychology through direct effects on brain function, the authors point out that this may already be a reality, albeit an unintentional one. They (...) conclude from their survey of prescription drugs already in use, that we should urgently investigate the ways they may be “influencing the shape of our societies” (2014, 123). The question of how we ought to respond to this possibility, I believe, must be considered in the broader context of existing attitudes and policy in response to substances with similar effects; and the relative significance of these drug effects compared with other factors, in particular social factors that shape society through their developmental influence on moral psychology. -/- First, it is important to consider the drugs described by the authors alongside widely used drugs with known, comparable effects. For example, alcohol has profound effects on features of cognition that seem relevant to moral agency, in altering risk assessment and increasing aggression (Bushman and Cooper 1990; George et al. 2005). Its impairing of inhibitory control arguably undermines the reflective processes that are often considered central to moral agency (Craigie 2011; Field et al. 2010). However, by and large the current policy adopted in liberal democratic societies is to educate people about these dangers but leave it up to adults to choose whether they use alcohol. Exceptions to this position are grounded in reasons of public protection, for example, in the case of blood alcohol limits for drivers in order to protect people against injury or death as a result of drunk driving. Restrictions are also sometimes placed on inebriation in the context of particular public roles, for example, serving on a jury, although the issue remains controversial (Law Reform Commission 2010, s. 8.21, 8.26, 8.27). This approach to alcohol regulation offers an established model for responding to the kinds of drugs in question. Broadly, it suggests that concerns about the effect of a drug on moral agency are only considered serious enough to warrant restricting its use when this puts others at risk of serious harms, or when a person is fulfilling a public role where sound decision making is of great importance (e.g., in maintaining trust in institutions such as the criminal justice system). Although at first it may be an alarming thought that pharmaceuticals [End Page 127] could be influencing individual moral psychology, the example of alcohol suggests that this this is a familiar experience, and something for which states already have a policy framework. -/- Caffeine is another commonly used drug with psychoactive properties that seem likely to affect moral agency. Along with potentially morally relevant effects on attention and aggression (Einöther and Giesbrecht 2013; Kuhns et al. 2010), research suggests a connection between cortisol—a hormone that is elevated by caffeine—and the processing of social cues relating to threat (Montoya et al. 2012; Putman et al. 2007). There are little in the way of restrictions on the use of caffeine. Nonetheless, one might be concerned about the possible effects of caffeine on moral agency and society, particularly if the effects are less obvious than in the case of alcohol (Kuhns et al. 2010). The same concern might apply to the pharmaceuticals in question. Perhaps there is a need to investigate these effects on thought and behavior because they are not easy to detect. The greater danger might be in the fact that people do not recognize how these drugs change their appraisals and decisions, rather than in the effects themselves. It seems a reasonable suggestion that if a drug has significant enough effects on interpersonal relationships, then this information should be made available as a part of an informed consent procedure. (shrink)

Drug effects on consciousness are powerful probes of how physical processes in the body are connected to conscious experience. Drugs that alter consciousness – producing arousal, sedation, sleep, anesthesia, analgesia, euphoria, amnesia, hallucinations, or psychedelic‐like intensification of perceptions, thoughts, and feelings – have been identified as interacting in various ways with cellular and molecular processes within the nervous system. While the focus has thus far been on synaptic connections between neurons, there is likely to be much more going on (...) in the interaction of drugs with living systems that has not yet been identified. Psychedelic drugs, plants, and fungi are associated with perhaps the most interesting and profound of the drug‐induced alterations of consciousness. Contemporary investigations of psychedelics include renewed interest in the transformational therapeutic potential of these substances, and may also lead to new insights into the nature of consciousness. (shrink)

Botanical preparations used by shamans in rituals for divination, prophecy, and ecstasy contain widely different psychoactive compounds, which are incorrectly classified under a single denomination such as “hallucinogens,” “psychedelics,” or “entheogens.” Based on extensive ethnopharmacological search, I proposed a psychopharmacological classification of magic plants in 1979. This paper re-evaluates this taxonomy in the context of consciousness research. Several groups of psychodysleptic magic plants are proposed: (1) hallucinogens—psilocybin mushrooms, mescaline cacti, dimethyltryptamine snuffs, and the synthetic ergoline lysergic acid diethylamide induce (...) strong perceptual changes, affective intensification, and cognitive enhancement. Their ethnobotanical uses include long lasting divination rituals, prophecy, and sacramental practice. (2) Trance-inducers—ergoline Convolvulaceae and South American Banisteriopsis produce quietness, abstraction, lethargy, mild sensorial and cognitive changes, and salient visual imagery changes used in trance rituals and specific divination practices. (3) Cognodysleptics—marijuana (tetrahydrocannabinol) and other terpene-containing plants induce changes in thought, imagination, and affective functions and are used in short-term divination or oneiromancy. (4) Deliriants—tropane-containing Solanaceae, wild tobacco, and Amanita muscaria (muscimol) induce a delirium characterized by dim and clouded consciousness, stupor, confusion, disorientation, perception distortion, difficulties in recollection, anxiety, irritability, excitation, and behavioral disorganization employed in sorcery, purification, or exorcism rituals. The core mental effects required for a drug to be used in shamanistic rituals include light-headedness, enhanced imagery, and experience intensification. This constellation was the reason why, in his classification of psychoactive compounds, the pioneer German psychopharmacologist Louis Lewin established in 1924 a group of drugs under the appropriate name of Phantastica. (shrink)

If we already had a periodic table of mental illness in hand, there would be less need for a book of this type. Although some psychiatrists do think of themselves as chemists, the analogy is without warrant. Not only does psychiatry lack an analogue of the periodic table, its principal tool -- the Diagnostic and Statistical Manual of Mental Disorders (DSM) -- is a contentious document. Even subsequent to the publication of DSM-III in 1980, which was intended to serve as (...) an operational guideline for clinical practice, it and its heirs (DSM-V was published in 2013) have often fueled rather than quelled controversy. Although beginning with that third major revision of DSM a concerted effort has been made to ensure greater consistency in diagnoses, psychiatry remains beset by concerns that it is insufficiently scientific, unduly influenced by the pharmaceutical industry, indecisive as to whether it should focus on the mind or the brain, incapable of distinguishing among types of diseases, inclined to expand illness criteria without adequate justification, overly reliant on subjective judgments, wont to conflate clinical and ethical judgments, and engaged in indiscriminate use of psychoactive drugs. These worries concerning its scientific and ethical status are among the reasons that psychiatry attracts the attention of philosophers. (shrink)

This chapter contains sections titled: Metaphorical Pharmacology of Cannabis Cannabis Effects and Meanings Applied.

Ketamine is a dissociative drug that has been used medically since the 1970s primarily as an anesthetic agent but also for various psychiatric applications. Anecdotal reports and clinical research suggest substantial potential for ketamine as a treatment in conjunction with psychological interventions. Here, we review historical and modern approaches to the use of ketamine with psychotherapy, discuss the clinical relevance of ketamine’s acute psychoactive effects, propose a unique model for using esketamine with Acceptance and Commitment Therapy, and suggest considerations (...) for moving medication-assisted psychotherapy forward as a field. (shrink)