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RECOMMENDED READS

 

THE VARIETIES OF PSYCHEDELIC EXPERIENCE

Robert Masters & Jean Houston

AKA ‘The Varieties’. A comprehensive and tactful academic treatise of psychedelic experience based on guided sessions with hundreds of healthy well-educated subjects. The words between these pages reveal the elusive and multifaceted effects of classical psychedelics for all to witness in plain, worldly English, leaving no stone un-turned. Easily one of the most masterful scholarly works ever written on visionary experiences. Authentic, intimate, highly sensible, judicious in its humour, and brimming with articulate archetypal examples. A highly accessible classic that stands the test of time–an audacious monument in terrain otherwise brimming with myst and fairytales. If nothing more, it defies the ineffable. One of the single most important books ever written, and worth changing your mind about picking up Pollan this winter.

THE ANTIPODES OF THE MIND – CHARTING THE PHENOMENOLOGY OF THE AYAHUASCA EXPERIENCE

Benny Shanon

Outstanding. From the book description: This is a pioneering cognitive psychological study of Ayahuasca, a plant-based Amazonian psychotropic brew. Benny Shanon presents a comprehensive charting of the various facets of the special state of mind induced by Ayahuasca, and analyzes them from a cognitive psychological perspective. He also presents some philosophical reflections. Empirically, the research presented in this book is based on the systematic recording of the author’s extensive experiences with the brew and on the interviewing of a large number of informants: indigenous people, shamans, members of different religious sects using Ayahuasca, and travellers. In addition to its being the most thorough study of the Ayahuasca experience to date, the book lays the theoretical foundations for the psychological study of non-ordinary states of consciousness in general.

PHANTASTICA – A CLASSIC SURVEY ON THE USE AND ABUSE OF MIND-ALTERING PLANTS

Lewis Lewin

From the book description: The publication of Louis Lewin’s Phantastica in 1924 began an era of ethnobotany that is still flourishing today. Until Lewin, books on the use of drugs were purely works of anthropology, concerned with how people used these plants, rather than how the plants produced their famous effects. Lewin, a world-renowned pharmacologist and toxicologist, was fascinated by both, and Phantastica was the first book to bring scientific insights to a survey of the use of drugs around the world. Lewin traveled extensively and acquired an astonishing variety of knowledge, reflected in this book, which provides detailed information on all major drugs of the time, including opium, cocaine, heroin, cannabis, peyote, fly agaric, henbane, datura, alcohol, kava, betel, coffee, tea, cocoa, and, of course, tobacco.

THE SCIENCE OF MICRODOSING PSYCHEDELICS

Torsten Passie

Great scholarly book by a great scientist. A lot like his and Hintzen’s The Pharmacology of LSD – more of a dense and detailed work of science than a casual coffee table read. Includes a much needed discussion on the sub-perceptual idea. Outlines prior research with psycholytic and active placebo doses of various psychedelics.

MESCALINE – A GLOBAL HISTORY OF THE FIRST PSYCHEDELIC

Mike Jay

From the book description: This eye-opening history of mescaline extends from the ancient Americas to the present day. Offering a rich narrative of mescaline’s many lives, Mike Jay draws on botany, pharmacology, ethnography, and the mind sciences as he explores how its mind-altering properties have been used by shamans, scientists, artists, and philosophers.

ONE RIVER – EXPLORATIONS AND DISCOVERIES IN THE AMAZON RAIN FOREST

Wade Davis

Harvard scientist and anthropologist Wade Davis was the protégé of the eminent biologist and celebrated explorer Richard Evans Schultes, known as the father of modern ethnobotany (whom brought 30 000 plant specimens back from the Amazon, 2000 of which were medicinal plants previously unknown to science). Described as “a rare combination of scientist, scholar, poet and passionate defender of all life’s diversity,” Wade is one of the most talented and dexterous linguistic craftsmen of our time, and we are beyond blessed to have such an articulate mind to tell the tale of Richard Evans Schultes and his legacy through his own eyes and through experiences with the man himself.

Wade Davis is also well-known for discovering the phenomenon of zombis in Haitian vodoun culture, which he told inThe Serpent And the Rainbow.

BEHAVIORAL NEUROBIOLOGY OF PSYCHEDELIC DRUGS

Adam L. Halberstadt, Franz X. Vollenweider, David E. Nichols (Eds.)

Medical volume. Each chapter is an independent academic research paper. From the back cover: This volume brings together the latest basic and clinical research examining the effects and underlying mechanisms of psychedelic drugs. Examples of drugs within this group include LSD, psilocybin, and mescaline. Despite their structural differences, these compounds produce remarkably similar experiences in humans and share a common mechanism of action. Commonalities among the substances in this family are addressed both at the clinical and phenomenological level and at the basic neurobiological mechanism level. To the extent possible, contributions relate the clinical and preclinical findings to one another across species. The volume addresses both the risks associated with the use of these drugs and the potential medical benefits that might be associated with these and related compounds.

HANDBOOK OF THE BEHAVIORAL NEUROBIOLOGY OF SEROTONIN

Christian P. Müller & Barry L. Jacobs (Eds.)

Medical volume. Each chapter is an independent academic research paper.

The work is divided into four parts:
1. Functional anatomy of the serotonergic system.
2. Review of the neurophysiology of the serotonergic system and its single components.
3. Involvement of serotonin in behavioural organization.
4. Serotonin in behavioural pathologies and psychiatric disorders.

DRUGS AND BEHAVIOR – AN INTRODUCTION TO BEHAVIORAL PHARMACOLOGY

Stephanie Hancock & William McKim

A well-organized textbook on the fundamentals of how drugs work. From the book description: Stephanie Hancock describes basic pharmacological concepts of drug administration and pharmacokinetics, research methodology and clinical trials, tolerance and withdrawal, drug conditioning, addiction processes, and the neuroscience of drug action. In each chapter, these concepts are applied to different classes of recreational and therapeutic drugs within a historical and social backdrop. The Eighth Edition has been substantially revised and updated to include the newest research findings and real-world examples related to drug use and addiction.

THE COMPASS OF PLEASURE

David J. Linden

Introductory psychology. This book is a fun read and a good undergraduate introduction to the neuropsychology of why we like and want what we do.

Dr. Linden is a neurobiologist and professor of neuroscience at the Johns Hopkins University School of Medicine, editor in chief of The Journal of Neurophysiology, and has published other works such as The Accidental Mind: How Brain Evolution Has Given Us Love, Memory, Dreams, and God

2019-12-11T19:17:05+00:00

Portal

Portal 2019-05-17T17:38:10+00:00

Retreats

Psychedelic Retreats and legal exemptions

If you’re thinking of traveling to the Amazon for a retreat, read this (ICEERS).


Openmindtrips
Explore facilitators, travel guides, work exchange, events, retreats, shamans and ceremonies throughout the world, with testimonials.

AyaAdvisors
Search and sort by highest rated, most affordable, and by category: Ayahuasca, Iboga, Magic Mushroom, Peyote, San Pedro and Kambo retreats.

TripSitters
Directory of psilocybin retreats and private sessions.

Retreat.Guru
Search psychedelic teachers, leaders, retreats and centers with reviews around the world.

Trusted Retreat Finder
Personal retreat curator that gets you personalized recommendations within a week.

Ayamundo
Search for ayahuasca retreats and reviews by country and by city.


Religious organizations with legal exemption to use psychedelics in Canada:

Céu do Montréal / The Eclectic Centre for the Universal Flowing Light

Céu da Divina Luz do Montreal

Église Santo Daime Céu do Vale de Vida in Val-David, Quebec

Céu de Toronto

Beneficient Spiritist Center União do Vegetal

Retreats 2019-10-20T14:17:26+00:00

Harm Reduction

Risks and safety

Resources:

If you plan on traveling for a retreat, read this (ICEERS)

MAPS: How to Work with Difficult Psychedelic Experiences

The Zendo Harm Reduction Manual (pdf)

Harm Reduction International – Global State of Harm Reduction 2018 (pdf)

The Manual of Psychedelic Support (pdf)

Psychedelics can be used safely…

  • The Global Drug Survey[1] has consistently found psilocybin and LSD to be the least addictive of all drugs.
  • The UK Independent Scientific Committee on Drugs deemed classical psychedelics to be among the least damaging to the self and to society, compared to all other drugs.[2]
  • In over 2000 carefully controlled clinical trials, where participants were properly screened for predisposition to psychosis and other contraindications, no serious adverse events were recorded,[3] and cases of Hallucinogen Persisting Perceptual Disorder (HPPD) are rare.[4]
  • Psilocybin used in the clinical setting is considered safe, well tolerated, showing no signs of neurotoxicity.[3]
  • Psychedelic use does not appear to be associated to negative mental health. In fact data suggest the opposite may be true.[5]
  • A deluge of research demonstrates that these experiences are often rated in 7/10 cases as the single or among the top five most meaningful experiences in the lives of participants, and a single experience in a controlled setting can provide profound and sustained relief to those suffering from addictions, depression, and anxiety.[6]

but they do carry risks.
In uncontrolled sets and settings, and in those predisposed to psychotic disorders, psychedelics can lead to significant problems. Psychedelics

  • may induce Hallucinogen Persisting Perceptual Disorder (HPPD) under circumstances involving intense fear or panic that goes unsoothed during the psychedelic experience.[4] See A Very Brief Summary of HPPD, based on Halpern, Lerner & Passie (2016).
  • should not be used by those with schizophrenia or bipolar disorder, or history of these in immediate family.[3]
  • can interact with antidepressant and other medication, (such as SSRIs, MAOIs and UDG enzyme modulators)[3]
  • decrease the threshold for seizures[3]
  • may affect a quarter of the population more dramatically due to a known serotonin 2A genetic polymorphism that disrupts sensory gating.[7]
  • may lead to anxiety, dysphoria, hypertension, exhaustion and general incapacitation, and disrupt vigilance, working memory, cognitive flexibility, and communication, and may lead to paranoid ideation or ideas of reference; at the highest doses, may lead to sense of disconnection from body and environment, and the loss of ability to distinguish fantasy from reality.[3][8]
  • may produce experiences beyond the user’s ability to conceptualize using existing world-models and language, and require a period of integration that may be understood as extending off into the following days, weeks or years, and may require specialized social support.

Benzodiazepines, antipsychotics and hypertension medication are typically kept on hand in case of emergencies.[3] Interruptions and uncertain environments & people should be completely eliminated, and the user should not operate heavy machinery or engage in activities that require sustained attention and carry a hazard.

Find support providers at Psychedelic.Support and PsychedelicsToday

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References

[1] Global Drug Survey (2018)

[2] Nutt, D. J., King, L. A., & Phillips, L. D. (2010). Drug harms in the UK: a multicriteria decision analysis. The. Lancet, 376(9752), 1558–1565. doi: 10.1016/S0140-6736(10)61462-6

[3] Huston, P., Cozzi, N., Vollenweider, F., Nichols, D., Greer, G., Johnson, M., May, D., Ross, S., Jerome, I. (2018) Psilocybin Investoator’s Brochure V2.0.  Usona Institute. 

[4] Halpern, J. H., Lerner, A. G., & Passie, T. (2016). A Review of Hallucinogen Persisting Perception Disorder (HPPD) and an Exploratory Study of Subjects Claiming Symptoms of HPPD. In A. Halberstadt, D. Nichols, F. X. Vollenweide (Eds), Behavioral Neurobiology of Psychedelic Drugs (pp. 333-360). doi:10.1007/7854_2016_457

[5] Johansen, P., & Krebs, T. S. (2015). Psychedelics not linked to mental health problems or suicidal behavior: a population study. J. Psychopharmacol., 29(3), 270–279. doi: 10.1177/0269881114568039

[6] Carhart-Harris, R. L., & Goodwin, G. M. (2017). The Therapeutic Potential of Psychedelic Drugs: Past, Present, and Future. Neuropsychopharmacology, 42(11), 2105-2113. doi:10.1038/npp.2017.84

[7]  Vollenweider, F. X. [Horizons]. (2011). Neuronal Networks and Neurotransmitter Dynamics underlying Altered States of Consciousness. Retrieved from https://vimeo.com/11258033

[8] Preller, K. H., & Vollenweider, F. X. (2016). Phenomenology, Structure, and Dynamic of Psychedelic States. in Behavioral Neurobiology of Psychedelic Drugs. Current Topics in Behavioral Neurosciences, 221-256. doi:10.1007/7854_2016_459

Harm Reduction 2019-11-16T15:02:15+00:00

Le Club des Hachischins

Le Club des Hachischins

The Club des Hachischins gathered between 1844 to 1849 in the lavish Hotel de Lauzun, on l’Île Saint-Louis, one of two tiny islands in the very pupil of Paris. Enveloped by golden ornamental detail, walls plated with the pearlescent canvases of great European classicists, members of the Club des Hachischins were greeted by the beaming eyes of French psychiatrist Dr. Jacques Joseph Moreau, and served an emerald dollop of Dawamesc, plucked from a crystal vase, atop a Japanese porcelain saucer, along with a silver-gilt spoon, and a dense cup of arabic coffee.

[… to be continued]

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Le Club des Hachischins 2019-11-07T15:56:14+00:00

Psychedelic Clinical Trials for Terminally Ill Patients Set to Begin at St. Vincent Hospital

Psychedelic Clinical Trials for Terminally Ill Patients Set to Begin at St. Vincent Hospital

Eric M. Fortier, B.A. | Jan 23, 2019

www.centerforpallcare.org

Dr. Margaret Ross, Clinical psychologist with Psychosocial Cancer Care and Palliative Care at St. Vincent’s Hospital, Melbourne, is leading a study recruiting terminally ill patients to participate in a guided psychedelic psychotherapy trial with synthetic psilocybin, set to begin by April 2019.

Confronting terminal illness can lead to a devastating sense of demoralization, loss of hope, meaning, desire for hastened death, depression, and anxiety. Terminal cancer is the second leading cause of death in the world. Cancer will take one in four of us, and almost half of us will face it—at least once, at a rate of 1.6 million people in the US alone every year.

Researchers at Johns Hopkins, NYU and UCLA made headlines in 2016 when they showed that a single six to eight hour guided psilocybin session led to overwhelming improvements in end-of-life anxiety, depression and quality of life for about 70% of patients. Changes were confirmed by relatives, and tended to last many months or more. These studies were featured in the documentary film A New Understanding–The Science of Psilocybin (2016), along with interviews with the participants, researchers and clinicians involved.

This psychedelic therapy research harks back to some foundational work laid out in the 1950s and 60s. Eric Kast, Stanislav Grof and the rest of Spring Grove started treating terminal-illness related pain and psychological distress with LSD, and established the working model being used in controlled experiments today.

Researchers find that psychedelic psychotherapy helps patients connect more deeply with their emotions and discover new ways of being and connecting with themselves, with others, and with the world. Although the mechanism by which psychedelics like psilocybin work in the brain is complex, it has been found that their activity at the serotonin-2A receptor reduces sensory filtering, amplifies emotions, exposes subconscious processes, and elicits autobiographical memories that can lead to insight, softening the boundaries of the self, and on occasion, peaking in full mystical experience. These are measured in the Mystical Experience Questionnaire as ego dissolution, insight, sacredness, amplified mood, and transcendence of time and space, and appear to predict lasting therapeutic effects.

These clinical trials are conducted under strictly controlled conditions with medical oversight and key exclusion criteria (such as having a family history of psychotic illness). Although there have been no reported serious adverse events (SAEs) in the past 15 years with over 2000 doses of  psilocybin administered in a clinical setting, unsupervised illicit use still carries risks.

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Psychedelic Clinical Trials for Terminally Ill Patients Set to Begin at St. Vincent Hospital 2019-12-08T03:14:05+00:00

Brief Moments in Darknet History

Brief Moments in Darknet History

2000s – Untested research chemicals like 25i-NBOMe start to hit the market, often sold as “LSD.”

2008 – Albert Hofmann dies on Apr 29.

2011 – The Silk Road opens, skyrockets BTC trade. Price of LSD declines. New era of LSD dawns as it soars through international mail disguised as plain white paper.

2012 – Imperial College publish their controversial psilocybin neuroimaging results, drawing a new mass of the academic world to psychedelics once again.

2013 – Founder of SilkRoad Ross Ulbricht trialed as ‘Dread Pirate Roberts;’ Silk road shuts down. Soon after, Silk Road 2 opens.

2013 – Erowid publishes warning about increasing malignant spread and sale of toxic NBOMe as “LSD.”

2014 – LSD Avengers begin using chromatography and other testing on darknet LSD samples and publishing results (e.g. Energy Control), holding LSD vendors accountable for their products. [The group has recently been declared corrupt for taking bribes to forge false Energy Control reports.]

2014 – Silk road 2 shuts down, Agora continues to become largest DNM throughout 2015. Evolution market shuts down with $12M exit scam from escrow BTC.

2015 – Market diversification, improvements of escrow services and decentralization.

2015 – DNM vendors Top Gear UK (TGUK), JesusofRave (JoR) and Trust and others credited with starting LSD price war–driving competition

2016 – Relative period of DNM stability, pure LSD crystal easily available by the gram worldwide. Producers ever closer to the market, removing layers of middlemen. LSD prices continue to drop below $2/100µg, combat NBOMe sales to take back the market.

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Brief Moments in Darknet History 2019-12-08T22:14:05+00:00

Multiple Functional Enhancements of Dopamine Signaling by LSD

Multiple Functional Enhancements of Dopamine Signaling by LSD – A Summary

by Eric M. Fortier, B.A.

This article is a brief summary of the following study: Hallucinogenic 5-HT2AR agonists LSD and DOI enhance dopamine D2R protomer recognition and signaling of D2-5-HT2A heteroreceptor complexes.[1]

Overview
Serotonin (5-HT) is known to counteract Dopamine 2 (D2) signaling via the 5-HT2A protomer (single receptor of a complex). This study was an attempt to elucidate the relation between the psychedelic actions of two high-affinity 5-HT2A agonists (LSD and DOI) and the D2LR + 5-HT2AR heteromeric receptor complex. Researchers hypothesized that LSD and DOI would produce a different kind of interaction at the receptor complex than that of endogenous serotonin.

Methods
Briefly, experimenters tested this hypothesis by manipulating D2 signaling in experimental HEK293 cells (in which they co-transfected both receptors) and the nucleus accumbens of rats, with the help of serotonin 2A agonists (LSD, DOI, and TCB2), and antagonist (ketanserin); a dopamine agonist (quinpirole), antagonist (3H-Raclopride) and inverse agonist (Haloperidol).

Results
Immunofluorescence and proximity ligation assays (PLA) detected an increased presence of the heteromeric complex on the cell surfaces of both the nucleus accumbens of rats and in co-transfected HEK293 cells after treatment with LSD or DOI. 3H-Raclopride displacement tests revealed an enhancement of D2 receptor affinity for high-affinity dopamine ligands, with LSD’s or DOI’s co-presence in the 5-HT2A protomer of the complex. CRE-luciferase reporter gene experiments with quinpirole revealed an enhancement of D2 protomer coupling to the Gi protein, with co-presence of LSD or DOI in the 5-HT2A receptor.

Implications
Higher affinity D2 binding, increased G-protein coupling to the receptor complex, and elevated expression of D2 receptors in the cell, all provide evidence for functionally specific enhancements of dopaminergic signaling in the primary motivation center of the brain.

Their results support the hypothesis that LSD and DOI produce in fact the opposite effects in D2L-5-HT2A receptor complexes than those of serotonin, and suggest that the psychoactivity of LSD and DOI may be partially attributed to the their enhancement of dopaminergic receptor function in the nucleus accumbens and dorsal striatum via the 5-HT2A protomer.

[Note: an increased expression of serotonin 2A receptors has been found to increase behavioral response to potent dopamine agonists,[2] and the D2 receptor appears to be key to the therapeutic effects of amphetamine on ADHD.[3]  More evidence suggests serotonin receptors modulate dopamine signalling,[4] which may be involved in their therapeutic efficacy, particularly in cases regarding addiction, motivation and priority setting. Incidentally, the modification of dopamine signalling by psychedelics, as well as the increasingly internally generated perceptual and thought content, and the shift of exteroception to interoception,[5] offer potential explanations for why so many anecdotal reports include alleviation of ADHD symptoms.]

Limitations
The authors state no explicit limitations, but these experiments did not examine the rats’ behavioral responses to the drugs. Behavioral observation, and perhaps human trials with psychological assessment, may be required to further understand the biological relevance of the D2L-5-HT2A heteromeric complex (and the lasting effects of potent 5-HT2A agonists on D2 receptors) in the psychoactivity of LSD.

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[1] Borroto-Escuela, D. O., Romero-Fernandez, W., Narvaez, M., Oflijan, J., Agnati, L. F., & Fuxe, K. (2014). Hallucinogenic 5-HT2AR agonists LSD and DOI enhance dopamine D2R protomer recognition and signaling of D2-5-HT2A heteroreceptor complexes. Biochemical and Biophysical Research Communications, 443(1), 278-284. doi:10.1016/j.bbrc.2013.11.104

[2] Herin, D. V., Bubar, M. J., Seitz, P. K., Thomas, M. L., Hillman, G. R., Tarasenko, Y. I., . . . Cunningham, K. A. (2013). Elevated Expression of Serotonin 5-HT2A Receptors in the Rat Ventral Tegmental Area Enhances Vulnerability to the Behavioral Effects of Cocaine. Frontiers in Psychiatry, 4. doi:10.3389/fpsyt.2013.00002

[3] Fan, X., Xu, M., & Hess, E. J. (2010). D2 dopamine receptor subtype-mediated hyperactivity and amphetamine responses in a model of ADHD. Neurobiology of Disease, 37(1), 228-236. doi:10.1016/j.nbd.2009.10.009 

[4] Chenu, F., Shim, S., Mansari, M. E., & Blier, P. (2013). Role of melatonin, serotonin 2B, and serotonin 2C receptors in modulating the firing activity of rat dopamine neurons. Journal of Psychopharmacology, 28(2), 162-167. doi:10.1177/0269881113510071

[5] Kometer, M., Cahn, B. R., Andel, D., Carter, O. L., & Vollenweider, F. X. (2011). The 5-HT2A/1A Agonist Psilocybin Disrupts Modal Object Completion Associated with Visual Hallucinations. Biological Psychiatry, 69(5), 399-406. doi:10.1016/j.biopsych.2010.10.002

Multiple Functional Enhancements of Dopamine Signaling by LSD 2019-12-08T03:14:29+00:00

Case Study: Attention Deficit Hyperactivity Disorder

Case Study: Attention Deficit Hyperactivity Disorder

by Eric M. Fortier, B.A.

Summary
In the case presented by Oltmanns et al. (2015), seven-year-old Ken exhibits several behaviors that interfere with his basic functioning. Various sources say Ken is hyperactive, distracted, temperamental, easily frustrated, often fidgeting, not wanting to sit still, rarely finishing assignments, and having poor relationships with peers and siblings. Importantly, he has been abnormally distractible, moody, aggressive and lacking discipline since kindergarten. As a result, Ken is struggling academically and socially.

Ken’s father often works away from home, leaving Ken’s mother alone with him and their daughter. His mother believes in severe physical punishment for correcting misbehavior, while his father thinks little of his misdoings, leading to inconsistent parenting; both of which likely exacerbate Ken’s disorder. This dynamic may act as an environmental trigger for a known genetic polymorphism that predisposes individuals to ADHD. Furthermore, Ken’s mother and father are experiencing marital strain over how to raise him.

Diagnosis and Treatment
Using the DSM-5 as a guide to diagnosis, Ken displays persistent age-inappropriate symptoms of inattention, hyperactivity and impulsivity that cause large impairments in daily functioning. According to multiple reports, he exhibits at least five of six minimum symptoms of inattention: often has trouble holding attention on tasks or play activities, does not seem to listen when spoken to directly, does not follow through on instructions and does not finish schoolwork, dislikes tasks that require mental effort over a long period, and is easily distracted; and at least six of six minimum symptoms of inattention: fidgets constantly, leaves his seat in situations when remaining seated is expected, runs about or climbs in situations where it is not appropriate and even dangerous, cannot play or take part in leisure activities quietly, appears “on the go” acting as if “driven by a motor,” and interrupts or intrudes on others. Reports from more than one source suggest a number of these symptoms began in early childhood, were present in more than one setting (at school, at home, and with peers), and interfered with academic performance, quality of social relationships, and family functioning. Based on the limited description provided in the case study, it does not appear like Ken meets the full criteria for ODD, CD, or other similar diagnoses, although some early symptoms such as aggression should be monitored throughout early development. According to these criteria, Ken presents a fairly typical case of ADHD with Combined Presentation, with at least eleven (albeit of minimum 12) symptoms distributed relatively evenly across the inattention and hyperactivity-impulsivity dimensions for the past six months. Although he may not meet the full criteria in this diagnostic guide, typical ADHD treatment approaches may work well for Ken.

Since the family situation is likely a contributing factor to Ken’s disorder, the therapist’s approach in this given case appears sound and effective. Gradually implementing a set of contingency systems with rewards for desired behaviors such as staying seated, paying attention and engaging positively with others, and consequences for other behaviors such as being disruptive, the therapist applies contemporary parent management training along with an educational intervention into Ken’s social surrounding. Focusing on Ken’s caretakers who will raise him for many years will be key in helping him develop self-regulating practices and a positive social life. A psycho-educational intervention may be of additional benefit, aimed at teaching parents and teachers about ADHD symptoms, how to build on his strengths, and about the course of the disorder.

Discussion
The link of Ken’s disorder to added stress on the family is bi-directional rather than simply cause or effect. For example, his disruptive and sometimes uncontrollable behavior, such as at the table and at school, can raise alarm in family, peers and teachers, who must adjust and cope with the uncomfortable and often stressful situation; they may react with social rejection, and in Ken’s case even severe physical punishment. The father’s nonchalance coupled with the severity of the mother’s punishments along with her resulting remorse represents a fairly typical case of inconsistent parenting, which is known to trigger ADHD symptoms in those carrying a heritable genetic polymorphism involving homozygous dopamine receptor alleles (Martel et al., 2010). This may be even more likely, seeing as Ken’s father states that he had the same symptoms as a child. Dealing with Ken has further led to marital discord, damaging his primary protective and guiding factor: the family unit.

The therapist’s contingency management approached appears in this case to have been highly successful. His reasons for deciding not to prescribe medication may have been manifold, besides the recommendation of behavioral therapy as the first line of treatment for preschoolers and in less severe cases of ADHD (and Ken only met 11 of 12 minimum symptoms). Stimulant medications involve multiple side-effects, and ADHD symptoms return when the medication leaves the body. It is not advised to take stimulants late in the day because they may interfere with sleep (exacerbating concentration difficulties, etc.), and as a result ADHD symptoms often return in the evening, disrupting home life. Stimulants have the potential to aggravate Ken’s already poor appetite, induce physiological stress, can cause weight loss, hair loss, headaches, increases in blood pressure and pulse and later heart conditions. It is a lifetime treatment, expensive in the long run, and generally less effective than behavioral approaches.

Kids on amphetamine?
Oltmanns et al. (2015) ask why one in five children are taking stimulant medication while the rates of ADHD are not one in five. Though a preliminary literature search did not return any results confirming this finding, it is important to keep in mind that stimulant medication is FDA-approved for other conditions such as narcolepsy, obesity, and as an adjunct treatment for obstructive sleep apnea. Still, mis-prescription does occur. For example, children with birthdays in August are significantly more likely to be diagnosed with ADHD compared to those born in September, a finding attributed to their low neurocognitive maturity relative to relatively much older peers when entering school (Chen et al., 2016).

It is impossible to address this question without openly acknowledging that pharmaceutical companies spend many millions of dollars a year in promoting their drugs to physicians. Moreover, it is no secret that medical professionals sometimes casually substitute standardized questionnaires with brief conversations, leading to prescription without critical evaluation, especially in the instance of long-term doctor-patient familiarity. Finally, students commonly share stimulants as gifts or as barter. Amphetamine has been widely used for sustaining alertness and accelerating the passage of time during arduous tasks as well as widely abused for its euphoric and sometimes manic effects. Since its primary function is to stimulate the reward system, it is inherently addictive. The powerfully rewarding effect (as well as the barter value) of Adderall for non-ADHD youth may also make it more likely that some will learn how to fill an ADHD questionnaire in order to obtain prescription stimulants.

A note on television
Research has also linked watching a lot of television during the toddler years with later attention problems. According to Gutnick, Robb, Takeuchi, & Kotler (2010), children ages 2-5 watched over three and a half hours of television a day on average, about a third of toddlers had a television in their bedrooms, sixty percent of toddlers were consuming online video, and one third of toddlers were doing this on a daily basis. Now it is crucial to consider the advent of mobile devices, and particularly short-form media, available on-line and on-demand. According to a 2017 survey by Elias & Sulkin, “online viewing is integrated into the basic daily routine of parents with very young children who use online viewing platforms to fulfill a wide range of their childrearing needs.” Current statistics of toddler television viewing were not found in typical academic studies, and purchasing data available for commercial interest was beyond the scope of this study. The AAP recommends severely restricting television and mobile device use in toddlers, if not eliminating it altogether.

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References

Chen, M., Lan, W., Bai, Y., Huang, K., Su, T., Tsai, S., Li, C. Chang, W., Pan, T., Chen, T., Hsu, J. (2016). Influence of Relative Age on Diagnosis and Treatment of Attention-Deficit Hyperactivity Disorder in Taiwanese Children. The Journal of Pediatrics, 172. doi:10.1016/j.jpeds.2016.02.012

Elias, N., & Sulkin, I. (2017). YouTube viewers in diapers: An exploration of factors associated with amount of toddlers’ online viewing. Cyberpsychology: Journal of Psychosocial Research on Cyberspace, 11(3). doi:10.5817/cp2017-3-2

Gutnick, A. L., Robb, M., Takeuchi, L., & Kotler, J. (2010). Always connected: The new
digital media habits of young children. New York: The Joan Ganz Cooney Center at Sesame Workshop. Retrieved from http://www.joanganzcooneycenter.org/wp-content/uploads/2011/03/jgcc_alwaysconnected.pdf

Martel, M. M., Nikolas, M., Jernigan, K., Friderici, K., Waldman, I., & Nigg, J. T. (2010). The Dopamine Receptor D4 Gene (DRD4) Moderates Family Environmental Effects on ADHD. Journal of Abnormal Child Psychology, 39(1), 1-10. doi:10.1007/s10802-010-9439-5

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Case Study: Attention Deficit Hyperactivity Disorder 2019-12-11T00:52:38+00:00

Adult Disorganized Attachment: Pathology, Absorption, and Mystical Experience

Adult Disorganized Attachment: Pathology, Absorption, and Mystical Experience

by Eric M. Fortier, B.A.

Introduction
This review outlines pathological and non-pathological outcomes for adult disorganized attachment (ADA), which extends Crowell, Farley & Shaver’s Two-Dimensional Model of Individual Differences in Adult Attachment Orientation. The two-dimensional model represents stable and predictable patterns of social behaviors and attitudes towards attachment figures. Now it is known that some adults have mixed attachment styles, and react with an unpredictable combination of anxious and avoidant orientations. This lack of organization in orientation has been researched in children, although it remains relatively unexplored in adults, especially from a social psychological point of view. Importantly, ADA holds the most dysfunctional pathology of all attachment styles, and there are few known adaptive or therapeutic implications for disorganized attachment in adults.

Summary
Paetzold, Rholes, and Kohn (2015) review literature on attachment from infancy to adolescence to develop a 9-item ADA scale, and provide evidence for its predictive validity. Of their sample (see Critiques section for details), ADA predicted higher internalizing symptoms, as measured by the Beck Anxiety Inventory (BAI) and Center for Epidemiology Studies Depression scale (CES-D), and externalizing symptoms, as measured by the Multidimensional Anger Inventory (MAI) and the Buss-Perry Aggression Questionnaire (BPAQ). They propose a working model of disorganized attachment in adulthood, to be understood as a confusing conflict between aggressive-approach and anxious-avoidance behaviors. Most notably, disorganization was the only predictor for physical aggression when compared with either anxious or avoidant attachment.

Paetzold et al. suggest a number of implications for ADA centered on the idea that the conflict between fear and anger leads to contradictory anxious avoidant and aggressive approach patterns toward romantic partners. They may use physical or verbal attacks or withdraw from the interaction; they may experience a hostile attribution bias, further contributing to dysfunctional anger in relationships, providing fertile ground for spousal abuse. Authors argue how fear, hostility and lack of trust impairs support-giving, and leads to sexual ambivalence, in which those with ADA may have sex to resolve conflict. Overall, those with ADA, it is hypothesized, might expect lower relationship satisfaction, leading to more break-ups and loneliness. Loneliness and repeated failed relationships combined with fear and lack of trust in the romantic partner may lead to less commitment, openness and self-disclosure.

ADA is also related to dissociation and absorption. Trait absorption refers to the tendency and depth with which one becomes engrossed in mental imagery, is considered non-pathological; is related to creativity; and most importantly in this review, strongly predicts propensity for mystical experiences. Mystical experiences are emotionally profound and personally meaningful events shown to produce lasting improvements in symptoms of depression and anxiety, prosocial engagement, self-care behaviors, wellbeing, and can lead to permanent increases in personality trait Openness (Maclean et al., 2011; Griffiths et al., 2017).

Since absorption appears to be related both to disorganized attachment and propensity for mystical experience, another team of researchers, Granqvist, Hagekull, and Ivarsson (2012) wanted to know whether ADA would predict propensity for mystical experience. Their results revealed that ADA moderately predicts mystical experience, strongly mediated by trait absorption. Theistic beliefs, new age spirituality, and level of religiousness were unrelated to ADA and absorption.

These results imply that failed resolution of trauma, and specifically disorganized attachment, expresses itself in a propensity for mystical experiences (unrelated to religious/spiritual beliefs), mediated by trait absorption. These experiences appear as non-pathological, adaptive outcomes of disorganized attachment. The propensity for mystical experiences as a potential life-changing turning point may replace other attempts at self-realization (e.g. through drugs or promiscuity). It is therefore argued that mystical experiences may be a promising therapeutic target for ADA.

Critique
The sample used by Paetzold et al. appears generalizable, including 510 participants who met the criteria for ADA, recruited through Amazon’s Mechanical Turk platform. The mean age was 34 years (58% female), and 68% of these claimed to be in a committed relationship. All measures used in this study were self-reported, and although this may be seen as a limitation, the anonymity of the survey method may invite more truthful responses than qualitative interviews, for example. In terms of limitations, among multiple measures of attachment and related pathology, there was no record of care-giving history or childhood trauma, which are known predictors of insecure forms of attachment. And although Paetzold et al. believe that disorganization would be even more predictive of relationship outcomes than internalizing and externalizing symptoms, behavior discussed in this review remains hypothetical, as no direct or objective measures of relationship outcomes were used to quantify the implications.

In Granqvist et al., only 8 of 67 participants met the criteria for ADA. Also, the data may not be generalizable because participants were recruited from various religious/spiritual gatherings. The only measure of disorganization used was the AAI, although it had similar predictive validity as Paetzold et al’s 9-item ADA scale. To test validity, Granqvist et al. proposed and tested two alternative mediational models and specifically showed that level of religiousness, theistic beliefs, and participation in new age spirituality did not explain any significant relation between disorganized attachment and mystical experience. On a similar note, they discuss a series of objections against classifying mystical experience as a pathological state:

  1. dream sleep is dissociative, but far from pathological.
  2. according to research, mystical experiences are not associated with pathological aspects of dissociation.
  3. lifetime mystical experience (35%) is ten times higher than dissociative psychopathology.
  4. Mystical experience is not associated with psychopathology in the literature.

As for the measurement of mystical experience, the MEQ-30 questionnaire that was used can only assesses positive experiences of ego dissolution, and does not include dimensions for those involving fear, terror and dissociation, such as those included in Dittrich’s (2010) more comprehensive Altered States of Consciousness questionnaire (5D-ASC). Inclusion of this fearful/anxious part of the mystical experience may show a stronger correlation with ADA due to ADA’s association with pathological symptoms.

The use of anonymous surveys likely entices more truthful responses because of the intimate and personal nature of relationshipsespecially dysfunctional ones. However, the nature of self-report measures and in some cases incentivized (as in Amazon’s Mechanical Turk) self-reports warrants careful interpretation. Still, all of the questionnaires had few if any hypothetical items, and relied mostly on primary experiences. Finally, these studies were correlational, increasing the difficulty of determining causality.

Proposal
The 5D-ASC (now 11D-ASC) characterizes mystical experience and pathological experiences as two opposite reactions to ego dissolution. I suggest that using questionnaires for depression, anxiety and aggression (such as those used by Paetzold et al.) along with a more comprehensive form of the MEQ-30, the 11D-ASC, should not only allow us to capture both the full spectrum and the frequency of altered states of consciousness in ADA, but also to detect whether and to what extent fear, anxiety and aggression characteristic of ADA contribute to the likelihood of experiencing anxious, resistant or fearful ego dissolution or pathological states. Since the polarity of ego dissolution (experienced ‘positively,’ or ‘negatively’) can be partially predicted by set and setting,* experimenting with factors of set and setting known or suspected to predict (such as recent adverse life events, mood, emotional regulation, safety and comfort, social support and trust for people around them), could inform our understanding of disorganized attachment pathology, direct present and future therapeutic approaches for disorganized attachment, and provide crucial information for developing treatment plans involving a focus on adaptive mystical experience.

*the set including the personality structure, expectation, life history, mindset, intention and mood prior and up to the experience; and the setting including the physical, cultural and social environment

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References

Granqvist, P., Hagekull, B., & Ivarsson, T. (2012). ADA Promotes Mystical Experiences via a Propensity for Alterations in Consciousness (Absorption). International Journal for the Psychology of Religion, 22(3), 180-197. doi:10.1080/10508619.2012.670012

Griffiths, R. R., Johnson, M. W., Richards, W. A., Richards, B. D., Jesse, R., Maclean, K. A., . . . Klinedinst, M. A. (2017). Psilocybin-occasioned mystical-type experience in combination with meditation and other spiritual practices produces enduring positive changes in psychological functioning and in trait measures of prosocial attitudes and behaviors. Journal of Psychopharmacology, 32(1), 49-69. doi:10.1177/0269881117731279

Maclean, K. A., Johnson, M. W., & Griffiths, R. R. (2011). Mystical experiences occasioned by the hallucinogen psilocybin lead to increases in the personality domain of openness. Journal of Psychopharmacology, 25(11), 1453-1461. doi:10.1177/0269881111420188

Paetzold, R. L., Rholes, W. S., & Kohn, J. L. (2015). ADA in adulthood: Theory, measurement, and implications for romantic relationships. Review of General Psychology, 19(2), 146-156. doi:10.1037/gpr0000042

Adult Disorganized Attachment: Pathology, Absorption, and Mystical Experience 2019-12-25T05:28:56+00:00
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