Table of Contents

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Volume 41, Number 4

December 2009

Experiences of Encounters with Ayahuasca—“the Vine of the Soul” — Anette Kjellgren, Ph.D.; Anders Eriksson, M.Sc. & Torsten Norlander, Ph.D.

Alter Ego Representations in San Agustin Monolithic Sculptures:  Possible Plant Hallucinogenic Influences — Marlene Dobkin de Rios, Ph.D.

Cannabis and Ecstasy/ MDMA: Empirical Measures of Creativity in Recreational Users — Katy A. Jones, Ph.D.; M. Blagrove, Ph.D. & A.C. Parrott, Ph.D.

Marijuana Use, Abuse, and Dependence: Evaluation of Panic Responsivity to Biological Challenge — Marcel O. Bonn-Miller, Ph.D. & Michael J. Zvolensky, Ph.D.

Nitrous Oxide Inhalation Among Adolescents: Prevalence, Correlates, and Co-Occurrence with Volatile Solvent Inhalation — Eric L. Garland, Ph.D., L.C.S.W.; Matthew O. Howard, Ph.D. & Brian E. Perron, Ph.D.

Landlords of Self-Governed Recovery Homes: An Initial Exploration of Attitudes, Opinions, and Motivation to Serve Others — Joseph R. Ferrari, Ph.D.; Darrin M. Aase, M.A.; David G. Mueller, Ph.D. & Leonard A. Jason, Ph.D.

Staff Perspectives on Modified Therapeutic Community Services for Homeless Dually Diagnosed Clients: An Exploratory Pilot Study — Nadia Siddiqui, M.Sc.; Janetta Astone-Twerell, Ph.D. & Ted Hernitche, L.S.C.W.

Substance Use Patterns and Mental Health Diagnosis Among Youth in Mental Health Treatment:  A Latent Class Analysis — Kara S. Riehman, Ph.D.; Robert L. Stephens, Ph.D. & Michelle L. Schurig, M.P.H.

Ethnic Differences in Delays to Treatment for Substance Use Disorders: African Americans, Black Caribbeans and Non-Hispanic Whites — Brian E. Perron, Ph.D.; Ben Alexander-Eitzman, Ph.D.; Daphne Watkins, Ph.D.; Robert Joseph Taylor, Ph.D.; Ray Baser, M.S; Harold W. Neighbors, Ph.D. & James S. Jackson, Ph.D.

A Review of the Community Reinforcement Approach in the Treatment of Opioid Dependence — Patrick J. Abbott, M.D.

SHORT COMMUNICATIONS

One Dozen Considerations when Working with Men in Substance Abuse Groups — Geoffrey L. Greif, D.S.W., L.C.S.W.-C.

Recovered, in Recovery or Recovering from Substance Abuse? A Question of Identity — Nick Doukas, M.S.W., R.S.W. & Jim Cullen, M.S.W., R.S.W., Ph.D.

INDEX — Volume 41 (1-4) 2009

COVER ART — Mitologia Amazonica by Anderson Debernardi. Photograph by Anette Kjellgren, from a private collection.

ABSTRACTS

Experiences of Encounters with Ayahuasca—“the Vine of the Soul” — Anette Kjellgren, Ph.D.; Anders Eriksson, M.Sc. & Torsten Norlander, Ph.D.

Abstract—Ayahuasca is a psychoactive brew used by the indigenous populations of the Amazon. The aim of this qualitative study was to gain insight into the experiences of western users of ayahuasca, as well as to ascertain the experienced meaning that participants felt by their participation. Twenty-five people from Northern Europe with experiences of group sessions with ayahuasca wrote anonymous descriptions of their experiences. The Empirical Phenomenological Psychological method was used for this analysis. The analysis resulted in 33 categories which were assembled into six general themes: (a) motivation and aim, (b) contractile frightening state (c) sudden transformation of the experience, (d) limitless expansive states with transcendental experiences, (f) reflections, and (g) changed worldview and new orientation to life. These themes provided a new structure, called the transcendental circle. Participants reported many positive psychological and physical improvements that indicate that ayahuasca could be of potential interest in the development of new medicines and therapies.

Keywords—altered states of consciousness, ayahuasca, personal development, psychedelic medicine, spirituality

Alter Ego Representations in San Agustin Monolithic Sculptures:  Possible Plant Hallucinogenic Influences — Marlene Dobkin de Rios, Ph.D.

Abstract—This article examines the evidence for plant hallucinogenic use (possibly Brugmansia, Brunfelsia chiricaspi, Desfontainia R., Anadenanthera peregrina, Banisteriopsis sps, Psychotropia viridis and Virola theidora) by the San Agustin culture, an extinct peoples who resided in the Magdelena River area of Colombia from the third century B.C. until the sixteenth century A.D. Based on thematic materials gathered from a cross-cultural survey of plant hallucinogens, the author examines themes in the monolithic sculptures of this culture in light of man-animal transformations and shamanic themes linked to plant hallucinogenic ingestion.

Keywords—alter ego, plant hallucinogens, San Agustin monolithic sculptures, shamanism, shape-shifting

Cannabis and Ecstasy/ MDMA: Empirical Measures of Creativity in Recreational Users  — Katy A. Jones, Ph.D.; M. Blagrove, Ph.D. & A.C. Parrott, Ph.D.

Abstract—This study investigated the associations between chronic cannabis and Ecstasy/MDMA use and one objective and two subjective measure of creativity. Fifteen abstinent Ecstasy users, 15 abstinent cannabis users, and 15 nondrug-user controls, completed three measures of creativity: the Consequences behavioral test of creativity, self-assessed performance on the Consequences test, and Gough’s Trait Self-Report Creative Adjective Checklist. The Consequences test involved five scenarios where possible consequences had to be devised; scoring was conducted by the standard blind rating (by two independent judges) for “remoteness” and “rarity,” and by a frequency and rarity of responses method. Cannabis users had significantly more “rare-creative” response than controls (Tukey, p < 0.05); this effect remained significant with gender as a covariate. There were no significant differences between the groups on the number of standard scoring “remote-creative” ideas or for fluency of responses. On self-rated creativity, there was a significant ANOVA group difference (p < 0.05), with Ecstasy users tending to rate their answers as more creative than controls (Tukey comparison; p = 0.058, two-tailed). Ecstasy users did not differ from controls on the behavioral measures of creativity, although there was a borderline trend for self-assessment of greater creativity. Cannabis users produced significantly more “rare-creative” responses, but did not rate themselves as more creative.  

Keywords—3, 4-methylenedioxymethamphetamine (MDMA), cannabis, creativity, consequences test, Ecstasy

Marijuana Use, Abuse, and Dependence: Evaluation of Panic Responsivity to Biological Challenge — Marcel O. Bonn-Miller, Ph.D. & Michael J. Zvolensky, Ph.D.

Abstract—The present investigation examined marijuana use, abuse, and dependence in relation to anxious and fearful responding to panic-relevant bodily sensations elicited by a biological challenge procedure among a sample of young adult marijuana users (n = 64; 46.9% women; M_age = 20.97, SD = 6.01). Results indicated that those who were dependent on marijuana had greater self-reported panic attack symptoms post-challenge than those who abused marijuana. No differences were found between those who did not meet criteria for either abuse or dependence (users), and those who abused or were dependent on marijuana. No group differences were found for heart rate reactivity. Results are discussed in relation to better understanding the role of marijuana use and its disorders in terms of panic responsivity.

Keywords—anxiety, biological challenge, comorbidity, marijuana, panic attacks

Nitrous Oxide Inhalation Among Adolescents: Prevalence, Correlates, and Co-Occurrence with Volatile Solvent Inhalation — Eric L. Garland, Ph.D., L.C.S.W.; Matthew O. Howard, Ph.D. & Brian E. Perron, Ph.D.

Abstract—Few studies have examined the prevalence of nitrous oxide (NO) inhalation or co-occurrence of NO and volatile solvent (VS) use in adolescents. Study aims were to (1) describe the independent and conjoint prevalence of NO and VS use in incarcerated youth, (2) compare adolescent users of both NO and VS inhalants (NO+VS) to users of NO-only, VS-only, and nonusers of NO and VS (NO/VS nonusers) with regard to demographic, psychological, and behavioral characteristics, and (3) conduct logistic regression analyses identifying correlates of NO use. Residents (N = 723) of Missouri Division of Youth Services were assessed with standardized psychosocial measures. Participants averaged 15.5 (SD = 1.2) years of age, were ethnically diverse and predominantly male. Lifetime prevalence of NO use was 15.8%. NO+VS users evidenced greater impairments compared to NO+VS nonusers. VS-only users evidenced impairments that were similar in kind but at lower prevalences compared to those displayed by NO+VS users, whereas NO-only youth had profiles that were similar to those of NO/VS nonusers. Psychiatric disorders, polydrug use, and temperamental fearlessness were correlates of NO use. NO+VS users were at high risk for behavioral and emotional problems. Screening and interventions for NO and VS inhalant use should be implemented in juvenile justice facilities.

Keywords—co-occurring disorders, juvenile justice, nitrous oxide, substance abuse, volatile solvents

Landlords of Self-Governed Recovery Homes: An Initial Exploration of Attitudes, Opinions, and Motivation to Serve Others — Joseph R. Ferrari, Ph.D.; Darrin M. Aase, M.A.; David G. Mueller, Ph.D. & Leonard A. Jason, Ph.D.

Abstract—Landlords of community-based recovery homes are an under-researched group. The few existing studies available suggest that landlords might be more open to renting to vulnerable populations if certain conditions are met or communication is more open between all parties involved. The present exploratory study surveyed landlords (n = 30) of self-governed recovery homes across the United States regarding their attitudes and opinions about renting to these homes, and motivations for community service. Results indicated that landlords generally had positive perceptions of renting to self-governed recovery environments, and even perceived benefits of renting to these homes compared to more traditional tenants. Implications of these findings for future research are discussed in the context of existing research and limitations of the present study.

Keywords—housing, Oxford House, recovery homes, substance abuse

Staff Perspectives on Modified Therapeutic Community Services for Homeless Dually Diagnosed Clients: An Exploratory Pilot Study — Nadia Siddiqui, M.Sc.; Janetta Astone-Twerell, Ph.D. & Ted Hernitche, L.S.C.W.

Abstract—The modified therapeutic community (MTC) is one treatment modality developed to meet the needs of the homeless dually diagnosed population. While studies have shown the effectiveness of the MTC, little is known regarding staff perspectives of this modality. Using data from in-depth qualitative interviews, this study examines key staff perspectives on treatment services offered at an MTC in New York for homeless, mentally ill substance abusers. Many staff members indicated that the services provided are innovative, state of the art, and comprehensive as compared to other programs that specifically treat only one need. The most beneficial aspects of the MTC modality noted were the number of social workers available and the introduction of art therapy groups. The MTC modality also fostered increases in communication and collaboration between staff to introduce more specialized clinical groups not outlined in MTC guidelines to better meet the needs of clients.

Keywords—dual diagnosis, homelessness, mental health, modified therapeutic community, staff perspectives, substance abuse treatment

Substance Use Patterns and Mental Health Diagnosis Among Youth in Mental Health Treatment:  A Latent Class Analysis — Kara S. Riehman, Ph.D.; Robert L. Stephens, Ph.D. & Michelle L. Schurig, M.P.H.

Abstract—This study examines patterns of substance use among youth served in systems of care, and how these patterns relate to diagnosis and other youth characteristics using latent class analysis. Results indicated a four-class solution with the four groups differing in their probabilities of reporting the use of 10 different substances. Class 1 was defined by high probabilities of all drug use. Class 2 had high probabilities of alcohol, tobacco, marijuana use, and low for other drugs. Class 3 had moderate probabilities of alcohol, tobacco, marijuana use, and low probabilities for other drugs. Class 4 had a high probability of tobacco use and no other drug use. Youth who had a mood disorder diagnosis, were male, older, White and had previously run away from home were significantly more likely to be in Class 1 relative to other classes. These differences have implications for prevention and treatment.

Keywords—adolescents, latent class analysis, mental health, substance abuse

Ethnic Differences in Delays to Treatment for Substance Use Disorders: African Americans, Black Caribbeans and Non-Hispanic Whites — Brian E. Perron, Ph.D.; Ben Alexander-Eitzman, Ph.D.; Daphne Watkins, Ph.D.; Robert Joseph Taylor, Ph.D.; Ray Baser, M.S; Harold W. Neighbors, Ph.D. & James S. Jackson, Ph.D.

Abstract—Prior research has shown that minority groups experience greater levels of disability associated with psychiatric and substance use conditions due to barriers to treatment. Treatment delays are an important part of the overall problem of service utilization and access to treatment, yet little work has been done to understand the factors associated with treatment delays among ethnic minorities. This study compares African Americans, Caribbean Blacks and non-Hispanic Whites regarding their probability of making treatment contacts over time, using a combined sample of African Americans and Caribbean Blacks from the National Survey of American Life (NSAL) and non-Hispanic Whites from the National Comorbidity Survey-Replication (NCS-R). Alcohol and other drug use disorders (abuse and dependence) were assessed using the World Mental Health Composite International Diagnostic Interview. Cumulative lifetime probability curves were used to examine race differences in treatment contact. Cox regression analysis was used to test the association between race and treatment groups while controlling for other potential confounding variables. Significant delays in making treatment contact were observed across all disorders. However, no evidence of delays was found for racial differences. In the multivariate analysis, race was not significantly associated with delays. However, comorbid anxiety disorders were found to be a consistent factor associated with a faster time to treatment.

Keywords—ethnic differences, racial differences, substance abuse treatment, survival analysis, treatment delays

A Review of the Community Reinforcement Approach in the Treatment of Opioid Dependence — Patrick J. Abbott, M.D.

Abstract—This article reviews the Community Reinforcement Approach (CRA) in the treatment of opioid dependence. It covers the use of CRA with both methadone maintenance patients and patients withdrawing from opioids. The data reviewed in the use of CRA in combination with methadone maintenance shows improvement in a number of areas. These include the reduction of opioid use, as well as other drugs of abuse, improved legal status, less psychiatric symptoms, and improved vocational and social functioning. CRA coupled with vouchers can assist in retaining patients in treatment long enough to improve opioid detoxification rates from buprenorphine and coupled with naltrexone may sustain abstinence. Further, the use of a standardized computerized format may extend the utility of CRA.

Keywords—buprenorphine, Community Reinforcement Approach, methadone, naltrexone, opioid dependence

SHORT COMMUNICATIONS

One Dozen Considerations when Working with Men in Substance Abuse Groups — Geoffrey L. Greif, D.S.W., L.C.S.W.-C.

Abstract—Men can present unique challenges when they come voluntarily or involuntarily to substance abuse groups.  Twelve considerations are offered for working with men that include understanding the context of masculinity, how men are socialized, the gender of the therapist, their relationships with their fathers and their children, their male friendships, and sexual issues. Clinical implications are included.

Keywords—gender, groups, masculinity, men, men’s roles, substance abuse

Recovered, in Recovery or Recovering from Substance Abuse? A Question of Identity — Nick Doukas, M.S.W., R.S.W. & Jim Cullen, M.S.W., R.S.W., Ph.D.

Abstract—There has always been widespread debate on how people with past substance abuse problems choose to identify themselves with regards to their recovery and the terms used to associate with that identity. Most of the disagreement over these terms is rooted on whether recovery is seen as an ongoing process (“recovering” or “in recovery”) or a life event that can be mastered (“recovered”). This article discusses these three controversial terms and attempts to make them available as terms that one can use or identify with by presenting different perspectives on the topic of recovery. Some of these perspectives may be unconventional when compared to traditional views of the recovery process, but they are the realities of many individuals who have had a past experience with substance abuse and may be confronted with prejudice when voicing their recovery in a past tense. The article makes comparisons between the DSM IV and the Big Book of AA and discusses identity vs. labels and the influence of the medical community on this controversial topic.

Keywords—abstinence, identity, labels, recovery