Monday, May 9, 2016

On hallucinogens and intimate partner violence

One of the latest papers to come out on the science of psychedelics, published last month in the Journal of Psychopharmacology, made quite a splash when it suggested that hallucinogens could have a “protective effect” on intimate partner violence (IPV, aka domestic violence).

I was asked my opinion on this. I had an opinion or two.

In the study, the researchers took a sample of male jail inmates – jailed for any number of reasons – and at some point during their jail time, asked them what drugs they had done in the past. Turns out all of them had used drugs in the past, but those who listed hallucinogens among those drugs were less likely to be re-incarcerated on IPV charges following their release than those who hadn’t used hallucinogens. To be specific, 27% of the hallucinogen-use group were arrested for later IPV, compared with 42% of the group that reported no hallucinogen use. (That is not to say inmates who had used hallucinogens weren’t also re-incarcerated, on other charges. But the difference emerged specifically for IPV.)

This comes as a bit of a surprise to the scientific community (although surely not to anyone who has ever tried a hallucinogen or is aware of their therapeutic benefits), as it’s considered well-established that drug use correlates with violence, and conversely, treatment for drug use decreases violence. But rather than follow this pattern, hallucinogens seem to be in a category of their own, doing the exact opposite. The results make the point that hallucinogens probably shouldn’t be lumped in with other drugs, and once again point to the potential benefits of hallucinogen use, not just for the individual but for society more generally.

Of course, my critical scientist mind immediately reminds me that correlation is not causation, and that the relationship could be mediated by any number of things. Maybe the kind of person who is drawn to hallucinogens is less prone to violence to begin with? Or less likely to have a partner? Or maybe hallucinogen use makes you less interested in drugs that are known to instigate violence, like alcohol or meth, so it’s not the presence of hallucinogens per se, but rather the absence of violence-promoting drugs? Or maybe it’s a socio-cultural phenomenon, seeing how 2/3 of the hallucinogen-using sample was white?

Who knows, the study doesn’t go into reasons for the relationship – although they did successfully control for the potential effects of ethnicity/socio-cultural factors, psychopathic personality, and alcoholism: the relationship held even when those factors were taken out of the equation. Nonetheless, we only know that this relationship exists, not why. But that’s already something.

It’s tempting to speculate, though, that this fits with the growing narrative of hallucinogens’ therapeutic benefits - and this is the angle favoured by the authors. For example, they remind the reader that psilocybin was recently shown in small clinical trials to help people quit drinking and smoking, and that studies of LSD-assisted psychotherapy, dating back as far as the 60s (when LSD was still legal), showed positive personality changes, in addition to proving helpful in treating alcoholism. They also note that even in healthy people, hallucinogens have been shown to increase ‘interpersonal regard,’ intimate emotional communication, empathy, and ‘broad-minded tolerance of others.’

Not mentioned in their summary are more recent findings that ayahuasca/DMT increases a person’s ‘mindfulness capacity,’ bringing their ability to ‘observe their mind without judging’ to a level reported by experienced meditators; that a single administration of LSD increases ‘suggestibility’ (susceptibility to suggestion, which can increase treatment effectiveness) and both psilocybin and LSD increased optimism and openness for over a year, suggesting a lasting personality change; that a single administration of psilocybin changes how people process social information; and that in general, hallucinogens re-organise how brain networks communicate, and that this correlates with a sense of ‘ego-dissolution,’ or one-ness with the world. Not to mention the long-documented ability of MDMA to induce feelings of interpersonal closeness and sociability. Seems that any one of those factors would make a person less likely to attack those around them, no?

So why is it that the authors’ conclusions are being questioned left and right? Their conclusions are relatively unassuming: 1. that hallucinogens are an exception to the rule regarding substance use and criminal behaviour; and 2. that further investigation is warranted into the potential of hallucinogens to prevent violent behaviour. Neither is particularly controversial.

Part of the problem is that none of this careful language and nuance is reflected in articles like the one by The Mirror, who mistakenly explains this “sensational study” in terms of “hallucinogen users and their sober compatriots” (none of the inmates were sober) and focuses almost exclusively on the treatment implications. No wonder publications like react negatively, dismissing the entire study as flawed for having ‘medicalised’ and thus excused violent behaviour (it didn’t).

These articles are making me realise that if we want to normalise and advance this conversation, we need to do much more than simply publicise study results; we need to come to an agreement on the currently delicate and tenuous state of psychedelic science, and the language around it. (Nevermind agreeing to perhaps read the actual studies, rather than misunderstanding and misinterpreting them based on an article by The Mirror.)

Look, psychedelic science is a hella controversial field. To catch on, and to gain the legality and legitimacy it needs in order to build its evidence base, it needs to overturn people’s deeply engrained beliefs about drugs, and overcome legal, academic, and practical obstacles at every turn. (And btw, it’s OK if you don’t believe it or think the field as a whole is hoakey – all the more reason to support the science trying to explore it. Let the evidence corroborate [or change] your opinion.) Anyway,  as it stands, psychedelic science is having a hard enough time, from funding shortages and publication bias to negative publicity and a terrible reputation to overcome; let’s not use it as a spring-board for arguments that could just as easily be made about less controversial examples (violent behaviour, for example, has been treated for ages with antidepressants and cognitive-behavioural approaches; plus we’ve been treating behavioural problems for ages, from gambling addiction to eating disorders – so this was a terrible example to pick to make a point about the ‘exculpatory’ nature of treatment).

As for the language around its therapeutic potential, we should agree on the meaning of ‘treatment.’ The article’s argument comes from a place where treatment = cure. We’re trying to give people LSD to “cure” the “illness” of partner violence, to medicate it out of people while they passively enjoy the benefits of having been given a “pass” for their behaviour. But no one is saying that. That’s not what the study is about. That’s not what treatment is about. Treatment isn’t about medical care, or fixing a problem without the person having to do anything. It’s about throwing every tool in our arsenal at every cause we know of for a behaviour in an effort to prevent that behaviour manifesting again. Why wouldn’t it be in everyone’s interest to have more tools in our arsenal – and especially one that gets at the very core of the humanity we want such offenders to cultivate?

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