A Nationwide Study Comparing Mental Health Professionals’ Willingness to Try Hallucinogenic Drugs in Basic Research or Clinical Practice

This survey study (n=347) examined Israeli mental health professionals’ attitudes toward recreational drug users and willingness to use five hallucinogens (LSD, MDMA, ketamine, cannabis, psilocybin) in research or clinical practice. Compared to nurses and paramedics, psychiatrists were more familiar with the potential therapeutic role of psychedelics and had a higher willingness to conduct research or use such substances for clinical purposes. However, psychiatrists were also the most susceptible to personal bias, as evidenced by cases wherein negative attitudes toward recreational users impeded their support for psychedelic within the context of clinical treatments or research.

Abstract

“Introduction: This study explored whether personal attitudes toward drug users are associated with professional approaches and whether the association between personal and professional attitudes varies across different mental health professions.

Methods: Participants (N = 347) included medical (psychiatrists and psychiatric nurses) and other (clinical psychologists and social workers) mental health professions from all 13 mental health centers in Israel. They completed questionnaires aimed to assess familiarity with medical usage of hallucinogenic drugs, personal attitudes toward recreational drug users and willingness to use five hallucinogens in research of clinical practice. Hypotheses were tested using multiple-group structural equation modeling (SEM).

Results: Psychiatrists reported the highest levels of familiarity with and willingness to use all types of hallucinogenic drugs, as compared to other mental health professionals. Psychiatrists held the strongest belief in the potential utility of hallucinogenic drugs; yet, their personal attitudes toward drug users affected negatively their willingness to try hallucinogenic drugs in clinical practice. This was the only significant association that was found.

Discussion: Future research and treatment programs should address the topic of hallucinogenic drug therapy, and specifically the need to separate between individual beliefs and professional clinical decision-making.”

Authors: Yotam D. Ginati, Nir Madjar, Joseph Ben-Sheetrit, Shaul Lev-Ran, Abraham Weizman & Gal Shoval

Summary

This study explored whether personal attitudes toward drug users are associated with professional approaches to treating them, and whether this association varies across different mental health professions. Psychiatrists held the strongest belief in the potential utility of hallucinogenic drugs, yet their personal attitudes toward drug users affected negatively their willingness to try them.

Introduction

Healthcare professionals are expected to offer their patients evidence-based, accurate diagnoses, as well as effective and safe treatments. However, subjective and contextual factors such as burnout, physical health, and personal standpoints or predispositions can mitigate their objective evaluations, professional recommendations and treatment outcomes.

The term “hallucinogen” was coined in 1954 to describe substances whose primary effects include the alteration of sensory perception, mood and thought patterns.

Recent evidence indicates that hallucinogenic drugs have promising therapeutic potential, but personal attitudes of mental health professionals are a concern. Understanding the relationships between personal attitudes and willingness to study hallucinogenic drugs is essential for increasing future research initiatives.

Hallucinogenic drugs in research

In the current study, five hallucinogens were used, including LSD, psilocybin, entacogens/emphatogens, dissociative, and atypical hallucinogens. These hallucinogens were used to treat depression, anxiety, substance abuse or addictions, as well as depression and anxiety in particular cases of life-threatening disease. MDMA, ketamine and cannabis are synthetic entactogen drugs that have been studied as potential treatments for several mental health disorders, including PTSD, anxiety, depression, social anxiety disorder, and autism spectrum disorder.

Hallucinogenic drugs in the clinic

Encountering hallucinogens in clinical psychiatry is mostly in the context of its harmful use and negative consequences. Mental health professionals hold negative views about drug users, and mistrust and stigmatization of health care providers are perceived as substantial barriers to initiate and maintain effective treatment.

When comparing mental health experts with other health care professionals, psychiatrists have stronger preference toward working with psychoactive substance users, and familiarity with these types of patients is positively associated with this preference.

The current study

The primary aim of this study was to explore the relationship between personal attitudes toward drug users and the willingness to be involved in research or treatments with hallucinogenic drugs among mental health professionals.

Participants

The study included 347 participants from 13 mental health centers in Israel, representing three major mental health professions: psychiatrists, psychiatric nurses and clinical psychologists and social workers.

Instruments

The surveys were developed for the purpose of the current study, and their internal reliability and structural validity were examined using single-factor analysis followed by confirmatory factor analysis. The surveys had a good fit when the RMSEA was less than 0.08.

Attitudes toward drug users

Participants were asked to rate their level of agreement with various statements regarding people who use psychoactive substances for recreational purposes. Single-factor analysis yielded adequate fit to data.

Willingness to use hallucinogen drugs for research and practice

The willingness to use hallucinogens for research or medical care was assessed using a Likert’s scale. A single factor analysis yielded adequate fit to data.

Familiarity with clinical usage

Participants were asked whether they were familiar with any potential therapeutic uses for five hallucinogens. Single-factor analysis and CFA supported the hypothesized structure of the variables.

Procedure

The study was approved by the Geha Mental Health Center Institutional Review Board and conducted among mental health clinicians working in public mental health centers in Israel. The anonymous questionnaires were distributed through electronic media or by hard-copy questionnaires and the response rate was 69.4%.

Statistical analyses

We examined differences in familiarity with clinical use of hallucinogens and willingness to use these substances for research or practice based on intra-individual differences and between profession groups using repeated-measures analysis of variance.

The primary method of analysis was structural equation modeling, with the subsamples based on professional training backgrounds being smaller. Multiple regression analysis was used to test the relationship between attitudes toward drug users and willingness to use.

Preliminary analyses

Psychologists expressed the highest willingness toward research and practice that involve cannabis and the lowest willingness toward psilocybin. There was a significant interaction between position and willingness to use hallucinogens for practice, with psychiatrists reporting higher levels of willingness compared with nurses and paramedical staff across all substances.

Those who were familiar with the clinical usage of each substance reported a higher willingness to use this particular substance for research or practice.

Primary analysis

The results indicated that attitudes toward drug users were significant for psychiatrists, marginally significant for paramedical staff, and non-significant for psychiatric nurses. The interaction between professional background and attitude toward drug users was significant when comparing psychiatrists and nurses.

A statistical analytical approach was used to examine the structural validity of the scales, and to ensure that we did not measure the same concept by using different instruments.

Discussion

Psychiatric nurses and paramedical staff were less familiar with the potential therapeutic role of hallucinogens than psychiatrists, and had lower optimism for the future treatment use of hallucinogenic drugs.

In general, negative attitudes toward drug users were negatively associated with willingness to conduct research or use hallucinogens for clinical purposes. However, the strongest association was found among psychiatrists, who reported negative attitudes toward psychoactive substance use.

Although we expected that those with more extensive medical training would be least affected by personal beliefs, we found that those with the most extensive scientific training were most susceptible to personal beliefs.

Initial evidence supports the potential effectiveness of hallucinogenic drugs for medical purposes. Furthermore, the use of hallucinogens is associated with reduced usage of other drugs, such as opioids or stimulants, and other delinquent or high-risk behaviors.

The current study showed that medical students’ beliefs and predispositions toward drug-using individuals can affect their objective evidence-based professional judgments. However, a short duration intervention can attenuate such a decline, and such individual attitudes can also augment the learning processes during medical training.

The findings are important considering that personal attitudes lead to behavioral intentions, which are the strongest predictors of individuals’ choices and behaviors. Understanding the contextual determinants that shape peoples’ intentions contributes to the understanding of their behavioral patterns.

The study was cross-sectional and had simplistic measures, and did not include information regarding the personal use of these drugs among the mental health professionals who participated.

Psychiatrists are more vulnerable to substance use disorders than the general population and other medical specialties, and their clinical experiences with people with substance use disorders may also influence their attitudes toward using these drugs medically.

Conclusions

Personal viewpoints may influence professional perspectives and interfere with clinical decision-making. This may be a barrier to the introduction of yet socially controversial novel therapeutic strategies.