Psychoactives, Volume 5, Issue 3 (September 2026) – 4 articles

Rotator cuff tears are common, and although surgical repair is frequently performed, re-tear and complication rates remain substantial. The impact of selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs) on postoperative outcomes after rotator cuff repair is not well understood. Using the TriNetX Research Network, adult patients undergoing arthroscopic rotator cuff repair were identified and stratified into SSRI/SNRI users (at least one prescription within 3 months preoperatively and continued use within 2 years postoperatively) and non-users. Propensity score matching was performed for demographic and medical comorbidities, yielding 2457 patients in each cohort. At 1-year follow-up, SSRI/SNRI users demonstrated lower rates of adhesive capsulitis compared with controls (3.1% vs. 5.8%; RR 0.53; 95% CI 0.41–0.70; p < 0.001), with similar revision rotator cuff repair rates. This pattern persisted at 2 years (3.6% vs. 6.1%; RR 0.58; 95% CI 0.45–0.75; p < 0.001), with comparable revision rates between groups. There were no differences in 30-day emergency department visits, readmissions, or 90-day postoperative infections. SSRI/SNRI users had lower early opioid use (21.0% vs. 29.5%; RR 0.71; p < 0.001) but higher prolonged (17.2% vs. 14.1%; RR 1.22; p = 0.003) and chronic opioid use (16.7% vs. 9.1%; RR 1.84; p < 0.001). In this large national cohort, SSRI/SNRI use was associated with lower rates of adhesive capsulitis and differences in postoperative opioid utilization, without differences in revision rotator cuff repair or short-term complications. These findings reflect associations rather than causation and highlight the need for further studies to clarify underlying mechanisms and clinical implications. Full article

Background/Objectives: In a recent meta-analysis of 1186 empirical studies, results showed that impulsivity may be one of the most important predictors of substance use. As such, the current study examined the association between an emerging psychological construct in the military veteran population, moral injury, and impulsivity—a construct found in high prevalence among military veterans. Methods: In this cross-sectional pilot study, 31 veterans completed the Moral Injury Purchase Task (MIPT), a behavioral economic assessment of sensitivity to moral injury–related relief, and the Monetary Choice Questionnaire. Demand indices for moral injury were derived, and delay discounting was quantified using area under the curve (AUC) and effective delay (ED50). Results: Participants were primarily White and male, with an average age of 38.55 years. Multivariable linear regression models adjusted for age, race, and sex. Higher moral injury intensity (b = 0.002, SE = 0.001, p = 0.04) and clinically significant moral injury (b = 0.17, SE = 0.07, p = 0.02) were associated with greater delay discounting AUCs, indicating increased preference for immediate outcomes. ED50 was not significantly associated with moral injury indices. Conclusions: Results suggest that moral injury may be linked to contextually driven shifts toward immediate reinforcement. Practitioners should consider including delay discounting in clinical settings. Full article

The nature of the psychedelic experience, and the distinctive phenomenological features it generates, leaves it susceptible to an unresolved epistemological tension between first-person phenomenological reports and claims about the fundamental nature of consciousness and reality. This tension is examined through the concept of ontological tourism: the practice of treating phenomenological data as sufficient grounds for ontological conclusions without adequate engagement with alternative mechanistic explanations or the philosophical requirements that such inferences demand. This practice, absent adequate epistemic scaffolding, poses a genuine threat to scientific integrity and clinical ethics. At the same time, reflexively dismissing phenomenological data as mere pharmacological artifacts represents an equally impoverished position. The tourist analogy cuts both ways: the tourist may be an unreliable cartographer, but the tourist has been somewhere. An alternative stance is proposed, one that takes subjective experience seriously as a form of evidence without overclaiming its metaphysical implications or dismissing its epistemic weight, along with a framework for achieving it. Ontological tourism risks bypassing the explanatory work that makes psychedelic phenomenology valuable to consciousness science. Full article

Cannabis use among adolescents and young adults has increased alongside legalization, commercialization, and higher product potency. However, evidence regarding the effectiveness of interventions to prevent or reduce cannabis use remains heterogeneous. To systematically synthesize evidence from randomized controlled trials (RCTs) evaluating behavioral, educational, psychosocial, family-based, and digital interventions targeting cannabis use among adolescents and young adults. Following PRISMA guidelines, MEDLINE, PsycINFO, CINAHL, Embase, and Web of Science were searched for randomized or cluster-randomized controlled trials involving participants aged 12–25 years. Study characteristics, intervention approaches, outcomes, and effectiveness were synthesized qualitatively. Of 973 records, 15 RCTs met the inclusion criteria. Studies varied in setting, intervention characteristics, delivery modality, and follow-up duration (2 months–7 years). School-based cognitive-behavioral interventions demonstrated the most consistent reductions in cannabis use and related harms by strengthening emotional regulation, problem-solving, coping skills, and social competence. Motivational interviewing, family-based, and digital interventions showed beneficial but variable effects. Behavioral interventions, particularly school-based cognitive-behavioral approaches, provide the strongest and most consistent evidence for reducing cannabis use and related harms among adolescents and young adults. However, methodological heterogeneity limits direct comparisons. Future well-powered RCTs with standardized outcome measures, longer follow-up, and implementation evaluations are needed to strengthen evidence-based prevention strategies. Full article