social behaviors—but not conduct disorder or antisocial personality disorder—on other hal-
lucinogen use disorder may be stronger in female s than in males. Use of specific hallucinogens
(e.g., salvia) is prominent am ong individuals ages 18–25 years with other risk-taking behaviors
and illegal activities. Cannabis use has also been implicated as a precursor to initiation of use of
hallucinogens (e.g., ecstasy), along with early use of alcohol and tobacco. Higher drug use by
peers and high sensation seeking have also been associated with elevated rates of ecstasy use.
MDMA/ecstasy use appears to signify a more severe group of hallucinogen users.
Genetic and physiological. Among male twins, total varian ce due to additive genetics
has been estimated to range from 26% to 79%, with inconsistent evidence for shared envi-
ronmental influences. 
Culture-Related Diagnostic Issues 
Historically, hallucinogens have been used as part of established re ligious practices, such
as the use of peyote in the Native American Church and in Mexico. Ritual use by indige-
nous populations of psilocybin obtained from  certain types of mushrooms has occurred in
South America, Mexico, and some areas in the United States, or of ayahuasca in the Santo
Daime and União de Vegetal sects. Regular use of  peyote as part of religious rituals is not
linked to neuropsychological or psychological de ficits. For adults, no race or ethnicity dif-
ferences for the full criteria or for any indi vidual criterion are apparent at this time. 
Gender-Related Diagnostic Issues 
In adolescents, females may be less likely th an males to endorse “hazardous use,” and fe-
male gender may be associated with increase d odds of other hallucinogen use disorder.