For decades, researchers have been investigating the potential benefits of psychedelic-assisted therapy for various mental disorders and trauma recovery. The results are extremely promising but also very controversial. Specifically, their focus is mainly on additions to alcohol and tobacco use. Thus, these will be the main scope of this article. So how do these drugs operate? What are their potential benefits? Let’s find out!

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This article will cover:

·       What are substance use disorders?

·       What are psychedelic drugs and psychedelic-assisted therapy?

·       How does psychedelic-assisted therapy work and what are its potential benefits?

What are addictions and substance use disorders?

Alcohol and tobacco are among the most widely abused addictive substances [13]. In the U.S. alone, 4.6% of teenagers and 8.5% of adults are estimated to suffer from  alcohol use disorder for a period of at least 12 months (AUD) [2]. Moreover, over 13% of adults in the U.S. suffer from tobacco use disorder [2]. Every year, three million deaths can be attributed to alcohol and over eight million to tobacco consumption [5]. These statistics show that substance use disorders can have detrimental effects on the individual.

The DSM-5 characterises alcohol use disorder (AUD) as a problematic pattern of alcohol use which causes significant distress and/or clinically significant behavioural, cognitive and physiological impairment [2]. This problematic use must be observed within a 12-month period. Similarly, tobacco use disorder is characterised by a problematic pattern of tobacco use that leads to clinically significant behavioural, cognitive and physiological impairment [2].

What are psychedelic drugs and psychedelic-assisted therapy?

Psychedelic drugs are a type of hallucinogens that produce states of altered perception, mood, emotions and cognitive processes (the so-called ‘trip’). Additionally, the person typically experiences lack of control over the psychedelic experience [1, 7]. The so-called ‘classic’ psychedelic drugs work as agonists of the 5-HT2A serotonin receptor [11]. They include lysergic acid diethylamide (LSD), psilocybin, mescaline and dimethyltryptamine (DMT) [11]. Psychedelics can be naturally occurring (e.g., psilocybin) or synthesised in a laboratory (e.g., LSD) [1].

Investigation into their therapeutic potential began following Albert Hoffman’s discovery of the psychoactive properties of LSD in 1943 but was discontinued following the ban of psychedelics in the early 1970s due to concerns about their recreational use [5]. However, in recent years the research has been resumed. Psychedelic-assisted therapy consists of supportive psychotherapy comprising preparation, administration and integration phases [11]. During the second phase, patients receive moderate to high doses of a psychedelic drug. Researchers propose several possible mechanisms which might contribute to the observed therapeutic effects. Consequently, two different approaches, each thought to operate on a different mechanism, have been used. The psycholytic approach involves an administration of smaller doses to facilitate insight, which is thought to promote awareness of unconscious processes [3]. The psychedelic approach uses higher doses to facilitate mystical-like experiences, which might cause a change in habitual thought and behavioural patterns [3].

How does psychedelic-assisted therapy work and what are its potential benefits?

It is important to keep in mind that all findings discussed here are only preliminary. This is because the samples used in the studies are not representative of various populations (primarily male participants have been used). Moreover, the methodology and design of the studies does not allow for definitive causal conclusions to be drawn.

Alcohol use disorder

Study by Garcia-Romeau and colleagues [6] investigated the relationship between naturalistic use of LSD and alcohol misuse. They found that following naturalistic use of LSD, there was a significant decrease in the mean number of drinks per week, from 25.5 to 4.3. Moreover, 83% of the respondents no longer met the criteria for AUD. These findings are supported by more empirically valid laboratory findings by Krebs and Johansen [10]. They found that unlike the control group, the administration of various doses of LSD led to decrease in alcohol misuse. These effects were maintained up to 6 months post-treatment but they disappeared by 12 months post-treatment. Furthermore, Bogenschutz and colleagues [4] found a significant decrease in alcohol dependence and the number of heavy drinking days following a psilocybin-assisted cognitive behavioural therapy (CBT). These improvements were maintained up to 36 months post-treatment. For comparison, traditional alcohol treatment (psychotherapy or medication) leads to some decrease in alcohol consumption, but over 70% relapses within a year post-treatment [6].

Tobacco use disorder

Tobacco-dependent participants in a study by Johnson and colleagues [8] completed 15-week treatment consisting of CBT and psilocybin administration. Following the treatment, 80% showed abstinence 6 months post-treatment. Moreover, Johnson and colleagues [9] also investigated the long-term effects and found that the abstinence rate dropped slightly to 67% at 12 months post-treatment and 60% at a more long-term follow-up [9]. For comparison, the mean abstinence rate following a traditional treatment (behavioural interventions, medication) is 31% [9].

Mechanisms

Garcia-Romeau and colleagues [6] also investigated participant’s opinions on why they thought psychedelics use reduced their alcohol misuse. They found that 28% considered changes in life-priorities and values to be the mediating factor, meaning that psychedelic experience might cause a person to re-evaluate their alcohol consumption and ultimately decrease it. Moreover, greater doses, insight and personal meaning of the mystical-like experiences were positively correlated with a reduction in alcohol misuse. Furthermore, participants who underwent psilocybin-assisted treatment reported that thanks to psilocybin they gained vivid insight into their self-identity and reasons for smoking [12]. This experience might have in turn facilitated abstinence.

To conclude,

Research shows preliminary evidence for the effectiveness of psychedelic-assisted therapy. LSD and psilocybin appear to be effective in decreasing alcohol misuse, but for now only in short-term. Moreover, psilocybin might also promote smoking cessation, even in the long-term. The unique mystical-like experience appears to increase insight and promote re-evaluation of life-priorities. If replicated under stricter methodology and with representative samples, these findings can serve as rationale to establish psychedelic-assisted therapy as a standard treatment option for substance abuse.

Extra resources:

• Video made by the media committee of Cedo Nulli (EUR student organisation):

part 1 https://www.instagram.com/p/CQqimiOhS05/

part 2 https://www.instagram.com/p/CQqjI7hp10j/

• Ted Talk: Future of psychedelic-assisted psychotherapy https://www.youtube.com/watch?v=Q9XD8yRPxc8

References

1. Alcohol and Drug Foundation. What are psychedelics? Retrieved on June 6, 2021 from  https://adf.org.au/drug-facts/psychedelics/

2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

3.     Bogenschutz, M. P., & Forcehimes, A. A. (2017). Development of a psychotherapeutic model for psilocybin-assisted treatment of alcoholism. Journal of Humanistic Psychology, 57(4), 389-414. https://doi.org/10.1177%2F0022167816673493

4. Bogenschutz, M. P., Forcehimes, A. A., Pommy, J. A., Wilcox, C. E., Barbosa, P. C. R., & Strassman, R. J. (2015). Psilocybin-assisted treatment for alcohol dependence: A proof-of-concept study. Journal of Psychopharmacology, 29(3), 289-299. https://doi.org/10.1177%2F0269881114565144

5. DiVito, A. J., & Leger, R. F. (2020). Psychedelics as an emerging novel intervention in the treatment of substance use disorder: a review. Molecular Biology Reports, 47, 9791-9799. https://doi.org/10.1007/s11033-020-06009-x

6. Garcia-Romeu, A., Davis, A. K., Erowid, F., Erowid, E., Griffiths, R. R., & Johnson, M. W. (2019). Cessation and reduction in alcohol consumption and misuse after psychedelic use. Journal of Psychopharmacology, 33(9), 1088-1101. https://doi.org/10.1177%2F0269881119845793

7. Jenkins, J. P. Psychedelic drug. Retrieved on June 6, 2021 from https://www.britannica.com/science/psychedelic-drug

8. Johnson, M. W., Garcia-Romeu, A., Cosimano, M. P., & Griffiths, R. R. (2014). Pilot study of the 5-HT2AR agonist psilocybin in the treatment of tobacco addiction. Journal of Psychopharmacology, 28(11), 983-992. https://doi.org/10.1177%2F0269881114548296

9. Johnson, M. W., Garcia-Romeu, A., & Griffiths, R. R. (2017). Long-term follow-up of psilocybin-facilitated smoking cessation. The American Journal of Drug and Alcohol Abuse, 43(1), 55-60. https://doi.org/10.3109/00952990.2016.1170135

10.  Krebs, T. S., & Johansen, P. Ø. (2012). Lysergic acid diethylamide (LSD) for alcoholism: meta-analysis of randomized controlled trials. Journal of Psychopharmacology, 26(7), 994-1002. https://doi.org/10.1177%2F0269881112439253

11.  Luoma, J. B., Sabucedo, P., Eriksson, J., Gates, N., & Pilecki, B. C. (2019). Toward a contextual psychedelic-assisted therapy: Perspectives from acceptance and commitment therapy and contextual behavioral science. Journal of Contextual Behavioral Science, 14(2019), 136-145. https://doi.org/10.1016/j.jcbs.2019.10.003

12.  Noorani, T., Garcia-Romeu, A., Swift, T. C., Griffiths, R. R., & Johnson, M. W. (2018). Psychedelic therapy for smoking cessation: Qualitative analysis of participant accounts. Journal of Psychopharmacology, 32(7), 756-769. https://doi.org/10.1177%2F0269881118780612

13.  Peacock, A., Leung, J., Larney, S., Colledge, S., Hickman, M., Rehm, J., Giovino, G. A., West, R., Hall, W., Griffiths, P., Ali, R., Gowing, L., Marsden, J., Ferrari, A. J., Grebely, J., Farrell, M., & Degenhardt, L. (2018). Global statistics on alcohol, tobacco and illicit drug use: 2017 status report. Addiction, 113(10), 1905-1926. https://doi-org.eur.idm.oclc.org/10.1111/add.14234