Psychedelic Assisted Therapy Works, But Why?
Let justice roll down like waters.
Amos 5:24
Dear Friends and Colleagues,
Last week we covered the story of how a conservative evangelical ended up at the 12,000 person Psychedelic Science conference this summer. She didn’t end up there because she is personally interested in using psychedelics but because she supports evidence-based drug policy and the promising ongoing research into the therapeutic benefits of psychedelic assisted therapy.
Christina isn’t the only one who has changed her mind. According to a recent poll from the UC Berkeley Center for Science of Psychedelics, 75% of American likely voters support ongoing psychedelic research. In a divided country, that is a surprising consensus. While some, very loud, folks might oppose their use on ideological grounds, a good chunk of the remaining opposition likely comes from a lack of knowledge.
Before 2016, I knew very little about psychedelics. I was deep into researching Addiction Nation when a friend sent me an article about a new treatment for smoking cessation. The death toll for smoking still clocks in at nearly 480,000 lives per year. In 2018, 55% of smokers attempted to quit but only 8% achieved abstinence 6–12 months later.
In a Johns Hopkins study involving three sessions with psilocybin combined with Cognitive Behavioral Therapy (CBT), 80% of participants were confirmed to have quit smoking at a six-month follow-up. A subsequent follow-up study showed that many of these changes persisted even longer term, with 60% remaining abstinent.
It isn’t just cigarettes. An NYU study showed strong initial results for treating alcohol use disorder and at the University of Alabama in Birmingham, there are encouraging early results for reducing cocaine use.
These results aren’t just happening in clinical settings. Another study demonstrated a significant correlation between self-administered psychedelics and subsequent decreased daily drug use. Another found a 30% reduction in risk for developing an opioid use disorder correlated with any psilocybin use.
The evidence continues to mount that psychedelic assisted therapy does work, but why?
Unlike many other pharmacological interventions, psilocybin is not administered regularly and is not considered physically addictive. For the smoking cessation study, it was only given to the subjects three times and the immediate perceptible effects were over in less than 8 hours. But the positive outcomes persisted for months, years, and in some cases, in perpetuity.
The first area researchers are looking at to understand why this treatment is so effective is around increases in neuro-plasticity, the brain’s ability to change itself. Now, lots of things can change the brain, and not all of those changes are beneficial. During the session, parts of the brain that don’t normally talk to each other begin to connect. And, after the session, it appears as if new neural pathways and connections are easier to form.
In the case of the Johns Hopkins study, participants also participated in CBT to give practical tactics and strategies for change. CBT is already effective on its own but the sessions appear to make it easier for people to apply what they are learning.
The second area of interest isn’t always mentioned in the press coverage. All of the participants in the smoking cessation study were given a “mystical experience questionnaire” and were asked a series of questions about how they would describe their experience during the session with psilocybin.
The questions were around feeling a sense of awe, wonder, cosmic unity and connection to all creation. The result? Researchers noted, “results suggest a mediating role of mystical experience in psychedelic-facilitated addiction treatment.”
To put it another way, the more participants described their experience in a way that was consistent with the experiences of those like Thomas Merton, Theresa of Avila, Meister Eckhart, and Hildegard of Bingen, the better the therapeutic results. If people felt like their session on psilocybin was an encounter with divine reality, they were more likely to quit smoking.
While this might sound odd, or downright heretical, to a Western Christian mindset, it has been at the heart of many Indigenous spiritual traditions for thousands of years. The Native American Church has used Peyote, a sacred cactus in their tradition, for more than a hundred years to help members struggling with alcoholism.
It’s now well known that Bill Wilson tried LSD, credited it with helping his depression, and advocated for its use in concert with the 12-step tradition. What isn’t as well known is that Wilson’s initial mystical experience when he had a vision for starting Alcoholics Anonymous was induced while he was under the influence of a psychedelic brew referred to as the “Belladonna Cure.”
If this still all sounds odd, that is completely understandable. While I learned about psychedelic assisted therapy while I was writing Addiction Nation, I didn’t cover it in my book because I was still trying to figure out what I thought about it all.
In the coming weeks we’ll dive into more of the religious context of psychedelic use, benefits for addiction treatment, common objections, and risks. In the round up today we’ve got some highlights and links to recent studies.
Keep the faith,
Timothy McMahan King
Senior Fellow, CNDP
Psilocybin-assisted treatment for alcohol dependence: a proof-of-concept study
This study, published in 2015, tested the theory that classic hallucinogens could have clinically relevant effects on alcohol and drug addiction. While this study contained a small sample size of 10 participants, it found that after one psilocybin session, the percentage of heavy drinking days and percent of drinking days are significantly lower than baseline at all follow-up points. Further, the study discussed that “although the change in drinking was correlated with the mystical quality of the experience, it was similarly associated with ratings of other acute effects. More work will be necessary to determine whether there are particular characteristics of the acute psilocybin experience that are predictive of therapeutic benefit in alcohol use disorder.”
Next, this 2022 study, analyzed data from a sample of people who used drugs (PWUD) between 2006–2018 in Vancouver, Canada. The study found that “among 3813 PWUD at baseline, 1093 (29%) reported daily use of illicit opioids and 229 (6%) reported psychedelic use in the past six months. Over study follow-up after adjusting for a range of potential confounders, psychedelic use remained independently associated with significantly reduced odds of subsequent daily opioid use.” These results are similar to other observational data regarding the relationship between psychedelic use and individuals with substance use disorders such as a 2017 “ large population-based study among 44,000 adults in the United States with a history of illicit opioid use, psychedelic use was associated with a 40% reduced risk of past year opioid misuse and 27% reduced risk of past year opioid dependence.”
Attempting to replicate and extend findings from this 2017 study, a recent study used data from the National Survey on Drug Use and Health between 2015–2019 and multivariable logistic regression to test whether the use of psychedelics was associated with lower odds of opioid use disorder. The study confirmed the 2017 study finding a lowered odds of opioid use disorder but clarified that this link only exists for psilocybin, and not for LSD or phenethylamine psychedelics.
Recently, BrainFutures compiled a review that summarized 46 randomized controlled trials, 47 open label studies, 8 meta-analysis, and 84 reviews focusing on the clinical applications of psychedelic-assisted treatment. The extensive review concluded:
“The overarching findings from this body of evidence indicate the following:
1. Psilocybin-assisted therapy is increasingly showing evidence of efficacy for the treatment of depression, including MDD and TRD, based on multiple randomized trials. Psilocybin has also been shown to be effective for anxiety and SUDs, specifically tobacco cessation.
2. A growing body of evidence points to ketamine, esketamine, and ketamine-assisted therapy being effective at rapidly reducing symptoms of depression, including MDD and TRD, as well as suicidality. Symptom relief from ketamine can last up to four weeks. In addition, ketamine has been shown to produce short-term reductions in anxiety, PTSD, and pain. Ketamine-assisted therapy has been shown to be effective for treating SUDs.
3. Based on multiple studies, including one successful FDA-approved Phase 3 clinical trial, MDMA-assisted therapy continues to demonstrate effectiveness at treating PTSD and anxiety following one or two treatments, with some of the research showing long-term response and remission rates.
4. LSD has fewer recent studies that meet today’s standards of scientific rigor, yet it holds a significant body of research published prior to its Schedule I listing in 1970. Many of these early findings show LSD-assisted therapy to be effective at treating alcoholism, with newer research focusing on depression and anxiety.
5. DMT, in the form of ayahuasca and similar brews, has not been well-researched clinically, yet reports from a handful of studies over the past decade have shown DMT’s promise for treating depression, including major depression and TRD, suicidality, and SUDs, with no lasting side effects.
6. Ibogaine is currently being researched in a limited capacity outside the U.S., yet a few studies are showing positive, effective results for the treatment of opioid addiction, including ongoing studies for methadone withdrawal and alcoholism.
7. Mescaline has largely not been the subject of modern formal clinical research trials. However, a self-report survey, comparative studies, and a number of reviews indicate that it could be effective at treating SUDs, especially alcoholism. Evidence of it reducing symptoms of PTSD, depression, and anxiety has also been indicated.
In the years ahead, technology, including adjunctive non drug devices such as virtual reality, may also prove helpful in aiding the integration of meaningful psychedelic experiences and/or prolonging symptom reduction—all toward supporting long term positive behavioral changes occasioned by these compounds.”