The idea of applying psychedelic substances in addiction therapy may sound conflicting. What does psychedelic therapy for addiction look like? What do we know about its outcomes? Let’s dive into how psychedelics can help with addiction.
First let’s discuss why psychedelics and addiction treatment can feel like conflicting ideas.
We know that people who are prone to one addiction may be more likely to develop dependencies for other substances. Bringing in a new substance seems counterintuitive under this reasoning.
If we prescribe psychedelic therapy for addiction, aren’t we just replacing one substance with another? In answering this question, it’s important to make the distinction between using psychedelics as medicine and as substances that create dependence.
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Psychedelics as Medicine vs. Dependence
While they’re psychoactively powerful, psychedelics don’t cause addiction or dependence on their own. Yet for some with a predisposition to addiction, patterns of dependency can play out even in relationships with non-addictive substances . Unsupervised psychedelics use could potentially become a problem for people who turn from one substance to another.
While classical psychedelics may not cause physical addiction or withdrawal symptoms, it’s possible to develop an unhealthy relationship with them. Ketamine and MDMA carry potential for misuse because they act differently in the brain compared to LSD or psilocybin.
Psychedelics therapy for addiction does not aim to replace one substance with another, but rather to help people overcome their dependence with limited sessions of psychedelic-assisted therapy to reach a new level of functioning.
In the therapeutic setting, psychedelic experiences are tightly controlled. Sessions are supervised, and integration happens with the help of an expert. Dependency in this setting with a limited number of doses is virtually impossible, since psychedelic sessions are spaced out among therapy sessions.
Still, it’s worthwhile to be wary of any new substance that claims to help with addiction. People who struggle with addiction and dependency are a uniquely vulnerable group. We should offer these people the option of psychedelic therapy, without over-representing it’s benefits. Psychedelics for addiction may not be a perfect solution for everyone, but they can have benefits for people who understand their risks and implications.
Kevin Franciotti started Psychedelics in Recovery (PIR), a nonprofit organization that adapts elements of twelve step fellowships, like AA, with intentional use of psychedelics for ongoing recovery support. He said,
“The founding members of PIR recognized they had found personal benefit from using psychedelics, and presumably had to negotiate within themselves that psychedelic use did not conflict with their interpretation of sobriety/abstinence. Rather than based on recreational or even medicinal desire, they are seeking psychospiritual experiences to deepen their practice of incorporating twelve-step spiritual principles of recovery into daily living.”
PIR hosts local and online meetings for those seeking support for addiction recovery.
How Does Psychedelic Therapy Help With Addiction?
We’re still learning how psychedelics work on addiction and create lasting personality change.
Psychedelics may change how brain networks communicate and help us grow new neurons. Some scholars believe that psychedelics have the ability to change neurotransmitters and effectively “reset” our brains. Psychedelic experiences can give us a new perspective on our lives, or help us think differently about ourselves and the world .
Here are a few psychedelic substances that could help with addiction, as well as how they’re believed to work:
Research into psychedelics for alcohol addiction goes as far back as the 1950s, when therapists began studying LSD to treat their patents. Meta-analysis of this research has shown a large potential benefit, pointing current research towards LSD therapy for addiction .
These early researchers believed that LSD gave them the ability to compress years of therapeutic interactions into just one or two sessions. After a few of these intense sessions, patients had a new sense of self. They could emerge with a new paradigm for their addiction and their life5 .
LSD isn’t the only psychedelic that has shown promise in addiction treatment. One small 2015 study used psilocybin with Motivational Enhancement Therapy to treat alcohol use disorder, and found that participants were able to cut their drinking days in half on average . A larger, phase 3 trial is now being planned.
Another study using psilocybin for nicotine addiction found that after three assisted psilocybin sessions, 12 out of 15 participants were still abstinent from nicotine. These results sustained after a six-month follow-up . This compares to the only 8% of Americans who are able to successfully quit nicotine every year . More participants are now undergoing this treatment, which uses Cognitive Behavioral Therapy before and after the psilocybin sessions.
Researchers studying psilocybin’s effects under fMRI have made guesses about how it can help with addiction. It’s possible that psilocybin works by suppressing our Default Mode Network, or DMN. It’s this network that comes alive when we think introspectively, or perseverate on negative thoughts. By deactivating the DMN, it’s possible that psilocybin could suppress cravings and help people break out of unhelpful thought patterns.
Ketamine is another psychedelic that shows promise for treating addiction. It’s proven to help with abstinence from both alcohol and heroin. It’s even been shown to bring down cravings for cocaine among people who are not trying to quit .
Ketamine may work to improve addiction by helping us re-organize and grow new brain cells. It’s also possible that ketamine helps people reconsider memories related to their addiction and create mystical experiences. It could also help make people more open to psychotherapy in general and help with suggestibility in the therapeutic setting10 .
But ketamine can be misused and a person can become psychologically dependent. There are serious side effects of long-term ketamine use which have been observed in recreational users. While higher doses of ketamine can induce psychedelic experiences, this difference in potential abuse liability is important to understand.
MDMA may seem especially counterintuitive in treating addiction because of its abuse potential in the form of Ecstasy. Yet in trials, MDMA therapy did not lead individuals to crave Ecstasy or other drugs11.
MDMA could help with addiction by healing psychological issues that are associated with addiction. It could also assist in the therapeutic process by helping people be more open to therapy and gain better insight into what drives their drinking behaviors.
We’ll need much more research into MDMA therapy for addiction before we can know whether this is a viable treatment option . New trials for MDMA-assisted psychotherapy for treating alcohol use disorders are starting soon.
Other psychedelics like ayahuasca have also shown preliminary benefits in addiction treatment. One Canadian study in First Nations people found statistically significant benefits in scales of hopefulness, empowerment, mindfulness, quality of life, and outlook. Participants self-reported tobacco, alcohol, and cocaine use also declined .
We’ve still got a lot to learn about psychedelic therapy for addiction. But what we do know is very promising. Psychedelic therapy could give us more tools to fight addiction in its many forms.
What Does Psychedelic Therapy for Addiction Look Like?
Any therapy for addiction and recovery can only begin once a patient is stabilized from active abuse. In the case of alcohol addiction, detox and withdrawal are the first steps before psychedelics should be considered. It’s important to do this under guidance of medical professionals.
After being stabilized, the next step for patients with addiction is often to choose between inpatient and outpatient treatment. Severe addictions may necessitate more supervision from therapists or medical staff. Being among triggering environments may lead people back to addictive habits and substances.
Patients need to decide for themselves when they are ready to embark on the journey of addiction recovery. It’s important for the patient to be a willing part of their own recovery process if they’re expected to sustain abstinence. Yet even in some cases when study participants were not interested in quitting a substance, psychedelics have helped reduce cravings10. 
Psychedelic therapy is delivered in a combination of regular therapy sessions and active drug sessions. The first few sessions are used to build rapport with the patient, and to establish expectations for the active drug sessions.
During active sessions, patients typically lay down in a low-lit room with their eyes covered. The therapist may choose music to play in the background. These sessions may last about six hours, with the therapist in direct supervision for the duration.
Post-substance therapy focuses on integrating experiences the patient had during this session. Specifically trained therapists can deliver this unique form of therapy to their patients
Much of the substances we’ve discussed here are not yet available in the therapeutic setting. Ketamine is an exception, and is now available as infusions or therapy in most states. Ketamine is often delivered in an outpatient setting, and some inpatient rehab facilities already offer ketamine infusions for addiction treatment.
Psilocybin will be available in Oregon within the next few years for anyone over 21. Canada has also adopted a new Special Access Policy (SAP) that will allow physicians to access psychedelics for their patients. The SAP is reserved only for people with untreatable diseases and those in end-of-life care.
We’re looking forward to more legislation that will make psychedelic therapy available to patients battling addiction. If you are interested in enrolling in clinical research trials for addiction, search our list of psychedelic clinical trials.
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