How Psychedelics Are Changing CBT for Addiction Recovery

Increasingly, clinicians and researchers are using psychedelics to treat a variety of disorders and diseases. They continue to be the subject of medicinal trials and studies, particularly when it comes to addiction treatment.

Equally, Cognitive Behaviour Therapy (CBT) is a long-standing treatment method for similar mental and physical health disorders, such as addiction and depression.

Therefore, looking at how psychedelic therapy can complement cognitive behavioral therapy for addiction recovery can present new and revolutionary ways to manage addictive behaviors. Doing so can also reduce the risk of relapse, creating an overall more successful experience for patients and practitioners alike.

Why is CBT Used for Addiction Recovery?

Cognitive Behaviour Therapy (CBT) is a type of therapy that therapists and clinicians commonly use to treat a variety of mental and physical disorders, from anorexia or addiction to anxiety and depression.

It falls under the umbrella of talking therapy. However, as the name suggests, it uses cognitive approaches to help us more fully understand how we think, how this impacts our behaviors, and ultimately how to change and adapt our behaviors.

Traditionally, CBT for addiction treatment has been used as a stand-alone treatment or alongside other addiction treatments, such as rehabilitation and medications such as Opioids.

When used as a sole treatment, CBT can help patients measure their recovery more tangibly. This is because CBT is a goal-focused approach. Addiction recovery can take several months and even years. As a result, progress can seem small, making it hard for patients to feel motivated to continue. However, CBT sets out a clear path of progression, making it a good option where patients with addiction can recognize their achievements.

“Psychedelic-assisted cognitive therapy could be a revolutionary way to aid addiction recovery if integrated pragmatically.”

— Chris Harley

How Can Psychedelic Therapy Be Used for Addiction Recovery?

It can seem counterintuitive to use psychedelics to treat addiction—especially if the patient is suffering from substance abuse. Even so, a growing number of psychologists are promoting psychedelics as potential treatments for addiction.

It is important to note that dosage, purity, and duration of use can all be controlled in a medicinal setting. In contrast, these can all be ambiguous when used recreationally.

Understanding and making distinctions between the types of substances or drugs, their levels of addiction, and their effect on the body and mind can help us further understand how patients can use certain substances in recovery while others can lead to addiction.

There are three main classifications for drugs:

1. Stimulants are drugs that stimulate the central nervous system and include substances like amphetamine, cocaine, and caffeine.
2. Depressants have a depressive effect on the central nervous system and include substances like alcohol, opioids, and cannabis.
3. Hallucinogens/psychedelics have a profound effect on perception and include lysergic acid diethylamide (LSD) and psilocybin mushrooms (‘magic’ mushrooms).

The most commonly addictive drugs tend to fall under stimulants and depressants, like cocaine and alcohol. In psychedelic therapy for addiction, the most widely used substances are Psilocybin, Ketamine, and LSD. These substances mainly impact a person’s perception through the senses.

In many cases, this can manifest in a broadening and opening of the mind. This effect can be beneficial in collaboration with cognitive behavioral therapy as it can broaden a patient’s perception and understand their behavioral patterns in a way that they may not have previously.

Therefore, psychedelic-assisted cognitive therapy could be a revolutionary way to aid addiction recovery if integrated pragmatically.

Ways Psychedelics Can Support Cognitive Behavioral Therapy for Addiction Recovery

Scheduling In-Depth Preparation Sessions

Preparation sessions are essential before embarking on both psychedelic and CBT treatment for addiction [1]. 

Patients may have some anxieties about one or both of the therapies. As such, it is important to build trust with patients before treatment commences.

In the preparation session, the therapist and patient can discuss any apprehensions they may have. Together, they can outline how the treatments will work, support each other, set a framework, and work through expected outcomes.

It’s also a good idea to provide patients with any tools or further reading before and during treatment.

Psychedelics Can Reduce the Risk of Relapse

Following traditional methods, such as inpatient rehabilitation, psychiatric medications, and talking therapies, 40-60% of people relapse after addiction treatment. However, combining psychedelic therapy with action-focused talking therapy like CBT can reduce the risk of relapse during and after treatment.

A trial led by the University of Exeter found that when combining low doses of ketamine with therapy, people with addiction were 2.5 times more likely to stay sober. This finding can mean that patients are more likely to focus on the skills and techniques learned in cognitive behavioral therapy for addiction without the threat or temptation of relapse [2].

Psychedelic therapy, mainly when using psilocybin as a treatment medication, has been shown to reduce alcohol cravings. In turn, this reduction can help to break addictive patterns and support long-term recovery in combination with CBT.

Increase Acceptance Methods Used in CBT for Addiction

Acceptance is something prevalent in addiction recovery and CBT. In acceptance-based cognitive behavioral therapy, patients work to accept their experiences. They use this acceptance to change unhelpful patterns of behavior and thought processes. Similarly, for patients recovering from addiction, acceptance is pivotal for them to move forward in their recovery journey rather than leaning towards avoidance-based behaviors.

Preliminary studies have found that psychedelic therapy can support the same acceptance-promoting strategies of CBT [2]. Some patients have even reported that traditional medications and short-term talking therapies tended to reinforce their avoidant tendencies. In contrast, treatment with psychedelics—namely psilocybin—actually encouraged acceptance [3].

Creating a Safe Environment for Patients and Practitioners

In many cases, the environment in which patients receive psychedelic therapy and CBT can have an impact on the effectiveness of treatment, especially in the treatment of addiction.

Both therapies encourage patients to explore unknown or uncomfortable places within their minds. As a result, the physical space where they undergo therapy must instill a sense of safety and support for the best results.

When combining CBT and psychedelics to treat addiction, it can be challenging to maintain the close monitoring of patients during psychedelic dossing sessions with the creation of a safe space to explore recovery. It may mean that more than one therapist or professional is present in sessions. Therefore, allowing time to build trust between patients and all practitioners who will be present during sessions is imperative.

Closing Thoughts

Psychedelic therapy and CBT therapy are still being trialed and are yet to be adopted by the majority of practitioners [4]. Yet, the early findings suggest that combining these two treatment paths can have highly positive effects on addiction recovery.

From decreasing chances of relapse to increasing self-acceptance, psychedelics can, in many ways, support the existing structure and support that CBT provides to recovering people with addiction.

Certain adjustments should be made to traditional CBT treatment when incorporating psychedelic therapies—such as a more in-depth preparation session. Overall, however, the treatments can work very well alongside each other with minimal disruption to existing practices.

References

Davidson, C. (2022). The Acid Test: Evidence for Using Psychedelics to Treat Addiction. Royal College of Psychiatrists. https://www.rcpsych.ac.uk/docs/default-source/members/faculties/addictions-psychiatry/addictions—essay-prize-winner—conor-davidson.pdf.

Wolff, M., Evens, R., Mertens, L. J, Koslowski, M., Betzler, F., Gründer, G., Jungaberle, H. (2020) Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance. Frontiers in Psychiatry, 11, https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2020.00005/full. 

Nutt, D. J., Morgan, C., Klaire, S. (2024) A Perspective on Psychedelics as Treatments for Addictions. Journal of Studies on Alcohol and Drugs, 85(5), 583–588. https://www.jsad.com/doi/10.15288/jsad.23-00032.

Watts, R., Day, C., Krzanowski, J., Nutt, D. & Carhart-Harris, R. (2017). Patients’ Accounts of Increased ”Connectedness” and “Acceptance” after Psilocybin for Treatment-Resistant Depression. Journal of Humanist Psychology, 57(5), 520–564 (2017). https://journals.sagepub.com/doi/10.1177/0022167817709585.