Alcoholics Anonymous and the Inconvenient Truth about Psychedelic Drugs
The most promising addiction treatment development must be taken seriously by 12-step programs
A friend told me about his experience with iboga, a psychoactive indole alkaloid plant native to the western part of Africa. The three-day experience, he said, cured him of his addiction to drugs and alcohol.
Indole alkaloids occur in many psychoactive plant species and fungi – as well as naturally occurring poisons such as strychnine and curare. Because I’ve been through a clinical trial using a psychedelic drug – psilocybin – to treat cancer-related depression, people who have had transformative psychedelic experiences frequently share their stories with me.
Ibogaine is derived from the root bark of the West African shrub Tabernanthe iboga. In its native form, iboga is also an appetite supressant and a stimulant.
Ibogaine’s powerful psychedelic properties remain a central component of ceremonial use in the Bwiti religion among the Gabonese Fang people of West Africa, who still use iboga in religious ritual.1
My friend had been a multiple drug user for decades – everything from cocaine, to crack to alcohol. From my limited perspective, I do not to this day know how he survived his addictions. He’d tried to stop using several times, without success.
Everything changed, though, when he decided to try iboga. He had connections through the underground of the city where he lived to a provider. The session was guided, and the guides remained with him at his apartment, assisting him when the journey became difficult, for the duration of his ibogaine-induced experience.
One of the many visions he had during his three-day long journey was especially noteworthy: a spirit, an ineffable mystical presence came to him towards the end of the trip and delivered the message that he would never need to use drugs or alcohol again. He would never again experience a craving for a substance. Years later, this prediction has proven to be true. My friend’s vision was echoed by another friend who took the ibogaine journey, whose description of the mystical event was almost identical. A spirit, who described itself as the spirit of the plant, came to him, spoke to him, and let him know what ever else happened, he would be relieved of his compulsion to drink. Years on, he hasn’t touched another drop, and his life has changed very much for for the better.
The one thing neither person can do is speak openly at Alcoholics Anonymous meetings about the intervention which finally provided the psychospiritual epiphany enabling them to stop using: the psychedelic experience.
Ibogaine’s potential for treating opioid dependence was discovered in 1962 by Howard Lotsof, based on personal experience and anecdotal reports. Doses up to 19 mg per kg were associated with attenuation of opioid withdrawal and craving. In contrast to most pharmaceutically-based therapies which require ongoing maintenance doses, ibogaine is typically administered as a single-dose treatment on a few occasions as an adjunct to a detoxification treatment model.2
A more recent study was carried out to assess whether psychedelic experiences affected alcohol use. Ten subjects received two doses of psilocybin over 12 weeks. Treatment protocol included 14 treatment sessions, including two psilocybin medication sessions at weeks four and eight, and 12 non-drug psychotherapy sessions, two of which were debriefing sessions.3 Of the ten, four reported 100 percent – total – reduction in drinking days. One reported a 72.3 percent reduction, one a 42.84 percent reduction. Three reported a less than 20 percent reduction. Results were not logged for the tenth. Although the study size was small, the reported effects align with results gathered through voluntary online surveys of psychedelic use and alcoholism, and anecdotal evidence.
All these results show great promise for alcholics and drug addicts seeking to alter their relationship with alcohol or drugs.
Why then, the resistance?
There’s an existing and growing tension between the well-established world of 12-step programs and the use of psychedelics for substance use disorders. Psychedelics as a tool for recovery and addiction challenge 12-step’s ideas about what sobriety is: a total abstinence from any mood- or mind-altering drug, psychedelics included.”
Ironically, it was one of AA’s co-founders, Bill Wilson, who began advocating for psychedelic-assisted alcohol abuse treatment after a stay in hospital in 1934, where he was given hourly doses of belladonna and henbane, both of which are alkaloid-containing plants with hallucinogenic properties.
Wilson at first struggled with the idea that one drug could be used to overcome addiction to another. LSD, which was first synthesised in 1938, is a non-addictive drug that alters thought processes and can inspire spiritual experiences. Wilson thought initially the substance could help others understand the alcohol-induced hallucinations experienced by addicts, and that it might terrify drinkers into changing their ways.
But after his first acid trip, at the Veterans Administration (VA) hospital in Los Angeles on 29 August 1956, Wilson began to believe it was insight, not terror, that could help alcoholics recover.
It was a matter of finding “a power greater than ourselves” that “could restore us to sanity.” He warned: “I don’t believe [LSD] has any miraculous property of transforming spiritually and emotionally sick people into healthy ones overnight. It can set up a shining goal on the positive side, after all it is only a temporary ego-reducer.”
Bill Wilson’s enthusiasm did not go over well with the AA rank and file, which, by the late 1950s, came to view his escapades with LSD as just another justification for substance abuse. The belief was that anything mind-altering was bad, and the lure of LSD was just another trick of the guileful shapeshifting demon of addiction.
As an example of this thinking, the following is an entry on an AA Subreddit:
My wife and I, both long term sober, have been discussing the idea of doing psychedelics as a path to a spiritual experience. Bill used LSD for just that reason. My concern is what does that mean to my sobriety. I have 11 years my wife has 10. The obsession to drink has long been removed. My main question is does anyone have any experience with this issue? If you chose to use psychedelics, what did it mean to your sobriety?
Frankly, I must admit I am dumbfounded that with that much sobriety [you] are thinking of using other drugs. Working the 12 steps provided a spiritual experience for me and I am grateful. If I chose to use psychedelics it would mean I was no longer sober. That’s my humble opinion.
Since the 1950s, several flavours of AA have developed alongside the originalist, God-based 12-step groups. These include agnostics, humanists, atheists, even satanic recovery groups. A group called Psychedelics in Recovery went live in 2019, and offers online as well as in-person meetings for those in the San Diego area.
What has yet to change, however, is the one-size-fits-all dogma of total abstinence from all mind-altering drugs offered up by the main stream foundational arm of the Alcoholics Anonymous worldwide organization. The question then arises: has the fundamentalist AA experience itself has become the drug, and cult-like, the cure has become a substitute for the disease?
There could be no worse outcome than someone who found psychedelic drugs useful to his or her sobriety discovering he or she is no longer welcome in the AA fellowship. One of the foundational tenets of AA’s success is the broad-based social support from within the AA community and — most importantly — the value of simply showing up. The last thing I’d think anyone would like to see would be members feeling unwelcome because of their psychedelic experiences, and becoming reticent to attend meetings. The most tragic outcome would be the loss of the crucial support system on which long term recovery depends.
Noller, Chris M et al. Ibogaine treatment outcomes for opioid dependence from a twelve-month follow-up observational study (2018). The American Journal of Drug and Alcohol Abuse. 44:1, 37-46. DOI: https://doi.org/10.1080/00952990.2017.1310218
Nielsen, Elizabeth M, et al. The Psychedelic Debriefing in Alcohol Dependence Treatment: Illustrating Key Change Phenomena through Qualitative Content Analysis of Clinical Sessions (2018). Frontiers in Pharmacology. 9:132. DOI: 10.3389/fphar.2018.00132