When I first started digging into the research on psychedelic medicines, the promising therapeutic results for anxiety, depression, and PTSD were what caught my attention. I soon became aware that the healing potential of these substances extended to many other disorders. Even though the excitement that has blossomed over using psychedelic treatments for treatment-stubborn disorders may seem like a brand new phenomenon, this enthusiasm is actually picking up where researchers left off in the early 1970’s (when many psychedelic substances were banned).
Clinical researchers from the 1950s through the early 1970s investigated – and found – promising ways psychedelic medicines (including LSD and other 5HT2A (serotonin) agonist or partial agonist hallucinogens) could be used on wide-ranging disorders, such as substance addiction (since psychedelics are not addictive substances in and of themselves) (1-3), existential distress in dying patients (4-6), pain (7), and more.
Let’s look at some of the evidence.
Alcohol Use Disorder. Just a single dose of LSD in the context of alcohol misuse treatment programs can significantly decrease how much alcohol is consumed for up to 6 months post-treatment – an extremely uncommon thing for a psychiatric drug. One dose of LSD is just as effective as the typically prescribed pharmacotherapies (e.g. naltrexone, acamprosate, disulfiram) that require daily consumption (8-10). A meta-analysis of randomized controlled trials from the 60s and 70s in 536 participants found this beneficial effect of LSD on alcohol misuse (11). In a more recent study, abstinence from alcohol was achieved for up to 3 months after participants received psilocybin-assisted psychosocial therapy (12).
Tobacco addiction. Kicking an addiction to smoking is tough, and most behavioral interventions and pharmacotherapies typically exhibit only modest success – ~35% success – at 6 months post-treatment (13,14). Using psilocybin with cognitive behavioral therapy for treatment-resistant tobacco/nicotine-dependent smokers, a recent pilot study found an incredible rate of 80% abstinence at the 6-month follow-up (15), and 67% abstinence at the 12-month follow-up (16). Notably (because we’ll come back to this), 86.7% of the participants rated the psilocybin experience among the five most personally meaningful and spiritually significant experiences of their life. Anonymous online surveys with larger populations (n = ~350) found that 74% of individuals who reported that they quit or reduced smoking after a psychedelic non-lab experience (i.e. out in the real world), reported greater than 2 years abstinence (17,18). In comparison to the barely effective standard of care, the results are indeed very promising. So promising, in fact, that the National Institute of Health (NIH) just funded its first large grant for a psychedelic drug trial – for psilocybin-assisted psychotherapy for tobacco addiction.
Opioid Use Disorder. Less research has been conducted on opioid use disorder, but one study found that LSD reduced heroin use in opioid-addicted individuals when compared to a control group for up to 12 months post-treatment (19). Ibogaine, a naturally occurring indole alkaloid found in the rootbark of a Central African plant called Tabernanthe iboga, has been used to eliminate cravings and withdrawal for opiate addictions (20). While clinical trials are on the way, ibogaine is still currently used around the world for addictions (21) and many observational studies exist (22,23), with the reporting of stunning results. As just one example, an opioid-addicted patient achieved total abstinence from all opioids within 5-6 days of ibogaine treatment, did not experience withdrawal symptoms, and maintained abstinence for (at least) 3 years. There are countless other similar extraordinary stories of overcoming addiction. Treatment with the iboga plant has been described as a “physical and mental reset” (24).
Chronic pain relief. Psychedelic treatments are known to be helpful in treating cluster headaches (25-27) and improving phantom limb pain (28, 29). Past investigations have also included cancer, ischemic, or neuropathic pain (7).
There are many more psychedelic substances with therapeutic potential being investigated for use on various disorders, and you can track recent efforts with Psilocybin Alpha’s Drug Development Tracker. Disorders include: generalized anxiety disorder, major depressive disorder, fibromyalgia, alcohol use disorder, opioid use disorder, attention deficit hyperactivity disorder (ADHD), cluster headaches, social anxiety in autistic adults, eating disorders, migraines, and Obsessive Compulsive Disorder (OCD).
How can these substances be so effective for such a wide range of health conditions?
We really don’t know (sorry!). But, we do know that the evidence hints at something more complicated than a single neurotransmitter explanation given the variety of widely different health conditions. We also know that – similar to the results from the psilocybin studies on anxiety and depression – the stronger the mystical experience (i.e. experiencing a reality that feels like ultimate reality, feelings of unity and interconnectedness, sacredness, peace and joy, distortion of time and space perception, ineffability, etc) in the psychedelic trip, the more likely the patient is to see therapeutic benefit, such as abstain from alcohol, tobacco, or other addictive substances (12,30). This is in line with other research that indicates increased spirituality can improve outcomes for substance addiction (31-34).
Then, there are also the personal therapeutic insights I touched on in an earlier newsletter. Patients report having significant insights into their personal problems during psychedelic treatments – problems that led to the addictive behaviors in the first place (35). It has been proposed that the ability of the psychedelic to break the patient’s deeply ingrained, habitual behavioral and emotional patterns (presumably by causing changes to brain functional dynamics) – patterns that keep them in the cycle of addiction – creates an opportunity for the person to create a new self-image, and ultimately become more self-accepting (3, 36).
Psychedelic substances simply create an opportunity for profound self-change. And while the concept of self-help, self-care, and even until very recently, mental health have been practically dismissed as optional pastimes, psychedelic research illuminates just how deeply our psyches are connected to our health.
Psychedelics are unique. With what other drug(s) do we have this kind of relationship, where you come out of the experience psychologically transformed by simply taking the medicine – sometimes after just one dose? And yet we continue to try to explain them mechanistically in the same way we explain other therapeutic substances. Psychedelic substances, more than any other, beg us to examine how human neuroscience, psychology, spirituality, and bodily health overlap. And I haven’t even gotten to the implications for consciousness and transpersonal events yet…
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