Can Psychedelics Play a Role in Addiction Treatment?
Friday, January 8th, 2016
The Twelve Steps of Alcoholics Anonymous (AA) hold that complete abstinence from alcohol and other drugs is essential to a successful recovery and that any breach of sobriety may trigger a relapse. However, it is little-known that Bill Wilson, the founder of AA, believed that the psychedelic LSD, while not a panacea for addiction, may actually be useful in the treatment of it. After participating in early research of LSD’s effects on alcoholism in the 1950s, he stated, “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. The vision and insights given by LSD could create a larger incentive—at least in a considerable number of people.” While the Controlled Substances Act of 1970 saw a long hiatus of psychedelics research, a growing body of contemporary research suggests that they may serve as an effective intervention in addiction treatment.
A recent study conducted at Johns Hopkins University found that just a few treatments with psilocybin, a psychedelic similar to LSD that is the psychoactive agent in “magic” mushrooms, may be remarkably effective in helping someone quit cigarettes when employed in conjunction with Cognitive Behavioral Therapy. The small study’s subjects were 15 long-time smokers, all of whom had made many failed attempts to quit. Six months after the completion of the 15-week treatment protocol, 80 percent of the subjects were still completely abstinent. By comparison, other behavioral or pharmacological treatments for smoking cessation demonstrate an abstinence rate of only 35 percent over a similar period.
Another small study conducted at the University of New Mexico found that psilocybin may be helpful in treatment for alcohol use disorder. The 10 subjects demonstrated significant decreases in alcohol consumption after undergoing two supervised sessions with psilocybin in conjunction with 12 sessions of primarily Motivational Interviewing, a therapy technique often used in addiction treatment. In addition, the improvements held with little variation after nine months.
Furthermore, other types of psychedelics could have potential in treatment. Two studies that are currently under review by scientific journals suggest that ibogaine, a multi-faceted psychedelic found in an African root bark, may serve as a promising intervention for opioid use disorder. However, ibogaine presents unique challenges as a treatment due to a high mortality rate of one in 300 treatment recipients.
While recent studies indicate that psychedelics may one day be useful in addiction treatment, there are still ambiguities to be clarified. First, it is unclear what mechanisms in psychedelic treatment lead to a successful outcome. Classical psychedelics (e.g., LSD and psilocybin) primarily act on the 5HT2A receptors for serotonin, a neurotransmitter that regulates, among many things, mood, appetite, memory, and learning. However, the relationship between 5HT2A receptor activity and addictive behaviors is unclear. Another study at Johns Hopkins found that psychedelics may occasion a mystical experience less reducible to neurotransmitter activity. In fact, key to completion of the Twelve Steps in AA is “having had a spiritual experience.” While this sort of experience— irrespective of its cause—may play a role in recovery, how so is unclear.
Second, the nature of addiction carries a number of issues that might make implementing treatment with psychedelics more challenging. For example, individuals with substance use disorder may have a co-occurring disorder (COD), such as anxiety or depression. In some cases, the COD is more severe than the substance use disorder, and treating it takes priority. Also, the COD may put the individual at risk for a negative treatment outcome. In the University of New Mexico study, researchers excluded individuals who had certain CODs and those who were abusing substances other than alcohol as a precaution. Unfortunately, the concurrence of substance abuse and other psychiatric disorders is common, so for whom psychedelic therapy could be safely employed is still unknown.
More research is needed to know whether and how psychedelics can be employed in addiction treatment. Currently, most psychedelics are classified as Schedule I, meaning they have no accepted medical use and a high potential for abuse. This puts numerous restrictions on scientists who wish to conduct research into their safety and efficacy as treatment modalities. Indeed, no government funding has ever been allocated for this purpose, requiring researchers to solicit private grant money. However, as the number of drug overdose and alcohol-related deaths continues to climb, perhaps it is time to facilitate more research into alternative treatments.