Psychedelics for Addiction
Overview: Psychedelic substances, when combined with psychotherapy, show promise in the treatment of substance use disorders. These substances, such as LSD, psilocybin, ayahuasca, ketamine, ibogaine, and MDMA, have been shown to reduce withdrawal symptoms, decrease cravings, and provide relief from underlying trauma that often contributes to addiction. While further research is needed, early results are encouraging and suggest that psychedelic-assisted therapy may provide a valuable tool in the treatment of addiction.
Early Addiction Research Using LSD
In the 1950s, researchers including English psychiatrist Humphrey Osmond, the man who coined the term “psychedelic,” began studying the potential efficacy of d-lysergic acid diethylamide, better known as LSD, for alcohol addiction at Weyburn Mental Hospital in Saskatchewan, Canada.
At that time, most people believed that alcoholism was caused by people having a weak or immoral character. But the experiments conducted by Osmond and his team, in which they gave people with alcohol problems high doses of LSD, found that LSD helped many people to stop drinking and recover from alcohol addiction.
As a result, Osmond and his colleagues showed that alcohol addiction might be caused by changes happening in people's bodies, rather than a lack of willpower. This was a significant change in thinking.
Research into LSD as a treatment for alcohol addiction gained popularity during a time when the outlook for treating alcohol addiction was bleak. This success led to a public campaign to promote LSD treatments for addiction, which was supported by the government, Alcoholics Anonymous, and the Bureau of Alcoholism.
However, the organization in charge of addiction research — the Addictions Research Foundation — was skeptical about the scientific quality of the studies done on LSD and addiction, and challenged the researchers to conduct more rigorous studies that followed proper scientific procedures.
Despite attempts to prove that the effectiveness of LSD-assisted therapy depended not just on medical factors, but on contextual factors also, such as the patient’s mindset, expectations, and the environment in which LSD sessions take place, studies were ultimately deemed to fall short of the requirements of current medical methodology, which emphasizes the importance of controlled trials.
In the 1960s, LSD leaked from the scientific research laboratory, and it soon became a popular recreational drug. The use of LSD in recreational contexts became associated with the counter-cultural movement, a social movement that included anti-establishment and anti-war movements, rejected traditional norms and values, and sought new ways of living and thinking.
This contributed to the negative perception of the drug and led to public concern and negative media attention, increased regulatory restrictions, and limitations on research. This made fewer people support the use of LSD for medical purposes.
Interestingly, A 2012 meta-analysis of six clinical trials conducted in the 60s and 70s involving over 500 participants found that LSD had beneficial effects on alcohol misuse. The authors of this meta-analysis found that taking a single dose of LSD as part of alcoholism treatment programs helped reduce alcohol misuse.
These findings suggest that further research is needed to explore the potential benefits of LSD for treating alcohol addiction, using modern scientific methods and standards.
Psilocybin for Tobacco and Alcohol Addiction
According to current projections, tobacco addiction is expected to continue being a significant health concern into the next decade, with an estimated 8 million deaths per year anticipated by 2030, while the World Health Organization reports that 3 million deaths every year result from the harmful use of alcohol.
In recent years, psilocybin, which is a classic psychedelic compound and the psychoactive component found in magic mushrooms, has shown potential to effectively treat tobacco and alcohol addiction when given alongside supportive therapy.
Psilocybin for Tobacco Addiction
A 2014 study published in the Journal of Psychopharmacology investigated whether two to three doses of psilocybin administered in combination with cognitive behavioral therapy (CBT) within a structured 15-week treatment protocol could treat tobacco addiction. The researchers measured biomarkers to assess smoking status and participants' self-reported smoking behavior.
After six months, 12 out of 15 participants (80%) reported not smoking for the past seven days. This observed smoking cessation rate is significantly higher than rates commonly reported for other types of therapies or medications, which typically have a success rate of less than 35%.
At the 12-month follow-up, 10 out of 15 participants (67%) were confirmed to be abstinent from smoking, while at long-term follow-up (16 months or more), nine participants (60%) remained abstinent.
Additionally, at the 12-month follow-up, 13 participants (86.7%) rated their psilocybin experiences as among the five most personally meaningful and spiritually significant experiences of their lives. This finding is consistent with previous survey data in which 78% of tobacco-dependent participants reported that spiritual resources could be beneficial when attempting to refrain from smoking and raises interesting questions regarding the relationship between spirituality and addiction recovery.
Psilocybin for Alcohol Addiction
Psilocybin, when used in conjunction with psychotherapy, has also recently been shown to produce "robust decreases" in the consumption of alcohol.
In this study, participants were randomly assigned to receive either psilocybin or the antihistamine drug diphenhydramine during two treatment sessions. Both groups also received 12 weeks of manualized psychotherapy.
The study found that during the 32-week double-blind period, which is the stage in a clinical trial where neither the participants nor the researchers are aware of which treatment the participant is receiving, the group that received psilocybin had a lower percentage of heavy drinking days (9.7%) compared to the diphenhydramine group (23.6%). Additionally, the psilocybin group had a lower mean daily alcohol consumption in terms of the number of standard drinks consumed per day.
These findings suggest that psilocybin could be a promising treatment option for substance use disorders, although further research is necessary.
The Anti-addictive Properties of Ayahuasca
The traditional Amazonian tea ayahuasca has also been seen to have potential efficacy in treating substance addiction. Ayahuasca is made by brewing the bark of the Banisteriopsis caapi vine, which contains monoamine oxidase inhibitors (MAOIs), and the leaves of the Psychotria viridis bush, which contains the classic psychedelic compound DMT. MAOIs inhibit the breakdown of DMT, allowing it to remain active and produce its psychedelic effects in ayahuasca.
A 2019 study examined the use of ayahuasca-assisted therapy for addiction among members of an Indigenous community in Canada. The study used a qualitative analysis approach to investigate the experiences of individuals who participated in ayahuasca-assisted therapy for addiction.
These preliminary findings suggested that ayahuasca-assisted therapy was a positive experience for participants, who reported decreased cravings for substances, improved relationships with themselves and others, and increased self-awareness and emotional healing.
A recent online study investigated the relationship between ayahuasca consumption in various settings and alcohol and drug use. Results indicated that increased ayahuasca consumption is strongly associated with decreased alcohol and drug use. These effects were more pronounced in individuals with a prior history of substance use disorders.
However, the authors of these studies note that further research is needed to fully understand the potential benefits and risks of ayahuasca-assisted therapy for addiction and to develop appropriate protocols for its use. Future studies should be improved to get more clear and more definitive results.
Explore By Use Case
Ketamine: Possible Efficacy for Heroin, Cocaine, and Alcohol Addiction
Ketamine is a type of drug called a dissociative anesthetic, which means that it can make people feel disconnected from their bodies and surroundings and produce distortions of time and space perception. Unlike classic psychedelics like LSD, psilocybin, and DMT which cause similar effects by interacting with a subtype of the serotonin receptor family called 5-HT2A, ketamine works by blocking a certain type of receptor called the n-methyl-d-aspartate (NMDA) receptor.
Clinical trials investigating ketamine as a potential treatment for addiction did not begin until the 1990s.
Ketamine for Alcohol Addiction
In one controlled clinical trial, the authors found that adding ketamine psychedelic therapy (KPT) to their standard alcoholism treatment led to a significant improvement in effectiveness. The KPT group showed a total abstinence rate of 65.8% (73 out of 111 patients) for more than one year, compared to only 24% (24 out of 100 patients) in the control group who received only conventional treatment. This study did not stand up to the rigor of modern-day double-blind randomized controlled trials, however, and so outcomes are best interpreted as preliminary.
A 2019 randomized controlled trial found that a single ketamine infusion (0.71 mg/kg) in conjunction with motivational enhancement therapy significantly increased abstinence rates and led to a lower likelihood of alcohol use, heavy drinking, and a longer time to relapse compared with placebo (midazolam). At the 6-month follow-up, 75% of the ketamine group remained abstinent, compared to 27% of the midazolam group.
Ketamine for Heroin Addiction
A randomized trial by the same researchers in 2002 showed that a high ketamine dose (2mg/kg) in the context of ketamine psychotherapy which involved preparation for the ketamine session, the ketamine session itself, and the post-session psychotherapy, produced significantly greater rates of abstinence in heroin-dependent patients than a low dose (0.2mg/kg). The higher dose also produced a greater and longer-lasting reduction in craving for heroin.
The researchers followed this up with a 2007 study in which they tested whether people with heroin dependence who received a single session of Ketamine-assisted therapy or multiple sessions were more likely to remain abstinent after one year. They found that people who received multiple sessions were more likely to remain abstinent compared to those who received only one session. Thirteen out of 26 subjects (50%) in the multiple ketamine-assisted therapy group remained abstinent, compared to 6 out of 27 subjects (22.2%) in the single session group.
Ketamine for Cocaine Addiction
A 2014 study showed that relative to the benzodiazepine medication lorazepam, ketamine enhanced motivation to quit cocaine and reduced cue-induced cocaine craving. These results were corroborated by a clinical trial conducted in 2016 that saw ketamine substantially reduce self-administration of cocaine.
In a 2019 randomized clinical trial, researchers wanted to see if one dose of ketamine could help cocaine-dependent adults who were practicing mindfulness-based relapse prevention. Fifty-five participants were randomly assigned to receive either a 40-minute infusion of ketamine or midazolam. Both groups started a 5-week course of mindfulness-based relapse prevention.
The study found that 48.2% of participants in the ketamine group stayed abstinent during the last 2 weeks of the trial, while 10.7% in the midazolam group did. The ketamine group was also 53% less likely to relapse compared to the midazolam group, and the ketamine group had lower scores of craving throughout the trial.
Ketamine’s potential to treat addiction is believed to be associated with several mechanisms, including:
- Neuroplasticity (reorganization of the brain)
- Neurogenesis (formation of new neurons)
- Synaptogenesis (formation of the links between neurons called synapses)
- Treatment of depressive symptoms
- Blocking reconsolidation of drug-related memories
- Provoking mystical experiences
- Enhancing psychological therapy efficacy
Although the research on ketamine as a therapy is still developing and has some limitations, the initial findings are positive. Ketamine has been shown to help people stay abstinent from alcohol and heroin and reduce craving for and use of cocaine. However, more well-designed studies are needed to confirm these results.
Ibogaine: Anti-addictive Promise
Ibogaine, which is a naturally-occurring, long-lasting psychedelic compound derived from the roots of the West African shrub Tabernanthe iboga, has also shown promise in treating addiction, according to preliminary research.
Traditionally used in days-long initiatory rituals and as a spirit-connecting tool in “Bwiti,” a syncretic and multi-ethnic religion in Central-West Africa, ibogaine owes its reputation as a potent addiction medicine to an American man named Howard Lotsof. After an experience with ibogaine that Lotsof claimed cured his heroin addiction, he went on to organize a focus group in New York City to spread word of ibogaine’s healing effects, and urge researchers to study the drug.
In 1990, 20 members of Lotsoff’s focus group ingested up to 19 mg/kg of ibogaine, seven of whom were chronic heroin users. All seven reported significant alleviation of withdrawal symptoms and heroin cravings in the days following the experiment, with five participants abstaining from heroin for six months or longer. Despite the study’s methodological weaknesses, Lotsof was so impassioned by the results that he made it his life ambition to advocate for policy changes and further research on the substance.
After several animal studies and some promising case reports lent support to Lotsoff’s pleas regarding ibogaine’s potential to treat addiction, treatments began taking place in the Netherlands.
The US National Institute on Drug Abuse (NIDA) also began supporting preclinical toxicological research and the development of human clinical trials. The US Food and Drug Administration (FDA) also granted researchers at the University of Miami approval to conduct safety trials, and approved protocols for studies with cocaine-dependent individuals.
However, the death of a female patient in the Netherlands brought ibogaine research to a halt, despite there being limited evidence of ibogaine’s involvement in the patient’s death.
In a study from 1999, researchers looked at 33 people who were dependent on heroin and were given ibogaine. The study found that 76% of the participants had no withdrawal symptoms after taking ibogaine.
Soon after this publication, professor of neurology and founder of clinical stage pharma company DemeRx, Dr. Deborah Mash, treated 150 cocaine- or heroin-dependent individuals in a free-standing clinic in St.Kitts, West Indies, reportedly achieving significant and sustained reductions in drug craving and withdrawal.
In recent years, despite the lack of clinical evidence, the ibogaine subculture has continued to expand as the substance itself gains increasing attention from the medical community. Currently, several treatment clinics operate in countries where ibogaine is legal, particularly in Mexico. New Zealand’s categorization of ibogaine as a non-approved prescription medicine in 2010 also speaks to its potential anti-addictive properties, although there is a clear need for further research concerning its safety and efficacy.
MDMA for Alcohol-use Disorder
MDMA (3,4-methylenedioxymethamphetamine), the drug commonly called “ecstasy” or “Molly,” has also been touted as a potentially effective treatment for substance-use disorders when used in conjunction with supportive psychotherapy.
The anti-addictive potential of MDMA had not been scientifically explored until recently, despite its efficacy in PTSD treatment and the widely reported link between trauma and addiction.
A 2021 study published in the Journal of Psychopharmacology demonstrated that MDMA-assisted psychotherapy may have the capacity to safely enhance the therapeutic processes in patients with alcohol-use disorder. Two 187.5 milligram doses of MDMA, paired with recovery-focused psychotherapy delivered before, during, and after MDMA sessions, was observed to reduce average weekly alcohol intake from 130.6 units to 18.7 units 9 months post detox.
This study's authors concluded that the potential efficacy of MDMA-assisted psychotherapy for alcohol addiction may be associated with its ability to reduce avoidance of distressing thoughts and memories, promote empathy, and address underlying trauma that can contribute to addiction. However, more research is needed to confirm these findings.
Psychedelics for Addiction: Promising Evidence, but Further Research Needed
In conclusion, the use of psychedelic substances in combination with psychotherapy shows promising results in the treatment of substance-use disorders. Studies suggest that these substances can help individuals overcome addiction by reducing cravings, promoting emotional regulation, and providing insights into the root causes of addiction.
As the field continues to evolve, it is clear that psychedelic-assisted therapy holds significant potential in addressing the complex and growing problem of substance-use disorders. However, further research is needed to better understand how these treatments work as well as the potential risks associated with them.
Explore By Substance
5-MeO-DMT
5-MeO-DMT (5-methoxy-N, N-dimethyltryptamine) is a short acting, serotonergic psychedelic, found naturally in the venom of the Sonoran Desert Toad (Bufo Alvarius). 5-MeO-DMT is gaining popularity as an effective tool for spiritual exploration and healing due to its extremely powerful psychoactive effects.
Ayahuasca
What is unique about ayahuasca is that it is a concoction of two plants, the combination of which is essential for the ayahuasca experience. Combining two plants to use as medicine may not seem groundbreaking in and of itself, but the fact that if one is taken without the other, the experience is entirely different, and arguably non-existent, is what makes the discovery of ayahuasca so surprising.
DMT
For millennia indigenous-American tribes have consumed N,N-dimethyltryptamine (DMT) as a key ingredient in sacred botanical brews, such as ayahuasca, and snuffs, such as yopo, as part of religious ceremonies in Central and South America.
Ibogaine
Ibogaine is a naturally occurring indole alkaloid derived from the roots of an threatened species of perennial rainforest shrub called Tabernanthe iboga. Ibogaine, which is believed to have potent anti-addictive properties, has been used by the indigenous peoples of central west Africa for centuries.
Ketamine
Though ketamine gained a reputation for being dangerous and easily misused and abused, it wasn’t until 1999 that the US classified it as a Schedule III controlled substance. While it is often associated with the party scene, ketamine therapy is helping change the lives of many with severe depression, PTSD, OCD and even chronic migraines.
LSD
In 1938, a Swiss chemist by the name of Albert Hofmann, working out of Sandoz Pharmaceuticals, became the first man to synthesize Lysergic Acid Diethylamide (LSD). Active at the microgram level (one-thousandth of a gram), LSD is the most potent psychoactive drug known to humankind.
MDMA
The MDMA molecule bears structural resemblance to stimulants and some psychedelics, invoking feelings of euphoria, empathy, and boundless energy. MDMA also intensifies sensory perception, enhancing one’s appreciation of music and color which makes it one of the most popular drugs among festival-goers and electronic dance music fans alike.
Mescaline
In the 16th century, Spanish chroniclers attempted to eradicate ritual use of peyote cactus among indigenous American cultures, which led to the plant’s eventual prohibition in 1720. In the face of adversity, several indigenous communities righteously persevered, continuing and preserving their sacred practice in clandestine secrecy, and even managing to spread it widely over the last 150 years.
Peyote
Peyote is a green spineless cactus that contains the classic psychedelic compound mescaline. Numerous Mesoamerican cultures, including the Huichol (Wixárika), the Cora (náayeri), the Tepehuanes, the Tonkawa, the Mescalero, and the Tarahumara (Rarámuri) have long regarded the plant as sacred, using it in spiritual and healing ceremonies for millennia.
Psilocybin
While evidence suggests that psilocybin mushrooms have been historically used in ritual settings for spiritual and medicinal purposes, they have gained popularity for recreational use, and clinical research on the therapeutic effects of psilocybin is promising.
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Salvia divinorum
Salvia is a psychotropic flowering herb from the Lamiaceae, or mint, family. Salvia’s large green leaves contain the powerful psychoactive compound, salvinorin A. Salvia leaves are used for medicinal and religious purposes by Mazatec shamans in the Mexican state of Oaxaca, and they are often used recreationally in the west.
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San Pedro
Since prehistory, San Pedro has been instrumental to Peruvian cultural traditions. in northern Peru in particular, it has been a tool to facilitate the shaman’s ‘‘journey’’ for healing purposes. Throughout this period, the visionary cactus has been known by many names, including huachuma or achuma.
