Psychedelic Therapy, Addiction, Drinking, and Substance Use
Are psychedelics drugs? Yes.
Can psychedelics help people who want to stop using drugs? Also, yes.
Psychedelics are mind altering molecules, usually derived from plants, which can help people who have unhealthy substance use issues.
For some, it may seem strange to use one drug in order to break addiction to another, but psychedelics are tools that can do just that.
Psychedelics for Addiction
One reason why psychedelics are effective for addiction is that they do not entail physical dependence, unlike many other drugs like opioids, cocaine, and methamphetamine. [1]
Another reason is that many psychedelics, like psilocybin magic mushrooms, are naturally occurring, so many accessible sources are pure, not contaminated or toxic.
Researchers are examining the efficacy of psychedelics in addiction treatment, and clinical trials show tremendous promise. [2]
Psychedelics have helped many people work through their addiction to drugs, smoking, drinking gambling, and other behaviors. This comes at a crucial time as drug abuse, opioid use disorder, opioid addiction, and opioid related overdose deaths reach record highs in America. [3]
In this article we will explore how psychedelics assist with addiction, what the science behind this is, and how we can better understand mental health, addiction, and psychedelics.
What is Addiction?
Through our 10+ years experience in therapy and clinical services, we've worked with clients with a range of psycho-social conditions.
If there's one thing we've learned about addiction, it's that it's incredibly complex.
We'll do our best to define it here.
Defining ‘Addiction’
We consider addiction to be the habitual engagement in a substance or a behavior to evade an emotion.
More often than not, there's an underlying feeling or experience, including trauma, that people seek to avoid by using substances.
Pop culture ideas, such as someone making the "choice" to become addicted or someone having an “addictive personality", have precisely zero empirical backing. [4]
Why Do People Use Drugs?
People use drugs because they work.
If someone's going through something difficult, then drinking, smoking, or substance use can be an effective way to address the pain associated with their challenges.
Some forms of addiction treatment overlook the efficacy of these substances. This belief can limit our understanding of why people compulsively use substances, i.e. to evade an emotion or cope with pain.
By acknowledging this aspect of substance use, we open up the conversation up to discuss ways to help people cope with or move through their challenging psychological experiences.
This is where psychedelics come into play.
How Do Psychedelics Help Treat Addiction?
In many ways, psychedelics act as a reset, refresh, or restart.
Psychedelics open individuals up to alternatives. Someone who drinks or uses substances can undergo a psychedelic experience and discover more options for coping with their challenges.
Psychedelics enhance connections in the brain and help us relate to our emotions, thoughts, and experiences differently.
Through intentional, therapeutic psychedelic treatment, the "addicted" person can open up to new feelings and actions they might take. It's not uncommon for drug use, smoking, or drinking to seem much less appealing after a profound psychedelic journey.
How does this happen?
A Snowy Hill: Analogy for the Brain and Psychedelics
One analogy from psychedelic treatment researchers made popular by Michael Pollan's book and Netflix documentary How To Change Your Mind is that of a snowy hill: [5]
Imagine the brain is a hill with snow and your thoughts are sleds going down that hill.
As sleds continue down the hill, we see grooves or tracks emerge. Every time a new sled goes down, those grooves become deeper and future sleds are drawn to those same grooves. It becomes more difficult for a sled to go another direction or a new direction altogether.
Our thoughts work similarly in that, as we develop, our neural connections get used over and over and begin to fire more consistently. This has many advantages, but one disadvantage is that we may find it more difficult to "think differently" about something, maybe an emotion or a habit.
Psychedelics are like a temporary fresh snowfall on the hill. The grooves are more even and the soft powder makes it easy for sleds to glide down in new ways.
Just like the sleds, our thoughts can go in new directions, opening us up to new possibilities.
Using this analogy, it's easy to see how the psychedelic journeyer can make new connections, often thinking and feeling differently. As Pollan's title suggests, it's a possible way to change-your-mind.
If psychedelics can open our minds up to new ideas and behaviors, then it's likely that this can help people find alternatives to using substances and drinking.
What Psychedelic Research Says
To determine if psychedelics really help people with addiction, clinical researchers explore the topic.
Back in the 1950s-1970s, several studies showed the efficacy of psychedelics in treating alcoholism and opioid dependence. [6] [7]
In recent years, research access to psychedelic medicine has reopened, and the results are just as promising for treating addiction.
Evidence suggests that magic mushrooms, which contain the active ingredient psilocybin, are highly effective at helping people quit using alcohol and tobacco. [8]
In three pilot studies, psilocybin therapy was administered to participants with alcohol use disorder. The participants that received the psychedelic treatment had significantly fewer heavy drinking days afterwards.
In one recent study on smoking, psilocybin assisted treatment was found effective, with 80% of people maintaining abstinence from smoking at 6 months. The study showed that 67% of participants remained smoke-free at 12 months. [9]
LSD has proven effective in reducing alcohol misuse in several clinical trials. [10]
A growing body of research suggests magic mushrooms, LSD, and other psychedelics are effective. Psychedelic studies are underway in many countries and are gaining attention.
Psychedelics vs Traditional Treatment
When we compare the potential of psychedelics for treating addiction and alcohol use disorder to contemporary recovery options in America, it's not even close.
Let's consider smoking as an example.
Traditional behavioral and pharmaceutical treatments are effective less than 35% of the time in achieving smoking cessation.
In a clinical trial at Johns Hopkins University, 80% of habitual tobacco users who underwent psilocybin-assisted therapy were smoke-free at the 6-month follow up. That's over twice as effective. [11]
When compared to traditional psychological treatments or pharmaceutical medications, research suggests the effectiveness of psychedelic-assisted treatment is substantially higher. [12]
One important note for psychedelic treatment in these research studies is that it involved both medical administration of the compound and psychotherapy. Some forms of traditional treatment will include therapy or emotional support, but certainly not all of them.
In our view, mental health is critical for understanding why and how people become addicted to something in the first place.
It seems then that the "problem" with addiction lies not within the drug itself, but with the environment within which the habitual use persists. This includes how we think about addiction and our treatment for it.
Substance Use Disorders and Mental Health
Are drugs inherently bad?
Most people who stop and think about this question will end up saying "No".
After all, most people use drugs every day: 85% of Americans consume at least one caffeinated beverage (e.g., coffee, tea) per day. [13]
And yes, caffeine is indeed a mind-altering substance - albeit one that’s very safe!
Again, people use drugs because they are effective. People drink coffee because it makes them more productive workers. People drink alcohol because it promotes social connectedness.
What do people use to overcome anxiety or depression?
Safe, intentional use of substances can lead to profound healing changes. However, overuse and abuse can result in addiction and overdose.
What then contributes to use that is safe or not?
One perspective, popularized by Columbia Professor and previous Department Head of Psychology Carl Hart, suggests that addiction is rooted in the socio-ecological factors of one's life. Factors such as a person's psychiatric history, life circumstances, and social identity play significant roles in predicting harmful effects of substance use. [14]
Mental Health Disorders
Most forms of addiction treatment acknowledge the role that psychology plays in drug dependence.
Individuals predisposed to psychiatric disorders are more likely to become habitual users of substances compared to the general population.
People with co-occurring disorders such as anxiety, depression, and trauma are also more likely to use substances regularly.
Why is this the case? People use these substances to cope with their co-existing issues.
The standard treatment for mental health, which prioritizes talk therapy and daily pharmaceuticals pills, such as SSRIs, don't adequately resolve issues for the majority of Americans. [15]
It's no surprise that researchers are looking beyond standard treatment to explore what else is happening when someone uses substances.
Life Circumstances
Another set of related factors within one's environment are their life circumstances.
Consider income level as a factor, and a brief look at the Midwest and the "Rust Belt" of America clearly demonstrate this point.
By the end of the 20th century, Midwestern cities and towns that had once thrived as economic centers for automotive vehicles and fossil fuel energy met their fate: the industry was changing and the jobs were leaving.
A strong middle class made up of business men and women, as well as blue-collar industrial workers, suddenly experienced job loss, pay cuts, and the loss of gainful employment.
Our social safety nets weren't enough.
There were very few job training programs to help these people find their next opportunity. Social welfare benefits were (and are) inadequate, and the pressure to support one's family grew too great, too quick.
Many people once prominent in their communities, well-respected, and able to provide for their loved ones found themselves devastated.
Shame and grief flooded the Rust Belt psyche. The area's issues persist today, as hard-working citizens there cannot progress economically and achieve a healthy level of resources.
So people look elsewhere. They use substances, because they are effective, to cope with their pain.
What’s more, most people cannot access a safe supply of medicines, so they turn to underground dealers, who can have unknowingly contaminated or impure products. (It’s a myth that drug dealers purposely contaminate their supply. Doing so makes zero sense from a behavioral economic perspective: contaminated products can disappoint, harm and even kill customers, which deters and prevents future business.)
The unregulated drug market leads to thousands losing their lives or being imprisoned, and this costs American taxpayers several million dollars each year. It's no surprise then that rate of opioid related overdose deaths rises every year. [16]
If we want to effectively address addiction, we must consider all factors contributing to substance use, such as mental health, socioeconomic status, and drug safety, among others.
Best Psychedelics for Treating Addiction and Substance abuse
As mentioned in the How To Change Your Mind analogy, psychedelics act like a reset or a fresh sheet of snow. However, not all psychedelics work the same.
While there's still plenty of research to be done on these medicines and addiction, researchers and clinicians are beginning to gain insight into most effective treatments.
Psychedelic mushrooms and other psychedelics are put to the test in observational studies to see which compounds are effective for helping people quit smoking, stop drinking, or work through other addictions.
In a Johns Hopkins University trial, 80% of habitual tobacco users who went through psilocybin treatment were smoke-free at the 6-month follow up. Traditional behavioral and pharmaceutical treatments are this effective <35% of the time. [17]
Researchers who study lysergic acid diethylamide (LSD) have found the compound most effective at treating alcohol use. [18]
While most psychedelics target serotonin, ketamine and ibogaine are medicines that have a different effect on the brain, but may also be effective for treating drug addiction. [19]
Beyond what the research says, it's important to consider the legality of compounds, clinical and traditional use, and your own risk tolerance.
Magic mushrooms and ketamine are two compounds with relatively higher levels of accessibility in America and with evidence supporting their controlled use effective for treating alcohol use disorder and managing opiate and alcohol withdrawal. [20]
How Psychedelic Assisted Therapy Fits In
Drugs and substance use don't exist in a vacuum.
We need to look at who takes these substances, what are their circumstances, why are they taking them, and more.
The same thing applies to psychedelics.
What's the difference between a music festival goer who drops acid and molly vs. the intentional journeyer who uses psychedelic drugs for healing? Their mindset and physical setting.
Set and setting are critical components for the efficacy of psychedelics in achieving therapeutic benefit. [21]
As a result, therapy or guidance in one's healing process is one critical component to create the appropriate set and setting for a psychedelic journey. Another great option is to process one's healing in support groups.
Intentional Psychedelic Use for Healing
Psychedelic compounds are powerful medicines. Working with them in an intentional and safe manner means that the potential for healing is high.
If someone is looking to overcome drug or alcohol dependence, working with a psychedelic professional might be of interest.
In psychedelic-assisted therapy, your guide or therapist serves as both a compassionate, emotionally supportive person and your accountability partner. For example, a guide might work with a client to explore their depression and work towards reducing their alcohol, tobacco, or cocaine consumption.
This dual role helps people make the most out of psychedelic treatment and move towards their goals.
Humans are social creatures and when we enter into these altered states we usually have a heightened awareness of our relation to another person. When you journey with a professional support person, the potential for having a powerful, healing experience increases and your likelihood achieving sobriety is impacted.
Disclaimer: While the body of research around psychedelic treatment for drug addiction is growing, many substances remain federally illegal in the United States. None of the information presented in this article is an endorsement of illicit drug use. No content, including this blog past, from Pivot Psychedelics is medical advice nor an adequate substitute for it. Please consult with a medical professional if you are experiencing substance use issues.
Sources:
Fantegrossi, W. E., Murnane, K. S., & Reissig, C. J. (2008). The behavioral pharmacology of hallucinogens. Biochemical pharmacology, 75(1), 17–33. https://doi.org/10.1016/j.bcp.2007.07.018
Johns Hopkins Medicine Receives First Federal Grant for Psychedelic Treatment Research in 50 years (18 October 2021). Johns Hopkins Medicine. www.hopkinsmedicine.org/news/newsroom/news-releases/2021/10/johns-hopkins-medicine-receives-first-federal-grant-for-psychedelic-treatment-research-in-50-years
Drug Overdose Death Rates. (30 June 2023). National Institute on Drug Abuse. www.nida.nih.gov/research-topics/trends-statistics/overdose-death-rates
Szalavitz, M. The Addictive Personality Isn't What You Think It Is. (5 April 2016). Scientific American. www.scientificamerican.com/article/the-addictive-personality-isn-t-what-you-think-it-is/
Pollan, M. (2019). How to change your mind: The new science of psychedelics. Penguin Books.
Hollister, L. E., Shelton, J., & Krieger, G. (1969). A controlled comparison of lysergic acid diethylamide (LSD) and dextroamphetmine in alcoholics. The American journal of psychiatry, 125(10), 1352–1357. https://doi.org/10.1176/ajp.125.10.1352
Savage, C., & McCabe, O. L. (1973). Residential psychedelic (LSD) therapy for the narcotic addict. A controlled study. Archives of general psychiatry, 28(6), 808–814. https://doi.org/10.1001/archpsyc.1973.01750360040005
van der Meer, P. B., Fuentes, J. J., Kaptein, A. A., Schoones, J. W., de Waal, M. M., Goudriaan, A. E., Kramers, K., Schellekens, A., Somers, M., Bossong, M. G., & Batalla, A. (2023). Therapeutic effect of psilocybin in addiction: A systematic review. Frontiers in psychiatry, 14, 1134454. doi: 10.3389/fpsyt.2023.1134454
Johnson, M. W., Garcia-Romeu, A., & Griffiths, R. R. (2017). Long-term follow-up of psilocybin-facilitated smoking cessation. The American journal of drug and alcohol abuse, 43(1), 55–60. https://doi.org/10.3109/00952990.2016.1170135
Krebs, T. S., & Johansen, P. Ø. (2012). Lysergic acid diethylamide (LSD) for alcoholism: meta-analysis of randomized controlled trials. Journal of psychopharmacology (Oxford, England), 26(7), 994–1002. doi: 10.1177/0269881112439253
Johnson, M. W., Garcia-Romeu, A., Cosimano, M. P., & Griffiths, R. R. (2014). Pilot study of the 5-HT2AR agonist psilocybin in the treatment of tobacco addiction. Journal of psychopharmacology (Oxford, England), 28(11), 983–992. doi: 10.1177/0269881114548296
Johnson, M. W., Garcia-Romeu, A., & Griffiths, R. R. (2017). Long-term follow-up of psilocybin-facilitated smoking cessation. The American journal of drug and alcohol abuse, 43(1), 55–60. doi: 10.3109/00952990.2016.1170135
Mitchell, D. C., Knight, C. A., Hockenberry, J., Teplansky, R., & Hartman, T. J. (2014). Beverage caffeine intakes in the U.S. Food and chemical toxicology : an international journal published for the British Industrial Biological Research Association, 63, 136–142. doi: 10.1016/j.fct.2013.10.042
Hart C. L. (2020). Exaggerating Harmful Drug Effects on the Brain Is Killing Black People. Neuron, 107(2), 215–218. doi: 10.1016/j.neuron.2020.06.019
InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Depression: How effective are antidepressants? [Updated 2020 Jun 18]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK361016/
Ohio Opioid Summary. (April 2019). National Institute on Drug Abuse. www.nida.nih.gov/sites/default/files/21980-ohio-opioid-summary.pdf
Johnson, M. W., Garcia-Romeu, A., Cosimano, M. P., & Griffiths, R. R. (2014). Pilot study of the 5-HT2AR agonist psilocybin in the treatment of tobacco addiction. Journal of psychopharmacology (Oxford, England), 28(11), 983–992. doi: 10.1177/0269881114548296
Fuentes, J. J., Fonseca, F., Elices, M., Farré, M., & Torrens, M. (2020). Therapeutic Use of LSD in Psychiatry: A Systematic Review of Randomized-Controlled Clinical Trials. Frontiers in psychiatry, 10, 943. doi: 10.3389/fpsyt.2019.00943
Kelmendi, B., Kaye, A. P., Pittenger, C., & Kwan, A. C. (2022). Psychedelics. Current biology : CB, 32(2), R63–R67. doi: 10.1016/j.cub.2021.12.009
Rieli Mendes, F., dos Santos Costa, C., Distefano Wiltenburg, V., Morales-Lima, G., Ariel Bonar Fernandes, J., Filev, R., (2022) Classic and non‐classic psychedelics for substance use disorder: A review of their historic, past and current research. Addiction Neuroscience, Volume 3. doi.org:10.1016/j.addicn.2022.100025.
Grinspoon, Lester, 1928- & Bakalar, James B., 1943-. (1979). Psychedelic drugs reconsidered / Lester Grinspoon & James B. Bakalar. New York : Basic Books
