Hallucinogens in Addiction Treatment: The Trippy New Era

LSD, ecstasy and magic mushrooms are helping people face death, cope with trauma and quit booze and smokes. Can these drugs revolutionize addiction treatment, or is it all just tangerine trees and marmalade skies?

“The room instantly lit up in a blinding glare of white, white light. I was seized by an ecstasy such as I had never known,” wrote AA's co-founder, Bill Wilson, of his first spiritual experience. He was dropping acid as part of an informal study supervised by a doctor in the ‘50s, when LSD was legal and the power of psychedelic-assisted therapy was heralded as potentially transformative.

So began a lifelong interest in altered states of consciousness that included extensive experiments with LSD. Wilson claimed that his initial experiences were crucial to his recovery and his belief in his mission to create a community of alcoholics helping one another. He was so enthusiastic that he contemplated advising other AA members to take acid, especially those incapable of feeling “a power greater than ourselves.” Still, he acknowledged the limits of its possible benefits: “I don't believe [LSD] has any miraculous property of transforming…sick people into healthy ones overnight,” he wrote to a fellow participant in the study. "[But] it can set up a shining goal on the positive side [and] create a large incentive [to recovery.]”

The AA fellowship disagreed. The idea of treating those who cannot control their substance use with another substance seemed, then as now, heretical. The link between spirituality and sobriety, however, remains a mainstay of modern recovery.

Today, some four decades after the counter-culture’s widespread recreational use of hallucinogens led to criminalization of the substances, there's a resurgence of interest in their therapeutic potential for mental illness and addiction. A dozen or more studies of LSD, psilocybin (the active ingredient in magic mushrooms) and MDMA (ecstasy) are ongoing in the US, Britain, Israel and Switzerland; a handful of others have recently concluded. Most of the patients involved in these studies are in dire straits: vets with PTSD, the terminally ill who have a terror of death, people with treatment-resistant depression and alcoholics.

The results are consistently positive. Indeed, the PTSD and cancer studies have garnered big headlines recently for their exceptionally beneficial outcomes. But these are tiny pilot studies—and because the drugs are still illegal and mired in controversy and stigma, research is likely to remain stalled.

Advances in neuroscience, coupled with the new model of mental illness and addiction as brain diseases, are largely responsible for rekindling this research. Neurons and their transmitters, receptors, pathways and the like are increasingly viewed as the source of the “self” and perception, cognition, emotion and other functions. Psychedelics have a uniquely powerful, even explosive, effect on both your neurochemistry and your “self.” But the trip itself typically only lasts for about 12 hours. Whether these "mystical" effects deliver enduring benefits is the question researchers seek to answer, for only then could these substances become “medicines.”

Rick Doblin believes the answer is yes. He's the founder and president of the nonprofit Multidisciplinary Association for Psychedelic Studies (MAPS), which funds pilot studies and advocates for these drugs' use in legal medical settings. “Addiction involves past material, a lot of denial and running away. Psychedelics bring material to the surface in ways where people need to surrender to them; it’s hard to hide from yourself under [them],” says Dobin. “The other part is more positive. People often have a spiritual sense of connection that they can later draw strength from.”

Psychedelic-based treatment can cause elevation in mood, openness and changes in values—which, for people with substance use disorders, can cause a reduction in craving, increase in motivation and, ultimately, a reduction in use, says Michael Bogenschutz, MD, a psychiatry professor at the University of New Mexico. “[But] the tricky thing is developing a neurobiological theory. We know a fair amount about the acute effects of psilocybin and drugs like it on the brain, and we’re learning something about the functional effects with fMRI,” he says. “So how do you get from those acute effects to a longer-lasting effect on behavior?”

"We know a fair amount about the acute effects of psilocybin on the brain. How do you get from there to a longer-lasting effect on behavior?"

Bogenschutz is investigating whether psilocybin can help alcoholics recover. In his first completed study, five people had two drug sessions over a 12-week period, along with standard Motivational Enhancement Therapy (MET), and at a one-month follow-up (admittedly a short interval) all five reported that they were either abstinent or had markedly reduced their days of heavy drinking. Notably, their drinking patterns remained mostly unchanged during the first month of the study, when they were receiving only the MET, but then dropped sharply following the first psilocybin adventure.

Hallucinogens have also been tested in smoking cessation. Based on previously positive results, Matthew Johnson, PhD, a Johns Hopkins University addiction researcher, is studying psilocybin’s anti-nicotine effects in 12 people (three administrations of the drug, plus cognitive-behavioral therapy). Three of the four participants who passed the one-year mark have quit smoking, while the fourth has gone from a pack a day to one cigarette a week. (The average rate of success in quitting smoking is between 20% and 40%.)

Psychedelic researchers often use the Pahnke-Richards “mystical experiences” scale, a rubric that attempts to quantify the essentially unquantifiable. “So far it looks like those who are more successful in quitting smoking have higher ‘mystical experience’ scores," says Johnson, "consistent with some of our previous research showing that the mystical nature of the experience, and not the drug strength per se, is associated with persisting benefit.”

Participants in Johnson’s trial reported an increased ability to consider the larger, “life” impact of their decisions. Instead of simply “knowing” the consequences of their smoking, they “felt” the seriousness of the repercussions. They also felt less controlled by past habits and patterns, and therefore capable of making new decisions.

In a study published in a 2012 Journal of Psychopharmacology, 94% of participants who took psilocybin said, in a 14-month follow-up, that it ranked among the top five most meaningful experiences of their lives; 39% said that it was the most meaningful.

Several scientific observations hint at how psychedelics may work in the brain to help quell addiction. First, they act on brain receptors thought to play a big role in drug-seeking behavior. Second, brain-imaging shows a drug-induced reduction in blood flow in brain regions involved in emotional processing and higher function and thinking. Research suggests that lowering activity of these functions has antidepressant and anti-anxiety effects. Third, psychedelics also appear to act on a brain network that confers a state of wakeful rest, daydreaming, rumination and self-referential thought. Psychedelics, which subdue this network, may help put the brakes on negative circular thinking that can constrict emotions—a common attribute of the addicted mind.

Yet tinkering with these brain functions can be a crapshoot. A.C. Parrott, PhD, a psychologist and MDMA expert at Swansea University in the UK, criticized the FDA for greenlighting MDMA PTSD trials. “MDMA is a very powerful, neurochemically messy and potentially damaging drug,” he told the Washington Post in 2008.