Hallucinogens in Addiction Treatment: The Trippy New Era

The Fix
Kelly Bourdet

Originally appearing here.

“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?”

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.

Recreational users often report bad trips, with adverse effects including panic attacks, paranoia, confused thinking, dissociation and erratic behavior. Psychedelic researchers are trained on how to soothe patients having a negative experience. In fact, some patients have said that “working through” a painful or frightening patch of
intoxication can be especially beneficial. However, individuals with underlying anxiety or psychosis may find that these drugs exacerbate these conditions. Momentary flashbacks, months or even years later, can also occur. An (unintentionally hilarious) YouTube video by MAPS shows how to calm a person on a bad trip.

Protocols for studies often call for multiple prepatory therapy sessions, so that you trust the researchers and are less likely to freak out during your trip. The physical setting is designed to be free of potential distraction or discomfort. You are typically encouraged to lie on the bed, sometimes wearing an eye mask and headphones (playing classical music), and to focus on your internal experience. A therapist may accompany you as a support and guide.

Patients in these trials may be the best source to judge the drugs’ effects and how they translate a brief trip into a longer-lasting transformation. “I now have the distinct sense that there’s so much more, so many different states of being,” a mother of three and former Johns Hopkins anesthesiologist, who enrolled in a psilocybin and cancer anxiety study after being diagnosed with leukemia, told the New York Times. “I have the sense that death is not the end but just part of a process, a way of moving into a different sphere.”

After taking MDMA, a veteran with PTSD recounted a spiritual experience not unlike Bill Wilson’s: “I saw a vision of God. And, by seeing this vision, I knew that I was in God’s hands and had nothing to worry about. This happened in just a flash. I also felt a movement in my head”it was as if my brain jerked. At that point, I completely relaxed.”

Yet skepticism abounds. Psychedelics operate on the principle that mental illness and addiction can be “radically healed,” which is in direct conflict with medical assumptions; indeed, to the scientific ear, that sounds less like medicine than magic. Some critics suggest that the trials themselves have a high placebo effect: Patients in extreme emotional pain are primed to believe that this class of drugs may have mysterious powers. In addition, the hallucinogenic experience is so intense and disorienting that these effects alone can seem beneficial. In cultures where use of psychedelic medicines is common, it is not thought that each experience will be revelatory or even especially powerful”lending credence to this criticism.

The only way to persuade the skeptics is with hard science. But to get a single study of a psychedelic up and running requires overcoming formidable challenges. Funding is scarce. “There’s no money in it,” John Halpern, MD, head of the Laboratory for Integrative Psychiatry at McLean Hospital, who is running an MDMA cancer study, told The New York Times. “What drug company is going to invest millions in a substance widely available in our flora and fauna?” Government regulations are predictably tight. Also, stigma looms large for interested scientists.

Yet there are signs of a new openness. The FDA has licensed a small number of labs to produce high-quality hallucinogens for experimental purposes. It has also approved a study by Rick Doblin on the psychological effects of MDMA for therapists in a MAPs training program on how to guide patients through psychedelic trips. Similarly, the Department of Veteran Affairs has said it will fund larger MDMA trials for vets with PTSD if the current study pans out.

It is as a treatment for alcoholism that hallucinogens may hold the greatest addiction-related promise. A recent meta-study of six LSD research trials conducted in the ’60s and ’70s and involving over 500 people found that those taking even a single dose of LSD had a 59% reduction in drinking at six months, compared to the control groups’ 38%. “Curing alcohol dependency requires huge changes in the way you see yourself. That’s what LSD does,” David Nutt, MD, a professor of psychiatry at Imperial College of London and leading psychedelic-based addiction researcher, told the BBC. (Nutt made a dramatic entrance to the debate over these experiments after he was sacked as the head of a panel of scientific advisors to the British government on drug policy, for publicly stating that tobacco and alcohol are more dangerous than LSD, MDMA and marijuana.) But the positive effects tended to disappear after one year, leading Nutt to suggest that the drug be re-administered at regular intervals.

The future of psychedelics as a “spiritual medicine” is unpredictable. In the short term, research is likely to limp along. A large-scale, controlled and neurobiologically based study is probably at least a decade away”if it ever happens. As neuroscience revolutionizes the entire field of mental illness and addiction research and treatment, however, hallucinogens may well gain legitimacy as a class of chemicals with unique properties worthy of serious investigation. Until then, modern-day Bill Wilsons struggling with recovery are stuck with the black market.
The Fix looks into the future of research into using psychedelic substances as potential treatment methods for addiction. The article highlights a large variety of psychedelic studies that are producing promising results for the future of treating addiction, as well as other conditions.