Smoke It Again, Abram

Acid Test author Tom Shroder writes for Psychology Today about research into the benefits of psilocybin-assisted psychotherapy for smoking cessation.

Originally appearing on Psychology Today: Part 1 / Part 2

Johns Hopkins researchers announced Thursday in the Journal of Psychopharmacology a stunning success rate in their pilot study using psilocybin-assisted therapy to help heavy smokers quit tobacco. The 12 of 15 recidivist smokers who managed to stop smoking for six months after three sessions with the psychedelic compound found in magic mushrooms represented an 80% success rate, unheard of in the notoriously difficult treatment of tobacco addiction. By contrast, the most successful current treatment – the drug varenicline – only has a 35% success rate.

It’s big news at a time when the use of psychedelic drugs for improving mental health is getting increasing attention after a generation in which all research had been shut down. In fact, in the Johns Hopkins findings, there is an unmistakable echo of research done in Canada half century ago.

Consider this from the study author, Matthew W. Johnson: “"Quitting smoking isn't a simple biological reaction to psilocybin, as with other medications that directly affect nicotine receptors."  Instead, Johnson said, it was the subjective experience the smokers had when taking the psilocybin that changed them — more like a conversion experience in religion, then getting a shot of penicillin to cure an infection.

This was exactly what psychiatrists Humphrey Osmond and Abram Hoffer concluded way back in the 1950s when they had great success using LSD therapy to help alcoholics stop drinking. Hoffer and Osmond’s treatments proved successful enough that the Canadian government would eventually issue a report saying LSD was no longer an experimental treatment for alcoholism, but one that had proven effective.

 “As a general rule,” Hoffer wrote, “those who have not had the transcendental experience are not changed; they continue to drink. However, the large proportion of those who have had it are changed.”

Now, five decades later, after draconian drug laws and a cultural panic reaction shut down Hoffer’s research and all other investigation of the possible benefits of psychedelic therapy, the researchers at Johns Hopkins are rediscovering the wheel, or maybe more apropos of smoking cessation, fire.

It’s hard not to wonder how the world would have been different if psychedelic clinical research had continued through all those fallow decades.

Those who had a transcendent experience, where people say they went into a mystical state that helped them feel unity with themselves and the universe, tended to have more success, the researchers said.

The Johns Hopkins study prepped its 15 subjects with four weeks of pretty standard cognitive behavior therapy – things like visualization, keeping journals, focusing on intent to quit and reasons for quitting, etc.  There were three psilocybin sessions, the first a moderate dose, and the final two a high dose. The subjects were encouraged to focus on their anti-smoking intent before taking the psilocybin in each session, otherwise they were simply encouraged to wear eyeshades and earphones (piping in music) and “go inside.” Attendants were there for their safety and reassurance if necessary, but there was otherwise very little direction given. There were no negative physiological outcomes from the psilocybin sessions. Five of the participants expressed moderate fear during the session (of losing control, losing grip on sanity) and one expressed extreme fear. All of the anxiety reactions were successfully resolved before the end of the session. The 13 participants (80%) who managed to quit and remain smoke free for six months were asked to identify the reasons for their success. The most frequently chosen answer was “by changing the way you orient yourself toward the future, such that you now act in your long term holistic benefit, rather than acting in response to immediate desire.”

The answer chosen as the most important was “by changing the way you prioritize values in life, so that reasons to smoke no longer outweighed reasons to quit.”

These rather basic changes in personality orientation are usually extremely difficult to achieve, both in daily life, and in traditional therapy. The fact that such a high proportion of participants managed these perspective shifts is most likely attributable to life-changing mystical-type experiences catalyzed by the psilocybin. All but two participants (87%) rated at least one psilocybin session among the ten most meaningful experiences of their lives.

This result too has an echo in that long ago LSD research by Humphrey Osmond and Abram Hoffer.  As Hoffer noted, the participants –hard-core alcoholics– who had significant spiritual experiences under the drug's influence were the ones who seemed to be able to stop drinking. The exact nature of the experiences was astoundingly varied, but they often involved some kind of transforming vision, such as one subject from an early alcoholism trial, who described a visualization of meeting himself in hell:

“How can I explain the face, vile, repulsive and scaly, that I took by the hand into the depth of hell from whence it came and then gently removed that scaly thing from the face and took it by the hand up, up into the light and saw the face in all its God given beauty.”

Perhaps the most remarkable thing about it is not the vision itself, but the fact that the experience was powerful enough to end a profound addiction, permanently.

Although Osmond, who also took LSD multiple times himself, had some of the fear responses observed in a minority of the Johns Hopkins participants (“Every so often the walls of the room would shiver, and I knew that behind those perilously unsolid walls something was waiting to burst through. I believed that would be disastrous …  I asked for some water. I drank the glass which [my friend] brought, and found that it tasted strange. I wondered if there might be something wrong with it: poison crossed my mind ….”), he came through in the end to this: “My experiences with these substances have been the most strange, most awesome and among the most beautiful things in a varied and fortunate life. These are not escapes from but enlargements, burgeonings of reality.”