Several studies have found psilocybin to be safe and effective in treating substance use disorders—but a first-of-its-kind analysis offers novel insights into exactly how psychedelic-assisted therapy works for people addicted to alcohol.
Researchers at NYU, UC San Francisco and the mental health practitioner training provider Fluence set out to investigate the therapeutic mechanisms that led a cohort of people with alcohol use disorders (AUDs) to significantly reduce negative drinking behavior after participating in an earlier landmark psilocybin clinical trial.
Thirteen volunteers who received the psilocybin treatment were contacted months later, and the investigators asked them in-depth qualitative questions about their experiences during and after the trial.
The study, published by the American Psychological Association in the journal Psychology of Addictive Behaviors, revealed several common themes among participants that could help inform future research and therapeutic applications as more states move to promote psychedelic studies and regulated access.
“Participants reported that the psilocybin treatment helped them process emotions related to painful past events and helped promote states of self-compassion, self-awareness, and feelings of interconnectedness,” the authors wrote. “The acute states during the psilocybin sessions were described as laying the foundation for developing more self-compassionate regulation of negative affect. Participants also described newfound feelings of belonging and an improved quality of relationships following the treatment.”
“Our results support the assertion that psilocybin increases the malleability of self-related processing, and diminishes shame-based and self-critical thought patterns while improving affect regulation and alcohol cravings. These findings suggest that psychosocial treatments that integrate self-compassion training with psychedelic therapy may serve as a useful tool for enhancing psychological outcomes in the treatment of AUD.”
The researchers emphasized that the purpose of the analysis wasn’t to identify an “objective reality” of the therapeutic mechanisms behind psilocybin; rather, “we sought to uncover the lived experiences of these individuals through collaborative inquiry.”
Participants described their past relationship with alcohol, with most expressing that they had used used “destructive coping strategies throughout their childhoods and into their adult lives to manage uncomfortable affects.” Alcohol “initially provided participants with an effective tool for managing and reducing distressing feelings and social anxiety.”
The study subjects almost universally said that they had experienced inner narratives that consisted of excessive blame, guilt and resentment toward people they were close to, and that inner voice was often self-critical and lended to intrusive thoughts.
Whereas alcohol “inhibited a sense of connection with self and others as well as meaning and belonging,” according to most of the participants, psilocybin “elicited an intense range of emotions that had been suppressed for long periods of time.”
“Participants described experiences of ‘catharsis’ and ’emotional rollercoaster[s],’” the study says. “Several participants specifically commented on how psilocybin helped them to process and release emotional pain that had been bound up with their alcohol use. Participants noted that psilocybin helped them develop self-awareness and new understandings about their alcohol use and coping patterns.”
Importantly, the subjects stressed the value of having therapists and a controlled environment in which to experience the psychedelic medicine. These were “essential elements in facilitating the psychological safety needed to examine and resolve psychological stuck points,” the paper says.
Many of the participants also described having a deepened sense of spiritual insight, and they learned mindfulness techniques that enabled them to “mentally disentangle from overwhelming thoughts and feelings, which would have previously driven them to drink.”
Another key takeaway from the qualitative analysis is that while the participants who went through the clinical trials generally reported fewer days drinking and reduced desire to drink, cravings didn’t fully disappear for everyone and it was understood that psilocybin on its own is not a panacea.
The differences in each person’s experience could help steer further investigational research into the types of dosages, settings, supportive therapy and follow-up measures that go into effective psilocybin-assisted treatment.
“A highly structured setting along with a strong therapeutic alliance, supportive therapy, and community-based aftercare support may be needed to transform rigid coping strategies into vehicles for healing and to manage strong cravings and prevent relapse,” the study says.
Another important consideration that the authors noted is that the participants are not necessarily representative of the community most at risk of substance misuse, as they were mostly white with an average income of $144,000 annually.
“In psychedelic research studies, Black, Indigenous, and People of Color have been vastly underrepresented even as the multigenerational effects of centuries of racialized policies burden them with high rates of trauma and other mental health sequelae,” they wrote. “This presents stakeholders with an ethical imperative to prioritize providing opportunities to individuals from historically underrepresented communities to ensure generalizability and that those who could stand to benefit most are not excluded.”
Still, the qualitative reports contribute “to an understanding of the therapeutic process as well as considerations for future research in the nascent field of psychedelic psychotherapy for ASUD and disorders characterized by rumination and emotional avoidance.”
Elizabeth Nielson, a study co-author and co-founder of Fluence, said in a press release that qualitative research “gives us a direct understanding of the lived experience of psychedelic therapy clinical trial participants, from their perspective and in their own words.”
“This study complements existing quantitative clinical research, adding detail and nuance to the picture of how the treatment unfolded and what future clinicians might encounter in their work with patients,” Nielson said.
At the federal level, the National Institute on Drug Abuse (NIDA) recently started soliciting proposals for a series of research initiatives meant to explore how psychedelics could be used to treat drug addiction, with plans to provide $1.5 million in funding to support relevant studies.
The research is especially timely as advocates and lawmakers work to promote psychedelics research and regulated access to substances like psilocybin.
Last month, Oregon regulators approved the nation’s first license for a psilocybin service center where people will be able to use the psychedelic in a supervised and facilitated environment. With that development, officials have now officially approved at least one license for each of the four business categories created by the state’s psilocybin law.
Also last month, the governor of Colorado officially signed a bill to create a regulatory framework for legal psychedelics under a voter-approved initiative.