Psychedelics for Addiction
Recent research on psychedelics, particularly with classic serotonin 2A receptor agonists such as LSD, psilocybin, and ayahuasca, has brought about new hope for people with addiction issues. An ever-growing body of evidence suggests that psychedelics administered to suitable recipients can occasion positive transitions in behavior, which has resulted in a forceful upsurge of interest in their anti-addictive potential when delivered in a therapeutic setting.
Preliminary research, particularly regarding our two most socially accepted addictive substances — tobacco and alcohol — certainly looks promising. To date, classic psychedelics are the most extensively studied and appear to be the most capable therapeutic adjuncts. However, so-called “atypical psychedelics” like ketamine, MDMA, and ibogaine, which exert their psychoactive effects differently from the classics, are also showing promise.
After decades of disinformation surrounding these often mystical-experience-inducing compounds, their therapeutic properties are once again, yet altogether more tentatively, approaching the forefront of mainstream consciousness, and receiving what appears to be a much-deserved increase in serious attention from the medical community.
Early Research Using LSD
Humphrey Osmond, the well-known English psychiatrist and the man who conceived the term 'Psychedelic,' began studying the efficacy of d-lysergic acid diethylamide for addiction, otherwise known as LSD, while furthering his research as an expatriate in Saskatchewan, Canada, at Weyburn Mental Hospital during the 1950s.
The research team, led by principal investigator Osmond, began by treating alcoholics with LSD, in which they realized substantial rates of recovery. They believed that alcoholism was best treated biochemically, which would subsequently beg the question as to whether or not alcoholism was a serious mental health condition and not a consequence of weak character, as was commonly believed at the time.
The unprecedented abstinence rates observed in early studies fortified a public campaign that looked to advance LSD treatments for addiction, supported by the provincial Government, Alcoholics Anonymous, and the Bureau of Alcoholism. Although these organizations spearheaded the campaign, LSD as a treatment for addiction still faced many obstacles. With questions surrounding the methodological rigor of Osmond’s trials, research on LSD for alcohol addiction ultimately failed to meet the standards of the foremost authority on addictions — the Addictions Research Foundation.
With a bleak outlook concerning alcohol addiction already in sight, LSD soon became the foremost biochemical contributor to a counter-cultural movement symbolizing non-compliance and rebellion. Unfortunately, sensationalist propaganda pushed by the mass media swayed public opinion and fueled opposition to LSD’s status as an efficacious addiction treatment.
This contributed to the neglect of LSD’s demonstrated efficacy and the drug’s eventual banning with the passing into law of the 1970 Controlled Substances Act. A 2012 meta analysis of six clinical trials conducted in the 60s and 70s involving over 500 participants found that LSD had beneficial effects on alcohol misuse.
Psilocybin for Tobacco and Alcohol Addiction
With 8 million deaths per year projected by 2030, it comes as no surprise that tobacco addiction remains a constant health consideration continuing into the ensuing decade. In recent years, however, psilocybin, the psychoactive component of so-called magic mushrooms, also a classic 2A receptor agonist, has been shown to produce significantly high abstinence rates when used in tandem with supportive therapy.
A 2014 study published in the Journal of Psychopharmacology found that two to three doses of 20 and 30 mg/70kg of psilocybin, administered in combination with cognitive behavioral therapy (CBT), resulted in considerably higher abstinence rates compared to traditional medication or therapeutic practices. In a follow-up study conducted twelve months later, 60% of the participants were "biologically confirmed as smoking abstinent," which compares favorably to the less than 31% abstinent rates typically seen with the current most effective approved smoking cessation medication.
While this study was not spiritually focused, it's important to mention that participants reported increased levels of spirituality concurrent with an improved smoking cessation outcome, which is consistent with previous pilot survey data in which 78% of substance-dependent participants stated that spiritual resources would be beneficial when attempting to refrain from smoking. This contribution to the addiction literature raises important questions regarding the apparent relationship between spirituality and addiction recovery.
Fortuitously, it's not just smoking-addicted folks that may benefit from this mystical mesh of mycelium embedded beneath our feet. Psilocybin, when used in conjunction with psychotherapy, has recently been shown to produce "robust decreases" in the consumption of alcohol compared to placebo (diphenhydramine) and psychotherapy
The Anti-Addictive Properties of Ayahuasca
The traditional Amazonian psychotropic brew, ayahuasca, has also been seen to have potential medicinal efficacy in treating substance addiction. This concoction, rich with psychoactive ingredients, namely the bark of the Banisteriopsis caapi vine and the leaves of the Psychotria Viridis bush, is administered in ayahuasca centers throughout the world, but most commonly in the Amazon, to which the brew is native.
Thousands of substance-addicted souls travel to the Amazon each year to participate in rehabilitative ayahuasca retreats aiming to rid themselves of dependence, be it psychological or physical, with many reportedly doing so with great success. Traditionally used for shamanic healing and religious purposes right across the continent of South America, the therapeutic effects of ayahuasca used in both naturalistic and controlled settings are being researched more so than ever, garnering impressive results.
Findings to date seem to suggest that the most potent anti-addictive effects of ayahuasca may be produced when it is consumed as part of a traditional ceremony, indicating that the brew’s therapeutic potential may be intimately tied to ritualistic use and the unique altered state of consciousness induced in this setting.
Under the influence of ayahuasca, users report experiencing profound realizations of drug-induced self-destruction and being guided instead towards a path of deep self-awareness on which they acknowledge that addiction may “lead to their ruin” unless a drastic behavior change is achieved.
It's not called the “vine of the soul” for nothing, folks.
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Ketamine: Possible Efficacy for Heroin, Cocaine,
and Alcohol Addiction
The drug Ketamine is a dissociative anesthetic that, unlike classic psychedelics, rapidly crosses the blood-brain barrier and primarily exerts its effects as an antagonist of the n-methyl-d-aspartate (NMDA) receptor.
In 2019, the Food and Drug Administration (FDA) approved the ketamine derivative esketamine (Spravato), in conjunction with an oral antidepressant, for treatment-resistant depression in adults after ketamine was shown to have profound antidepressant effects in several controlled trials. Also, ketamine clinics in North America administer intravenous ketamine off-label (use of approved medication for an unapproved indication) to patients suffering from depression and anxiety.
The first person to explore ketamine as a potential addiction treatment was controversial psychotherapist Salvador Roquet, whose illegal practices eventually led to his imprisonment. Clinical trials did not begin until the 1990s, however, with the dawn of Krupitsky and Grinenko’s ketamine psychedelic therapy (KTP), in which intramuscularly injected ketamine was shown to promote alcohol abstinence in detoxified patients. These trials did not stand up to the rigor of modern-day double-blind randomized controlled trials, however, and so outcomes are best interpreted as preliminary.
The findings of a stronger, randomized trial by the same researchers in 2002 showed that a high ketamine dose (2mg/kg) produced significantly greater rates of abstinence in heroin-dependent patients than a low dose (0.2mg/kg). Krupitsky and colleagues followed this up with a 2007 study in which they showed that three sessions of ketamine psychedelic therapy maintained abstinence in 50% of previously heroin-dependent participants compared to 22% who received just one session.
More recent ketamine research is consistent with earlier findings. A 2014 study showed that relative to the benzodiazepine medication lorazepam, ketamine enhanced motivation to quit cocaine and reduced cue-induced cocaine craving, results which were mediated by ketamine-induced mystical experience.
These results were corroborated by clinical trials conducted in 2017 and 2019 that saw ketamine substantially reduce self-administration of cocaine, cocaine craving, cocaine reactivity, and cocaine use in normal life in cocaine-dependent users relative to the benzodiazepine medication midazolam. A 2019 randomized controlled trial found that a single ketamine infusion (0.71 mg/kg) in conjunction with motivational enhancement therapy significantly increased abstinence rates and led to a lower likelihood of alcohol use, heavy drinking, and a longer time to relapse compared with placebo (midazolam).
At the 6-month follow-up, 75% of the ketamine group remained abstinent, compared to just 27% of the midazolam group.
Ketamine’s anti-addictive potential is hypothesized to be associated with several mechanisms, including its ability to enhance neuroplasticity (reorganization of the brain), neurogenesis (formation of new neurons), and synaptogenesis (formation of synapses between neurons), as well as its atypical production of profoundly meaningful psychedelic experiences.
An “essential medicine” for many years, ketamine is sure to garner increasing attention in the next decade as a treatment for addiction.
Ibogaine: A Naturally Occurring Compound with Promise
The naturally-occurring, long-lasting psychedelic compound ibogaine, derived from the roots of the West African shrub Tabernanthe iboga, has also shown considerable promise in treating addiction, according to preliminary research.
Traditionally used in days-long initiatory rituals and as a spirit-connecting tool in “Bwiti,” a syncretic and multi-ethnic religion in Central-West Africa, this psychoactive indole alkaloid owes its reputation as a potent addiction medicine to an American man named Howard Lotsof, who, having spontaneously cured himself of heroin addiction after a 30-hour long, dreamlike ibogaine experience, organized a focus group in New York City to the spread word of ibogaine’s healing effects, and urge researchers to study this pharmacologically complex compound.
In 1990, 20 members of Lotsoff’s focus group ingested up to 19 mg/kg of ibogaine HCL, seven of whom were chronic heroin users. All seven reported significant alleviation of withdrawal symptoms and heroin cravings in the days following the experiment, with five participants completely abstaining from heroin for six months or longer. Despite the study’s methodological weaknesses, Lotsof was so impassioned by the results that he made it his life ambition to advocate for policy changes and further research on the substance.
After several animal studies and a plethora of promising case reports lent support to Lotsoff’s impassioned pleas regarding ibogaine’s healing power, treatments began taking place in the Netherlands. The US National Institute on Drug Abuse (NIDA) also began supporting preclinical toxicological research and the development of human clinical trials, and the FDA granted researchers at the University of Miami approval to conduct safety trials, and approved protocols for studies with cocaine-dependent individuals. Unfortunately, however, the death of a female patient in the Netherlands brought research to halt, despite there being no evidence of ibogaine’s involvement in the patient’s death.
A retrospective study published in 1999 in which 33 heroin-dependent individuals received 19.3 ± 6.9 mg/kg of ibogaine HCL observed complete resolution of withdrawal in 76% of participants. Soon after this publication, professor of neurology and founder of clinical stage pharma company DemeRx, Dr. Deborah Mash, treated 150 cocaine- or heroin-dependent individuals in a free-standing clinic in St.Kitts, West Indies, reportedly achieving significant and sustained reductions in drug craving and withdrawal.
In recent years, despite the lack of clinical evidence, the ibogaine subculture has continued to expand as the substance itself gains increasing attention from the medical community. Currently, several treatment clinics operate in countries where ibogaine is legal, particularly in Mexico. New Zealand’s categorization of ibogaine as a non-approved prescription medicine in 2010 also speaks to its legitimate anti-addictive properties, although there is a clear need for further research concerning its safety and efficacy.
MDMA for Alcohol-Use Disorder
The unique pro-social, boundary-dissolving, and fear-inhibiting properties of MDMA (3,4-methylenedioxymethamphetamine), the drug commonly called “ecstasy” or “Molly,” may deem it a suitable and effective treatment for substance-use disorders when used in conjunction with psychotherapy. Surprisingly, the anti-addictive potential of MDMA had not been scientifically explored until recently, despite its efficacy in PTSD treatment and the widely reported link between trauma and addiction.
A 2021 study published in the Journal of Psychopharmacology demonstrated that MDMA-assisted psychotherapy may have the capacity to safely enhance the therapeutic processes in patients with alcohol-use disorder. Just two 187.5 milligram doses of MDMA, paired with recovery-focused psychotherapy delivered before, during, and after MDMA sessions, was shown to reduce average weekly alcohol intake from 130.6 units to 18.7 units 9 months post detox.
This study's authors concluded that the treatment’s efficacy may be associated with MDMA’s tendency to reduce avoidance of distressing images, memories, and thoughts, to promote empathy for oneself and others, as well as the therapy’s apparent facilitation of safe access to and at least partial resolving of underlying trauma that for many is the root cause of addiction.
Psychedelics for Addiction: A New Age of Addiction Therapy?
The promising findings of recently conducted clinical studies offer hope. Psychedelic-assisted psychotherapy may be the key to unlocking a life unmarred by harmful drug addiction. With the misuse of opioids, stimulants, and related overdoses on the rise, it is crucial to spread awareness of the apparent efficacy of these alternative treatment modalities.
It is hoped that with further, more rigorous research expected in the coming years, the healing power of psychedelics can soon be utilized safely and responsibly in a therapeutic setting to improve the lives of those suffering from addiction.
Explore By Substance
5-MeO-DMT
5-MeO-DMT (5-methoxy-N, N-dimethyltryptamine) is a short acting, serotonergic psychedelic, found naturally in the venom of the Sonoran Desert Toad (Bufo Alvarius). 5-MeO-DMT is gaining popularity as an effective tool for spiritual exploration and healing due to its extremely powerful psychoactive effects.
Ayahuasca
What is unique about ayahuasca is that it is a concoction of two plants, the combination of which is essential for the ayahuasca experience. Combining two plants to use as medicine may not seem groundbreaking in and of itself, but the fact that if one is taken without the other, the experience is entirely different, and arguably non-existent, is what makes the discovery of ayahuasca so surprising.
DMT
For millennia indigenous-American tribes have consumed N,N-dimethyltryptamine (DMT) as a key ingredient in sacred botanical brews, such as ayahuasca, and snuffs, such as yopo, as part of religious ceremonies in Central and South America.
Ibogaine
Ibogaine is a naturally occurring indole alkaloid derived from the roots of an threatened species of perennial rainforest shrub called Tabernanthe iboga. Ibogaine, which is believed to have potent anti-addictive properties, has been used by the indigenous peoples of central west Africa for centuries.
Ketamine
Though ketamine gained a reputation for being dangerous and easily misused and abused, it wasn’t until 1999 that the US classified it as a Schedule III controlled substance. While it is often associated with the party scene, ketamine therapy is helping change the lives of many with severe depression, PTSD, OCD and even chronic migraines.
LSD
In 1938, a Swiss chemist by the name of Albert Hofmann, working out of Sandoz Pharmaceuticals, became the first man to synthesize Lysergic Acid Diethylamide (LSD). Active at the microgram level (one-thousandth of a gram), LSD is the most potent psychoactive drug known to humankind.
MDMA
The MDMA molecule bears structural resemblance to stimulants and some psychedelics, invoking feelings of euphoria, empathy, and boundless energy. MDMA also intensifies sensory perception, enhancing one’s appreciation of music and color which makes it one of the most popular drugs among festival-goers and electronic dance music fans alike.
Mescaline
In the 16th century, Spanish chroniclers attempted to eradicate ritual use of peyote cactus among indigenous American cultures, which led to the plant’s eventual prohibition in 1720. In the face of adversity, several indigenous communities righteously persevered, continuing and preserving their sacred practice in clandestine secrecy, and even managing to spread it widely over the last 150 years.
Peyote
Peyote is a green spineless cactus that contains the classic psychedelic compound mescaline. Numerous Mesoamerican cultures, including the Huichol (Wixárika), the Cora (náayeri), the Tepehuanes, the Tonkawa, the Mescalero, and the Tarahumara (Rarámuri) have long regarded the plant as sacred, using it in spiritual and healing ceremonies for millennia.
Psilocybin
While evidence suggests that psilocybin mushrooms have been historically used in ritual settings for spiritual and medicinal purposes, they have gained popularity for recreational use, and clinical research on the therapeutic effects of psilocybin is promising.
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Salvia divinorum
Salvia is a psychotropic flowering herb from the Lamiaceae, or mint, family. Salvia’s large green leaves contain the powerful psychoactive compound, salvinorin A. Salvia leaves are used for medicinal and religious purposes by Mazatec shamans in the Mexican state of Oaxaca, and they are often used recreationally in the west.
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San Pedro
Since prehistory, San Pedro has been instrumental to Peruvian cultural traditions. in northern Peru in particular, it has been a tool to facilitate the shaman’s ‘‘journey’’ for healing purposes. Throughout this period, the visionary cactus has been known by many names, including huachuma or achuma.
