Several lines of evidence suggest that classic (5HT2A agonist) hallucinogens have clinically relevant effects in alcohol and drug addiction. Although recent studies have investigated the effects of psilocybin in various populations, there have been no studies on the efficacy of psilocybin for alcohol dependence.
However, the findings from this study provide a strong rationale for controlled trials with larger samples to investigate efficacy and mechanisms. With that said, we will be doing an in-depth look at current research pertaining to this area!
A Brief Overview on Psychedelics and Psychiatric Treatment
In the 1950s through early 1970s there was extensive research on the use of LSD and other classic (5HT2A agonist or partial agonist) hallucinogens in the treatment of addiction, existential distress in dying patients, pain, and other conditions. However, the past decade has seen a rapid growth of interest in potential clinical applications of the classic hallucinogen psilocybin.
Extensive clinical research with the classic hallucinogens (LSD, psilocybin, DMT, mescaline) has established their relative safety within a clinical research setting when subjects are carefully screened, supervised, and followed up
- A recent meta-analysis examined the six published randomized trials of LSD treatment of alcoholism. A total of 325 participants received active treatment with LSD, and 211 received control treatment. At the first post-treatment follow-up (ranging from 1 month to 12 months) the odds ratio for improvement was 1.96, favoring LSD (95% confidence interval 1.36–2.84, Z= 3.59, p = 0.0003).
- A recent pilot study of psilocybin as an adjunct in smoking cessation treatment resulted in remarkable rates of abstinence (80%-point abstinence at 6-month follow-up.
Psychological Models of Psycheldic Treatment
Clinical work with classic hallucinogens has emphasized the central role of the altered state of consciousness experienced during the drug’s acute effects. Currently, there are two models of ‘psychedelic treatment’ in place.
The first one is the “psycholytic” model of treatment emphasized the use of classic hallucinogens to enhance the process of psychodynamic psychotherapy by making unconscious material more accessible. The second model is the “psychedelic” treatment model on the other hand emphasized the use of relatively high doses of classic hallucinogens (usually LSD) to occasion a “peak-psychedelic” or mystical experience of ego loss, often likened to psychological death and rebirth.
- The latter model was used in most of the clinical studies conducted in North America using LSD in the treatment of addiction or existential anxiety in the dying. The concept of a singular transformative experience leading to lasting behavior change is consistent with classic descriptions of religious conversion “spiritual awakening” in the context of Alcoholics Anonymous and spontaneous Quantum Change experiences.
Recent studies have demonstrated that the self-reported “mystical” dimension of the psilocybin experience (feelings of unity, sacredness, ultimate reality, transcendence of time and space, deeply felt positive mood, and ineffability significantly predicts the lasting personal significance of the experience and personality change in normal volunteers receiving psilocybin.
The evidence summarized above provides a convincing rationale for investigating whether a classic hallucinogen can improve treatment response among patients with alcohol dependence. Despite the accumulating evidence that psilocybin has clinically relevant effects and is safe under controlled conditions, there are no prior studies of psilocybin in the treatment of alcohol dependence. Therefore, the aim of the current study is to quantify the psychoactive effects and tolerability of oral psilocybin in alcohol-dependent participants, and to evaluate outcomes during and after completion of treatment.
An Overview of the Methodology and Findings
- Participants were recruited from the community using advertisements in local media and flyers. They were males and females aged 25–65 with a diagnosis of active alcohol dependence, ascertained using the Structured Clinical Interview for DSM-IV (SCID), and at least two heavy drinking days in the past 30 days, who were concerned about their drinking and not currently in treatment
- The psychosocial intervention comprised a total of 12 sessions: seven sessions of Motivational Enhancement Therapy (MET: a structured approach using the principles of motivational interviewing, three preparation sessions, and two debriefing sessions. Four sessions occurred before the first psilocybin session, four sessions between the first and second psilocybin sessions, and four sessions after the second psilocybin session.
Dosing and Administration of Study Medications
- The psilocybin sessions took place in a room that was specially prepared to provide a living-room-like environment for the sessions. Individualized doses of psilocybin (based on participant weight) were prepared by the study pharmacist on the morning of the session and placed in a single gelatin capsule. Participants ingested the psilocybin capsule followed by 4 ounces of water. They were instructed to lie on a couch wearing eyeshades and headphones (providing a standardized program of music), and to direct their attention toward their internal experience. Participants remained under observation for at least 8 hours following psilocybin administration. Both therapists were present throughout the session. Interactions with the participants were supportive and non-directive.
- For the first psilocybin session, participants received a dose of 0.3 mg/kg. For the second session, the dose was increased to 0.4 mg/kg.
Participants exhibited significant improvement in drinking, with large pre–post effect sizes, as well as significant changes in psychological measures relevant to drinking. Importantly, much of the improvement occurred following the administration of psilocybin, at which time participants had already received 4 weeks of psychosocial treatment and 4–6 hours of assessment. Also, strong correlations were observed between measures of intensity of the acute drug effects and clinical outcomes. Although change in drinking was correlated with the mystical quality of the experience, it was similarly associated with ratings of other acute effects.
- Following the first psilocybin session, percent heavy drinking days and percent drinking days are significantly lower than baseline at all follow-up points.
- Percent heavy drinking days decreased during weeks 5–12 relative to baseline.
However, more work will be necessary to determine whether there are particular characteristics of the acute psilocybin experience that are predictive of therapeutic benefit in alcohol use disorder.