Alcohol consumption disorder places a heavy clinical, social, and personal cost on those who experience it, as well as a huge financial impact on society. After medical detoxification and focused treatment programmes, there is a high rate of relapse with current treatments, both psychological and pharmaceutical. Lysergic acid diethylamide (LSD)-assisted psychotherapy, used to treat what was then known as alcoholism, is considered to be one of the early examples of psychedelic drug-assisted psychotherapy.
- Results were mixed, though, and as a result of social pressures and cultural shifts, psychedelic therapy with LSD and other “traditional” psychedelics lost popularity.
Psychedelic clinical research is currently being revisited, and this time it’s focusing on alcohol use disorder and other substance use disorders. Any type of substance use disorder has never been fully studied as a candidate for treatment with 3,4-Methylenedioxymethamphetamine (MDMA)-assisted psychotherapy. However, MDMA has gained popularity recently as a remedy for post-traumatic stress disorder (PTSD).
- When administered in a clinical setting, MDMA Therapy is well adapted to allowing a patient to explore and address upsetting memories without being overtaken by negative emotion because of its distinct receptor profile and reasonably well-tolerated subjective experience of drug effects.
In a currently ongoing study in England, researchers are speculating that patients with Alcohol-Use Disorder (AUD) who have undergone a medical detoxification from alcohol might benefit from a course of MDMA-assisted psychotherapy given that alcohol use disorder is so frequently linked to early traumatic experiences.
- The Psychosocial and Clinical Effects of Alcohol-Use Disorder
Despite the fact that drinking alcohol is a common social behaviour and that many drinkers don’t have any issues, about 24% of adults in England consume alcohol in a hazardous way, and 6% of men and 2% of women fulfill the diagnostic criteria for alcohol use disorder.
- The disorder is characterized by withdrawal symptoms when alcohol consumption is stopped, drinking to prevent withdrawal symptoms, tolerance, and a persistent want to drink despite unfavourable effects (APA, 2015). Illness and injuries resulting from alcohol use disorders have a profound social impact on family, friends, and the larger community.
Patients commonly report using alcohol as a method of self-medication and frequently come with significant levels of despair, anxiety, and social alienation. There is a link between AUD and PTSD, and many people with the illness have a history of psychological trauma.
- “Considering related health disorders, crime, anti-social behaviour, accidents, loss of productivity and domestic problems, the Department of Health estimates that alcohol use disorder is now costing around £20 billion a year in England alone.” (Sessa, 2018).
- Current Psychopharmacological and Therapeutic Treatments for Alcohol-Use Disorder
The huge disparities between patients, the severity of the condition, and the numerous confounding psychosocial factors at play are reflected in the wide variety of treatments available for alcohol consumption disorder. At a cost of 3.1 million, nearly 200,000 prescription drugs were given out in the UK in 2013 to treat AUD, and there were 6490 alcohol-related fatalities in 2012.
- Acamprosate, disulfiram, naltrexone, nalmafene, and benzodiazepines are examples of approved pharmaceutical treatments (Sessa, 2018). The competitive opioid antagonist’s naltrexone and nalmafene, as well as the glutamate antagonist acamprosate, are used to lessen the frequency of cravings.
- Benzodiazepines are frequently recommended as part of an alcohol detoxification programme, and disulfiram discourages use by causing an unpleasant bodily reaction if alcohol is consumed (Sessa, 2018).
Numerous psychological therapies are available, but their effectiveness is far from optimal and they have substantial recurrence rates. Forty-six therapies were graded according to the rates of abstinence attained in a systematic assessment of 361 controlled studies using both pharmaceutical and psychotherapy treatments.
- The strategy of brief interventions came in first, followed by motivational enhancement therapy. Acamprosate and naltrexone pharmacotherapy came in third and fourth, respectively. Three-year abstinence rates were found to be 36% for 12-step facilitation (TSF), 27% for motivational enhancement therapy (MET), and 24% for cognitive-behavioral coping skills (CBT) participants in a sizable prospective study (Sessa, 2018).
- Both naltrexone and acamprosate show only minor positive effects in relapse prevention, and only when used in conjunction with well-delivered psychosocial interventions, which for alcohol use disorder have notoriously high drop-out rates of between 50 and 75%. (Sessa, 2018).
- A more recent review evaluated the efficacy of relapse prevention medications in various combinations with behavioural treatment. According to some research, relapse rates after therapy are approximately 60% at 12 months and up to 80% at 3 years (Sessa, 2018)
In conclusion, treatments are far from adequate despite the severe clinical, social, and financial costs of alcohol use disorder. Considering this, research investigations investigating the potential value of a novel strategy using psychedelic-assisted psychotherapies for alcohol and other substance use disorders have seen a large amount of revisitation in recent years.
- The Use of Psychedelics as a treatment for Substance-Use Disorders (SUD)
Alcohol consumption disorder has been a recognised target for psychedelic-assisted therapy since the 1950s, when the idea first emerged that a powerful, drug-induced spiritual or mystical peak experience could be developed as a means of triggering sobriety (Sessa, 2017a).
- With varied degrees of efficacy, LSD-assisted psychotherapy was investigated, although there was significant heterogeneity among the trials conducted. Early, unreliable studies revealed abstinence rates of between 30% and 50% (Sessa, 2018).
Some researchers questioned the claims made by the pioneers in the field and discovered no appreciable differences in drinking patterns between the randomised groups or no long-lasting gains.
- However, to counteract the heterogeneity of the early studies, a meta-analysis paper from 2012 reviewed six randomised trials of LSD for alcohol use disorder from the 1950s and 1960s. It found generally positive results, with 59% of the LSD-treated participants significantly improving compared to 38% of the controls (Sessa, 2018).
- Present-day Research on Psychedelics for Addictions
Based on the idea underlying the experiments from the 1950s and 1960s, a group in Eastern Europe looked into the potential application of ketamine-assisted psychotherapy for both alcohol and opiate use disorders in the 1990s.
- Ketamine psychotherapy resulted in total abstinence for more than a year in 66% of the alcoholic patients, compared to 24% in the control group, according to placebo-controlled studies including more than 1000 patients. Exeter, UK is actively re-examining ketamine therapy for the treatment of alcohol use disorder (Sessa, 2018).
In a report published in 2012, reviewed the use of psychedelic psychotherapy as a treatment for substance use disorders. Ten volunteers with alcohol use disorders participated in a single-group proof-of-concept research conducted. Psilocybin was administered twice to participants, who also underwent 12 weeks of outpatient psychosocial therapy, including Motivational Enhancement Therapy.
- Results showed that after taking psilocybin, abstinence dramatically increased, and the improvements persisted for 36 weeks of follow-up (Sessa, 2018).
A small psilocybin-assisted psychotherapy pilot study for treating nicotine use disorder was another recent psychedelic-assisted research study for treating other substance use disorders, and it resulted in abstinence rates from smoking cigarettes that were significantly higher than those of currently available nicotine cessation treatments (Sessa, 2018).
- According to researchers, the psychedelic chemical ayahuasca has also been studied as a potential treatment for a variety of substance use disorders. One Canadian study found that ayahuasca significantly improved abstinence maintenance for cocaine use disorder (Sessa, 2018).
MDMA Therapy has not yet been suggested as a treatment for any substance use problems in published studies. However, the author is presently conducting a feasibility and safety study, postulating that MDMA-assisted psychotherapy might be effective in treating alcohol consumption disorder due to its ability to speed up the psychotherapeutic process and address underlying psychological trauma.
- The proposed MDMA-assisted study will be conducted on more severe, physically dependent daily drinkers who will go through a medical detox from alcohol before beginning the psychotherapeutic course of sessions, in contrast to the psilocybin-assisted psychotherapy for alcohol use disorder.