Can Psychedelics Solve the Addiction Crisis?

This was originally published on my blog, www.psychaddiction.com.

Psychedelics are back in the limelight. After a nearly five?decade?pause, researchers have turned their attention back to these incredible compounds known for their vivid hallucination producing effects. News outlets and distinguished authors have jumped to the call and are quickly embracing psychedelics as the best new treatment for all manner of ailments: depression, addiction, post-traumatic stress disorder, and more. There are already several facilities in Mexico and South America catering to a clientele of psychedelic treatment tourists. But are we really entering a new era of mental health treatment, or are psychedelics another flash in the pan quick fix solution that can’t live up to the hype??

Research into the therapeutic effects of psychedelics has been going on since the late 1800s, but its heyday was in the 60’s and 70’s. LSD was just discovered, and scientists eagerly began applying it to problems such as alcoholism, depression, and general well-being. However, this research was cut short due to new strict drug regulations regarding psychedelics, effectively stomping out all academic research on the therapeutic value of these drugs.?

Much of that early work showed promise. In particular, LSD was considered as a potential new treatment for alcoholism, with even Bill Wilson (founder of Alcoholics Anonymous) being convinced of its utility. In a meta-analysis of randomized controlled trials throughout the 60’s and 70’s testing LSD’s effectiveness at treating alcoholism, Krebs and Johansen (2012) found that a single, large dose of LSD was just as good or better at both reducing drinking and promoting abstinence than daily doses of naltrexone, disulfiram, or acamprosate – our three best medications to treat alcoholism currently. Between six different trials,?59% showed improvement with LSD and therapy compared to 38% who received therapy and a placebo.?

Other addictions and substances are now being investigated as well, some producing startling results. Psilocybin, for instance, has shown promise with tobacco addiction. A recent pilot study looking at psilocybin-enhanced therapy for daily smokers had a remarkable 80% of their participants abstinent from cigarettes?six months after?the treatment (Johnson et al., 2014). Being a pilot study, there were obviously significant caveats: only 15 participants, no blinding or randomization, and no control group. Nonetheless, it showed that psychedelics may have a promising future in addiction treatment.?

The findings indicate a treatment that is distinctly unlike most of what we see in modern medicine. Instead of providing a specific, targeted effect to a particular receptor in the brain, psychedelics offer an immensely powerful experience which can catalyze behavioral change. The subjective experience of psychedelics cannot be understated – vivid hallucinations, both auditory and visual. Overwhelming emotional experiences and a sense of connectedness to all things. With larger doses, one can even experience “ego-death”, the feeling that your sense of self crumbles before a greater reality. Moreover, these experiences are characterized by their noetic quality – the perception that they are real and authentic experiences, not fleeting delusions to be ignored.?

Such experiences are rarely seen in everyday life, but are comparable to a powerful spiritual or religious experience, or a strong psychotic episode. It seems no coincidence that in Alcoholics Anonymous, a spiritual experience is the desired goal of working the 12 steps and the source of a newfound ability for abstinence. These experiences can create a turning point, a moment of significance which can drive someone in a different direction – away from substance use, towards stronger social connections, or to exert themselves in a new endeavor. Indeed, many studies have found that the stronger a participant endorses a mystical experience during their trip, the more likely they are to maintain abstinence?(Bogenschutz & Johnson, 2016).?

But could a specific drug action be creating this effect? Each hallucinogen has a wide variety of drug actions, but the psychedelic effects seem to be primarily linked to agonism at the 5-HT2A (serotonin 2A) receptor?(Bogenschutz & Johnson, 2016). Classic hallucinogens have led to downregulation of the 5-HT2A receptors in rat models?(Gresch et al., 2005), potentially decreasing symptomology of a host of different mental health outcomes correlated with increased 5-HT2A binding, but this has not been shown to occur in humans.??

There are also neuroimaging studies which show an increased connectivity between the default-mode network?and task-positive networks after being administered a hallucinogen (Carhart-Harris et al., 2013). This increased?connectivity is also observed in meditative states, and could potentially tie in to therapies such as Mindfulness-Based Relapse Prevention (MBRP). MBRP is one of the most effective treatment modalities for substance use disorders?(Bowen et al., 2014), outperforming even gold-standard treatments in terms of relapse and craving. However, the increased connectivity between these networks does not persist after the drug wears off. Perhaps with repeated administrations or micro-dosing, increased connectivity could lead to similar results, but there is currently no research into this area.??

Each of these actions has some far-flung connection to addiction, but the evidence for any particular drug action is woefully thin. For now, we know that psychedelic-enhanced therapies may indeed?prove a useful tool for addiction treatment, but they are by no means a guaranteed cure. If we take the limited current evidence at face-value, we might expect a moderate increase in treatment success compared to conventional treatments.??

The most promising areas of psychedelic treatment might be tobacco addiction, where psilocybin has seemingly excelled, or perhaps methamphetamine treatment, where there are currently no medications available that have been shown to improve outcomes. With so many avenues for further research, there is good reason to be excited about psychedelic potential. But when media outlets loudly cry about their revolutionary status in medicine, a treatment center south of the border offers an addiction cure through Ayahuasca, or someone offers you a chance to invest in their new ibogaine IPO, take it with a grain of salt – we can’t let our hopes of curing addiction get ahead of the research.?

References?

Bogenschutz, M. P., & Johnson, M. W. (2016). Classic hallucinogens in the treatment of addictions.?Progress in Neuro-Psychopharmacology and Biological Psychiatry,?64, 250–258.?https://doi.org/10.1016/j.pnpbp.2015.03.002?

Bowen, S.,?Witkiewitz, K.,?Clifasefi, S. L., Grow, J., Chawla, N., Hsu, S. H., Carroll, H. A., Harrop, E., Collins, S. E.,?Lustyk, M. K., & Larimer, M. E. (2014). Relative Efficacy of Mindfulness-Based Relapse Prevention, Standard Relapse Prevention, and Treatment as Usual for Substance Use Disorders: A Randomized Clinical Trial.?JAMA Psychiatry,?71(5), 547–556.?https://doi.org/10.1001/jamapsychiatry.2013.4546?

Carhart-Harris, R. L., Leech, R.,?Erritzoe, D., Williams, T. M., Stone, J. M., Evans, J., Sharp, D. J., Feilding, A., Wise, R. G., & Nutt, D. J. (2013). Functional Connectivity Measures After Psilocybin Inform a Novel Hypothesis of Early Psychosis.?Schizophrenia Bulletin,?39(6), 1343–1351.?https://doi.org/10.1093/schbul/sbs117?

Gresch, P. J., Smith, R. L., Barrett, R. J., & Sanders-Bush, E. (2005). Behavioral Tolerance to Lysergic Acid Diethylamide is Associated with Reduced Serotonin-2A Receptor Signaling in Rat Cortex.?Neuropsychopharmacology,?30(9), 1693–1702.?https://doi.org/10.1038/sj.npp.1300711?

Johnson, M. W., Garcia-Romeu, A., Cosimano, M. P., & Griffiths, R. R. (2014). Pilot study of the 5-HT2AR agonist psilocybin in the treatment of tobacco addiction.?Journal of Psychopharmacology,?28(11), 983–992.?https://doi.org/10.1177/0269881114548296?

Krebs, T. S., & Johansen, P.-?. (2012). Lysergic acid diethylamide (LSD) for alcoholism: Meta-analysis of randomized controlled trials.?Journal of Psychopharmacology,?26(7), 994–1002.?https://doi.org/10.1177/0269881112439253?