Can 12-Step Groups and Psychedelic Addiction Treatment Coexist?

The experience that had brought on his newfound dedication to sobriety was a stay at a clinic in Mexico, where he took the psychedelic drug, ibogaine. When others in his programs would ask what detox program he went to, and he was honest about it involving a psychedelic drug, he got mixed responses. 

“People didn’t quite understand,” said Kevin, who is using only his first name to protect his identity and that of others in his 12-step groups. Some said things like, “Oh that sounds like a cool drug, I’d love to try it,” and treated his experience as if it was recreational. Others felt that Kevin's psychedelic use would be a barrier to his recovery.

“I quickly felt alienated about that part of my story,” Kevin said. “I wanted to fit in. I wanted to be a part of the social structure of the rooms." 

Starting from the first time he shared in a meeting, he started to censor himself. "I would gloss over the ibogaine treatment," he said. "I'm pretty sure I'd really never mentioned it, aside from those private conversations that I quickly stopped. Over time, it stripped away the ability for me to merge that part of my story into this public forum.”

12-step programs, also called fellowships, include the well-known Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), and there are dozens of other groups for different issues. In 2020, AA estimated there were over two million active members and 129,790 groups worldwide. 12-step programs provide considerable help for many: They're free and widely available, and though they're not run by professionals, a 2020 Cochrane review of AA found that it can be as or more effective than other established treatments, such as cognitive behavioral therapy, for increasing abstinence.

Yet there's an existing and growing tension between the well-established world of 12-step programs and the use of psychedelics for substance use disorders. Psychedelics as a tool for recovery and addiction challenge 12-step's ideas about what sobriety is: a total abstinence from any mood- or mind-altering drug, psychedelics included. 

As psychedelics become a more realistic option for a variety of conditions,  practitioners will have to figure out how to integrate them with already existing treatments. In the case of depression, for example, psychotherapists will have to educate themselves on integration and harm reduction. Given the promising preliminary studies on using psychedelics for alcoholism and smoking cessation, and ongoing or forthcoming studies on psychedelics for cocaine and opioid addiction, how psychedelics might coexist or overlap with 12-step programs or medication based-treatments is an open question. 

The issue is not necessarily whether psychedelics are "better" than 12-step programs, or vice versa, but rather what are the consequences if these two recovery options remain mutually exclusive— if a person in AA feels that psychedelics can never be an option for them, or a person who utilizes psychedelics for recovery feels they can’t remain in their 12-step group.

Fellowships like AA are not monolithic. Because of their organic nature, their acceptance of those who may be interested in psychedelics will vary widely. While some fellowships will likely be at least tolerant of members expressing an interest in psychedelics, others will inevitably stick to a stricter definition of what it means to be abstinent from all drugs and alcohol. (The definition of a "drug" is of course somewhat subjective, considering that nicotine and caffeine are used widely throughout fellowships.) 

Historically, 12-step programs haven't always been welcoming to exceptions, as in the case of medication-assisted therapy (MAT), like methadone or buprenorphine, for opioid use disorder. Narcotics Anonymous distinguishes between being truly “clean” and being on medications. Alcoholics Anonymous has also had a mixed view on psychiatric medications. 

Since there's practically no research on the overlap between 12-step and psychedelics, a graduate student at the University of Michigan has just started a study that will be surveying people on this very question. "This understanding will help us develop health education strategies and public health recommendations to reduce barriers to those seeking psychedelic treatment to aid in their addiction recovery," Kelsey Taylor said. 

When Kevin was finally reaping the benefits of recovery—able to finish his college degree and stay away from opioids—he couldn’t escape the nagging sense of alienation that he didn’t fully belong with the recovery community, or that if people knew his full story, they would find something wrong with it.

“And I couldn’t stop being interested in psychedelics,” he said.

Psychedelics appear to work differently. They do have physical effects on the body and brain, but they also bring about profound psychological experiences that—anecdotally—people say help them stop using. 

“It really gets to more of the core of what addiction is, cutting across these substances,” said Matthew Johnson, the associate director of the Johns Hopkins Center on Psychedelic and Consciousness Research. Johnson is interested in the commonalities that underlie addictions to various substances, and how psychedelics can be used to address that bigger picture.

“Frankly, that’s something that the medical and research psychology communities haven't dealt with well,” he said. “And something that traditions like a 12-step or religious program have. One can have critiques about any particular method, but the thing that they've always gotten is it's about something bigger. It's not just about quelling the craving of the nicotinic receptor or the GABA receptor. It's about your life and the story of your life that's gone out of whack.”

That's not to say that physical dependence isn’t an important piece of the puzzle. In fact, in a study that Johnson is getting off the ground now, he and his colleagues will be testing if psilocybin sessions are helpful for people who are taking methadone but still struggling with drug use. Yet the goal is not to have them come off methadone, and there won’t be any encouragement to do so. It will instead be to help with the psychological side of addiction.

Ironically, Johnson said he’s heard some of the same notions of sober purity from those in the psychedelic community that can be found in the 12-step communities. “There can be a lot of puritanism and anti-methadone and anti-buprenorphine in the psychedelic community, which I really don’t like,” Johnson said. 

Peter Hendricks, a professor at University of Alabama at Birmingham's Health and Behavior department in the School of Public Health, is close to completing a randomized placebo double-blind trial for psilocybin-assisted therapy for cocaine addiction. He and his colleagues recently unblinded 10 of their participants and found that those who got psilocybin, compared to the placebo, had more abstinent days from cocaine. (In the study, the placebo is an antihistamine called diphenhydramine.) 

Ten is a small number, so Hendricks said they can’t draw any conclusions from it yet. “But the trend, if it continues, would certainly be consistent with this idea that there's an anti-addictive effect, one that would need to be interrogated further in larger trials,” he said. 

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This doesn’t mean that psychedelics will work for everyone, and they likely won't. As is the case with most complex conditions, people with substance use disorders have a myriad of contributing factors, from genetics and physiological dependence to psychological and social factors. But it could be, for some, another tool to reach for. 

“We don’t know conclusively if psychedelics are going to be effective in the treatment of addictive disorders,” Hendricks said. “It looks very promising right now. And if we continue to collect data that confirm our hypotheses, it would be nice to have AA more accepting of it.”

AA's General Service Office and NA's World Services did not respond to requests for comment, nor did Oxford House. The president of the nonprofit National Association of Sober Living, Judith Roberts, said in an email, "No one person speaks for any 12-step fellowships but according to the literature of NA and AA, they support 100% abstinence of alcohol and drugs. I am sure there are a wide variety of positions with different facilities who deal with alcoholism and addiction across the United States. However, it is the position of the National Sober Living Association that the only safe and effective pathway to recovery is 100% abstinence from mind and mood altering substances. As such psychedelics would not qualify or be used as a tool of recovery. In addition, based upon many years of experience, psychedelics would not aid a person in stopping substance abuse, but would in fact only contribute in triggering the dangerous phenomenon of craving that addicts and alcoholics experience." 

“There’s a good chance that psychoactive plants played a role in what came to be known as the founding vision of Alcoholics Anonymous,” wrote Don Lattin in his book Distilled Spirits, about Bill Wilson, Aldous Huxley, and Gerald Heard. 

Wilson later became very active in psychedelics, and took LSD under supervision in the 1950s with UCLA researcher Sidney Cohen and psychologist Better Eisner. Wilson believed that LSD could assist “cynical alcoholics” by promoting spiritual experiences that would get them started on their recovery. In his book, Lattin described a letter that Wilson wrote to Carl Jung, in which he wrote “at length about his experiments using LSD to help members of Alcoholics Anonymous have the spiritual awakening that is central to the twelve-step program of recovery." 

But even in the 1950s, when LSD was still legal, AA had a problem with Wilson's experimentation. Wilson wrote to Cohen later that he was being gossiped about in AA groups. As Lattin documented, Wilson wrote that it was desirable to leave his name out “when discussing LSD with AAs.”

In 1984, a document published by AA World Services stated plainly what the group thought of Wilson's psychedelic use: “As word of Bill's activities reached the fellowship there were inevitable repercussions. Most AAs were violently opposed to his experimenting with a mind-altering substance. LSD was then totally unfamiliar, poorly researched, and entirely experimental – and Bill was taking it."

Ultimately, Wilson stepped down from AA’s governing board in large part because of his experimentation with psychedelics, setting a precedent that the two could not co-exist in the open.

On the Alcoholics Anonymous subreddit, it’s easy to still find people expressing an interest in psychedelics, and quickly being shut down. One user wrote, “My wife and I, both long term sober, have been discussing the idea of doing psychedelics as a path to a spiritual experience. Bill used LSD for just that reason. My concern is what does that mean to my sobriety. I have 11 years my wife has 10. The obsession to drink has long been removed. My main question is does anyone have any experience with this issue? If you chose to use psychedelics, what did it mean to your sobriety?”

A responder replied, “Frankly, I must admit I am dumbfounded that with that much sobriety [you] are thinking of using other drugs. Working the 12 steps provided a spiritual experience for me and I am grateful. If I chose to use psychedelics it would mean I was no longer sober. That's my humble opinion.”

Just because Wilson found personal benefit from psychedelics doesn’t mean that it’s necessarily the right thing for every person, or even a perfect match for those in AA or other fellowships. Interestingly, though LSD was helpful for Wilson, it didn't help stop smoking, the one addiction he could never shake; he ultimately died of emphysema. 

In 2016, Kevin helped co-found a group called Psychedelics in Recovery (PIR): a place for people in recovery to talk about an interest in psychedelics, or past and ongoing use. Their website went live in 2019 and its numbers grew considerably in 2020. It currently has between 750 and 1000 email subscribers, and its private Facebook group has about 1500 members. It hosts 15 weekly meetings, with about 20 people on average in attendance.

To be a member of the group is simple: If you would consider being a member in any 12-step group, and you’re also interested in or actively doing psychedelics, then you are welcome in PIR. Many people who come to PIR meetings haven’t tried psychedelics and are curious about them, but have a lot of fear: Would it mean they’re still sober? What will their sponsor say? Will they have to leave their fellowships? Who could they tell? 

PIR represents the first fellowship group that's tackling these issues head on—what happens when 12-step meets psychedelics? When psychedelics meet MAT? And members of PIR said that the stakes are high: If someone feels like they're no longer welcome in a fellowship because of an interest in psychedelics, they may lose crucial support that their recovery depends on.

“If someone has had an ayahuasca session that truly inspired them and they want to talk about that at their meeting, and they’re on methadone or buprenorphine—if the person’s not shooting themselves up with heroin and or drinking themselves to death, it’d be nice if there was a place for that person,” Johnson said. 

Yadim ended up back in his hometown of San Diego in 2018, trying to stop using meth, but compensated with alcohol and GHB use instead. In September 2018, local news stations in San Diego reported on a fire that blazed through Yadim's sister's apartment, destroying nearly everything except for a family photo album. 

The news clip also captured Yadim being physically restrained against the sidewalk pavement and arrested on charges of arson. It was rock bottom for Yadim, who came to jail and said he accidentally started the fire during a black out. The video made its way to his clients, and he lost all of them.

Yadim tried traditional approaches to addressing his addiction. He went to an in-patient program dedicated to the LGBTQ population, and was introduced to 12-step programs. “But after six years of slamming meth everyday, it just does something to you,” he said. “I just didn’t feel normal. I didn’t feel joy or excitement or pleasure for anything. I felt like a zombie.” After he left the in-patient facility, he relapsed. “It was the only thing that I knew that would make me feel something again.”

Yadim started to seriously contemplate suicide, making a plan for when he knew his parents wouldn’t check on him. But as he was thinking about it, a VICE documentary about an ibogaine clinic in Mexico came on the television. “It was a lightbulb moment,” Yadim said. “I told myself, ‘Wait. Before you do this, try this. Check this out.’”

Yadim went to the clinic, and credits the experience as the “catalyst” to his recovery. “The experience was brutal, terrifying, and beautiful all at the same time,” he said. "I didn't want to get high after that."

But when his 10 days at the clinic were done, it wasn’t as if Yadim was magically cured. Instead, he said he had a willingness and eagerness to rededicate himself to the programs he had walked away from. When he returned to San Diego, he started going to 12-step meetings two to three times a day. He got into sober living. He enrolled in an outpatient program. “I was able to make a lot of really healthy decisions for myself to ensure there was a cushion between using again,” he said.

Yadim, unlike Kevin, opened up more about his ibogaine experience and his continuing interest in psychedelics. He didn’t talk about it openly at meetings, but told a few trusted friends and also the head of his sober living facility. The director of his out-patient program called him into her office, and asked him to tell her about his ibogaine experience. Then, she advocated for him to be eligible for sober living—something that likely wouldn’t have been possible without such an ally, Yadim said. 

“She basically said, 'Whatever you’re doing is working and I just want you to continue doing what you need to get better,'” Yadim said. “And I was able to go to ayahuasca ceremonies while I was in sober living, which was amazing because I think most places would not have allowed it.”

Yadim was relieved, because he was tired of lying. “I could have just said I was going to a friend’s house for the night,” he said. “But I didn’t want to be secretive around these medicines, I wanted to be upfront. In the 12-step program, we often hear, 'We’re only as sick as our secrets.' I didn't think it was anything to be ashamed of.”

Every winter Max’s mental health would deteriorate, and they would often end up in the hospital for suicidality. Last fall, they began to feel depressed again. “I was frustrated because I do everything I’m supposed to do, everything I’m told in my 12-step program and taking meds, and still having the same result,” said Max, who is using a pseudonym to protect their identity. 

During online research Max found PIR, and decided to go to a meeting. “My assumption of PIR was that it was going to be a bunch of people with no long-term sobriety, or just using this fellowship as a means to say they're sober when they're not,” Max said. “I had a lot of stigma towards it and assumptions, and I was totally wrong—which I’m grateful for. That’s not what my experience has been like.”

Max has been going to PIR meetings a couple of times a week since October, and has started using psychedelics over the last few months. “This is the first winter I haven't ended up in the hospital,” Max said. “It’s the first time in my life since I was eight years old that I'm not suicidal.”

But when Max brought up their interest in psychedelics in their other groups, they got mixed messages. When Max told their sponsor, they said they didn’t want to be around someone using psychedelics, and Max had to find a new sponsor. “It wasn’t hard feelings or anything like that, they just didn’t want to be around it, I guess,” Max said.

Taylor, the graduate student at Michigan, said this reflects her own experience, and why she's conducting her study. "I experienced stigma for the use of psychedelic medicine, and know that it is common to feel ashamed about admitting to any drug use, particularly when you are in a community of recovery whose ideal is abstinence," she said. 

Kevin’s sponsor, who he has worked with for three years, knows about Kevin’s interest in psychedelics, and his past use. “His response was fairly open-minded, but somewhat typical,” Kevin said. “He drew on his past experience with mushrooms and said he never walked away from it thinking that he just did a drug in the same way that he would approach alcohol or cocaine. But at the same time he considered any desire to use mushrooms to be a 'reservation,' to be something that's preventing me from fully surrendering like the AA way of life.” 

Kevin has stayed with his sponsor for three years, because he wanted to work with someone who was very familiar with the steps and knew the Big Book—a kind of manual for AA— well. “He's evolved a little bit,” Kevin said. “He's become more curious about the growth of PIR because it really has exploded in growth in the past year.”

But even with that growth, Kevin said PIR cautions members about sharing too openly with their other groups. “There are people in our fellowship that have never told their sponsor or their AA group, and they don’t feel the need to and that’s OK,” Yadim said. “They come to our meeting and share honestly about everything here. And that’s enough for them.”

“I’ve heard stories of people’s sponsors firing them,” Kevin said. “I’ve also heard people be welcomed. We suggest personal discretion when it comes to discussing this in mainstream circles. For me at least, my personal approach may stem from this familiarity with my early days in NA censoring myself.”

That resonates with Hendricks. “Addiction is a chronic relapsing disorder. I think that it would be really nice if we could administer LSD or psilocybin once and folks will stop using and never use again, and that will be the end of the story,” Hendricks said. “But I think that’s probably unlikely. My hunch is that for most people, it's still going to require a lot of work and commitment and engagement with treatment and almost daily commitments to remain abstinent.”

That’s why it would be even more of a risk for 12-step groups to be hesitant or resistant to psychedelics at large, Yadim said, because it was the combination of his psychedelic use plus the support from such groups that helped him maintain his recovery.

"One of the main pillars of AA and similar groups in the recovery community is to reduce the shame around addiction, and share experience, strength, and hope to foster unique and individual paths to sustained sobriety," Taylor said. "If psychedelic medicine helps someone stay sober, but they are stigmatized against by those who are supposed to support them, it simply keeps the cycle going."

“These dogmatic narratives, in my opinion, are not necessarily helpful because it leaves very little wiggle room and there is a risk of the patient feeling shamed and excluded if they don't rigidly stick to it,” said Ben Sessa, an addiction psychiatrist and chief medical officer at AWAKN Life Science. 

Sessa and his colleagues have been researching how MDMA-assisted therapy can help with alcohol use disorder. They started with an observational study looking at how well people did post-detox in Bristol, U.K. with traditional treatment—a combination of therapy, group therapy, AA, and anti-craving drugs. “The rates of relapse in that study were 75% of the population we looked at were back at pre-detox levels of drinking at the end of nine months,” Sessa said. “That’s with all the very best gold standard treatments. That’s a terrible outcome.”

Then, they designed an MDMA therapy protocol for alcoholism: It’s eight weekly sessions, and in two of them, a person will take MDMA. At the end of nine months, about 20% of people were drinking at their pre-treatment levels. 

This was a small pilot study, and didn’t have a placebo group. Up next, Sessa said they’re planning a randomized controlled study in which they compare MDMA-assisted psychotherapy against placebo-assisted psychotherapy to validate their findings. Their ultimate goal is to get MDMA-assisted psychotherapy licensed as a treatment for alcoholism. 

Sessa thinks that a better way of measuring outcomes for all addictions is how people are functioning. According to a dogmatic view of sobriety, someone like Yadim may not be sober. But how is he doing? 

“It’s not so much what their categorical diagnosis is or what they are or aren’t taking in terms of drugs or medicine,” Sessa said. “It’s more like, can you hold down a job? Can you see your children? Do you have enough money to live? Does your family like you? Do you have friends? Are you homeless and living on the street or are you financially secure?”

Sessa said that for some people, total abstinence is the answer—but it’s not universal. “I think we need to get away from this concept that it’s either all or nothing,” Sessa said. “And I do worry that some people with AA, they they propagate this narrative that you are a complete failure unless you've totally given it up forever.”

The most important thing is to give people options, Max said. “People are already dying and falling through the cracks,” Max said. “The amount of friends I’ve had died from fentanyl overdoses because they were only given one option, whether that was an ibogaine clinic only or only 12-step meetings. It's preventable deaths that are not being prevented. And so if this is one drop in the bucket that can help prevent one of my friends dying, then yeah, I'm for it. “

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