It'd been two weeks since Jack's last drink. When the researchers had asked him to quit on the spot, Jack wasn't sure he'd make it—at his peak, the 26-year-old drank 30 to 40 beers a day, enough to put him in the 95th percentile for alcohol consumption. He knew he had a problem. He'd tried AA. Rehab, too. He'd even taken Antabuse, a prescription drug that induces nausea when combined with alcohol. By the time he'd signed up for the study, it was, as he put it, "out of desperation." Jack listened as the researchers explained again what he needed to do—hardly believing their instructions. Then he reclined on the large suede sofa, reached for the pair of headphones on the table next to him, and clamped them over his ears. The ambient music swelled. He tugged the eyeshade across his face, took a deep breath, and slipped the 25-milligram psilocybin capsule under his tongue. And then he swallowed.
Psychedelics scare Jack—just like they scare a lot of people. "I always stayed away from them," he says. "I didn't want the chance to have a bad trip, or a bad experience." In controlled settings, however, a growing body of government-approved research over the past two decades has shown that psychedelics like psilocybin—the active alkaloid in magic mushrooms—could have surprising upside, especially for treating diseases like alcoholism.
Phase II of the FDA/DEA approved, double-blind study is underway at NYU, following up on a promising proof-of-concept study at the University of New Mexico published last year. This research is the first in more than four decades to use psychedelics to treat alcohol abuse—180 patients will be treated over the next five years. That makes it one of the largest clinical trials ever to use a hallucinogen like psilocybin, which is still classified as a schedule I drug, a category reserved for any substance with a high likelihood of abuse and no proven benefits.
"I've always been fascinated by how people change and how that works," says Michael Bogenschutz, a psychiatrist and the lead investigator in the two studies. "In that context, I was aware of people having a sudden change of events after years of struggling with addiction." Studies like Bogenschutz's seek to disprove the notion that psilocybin can't be medicine, and show that psilocybin treatments might even induce that change, inspiring it at a more fundamental, ego-driven level.
Experiencing total ego loss or "ego death"—as in, the loss of identity or sense of physical reality—is a common way that people describe recreational, unmonitored psychedelic use, and a potentially frightening one, too. But that's not necessarily what study participants like Jack experience in their sessions, says Bogenschutz. Rather, he's seeing a new pattern emerge among many of the 30 subjects he's treated so far: that of being "touched by God," or at least gaining an awareness of a higher power. Hank, another study participant, grew up in an agnostic family. At forty years old, he found his marriage in shambles, and his father dying. He cried for the better part of eight hours during his first psilocybin session. In his second, with the eyeshades over his face, he saw a vision of his father as a skeleton.
It was by no means a pleasant, easy episode for Hank, but he maintains, more than a year later, that he gained "an understanding that there's another plane to this whole thing," and that he saw what he needed to see. "It allowed my subconscious to open up and let me work on things that I was concerned about in my life." All this raises the question: Can psilocybin be a higher-power facilitator? And might that accelerate people's progress towards recovery?
Finding God to cure addiction is nothing new. William James, known as the Father of American Psychology, wrote in his 1902 book, The Varieties of Religious Experience, "The only cure for dipsomania [alcoholism] is religiomania." But the most famous contemporary example is Bill Wilson, better known as "Bill W.," cofounder of Alcoholics Anonymous, whose spiritual awakening precipitated his path to sobriety.
"I felt lifted up," Wilson wrote of his revelation, which occurred during his 1934 hospitalization, "as though the great clean wind of a mountain top blew through and through. God comes to most men gradually, but His impact on me was sudden and profound." God is mentioned either by name or as "Him" in half of the Twelve Steps, and referred to as, "a Power greater than ourselves [that] could restore us to sanity" in another.
Some 20 years later, Wilson experimented with LSD—a much more difficult psychedelic to control than psilocybin, but the most widely experimented psychedelic of the time—and thought he saw a potential game-changer for the recovery movement. Meanwhile, psychiatrist Humphrey Osmond, who would become a friend of Wilson's, administered LSD to in-patient alcoholics at Weyburn Hospital in Saskatchewan, Canada. This was in 1953, right at the dawn of psychedelic exploration in the psychiatric community, back when those substances were still legal. (It was Osmond who coined the term "psychedelic" in a letter to author and fellow psychonaut Aldous Huxley: "To fathom hell or soar angelic, just take a pinch of psychedelic.")
"Bill Wilson thought LSD could help cynical alcoholics undergo the 'spiritual awakening' that stands at the center of twelve-step work," writes author Don Lattin in his 2012 book on Wilson and AA, Distilled Spirits. AA, on the other hand, was less than enthused with this strategy.
"From the beginning it was very controversial within AA," Lattin says. It wasn't long before Timothy Leary made LSD front page news, and inevitably, all above-ground clinical research with psychedelics halted until the 1990s. Now the new psychedelic therapy model—revived from the 1950s and reimagined for the twenty-first century—may be able to chemically induce the same kind of transformative, spiritual awakening, and offer a new treatment paradigm, one that melds the ancient healing model of religion and spirituality with contemporary standards for safe medical practice.
"You're not focusing on why the ceiling tiles are moving," says Hank of a typical session. "Or how the light is hitting your eyes in one direction or another, or that the sunset is so beautiful. You're instead completely enveloped in that higher experience that everyone talks about."
Researchers have strategically chosen psilocybin, not LSD, as the focal point of their research. "The political baggage with LSD is just extraordinary," says Matthew Johnson, a psychologist and co-investigator on Johns Hopkins' psilocybin studies. "It's still associated with the counterculture of the '60s." One LSD session could also last up to twelve hours, and a challenging comedown is common. "Psilocybin fits into the workday perfectly—five to six hours," says Johnson. "And it ends when it ends. It fades down a little, and then it's gone," he adds.
Not everyone who takes psilocybin undergoes a mystical experience. And for those who do hit on something spiritual, psychedelics like psilocybin are not the exclusive agents of that connection. "It's almost more interesting to me that some people have experiences like this without the help of any drugs at all," says Bogenschutz. "Because it tells you that it's a normal human experience. It's not just being intoxicated. Plenty of people take high doses of psychedelics and don't have that. So it's not a direct effect—the drug makes it possible for these things to happen more frequently than they do in people's everyday lives."
How psilocybin facilitates these moments of epiphany, however, remains a mystery to the people studying it. "We have no idea [how it works]," says Johnson. "There is evidence that acute changes in brain network activity are associated with increased feelings of unity," he says. Researchers have also found that the drug stimulates a primary receptor—serotonin 2A—and that it lights up the regions of the brain that control serotonin release. Johnson adds, however, that there is no data yet on how psilocybin might affect an addict's brain differently from someone else's. Many studies are also preliminary, and most of the findings to date are speculative. "Right now, we can say much more about the psychological mechanisms, rather than the biological ones."
Studies using brain imaging—one of which is being led by Johnson's team—are also in the early stages. One study aims to examine psychedelics in relation to what's known as the default mode network—regions of the brain responsible for referential thought—which destabilize under the influence of psilocybin. This network is also overactive in people with mood disorders like depression and addiction, says Johnson. Some researchers believe that if you can make those hubs break down, it may trigger a subsequent collapse of the ego—increasing the likelihood of a transformative experience.
Some of Bogenschutz's study participants, meanwhile, think this experience goes beyond what neuroscience can explain. In other words, they truly believe they've experienced a phenomenon not of this world. "There's a woman I interviewed [from Bogenschutz's study] who was brought up Catholic," says Lattin, who is currently working on a new book about the psychedelic-assisted therapy movement. "She hadn't been to church for years, didn't think of herself as religious, but she basically had a vision of Jesus during her psilocybin session."
Jack didn't experience any specific dogma in his active sessions. But, he says, "It was the most spiritual instance I've ever encountered. It was like a higher power. Maybe it could've been God." The important point for Jack isn't the details of what he saw or felt during his sessions. It's that he got the wakeup call he needed. "It's almost like I'm in one of those cages that they put you in underwater to go to see sharks. I'm close to the edge, and in dangerous waters, but I can see it clearly. I can get an up close view of this disease and how it's affected me. It's almost like staring death in the face."
The plain and unavoidable fact that psilocybin is a recreational drug may be the primary obstacle to it becoming a realistic option for therapists to recommend. "It does sound understandably wacky to some people," says Johnson, who is quick to point out that the class of drugs containing psilocybin is rarely abused, and not known to be addictive. "They do not lead to compulsive drug seeking," he says. "Most people have to work up the courage to use them frequently, rather than resist the temptation to keep using them." More work, however, needs to be done before it's clear if there are any long-term consequences to using psilocybin—such as changes to a patient's brain chemistry. In the meantime, Jack says the grip that alcohol once held on him is still gone. "I focus on the things that matter to me now," he says. "It's as if the whole world started to make sense. In a way, everything was answered." Study participants' names have been changed to protect their privacy.