Psychedelic drugs have been flirting with mainstream respectability lately, mainly thanks to scientific studies that have used them as tools to do things like illuminate the workings of the brain and treat depression.
Another step toward mainstream medical acceptance of formerly "out-there" substances such as psilocybin, LSD, and MDMA, may involve turning them against other drugs. Across the US and UK, new clinical trials are using psychedelics in an attempt to treat addiction to everything from controlled substances including cocaine to alcohol and cigarettes.
Even though it's still not clear exactly how these drugs work in the brain, researchers think that the psychedelic experience itself could help people change their perspective, and their behavior, when it comes to drug addiction. And these psychologists are keen to try something new, because, as they admit, the current options are limited.
"It's a new paradigm for psychiatry."
"For those of us who work in addiction, our existing treatments are not impressive, they're disappointing, and at a minimum, why not give this a try?" said Peter Hendricks, an addictions psychologist at the University of Alabama at Birmingham. He's in the middle of running a double blind clinical trial treating cocaine users with therapy coupled with psilocybin, the active ingredient in magic mushrooms, or a placebo drug.
Hendricks said that frustration with the lack of existing options—a current treatment in Alabama is "contingency management," essentially paying people to pass their urine drug screens—made him take a look at psychedelics. He was aware that 50 years ago researchers had looked at LSD to treat alcohol and narcotic addictions, and did a survey with a local drug supervision program and found that among the 25,000 people surveyed, previous psychedelic use was a good predictor of completing the program drug-free.
That was enough for him to look into doing a trial (Hendricks said that the FDA and DEA were very easy to work with for approval). He has some patients in treatment right now, and is recruiting more through addiction centres and ads in the local Birmingham paper. The study calls for several sessions to prepare patients to take psilocybin, one treatment with the drug, and then several standard therapy sessions for addiction.
It's a similar dosing strategy to previous studies using psilocybin to treat end of life anxiety and depression, both of which used a single psychedelic treatment session and produced promising results.
"It's sort of like a crash course in mindfulness; I'm starting to think of it like that."
Researchers still aren't quite sure how psychedelics work in a treatment scenario. They do, however, have some theories, and they're centered around the trip that these drugs deliver.
"People will often report a changed relationship in observing themselves. I think this is much like what we refer to as mindfulness: someone's ability to view their own motivations and behaviour from a more detached and less judgemental perspective," said Matthew Johnson, a professor of psychology at Johns-Hopkins University who is testing psilocybin in a trial aimed at nicotine addiction.
"It's sort of like a crash course in mindfulness; I'm starting to think of it like that," he told me.
Hendricks has a similar take. "Right now we can only speculate," he said. "But something happens to re-order priorities, whereas before [in the case of addiction] it was drugs, now it could be work or family."
In any event, how a drug works may be a less important question than whether it works; mechanistic details aren't always necessary in psychiatry. Lithium, for example, is considered an effective treatment for bipolar disorder—and nobody's quite sure how it works.
If psychedelics are actually able to force a new perspective with a single intense dose, these trials could be the ones to show it. Hendricks' study, and another group at NYU using psilocybin to treat alcohol dependence, are randomized and double-blinded, the gold standard of modern medical research.
Johnson's study on smoking is open-label, meaning that the researchers and patients know who is getting the drug treatment, but he's comparing his results to nicotine patches, one of the few effective treatments out there.
The trials may also make addiction the largest frontier in psychedelic research. The NYU study alone has nearly 200 participants. The University of Alabama and Johns Hopkins combined will treat over 100. And two trials beginning in the UK later this year, using MDMA and ketamine to treat alcoholism, hope to recruit an additional hundred.
The data from those trials won't be available for a few more years. But the researchers are hopeful that the appeal of a one-time treatment will change the way people think about treating addiction.
"It's a new paradigm for psychiatry. I mean, normally you swallow a pill, you take a pill, it's in your system, and it has its effects," said Johnson. "Once it's out of your system, the effect is gone."