The Comeback of Psychedelic Therapy
HALLUCINOGENS ARE SPARKING MEDICAL & PROFESSIONAL INTEREST ONCE AGAIN
You all have heard of AA, Alcoholics Anonymous (or at least most of you have). You also probably know that alcoholics, as the name suggests, attend AA meetings and follow a way of life, called the 12-step program, in search of bettering their well-being and staying alcohol and drug free.
What you may not have known is that Bill W. (Wilson), who co-founded Alcoholics Anonymous along with Dr. Bob Smith, had a lifelong fascination with psychedelics that took root during his first-ever hallucinatory experience with acid.
“The room instantly lit up in a blinding glare of white, white light. I was seized by an ecstasy such as I had never known,” Bill W. recounted. He had taken a dose of lysergic acid diethylamide, also known as LSD, as part of a clinical study being run by Dr. Smith. At the time, they were looking into a “spiritual remedy” for alcoholism, after Bill had found Dr. Smith by rifling through church phone books; Bill had seen the worse side of his own addiction by then.
Bill quit alcohol after his LSD trip. And some time after, Dr. Smith quit alcohol after his LSD experiences with Bill. He relapsed once afterwards, for a short time. Aside from that, he stayed alcohol free “up to the moment of his death in 1950,” Bill remembered.
In fact, Bill was so fired up about his psychedelic experience and the recoveries he had witnessed, he even tried to incorporate psychedelics and LSD as part of AA’s advice to alcoholics in the program. “I don’t believe it has any miraculous property of transforming...sick people into healthy ones overnight...[but] it can set up a shining goal on the positive side and create a large incentive [for recovery],” he remarked. Already, one of the 12-step program’s core values involved recognizing a “higher power greater than one’s self,” and while this is usually taken as a reference to God, Bill points out that atheist and agnostic alcoholics still need a spiritual motivation to drive them towards recovery. He saw LSD as a potential solution.
The rest of AA never took to his ideas of incorporating psychedelics. But in the past decade, some seventy years after Bill dropped acid and saw the “white light” that ended his alcoholism forever, hallucinogenic drugs have made a comeback to the mainstream medical industry. And today, their potential benefits in addiction recovery are leading the charge.
Psychedelics’ return to popular attention was pushed along by advances in medical technology, neuroscience breakthroughs, and changes in the way the medical field views and understands the mechanisms of the conscious mind. The discovery of neuron cells and the neurotransmitter chemicals that transmit information between these have fundamentally changed the accepted model of human psychology; the movement of electrical impulses and information across these neurons are thought to be the very basis, or “skeleton,” of the consciousness itself, including all of its perception, intelligence, emotion, and human “sense of self.”
Hallucinogens profoundly alter the way neurons send and receive information, acting within the mechanisms of the brain’s neurotransmitter systems, including those responsible for interpreting serotonin and dopamine. While a hallucinogen or psychedelic is active in one of these systems, perhaps by binding to and activating a receptor within one, the user’s conscience experience will be profoundly affected (as was hopefully intended). But there will also be physical changes in the user’s brain chemistry and the way neuron cells inside the affected system interact with each other. These physical effects can be picked out visually on a modern brain imaging display. The functional magnetic resonance imaging or fMRI procedure, and other ways of observing the brain’s pharmacokinetics, has shed new light on the unique physiological actions of psychedelic compounds in the brain.
But the question researchers like Rick Doblin, who founded and currently serves as President of the Multidisciplinary Association for Psychedelic Studies, or MAPS, are trying to answer today is whether or not these physical and psychological effects will have any lasting psychological impact. And if they do, the goal is to identify any of the ones that are medically beneficial. Doblin thinks evidence so far has shown promise. “Addiction involves past material, a lot of denial and running away. Psychedelics bring material to the surface in ways where people need to surrender them; it’s hard to hide from yourself under [them]... The other part is more positive. People often have a spiritual sense of connection that they can later draw strength from,” he explains.
Right now, a total of twelve or more clinical studies being carried out in the United States, Israel, Switzerland, and the UK are looking into the effects of three psychedelics: MDMA, or ecstasy, lysergic acid diethylamide (LSD), or acid, and psilocybin, or the active compound in hallucinogenic mushrooms. Several more ongoing studies have just published the results and conclusions of their past years of research. Worldwide, interest in psychoactive use in therapy and medicine is snowballing.
Two publications that have recently caught the public spotlight. In one, when patients suffering from severe PTSD were administered MDMA, their symptoms were drastically reduced. In the other, doctors who dosed terminally ill cancer patients with MDMA, LSD, and psilocybin discovered that they were all effective in curbing or even completely eliminating the the oncoming “fear of death” common people suffering from the condition.
Psychedelics’ profound effects on mood have also been utilized towards curing substance addictions, from fighting off hard drug withdrawals to aiding sufferers of alcohol and tobacco addiction. Dr. Matthew Johnson, a researcher of substance related addiction at Johns Hopkins University, is currently looking into hallucinogenic mushrooms and their chief ingredient psilocybin’s ability to fight off nicotine cravings. On average, around one to two out of five people who try to stop smoking end up quitting successfully (according to studies and statistics). In Johnson’s trials, out of the four smokers who stuck with the psilocybin therapy for a year or more, three of them quit cigarettes completely. The fourth went from burning through a pack a day to smoking only one individual cigarette a week.
In another recently completed study, researcher Dr. Bogenschutz tested the combination of psilocybin therapy and MET, or Motivational Enhancement Therapy, on participants suffering from alcoholism. During the first month of the trials, when only MET was given and the psilocybin was not yet introduced, the participants’ alcoholism stayed relatively unchanged. After psilocybin was brought into the equation, Bogenschutz saw the alcoholics’ drinking patterns drop drastically; in a follow-up study conducted just one month after the end of the trials, all five participants said they had either profoundly reduced their drinking or had quit completely.
David Nutt (the same David Nutt that made the public announcement that LSD, THC, and MDMA are all less physiologically harmful than alcohol and tobacco as the head of a panel of medical professionals advising the British government, getting himself kicked out of the position for the statement), explains that LSD holds similar properties in fighting alcoholism. “Curing alcohol dependency requires huge changes in the way you see yourself. That’s what LSD does,” he says. A meta-study covering six separate LSD trials in earlier decades supports Nutt’s conclusion, discovering that in a group of over 500 participating alcoholics taking LSD, even just once, the patients averaged an 11% higher drinking reduction - 49%, compared to 38% in patients who underwent therapy without any use of psychoactives.
There seems to be a significant connection between the success of the psychedelic therapy administered for substance abuse, and the intensity the consciousness-expanding experiences that the psychedelics bring on. After testing psilocybin on participants addicted with nicotine, Johnson noted, “So far it looks like those who are more successful in quitting smoking have higher [Phanke-Richards] ‘mystical experience’ scores, consistent with some of our previous research showing that the mystical nature of the experience, and not the drug strength per se, is associated with persisting benefit.” The smokers who quit their addiction after Johnson’s trial said that they had renewed their way of thinking about cigarettes and their effects, and that they had realized the gravity of the consequences of their addictions more clearly. On top of this, they felt less connected to the way of life that they had built with nicotine, with a greater ability to change themselves and move on from the past.
The three psychedelics that are currently catching the most attention as potential substance abuse treatments, namely psilocybin, LSD and MDMA, are all strong entheogens, or substances that lead to profound and spiritual experiences. A study published shortly before Johnson’s psilocybin trials concluded that ninety-four percent of people who took psilocybin in the study’s trials said that the hallucinatory experience was among the “top five most meaningful” in their life. Thirty-nine percent actually ranked their psilocybin trip as their single most profound experience, ever.
But understanding how these profound effects actually bring about lasting psychological change, especially with regards to substance abuse, is not easy for researchers, even with the medical technology available today. On top of this, correlating these conscious experiences with what physically goes on inside the brain is even more difficult.
Most addictive drugs work on different receptors within the brain and body. Heroin, for example, binds and activates to the human opiate receptors; cocaine interferes with the serotonin reuptake system, halting the natural cycle of recycling and causing a buildup of serotonin within the system and exciting the serotonin receptors. Knowing this, researchers have begun to draw connections between drug-receptor interactions and the way substance addiction chemically takes hold in the brain. With different methods of brain-imaging, significantly reduced blood flow in brain areas responsible for processing emotion and anxiety can be seen in patients on psychedelics.
Even with this knowledge, doctors don’t have enough information to begin carelessly experimenting with psychedelics and the brain systems they interact with. At this point in medical tech, brain imaging has revealed areas of the brain affected with reduced or increased blood flow while psychedelics are in the system, along with pinpointing areas of the brain that change in electrical activity. Pharmacological studies have also shown that many psychedelics are direct agonists or antagonists of neurotransmitter receptors; LSD and psilocybin have both been observed binding to several different 5-HT receptors, which are responsible for receiving and interpreting serotonin. In addition, these portions of the brain with increased blood flow are linked to executive management of the brain’s states of wakefulness, introspection, and “self-referential” thinking. These areas also function very differently in substance abuse patients; pessimistic thinking and destructive vicious cycles typical of a hard drug addictions are attributed to the drug’s activity in these brain areas, and several psychedelics have been seen reversing the symptoms of these effects.
But still, the complexity of the human brain makes beneficial use of psychedelics in a medicinal setting “neurochemically messy,” says psychologist A.C. Parrott and others like him. Discussing the US Food and Drug Administration’s decision to approve the recent PTSD studies involving patient trials of MDMA, Parrott referred to the psychedelic as “very powerful...and potentially damaging.” Extensive, chronic abuse of ecstasy has been linked to neurodegeneration in recreational users, though alternate studies have concluded that MDMA shows no evidence for any forms of neurotoxicity.
And psychedelic trips can always bring on a bad trip. The people who would be using psychedelics for therapeutic uses would not necessarily have any previous experience with altered states of consciousness. Abnormal thinking patterns, confusion, and paranoia paired with sensory distortions can lead to a sensation of helplessness and lack of control in some, and the need for clinicians to inform patients who are using psychedelics of the extreme psychological effects when administering them to actual patients is ever more crucial. Researchers are still searching for the best ways to avoid these bad trips while administering their psychedelics, ensuring that their patient’s environment is safe and comfortable, and thoroughly checking any potential cross-reactions between the hallucinogens and any other supplements the person might be taking. All of this becomes especially important when a patient has previous history of psychological instability or even simply a family history of such conditions. Dormant cases of schizophrenia which were previously symptom free have been observed to rise up once again after doses of LSD, MDMA, mescaline, psilocybin, and other psychedelics, though this rarely happens without repeated, chronic recreational dosing.
Today, clinicians follow a standard protocol when a patient or trial participant has a bad trip or begins to lose their grip. A number of techniques can be used. “Talking down” the patient with comforting words, dimming the lights and laying the patient at a slight angle, and even administering drugs that curb the psychedelic trip’s effects are all effective ways of helping a patient through a bad trip, once it has already started. Before trials, patients are recommended a few preparatory therapy sessions with the clinician that will be with them through their psychedelic experience so that the patient can get to know and trust them. The trial itself is carried out in a softly lit room, while the patient lies on a bed with their legs and arms uncrossed, free from physical distractions. Sometimes, the patient will put on noise cancelling headphones or wear a blindfold. The attending clinician stays with the patient during the entire trial, aiding them through their psychedelic experience. (Keep in mind that patients with PTSD, cancer, and other conditions that psychedelic therapy is currently aimed at are probably not going to have much, if any, previous experience with the psychedelic they’re going to take. So the ability of a clinician to keep a patient from freaking out and falling into a bad trip is key to the therapy’s practicality and success.)
But even with these measures in place, some patients just don’t feel comfortable venturing into the unknown world of psychedelics for their very first time. And even with all the ongoing studies, some doctors and clinicians still don’t feel comfortable prescribing hallucinogenics to their patients. Stereotypes continue to pin psychedelics and their effects as harmful, dangerous, and physically addictive. Among many of the roadblocks medicinal hallucinogenics face today, one of the largest is still the gross lack of funding. “There’s no money in it,” put frankly by head of the Laboratory for Integrative Psychiatry at McLean Hospital, John Halpern. Halpern runs his own study at the facility, searching for the different ways MDMA can be used effectively against cancer. Talking to The New York Times, he comments on the mindset behind the lack of funding: “What drug company is going to invest millions in a substance [not] widely available in our flora and fauna?”
And governments worldwide are still coming down hard on regulation of psychedelics and related controlled substances. In recent years, illicit drug trade has become an increasingly violent industry as nations around the globe have fought against it, passing stricter and harder legislation as previous laws fail to curb the ongoing war. The Controlled Substances Act, passed in the United States in 1970, continues to control psilocybin, LSD, and MDMA as Schedule I substances, defining them in law as having “no currently accepted medical use in treatment in the United States” and stopping the majority of U.S. clinical trials from ever proceeding. The Netherlands, one of only a handful of nations to legalize cannabis recreationally, outlawed psychoactive mushrooms completely in December 2008.
Other nations are sure to follow in coming years. But the fight continues. The United States’ Food And Drug Administration has given the green light to a select number of trials on hallucinogens in different states. These include a study carried out by Doblin, in which he investigated the various effects of a bad trip, forming a basis for therapists at MAPS who planned to administer psychedelics to help and guide patients through the experience. The United States’ Department of Veteran Affairs will also be funding further experiments with MDMA, like Doblin’s, and exploring their use in combating PTSD, judging by the results of the ongoing clinical trials worldwide.
The legal battlefield surrounding clinical psychedelic use is fierce one. Current laws clamp down on trials that could bring new psychedelic evidence to light, making it difficult for researchers to uncover valuable information. But as federal governments stay strict on their scheduling and drug enforcement procedures, local governments around the world continue to protest, passing contradicting legislation and calling out to citizens for input and support.
If you asked what’s to come of therapeutic psychedelics in the following decades, no one could tell you for certain. But many people would say they see great potential in their psychological and physiological effects; and each day, new evidence finds another clinical benefit to a hallucinogen like MDMA or LSD, or to a tryptamine like DMT, or to medicinal THC, or to any of the vast number of psychedelics in existence. The next groundbreaking benefit could be discovered in months, or weeks, or even tomorrow. But until then, doctors and researchers will work with the information they have. And patients around the globe will have to stick with traditional therapy and approved medication - for now.