Study results by researchers at Johns Hopkins University indicate that 12 out of 15 volunteers receiving psilocybin-assisted psychotherapy for smoking cessation were able to remain smoke-free after a six-month follow-up.
Several decades ago, research with classic psychedelics was at the cutting edge of psychiatry. The treatment of addiction was one of the primary interests for the application of these compounds. In the late 1950s, clinicians and researchers at the Weyburn Mental Hospital in Saskatchewan, Canada, under the leadership of Humphry Osmond and Abram Hoffer, pioneered the use of classic psychedelics, including LSD and mescaline, in the treatment of alcohol addiction. Their high reported rates of alcoholism recovery inspired other laboratories to investigate classic psychedelics in the treatment of addiction, primarily alcoholism but also opioid dependence. This research endeavor was consistent with anthropological data that accumulated over the next couple of decades showing that the sacramental use of classic psychedelics by indigenous people (e.g., peyote use by Native Americans; Ayahuasca use in South America) was associated with recovery from alcohol and other drugs. A meta-analysis of the older studies that used LSD to treat alcoholism was published in 2012 in the Journal of Psychopharmacology by Norwegian researchers Teri Krebs and Pål Johansen. Using only randomized trials with control groups, that meta-analysis found that LSD treatment approximately doubled alcohol recovery rates at the first study follow-up visit. Those kinds of results are worthy of intensive further study and the allocation of substantial federal research money to addiction scientists studying these approaches.
However, at the height of this research in the early 1970s, when more rigorous and larger studies should have been conducted, these clinically promising compounds became highly restricted, federal sources withdrew research funds to study them, and professional research on them became strongly marginalized. This was not primarily a reaction to medical study results, but was rather a reaction to the recreational use of these drugs and associated social movements, and because a very, very few of the hundreds of scientists who had conducted research with these drugs began to promote their wider recreational use. As Rick Strassman, M.D., stated in his 2001 book DMT: The Spirit Molecule (Park Street Press, p. 28), psychedelics “… began as ‘wonder drugs,’ turned into ‘horror drugs,’ then became nothing” to the medical and scientific community.
This week in the Journal of Psychopharmacology, our research team* published the world’s first scientific study of a psychedelic in the treatment of tobacco addiction. Specifically, we used psilocybin, an active agent in “magic mushrooms” as the medication. Along with LSD and mescaline, psilocybin is considered a classic psychedelic, and like these other substances, exerts its primary effects by activating the serotonin 2A receptor in the brain. The point of the study was to establish safety and determine whether the intervention showed effects promising enough to warrant a larger controlled trial. This open-label study (meaning, participants knew they were getting the drug on session days) integrated 2 or 3 moderate–to-high dose psilocybin sessions with a cognitive behavioral therapy program, which is the general orientation of most smoking cessation programs. Participants were 15 smokers who smoked about a pack a day, had been smoking an average of over 30 years, and had attempted to quit smoking on multiple previous occasions. We found no clinically significant unexpected adverse events in the study, and found that 80% of participants were biologically verified as smoke free at a 6-month follow-up visit. This abstinence rate substantially exceeds those commonly reported for other behavioral or pharmacological approaches for smoking cessation, which are typically less than 35%.
Ten weeks after the target quit date, which was the day of their first psilocybin session, participants were asked what was most memorable and what was most spiritually significant about the psilocybin session experiences. The following are excerpts from each of the 12 individuals who remained quit at the 6 month follow up visit.
- Feelings of gratefulness, a great (powerful) remembrance of humility… of my experience of being, the experience of my being in and within the infinite.
- Not at all religious but significant in motivating me to nurture my spiritual life.
- It changes what I believe… We are all one and divine.
- The awareness that all is one and then the realization that I am an integral piece of the one’s puzzle.
- Oneness with universe; being forgiven.
- Rich joy and awe. My body melting and becoming one with the universe felt both painless and profound… Feeling complete as a person and physically a part of all thin
- There is a meaningful presence that humbles any human heart.
- Simultaneously being aware and saturated in the majesty of existence.
- Seeing God speaks for itself; seeing and feeling forever was like traveling through space-time.
- The sessions permitted me to go inside and see and feel the nature of the mind.
- Recognizing the source and manifestation of visions… source of unconscious content.
- I believe I channeled the power of the Goddess and that I hold that power in me. I believe she exists everywhere and I look for her to add spark, life, and joy to everyday ordinary situations.
Although the open-label nature of the study prevents us from making definitive conclusions regarding the efficacy of psilocybin per se, we consider the overall success rate as extremely promising and worthy of rigorous follow-up research. We are now initiating a follow-up trial involving a randomized control condition and integrating brain scans to help determine potential biological mechanisms.
To me, the most exciting things about this research are its potentially wide clinical applicability, and its potential to help us better understand how people change, in general. Virtually all medications that are approved to treat addiction (or are being studied to do so) ultimately work by decreasing drug craving, reward, or withdrawal for that particular drug or drug class. For example, most drugs used to treat smoking cessation essentially quell the nicotine receptors in the brain so that withdrawal is lessened and smoking is less rewarding. Research shows that these medications can help, but only modestly, with the large majority of people relapsing to smoking. In my view they do not ultimately work for many people because they only interact with relatively simple drug effects rather than affecting the complete addiction syndrome. Addiction involves far more than a narrow biological reaction at a single brain receptor. Addiction has to do with the relationship the person has developed with the drug across multiple environments, that person’s life history, and the other sources of reward in the person’s life, including understudied sources of reward such as meaning in life, relations with loved ones, and connection to something beyond ourselves. Big picture stuff. The stuff that many formerly addicted people talk about when describing their recovery. In our study we found that those who had profound mystical-type or transcendental experiences on psilocybin were more likely to remain quit. People said the psilocybin helped in quitting smoking by changing their holistic view of themselves over time, by strengthening their belief in what they were capable of, and by changing what they prioritized in life. I believe these higher-order psychological processes likely have higher-order biological brain correlates. For example, the work of Robin Carhart-Harris, Ph.D., and his team at Imperial College in London is leading to an understanding of how psilocybin occasions a profound acute change in the sense of self at the biological level. The higher-order nature of these processes explains why psychedelics could help with not only tobacco addiction, but also with alcohol addiction and opioid addiction, as supported by historical research. Indeed, Michael Bogenschutz, M.D. at the University of New Mexico recently reported promising open-label pilot study results for psilocybin in treating alcoholism at the 2013 College on Problems of Drug Dependence meeting. Moreover, psychedelic therapy should also be applicable to cocaine addiction, and methamphetamine addiction, and non-drug behavioral disorders like gambling addiction and eating disorders, and perhaps a range of other problematic behaviors. Of course, each of these disorders needs to be carefully and rigorously studied in its own right to verify this hypothesis. Along these lines, Peter Hendricks, Ph.D., at the University of Alabama Birmingham is preparing to conduct a study using psilocybin in the treatment of cocaine addiction.
In the 17 years that I have studied addiction, I have encountered no intervention that I view as more promising for broadly addressing behavior change as the cautious and controlled administration of these psychedelic compounds. Unprecedented in pharmacological history, these potential medications were left dormant for several decades until recently. Western science had an awkward adolescence in its dealing with these drugs in the 1960s. But both science and society has matured, and now is the time for change, to fully explore the medical efficacy of these substances under safe and controlled conditions. Indeed, current research with these compounds follows cautious guidelines including empirically informed inclusion/exclusion criteria, establishment of rapport between staff and participants before sessions, and interpersonally supportive session monitoring and follow-up care, as described in a paper I published with colleagues in the Journal of Psychopharmacology in 2008. My hope is that more scientists become intrigued by this research and that we collectively make substantial progress in using these compounds for developing technologies for positive behavior change, with regard to addictions and beyond.
* The author would like to acknowledge his incredibly dedicated and talented co-authors on the smoking cessation study: Albert Garcia-Romeu, Mary P. Cosimano, and Roland R. Griffiths. He also thanks Peter Hendricks for helpful comments in preparing the present article.