Attitudes and perceptions of psychedelic therapy among clinical trial participants with alcohol use disorder: a mixed-method study

Alcohol use disorder (AUD) is described as a major global health problem with substantial mortality, disability, and very low treatment uptake. The authors note that existing treatments often have limited long-term success, while psychedelic therapy has re-emerged as a possible novel option. Although earlier studies have suggested potential benefits of psychedelic-assisted therapy for AUD, findings remain mixed and methodological concerns, including issues such as functional unblinding, mean that uncertainty persists. The paper also emphasises that most previous work on acceptability has focused on clinicians or general populations, leaving the perspectives of people with AUD comparatively underexplored. Kirsch and colleagues therefore set out to examine attitudes and perceptions of psychedelic therapy among people with AUD, using a mixed-method design. They aimed to test whether willingness to take part in a psychedelic therapy trial was associated with expectations of research success, knowledge of psychedelic research, and age, and to explore qualitatively what shapes patients’ views, including perceived benefits, concerns about addiction or loss of control, and the influence of personal and social experiences. The study was framed as an exploratory attempt to address a gap in understanding patient perspectives relevant to informed consent, recruitment, and patient-centred trial design.

The study used a mixed-method approach with separate quantitative and qualitative components. The quantitative part was embedded in two ongoing non-psychedelic clinical trials for AUD: a virtual reality-based cue exposure therapy study and a neuromodulation and mindfulness study. Participants were recruited from outpatient and inpatient psychiatric treatment settings across Berlin and Brandenburg, with additional outreach via clinics, counselling centres, peer support networks, flyers, posters, and online advertisements. The combined quantitative sample comprised 102 trial participants, with an additional 10 participants from the qualitative arm also completing the questionnaire. At baseline, participants completed a brief four-item questionnaire assessing awareness of clinical psychedelic research, willingness to participate in a psychedelic therapy trial for alcohol dependence, preferred trial setting if willing, and perceived promise of psychedelic research rated on a 5-point Likert scale. Sociodemographic and health-related data were also collected. The authors used binary logistic regression to examine whether willingness to participate was predicted by knowledge of psychedelic research, expectations of research success, and age. Results were expressed as odds ratios, and model fit was assessed using NFI, Cox-Snell, and Nagelkerke indices. Analyses were conducted in R-Studio, with significance set at p < .05. For the qualitative component, 10 participants were recruited from the Addiction Outpatient Clinic at Charité Universitätsmedizin Berlin. They were interviewed between May and August 2025 using a semi-structured guide with 13 questions, most of them open-ended, covering prior knowledge, personal contact with psychedelics, stereotypes, addiction concerns, and factors shaping attitudes. Interviews took place one-to-one in a therapy room, lasted around 10-13 minutes, and were audio-recorded, automatically transcribed, and manually corrected. The transcripts were analysed thematically in MAXQDA using an abductive approach that combined inductive coding with deductive attention to topics in the interview guide. The authors also describe co-review of coding decisions to reduce subjective bias. Ethical approval was obtained for the qualitative study, and all participants gave written informed consent.

In the quantitative sample, 62.5% of participants said they were aware of psychedelic research for psychiatric disorders, and 64.3% said they would be willing to participate in a psychedelic therapy trial. On the 5-point item assessing promise, responses were broadly favourable but mixed: the mean score was 3.55, with the largest single group answering neutrally, while 27 somewhat agreed and 31 strongly agreed that psychedelic research is promising. Overall, the sample showed conditional openness rather than uniformly enthusiastic support. The logistic regression found that only expectations of research success significantly improved model fit. Expectations were associated with willingness to participate, with an odds ratio of 3.30 (95% CI 1.98 to 6.16; p < .001), meaning that higher perceived promise was linked to substantially greater willingness. By contrast, neither knowledge of psychedelic research nor age significantly predicted willingness once expectations were included in the model. Knowledge was significant in a simpler model but lost significance after expectations were added. The authors report moderate explanatory power for the model and effectively zero intraclass correlation for subsample membership. The qualitative analysis generated two overarching themes: attitudes towards psychedelic therapy, and knowledge and contact with psychedelic substances. Participants expressed positive, neutral/ambivalent, and negative positions. Positive attitudes were usually tied to perceived therapeutic potential, especially if use occurred under medical supervision. Ambivalent participants saw possible benefits but also major risks, particularly loss of control and addiction. Negative attitudes were often strongly shaped by fears that psychedelics are addictive or unsafe. Participants also differed in how stable they considered their views: some described them as unsettled and knowledge-dependent, while most said they were already fairly firm. A second theme concerned the sources of these attitudes. Participants cited media, books, personal experiences, reports from others, and their broader social and cultural context. Some had direct experience with psychedelics or had heard about both positive and frightening experiences. Others linked their caution to alcohol-related experiences, broader substance use histories, or fears of losing control. The authors highlight that many participants associated psychedelics with addiction risk, despite the fact that this is not supported by scientific evidence for classical psychedelics.

Kirsch and colleagues interpret the findings as showing that many people with AUD who are already engaged with clinical research are aware of psychedelic therapy and are conditionally open to it, but this openness depends mainly on how promising they think the treatment is. They argue that expectations of success are more important than simple knowledge of psychedelic research in shaping willingness to participate. In their view, this makes therapeutic optimism a central factor for acceptability in this population. The authors compare their findings with earlier research on acceptability of other AUD interventions, noting that previous studies often found familiarity and stigma to be key determinants. By contrast, their data suggest a somewhat different pattern for psychedelic therapy: willingness was not driven by knowledge alone, but by perceived potential benefit. They also say the qualitative findings add depth by showing how personal substance use histories, media exposure, and social context shape attitudes. The paper particularly emphasises the widespread misconception that psychedelics are highly addictive, which participants often cited as a reason for caution or rejection. The authors identify several limitations. The sample may not represent the broader AUD population because participants were drawn from clinical trials and outpatient services, creating likely participation bias. They also note possible recall bias, social desirability bias, and the absence of a quantitative measure of prior psychedelic use, even though such experience appeared important in the interviews. The brief, self-constructed four-item questionnaire is also presented as a limitation because it lacks established psychometric validation. For the qualitative work, the authors note that the short interviews may not have captured all relevant views, and that thematic analysis is inherently interpretative. In terms of implications, the authors argue that future psychedelic trials in AUD should include thorough informed consent that explicitly addresses expectations and misconceptions, especially around addiction risk and loss of control. They suggest that psychoeducation should distinguish classical psychedelics from other substances with high dependence potential, and they recommend involving patients and patient groups in future study design. They also call for larger, more diverse samples, validated attitude measures, and quantitative assessment of prior psychedelic experience in future research.

The authors conclude that a substantial proportion of people with AUD who are participating in clinical research are aware of psychedelic therapy and open to considering it in a study context. They state that willingness to participate is primarily linked to expectations that the treatment will be successful. They further conclude that misconceptions about addiction and risk are important barriers, and that targeted psychoeducation and transparent informed consent are needed to support ethical and equitable recruitment in future trials. They also call for larger, more representative studies to extend these preliminary findings.