Classic psychedelics in the treatment of substance use disorder: Potential synergies with twelve-step programs
This paper proposes that there are synergies to be found between psychedelics for substance use disorders and the twelve-step facilitation (TSF) program, specifically Alcoholics Anonymous (AA). Although controversial, as total abstinence is often promoted, the founder of AA (Bill Wilson) did have positive experiences with psychedelics.
Authors
- Albert Garcia-Romeu
- Peter Hendricks
- Matthew Johnson
Published
Abstract
Several pilot studies have provided evidence supporting the potential of classic psychedelics like psilocybin in the treatment of substance use disorders (SUDs). If larger trials confirm efficacy, classic psychedelic-assisted psychotherapy may eventually be integrated into existing addiction treatments such as cognitive behavioral therapy, contingency management, and medication-assisted therapies. Many individuals seeking treatment for SUDs also join twelve-step facilitation (TSF) programs like Alcoholics Anonymous (AA), which are among the most widely available and accessed treatments for alcohol use disorder worldwide. For such individuals, engaging in classic psychedelic-assisted psychotherapy could be seen as controversial, as members of AA/TSF programs have historically rejected medication-assisted treatments in favor of a pharmacotherapy-free approach. We argue that classic psychedelics and the subjective experiences they elicit may represent a special, more compatible case than conventional medications. In support of this claim, we describe Bill Wilson's (the founder of AA) little known experiences with psychedelics and on this basis, we argue that aspects of classic psychedelic treatments could complement AA/TSF programs. We provide a review of clinical trials evaluating psychedelics in the context of SUDs and discuss their potential large-scale impact should they be ultimately integrated into AA/TSF.
Research Summary of 'Classic psychedelics in the treatment of substance use disorder: Potential synergies with twelve-step programs'
Introduction
The paper frames a renewed interest in classic psychedelics—particularly psilocybin and LSD—as potential treatments for substance use disorders (SUDs). It contextualises this resurgence against the historical relationship between Alcoholics Anonymous (AA) and psychedelics, recounting founder Bill Wilson's early hallucinogen experiences and his later advocacy for LSD as a tool to facilitate the spiritual awakening central to AA's model. The authors note that contemporary research has returned to exploring classic psychedelics' low physiological toxicity, low addiction potential, and consistent capacity to elicit self‑transcendent or 'mystical' experiences that have been associated with clinical benefit across several psychiatric conditions, including SUDs. Yaden and colleagues set out to review clinical and observational evidence for classic psychedelics in treating a range of SUDs and to consider whether psychedelic-assisted treatments could be compatible with, or even complementary to, twelve-step facilitation (TSF) programmes such as AA. The paper argues that psychedelic-induced mystical experiences align philosophically and mechanistically with AA/TSF goals and therefore may represent a special case among pharmacotherapies that warrants exploration of integration or at least reduced stigma within TSF communities.
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Yaden, D. B., Berghella, A. P., Regier, P. S., Garcia-Romeu, A., Johnson, M. W., & Hendricks, P. S. (2021). Classic psychedelics in the treatment of substance use disorder: Potential synergies with twelve-step programs. International Journal of Drug Policy, 98, 103380. https://doi.org/10.1016/j.drugpo.2021.103380
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Whitney, S., Yaden, D. B., Lipson, J. et al. · Frontiers in Psychology (2022)
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