Depressive DisordersAnxiety DisordersAlcohol Use Disorder (AUD)Substance Use Disorders (SUD)Psilocybin

Development of a Psychotherapeutic Model for Psilocybin-Assisted Treatment of Alcoholism

The authors develop and describe a psychotherapeutic model specifically tailored to psilocybin-assisted treatment of alcoholism and report its use in an ongoing clinical trial. They situate the model within the history and proposed mechanisms of psychedelic therapy, compare alternative approaches, and emphasise the need for research to determine the most effective psychotherapeutic frameworks.

Authors

  • Michael Bogenschutz

Published

Journal of Humanistic Psychology
meta Study

Abstract

Research activity on the potential clinical value of classic hallucinogens and other psychedelics has increased markedly in the past two decades, and promises to continue to expand. Experimental study of hallucinogen-assisted treatment, and any future clinical use, requires the development of psychotherapeutic models that are appropriate to the disorder being treated and effectively integrated with the pharmacologic component of the treatment. To provide a framework for thinking about possible treatment models, we provide an overview of the history of psychedelic-assisted treatment, review what is known about the therapeutic mechanisms of these treatments, and consider the various purposes of psychotherapy in the context of both research and clinical use of psychedelic-assisted treatment. We then provide a description of a therapy model we have developed and are currently using in a trial of psilocybin-assisted treatment for alcoholism. Finally, we discuss advantages and disadvantages of a range of alternative models, emphasizing the need for research to determine the most effective treatment models for any indications for which efficacy becomes established.

Available with Blossom Pro

Research Summary of 'Development of a Psychotherapeutic Model for Psilocybin-Assisted Treatment of Alcoholism'

Introduction

Classic hallucinogens such as LSD, psilocybin, DMT, and mescaline act primarily at the serotonin 2A (5HT2A) receptor and have seen a resurgence of research interest over the past two decades. Earlier clinical work from the 1950s–1970s and more recent pilot studies suggest potential therapeutic effects for conditions including addiction, anxiety, and depression, but the optimal way to integrate the acute psychedelic experience with disorder-specific psychotherapy remains unclear. Historical approaches ranged from repeated low-to-moderate dosing with psychodynamic work (psycholytic) to single high-dose sessions aimed at producing a peak or mystical experience (psychedelic model), and contemporary research requires models that marry pharmacology and psychosocial care within rigorous study designs and safety frameworks. Bogenschutz and Forcehimes set out to describe the rationale and development of a psychotherapeutic model tailored to psilocybin-assisted treatment of alcohol dependence. The paper outlines the historical context, reviews hypothesised biological and psychological mechanisms relevant to addiction, discusses the possible functions of psychotherapy in psychedelic treatment, and then presents a manualised, integrated model combining an alcohol-focused therapy (Motivational Enhancement and Taking Action, META), therapy aimed at preparation/support/integration for psychedelic sessions (PSI), and the psilocybin administrations themselves. The model has been implemented in a randomised, double-blind, controlled trial context and is intended both as a treatment manual for research and a starting point for future clinical use if efficacy is established.

Expert Research Summaries

Go Pro to access AI-powered section-by-section summaries, editorial takes, and the full research toolkit.

See Pro PlansAlready have an account? Sign in

Study Details

References (27)

Papers cited by this study that are also in Blossom

Health status of ayahuasca users

Barbosa, P., Mizumoto, S., Bogenschutz, M. P. et al. · Drug Testing and Analysis (2012)

Psilocybin-assisted treatment for alcohol dependence: a proof-of-concept study

Bogenschutz, M. P., Forcehimes, A. A., Pommy, J. A. et al. · Journal of Psychopharmacology (2015)

Therapeutic mechanisms of classic hallucinogens in the treatment of addictions: from indirect evidence to testable hypotheses

Bogenschutz, M. P., Pommy, J. A. · Drug Testing and Analysis (2012)

Neural correlates of the psychedelic state as determined by fMRI studies with psilocybin

Carhart-Harris, R. L., Erritzoe, D., Williams, T. et al. · PNAS (2012)

Functional connectivity measures after psilocybin inform a novel hypothesis of early psychosis

Carhart-Harris, R. L., Leech, R., Erritzoe, D. et al. · Schizophrenia Bulletin (2012)

241 cited
The entropic brain: a theory of conscious states informed by neuroimaging research with psychedelic drugs

Carhart-Harris, R. L., Leech, R., Shanahan, M. et al. · Frontiers in Human Neuroscience (2014)

Report on psychoactive drug use among adolescents using ayahuasca within a religious context

Doering-Silveira, E., Grob, C. S., Dobkin de Rios, M. et al. · Journal of Psychoactive Drugs (2005)

114 cited
‘Hitting highs at rock bottom’: LSD treatment for alcoholism, 1950-1970

Dyck, E. · Social History of Medicine (2006)

90 cited
Assessment of addiction severity among ritual users of ayahuasca

Fábregas, J. M., González, D., Fondevila, S. et al. · Drug and Alcohol Dependence (2010)

222 cited
Psilocybin-occasioned mystical experiences in the treatment of tobacco addiction

Garcia-Romeu, A., Griffiths, R. R., Johnson, M. W. · Current Drug Abuse Reviews (2015)

Show all 27 references
Recent advances in the neuropsychopharmacology of serotonergic hallucinogens

Halberstadt, A. L. · Behavioural Brain Research (2014)

Psychological and cognitive effects of long-term peyote use among Native Americans

Halpern, J. H., Sherwood, A. R., Hudson, J. I. et al. · Biological Psychiatry (2005)

Evidence of health and safety in American members of a religion who use a hallucinogenic sacrament

Halpern, J. H., Sherwood, A. R., Passie, T. et al. · Medical Science Monitor (2008)

Human hallucinogen research: guidelines for safety

Johnson, M. W., Richards, W. A., Griffiths, R. R. · Journal of Psychopharmacology (2008)

Pilot study of the 5-HT2AR agonist psilocybin in the treatment of tobacco addiction

Johnson, M. W., Garcia-Romeu, A., Cosimano, M. P. et al. · Journal of Psychopharmacology (2014)

Psilocybin biases facial recognition, goal-directed behavior, and mood state toward positive relative to negative emotions through different serotonergic subreceptors

Kometer, M., Schmidt, A., Bachmann, R. et al. · Biological Psychiatry (2012)

Psilocybin-induced decrease in amygdala reactivity correlates with enhanced positive mood in healthy volunteers

Kraehenmann, R., Preller, K. H., Scheidegger, M. et al. · Biological Psychiatry (2015)

Lysergic acid diethylamide (LSD) for alcoholism: meta-analysis of randomized controlled trials

Krebs, T. S., Johansen, P. Ø. · Journal of Psychopharmacology (2012)

Ketamine psychotherapy for heroin addiction: immediate effects and two-year follow-up

Krupitsky, E. M., Burakov, A. M., Romanova, T. N. et al. · Journal of Substance Abuse Treatment (2002)

Single versus repeated sessions of ketamine-assisted psychotherapy for people with heroin dependence

Krupitsky, E. M., Burakov, A. M., Dunaevsky, I. V. et al. · Journal of Psychoactive Drugs (2007)

154 cited
Ketamine psychedelic therapy (KPT): a review of the results of ten years of research

Krupitsky, E. M., Grinenko, A. Y. · Journal of Psychoactive Drugs (1997)

Reactions to psilocybin administered in a supportive environment

Leary, T., Litwin, G. H., Metzner, R. · Journal of Nervous and Mental Disease (1977)

A clinical study of LSD treatment in alcoholism

Ludwig, A., Levine, J., Stark, L. et al. · American Journal of Psychiatry (1969)

158 cited
Treatment of alcoholism using psychedelic drugs: a review of the program of research

Mangini, M. · Journal of Psychoactive Drugs (2011)

The effects of psilocybin and MDMA on between-network resting state functional connectivity in healthy volunteers

Roseman, L., Leech, R., Feilding, A. et al. · Frontiers in Human Neuroscience (2014)

229 cited
Prediction of psilocybin response in healthy volunteers

Studerus, E., Gamma, A., Kometer, M. et al. · PLOS ONE (2012)

Lysergide Treatment of Schizophrenic and Nonschizophrenic Alcoholics; A Controlled Evaluation

Tomsovic, M., Edwards, R. V. · Journal of Studies on Alcohol and Drugs (1970)

55 cited

Cited By (29)

Papers in Blossom that reference this study

Multidimensional Personality Changes Following Psilocybin-Assisted Therapy in Patients With Alcohol Use Disorder: Results From a Double-Blind, Placebo-Controlled Clinical Trial

Pagni, B. A., Zeifman, R. J., Mennenga, S. E. et al. · American Journal of Psychiatry (2025)

Psilocybin-induced changes in neural reactivity to alcohol and emotional cues in patients with alcohol use disorder: an fMRI pilot study

Pagni, B. A., Petridis, P. D., Podrebarac, S. K. et al. · Scientific Reports (2024)

20 cited
Reports of self-compassion and affect regulation in psilocybin-assisted therapy for alcohol use disorder: An interpretive phenomenological analysis

Agin-Liebes, G. I., Nielson, E. M., Zingman, M. et al. · Psychology of Addictive Behaviors (2024)

Ensuring the affordable becomes accessible-lessons from ketamine, a new treatment for severe depression

Rodgers, A., Bahceci, D., Davey, C. G. et al. · Australian and new-zealand Journal of Psychiatry (2023)

5 cited
Must Psilocybin Always “Assist Psychotherapy”?

Goodwin, G. M., Malievskaia, E., Fonzo, G. A. et al. · American Journal of Psychiatry (2023)

Psychedelic-supportive psychotherapy: A psychotherapeutic model for, before and beyond the medicine experience

Wolfson, P. E. · Journal of Psychedelic Studies (2023)

Therapeutic (Sub)stance: Current practice and therapeutic conduct in preparatory sessions in substance-assisted psychotherapy-A systematized review

Thal, S. B., Wieberneit, M., Sharbanee, J. M. et al. · Journal of Psychopharmacology (2022)

Percentage of Heavy Drinking Days Following Psilocybin-Assisted Psychotherapy vs Placebo in the Treatment of Adult Patients With Alcohol Use Disorder

Bogenschutz, M. P., Ross, S., Bhatt, S. R. et al. · JAMA Psychiatry (2022)

497 cited
Classic psychedelics and alcohol use disorders: A systematic review of human and animal studies

Calleja-Conde, J., Morales-García, J. A., Echeverry-Alzate, V. et al. · Addiction Biology (2022)

Models of Psychedelic-Assisted Psychotherapy: A Contemporary Assessment and an Introduction to EMBARK, a Transdiagnostic, Trans-Drug Model

Belser, A. B. · Frontiers in Psychology (2022)

57 cited
Show all 29 papers
Integration in Psychedelic-Assisted Treatments: Recurring Themes in Current Providers’ Definitions, Challenges, and Concerns

Earleywine, M., Low, F., Lau, C. et al. · Journal of Humanistic Psychology (2022)

Presence, Trust, and Empathy: Preferred Characteristics of Psychedelic Carers

Thal, S., Engels, L. B., Bright, S. J. · Journal of Humanistic Psychology (2022)

The Need for Psychedelic-Assisted Therapy in the Black Community and the Burdens of its Provision

Smith, D., Faber, S., Buchanan, N. T. et al. · Frontiers in Psychiatry (2022)

Critical Period Plasticity as a Framework for Psychedelic-Assisted Psychotherapy

Yehuda, R., Lepow, L., Morishita, H. · Frontiers in Neuroscience (2021)

Spiritual experiences in psychedelic-assisted psychotherapy: Case reports of communion with the divine, the departed, and saints in research using psilocybin for the treatment of alcohol dependence

Podrebarac, S. K., O'donnell, K. C., Mennenga, S. E. et al. · Spirituality in Clinical Practice (2021)

Associations between ayahuasca consumption in naturalistic settings and current alcohol and drug use: Results of a large international cross-sectional survey

Perkins, D., Opaleye, E. S., Simonová, H. et al. · Drug and Alcohol Review (2021)

Systematized Review of Psychotherapeutic Components of Psilocybin-Assisted Psychotherapy

Horton, D. M., Morrison, B., Schmidt, J. · American Journal of Psychotherapy (2021)

Using Psychedelics With Therapeutic Intent Is Associated With Lower Shame and Complex Trauma Symptoms in Adults With Histories of Child Maltreatment

Healy, C. J., Lee, K. A. · Chronic Stress (2021)

Effects of ayahuasca and its alkaloids on substance use disorders: an updated (2016-2020) systematic review of preclinical and human studies

Rodrigues, L. S., Rossi, G. N., Rocha, J. M. et al. · European Archives of Psychiatry and Clinical Neuroscience (2021)

Ethical and legal issues in psychedelic harm reduction and integration therapy

Pilecki, B., Luoma, J. B., Bathje, G. J. et al. · Harm Reduction Journal (2021)

Psychedelic Harm Reduction and Integration: A Transtheoretical Model for Clinical Practice

Palhano-Fontes, F., Gorman, I., Nielson, E. M. et al. · Frontiers in Psychology (2021)

Culture and psychedelic psychotherapy: Ethnic and racial themes from three Black women therapists

Williams, M. T., Reed, S., George, J. · Journal of Psychedelic Studies (2021)

41 cited
Psychedelics and Psychotherapy

Nayak, S., Johnson, M. W. · Pharmacopsychiatry (2020)

Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance

Wolff, M., Evens, R., Mertens, L. J. et al. · Frontiers in Psychiatry (2020)

Psilocybin-assisted therapy of major depressive disorder using Acceptance and Commitment Therapy as a therapeutic frame

Sloshower, J., Guss, J., Krause, R. et al. · Journal of Contextual Behavioral Science (2020)

States and traits related to the quality and consequences of psychedelic experiences

Russ, S. L., Carhart-Harris, R. L., Maruyama, G. et al. · Psychology of Consciousness Theory Research and Practice (2019)

The influence of therapists’ first-hand experience with psychedelics on psychedelic-assisted psychotherapy research and therapist training

Nielson, E. M., Guss, J. · Journal of Psychedelic Studies (2018)

The psychedelic debriefing in alcohol dependence treatment: illustrating key change phenomena through qualitative content analysis of clinical sessions

Kraehenmann, R., Nielson, E. M., May, D. G. et al. · Frontiers in Pharmacology (2018)

Clinical interpretations of patient experience in a trial of psilocybin-assisted psychotherapy for alcohol use disorder

Bogenschutz, M. P., Podrebarac, S. K., Duane, J. H. et al. · Frontiers in Pharmacology (2018)

Your Personal Research Library

Go Pro to save papers, add notes, rate studies, and organize your research into custom shelves.

See Pro PlansSign in