Longitudinal and transcultural assessment of the relationship between hallucinogens, well-being, and post-traumatic growth during the COVID-19 pandemic

The authors situate the study in the context of widespread mental-health consequences of the COVID-19 pandemic, noting increases in anxiety, depression, post-traumatic stress and general distress observed internationally during 2020. They describe a concurrent resurgence of scientific interest in classical hallucinogens (for example psilocybin and MDMA) as potential treatments for mood, anxiety and trauma-related disorders, and identify an evidence gap about how lifetime or regular use of hallucinogens relates to psychological wellbeing and post-traumatic growth (PTG) in the population-level, real-world context of a major global stressor. A. and colleagues therefore set out to examine longitudinal relationships between hallucinogenic drug use, mental-health measures (psychological distress and psychopathology), peritraumatic stress and PTG during the pandemic. They implemented a transcultural online survey (English, Spanish and Portuguese) launched at the peak of early lockdowns in April 2020, with follow-ups at approximately two and six months, to assess whether lifetime and/or regular use of hallucinogens was associated with differences in wellbeing, symptom scores and PTG over time across culturally diverse respondents.

Design and recruitment: The study was a longitudinal online survey disseminated by snowball sampling beginning 7 April 2020. The questionnaire was developed originally in Spanish and translated into Portuguese and English. Recruitment occurred via researchers' networks, social media, academic and community websites, and platforms related to psychedelics and cannabis. The baseline sample comprised 2,971 participants; 1,024 completed the first follow-up (≈2 months) and 455 completed the last follow-up (≈6 months). Measures: The survey collected sociodemographic, lifestyle and COVID-19-related information plus detailed substance-use questions with emphasis on hallucinogens (MDMA, ayahuasca, psilocybin-containing mushrooms, LSD, peyote, San Pedro, Incilius alvarius [5-MeO-DMT], changa and other psychedelics). At baseline participants were classified as regular users (more than once per six months), occasional users (ever tried but not regular), or never-users; at follow-ups participants reported whether their use of each drug was more often, less often, or the same compared with before. Validated psychometric instruments included the GHQ-12 (psychological distress) at all time points, the Brief Symptom Inventory (BSI) with nine subscales and the General Severity Index (GSI) at all time points, the Peritraumatic Stress Inventory (PSI) at baseline only, and the Post-traumatic Growth Inventory (PGI) at the two follow-ups. Cronbach's alpha was computed for each instrument and language version. Statistical analysis: Descriptive statistics (percentages, means and SDs) described the sample and COVID-related items across time points. Longitudinal associations between hallucinogen use (users vs non-users and frequency categories) and psychometric outcomes were modelled using generalized estimating equations (GEE) with an exchangeable correlation structure to account for within-person correlations and missing data. Dependent variables included COVID-related wellbeing items (1–10 scales), GHQ scores, the nine BSI scales and GSI, and five PTG subscales. GEE models were adjusted for age, gender, questionnaire language, religion and practice, and other substance use (alcohol, tobacco, cannabis, cocaine, amphetamine). Additional GEE models examined associations of peritraumatic stress, GSI and GHQ with PTG, adjusted for demographic covariates. Analyses were performed in SPSS v24; a Bonferroni-adjusted significance threshold of p ≤ 0.003 was applied (0.05/20).

Reliability: Internal consistency was high for all instruments across languages. Reported Cronbach's alpha values were: GHQ-12 ~0.87–0.89, BSI ~0.96–0.97, PSI ~0.82–0.89 and PGI ~0.94–0.95 for the English, Portuguese and Spanish versions. Sample and COVID-related context: Baseline N=2,971; follow-ups at 2 months N=1,024 and 6 months N=455, indicating substantial attrition. Epidemiological indicators changed across assessments: the proportion reporting COVID-19 positivity rose over time; confinement and isolation proportions varied (examples reported include 47% confined at 2 months and 86% at 6 months, and isolation rising from 55.8% to 74.1%). About half the sample reported an early reduction in personal income, falling to 33.4% by six months. Reported engagement in many lifestyle activities increased during confinement (aerobic exercise, martial arts, music/singing, reading), while yoga, Pilates and meditation decreased. Substance-use patterns shifted: at the first follow-up alcohol, tobacco and cannabis use increased, while amphetamines, MDMA and hallucinogenic drug use decreased. Associations with hallucinogenic drug use: Across longitudinal analyses, hallucinogenic drug use was associated with better outcomes on several measures. Specifically, hallucinogen use over time was associated with higher psychological wellbeing (B = 0.48; SE = 0.10; p < 0.001), lower ratings of information provided by the media (B = -0.44; SE = 0.10; p < 0.001), and less psychological distress (GHQ) (B = -0.73; SE = 0.16; p < 0.001). When stratified by frequency at baseline, regular users (more than once per six months) scored higher on psychological wellbeing and lower on psychological distress and on most BSI subscales (except GSI) relative to occasional and never-users. Regular use was specifically associated with higher scores on PTG subscales for new possibilities and spiritual change. Multivariable models for PTG: In adjusted GEE models including peritraumatic stress, GSI and GHQ, psychological distress was independently associated with lower scores across all five PTG domains, while regular psychedelic use was independently associated with higher PTG scores. Corrected mean PTG scores differed across never, occasional and regular users (graphical representation referenced in the paper). Transcultural comparisons: Analyses comparing English-, Spanish- and Portuguese-speaking respondents found significant differences across languages for media/politician information ratings, stress levels, BSI scores and psychedelic use at all time points. The pattern of differences was heterogeneous and did not show a uniform directional trend.

The authors interpret their findings as evidence that lifetime and, more strongly, regular use of hallucinogens was associated with more favourable scores on multiple indicators of mental health and wellbeing during the COVID-19 pandemic. Regular users showed lower psychopathology scores across most BSI dimensions and higher post-traumatic growth (PTG) scores after adjustment for covariates and longitudinally measured psychological variables. In multivariable models, higher psychological distress (GHQ) was linked with lower PTG, whereas regular hallucinogen use was independently associated with higher PTG. A. and colleagues relate their results to existing literature reporting positive associations between hallucinogen use and wellbeing, resilience and lower measures of mental-health impairment, and they note consistency with studies of MDMA-assisted psychotherapy that report enhanced PTG. The authors discuss potential mechanisms that might underlie these associations—repeated exposure to challenging psychedelic experiences, personality differences (for example greater openness or self-transcendence), modulation of coping strategies, and transformative features of psychedelic experiences such as ego dissolution and spiritual insights—which could foster adaptive processes reflected in PTG and resilience. The authors acknowledge several important limitations. There was substantial attrition over follow-ups, which may have biased longitudinal inferences and contributed to a decline in reported hallucinogen use across assessments. The transcultural comparison used questionnaire language rather than country, grouping diverse regions (for example Spain with South American countries, Portugal with Brazil), which may obscure important contextual differences. All data were self-reported, with attendant biases (including possible positive appraisals among users). The unique context of widespread confinement at baseline and changing restrictions across follow-ups may have influenced who completed the online survey, potentially biasing the sample toward those in confinement. The authors therefore urge caution in interpretation and call for further research to clarify causality and mechanisms. The discussion also touches on policy implications: given the observed associations and an expanding evidence base for therapeutic effects of classical hallucinogens, the authors argue that current scheduling (Schedule I) may be misaligned with emerging scientific evidence and suggest re-evaluation of drug policies, while acknowledging the need for rigorous research and cautious policy change.

The conclusions section (as extracted) states that users of hallucinogenic drugs scored better on pandemic-affected dimensions such as psychopathology, wellbeing and post-traumatic growth, with effects more pronounced among regular users. The extracted text of the Conclusions is truncated mid-sentence ("From these results, we can suggest that either these drugs exert certain"), so the final sentence and any additional concluding remarks are not available in the provided extraction.