Trial PaperAnxiety DisordersAlcohol Use Disorder (AUD)Tobacco/Nicotine Use Disorder (TUD)Substance Use Disorders (SUD)Safety & Risk ManagementPsilocybin

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

In a single-group proof-of-concept study of 10 participants with DSM‑IV alcohol dependence, psilocybin administered alongside motivational enhancement therapy produced a significant increase in abstinence after dosing that was largely maintained to 36 weeks, with the intensity of the first session strongly predicting subsequent reductions in drinking, craving and increased abstinence self‑efficacy. There were no significant treatment‑related adverse events, supporting the need for larger controlled trials to evaluate efficacy and mechanisms.

Authors

  • Michael Bogenschutz
  • Rick Strassman
  • Paulo Barbosa

Published

Journal of Psychopharmacology
individual Study

Abstract

Several lines of evidence suggest that classic (5HT2A agonist) hallucinogens have clinically relevant effects in alcohol and drug addiction. Although recent studies have investigated the effects of psilocybin in various populations, there have been no studies on the efficacy of psilocybin for alcohol dependence. We conducted a single-group proof-of-concept study to quantify acute effects of psilocybin in alcohol-dependent participants and to provide preliminary outcome and safety data. Ten volunteers with DSM-IV alcohol dependence received orally administered psilocybin in one or two supervised sessions in addition to Motivational Enhancement Therapy and therapy sessions devoted to preparation for and debriefing from the psilocybin sessions. Participants’ responses to psilocybin were qualitatively similar to those described in other populations. Abstinence did not increase significantly in the first 4 weeks of treatment (when participants had not yet received psilocybin), but increased significantly following psilocybin administration ( p < 0.05). Gains were largely maintained at follow-up to 36 weeks. The intensity of effects in the first psilocybin session (at week 4) strongly predicted change in drinking during weeks 5–8 ( r = 0.76 to r = 0.89) and also predicted decreases in craving and increases in abstinence self-efficacy during week 5. There were no significant treatment-related adverse events. These preliminary findings provide a strong rationale for controlled trials with larger samples to investigate efficacy and mechanisms. TRIAL REGISTRATION: NCT02061293

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

Introduction

Classic (5HT2A agonist) hallucinogens were widely researched from the 1950s to the early 1970s for conditions including addiction. A meta-analysis of randomized trials of LSD for alcoholism reported an odds ratio favouring LSD at first post-treatment follow-up, and more recent work has renewed clinical interest in psilocybin. Small modern trials have examined psilocybin for anxiety in advanced cancer and as an adjunct for smoking cessation, and clinical research has generally supported the safety of classic hallucinogens when subjects are carefully screened and supervised. Despite this background and mechanistic rationale, there were no prior studies specifically testing psilocybin in people with alcohol dependence. Bogenschutz and colleagues therefore conducted a single-group, proof-of-concept study to quantify the acute psychoactive effects and tolerability of oral psilocybin in alcohol-dependent participants, and to provide preliminary outcome and safety data across a 36-week follow-up. The study aimed to evaluate whether administration of psilocybin, given alongside a manualised psychosocial intervention, was associated with changes in drinking behaviour and related psychological measures and whether acute subjective effects predicted clinical outcomes.

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Study Details

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Mystical Experiences in Retrospective Reports of First Times Using a Psychedelic in Finland

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Psilocybin and LSD Have No Long-Lasting Effects in an Animal Model of Alcohol Relapse

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

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Rostral Anterior Cingulate Thickness Predicts the Emotional Psilocybin Experience

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24 cited
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Therapeutic Use of LSD in Psychiatry: A Systematic Review of Randomized-Controlled Clinical Trials

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Modulation of Social Cognition via Hallucinogens and “Entactogens”.

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Acute effects of lysergic acid diethylamide (LSD) on resting brain function

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Psychedelic microdosing benefits and challenges: an empirical codebook

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Effects of acute and repeated treatment with serotonin 5-HT2A receptor agonist hallucinogens on intracranial self-stimulation in rats

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41 cited
Psilocybin lacks antidepressant-like effect in the Flinders Sensitive Line rat

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Classic psychedelics: An integrative review of epidemiology, therapeutics, mystical experience, and brain network function

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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)

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Ona, G., Troncoso, S. · Journal of Psychedelic Studies (2019)

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197 cited
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142 cited
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Psychiatry might need some psychedelic therapy

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Current perspectives on psychedelic therapy: use of serotonergic hallucinogens in clinical interventions

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143 cited
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DMT models the near-death experience

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A Gratuitous Grace: The Influence of Religious Set and Intent on the Psychedelic Experience

Neitzke-Spruill, L., Glasser, C. · Journal of Psychoactive Drugs (2018)

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219 cited
The abuse potential of medical psilocybin according to the 8 factors of the Controlled Substances Act

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Out of the box: A psychedelic model to study the creative mind

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Integrating Psychedelic Medicines and Psychiatry: Theory and Methods of a Model Clinic

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The Use of Salvia divinorum from a Mazatec Perspective

Maqueda, A. E. · Plant Medicines Healing and Psychedelic Science (2018)

Changes in Withdrawal and Craving Scores in Participants Undergoing Opioid Detoxification Utilizing Ibogaine

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

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Powerful substances in tiny amounts An interview study of psychedelic microdosing

Johnstad, P. G. · Nordic Studies on Alcohol and Drugs (2018)

121 cited
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213 cited
Quality of acute psychedelic experience predicts therapeutic efficacy of psilocybin for treatment-resistant depression

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Rucker, J., Iliff, J., Nutt, D. J. · Neuropharmacology (2017)

Psilocybin for treatment-resistant depression: fMRI-measured brain mechanisms

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Neuroticism is associated with challenging experiences with psilocybin mushrooms

Barrett, F. S., Johnson, M. W., Griffiths, R. R. · Personality and Individual Differences (2017)

78 cited
Psychedelic Drugs in Biomedicine

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Psychedelic pleasures: An affective understanding of the joys of tripping

Bøhling, F. · International Journal of Drug Policy (2017)

Shannon entropy of brain functional complex networks under the influence of the psychedelic Ayahuasca

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Kaelen, M., Lorenz, R., Barrett, F. S. et al. · Biorxiv (2017)

Patients’ accounts of increased “Connectedness” and “Acceptance” after psilocybin for treatment-resistant depression

Watts, R., Day, C. M., Krzanowski, J. et al. · Journal of Humanistic Psychology (2017)

Potential Therapeutic Effects of Psilocybin

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Thomas, K., Malcolm, B., Lastra, D. · Journal of Psychoactive Drugs (2017)

Patient Experiences of Psilocybin-Assisted Psychotherapy: An Interpretative Phenomenological Analysis

Belser, A. B., Agin-Liebes, G. I., Swift, T. C. et al. · Journal of Humanistic Psychology (2017)

Modern clinical research on LSD

Liechti, M. E. · Neuropsychopharmacology (2017)

Psychedelics, personality and political perspectives

Nour, M. R., Evans, J., Carhart-Harris, R. L. · Journal of Psychoactive Drugs (2017)

164 cited
The therapeutic potential of psychedelic drugs: past, present, and future

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Morgan, C. J. A., McAndrew, A., Stevens, T. et al. · Current Opinion in Behavioral Sciences (2017)

Phenomenology, Structure, and Dynamic of Psychedelic States

Preller, K. H., Vollenweider, F. X. · Behavioral Neurobiology of Psychedelic Drugs (2016)

Classical hallucinogens and neuroimaging: A systematic review of human studies: hallucinogens and neuroimaging

Dos Santos, R. G., Osório, F. L., Crippa, J. A. et al. · Neuroscience and Biobehavioral Reviews (2016)

The serotonin 5-HT2C receptor and the non-addictive nature of classic hallucinogens

Canal, C. E., Murnane, K. S. · Journal of Psychopharmacology (2016)

Psychedelics as Medicines: An Emerging New Paradigm

Nichols, C. D., Nichols, D. E., Johnson, M. W. · Clinical Pharmacology and Therapeutics (2016)

Psychological and neuropsychological assessment of regular hoasca users

Barbosa, P., Strassman, R. J., da Silveira, D. X. et al. · Comprehensive Psychiatry (2016)

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

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The Associations of Naturalistic Classic Psychedelic Use, Mystical Experience, and Creative Problem Solving

Sweat, N. W., Bates, L. W., Hendricks, P. S. · Journal of Psychoactive Drugs (2016)

Alterations of consciousness and mystical-type experiences after acute LSD in humans

Liechti, M. E., Dolder, P. C., Schmid, Y. · Psychopharmacology (2016)

190 cited
Long-term follow-up of psilocybin-facilitated smoking cessation

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562 cited
A Public-Health-Based Vision for the Management and Regulation of Psychedelics

Haden, M., Emerson, B., Tupper, K. W. · Journal of Psychoactive Drugs (2016)

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LSD modulates music-induced imagery via changes in parahippocampal connectivity

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Psilocybin with psychological support for treatment-resistant depression: an open-label feasibility study

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1174 cited
LSD acutely impairs fear recognition and enhances emotional empathy and sociality

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Nunes, A. A., Dos Santos, R. G., Osório, F. L. et al. · Journal of Psychoactive Drugs (2016)

80 cited
LSD-induced entropic brain activity predicts subsequent personality change

Lebedev, A. V., Kaelen, M., L€ Ovd En, M. et al. · Human Brain Mapping (2016)

292 cited
Neural correlates of the LSD experience revealed by multimodal neuroimaging

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Novel psychopharmacological therapies for psychiatric disorders: psilocybin and MDMA

Grob, C. S., Mithoefer, M. C., Brewerton, T. D. · Lancet Psychiatry (2016)

The paradoxical psychological effects of lysergic acid diethylamide (LSD)

Carhart-Harris, R. L., Kaelen, M., Bolstridge, M. et al. · Psychological Medicine (2016)

253 cited
New World Tryptamine Hallucinogens and the Neuroscience of Ayahuasca

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Serotonergic Hallucinogen-Induced Visual Perceptual Alterations

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LSD enhances the emotional response to music

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