Psychedelic therapy for smoking cessation: Qualitative analysis of participant accounts

Sample and verification: Twelve participants were interviewed. The extracted text does not report a full demographic table within the interview section, but notes that five interviewees had never used a classic hallucinogen previously and the other seven reported a mean of about 10 lifetime occasions of hallucinogen use many years before the study. Across the original pilot, 12/15 (80%) were biologically verified abstinent at six months, 10/15 (67%) at 12 months, and 9/15 (60%) at the long-term follow-up (average 30 months). In the interviewed subset, 10 participants (67%) were abstinent at 12 months and 9 participants (60%) were abstinent at the long-term interview; one individual self-identified as a non-smoker but tested positive, consistent with occasional party smoking. Prior relationship to smoking: Participants reported diverse roles for cigarettes before treatment, including using smoking to transform or moderate emotions, to connect with others, and as a habitual or identity-defining behaviour. Several recounted strong emotional attachments to cigarettes, describing them metaphorically as 'friends' or as central to relationships with family members. Psilocybin-related mechanisms: Eleven of the 12 interviewees who quit at the TQD attributed their cessation in part to psilocybin session experiences. Three interrelated psychological themes emerged repeatedly: (a) insights into self-identity, where sessions revealed a sense of a deeper or more authentic self that made smoking seem incongruent with that self (for example one participant reported, "I'm not a 'smoker'"), (b) smoking-specific insights such as recognising that a single cigarette implied recommitment to long-term smoking, and (c) experiences of interconnectedness, awe and sustained curiosity that diminished the relative importance of smoking. Acute session content often evoked powerful imagery, symbolic metaphors and reactivation of core values that participants described as either 'remembering' or reconnecting with prior aspects of themselves. Withdrawal and affective tone: Eleven of 12 interviewees reported marked reductions in withdrawal intensity and frequency following the first psilocybin session compared with prior quit attempts; seven reported no withdrawal symptoms and four reported attenuated symptoms. Participants attributed reduced withdrawal to ongoing reflection on session contents and to lingering positive affect. The affective quality of the first session correlated with participants' immediate post-session cravings: generally positive first sessions were followed by few cravings, whereas sessions with negative tone were associated with urges to smoke in some cases. Non-drug treatment factors: Preparatory CBT and related activities were uniformly viewed as important. Specific elements cited included the personal mantra, keeping a smoking diary, a scented oil cue, and mindfulness practice. Rapport with study guides was repeatedly emphasised: ten participants identified trust and bonding with guides as crucial for safety and for enabling deep session work, and several reported that not wanting to 'let down' guides reinforced abstinence. The enforced abstinence during the initial 8–10 hour psilocybin session and the requirement to remain abstinent for several days to qualify for subsequent sessions created a sense of momentum that helped some participants maintain abstinence. Interviewees also noted that entering sessions with clear therapeutic intent was important; without such intent, some felt the experiences could have made quitting less likely. Dose sequencing and session meaning-making: Nine participants ranked sessions by significance; six identified the second session as most important, two favoured the third, and none identified the first as singularly most meaningful. Several described insights as unfolding across sessions rather than arising solely within one session, and many reported that preparatory and integration work and guide support helped turn challenging first-session material into productive subsequent experiences. Music, ritual and acceptability: All participants considered session music central to their experiences, sometimes describing it in agential terms. Attitudes to ritual varied—some participants welcomed it while others found certain ritual elements uncomfortable. Most interviewees reported that psilocybin was not addictive; a minority were open to further supervised use, but several did not wish to repeat the experience. Persisting non-smoking effects: Beyond cessation, participants reported long-term positive changes at an average of 30 months post-TQD, commonly increased aesthetic appreciation, heightened altruism and pro-social behaviour, greater openness or authenticity, improved relationships, and shifts in priorities. These auxiliary effects were typically attributed to the psilocybin sessions in conjunction with counselling. Participant suggestions for future research: Recommendations included exploring psilocybin for grief or depression, tailoring clinical space and music more to individual preferences, allowing periods of silence during sessions, reducing immediate post-session paperwork, and adjusting ritual elements according to participant comfort.

Noorani and colleagues interpret participant accounts as indicating multiple, overlapping mechanisms through which psilocybin-facilitated treatment may support smoking cessation. Central among these were powerful psychological insights into identity and smoking behaviour, sustained experiences of interconnectedness, awe and curiosity, and reductions in withdrawal and craving following sessions. The authors highlight that these drug-related effects appear to interact with non-drug elements of the protocol—preparatory CBT, rapport with guides, enforced initial abstinence and a clear therapeutic intent—to produce a coherent therapeutic process. The authors situate the qualitative findings alongside prior quantitative work linking mystical-type experiences to therapeutic outcomes, noting that several features reported by participants map onto commonly used dimensions of the mystical-type phenotype (for example unity, sacredness or awe, noesis, positive mood). At the same time, Noorani and colleagues emphasise that meaningful therapeutic material can also arise from challenging sessions, and that such material may require structured aftercare and integration to produce benefit. Several practical implications for future research are drawn from participant testimony. The incremental deepening of meaning across sessions suggests multi-session designs may be preferable to single-session approaches; in this sample the second session was most often rated as most significant, and a two-session ascending-dose strategy is discussed as a potential compromise between single and multiple administrations. The timing between sessions also emerged as important, with the two-week interval used here perceived as long enough to encourage abstinence in some participants but short enough to limit relapse risk. The authors further underscore the importance of careful attention to music selection, therapeutic setting, ritual elements and post-session integration practices. Limitations acknowledged by the investigators include the retrospective qualitative design, small sample size, open-label parent trial and the absence of three participants who declined interviews (two of whom had not quit). These features preclude causal inferences about efficacy and make it impossible to isolate the independent contributions of guides or other protocol elements. The authors also note ethical and practical challenges in experimentally manipulating therapist support in this context. Overall, they present the findings as hypothesis-generating material to inform the design of future controlled trials and to refine best-practice procedures for psychedelic-assisted addiction treatments.

The authors conclude that conducting psilocybin sessions within a structured therapeutic protocol produced participant-reported mechanisms plausibly related to smoking cessation, including psychological insight, experiences of interconnectedness, sustained awe and curiosity, and attenuated withdrawal. Preparatory counselling and strong rapport with session guides were also highlighted as important contributors. Noorani and colleagues recommend that future research should include randomised trials and examine optimal numbers of sessions, inter-session intervals, and the variety of meaningful experiences beyond mystical-type effects, while paying attention to protocol elements such as music, setting and integration to maximise therapeutic benefit and feasibility at scale.