Alcohol Use Disorder (AUD)Substance Use Disorders (SUD)Neuroimaging & Brain Measures

Studying the Effects of Classic Hallucinogens in the Treatment of Alcoholism: Rationale, Methodology, and Current Research with Psilocybin

This review (2013) summarizes preclinical evidence to support the therapeutic efficacy of psychedelics in the treatment of alcoholism and makes suggestions for future paradigms to assess their clinical efficacy, bearing in mind the issues of blinding and expectancies that are addressed within double-blind placebo-controlled study designs.

Authors

  • Michael Bogenschutz

Published

Current Drug Abuse Reviews
meta Study

Abstract

Recent developments in the study of classic hallucinogens, combined with a re-appraisal of the older literature, have led to a renewal of interest in possible therapeutic applications for these drugs, notably their application in the treatment of addictions. This article will first provide a brief review of the research literature providing direct and indirect support for the possible therapeutic effects of classic hallucinogens such as psilocybin and lysergic acid diethylamide (LSD) in the treatment of addictions. Having provided a rationale for clinical investigation in this area, we discuss design issues in clinical trials using classic hallucinogens, some of which are unique to this class of drug. We then discuss the current status of this field of research and design considerations in future randomized trials.

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Research Summary of 'Studying the Effects of Classic Hallucinogens in the Treatment of Alcoholism: Rationale, Methodology, and Current Research with Psilocybin'

Introduction

Classic hallucinogens — here defined as serotonergic 5-HT2A agonists such as psilocybin, mescaline, and LSD — have re-emerged as candidates for therapeutic use in a range of psychiatric conditions, including addictions. Earlier clinical work from the 1950s–1970s, basic science linking these drugs to 5-HT2A-mediated cortical and intracellular signalling, and observational findings from religious groups that use sacramental hallucinogens have all been invoked as indirect or direct support for their potential to affect addictive behaviour. Renewed, rigorous human research with psilocybin and improved neuroscientific tools have intensified interest in re-evaluating these agents for alcohol dependence. Bogenschutz frames this paper as a consolidating review that (1) summarises the preclinical, neuroimaging, observational, and clinical evidence relevant to using classic hallucinogens in addictions, (2) presents a rationale for clinical investigation, and (3) outlines methodological issues and design options for future randomised trials — with particular attention to psilocybin. The aim is practical as well as conceptual: to identify what is known, what remains uncertain, and how trials should be designed to answer the key efficacy and mechanistic questions.

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