Substance Use Disorders (SUD)Public Health, Prevention & Behaviour Change

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

This review and hypothesis-building paper (2012) presents where we stand with psychedelic research for the treatment of addiction and provides a rationale for further research.

Authors

  • Michael Bogenschutz

Published

Drug Testing and Analysis
meta Study

Abstract

Alcohol and drug addiction are major public health problems, and existing treatments are only moderately effective. Although there has been interest for over half a century in the therapeutic use of classic hallucinogens to treat addictions, clinical research with these drugs was halted at an early stage in the early 1970s, leaving many fundamental questions unanswered. In the past two decades, clinical research on classic hallucinogens has resumed, although addiction treatment trials are only now beginning. The purpose of this paper is to provide a targeted review of the research most relevant to the therapeutic potential of hallucinogens, and to integrate this information with current thinking about addiction and recovery. On the basis of this information, we present a heuristic model which organizes a number of hypotheses that may be tested in future research. We conclude that existing evidence provides a convincing rationale for further research on the effects of classic hallucinogens in the treatment of addiction.

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

Introduction

Classic hallucinogens are a pharmacologically heterogeneous group of compounds that act primarily via agonism at 5-HT2A receptors and include agents such as LSD, psilocybin and mescaline. Historical clinical work through the 1950s to early 1970s explored their use across a range of psychiatric conditions, including alcohol and drug addiction, and identified both psycholytic (low–moderate dose, therapy-facilitating) and psychedelic (higher dose, mystical-experience-facilitating) therapeutic models. Many early reports described lasting psychological and behavioural change following hallucinogen-assisted therapy, but methodological limitations in older studies and regulatory constraints following the Controlled Substances Act curtailed research for several decades. This paper, authored by Bogenschutz and Pommy, aims to provide a targeted review of the recent (approximately 20 years) literature most relevant to the therapeutic potential of classic hallucinogens for addictions, integrating that literature with contemporary models of addiction and recovery. On that basis the authors present a heuristic, testable conceptual model that organises possible biological and psychological mechanisms by which hallucinogen administration might reduce substance use and promote recovery. The extracted text does not provide a formal systematic review protocol or search strategy, instead describing a selective synthesis intended to guide future empirical work.

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