Psychedelic substances have a rich and complex history of use and often include drugs like LSD, psilocybin, DMT, and others. Their subjectively experienced effects, often referred to as a “trip”, involve subtle or drastic changes in perception, consciousness, and overall psychological processes. Although psychedelics have often been given a bad reputation in terms of recreational usage, these substances have been employed for spiritual, ceremonial, shamanistic, and healing practices for centuries. Naturally derived psychedelic substances can often be found in plants, fungi, and even animals. Currently, a resurgence in research and clinical attention has been paid to how psychedelics can facilitate therapeutic progress and lead to vast improvements in overall wellbeing in difficult to treat mental disorders.
What Are Psychedelics & How Do They Work?
The “classic psychedelics” tend to refer to lysergic acid-diethylamide (LSD), psilocybin (magic mushrooms), N,N-dimethyltryptamine (DMT), mescaline (peyote), among others. While sharing similar perceptual and sensory effects, along with being commonly grouped within the category of psychedelics, substances like MDMA and ketamine are actually pharmacologically distinct. Dosage is one of the primary factors predicting the types of effects which will occur, with the “set and setting” defining the importance of psychological state and environmental considerations influencing the subjective experience. The most implicated receptor interaction in producing classical psychedelic effects is agonist or partial agonist activity at serotonin (5-HT) receptor type 2A.
What Do We Know & What is Left to Understand?
Following the discovery of LSD by Albert Hoffman, interest in the uses of psychedelics rapidly expanded, with investigations into “controlled psychoses” and use as psychotherapeutic tools occurring shortly after. The CIA even conducted a series of unethical and illegal experiments on uninformed human subjects as a part of Project MKUltra, with their use as interrogation tools being explored. Although studies into their psychological effects and psychotherapeutic potential have occurred through such investigations like the Harvard Psilocybin Project and Marsh Chapel Experiment, various gaps in our understanding of psychedelics persist. Overall, no unifying theory to the subjective and phenomenological effects of psychedelic substances exists, although cognitive neuroscience has shed light on these and has been used to bridge the gaps in our understanding.
How Can Psychedelics Be Therapeutically Used?
Psychedelic Therapy involves an individual being given a moderate to high dose of a psychedelic substance in order to illicit mystical and transcendent states to arrive at greater degrees of self- discovery and understanding of one’s concerns. Incorporated in this process by the psychotherapist facilitating the session includes elements of cognitive-behavioral therapy (CBT) and motivational enhancement therapy (MET), such as decreasing ambivalence for positive change, cognitive reframing of concerns, examination of core beliefs, and evaluation of schemas. In contrast, a differing form of using psychedelics therapeutically is represented by Psycholytic Therapy, in which low to medium doses of psychedelics are given to approach subconscious issues and use of defense mechanisms with the ultimate goal being the discharge of emotionally salient psychic tension. Psychedelic-Assisted Therapy, which has gained the greatest prominence in recent times, involves an individual being encouraged to focus their attention inward while lying down in a relaxed position and listening to carefully chosen music for the duration of the session. In this process, psychotherapists are non-directive and facilitate the individual’s self- discovery and sense of trust, openness, and reflection of the drug’s effects. Therapy session precipitate and follow administration of psychedelic-facilitated sessions, including to prepare the individual for the effects, process experiences afterwards, and integrate meaning drawn from memories, feelings, and ideas expressed during the session. The mechanisms behind psychedelic-assisted treatments remain poorly understood but have been hypothesized to result from the importance of insight, increased personality openness, changes in potentially harmful beliefs and values, and increased motivation and self-efficacy.
What Is the Evidence Behind Psychedelic-Assisted Therapies?
The use of psychedelic-assisted therapies has been indicated as effective for the treatment of treatment-resistant depression (TRD), substance use disorders, trauma-related disorders like PTSD, cluster headaches, depression and anxiety associated with terminal illnesses, end-of-life care, and others. Studies using psilocybin with cancer patients expressing symptoms of depression and anxiety reported a range of positive effects including greater relational-embeddedness, emotional range and wisdom, revised life priorities, alterations in identity, and a general shift from feeling separate from others to a sense of interconnectedness. In 2018, the FDA described psilocybin as a “breakthrough therapy” for TRD. Novel psychedelics like the West African iboga plant-derived ibogaine has been reportedly effective in treating opioid addiction and withdrawal effects, along with facilitating introspection and reflection of subjective sources of addiction and transformative experiences aimed at gaining greater perspective on behavioral change. While not strictly a psychedelic substance, ketamine has recently been approved by the FDA under the formulation esketamine in the treatment of adults. Additionally, MDMA-assisted therapy has been implicated in the potential treatment of PTSD, anxiety in the terminally ill, and for social anxiety. Similarly, the FDA granted status in 2017, with Phase II trials demonstrating significant reductions in PTSD symptoms, with long-term improvements being maintained in most patients one year after administration.
Barriers & Considerations Toward Implementation
More clinical studies are needed to confirm the safety and efficacy of psychedelic-assisted therapies, with cultural stigma surrounding use of such substances has persisted and hindered research since the 1960s. Promotion of a hard reduction model has been implicated for clients who endorse the use of psychedelics outside of therapeutic contexts, with a firm and clear boundary that therapist cannot legally attend or facilitate dosing sessions. All substances discussed are currently classified by the DEA as Schedule 1 controlled substances under the Controlled Substances Act. The National Institute on Drug Abuse (NIDA) states certain hallucinogens to be potentially addictive (PCP), with concerns for drug craving and tolerance produced over time. Medical administration of hallucinogens should include careful consideration of the appropriate dosage, patient screening, and appropriate preparation of the patient including preparation and follow-up of psychedelic-assisted psychotherapy sessions in accordance with an approved procedure based on research evidence. Significant increases in psychedelic tourism, such as Westerners travelling to South America for & authentic ayahuasca experiences & has called to question whether certain psychedelics and their historic uses should be separated or celebrated by outsiders in their traditional uses.
- Austin Stokes