It might seem counterintuitive to treat substance use disorders (SUDs) with psychedelic drugs, but there’s a long history of such treatments and a growing body of scientific studies exploring their use.

Most scientists agree that addiction takes place in the brain, though the exact mechanism is still somewhat opaque. Both substance use disorders and behavioral addictions follow similar channels through the brain involving dopamine and neurotransmitters. If psychedelics move through the same brain channels to provide relief from withdrawal symptoms without becoming addictive, they can be used therapeutically.

In late 2022, the journal Addiction Neuroscience published a review of the literature on psychedelics in the treatment of SUDs. The literature is divided into “classic psychedelics” including LSD, DMT, psilocybin, and mescaline, and non-classic psychedelics such as ibogaine, ketamine, MDMA, salvinorin A, and THC. The authors conclude:

[T]he literature presents moderate evidence on the controlled use of psilocybin and ketamine for Alcohol Use Disorder, ketamine for management of opiate and alcohol withdrawal, and THC preparations for reducing withdrawal symptoms in Cannabis and possibly in Opioid Use Disorder.

The authors point out that most of the studies on psychedelic treatment for SUDs combined psychotherapy with the drugs. There is evidence showing the combination of psychotherapy and psychedelics in the treatment of SUDs can be effective but there is almost no scientific evidence that the psychedelics are effective without psychotherapy. The use of psychedelics in the treatment of addiction may be limited to detox and withdrawal, not stopping use or preventing relapse.

The latest wrinkle in the use of psychedelics to treat addiction is an attempt to engineer psychedelics that do not get the user high. The University of Chicago podcast series, Big Brains, recently published an interview with David E. Olson, founding director of the UC Davis Institute of Psychedelics and Neurotherapeutics.

Olson’s focus is on using psychedelics in the treatment of mental health disorders, but he says there’s some evidence they might be effective in treating SUDs. His team is reverse engineering psychedelic compounds and reformulating new compounds. Olson explains the benefits in a transcript from the podcast:

Our novel compounds are producing therapeutic efficacy that is comparable to these first-generation molecules, and we can use traditional antidepressants as negative controls. And so what we’re looking for are new drugs that produce effects that are as rapid and sustained as molecules like ketamine and psilocybin but that lack the subjective effects.

Olson goes on to discuss how his team is developing non-hallucinogenic compounds that “still produce very robust, sustained therapeutic effects even after a single administration.” One of Olson’s hopes for the new compounds is that they will enable people to take the drugs without a psychotherapist present. This would tremendously reduce the cost of administering these therapeutics, and possibly reduce their effectiveness if not accompanied by psychotherapy.

We will continue to report on the use of psychedelic drugs and their derivatives here on AddictionNews and on what their use reveals about the methods of both behavioral addictions and substance use disorders.

Written by Steve O’Keefe. First published January 17, 2024.

Sources:

“Classic and non‐classic psychedelics for substance use disorder: A review of their historic, past and current research,” Addiction Neuroscience, September 2022.

“Psychedelics without the hallucinations: A new mental health treatment?” University of Chicago Big Brains Podcast, retrieved January 2024.

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