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Altered States, 1980(Film still)

Are psychedelics the key to treating addiction?

There’s mounting evidence to suggest that psychedelic drugs combined with therapy could be effective treatments for addictions such as substance abuse

Sophie had struggled with drugs and booze since she was 16. She would often drink until she blacked out, and by her mid-20s she was dependent on heroin and crack. She became pregnant at 26 and was able to stop everything, “but cocaine crept back in,” she recalls. “I would use it and not be able to stop.” It was much the same with alcohol. “I used to drink every day before I had my daughter, but even after, I was still drinking a lot.”

When her daughter was two, in 2017, Sophie began working with ayahuasca. During one of her first experiences with the hallucinogenic Amazonian brew, she was instructed to “stop taking drugs; cut out the salt, the sugar and excessive caffeine. Drink water and try the mushrooms.” Sophie takes a breath. “It was so clear and precise,” she says. Seven years later, despite a couple of hiccups, she has hardly looked back.

The stories about transformations from dependencies thanks to psychedelics just keep growing. And science is steadily beginning to repudiate the mounting real-world evidence. The class of mind-expanding drugs – not least ibogaine, which can temporarily eradicate deep-rooted drug withdrawal symptoms thus allowing an immediate window for sustained recovery – could be primed to oust many of the established routes out of drug and alcohol misuse.

The idea of using psychedelics to treat addiction is not a new concept, says Rayyan Zafar, a neuropsychopharmacologist at Imperial College London and researcher for the charity Drug Science. Without the war on drugs, it could have happened in the mainstream much earlier.

“My friends believe that LSD temporarily triggers a change in blood chemistry that inhibits or reduces ego thereby enabling more reality to be felt and seen,” wrote Alcoholics Anonymous (AA) founder Bill Wilson in 1961The drug, also known as acid, was given to 150 serious alcoholics and achieved “startling results” over three years during the original psychedelic boom. The recipients were studied in comparison to a group that only underwent AA’s spirituality-tinged abstinence-based 12-step programme. Amazingly, the group which tripped experienced far more sustained recoveries.

This tallies with Sophie’s experience, but the push by Wilson – who himself quit alcohol thanks to an experimental blend of psychotropic plants – to introduce LSD to AA, a global mutual aid fellowship that has chapters in most cities across the Western world, was repulsed by more circumspect figures within the movement before the impending drug war demonised LSD as a mind-addling poison. “12 steps have been amazing but I’m not so dogmatic,” Sophie says, alluding to the strict rules and military-style discipline promoted to stay on the wagon by AA. She needed something else to reset her system aside from willpower and community.

AA remains the default treatment for alcoholism in much of the world and it has an estimated two million members. But it has faced growing scrutiny amid reported success rates of less than ten per cent and claims that its 12-step programme is “perhaps no longer the most reliable route to sound long-term mental health”. The core text of AA still says: “There is no such thing as making a normal drinker out of an alcoholic. Science may one day accomplish this, but it hasn’t done so yet.” 

“Mushrooms gave me more desire to have peace, love and joy in my life” – Sophie

Sophie admits that she has drunk a couple of times in the intervening years, and mostly ended up binge drinking to the point of blacking out. But each occasion strengthened her resolve to stay entirely sober, which she has been for several years now. “Mushrooms gave me more desire to have peace, love and joy in my life,” she says. In the throes of one trip, she was forced to look at herself in the mirror and examine “why I was an addict in the first place; the self-loathing, the low self-esteem, and toxic thoughts. It was fucking brutal.”

Who knows – perhaps AA may one day offer pathways to psychedelic treatment. But with LSD tainted by the drug war and other psychedelics deemed more palatable (especially since it is more difficult to take a massive dose of shrooms than acid, for example), it will have to wait its turn. But already, in Switzerland, a pain therapy clinic is dosing patients with psilocybin, the psychedelic drug derived from magic mushrooms. One patient recently claimed she had gone to rehab for her alcoholism almost 20 times, but only the psychedelics helped. Ketamine is also being served intravenously to people, including some with alcohol use disorder, in the US and UK, and trials are underway to ascertain the optimal treatment combinations.

“Thousands of people struggle every day with this condition [alcoholism], tragically some even die, without ever hearing about the alternatives,” writes Jon Stewart, whose long period going to AA meetings got him sober before he became disenchanted with the movement. “During my 14 years in AA, I saw people come and go largely for two reasons: either they ‘couldn’t get the God bit’, or they couldn’t maintain abstinence […] The majority of alcoholics, those who may never be able to give up the booze entirely, desperately need to be made aware of the other options now available.”

“The growing evidence that psilocybin therapy helps in alcohol and tobacco addiction raises the exciting possibility it might also work in behavioural addictions such as gambling” – Professor David Nutt

“Under Wilson’s guidance, AA would have been an LSD psychotherapy sort of treatment program with community care,” says Zafar. The growing promise shown by some of the psychedelic options for substance use disorder led him and his team to successfully apply for funding from the UK government for a world first clinical and neuroimaging study of psilocybin for gambling use disorder study. It’s only the UK’s second public grant for psychedelic research, and the first since a seminal study almost a decade ago. “The growing evidence that psilocybin therapy helps in alcohol and tobacco addiction raises the exciting possibility it might also work in behavioural addictions such as gambling,” says Professor David Nutt, head of the Imperial College Centre for Psychedelic Research. “Our pilot study will help address this question.”

No doubt there will be resistance, just like Wilson faced towards his LSD plan. The UK gambling industry generates more than £10 billion in profit a year, while its social costs – often shouldered by the most vulnerable – could be in excess of £1.5 billion. “There aren’t any currently licensed pharmacological interventions,” says Zafar. “There is no medicine. Psychedelics have not been dosed to patients with gambling addictions ever before in a clinical trial,” adds Zafar.

His five initial patients will therefore be part of a pioneering research project through which they may significantly improve their quality of life. “Psychedelic addiction treatment works,” he says, citing emerging evidence that suggests people who have consumed psilocybin are significantly correlated with a far lower risk of opioid use disorder, an affliction with epidemic-like consequences in the US.

Researchers are however unsure of exactly how psychedelics rewire the brain away from substance use dependency. “We need to develop probes that look into the reward system in the brain,” adds Zafar, “to understand whether psychedelic therapy can change some of the dysfunction that we observed in people with gambling disorders within their reward systems.”

Some, like Sophie, are already keen to gamble on psychedelics to tackle their dependencies. Heroic Hearts Project UK, a non-profit supporting UK military and emergency services veterans to gain access to psychedelic therapy, intends to facilitate a psilocybin retreat next year specifically for veterans with gambling addiction linked to PTSD. “Having received some very positive support for exploring therapeutic options for military and emergency services first responders veterans with gambling addiction, it is our intention to continue planning for a psilocybin retreat in the Netherlands next year,” says Keith Abraham, CEO of Heroic Hearts Project UK, which is awaiting official charity status. “We hope that any prospective participants with gambling addiction find some valuable insights into their situation and relief from their symptoms.”