Psilocybin and MDMA in Couples Therapy: Investigating Treatment for Substance Use Disorders and Codependency
Contemporary Family Therapy – December 11, 2025
Source: OpenAlex
Summary
Addressing the complex interplay of addiction and relationship dynamics, a review explores how psychedelic-assisted therapy could transform couples facing substance use disorders (SUDs). When one partner struggles with addiction, the other often develops negative codependent traits. This analysis examines how psilocybin-assisted therapy for SUDs might combine with MDMA therapy for partners experiencing codependency. Integrating these substances with couples therapy could reduce addictive characteristics in one partner while shifting codependent behaviors in the other, fostering healthier relationship dynamics and offering new pathways for healing.
Abstract
Abstract Substance use disorders (SUDs) are increasingly common in the United States, and while this may be a dilemma for those using, it also inflicts problems for those around the user. In couples where drug abuse is present, negative codependent characteristics can arise independently in the non-user, having a damaging effect on the couple dynamic. This is a narrative review to identify how psilocybin-assisted therapy (PAT) has been used to treat SUDs and 3,4-methylenedioxymethamphetamine (MDMA) for disorders like PTSD, examining how MDMA may also be able to treat codependency in a spouse uniquely afflicted by their counterpart’s addiction. When utilizing the combination of these two substances with couples therapy, a reduction of addictive characteristics in one client with a SUD may occur while also shifting codependent behaviors in the romantic partner. Clinical implications as well as limitations on current research are discussed along with further suggestions for psychedelic-assisted couples therapy [149].