Comparing Substance Use Consequences between Serotonergic Psychedelics, MDMA, and other Drugs of Abuse Among United States Adults with History of Psychiatric Illness
Joshua C. Black, Nicole Schow, Hannah L. Burkett, Morgan Pena, Jennifer S. Jewell, Annika Czizik, Andrew A. Monte, Richard C. Dart
International Journal of Mental Health and Addiction April 1, 2025 Peer reviewed DOI: 10.1007/s11469-023-01163-2 via Springer Nature
Summary
Psychedelic use among adults with psychiatric illnesses is more common than in the general population, with prevalence rates of 5.1% for anxiety disorders, 5.1% for major depressive disorder, 6.9% for PTSD, and 9.2% for bipolar disorder compared to 2.6% overall. While psychedelic use was linked to increased severity in substance use disorder scores, these increases were less pronounced than those seen with opioids or stimulants. This suggests that managing risks associated with psychedelics should differ from strategies used for other substances.
Study at a glance
| Design | cross-sectional survey |
|---|---|
| Population | adults with psychiatric illness history in the US |
| Key finding | Psychedelic use among adults with psychiatric illnesses is more prevalent than in the general population and is associated with increased substance use disorder severity scores. |
Abstract
Psychedelic-assisted therapy could transform treating psychiatric illness, but harms from exacerbating substance use disorder (SUD) among adults with psychiatric illness using psychedelics have not been studied. A cross-sectional survey in the US was used to test whether Drug Abuse Screening Test scores (DAST-10, validated instrument predicting SUD) were more severe when psychiatric illnesses (anxiety disorder, major depressive disorder [MDD], post-traumatic stress disorder [PTSD], and bipolar disorder) and serotonergic psychedelic or MDMA use were combined. Any psychedelic use among adults with psychiatric illness history (anxiety: 5.1% [95% CI: 4.7, 5.6]; MDD: 5.1% [4.3, 5.8]; PTSD: 6.9% [5.9, 7.9]; bipolar: 9.2% [8.0, 10.5]) was more prevalent than the general population (2.6% [2.5, 2.8]). Significant increases in scores were associated with psychedelic use independent of other concurrent drug use, but increases were smaller than for opioids or stimulants. Approaches to managing SUD risks with psychedelics should differ from past approaches for other drugs.