Psychedelics in the Treatment of Substance Use Disorders

Psychedelics such as LSD, MDMA, and psilocybin may hold treatment potential for alcohol, opioid, tobacco, and other substance use disorders, based on growing evidence from observational studies and clinical trials. The mechanisms are not fully understood, but the subjective psychedelic experience appears necessary for therapeutic effects, possibly serving as a turning point that elicits lasting behavioral change. Randomized, placebo-controlled trials are needed and some are underway. Even with compelling evidence, these substances may face challenges to integration into current treatment paradigms due to clinician concerns about addictive potential and philosophical objections from 12-step facilitation programs.

Study at a glance

Abstract

Growing evidence from observational studies and clinical trials suggests that psychedelics such as lysergic acid diethylamide, 3,4-methylenedioxymethamphetamine, and psilocybin may hold treatment potential for alcohol, opioid, tobacco, and other substance use disorders (SUDs). The mechanisms by which psychedelics might exert therapeutic efficacy in these conditions have not been fully elucidated, although the subjective effects of the psychedelic experience appear necessary. Given the often profound nature of psychedelic experiences, they may serve as turning points in the life narratives of users, eliciting lasting behavioral change. To better characterize the extent of psychedelics' therapeutic potential in patients with SUDs, randomized, placebo-controlled trials are needed, with some already underway. However, even if such trials demonstrate compelling evidence of psychedelics' therapeutic potential, these substances may still face considerable challenges to integration into the current SUDs treatment paradigm because of clinician concerns about their addictive potential and philosophical objections from 12-step facilitation programs. [ Psychiatr Ann. 2022;52(9):365–370.]