Psychedelic Treatments for Substance Use Disorder and Substance Misuse: A Mixed Methods Systematic Review

A systematic review of seven studies on psychedelic treatments for substance use disorder and substance misuse found positive results for measures of abstinence, substance use, craving, and withdrawal, but the data were scarce and covered a wide range of addictions (opioid, nicotine, alcohol, cocaine, and unspecified substances). Qualitative synthesis from three studies indicated that psychedelic-assisted treatments enhanced self-awareness, insight, and confidence. However, the review concludes that there is currently insufficient research evidence to suggest the effectiveness of any psychedelic (psilocybin, ibogaine, or ayahuasca) for any specific substance use disorder or misuse.

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Abstract

Renewed interest in psychedelic substances in the 21st century has seen the exploration of psychedelic treatments for various psychiatric disorders including substance use disorder (SUD). This review aimed to assess the effectiveness of psychedelic treatments for people with SUD and those falling below diagnostic thresholds (i.e. substance misuse). We systematically searched 11 databases, trial registries, and psychedelic organization websites for empirical studies examining adults undergoing psychedelic treatment for SUD or substance misuse, published in the English language, between 2000 and 2021. Seven studies investigating treatment using psilocybin, ibogaine, and ayahuasca, alone or adjunct with psychotherapy reported across 10 papers were included. Measures of abstinence, substance use, psychological and psychosocial outcomes, craving, and withdrawal reported positive results, however, this data was scarce among studies examining a wide range of addictions including opioid, nicotine, alcohol, cocaine and unspecified substance. The qualitative synthesis from three studies described subjective experience of psychedelic-assisted treatments enhanced self-awareness, insight, and confidence. At present, there is no sufficient research evidence to suggest effectiveness of any of the psychedelics on any specific substance use disorder or substance misuse. Further research using rigorous effectiveness evaluation methods with larger sample sizes and longer-term follow-up is required.