A Tragedy of Errors: The State of Psychedelic Research in the Treatment of Alcohol Use Disorder.

Research into psychedelic drugs for treating alcohol use disorder (AUD) has revived, but several fundamental limitations restrict the conclusions that can be drawn. These include general issues like functional unblinding and the ambiguous definition of psychedelic-assisted psychotherapy, as well as AUD-specific challenges such as how the mystical experience relates to the spiritual experience described in Alcoholics Anonymous literature. Current neuroimaging studies are also limited in design and fail to directly examine the cognitive and circuit-level processes likely underlying treatment response. This review bridges historical, conceptual, and mechanistic aspects of this research and offers suggestions for future studies to more clearly specify the role of psychedelics in AUD treatment.

Study at a glance

Abstract

The past two decades have seen the reemergence of research investigating the therapeutic potential of psychedelic drugs across neuropsychiatric illnesses. One condition, alcohol use disorder (AUD), is of relevance given the broad public health implications and both limited effectiveness and attrition associated with currently available treatments. While emerging research has suggested that the benefits of psychedelic drugs in the treatment of AUD may be considerable, several fundamental aspects of this work limit the conclusions that can be drawn. These limitations include those that apply to research involving psychedelics generally-including functional unblinding and the role and definition of "psychedelic assisted psychotherapy" and some unique to AUD, including the nature of the mystical experience and how it relates to the "spiritual experience" as described in the literature of Alcoholics Anonymous (AA), of which the history of psychedelic research in AUD is closely intertwined. Additionally, current mechanistic neuroimaging studies examining the therapeutic effects of psychedelics in AUD are limited by design and do not directly interrogate the cognitive and circuit-level processes likely underlying treatment response. This review describes these limitations in detail by bridging historical, conceptual, and mechanistic aspects of psychedelic research in AUD and offers suggestions for future studies, the results of which may more clearly specify the role and utility of psychedelic drugs in the treatment of AUD.