Psychedelic therapy as a complementary treatment approach for alcohol use disorders
Peter EISCHENS and William Leigh ATHERTON
Journal of Psychedelic Studies, 2018, 2, (1), pp. 36–44
Background : Traditional treatment interventions for alcohol use disorders (AUD) have produced mixed outcomes and the global increase in AUDs demands novel and innovative approaches to addiction treatment. Psychedelic substances have been reintroduced into the Western medical community as a potential intervention to complement the treatment of AUDs.
Objectives : This paper will discuss the implications of using psychedelic substances as a complementary approach within the treatment of AUDs.
Methods : A thorough review of pertinent research focused on the use of psychedelics in relation to the affective, cognitive, social, legal, and spiritual issues commonly associated with AUDs.
Results : Research suggests the clinical efficacy and safety of psychedelic therapy as a complementary treatment for AUDs.
Conclusion : Future directions and implications to AUD treatment are provided.
Keywords : psychedelic substances, alcohol use disorders, complementary and integrative approach
According to the recent US National Epidemiological Survey on Alcohol and Related Conditions, the prevalence of a lifetime occurrence of an alcohol use disorder (AUD) in the United States hovers just under 30% (Grant et al., 2015). These numbers increase significantly when a comorbid mental illness is present (Kilgus, Maxmen, & Ward, 2016). Additionally, the risk of disease rises with dosage increases of alcohol consumption (Room, Babor, & Rehm, 2005). Total alcohol consumption accounts for ∼4% of the world’s total burden of disease (Ezzati et al., 2002), despite AUDs being preventable and treatable. Current treatment modalities being used for individuals with AUDs exhibit low efficacy in producing lasting positive outcomes, especially during the initial recovery period (Marlatt & Witkiewitz, 2002). Complementary interventions for AUDs have the potential to create more robust treatments with
greater successful outcomes.
Common treatment models for AUDs include screening and brief interventions, specialized treatment programs, and mutual help groups (Room et al., 2005). Brief interventions are typically utilized in primary care settings after a patient has been identified as abusing alcohol. The goal of a brief intervention may be to limit the alcohol use of the patient prior to the development of an AUD (Tam, Knight, & Liaw, 2016). Specialized treatment may include components of withdrawal management, therapy, pharmacotherapy, and residential or outpatient rehabilitation (Room et al., 2005). Mutual help groups typically refer Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) organizations. The primary stated outcome of groups, such as AA and NA, is chemical abstinence (Alcoholic Anonymous, 2001). Pharmacological therapies, such as acamprosate and naltrexone, for treating addiction have also increased throughout the past few decades.
The effectiveness of pharmacological therapies for addiction is often measured by chemical abstinence and outcomes have been moderately successful (Caputo et al., 2003; Krampe, Spies, & Ehrenreich, 2011). These treatments attempt to illicit behavior change (Krampe et al., 2011) and decrease alcohol cravings (Caputo et al., 2003; Kalk & Lingford-Hughes, 2014). However, most pharmacological interventions require daily medication intake to be effective and have the potential to produce negative side effects, including extreme physical illness (Krampe et al., 2011), use disorder behaviors (Stein et al., 2011), and acute toxicity (Brennan & Van Hout, 2014).
The efficacy of the currently applied treatment methods is questionable. Approximately 25% of patients remain abstinent 1 year after treatment (Walters, Bennett, & Miller, 2000). For those who do not seek treatment, remission rates may further decline (Moos & Moos, 2006). Researchers have reported that patients seeking addiction treatment will have an average of 3.5 treatment attempts, indicating a lack of effectiveness in current treatment modalities for longterm recovery (Anglin, Hser, & Grella, 1997). Early recovery in particular is associated with elevated relapse rates and situational challenges (Marlatt & Witkiewitz, 2002), which may require explicit and targeted interventions. Formal treatment typically occurs within the initial months of an individual’s recovery; however, cognitive impairments that increase susceptibility to relapse persist for up to 1 year (Stavro, Pelletier, & Potvin, 2013). Significant cognitive impairments during the first year of chemical abstinence (Stavro et al., 2013) and diminished inhibitory control over drinking (Field, Wiers, Christiansen, Fillmore, & Vester, 2010) create urgency within the initial recovery period to effectively prevent full relapse. Early recovery may be the most poignant period for effective interventions. A recent study of 175 subjects undergoing outpatient treatment demonstrated a relapse rate greater than 50% within the first 4 weeks of treatment (Charney, Zikos, & Gill, 2010).
The lack of treatment efficacy coupled with the global increase in substance use disorders demands novel
approaches to addiction treatment, particularly during early recovery (Tupper, Wood, Yensen, & Johnson, 2015). Alcohol substantially impacts domains of physical, psychological, social, and spiritual health, which should be addressed during this critical period (Heather, 1994). As the counseling community begins to experience greater acceptance of introspective practices (Johansen & Krebs,
2015), psychedelic treatment models present as a viable option for novel addiction treatment that promotes introspection and addresses the domains of wellness most impacted by AUDs (Ross, 2012). The standardization of clinical psychedelic treatment (Johnson, Richards, & Griffiths, 2008) and renewed interest in the use of psychedelics on a myriad of biopsychosocial issues demonstrates the potential for psychedelic therapy to be a legitimate complementary intervention for the treatment of AUDs.