Cessation and reduction in alcohol consumption and misuse after psychedelic use
Albert Garcia-Romeu, Alan K Davis, Fire Erowid, Earth Erowid, Roland R Griffiths and Matthew W Johnson
Journal of Psychopharmacology, 2019, 1–14
Background : Meta-analysis of randomized studies using lysergic acid diethylamide (LSD) for alcohol use disorder (AUD) showed large, significant effects for LSD efficacy compared to control conditions. Clinical studies suggest potential anti-addiction effects of LSD and mechanistically-related classic psychedelics for alcohol and other substance use disorders.
Aims : To supplement clinical studies, reports of psychedelic use in naturalistic settings can provide further data regarding potential effects of psychedelics on alcohol use.
Methods : An anonymous online survey of individuals with prior AUD reporting cessation or reduction in alcohol use following psychedelic use in nonclinical settings.
Results : 343 respondents, mostly White (89%), males (78%), in the USA (60%) completed the survey. Participants reported seven years of problematic alcohol use on average before the psychedelic experience to which they attributed reduced alcohol consumption, with 72% meeting retrospective criteria for severe AUD. Most reported taking a moderate or high dose of LSD (38%) or psilocybin (36%), followed by significant reduction in alcohol consumption. After the psychedelic experience 83% no longer met AUD criteria. Participants rated their psychedelic experience as highly meaningful and insightful, with 28% endorsing psychedelic-associated changes in life priorities or values as facilitating reduced alcohol misuse. Greater psychedelic dose, insight, mystical-type effects, and personal meaning of experiences were associated with a greater reduction in alcohol consumption, controlling for prior alcohol consumption and related distress.
Conclusions : Although results cannot demonstrate causality, they suggest that naturalistic psychedelic use may lead to cessation or reduction in problematic alcohol use, supporting further investigation of psychedelic-assisted treatment for AUD.
Keywords : Psychedelics, hallucinogens, alcohol, psilocybin, lysergic acid diethylamide (LSD)
Alcohol use disorder (AUD) is widespread (WHO, 2018), with an estimated 68.5 million (29.1%) American adults exhibiting lifetime prevalence, and 32.6 million (13.9%) currently meeting Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5; American Psychiatric Association, 2013) criteria for AUD diagnosis (Grant et al., 2015). The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports that 28% of American adults currently exhibit unhealthy alcohol use patterns (Saitz, 2005), many of whom could benefit from targeted healthcare interventions (US DHHS, 2005). Only 19.8% of individuals with lifetime prevalence of AUD have, however, ever sought treatment (Grant et al., 2015).
Current FDA-approved pharmacotherapies for AUD include acamprosate (Carmen et al., 2004), naltrexone (Maisel et al., 2013), and disulfiram (Jørgensen et al., 2011; SAMHSA, 2015). Additionally, psychosocial treatments such as screening and brief intervention or motivational enhancement therapy (MET), alone or with medications, have shown some success in reducing excessive drinking, though upwards of 70% of individuals with AUD generally relapse to heavy drinking within the first year after treatment (Anton et al., 2006; Davis et al., 2018a; Dawson et al., 2005; Jonas et al., 2012; Martin and Rehm, 2012; Miller et al., 2001; Moyer, 2013; Saitz, 2010; Vaillant, 2003; Vasilaki et al., 2006; Weiss et al., 2008). Poor treatment response is typically associated with greater baseline alcohol use severity indicators (Davis et al., 2018a; Saitz, 2010), suggesting an unmet intervention need in heavy users.
Serotonin 2A (5-HT2A) agonist “classic hallucinogens” (hereafter referred to as “psychedelics”) have shown promise in treating AUD (Bogenschutz et al., 2015; Krebs and Johansen, 2012). Psychedelics, primarily lysergic acid diethylamide (LSD), were studied for their potential to help reduce problematic alcohol use in the 1950s through 1970s (Abuzzahab and Anderson, 1971; Bowen et al., 1970; Chwelos et al., 1959; Dyck, 2006; Hollister et al., 1969; Krebs and Johansen, 2012; Kurland et al., 1967; Ludwig et al., 1969; Mangini, 1998; Osmond et al., 1967; Pahnke et al., 1970; Smart et al., 1966; Smith, 1958, 1959; Tomsovic and Edwards, 1970). Results from early clinical research with LSD for alcohol misuse were not always consistent due to considerable variation in methods between studies (Abuzzahab and Anderson, 1971; Carhart-Harris et al., 2018; Hartogsohn, 2016, 2017; Johnson et al., 2008; Rucker et al., 2018). A meta-analysis of six randomized controlled trials administering a single high-dose of LSD (ranging from 3 μg/kg to 800 μg) for treatment of alcoholism (total n = 536) found that individuals who received LSD exhibited significantly greater odds of improvement in alcohol misuse at the first follow-up assessment than those in control groups (OR = 1.96, p = 0.0003; Krebs and Johansen, 2012). Dichotomized data from five of those trials showed 59% of LSD patients improved at initial follow-up compared to 38% of control patients (Krebs and Johansen, 2012). These effects rival those of currently available AUD medications, with meta-analyses showing significant improvement in alcohol abstinence rates with acamprosate vs. placebo (OR = 1.88, p < 0.001; Carmen et al., 2004), non-significant improvement in abstinence rates with naltrexone vs. placebo (OR = 1.26, p = 0.08; Carmen et al., 2004), and significantly increased abstinence with unsupervised disulfiram vs. other or no treatment (OR = 1.59; p = 0.02; Jørgensen et al., 2011).
From 1971 to the 1990s, human research with psychedelics largely stalled due to Schedule I classification and associated stigma (Bonson, 2017; Nutt et al., 2013). Novel studies investigating the effects of psychedelics such as dimethyltryptamine (DMT; Strassman and Qualls, 1994; Strassman et al., 1994), mescaline (Hermle et al., 1992, 1998), and psilocybin were, however, gradually reinitiated (Gouzoulis-Mayfrank et al., 1998, 1999; Griffiths et al., 2006, 2008; Spitzer et al., 1996; Vollenweider et al., 1997), including a reemergence of clinical research examining psychedelics as potential treatments for addiction (Bogenschutz et al., 2015; Garcia-Romeu et al., 2015, 2016; Johnson et al., 2014, 2017a; Sessa and Johnson, 2015; Tupper et al., 2015).
In the first contemporary study to reassess psychedelicassisted treatment for alcohol misuse, Bogenschutz and colleagues (2015) administered one or two doses of psilocybin (0.3 mg/kg and 0.4 mg/kg) with motivational enhancement therapy to 10 treatment-seeking volunteers meeting DSM-IV (American Psychiatric Association, 1994) criteria for alcohol dependence in an open-label trial. Participants reported significantly fewer drinking days and heavy drinking days for 32 weeks after the first dose of psilocybin compared to baseline (Bogenschutz et al., 2015). Consistent with observations from earlier studies of LSD (Kurland et al., 1967, Pahnke et al., 1970), and contemporary pilot research of psilocybin-facilitated treatment for tobacco dependence (Garcia-Romeu et al., 2015), results suggested qualitative attributes of the drug experience (e.g., mystical-type effects, ego dissolution, intensity) as potential key factors facilitating subsequent behavior changes (Bogenschutz et al., 2015; Nielson et al., 2018). Although these recent findings are limited by the small sample size and lack of randomized comparison or blinding conditions, additional controlled research on psilocybin facilitated treatment of alcohol dependence is currently underway (ClinicalTrials.gov Identifier: NCT02061293, 2014a).
Anecdotal reports and observational data also suggest a potential link between psychedelic use in non-treatment settings, and associated reductions in problematic alcohol and drug use (Albaugh and Anderson, 1974; Barbosa et al., 2012, 2018; Fábregas et al., 2010; Halpern et al., 2008; Hill, 1990; Lattin, 2012; Prue, 2013; Thomas et al., 2013). Instances in which naturalistic psychedelic use are followed by subsequent cessation or reduction in alcohol misuse have not, however, been systematically investigated. Anonymous online surveys have previously been used to collect data regarding trends in naturalistic substance use that help inform potential risks and benefits of particular drugs and provide complementary evidence for hypothesis generation and testing in laboratory research and clinical trials (Davis et al., 2018b; Johnson et al., 2017b; Winstock et al., 2014). The aims of the present anonymous online survey study were to systematically characterize, and determine patterns within, instances in which naturalistic psychedelic use led to self-reported reductions in alcohol misuse outside a formal treatment setting. We hypothesized that some individuals would report lasting reductions in their problematic alcohol use attributed to an experience with a classic psychedelic, and that greater reductions would be associated with greater ratings of mystical-type subjective qualities for the psychedelic experience.