Mental health of a self-selected sample of psychedelic users and self-medication practices with psychedelics
Natasha L. MASON and Kim P. C. KUYPERS
Journal of Psychedelic Studies, 2018, 2, (1), pp. 45–52
Background : A substantial number of people worldwide suffer from mental health problems during their lifetime. First-line treatments are not effective for everybody. Recent studies suggest that psychedelic drugs have high therapeutic potential for a variety of mental disorders.
Aims : This survey study aimed to assess the tendency of psychedelic users to self-medicate with psychedelics and to compare the effectiveness of self-administered psychedelics to treat their disorder and the treatment offered by a medical professional.
Methods and results : In total, 1,967 respondents consented were ≥18 years and completed the questionnaire. The mean (±SD) age was 25.9 (8.7); 79% were males, 20% females, and 1% classified themselves as “other.” Almost half of the respondents (46%) indicated to have suffered/to be suffering from a mental disorder, with 77% being diagnosed by a medical professional. In 99% of the diagnosed cases, the treatment was offered; 77% searched for treatments outside a medical professional’s recommendation with 81% who had used/were using psychedelics to treat/cure symptoms. Self-administered psychedelic treatment had a higher likelihood of being efficacious, with higher symptoms reduction and larger quality of life improvement compared to treatment offered by a medical professional.
Conclusions : Lifetime prevalence of psychopathologies in the current sample of psychedelic drug users seemed to be higher than in the general population. Self-medication with psychedelics was not highly frequent; although when it occurred, it was rated as significantly more effective as treatment offered by a medical professional. Current findings support research exploring the potential of psychedelics in the treatment of psychopathologies.
Keywords : psychedelics, psychiatric disorders, self-medication, effectiveness of treatment
A substantial number of people worldwide suffer from mental health problems during their lifetime (Kessler et al., 2005; Steel et al., 2014). The psychiatric symptoms often lead to distress, compromising patients’ quality of life (Connell, Brazier, O’Cathain, Lloyd-Jones, & Paisley, 2012). Standard treatments like cognitive behavioral therapy or psychiatric drugs, such as antidepressants or anxiolytics, are usually efficient means to reduce symptoms or even lead to remission. It is however known that therapy is not a “one-size-fits-all” cure and some patients never reach the stage of remission. An example is treatment-resistant depression, which is prevalent in 12%–20% of the depressed population (Mrazek, Hornberger, Altar, & Degtiar, 2014). These numbers highlight the need for new therapeutic targets and agents, or combinations of existing and new treatments (Mrazek et al., 2014). Recently, there has been renewed interest in the use of psychedelics in the treatment of psychiatric conditions, such as treatment resistant depression, post-traumatic stress disorder (PTSD), and depression (Carhart-Harris et al., 2016; Carhart Harris & Goodwin, 2017; Mithoefer, Grob, & Brewerton, 2016; Sessa, 2014).
Psilocybin and its metabolite psilocin are the primary psychoactive compounds of hallucinogenic mushrooms and a prototypical example of a classical psychedelic compound (dos Santos et al., 2016). Psilocybin’s effectiveness as a therapeutic agent has been investigated in the treatment of psychiatric conditions as obsessive– compulsive disorder (OCD), anxiety, depression, and substance dependence, and has shown promising results (Bogenschutz et al., 2015; Carhart-Harris et al., 2016; dos Santos et al., 2016; Grob et al., 2011; Johnson, Garcia-Romeu, Cosimano, & Griffiths, 2014; Moreno, Wiegand, Taitano, & Delgado, 2006). Lysergic acid diethylamide (LSD) and ayahuasca, two other examples of psychedelic substances, have also suggested to be beneficial in the treatment of substance-use disorders (dos Santos et al., 2016; Krebs & Johansen, 2012). Similarly, 3,4,-methylenedioxymethamphetamine (MDMA) has been shown to be efficacious as an adjunct to psychotherapy in the treatment of PTSD and social anxiety (Danforth, Struble, Yazar-Klosinski, & Grob, 2016; Mithoefer, 2016; Mithoefer et al., 2013, 2016; Mithoefer, Wagner, Mithoefer, Jerome, & Doblin, 2011). Although not a typical psychedelic, MDMA shares the characteristic with classical psychedelics in that it acts on the 5-HT2A receptor (Liechti, Saur, Gamma, Hell, & Vollenweider, 2000; van Wel et al., 2011).
National drug surveys have reported an estimate of last year prevalence (LYP) of less than 1% for LSD and hallucinogenic mushrooms among young adults, aged between 15 and 34 years in Europe. This situates these two psychedelics in the same range of LYP as the “typically” or “traditionally” used recreational drugs such as cocaine (1.9%), MDMA (1.7%) or amphetamines (1.0%), and at the lower end compared to cannabis (13.3%; EMCDDA, 2016). When looking at lifetime prevalence of psychedelics, European surveys have shown prevalence rates in young adults (15–34 years of age) between 0.1% and 5.4% for LSD and 0.3%–8.1% for psilocybin (EMCDDA, 2012). The National Drug Survey on Drug use and Health showed a higher lifetime prevalence rate (17%); however, this survey included a larger age range (>12 years), and clustered LSD, psilocybin, and mescaline (Krebs & Johansen, 2013a).
Despite the number of people having used these substances, population studies have shown that the use of psychedelics is not associated with higher mental health problems (Hendricks, Thorne, Clark, Coombs, & Johnson, 2015; Johansen & Krebs, 2015; Krebs & Johansen, 2013a). On the contrary, in several cases, lower rates of mental health problems were reported in users compared to nonusers (Johansen & Krebs, 2015; Krebs & Johansen, 2013a). In a sample of 190,000 responders, lifetime classic psychedelic use was associated with a significantly reduced odds of past month psychological distress, past year suicidal thinking, planning, and attempts (Hendricks et al., 2015).
Altogether, the fact that psychedelics show therapeutic potential in the treatment of psychiatric conditions and the fact that even lower rates of mental problems are reported in users, poses the question as to whether psychedelic users try to self-medicate with these substances. The aim of this study was therefore to investigate, by means of an online questionnaire study, whether psychiatric disorders are prevalent in psychedelic users and whether those users have taken psychedelics to alleviate psychological or physical suffering of disorders. In addition, it was investigated whether self-rated treatment effectiveness was different for treatment offered by a medical professional compared to a self-administered psychedelic. It was expected that psychedelic users who suffered from a diagnosed psychopathology would self-medicate with psychedelics.