Psilocybin-occasioned mystical experiences in the treatment of tobacco addiction

This follow-up study (n=15) to an open-label pilot-study of psilocybin-facilitated smoking addiction treatment found that the mystical experience (MEQ) but not the intensity of the experience was predictive of smoking abstinence (80% at 6-month follow-up).

Abstract

“Psilocybin-occasioned mystical experiences have been linked to persisting effects in healthy volunteers including positive changes in behavior, attitudes, and values, and increases in the personality domain of openness. In an open-label pilot-study of psilocybin-facilitated smoking addiction treatment, 15 smokers received 2 or 3 doses of psilocybin in the context of cognitive behavioral therapy (CBT) for smoking cessation. Twelve of 15 participants (80%) demonstrated biologically verified smoking abstinence at 6-month follow-up. Participants who were abstinent at 6 months (n=12) were compared to participants still smoking at 6 months (n=3) on measures of subjective effects of psilocybin. Abstainers scored significantly higher on a measure of psilocybin-occasioned mystical experience. No significant differences in general intensity of drug effects were found between groups, suggesting that mystical-type subjective effects, rather than overall intensity of drug effects, were responsible for smoking cessation. Nine of 15 participants (60%) met criteria for “complete” mystical experience. Smoking cessation outcomes were significantly correlated with measures of mystical experience on session days, as well as retrospective ratings of personal meaning and spiritual significance of psilocybin sessions. These results suggest a mediating role of mystical experience in psychedelic-facilitated addiction treatment.”

Authors: Albert Garcia-Romeu, Roland R. Griffiths & Matthew W. Johnson

Notes

This is a follow-up to the open-label study with psilocybin-assisted therapy for smoking cessation by Johnson and colleagues (2014).

Summary

Psilocybin-occasioned mystical experiences are linked to persisting effects in healthy volunteers, including positive changes in behavior, attitudes, and values, and increases in the personality domain of openness. In an open-label pilot study, psilocybin-facilitated smoking addiction treatment was associated with mystical-type subjective effects, rather than overall intensity of drug effects.

Introduction

Researchers examined serotonin 2A receptor (5-HT2AR) agonist psychedelics for the treatment of addiction from the late 1950s through early 1970s, with mixed results. However, a meta-analysis of six randomized controlled studies found that LSD significantly decreased alcohol misuse in individuals suffering from alcoholism.

A controlled study found that patients who received LSD-facilitated treatment for opioid-dependent parolees had a statistically significant difference in biologically verified opioid abstinence at 6 months compared to a treatment-as-usual outpatient control group.

Since the 1970s human research with psychedelics has been limited due to legal barriers and a lack of funding. However, recent research suggests that psilocybin may hold considerable therapeutic potential in the treatment of a variety of conditions.

A pilot study conducted by the authors found that psilocybin may be effective in the treatment of smoking addiction, with 80% of participants demonstrating biologically verified smoking abstinence at 6-month follow-up.

Mechanisms of Psychedelic-facilitated Addiction Treatment

Investigators have speculated about the potential mechanisms of psychedelics in addiction treatment, including serotonergic, glutamatergic, and dopaminergic signaling, local brain metabolic activity and functional connectivity among brain regions, and effects of psychedelic-occasioned experiences on higher-order psychological constructs.

A secondary analysis of data from a psilocybin-facilitated smoking cessation treatment study is presented. This analysis probes potential psychological mechanisms mediating treatment outcomes.

Methods

Participants

Fifteen healthy adult smokers were recruited locally in the Baltimore area with advertisements offering a novel treatment involving psilocybin for smoking cessation. The participants were relatively well educated and had multiple past unsuccessful quit attempts.

Procedures

Participants underwent a 15-week smoking cessation treatment intervention, which consisted of cognitive-behavioral therapy (CBT) and additional elements of mindfulness training and guided imagery exercises. The TQD was set for week 5 of treatment, and facilitators met weekly with participants to discuss treatment experiences.

Measures

Smoking Biomarkers

Breath carbon monoxide and urine cotinine were used to assess participants’ smoking status weekly from study intake through end of treatment, and again at 6-month follow-up.

Timeline Follow-back (TLFB)

Participants self-reported their daily cigarette consumption over the past 30 days at study intake and at each follow-up visit.

Hallucinogen Rating Scale (HRS)

The HRS is a 99-item questionnaire used to assess subjective effects of hallucinogens in six domains, including intensity, somaesthesia, affect, perception, cognition, and volition.

Mysticism Scale

A 32-item questionnaire was used to assess participants’ experiences during a psilocybin session. The questionnaire includes three factor structure assessing dimensions referred to as introvertive, extrovertive, and interpretation.

States of Consciousness Questionnaire (SOCQ)

This 100-item measure has previously been used to characterize the subjective effects of psilocybin, and includes 43 items dedicated to evaluating mystical experience, and 57 distracter items.

Scores on the SOCQ were calculated using 43 items assessing mystical experience, and a mean total SOCQ score was calculated as a mean of all items from the preceding six scales.

Ratings of Personal Meaning, Spiritual Significance, and Well-being

Participants rated their psilocybin experiences one week after each session, and were asked to provide open-ended comments on their session experiences in their own words at the end of treatment.

Data Analysis

Analyses were performed to assess whether pre-existing differences between groups might be responsible for differences in observed smoking cessation outcomes at 6 months.

Analyses were performed to assess whether subjective effects questionnaire data about psilocybin session experiences were associated with smoking cessation outcomes at 6 months.

Change scores were calculated for several smoking-related measures from study intake to 6-month follow-up. These scores consisted of each participant’s score at study intake subtracted from their score at 6-month follow-up.

Pearson’s correlations were calculated to determine the correlates of smoking cessation success among participants’ change scores on smoking-related measures, personal meaning, spiritual significance, and impact on well-being, and HRS intensity subscale.

Differences in Smoking-related Measures at Study Intake

Two-tailed unpaired t-tests showed that participants who were still smoking at 6-month follow-up had higher urine cotinine levels than those who were abstinent.

Differences in Measures of Psilocybin Session Experiences

Smoking-abstinent participants had higher SOCQ scores, a higher Mysticism Scale score, and a higher HRS intensity subscale score than those who continued to smoke at 6 months.

Occurrence of “Complete” Mystical Experience

In the study, 42 psilocybin sessions were administered to 15 participants. Six participants reported challenging psilocybin experiences, but these were managed by study staff.

Thirteen of 42 psilocybin sessions were categorized as “complete” mystical experiences, and 9 out of 15 participants had a “complete” mystical experience during at least one psilocybin session.

Correlations between Measures of Psilocybin Session Experience and Smoking Cessation

Significant correlations were found between change scores of all smoking-related measures, as well as between mean scores on the SOCQ and change scores of the QSU craving, urine cotinine, breath CO, TLFB daily smoking, SASE confidence to abstain, and SASE temptation to smoke.

Discussion

Psilocybin, administered to drug-dependent individuals in the context of an addiction treatment program, was capable of occasioning “complete” mystical experiences at rates comparable to those previously exhibited in healthy volunteers. These experiences were significantly correlated with measures of smoking cessation treatment outcomes at 6-month follow-up.

The causes and mechanisms of psychedelic-occasioned mystical experiences are still not well-understood, though similar positive transformations in personality and/or behavior have been reported in other contexts.

Participants’ psilocybin session experiences were associated with decreased temptation to use tobacco and increased self-efficacy to abstain from smoking. Furthermore, the magnitude of the mystical qualities of the psilocybin experiences were predictive of subsequent decrease in tobacco craving and use.

The use of 5-HT2AR agonists can safely and reliably occasion mystical experiences in healthy and clinical populations, providing the unprecedented ability to study them rigorously using all the tools available to modern scientific inquiry.

The results of the present study are limited by the small and homogeneous sample, and should be interpreted with caution due to the post-hoc nature of the data analyses and multiple comparisons performed.

Psilocybin-occasioned mystical experience is associated with higher order psychological constructs relevant across addictions, and may be used to treat a wide variety of addictions, including smoking, alcoholism, and opioid dependence.

A single discrete experience can result in lasting beneficial effects in an individual’s attitudes or behavior. We propose that psychedelic-occasioned peak experiences may function in a similar fashion to post-traumatic stress disorder (PTSD) in that they can cause lasting behavioral (and likely biological) changes associated with lasting benefit.

Relationships between psilocybin session experiences and smoking-related measures were examined. Psilocybin session experiences were associated with changes in smoking craving, confidence to abstain, and temptation to smoke.

Table 2

All volunteers who demonstrated biologically verified smoking abstinence at 6-month follow-up provided verbatim written comments about their psilocybin session experiences.