This randomized study (1969, n=176) found no long-lasting (up to 12 months later) positive effects of LSD-assisted therapy (210μg/70kg) versus no therapy, an effect that was found in other studies from this time.

Abstract

“One hundred seventy-six male alcoholic patients participated in a controlled investigation of the differential efficacy of three LSD treatment procedures and a “no therapy,” or milieu treatment, condition. Half of each group was also assigned to disulfiram after discharge from the hospital to determine whether any of these techniques could be enhanced by its use. Although significant improvement was shown within all treatment groups as measured by a number of clinical assessments in the post-treatment and follow-up periods, no one treatment condition proved to be superior. The authors conclude that the dramatic claims for the efficacy of LSD treatment in alcoholism are unjustified.”

Authors: Arnold Ludwig, Jerome Levine, Louis Stark & Robert Lazar

Summary

By Arnold Ludwig, M.D., Jerome Levine, M.D., Louis Stark, and Robert Lazar

One hundred seventy-six male alcoholic patients participated in a controlled investigation of three LSD treatment procedures and a “no therapy” condition. None of the treatments proved superior.

rFHIS REPORT represents the culmination of a three-year investigation into the effectiveness of three experimental LSD treatment conditions and a control treatment condition. It was also determined whether the effectiveness of any of these techniques could be enhanced by placing the patients on disulfiram (Antabuse) subsequent to hospital discharge.

A large-scale controlled follow-up study with alcoholic patients was conducted to compare the effectiveness of hypnodelic treatment with other LSD techniques and with no therapy. Additionally, a selected sample of patients received disulfiram upon hospital release.

The inpatient treatment phase was conducted at the Alcoholic Treatment Center of Mendota State Hospital. 195 out of 254 patients volunteered and 176 were treated, with a responsible relative being contacted prior to treatment and at the six- and 12-month intervals following hospital release.

Hypnodelic therapy condition (hypnosis + LSD + psychotherapy) involves giving the appropriate dosage of LSD, performing a hypnotic induction, and then beginning an active, dynamically oriented psychotherapy.

Drug therapy condition (LSD alone): patients were given the appropriate dosage of LSD and instructed to relax and think about their problems. Therapists remained in the treatment room throughout the session.

Patients assigned to the no therapy condition spent an equivalent amount of time in contemplation and meditation by themselves, and made constructive plans for the future. They had an opportunity to work through any residual problems in their ongoing formal group therapy program.

Patients were told whether or not they would receive disulfiram prior to hospital release. Those selected were strongly encouraged to take a fixed, prescribed dosage every day, given a disulfiram identification card for their wallets, and started on the drug four days prior to hospital discharge.

Thirteen psychiatrists participated as therapists in the study. Each therapist treated either one or two blocks of eight patients, with each patient receiving one of the four experimental treatment conditions and one-half of the patients receiving disulfiram.

Symptomatology and personality characteristics-the CPI and PEP are self-report inventories that indicate the improvement or deterioration of a patient’s psychological health.

The Breathalyzer is a highly reliable instrument for determining blood alcohol level from a sample of expired air, and the Drinking Follow-up Form is used to obtain information regarding drinking behavior.

The Behavior Rating Scale (BRS) was used to evaluate patient social adjustment in six general areas: home interpersonal relationships, social interpersonal relationships, personal social responsibilities, employment, drinking pattern, and legal adjustment.

The treatment team was separated entirely from the follow-up evaluation team, and the follow-up social workers were forbidden to discuss the patients with any of the therapists. The nurses and other ward staff knew who had received LSD and who had not.

The treatment outcome evaluation was divided into two phases-inpatient and follow-up. The inpatient phase focused on effects of treatment on symptomatology and personality change, while the follow-up phase included evaluation of behavior and community adjustment.

The follow-up evaluations were scheduled at three, six, nine, and 12 months after hospital discharge. A monetary incentive was added for the nine- and 12-month periods to increase patient motivation to partake in the follow-up evaluations.

We followed up with 92.04 percent, 94.31 percent, 87.50 percent, and 96.02 percent of the total sample of study patients at the three-, six-, nine-, and 12-month periods, respectively.

inpatient Evaluation

Inpatient evaluation focused on symptomatology and personality change, and patients were evaluated prior to and two weeks after the experimental treatment session but before being assigned to disulfiram therapy. All treatment groups improved from baseline to post-treatment evaluation, but there were no consistent significant differences.

Follow-Up Evaluation

Inpatient evaluation is important, but after the patient has left the hospital, it is also important to assess his adjustment with family, employment status, and difficulty with the law.

We must deal with two factors of therapy, the type of experimental treatment and whether disulfiram was subsequently administered.

Observable or reportable behavior (i.e., drinking behavior) increased sharply during the first three months, followed by a general plateauing from six to 12 months.

Figure 3 depicts the percentage of patients drinking during any given month. There was significant improvement over baseline levels for every group at every period, but no difference in improvement was found between the groups or between the groups taking disulfiram and the groups not taking it.

Table 4 gives the mean total adjustment scores on the Behavior Rating Scale for each of the treatment and disulfiram groups at the three, six, nine, and 12-month periods.

The Psychiatric Evaluation Profile (PEP) and California Psychological Inventory (CPI) were used to assess symptomazology and personality characteristics. There was significant improvement on the Distress and Competence factors for all treatment groups.

Results using the California Psychological Inventory are similar to the above reported results, with improvement from pretreatment to posttreatment testing on most measures.

We would like to report significant results for the hypnodelic treatment technique as well as for the other LSD treatment conditions, but the overwhelming evidence indicates that none of the LSD treatment procedures produces greater therapeutic benefit than the “no therapy” condition.

The results of the research studies did not conform to the often dramatic responses of patients observed clinically shortly after the various LSD treatments. The follow-up data showed that the therapeutic affirmations and resurgence of constructive motivation following LSD procedures did not ensure any better treatment response than simple exposure to the hospital ward milieu.

After hospital admission, patients tend to gain therapeutic gain due to medical care, adequate nutrition, group discussion of their problems, exposure to an anti-drinking but supportive environment, and the sudden cessation of drinking.

Despite overall improvement in attitude and social adjustment, the total treatment program is generally unsuccessful in producing sobriety. However, most patients are able to carry on most of their other social tasks at least at a higher level than that noted on hospital admission, while engaging in periodic drinking.

The overall follow-up results for patients treated with disulfiram are disappointing, as almost all patients stop taking the drug some-time within the year of follow-up.

Disulfiram is an effective agent in itself, but the major therapeutic problem seems to be the failure of any experimental treatment conditions to stimulate sufficient motivation for patients to continue taking this drug after hospital discharge.

The failure of the three LSD conditions to produce dramatic or even significant results could be attributed to two basic faults of the experimental treatment program: insufficient preparation of patients prior to their LSD treatment and inadequate follow-up care.

Further treatment was futile because no encouraging signs of greater therapeutic benefit were noted at the posttreatment inpatient evaluation or three-month posttreatment evaluation.

We have attempted to control for therapist skill by assigning therapists an equal number of patients in each experimental treatment category, but the results indicate that these variables are insignificant in influencing treatment effect.

This report presents a relatively uncomplicated analysis of treatment outcome in heterogeneous samples of chronic alcoholic patients randomly assigned to the experimental treatment conditions. The results show that the various LSD procedures do not offer any more for the treatment of alcoholism than an intensive milieu therapy program.

This report represents the culmination of a three-year investigation into whether there would be differential effectiveness among three experimental LSD treatment conditions.

Thirteen psychiatrists treated 176 male alcoholic patients with LSD. The results indicated significant improvement from baseline to post-treatment and follow-up testing for all treatment conditions, but no one treatment condition proved superior to any other.

The authors thank several people for their contributions to this project, including the nurses Ann Mueller, Jan Kaster, Marian Lull, and Barbara Luther.