An online survey of tobacco smoking cessation associated with naturalistic psychedelic use

This retrospective cross-sectional anonymous online survey (n=358) characterized individuals who reported having quit or reduced smoking after ingesting a psychedelic in a non-laboratory setting more than 1 year ago. Of the 358 participants, 38% reported continuous smoking cessation, 28% reported a persisting reduction, and 34% reported a temporary reduction before returning to baseline smoking levels.

Abstract

“Data suggest psychedelics such as psilocybin and lysergic acid diethylamide (LSD) may hold therapeutic potential in the treatment of addictions, including tobacco dependence. This retrospective cross-sectional anonymous online survey characterized 358 individuals (52 females) who reported having quit or reduced smoking after ingesting a psychedelic in a non-laboratory setting ⩾1 year ago. On average, participants smoked 14 cigarettes/day for 8 years, and had five previous quit attempts before their psychedelic experience. Of the 358 participants, 38% reported continuous smoking cessation after psychedelic use (quitters). Among quitters, 74% reported >2 years’ abstinence. Of the 358 participants, 28% reported a persisting reduction in smoking (reducers), from a mode of 300 cigarettes/month before, to a mode of 1 cigarette/month after the experience. Among reducers, 62% reported >2 years of reduced smoking. Finally, 34% of the 358 participants (relapsers) reported a temporary smoking reduction before returning to baseline smoking levels, with a mode time range to relapse of 3–6 months. Relapsers rated their psychedelic experience significantly lower in personal meaning and spiritual significance than both other groups. Participants across all groups reported less severe affective withdrawal symptoms (e.g. depression, craving) after psychedelic use compared with previous quit attempts, suggesting a potential mechanism of action for psychedelic-associated smoking cessation/reduction. Changes in life priorities/values were endorsed as the most important psychological factor associated with smoking cessation/reduction. Results suggest psychedelics may hold promise in treating tobacco addiction as potentially mediated by spiritual experience, changed priorities/values, and improved emotional regulation.”

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

Notes

This study provides more real-world context to an earlier pilot study by Johnson and colleagues (2014) which showed that 80% of participants, in the open-label study, were smoking-free after 6 months.

Summary

Introduction

Converging evidence suggests that serotonin 2A receptor (5-HT2AR) agonist hallucinogens may be an effective aid in the treatment of addiction, and that ceremonial use of 5-HT2AR agonists may be associated with addiction recovery among indigenous cultures and syncretic religions.

Psilocybin has been shown to have positive effects in healthy volunteers, including increased personality openness, positive behavior change, and high ratings of psychedelic session personal meaning and spiritual significance. Moreover, neuroscientific studies have discovered biological effects of psychedelics, including alterations in default mode network activation and changes in amygdala reactivity to negative cues.

Data suggest psychedelics may hold therapeutic potential in the treatment of addictions, including tobacco dependence. Among participants who reported having quit or reduced smoking after ingesting a psychedelic, spiritual experience, changed priorities/values, and improved emotional regulation were endorsed as the most important psychological factors associated with smoking cessation/reduction.

Several reports have appeared on websites related to psychoactive substances that describe smoking cessation resulting from non-clinical use of 5-HT2AR agonists.

Anecdotal reports of smoking cessation or reduction attributed to the use of psychedelics in non-treatment contexts complement clinical studies that suggest psychedelics have anti-addiction effects. The present survey study examined factors associated with longer durations of abstinence, sustained abstinence versus relapse, and cessation versus reduction.

Method

This anonymous survey was conducted online via SurveyMonkey from September 2013 to May 2014 to learn more information about whether psychedelic drugs are associated with reduction or cessation of cigarette smoking. Participants had to be at least 18 years of age and speak, read, and write English fluently.

Measures

The survey assessed participants’ previous smoking behavior, including number of cigarettes smoked per day (CPD), and assessed previous serious quit attempts (one day) and associated withdrawal symptoms. Participants indicated whether they were totally abstinent from smoking since their reference psychedelic experience.

Participants provided detailed information regarding their reference psychedelic experience, and were asked to rate the personal meaning and spiritual significance of their reference psychedelic experience, as well as endorse potential mechanisms of change attributed to their psychedelic-associated smoking cessation or reduction.

The Fagerström Test for Cigarette Dependence was completed retrospectively and asked questions about smoking behavior in the 6-month period prior to the reference psychedelic experience.

Participants were asked to complete the Questionnaire on Smoking Urges twice, once retrospectively and once in the present tense, to examine within-subject changes in smoking craving following an individual’s reference psychedelic experience.

The Toronto Alexithymia Scale measures difficulty identifying and describing one’s internal emotional state and is associated with greater tobacco craving during a smoking cessation attempt.

The Mystical Experience Questionnaire is a 30-item measure designed to assess the occurrence and intensity of mystical-type experiences occasioned by 5-HT2AR agonists. Individuals who scored higher on the MEQ30 were more successful in maintaining long-term abstinence.

The Tellegen Absorption Scale is a 34-item measure of absorption, a personality trait linked to suggestibility and general predisposition to altered states of consciousness. High scores predict greater rates of long-term smoking abstinence.

Data analysis

Participants were categorized into three groups according to smoking cessation outcome: quit, reduce, and relapse. Data were assessed for normality of distribution using omnibus tests.

A one-way analysis of variance (ANOVA) was performed to assess between-group differences, Kruskal – Wallis tests by ranks were performed to assess between-group differences, Chi-square analyses were used to test for differences between groups in categorical variables, and a Spearman rank correlation analysis was conducted to assess the relationship between mystical experience and trait absorption.

Results

Participant information

A total of 1273 individuals completed the survey, but 358 were removed from data analysis because of inconsistent data, smoking cessation, or long-term outcomes of psychedelic-associated smoking cessation and reduction.

Participants learned about the survey through advertisements on www.erowid.org, and most came from the United States, Canada, and the United Kingdom. Psilocybin mushrooms and LSD were the most commonly used psychedelics.

Smoking outcomes and group comparisons

137 participants reported complete smoking cessation, 100 participants reported persisting reduction in smoking, and 121 participants reported a temporary reduction in their smoking before returning to baseline smoking levels. Only 8.4% of participants reported going into their reference psychedelic experience with a premeditated intention to quit or reduce smoking.

There were no significant between-group differences in age, sex distribution, racial composition, educational achievement, prevalence of self-reported psychiatric diagnoses, number of previous quit attempts, years smoking, or retrospective cigarette dependence scores. However, there were significant between-group differences in alexithymia scores, cigarettes per day prior to the reference psychedelic experience, and confidence to abstain from smoking.

No significant differences were observed between groups with regard to lifetime hallucinogen use, substance associated with the reference psychedelic experience, intention for the experience, or setting in which the experience took place. However, there was a significant between-groups difference in the age at which the reference psychedelic experience occurred.

Withdrawal symptoms

Participants rated the severity of withdrawal symptoms after their psychedelic-associated smoking cessation or reduction as similar to previous quit attempts, with affective features of withdrawal rated as less severe.

Mechanisms of change, personal meaning, and spiritual significance

Participants described their reference psychedelic experience as personally meaningful and spiritual or mystical in nature, and endorsed changing life priorities, changing orientation toward the future, and strengthening their belief in their own ability to quit smoking as the most important potential mechanisms leading to quitting.

Significant differences were found between the relapse and quit groups in ratings of personal meaning and spiritual significance of the reference psychedelic experience. The relapse group rated their reference psychedelic experience as less personally meaningful and spiritually significant than the quit and reduce groups.

Other outcomes attributed to reference psychedelic experience

Participants reported cessation or reduction of tobacco smoking, alcohol, and other drugs, with no significant between-group differences. Most participants reported no negative effects, and some reported acute anxiety or dysphoria.

Discussion

This online survey study provides detailed information on 358 individuals who reported smoking cessation or reduction after using a serotonergic psychedelic in a non-laboratory setting 1 year ago. The results are consistent with laboratory data findings that controlled administration of 5-HT2AR agonists may hold therapeutic potential in treating tobacco and other substance use disorders.

In a prior laboratory study, volunteers who underwent psilocybin-facilitated smoking cessation treatment were purposefully attempting to quit smoking. In this survey, participants were largely not intending to reduce their smoking.

Several group differences highlight potentially relevant clinical factors regarding smoking cessation and relapse, including higher ratings of personal meaning and spiritual significance of the reference psychedelic experience in those who maintained long-term smoking abstinence and higher ratings of spiritual significance in those who reported persisting smoking reductions.

Participants did not differ significantly with respect to demographics, the psychedelic used, setting, or intention for use during the reference psychedelic experience. Adverse effects were reported at similar rates across groups, and were predominantly described as psychological or physical discomfort.

Participants reported reduced or cessation of alcohol or other drug use after their reference psychedelic experience, suggesting that psychedelics may provide benefits against a range of substance use disorders, rather than being specific to tobacco per se.

Psychedelics may prompt motivational insights that may lead to smoking cessation. However, when smoking cessation is the a priori goal of the psychedelic experience, and when combined with effective behavioral therapy, these insights may lead to substantially higher probability of persisting behavior change.

The results presented here are limited due to participant self-selection and recall bias, and the online study format makes it impossible to verify data.

Although the current study design cannot address absolute prevalence or efficacy of psychedelic-associated smoking cessation or reduction, the results suggest that psilocybin and other serotonergic psychedelics may hold considerable potential in the treatment of tobacco, and possibly other substance use disorders.