This editorial (2015) discusses the potential of and obstacles to psychedelic therapies for substance dependence.

Abstract

“After a 40-year hiatus there is now a revisiting of psychedelic drug therapy throughout psychiatry, with studies examining the drugs psilocybin, ketamine, ibogaine and ayahuasca in the treatment of drug dependence. Limitations to these therapies are both clinical and legal, but the possibility of improving outcomes for patients with substance dependency imposes an obligation to research this area.”

Authors: Ben Sessa & Matthew W. Johnson

Summary

After one hundred years of modern psychiatry, the treatments available for enduring remission from drug dependence remain poor. Psilocybin, ketamine, ibogaine and ayahuasca are being studied to directly tackle drug dependence.

Why concentrate on drug dependence?

People who are drug-dependent are stigmatised, maligned by society and blamed, but the authors have found that many of these patients are helpless, needy victims of adverse psychosocial circumstances.

Alcohol addiction

One adult in 20 in the UK is a dependent drinker, and one quarter of all adults drink in a hazardous fashion. Alcohol dependence and misuse is a major factor in offending behaviour, and there remains a lack of coherence and agreement about the most efficacious alcohol dependence treatment.

Opiate dependence

Misuse of heroin and related opioids is a major public health concern, and methadone and buprenorphine are the most commonly prescribed medications for opioid dependence. However, these medications have limitations.

Stimulant dependence

Cocaine is the second most popularly used illegal drug in the UK and is treated with psychological strategies such as contingency management, cognitive-behavioural therapy and motivational interviewing.

Nicotine dependence

People who smoke are less marginalised than those using other drugs, but tobacco is associated with more deaths than any other legal or illegal drug. Psilocybin combined with cognitive-behavioural therapy may improve smoking cessation.

Psychedelic therapy and substance misuse

In the 1950s and 1960s psychiatrists Humphry Osmond and Abram Hoffer used lysergic acid diethylamide (LSD) to induce organic psychosis to encourage sobriety. They reported abstinence rates far surpassing other treatments before or since.

Cross-cultural use of psychedelics

Indigenous populations have used psychedelic plants to tackle addictions, including the West African use of iboga and the South American use of ayahuasca.

Possible therapeutic mechanisms

Personality change may be relevant to drug dependence, given that maladaptive personality traits often accompany drug use disorders. Psychedelics may also have therapeutic effects by changing attitudes and behaviour, and by giving patients emotional strength to continue abstinence.

Contemporary studies

A team in Russia investigated the potential role for psychedelic drug-assisted psychotherapy with ketamine for both alcohol and opiate addictions. They found that 66% of patients in the ketamine group achieved total abstinence for more than a year, compared with just 24% of the control group.

Theoretical objections to psychedelic treatment

There are objections to treating drug dependence with other potentially misused drugs, but current treatments already involve maintenance pharmacotherapy with controlled drugs.

The psychedelic renaissance

After a 40-year hiatus, there is now a revisiting of psychedelic drug therapy throughout psychiatry. However, many of these drugs are restricted at the Schedule I or Class A level, forbidding all medical use outside of highly regulated medical research.