Cessation and reduction in alcohol consumption and misuse after psychedelic use

This survey study (n=343) suggests that naturalistic psychedelic use may be associated with reduced problematic alcohol consumption. This complements clinical studies that found similar results with smaller sample sizes.

Abstract

“Background: Meta-analysis of randomized studies using lysergic acid diethylamide (LSD) for alcohol use disorder (AUD) showed large, significant effects for LSD efficacy compared to control conditions. Clinical studies suggest potential anti-addiction effects of LSD and mechanistically-related classic psychedelics for alcohol and other substance use disorders.

Aims: To supplement clinical studies, reports of psychedelic use in naturalistic settings can provide further data regarding potential effects of psychedelics on alcohol use.

Methods: An anonymous online survey of individuals with prior AUD reporting cessation or reduction in alcohol use following psychedelic use in non-clinical settings.

Results: 343 respondents, mostly White (89%), males (78%), in the USA (60%) completed the survey. Participants reported seven years of problematic alcohol use on average before the psychedelic experience to which they attributed reduced alcohol consumption, with 72% meeting retrospective criteria for severe AUD. Most reported taking a moderate or high dose of LSD (38%) or psilocybin (36%), followed by significant reduction in alcohol consumption. After the psychedelic experience 83% no longer met AUD criteria. Participants rated their psychedelic experience as highly meaningful and insightful, with 28% endorsing psychedelic-associated changes in life priorities or values as facilitating reduced alcohol misuse. Greater psychedelic dose, insight, mystical-type effects, and personal meaning of experiences were associated with a greater reduction in alcohol consumption, controlling for prior alcohol consumption and related distress.

Conclusions: Although results cannot demonstrate causality, they suggest that naturalistic psychedelic use may lead to cessation or reduction in problematic alcohol use, supporting further investigation of psychedelic-assisted treatment for AUD.”

Authors: Albert Garcia-Romeu, Alan K. Davis, Fire Erowid, Earth Erowid, Roland R. Griffiths & Matthew W. Johnson

Summary

Introduction

Alcohol use disorder is widespread, affecting 29.1% of American adults, and 13.9% of those who meet DSM-5 criteria for AUD. Only 19.8% of individuals with lifetime prevalence of AUD have ever sought treatment.

Pharmacotherapies for AUD include acamprosate, naltrexone, and disulfiram, as well as psychosocial treatments such as screening and brief intervention or motivational enhancement therapy. However, poor treatment response is typically associated with greater baseline alcohol use severity indicators.

Serotonin 2A (5-HT2A) agonist “classic hallucinogens” have shown promise in treating AUD. LSD was the first psychedelic studied for its potential to help reduce problematic alcohol use.

Meta-analysis of studies using LSD for alcohol use disorder showed significant effects.

Research with LSD for alcohol misuse was not always consistent due to considerable variation in methods between studies. However, a meta-analysis of six randomized controlled trials administering a single high-dose of LSD for treatment of alcoholism found that individuals who received LSD improved at initial follow-up.

From 1971 to the 1990s, human research with psychedelics largely stalled due to Schedule I classification and associated stigma. However, novel studies investigating the effects of psychedelics were gradually reinitiated.

In an open-label study, 10 treatment-seeking volunteers receiving psilocybin reported significantly fewer drinking days and heavy drinking days for 32 weeks after the first dose compared to baseline. Qualitative attributes of the drug experience were suggested as potential key factors facilitating subsequent behavior changes.

A study was conducted to investigate whether naturalistic psychedelic use is followed by subsequent cessation or reduction in alcohol misuse outside a formal treatment setting. The study found that greater reductions were associated with greater ratings of mystical-type subjective qualities for the psychedelic experience.

Materials and methods

This cross-sectional, anonymous, online survey study was conducted using Survey Monkey from October 2015 to August 2017 among individuals who had overcome alcohol or drug addiction after using psychedelics. Participants provided informed consent by choosing to complete the survey after reviewing introductory information.

Measures

Participants provided demographic information and lifetime drug use data, and described their reference psychedelic experience, including the substance used, duration of alcohol misuse, and use of medication or other AUD treatments.

Participants completed the AUDIT-C, the DSM-5 Alcohol Use Disorder Symptom Checklist, and the Alcohol Urge Questionnaire after their reference psychedelic experience. They were also asked to endorse potential mechanisms of change attributed to their psychedelic-associated alcohol use cessation or reduction.

The AUDIT-C is a validated measure of alcohol use that has good reliability and construct validity.

The DSM-5 alcohol use disorder symptom checklist was used to determine past and current alcohol use behavior in participants with a reference psychedelic experience.

The AUQ measures alcohol craving across three domains, with higher scores indicating greater craving.

The Mystical Experience Questionnaire (MEQ30) is a validated 30-item measure assessing the intensity of mystical-type experiences. It consists of four dimensions: mystical, positive mood, transcendence of time and space, and ineffability.

Participants were asked to rate the persisting effects of their reference psychedelic experience, including personal meaning, psychological challenge, psychological insight, spiritual significance, and change in well-being or life satisfaction.

Data analyses

We calculated descriptive statistics and compared pre- to postreference psychedelic experience scores for the AUDIT-C, DSM-5 symptom checklist, AUQ, and self-reported drinks per week. We calculated Pearson correlation coefficients between AUDIT-C change scores and all primary study variables.

Based on correlation data, a model was proposed to explain the effect of psychedelic experience on alcohol reduction. This model included pre-AUDIT-C, dose, insight, personal meaning, and intercorrelation of acute mystical and insightful experiences that occurred during the psychedelic experience.

Respondent characteristics

During recruitment, 4095 people clicked on one of the recruitment ads and started the survey. Of these, 1429 met study inclusion criteria, consented to participate, and began filling out the survey regarding alcohol. The final sample comprised 343 adults, with a mean age of 31.4 years. The most commonly used classic psychedelics were LSD and psilocybin, with most respondents reporting ten lifetime uses of both drugs.

Alcohol use, treatment, and mental health prior to psychedelic experience

Most respondents had a severe alcohol use disorder (AUD) prior to their reference psychedelic experience, and had been dealing with a drinking problem for approximately seven years on average. They had also been diagnosed with a mood disorder, anxiety disorder, or a substance use disorder not otherwise specified.

Reference psychedelic experience

Approximately three quarters of participants reported using either psilocybin (36%) or LSD (38%) in the reference psychedelic experience, and most had the experience in their home. Most participants reported having the experience for psychological or spiritual exploration, and only a small minority intended to reduce/quit drinking alcohol.

Most respondents rated their reference psychedelic experience among the 10 most personally meaningful, 39% rated it among the 10 most psychologically challenging, and 74% rated it among the 10 most psychologically insightful experiences of their lives.

Adverse effects

Most participants reported no persisting adverse effects beyond the period of acute drug action from their reference psychedelic experience, and only two individuals reported extreme severity. None of these individuals reported any decrease in well-being or life satisfaction related to the reference psychedelic experience.

Alcohol withdrawal symptoms

Several alcohol withdrawal symptoms were reported by at least half of the sample, but most reported that the symptoms were less severe after the reference psychedelic experience compared to prior attempts to reduce or stop alcohol use.

Alcohol consumption following the psychedelic experience

Almost all respondents reported that they had greatly reduced or quit drinking alcohol since their reference psychedelic experience, and the majority were no longer above the threshold considered to be a risky drinker.

Participants in the study no longer met criteria for alcohol use disorder (AUD) at the time of responding to the survey, and most had not sought any other treatment for alcohol use problems since their reference psychedelic experience.

Path analysis

Pearson correlation coefficients revealed that the AUDIT-C change score was significantly positively associated with dose of psychedelic substance, intensity of acute mystical experiences, ratings of the experience as personally meaningful and insightful, and pre-AUDIT-C scores.

Greater alcohol consumption prior to the reference psychedelic experience and greater alcohol distress were directly related to greater change in alcohol consumption. Additionally, greater acute insight and greater mystical effects were directly related to greater personal meaning associated with the experience.

Other effects

Participants reported improvements or deterioration in several domains after the reference psychedelic experience, including alcohol consumption, other drug use, diet and nutrition, physical activity and exercise, interpersonal relationships, and work/career.

Discussion

In some cases, naturalistic psychedelic use outside of treatment settings is followed by pronounced and enduring reductions in alcohol misuse. These results are consistent with reports that psychedelic use in both clinical and religious contexts has been linked to decreases in problematic alcohol consumption. Although only 10% of participants reported an explicit intention to change their drinking behavior, many reported long-lasting improvements in personal relationships, diet, exercise, and work or career.

Psychedelic experiences can reduce alcohol and other substance misuse. A large majority of respondents rated their reference psychedelic experiences among the 10 most personally meaningful experiences of their lives, and more than half considered it among the five most spiritually significant experiences of their lives.

Studies of psychedelic-assisted addiction treatment have found that greater overall intensity and greater mystical-type effects of the drug experience are highly correlated with treatment outcome, and that these effects may be mediated by serotonin 2A agonist psychedelics in humans.

Spirituality has been found to play an important role in recovery from alcohol dependence, and may be a protective factor against alcohol misuse. Psychedelics may represent an alternative path to spiritual or otherwise highly meaningful experiences.

In the 1950s, Lattin participated in medically supervised administration of LSD and cited similarities between his sobriety and his experience with LSD. Evidence is growing that underlying neurological correlates of psychedelic effects may contribute to their therapeutic potential.

Although psychedelic-occasioned experiences including both mystical-type effects and psychological insight subtypes have garnered much of the attention surrounding behavioral and psychological changes observed following psychedelic administration in the laboratory, evidence suggests that other psychological mechanisms may provide more breadth in understanding positive outcomes. Most respondents reported their reference psychedelic experience as among the 10 most psychologically insightful experiences of their lives. Additionally, the intensity of the mystical experience predicted change in alcohol consumption. Although preliminary, these data suggest that psychological insight is an important mechanism of behavior change following a psychedelic experience.

Psychedelics have been shown to have anxiolytic and antidepressant effects in individuals with treatment-resistant depression and anxiety.

Patients with symptoms of anxiety or depression associated with life-threatening illness reported less severe affective withdrawal symptoms after the reference psychedelic experience compared with previous attempts to cut down or stop drinking. Results suggest that the anxiolytic and antidepressant effects of psychedelics may be key mediators of potential efficacy in ameliorating alcohol and other substance use disorders, and that emotional processing and social cognition may be another potential mechanism.

This study has several limitations, including participant self-selection, volunteer bias, and the retrospective nature of the data. No definitive conclusions can be drawn about the role of psychedelics in alcohol use reduction, and rates of increased alcohol consumption after psychedelic use were not assessed. Due to the homogeneity of the study sample, results are not necessarily generalizable to other populations. However, results are consistent with greater psychedelic use among White males in national epidemiological data.

Despite a lack of federal support for therapeutic psychedelic research, historical clinical research, and contemporary pilot laboratory results indicate that serotonergic psychedelics may hold considerable potential in the treatment of AUD. Considering the substantial mortality and morbidity associated with unhealthy alcohol use, the high prevalence of AUD, and the limitations of current treatments, psychedelic-assisted treatment of AUD represents an innovative, timely, and compelling direction for future research.