Classic Psychedelics as a Psychotherapeutic Aid in the Treatment of Stimulant Use Disorder: a Case Report

This case study (2020) describes a 22-year-old male with a history of mood disorder and polysubstance use who decided to seek out psychotherapy for the first time following consumption of 3.5 grams of psilocybin-containing mushrooms. As treatment progressed, the patient reported being better able to consolidate his therapeutic gains through the integration of insights obtained through his use of classic psychedelics, ultimately remaining abstinent from all stimulant drugs. 

Abstract

“Despite nascent research supporting the efficacy of classic psychedelics as a psychotherapeutic aid for the treatment of substance abuse, to date, there is limited published research exploring their use in the treatment of stimulant use disorder and dual diagnosis. A 22-year-old male with a history of mood disorder and polysubstance use presented to a private Australian mental health clinic. While undergoing psychological treatment for mood and stimulant use disorder, this patient reported significant benefit from his use of classic psychedelics. Following consumption of 3.5 grams of psilocybin-containing mushrooms, he decided to seek out psychotherapy for the first time. Throughout treatment, subjective reports of his classic psychedelic use, which among others, included two occasions of having consumed 200 μg of lysergic acid diethylamide and 100 mg of dimethyltryptamine, were recorded and a psychometric tool used to capture mystical experiences was administered. As treatment progressed, the patient reported being better able to consolidate his therapeutic gains through the integration of insights obtained through his use of classic psychedelics, ultimately remaining abstinent from all stimulant drugs. The results of this case report suggest that classic psychedelics may be effective psychotherapeutic aids to be used in traditional substance abuse treatment programs. It is hoped that this case report will inform future research in this field.“

Authors: Shevaugn Johnson & Quentin C. Black

Summary

A 22-year-old male with a history of mood disorder and polysubstance use presented to a private Australian mental health clinic, where he used classic psychedelics as a psychotherapeutic aid. He reported significant benefit from his use of classic psychedelics, and ultimately remained abstinent from all stimulant drugs.

Western research on psychedelics predominates between the 1950s and 1970s, but research remained stagnant for several decades due to drug policies. However, there has been a resurgence of research since the 2000s. The “classic” psychedelics, including psilocybin, LSD, DMT, and mescaline, have unique neurophysiological and psychological effects that are derived primarily from complex mechanisms of interaction with serotonin 2A receptors. New brain imaging research has detected acute and post-acute changes in the default mode network.

Classic psychedelics have also shown promise for their use in assisting the treatment of substance use disorder. These include LSD, psilocybin, and a meta-analysis of studies on LSD and alcohol dependence.

A recent systematic review found no serious adverse events long-term associated with classic psychedelic use, and mystical experiences are thought to play an important role in negative symptom reduction.

One randomized control trial is investigating the use of psilocybin in the treatment of cocaine use disorder; preliminary results indicate that the psilocybin group had more abstinent days, lower self-reported severity of dependence, improvements in mood, and higher life satisfaction ratings.

Although some research has looked at the benefits of psychedelic-assisted psychotherapy in treating dual diagnosis, no peer-reviewed research has been published on the therapeutic benefits of classic psychedelic-assisted therapy for stimulant use disorder.

This article will reflect on the experience of an individual who used classic psychedelics to treat his stimulant use disorder and major depressive disorder.

Case Report

A 22-year-old Indian-Australian male was diagnosed with major depressive disorder, stimulant use disorder, and cannabis use disorder and commenced an individual program of focused-cognitive behavioral therapy.

John’s family history revealed that his mother struggled with lupus and an unknown bone disorder, that he had a half-sister who died by suicide at age eighteen, and that his biological father abandoned him when he was 3 years of age.

John had tried cannabis and psychedelics at the age of sixteen and seventeen, and had become dependent on the stimulant-psychedelic MDMA. He used methamphetamine intranasally from age nineteen to twenty.

John reported benefiting from his use of classic psychedelics, which included psilocybin, LSD, mescaline, and DMT. He noted that his cravings for stimulant drugs reduced substantially during this period, and that he discovered spirituality “on his own terms” through his use of classic psychedelics.

John reported having used MDMA weekly to monthly until September of 2016, at which point he achieved complete abstinence from all stimulants.

John experienced deep insights about the “emptiness of the stimulant high” and learned to self-reflect from a neutral place of observation. He concluded that he had gained what he could from these substances and now had to look within for the answers.

Classic psychedelics provided insight into various mechanisms to aid in managing John’s depression, and allowed him to observe himself from a lens of non-judgment. This helped John to apply a problem-solving approach toward his symptoms of mood disorder and no longer endorsed a “victim-mentality”.

John completed six weeks of the Matrix program, which involved seven groups per week, and was no longer dependent on stimulant drugs. He reduced his intake of classic psychedelics to once per year.

Two months after his final therapy session, John completed a thirty-item revised Mystical Experience Questionnaire (MEQ-30), where he was asked to reflect on his past experiences with classic psychedelic substances. He answered the questions according to his feelings, thoughts, and experiences at the time of the session.

John reported that his frequent use of classic psychedelics caused him to lose interest in the competitive nature of a capitalistic society and that his perception of bright lights had been altered.

A telephone follow-up in September 2019 was made, and John reported being abstinent from all stimulant drugs for approximately 2.5 years. He also reported consistently cutting back his use of classic psychedelics to once per year.

Discussion

Nascent findings support the use of classic psychedelics in the treatment of mental illness and substance use disorder, but no published research has explored their use in the treatment of stimulant use disorder with or without a dual diagnosis.

This case report demonstrates the benefit of investigating classic psychedelic-assisted psychotherapy in the management of stimulant use disorder with or without a dual diagnosis.

The patient appeared to have a full mystical experience, which might explain his perceived subjective benefits. Further research might consider administering the MEQ-30 close to the most recent episode of psychedelic use, and capturing the severity of dependence across time.

While John credited his success to his use of classic psychedelics, his continued use of cannabis might have influenced his recovery. Furthermore, there is preliminary evidence for the use of MDMA-assisted psychotherapy in populations with autism spectrum disorder who experience social anxiety.

John’s difficulty adjusting to mainstream culture could be due to having used classic psychedelics outside the context of therapist-supervised psychedelic therapy, which would have provided him with adequate support needed for integration back into society.

In summary, this case report highlights the potential benefit of exploring the use of classic psychedelic-assisted psychotherapy in the treatment of stimulant use disorder.