Psychedelic therapy for smoking cessation: Qualitative analysis of participant accounts

This long-term, qualitative follow-up study dissects the factors that lead to long-term smoking cessation. Vivid insights, rapport with the study team, good preparation, were some of the factors that led to this effect.

Abstract

“Background: Recent pilot trials suggest feasibility and potential efficacy of psychedelic-facilitated addiction treatment interventions. Fifteen participants completed a psilocybin-facilitated smoking cessation pilot study between 2009 and 2015.

Aims: The aims of this study were as follows: (1) to identify perceived mechanisms of change leading to smoking cessation in the pilot study; (2) to identify key themes in participant experiences and long-term outcomes to better understand the therapeutic process.

Methods: Participants were invited to a retrospective follow-up interview an average of 30 months after initial psilocybin sessions. Semi-structured interviews were conducted with 12 of the 15 participants. Data were analysed using thematic analysis.

Results: Participants reported gaining vivid insights into self-identity and reasons for smoking from their psilocybin sessions. Experiences of interconnectedness, awe, and curiosity persisted beyond the duration of acute drug effects. Participants emphasised that the content of psilocybin experiences overshadowed any short-term withdrawal symptoms. Preparatory counselling, strong rapport with the study team, and a sense of momentum once engaged in the study treatment were perceived as vital additional factors in achieving abstinence. In addition, participants reported a range of persisting positive changes beyond smoking cessation, including increased aesthetic appreciation, altruism, and pro-social behaviour.

Conclusions: The findings highlight the value of qualitative research in the psychopharmacological investigation of psychedelics. They describe perceived connections between drug- and non-drug factors, and provide suggestions for future research trial design and clinical applications.”

Authors: Tehseen Noorani, Albert Garcia-Romeu, Thomas C. Swift, Roland R. Griffiths & Matthew W. Johnson

Notes

  • At 30 months (2,5 years) after the therapies (counseling, 3x psilocybin at 20 and 30mg/70kg) 60% of participants were still smoking-abstinent
  • Profound personal experiences (during the session) were the reasons each (non-smoking) participant gave for quitting
  • The paper is full of qualitative examples (quotes) that may be useful for future research

This paper builds on Johnson et al. (2014) which was the pilot study on smoking cessation. Also see the quantitative long-term follow-up (Johnson et al., 2017) which showed that at 30 months on average 60% was still abstinent.

“The aims of this study were as follows: (1) to identify perceived mechanisms of change leading to smoking cessation in the pilot study; (2) to identify key themes in participant experiences and long-term outcomes to better understand the therapeutic process.”

An ultimate goal of this is to better understand what in the psychedelic experience helps (or helped the smokers) and see how this can be used or surfaced in future research. “… such experiences can offer insights for improving best practice in the emerging field of psychedelic research and psychotherapy for substance use disorders.”

“A sub-theme that emerged regarding six participants’ prior experiences with smoking was its ability to produce strong feelings of connection.”

Smoking (or cigarettes) was seen as a friend, a companion and/or a way to connect to others.

“All 11 participants reported gaining profound insights into their self-identity or smoking behaviour. Themes of interconnectedness, awe, and curiosity were identified as additional features of psilocybin sessions that helped participants quit smoking. Finally, all participants who successfully quit after their TQD reported marked post-session reductions in cigarette withdrawal symptoms in comparison with previous quit attempts.”

Seven of the participants indicated that they gained valuable insight into themselves. The sessions showed an (earlier) better self. For others, it showed that their identity was not linked to smoking.

Again seven participants said they gained insight into their smoking behavior. They thought about the underlying reasons for smoking (e.g. anxiety) and the commitment to smoking (they wanted to break).

Eight participants experienced feelings of interconnectedness. This was also linked to the negative effects of smoking (pollution, harm to health).

Six participants (of the 11) had sustained feelings of awe (which overshadowed their ‘mundane’ smoking habits).

The participants had reduced withdrawal symptoms and cravings, 7 even experienced no withdrawal symptoms. Importantly this was (after the first session) so for participants with a positive experience, not so for those (2) with a negative experience.

The counseling also positively contributed to the smoking cessation. One specific mentioned was the mantra they made for themselves (mission statement about key motivations to quit smoking). Another was the rapport built up with the councilors themselves.

It’s hard to distill from this study how much this and other ‘normal’ interventions (like keeping a smoking diary) are necessary components. Participants do mention them as needed (especially those with a negative first experience). Yet the amount of counseling is not something that would make this a viable method to help (the general public) to stop smoking.

“…two sessions using ascending doses may represent a good middle-ground for future clinical research in psychedelic-assisted addiction treatment.”

In the discussion, there is a reflection on the number of sessions. A second session may be necessary to gain more insight, a third seems to yield little extra benefit.

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