Psychedelic treatment for co-occurring alcohol misuse and post-traumatic stress symptoms among United States Special Operations Forces Veterans

This survey study (n=51) examined the correlation between psychedelic treatment and changes in alcohol misuse among trauma-exposed US Special Operations Forces Veterans (SOFV). Participants underwent treatment with either ibogaine or 5-MeO-DMT at a clinic in Mexico. Treatment led to reductions in alcohol misuse, PTSD symptoms as well as increasing psychological flexibility.

Abstract

“Background & aims: Special Operations Forces Veterans (SOFV) have unique treatment needs stemming from multiple repeated forms of combat exposure resulting in a complex sequela of problems including alcohol misuse and post-traumatic stress symptoms. Current approved pharmacologic treatments for alcohol misuse and PTSD are lacking in adherence and efficacy, warranting novel treatment development. The current study examined the correlations between psychedelic treatment and changes in alcohol misuse among trauma exposed United States SOFV.

Method: An anonymous internet-based survey was conducted among SOFV who completed a specific psychedelic clinical program in Mexico. Retrospective questions probed alcohol use and post-traumatic stress symptoms during the 30-days before and 30-days after the psychedelic treatment. A total of 65 SOFV completed treatment and were eligible for contact. Of these, 51 (78%) completed the survey, and 27 (42%) reported alcohol misuse (≥4 on the AUDIT-C) in the 30 days prior to treatment and were included in analyses (Mean Age = 40; male = 96%; Caucasian/White = 96%).

Results: There were significant and very large reductions in retrospective reports of alcohol use (P < 0.001; d = –2.4) and post-traumatic stress symptoms (P < 0.001; d = –2.8) and a significant and large increase in psychological flexibility (P < 0.001; d = –1.8), from before-to-after the psychedelic treatment. In the 30 days after treatment, 85% reduced their alcohol consumption to non-risky levels (33% abstinent; 52% non-risky drinking). Increases in psychological flexibility were strongly associated with reductions in alcohol use and post-traumatic stress symptoms (rs range 0.38–0.90; ps < 0.05).

Conclusion: Rigorous longitudinal studies should be conducted to determine whether psychedelic-assisted therapy holds promise as an intervention in this population.”

Authors: Pratheek Mangini, Lynnette A. Averill & Alan K. Davis

Summary

A study was conducted among trauma exposed United States Special Operations Forces Veterans to examine the correlations between psychedelic treatment and changes in alcohol misuse. Results showed that psychedelic treatment was associated with significant and large reductions in alcohol use and post-traumatic stress symptoms.

INTRODUCTION

Special Operations Forces (SOF) personnel are selected for their superior physical and psychological resilience, and are trained to endure the many challenges related to combat. However, they are often exposed to a greater number of deployments and intense combat episodes, correlating with increased prevalence of mental health problems.

Alcohol misuse is pervasive among US Veterans, with 1 in 4 meeting criteria for alcohol use disorder and 56% reporting heavy drinking. Veterans suffer significant deleterious effects from alcohol misuse that spans physical, cognitive, and social domains.

The high rates of alcohol misuse among Veterans can be attributed to traumatic experiences and mental health illness. PTSD doubles one’s risk of alcohol misuse compared to those without a diagnosis.

The Department of Defense reports that alcohol misuse costs approximately 1.1 billion dollars per year, and current pharmacologic treatments are lacking in efficacy. Therefore, this study will assess whether psychedelic treatment with ibogaine and 5-MeO-DMT is associated with reductions in alcohol use and PTSD symptoms among SOFV engaged in high-risk drinking.

Recruitment procedure for retrospective survey

This study is comprised of data from a previously published survey of SOFV who engaged in ibogaine and 5-MeO-DMT treatment in Mexico between 2017 and 2019. The study included 51 SOFV (78% of all SOFV treated at this clinic), and 53% of respondents reported alcohol misuse in the month prior to treatment.

Clinical program

The SOFV took part in a clinical psychedelic program in Mexico over 3 days. Patients completed an initial medical and psychological screening and underwent a urine toxicology screen and alcohol breathalyzer to confirm no alcohol consumption.

Ibogaine administration included a single oral dose of 10 mg kg of ibogaine hydrochloride (99% purity), and patients received continuous medical monitoring and intravenous fluids throughout the session. 5-MeO-DMT administration included three doses of 5 mg, 15 mg, and 30 mg for a total of 50 mg.

Measures

Alcohol use was measured using the Alcohol Use Disorders Identification Test – Consumption (AUDIT-C), and a change score was calculated by subtracting the mean of the total AUDIT-C after treatment score from the total AUDIT-C before treatment score.

PTSD symptoms were assessed using the PCL-5 and a change score was calculated by subtracting the mean of the total PCL-5 after treatment from the total PCL-5 before treatment.

Psychological flexibility was measured by comparing scores on the Acceptance and Action Questionnaire (AAQII) 30 days before and 30 days after treatment. Lower scores are associated with greater psychological flexibility.

Respondent characteristics

The sample was comprised of SOFV who retrospectively reported a positive screen for alcohol misuse on the AUDIT-C prior to treatment. Most respondents were middle-aged men and the majority had served in Operations Enduring Freedom/Iraqi Freedom/New Dawn.

Change in alcohol misuse, PTSD symptoms, and psychological flexibility

Patients reported large decreases in alcohol use, PTSD symptoms, and psychological flexibility following their psychedelic treatment. These decreases were moderately correlated with decreases in alcohol use and strongly correlated with decreases in PTSD symptoms.

DISCUSSION

The present study demonstrated that sequential administration of ibogaine and 5-MeO-DMT reduced alcohol use and PTSD symptoms among a clinical sample of SOFV. This finding is consistent with prior studies showing that MDMA, a serotonergic psychedelic, has been shown to produce significant PTSD symptom reduction.

Findings from this study showed that psychedelic treatment decreased alcohol use and PTSD symptoms, and increased psychological flexibility, in patients with comorbid PTSD and AUD. Furthermore, treatment was associated with rapid improvement in symptoms, highlighting a potential breakthrough in therapeutics for this difficult to treat population.

Although the neurophysiologic effects of psychedelics are complex, it is possible that ibogaine and 5-MeO-DMT reduce alcohol use and PTSD symptoms through modulation of synapse formation and dopaminergic transmission in the addiction pathway.

Although the results of this study are promising, there are limitations such as selection bias and recall bias, and the sample size was small. In addition, two different substances with varying doses were administered in succession, making it challenging to parse out differential benefits.

Future studies should evaluate the benefits of ibogaine and 5-MeO-DMT on mental health and substance misuse in Veteran populations, and should assess whether these benefits persist in the long-term.

ACKNOWLEDGMENTS

The authors would like to thank the VETS foundation, Martin Polanco, Joseph Barsuglia, and Nathan Sepeda for their support and the Veterans for completing the questionnaires.