Addiction, or substance use disorder (SUD), is a complex condition in which there is the uncontrolled use of a substance despite harmful consequences (American Psychiatric Association, 2020). People with a substance use disorder have the inability to stop using a substance like alcohol, tobacco or illicit drugs, or stop engaging in a behaviour despite it causing psychological and physical harm. Addiction is not limited to substance use and can also involve activities such as gambling, eating or working (Felman, 2021). People with a substance use disorder may have distorted thinking and behaviours which has been accredited to changes in the brains structure and function. As a result of these changes, people often experience intense cravings, changes in personality and other behaviours (American Psychiatric Association, 2020). Substance use disorder causes people to feel compelled to satisfy their addiction regularly due to cravings and prioritizing this above all else. These symptoms/behaviours include; spending money they do not have on their addiction, failing to meet obligations in work/other responsibilities, carrying out risky behaviours like driving while intoxicated or spending the majority of their time trying to satisfy their addiction (Mayo Clinic, 2017). While symptoms can only be experienced by the person with the disorder, signs which can be observed by other people exist including; secretiveness, stealing and changes in their social group, to name a few (Hartney, 2020). According to the latest World Drug Report from the United Nations, over 35 million people suffer from substance use disorders globally and these disorders represent a significant health burden, accounting for 1.5% of the global disease burden as measured in DALYs (Ritchie & Roser, 2019).
Diagnosing substance use disorder requires a multidisciplinary approach, involving evaluation and assessment by a psychiatrist, a psychologist or licensed alcohol and drug counsellor (Mayo Clinic, 2017). The DSM-V sets out 11 criteria for diagnosing someone with a substance use disorder. Some of these criteria include; hazardous use, social/interpersonal problems related to use, withdrawal and physical/psychological problems related to use (Hartney, 2020). A person must meet two or more of these criteria within a 12-month period in order to be diagnosed with a substance use disorder. Several instruments have been designed to measure addiction severity such as the Addiction Severity Index (ASI) or the Substance Dependence Scale (SDS). Currently, there is no cure for substance use disorder. Treatment is based on individual needs and any related medical or mental health disorders a person may be experiencing. For substance use disorders, detoxification is often the first point of call. Medically-assisted detox allows a person to rid their body of addictive substances in a safe environment and is especially beneficial to people experiencing withdrawal symptoms (Underwood, 2020). Cognitive Behavioural Therapy (CBT) is another useful tool for a range of addiction disorders as it helps people to recognize their unhealthy behaviours as well as develop coping skills. Twelve-step therapy (12-steps programs) is another form of useful therapy, with organizations like Alcoholics Anonymous (AA) using this form of therapy. Depending on the type of substance used in the disorder, a range of medications exist. For alcohol and opioid addiction, Vivitrol is often used which acts by blocking opioid receptors in the brain, therefore, minimizing the urge to use. A combination of behavioural therapy and medication is often used to treat people with substance use disorders.
Research into the potential of psychedelics to treat addiction disorders dates back to the first era of psychedelic research in the 1950s and 1960s. In the 1950s, Humphrey Osmond and his colleagues began treating alcoholics in Canada with LSD and achieved significant rates of recovery (Dyck, 2006). These researchers also engaged with Alcoholics Anonymous groups and co-founder of AA Bill Wilson believed that LSD could help alcoholics achieve a “spiritual awakening and start on the path of recovery.” However, like the majority of psychedelic research from this era, trials were not conducted with methodological rigour and therefore, findings from trials using psychedelic’s to treat alcoholism were not widely accepted. A comprehensive review of research focused on the potential of psychedelics to treat alcoholism during this era can be found here. Nevertheless, the findings from this era have inspired modern researchers to explore this potential for a range of substance use disorders, using the highest possible standards of modern clinical practice.
Research is taking place across the globe regarding the potential of various psychedelic drugs to treat addiction disorders. After making a case for utilizing MDMA-assisted therapy for the treatment of alcohol disorder in 2017, Dr Ben Sessa carried out the worlds first clinical trial investigating the safety and tolerability of MDMA in patients with alcohol use disorder. Published in 2021, this trial found that not only was MDMA well tolerated by participants (n=13), alcohol consumption at nine months post-trial was 18.7 units per week compared to 130.6 units per week before the trial began. Now working with Awakn Life Sciences, Dr Sessa and the team at Awakn are exploring the use of psychedelics to treat addiction disorders such as; gambling addiction, behavioural addiction, opioid addiction as well as tobacco addiction. Recently, Awakn announced that they are currently recruiting for the worlds first trial using ketamine to treat gambling addiction, led by Dr Celia Morgan at the University of Exeter. Moreover, Awakn is developing new chemical entities, synthetic derivatives of other psychedelics, in order to help them tackle addiction. Recently, the research group at Johns Hopkins announced they have received the first government-awarded grant in over half a century to study the effects of psychedelics. Led by Matthew Johnson, the team here will be investigating the effects of psilocybin-assisted therapy on smoking cessation. Earlier work by the team at Johns Hopkins suggests that in the context of a structured treatment program, psilocybin holds considerable promise in promoting long-term smoking abstinence. Other companies active in this space include Universal Ibogaine and Entheon Biomedical. As the name suggests, Universal Ibogaine is treating persons with addiction disorders using ibogaine. Etheon Biomedical on the other hand is attempting to use DMT to treat addiction, with an animal model study underway in Israel.
Similar to other disorders for which psychedelics hold promise, in addiction disorders, psychedelics are believed to interact with the brain’s default mode network (DMN) thereby, producing their therapeutic effects. Aberrant patterns of brain functional connectivity in the DMN have been observed across different classes of substance use disorder (SUD) and are associated with craving and relapse (Zhang & Volkow, 2019). Under the influence of psychedelics, activity within this region of the brain is believed to decrease, allowing people to break free from destructive neural patterns which drive their addictive behaviours and lifestyle. In one trial, participants emphasized that the content of psilocybin experiences overshadowed any short-term withdrawal symptoms. Participants in this trial also emphasized the importance of preparatory counselling and strong rapport with the study team as being vital factors in achieving abstinence from their addiction. Compared to conventional treatments, psychedelics have been shown to have positive long-lasting effects on the symptoms of addiction, making them a potentially very useful tool for treating addiction disorders. As research in the field progresses, psychedelic-assisted psychotherapy is poised to become a viable treatment option for people with addiction disorders.
- American Psychiatric Association. (2020). What is addiciton? Washington DC: American Psychiatric Association. Retrieved from https://www.psychiatry.org/patients-families/addiction/what-is-addiction
- Dyck, E. (2006). ‘Hitting Highs at Rock Bottom’: LSD Treatment for Alcoholism, 1950–1970. Social History of Medicine, 313-329. Retrieved from https://academic.oup.com/shm/article-abstract/19/2/313/2259116
- Felman, A. (2021). What is addiction? Medical News Today. Retrieved from https://www.medicalnewstoday.com/articles/323465
- Hartney, E. (2020). Signs and Symptoms of Addiction. Verywell Mind. Retrieved from https://www.verywellmind.com/symptoms-of-addiction-22244
- Hartney, E. (2020). The 11 Official Criteria for Addiction/Substance Use Disorder. Verywell Mind. Retrieved from https://www.verywellmind.com/what-are-the-official-criteria-for-addiction-22493
- Mayo Clinic. (2017). Drug addiction (substance use disorder). Rochester: Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/drug-addiction/symptoms-causes/syc-20365112
- Ritchie, H., & Roser, M. (2019). Drug Use. Our World in Data. Retrieved from https://ourworldindata.org/drug-use#disease-burden-from-substance-use-disorders
- Underwood, C. (2020). 6 Treatments For Addiction That Are Proven Successful. WebMD. Retrieved from https://www.webmd.com/connect-to-care/addiction-treatment-recovery/successful-treatments-for-addiction
- Zhang, R., & Volkow, N. (2019). Brain default-mode network dysfunction in addiction. Journal of Neuroimaging. Retrieved from https://www.researchgate.net/publication/333920984_Brain_default-mode_network_dysfunction_in_addiction