The Next Big Addiction Treatment

There’s been a lot of research in recent years that suggests that psychedelic drugs can help people manage mental health issues like depression, anxiety, chronic pain, and even eating disorders.

But a growing body of data points to one as the main contender for treating the incurable disease of drug addiction.

REUTERS/Yves Herman/Illustration/File Photo

Psilocybin, the active ingredient in psychedelic mushrooms, has shown promise in limited preliminary studies, not only in alcohol and harder drugs, but also in nicotine, all of which are resistant to long-term treatment.

“The old rule of thumb is one-third of people get better, one-third stays the same, and one-third keep getting worse,” said Michael Bogenschutz, a psychiatrist at the University of New York’s Grossman School of Medicine. York, who is studying psilocybin-assisted therapy. . therapy as a treatment for alcohol abuse.

“What fascinates me about this whole process is how many different experiences people can have that ultimately help them make those profound changes in his behavior.”

Take for example Aimée Jamison, who several years ago wanted to quit smoking before her 50th birthday.

Statistically speaking, Jamison’s chances of success weren’t very good.

According to the Centers for Disease Control and Prevention, 55% of adult smokers tried to quit in 2018, but only 8% succeeded.

Jamison, an investor who lives part-time in Boston, had heard of psychedelic therapies, but the drug is largely illegal for personal use.

So, in the fall of 2018, he flew to Baltimore to participate in a clinical test at the Johns Hopkins Center for Psychedelic & Consciousness Research.

When he had to abstain from nicotine for a day before a brain scan, could barely sleep and called it “the most hellish 24 hours I’ve ever had.”

After three talk therapy sessions at the Hopkins Clinic, she was given one pill it contained 30 milligrams of psilocybin, a relatively high dose.

After swallowing the pill, he put on an eye mask, lay down on a couch, and embarked on a psychedelic journey with two nearby therapists overnight. next five hours.

When his journey was over, he sat down and looked at the therapists.

“Now I understand why I smoked,” he said, “and I don’t need it anymore.”

Over the next two months, Jamison attended several more therapy sessions, but did not take any additional psilocybin.

She hasn’t touched a cigarette for years.

An earlier version of this study (in which participants had two or three sessions of psilocybin), published in 2014, reported an 80% success rate in 15 smokers, compared to the 35% typically seen in patients taking Chantix, the main conventional anti-smoking drug. .

Building on these positive results, the Hopkins study expanded to include more participants, and last year the team received a $4 million grant from the National Institutes of Health.

It is not yet known how effective psilocybin use is in treating long-term addiction and whether some people are more likely to benefit from it than others.

Some study participants had experiences disturbing during their travels, and experts say people should not taking the drug outside of legitimate research studies or without medical supervision.

The five-hour duration of the experiment will also make it expensive in a health care setting, which could limit its use in low-income communities disproportionately affected by drug and alcohol abuse.

Still, many experts eager for new addiction therapies say psilocybin represents a potentially exciting new treatment for people with a difficult-to-treat disease.

Treat more than a chemical addiction

One of the reasons addictions are so hard to deal with is that most they are more than a chemical addiction.

Long after short-term withdrawal symptoms have disappeared, people with addiction are often faced with living without strain relief valve which gave them their habit.

Those who want to quit may persevere for a few weeks or months, but when stressed or upset, their brain often returns to familiar addiction territory.

Some experts say that psilocybin fulfills this psychological need.

Along with LSD and mescaline, it is known as a “classic psychedelic”, which activates switches in the brain’s visual cortex, the serotonin 5-HT2a receptors, producing hallucinations.

During the psychedelic heyday of the 1950s and 1960s, these drugs were valued for treating depression and the addiction with mixed results.

But that work stopped in the 1970s with the passage of the Controlled Substances Act, which placed LSD and psilocybin in the legal categoryl more restrictiveknown as List 1.

In 2000, Johns Hopkins psychopharmacologist Roland Griffiths received the green light from the Food and Drug Administration to study the psychological effects of psilocybin on 30 volunteers.

In a survey of participants two months after their session, more than half ranked it as one of the most meaningful experiences of their lives.

Psychedelic research has flourished ever since.

A British study published earlier this year found that people with severe alcohol use disorder who received drug-assisted therapy ketamine abstained from drinking 10% longer for six months than those who received only a placebo in addition to therapy or education.

However, some studies on ketamine and addiction suggest that its antidepressant effect disappears over time and participants may need repeat infusions. This is a potential problem because the drug itself has the potential to become a drug of abuse and overdoses can, in rare cases, be fatal.

Researchers enthusiastic about psilocybin say that its longer, more intense psychedelic experience makes it a longer-lasting therapy.

It usually only requires a single session or sometimes multiple sessions to be effective, as long as it is integrated with psychotherapy or some other form of advice.

“People have a greater mental flexibility after psilocybin,” said Matthew Johnson, a Johns Hopkins psychologist who is leading the smoking trial.

“This increased openness could be a permanent change that can help overcome addiction.”

An uncertain future

Although psilocybin remains illegal under federal drug laws, some cities, including Denver and Santa Cruz, California, have decriminalized it.

In November 2020, Oregon voted to become the first state to legalize it for medical purposes.

Psilocybin is considered more sure than ketamine and is not addictive, but it does have its downsides.

The greatest risks may come from someone using the drug alone and finding themselves in traffic or other dangerous situations while high.

Even in the supervised environment of a research laboratory, users often experience side effects such as vomiting or loss of coordinationand the journey itself can produce anxiety, pain or even a Psychotic attack.

“One of the big challenges with these treatments is that the effects are somewhat unpredictable,” Bogenschutz said.

The California Institute for Integrative Studies is one of the organizations best known for offering a certification program to train future therapists working with psychedelics, but since psilocybin-assisted therapy remains illegal, a underground market treatment nationwide.

Jon Kostakopoulos, a recovering alcoholic who founded the Apollo Pact, a nonprofit that advocates for increased federal funding for psilocybin research, said the psychedelic landscape can be difficult for people to navigate.

He said he spoke to several people who committed suicide after their psychedelic guides told them to stop taking their conventional antidepressants in preparation for their psilocybin trip.

Kostakopoulos tries to steer people toward legitimate clinical trials, like the pilot study he participated in at New York University that he says helped him quit drinking.

“I think you have to do it with properly trained professionals,” he said.

“There are shady actors.”

Some also worry that psilocybin goes untested in the poorest communities where addiction takes its toll.

“We need to develop treatments to help everyone,” said Peter Hendricks, a psychologist who studies psilocybin and drug addiction at the University of Alabama at Birmingham.

A clinical trial that has lasted for more than five years is about to conclude, the objective of which is to evaluate the potential of psilocybin as a treatment for cocaine abuse.

It focused on recruiting users from low-income communities around Birmingham, including among the homeless, where addiction is rampant.

On its own, psychotherapy is generally not an effective treatment for cocaine use disorders.

However, in the Hendricks trial, a preliminary analysis of the first 10 participants showed that those who received psilocybin concurrently with therapy had used cocaine on fewer days over the following six months than those who had received a placebo along with therapy.

They also reported that it was much easier to abstain from cocaine and reported greater life satisfaction.

Hendricks, however, cautions that people shouldn’t get their hopes up too high.

“Existing treatments are very ineffective,” he said.

“I’m hoping to go from being pretty ineffective to not being bad or decent.”

Brendan Borrell is a Los Angeles-based journalist and author of “The First Shots: The Epic Rivalries and Heroic Science Behind the Race to the Coronavirus Vaccine.”

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