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You’re not hallucinating.
As counterintuitive as it may seem, psilocybin, known to recreational drug users as “magic mushrooms,” or “shrooms,” may one day be part of the treatment for people with alcohol addiction.
The hallucinogenic compound, when used in conjunction with intensive psychotherapy, can dramatically reduce heavy drinking in alcohol-addicted individuals, according to research done at the University of New Mexico and at New York University. The research is outlined in a report published Aug. 24 in the JAMA Psychiatry journal.
Dr. Snehal Bhatt, chief of addiction psychiatry at UNM’s Health Sciences Center, and one of the leading researchers who conducted the study, said there were 95 participants between the two universities, which recruited people from the community from March 2014 through March 2020. Participants, age 25 to 65, were broken into two groups, with half given psilocybin and the other half the antihistamine, diphenhydramine – basically Benadryl.
The regimen was assembled like a “psilocybin club sandwich,” Bhatt said. “Participants received four weeks of intensive therapy, then one session with the medicine, then four more weeks of therapy, then a second session of medicine, then four more weeks of therapy. So, the total intervention was 12 weeks.”
The only difference was in the type of medication that was given.
“Everything else was the same,” he said. The result was “robust reductions in drinking, actually in both groups,” most likely because of the psychotherapy; but the reductions in the psilocybin group were more pronounced in the percentage of time they spent drinking, and the number of drinks consumed – which dropped on average from seven drinks per day to about one drink per day.
Six months after the end of treatment, the benefits persisted, with nearly 48% of the people in the psilocybin group reporting that they had been totally abstinent during the preceding four weeks, compared to 25% of the diphenhydramine group.
“That points to the importance of psychotherapy,” Bhatt said. “They (study participants) improved, and improved quite a bit, and when psilocybin was added, the improvement was far greater.”
The psychotherapy, said Bhatt, consisted of preparing participants for what to expect during medication sessions, supporting them during the sessions so they “integrate material that may come up,” and then providing counseling that’s “designed to increase their motivation to stop drinking.”
Psilocybin works by enhancing neuroplasticity and allowing more avenues of communication between different parts of the brain, Bhatt said. The drug can also cause people to have spiritual or mystical experiences, which can be meaningful and lead to more insights and an ability to control their drinking.
Using these as a vehicle to treat alcohol addiction is a very different approach than the better known Alcoholics Anonymous, which is not actually a treatment program but is instead a mutual help group where people with lived experience support one another, Bhatt said.
The study is the biggest one done thus far looking at psilocybin as part of the treatment for alcohol use disorder, he said. “I think it’s really promising and creates new treatment options and a new paradigm.”
Instead of relying on the daily ingestion of medications for an indefinite period of time, “we’re seeing maybe a couple of sessions with the medicine and really intensive psychotherapy to hopefully get at some of the underlying issues that might be driving some of the alcohol abuse.”
And there is plenty of alcohol abuse in New Mexico.
Although fatal traffic accidents as a result of drunken driving have declined, the state leads the nation in overall alcohol-related deaths with a rate that is double the national average, according to the New Mexico Department of Health.
In 2020, an average of five people died every day of alcohol-related causes in New Mexico, and one in five deaths among working-age adults (ages 20-64) in the state was attributed to alcohol, DOH reports. Chronic liver disease from alcohol abuse was responsible for about one-third of the 1,878 alcohol-related deaths in New Mexico that year.
Because the strength of psilocybin growing in the wild varies with soil, temperature and other environmental factors, chemically identical doses of synthetic psilocybin were used in the safely controlled and therapeutic setting of the trial, Bhatt said.
Which isn’t to say that psilocybin is safe, he emphasized. Some participants experienced headaches, nausea, and a slight increase in blood pressure and heart rate, which normalized within six hours. “No one had any persisting problems and no one had any suicidal or psychotic illnesses,” he said.
As a further safety check, potential subjects were disqualified from the trial if they had a history of psychosis, uncontrolled blood pressure or other major health issues, Bhatt said.
“What I wouldn’t want to do is to make a jump from the safety that we demonstrated in the trial to saying that psilocybin is safe in a recreational setting,” he said. “These are powerful medications and you don’t really want to be messing with that.”
Part of the inspiration for the trial was the use of LSD in studies conducted in the 1960s and ’70s for the treatment of substance abuse disorders. LSD was rejected for use in the more recent study because it’s a longer acting compound – 12 hours, versus six for psilocybin. In addition, LSD tends to affect more receptors in the brain, Bhatt said, while psilocybin is more predictable in terms of “which part of the brain is going to be affected and what the physiologic effects might be.”
The peyote cactus, which contains the psychoactive compound mescaline, was also rejected in part because “it’s got a slightly different receptor-binding profile in the brain,” he said. “We were worried about some of the side effects and that we wouldn’t be able to control it as well.” Furthermore, peyote has cultural and religious significance to Native Americans, and the cactus is listed as a vulnerable species.
Additional phases of the psilocybin study are expected to continue at UNM within the next year, Bhatt said; however, it’s unclear if the study might include chronically homeless people, many of whom have alcohol addictions concurrently with addictions to other substances, as well as any number of mental health issues, he said.
Psychotherapy enhanced with psilocybin could potentially help some of them, Bhatt said, “but the first thing I would think about is the ethics in dealing with a vulnerable population like that.”