Can psychedelic drugs be medicine?
01:49 - Source: CNN
CNN  — 

The psychedelic compound psilocybin, commonly known as “shrooms” or magic mushrooms, may help people who struggle with alcohol dependence better manage their drinking, a new study found.

In what researchers are calling the first published randomized trial to examine the effects of psilocybin on any type of addiction, people who underwent two psychedelic mushroom “trips” with the help of a psychotherapist reduced “their days of heavy drinking by 83% over eight months,” said senior study author and psychiatrist Dr. Michael Bogenschutz, director of the NYU Langone Center for Psychedelic Medicine, in a news conference.

People in the study, published Wednesday in the journal JAMA Psychiatry, consumed an average of seven drinks on the days when they drank, Bogenschutz said.

Jon Kostas started drinking at age 13 and at the height of his struggle with alcohol  would consume as many as 30 drinks a night.

“I’d say (psilocybin) saved my life,” said 32-year-old study participant Jon Kostas at the news conference. “My first AA meeting was at 16 years old. I was 25 when I found the clinical trial and by that time, I was ‘treatment-resistant.’ I had tried everything to no avail.”

At the end of the eight-month trial, 48% of the patients who used psilocybin reported quitting alcohol use entirely, according to the researchers, who collected hair and fingernail samples to confirm reports of abstinence. That’s twice as many as those in the placebo group who were able to abstain, Bogenschutz said.

“If these effects hold up in future trials, psilocybin will be a real breakthrough in the treatment of alcohol use disorder,” said Bogenschutz, a professor of psychiatry at NYU Grossman School of Medicine. He is also a paid consultant to several companies bringing psychedelics to market.

The need for new treatments for alcoholism is critical, experts say. Only three medications have been approved by the US Food and Drug Administration since 1949 to treat the disease and all have limitations, according to studies.

However, while the treatment “seems to help a significant percentage of people,” it is not a cure-all, said Dr. David Hellerstein, professor of clinical psychiatry at the Columbia University Irving Medical Center. He was not involved in the research.

“To me the most intriguing advance (of the study) is that it is a very different type of treatment than has been traditionally used for alcohol addiction,” said Hellerstein, who conducts research on psilocybin for treatment-resistant depression.

“Therefore, it may open new avenues for significant progress with this devastating condition.”

What’s old is new again

This isn’t the first time science has studied the use of psychedelics for alcohol use disorder, defined today as the inability to stop drinking even when it causes physical or emotional harm to the drinker or others.

UK psychiatrist Dr. Humphry Osmond began giving LSD to treatment-resistant alcoholics in the 1950s and found that 40% to 45% of those who took LSD were still sober after a year. Other researchers duplicated his results.

During the 1940s and early 1950s, tens of thousands of patients took LSD and other psychotropics to study their effects on cancer anxiety, alcoholism, opioid use disorder, depression, and post-traumatic stress disorder or PTSD. Researchers began to see psychedelics as possible “new tools for shortening psychotherapy.

But when Harvard psychologists Timothy Leary and Richard Alpert were fired from the Harvard Psilocybin Project in 1962 after the university discovered they had been giving LSD to their students, the use of psychedelics for research began to lose its luster.

Leary began to speak out publicly, encouraging young people to take LSD recreationally. He quickly became the face of the drug counterculture movement with his signature message, “Turn on, tune in, drop out.”

No longer administered solely in the relative safety of a lab or psychiatrist’s office, LSD began to feature in horror stories of bad “acid” trips at colleges and concerts – headlines that appeared alongside images of anti-Vietnam protests and Woodstock attendees.

A laboratory researcher removes a psilocybin  mushroom from a container.

In 1966, the United States outlawed LSD and research projects were shut down or forced underground. Then came the 1970 Controlled Substances Act, signed by President Richard Nixon. It classified all hallucinogenics, including psilocybin, as Schedule I drugs – substances with “no currently accepted medical use” and a high probability of abuse.

“Studies come to a screeching halt,” Hellerstein said. “We are now just beginning to make up for decades of lost time.”

A worrisome rise in drinking

The new study enrolled 93 people with a diagnosed alcohol disorder who all had drunk heavily at least four days in the prior month. The researchers defined heavy drinking as five or more drinks in a day for men and four or more drinks a day for women.

Interestingly, that is also the US Centers for Disease Control and Prevention’s definition of binge drinking, a problem studies show is on the rise in the US.

That is particularly true for women, who increased their heavy drinking days at the start of the pandemic by 41%. More young people are drinking alone as well, which can strongly increase the risk for alcohol use disorder later in life, according to a July 2022 study.

In the new study, one group of 48 people received two doses of psilocybin a month apart. A second group of 45 people twice received a placebo, diphenhydramine, a common antihistamine that is also a strong sedative. Each treatment session occurred in the presence of a therapist to help process and integrate thoughts or emotions over a two-day period.

Each person also underwent a series of psychotherapy sessions for 12 weeks that included motivational and cognitive behavioral techniques aimed at reducing drinking.

“Psychotherapy was an integral part of the treatment model, and so we can’t make any statements about what the psilocybin would be doing in terms of therapeutic effects without that psychotherapeutic platform,” Bogenschutz said.

In fact, the placebo group reduced their heavy drinking by 51% with only the therapy intervention, the study found, compared with an 83% reduction in those who received both psilocybin and therapy.

However, the study was not truly blinded: About 95% of those involved correctly guessed whether they were taking psilocybin or the antihistamine, the researchers said.

That’s an issue, Hellerstein said, since people participating in such studies have a strong expectation that a “trip on a psychedelic will help them, so it is very difficult to separate medication effects from the expectation for major improvement.”

Consequently, it can be challenging to “prove that the psychedelic experience and treatment are the cause of improvement,” Hellerstein added.

One of the participants in the study, 60-year-old Paul Mavis of Wilton, Connecticut, was able to stop drinking even though he was part of the placebo group.

He credits that success to the intensive therapy he received during the study. “I haven’t had a drink or even a craving – it’s weird. It was if I never drank in my life,” Mavis said in a news conference about the research.

Paul Mavis said had a sudden epiphany in therapy, where he realized that "drinking equals death. Boom. As though someone flipped a switch, I knew I was done with drinks for good."

Mavis said he did take a dose of psilocybin, under supervision, toward the end of the study.

“This was a profound, deeply moving, mind-altering but still very, very exceptional experience,” Mavis said, adding that it was not one he would rush to repeat, especially without the help of a therapist.

“No, this was this was a very profound thing that should be done under serious supervision in my humble opinion,” he said.

As Mavis noted, the level of psychotherapy used in the study was intensive, which is common with studies involving hallucinogens. Future research should investigate whether similar results can be achieved with less therapy to make the intervention more scalable, Hellerstein said.

“Expert and time intensive psychotherapy is often not available in many locations and settings,” he said. “If the psilocybin trip alone leads to decreased alcohol use, with very minimal psychotherapy support, that could make it possible to extend the treatment much more broadly.”