The “Tripping Cure”
The father of modern psychotherapy, Sigmund Freud, once referred to therapy as the “Talking Cure.” Could it be that we are on the cusp of a revolution in our field with the advent of the “tripping cure” – psychedelic-assisted psychotherapy? Well, thanks to some recent and very promising research results, we are getting closer to finding out. Especially in the context of addiction treatment, psychedelics are emerging as a powerful clinical tool.
However, despite recent gains, much work still needs to be done before your community doctor is willing – or able – to offer you a trial dose of the “tripping cure.”
Psychedelics and psychoactive drugs have been used for millennia in traditional healing and shamanic contexts. Psilocybin-containing mushrooms, ayahuasca, and Iboga all have long and rich histories in their respective cultural traditions, and have been used for purposes of healing and rites of passage ceremonies for centuries.
More recently, after the discovery of LSD by Albert Hoffman, as well as the famous experiential reports of mescaline by Aldous Huxley, Humphrey Osmond and others, the therapeutic potential of psychedelics was identified immediately by the Western medical community and was quickly applied in the context of addiction therapy. Unfortunately, the prohibition of all psychedelic drugs during the height of the drug war brought this burgeoning field to a screeching halt. This prohibition persists today, though we are starting to see legitimate research being proposed, approved and published, with results that are grabbing headlines throughout the world.
A Word on Terminology
Technically, “classical psychedelics” all act on the a specific subset of neurotransmitters in the brain – the 5HT2A or, serotonin 2A, receptor system. This includes LSD, Ayahuasca, mescaline and psilocybin. However, the term psychedelics is now commonly and scientifically applied to a wider range of substances (formerly referred to as hallucinogens) that includes MDMA (Molly, ecstasy), ibogaine, and others.
Many other terms had been offered for this class of substances, including psychomimetics, mysticomimetics, and others. Early proponents noted that these drugs do not necessarily induce hallucinations or psychosis in the strictest sense of those terms. Thus, “psychedelic” seems to have stuck and is now being used even in the context of published, peer-reviewed scientific journal articles.
Psychedelics Currently Being Explored as Therapeutic Tools
- LSD (Lysergic acid diethylamide) was first synthesized by Albert Hoffman, PhD, a research chemist for Sandoz, in 1943. By the 1960s, it had found widespread use and acceptance among many in academia and elsewhere for its ability to provide users with profound and impactful experiences. It was the most powerful psychedelic known at the time, with dosing measured in micrograms (or, 1/1,000,000 of a gram), and the discovery of its chemical structure led to major innovations in brain research due to its similarities with serotonin.
Early studies of LSD-assisted treatment of alcoholism were quite promising. Conducted throughout the 1950s and through 1970, researchers usually provided patients with a single dose of LSD, sometimes along with psychotherapy. Some compared LSD to a control condition, like amphetamine or another stimulant, and many occurred with male inpatients seeking specialty treatment for “alcoholism”. A recent review of the 6 most comprehensive, well-designed studies throughout this time showed LSD to be quite effective at reducing problematic drinking. Sadly, this research came to a screeching halt soon after, thanks to the Controlled Substances Act and its labeling as a Schedule 1 substance (no medicinal value).
More recently, academic institutions and international governments have started opening the door again to human trials involving LSD. The Multidisciplinary Association for Psychedelic Studies has recently performed a Phase 2 pilot study showing LSD-assisted psychotherapy is effective in treating anxiety associated with a recent terminal illness diagnosis. The trial, completed in Switzerland, the US and elsewhere, has shown that LSD is safe, effective, and well-tolerated by the patients involved and will hopefully lead the way to additional studies both internationally and here in the US.
- Psilocybin – or “magic mushrooms” – has also gained traction lately as a potential therapeutic tool to treat addiction. Dennis McKenna, PhD, a founding board member of the Heffter Research Institute, has called psilocybin the “ideal” clinical psychedelic, thanks to its short duration, reliable and predictable effects, and the fact that it is non toxic. Here in the US, the Heffter Research Institute has sponsored FDA-approved clinical trials of psilocybin-assisted therapy for the treatment of smoking cessation, severe alcohol dependence, and cocaine addiction. They recently published very impressive results from trials treating anxiety and depression in patients with advanced-stage cancer. The Institute has developed a psilocybin-specific treatment protocol to better standardized the administration of the psychedelic, and to ensure the safety of the participants. Other studies are underway for the treatment of obsessive-compulsive disorder, as well as for cluster headaches.
In a small pilot study of heavy smokers, 15 male subjects were treated with 2-3 psilocybin doses, scattered among 15-plus weeks of intensive psychotherapy. Whereas current treatments for smoking cessation – like patches, gum, or medications – typically result in 15-30% success rates, psilocybin resulted in a mind-blowing 80% abstinence rate at the 6-month follow up. Currently, researchers are in the process of recruiting up to 75 participants for a larger follow-up study.
- Ayahuasca is a traditional shamanic medicine used for centuries by curanderos and shamans in the Amazon rainforest and South America. It is brewed and prepared using two plants, Banisteriopsis caapi and Psychotria viridis, which, when combined, enable the psychedelic chemical DMT to become orally active. This results in an hours-long psychedelic experience that is traditionally guided by an experienced shaman.
Ayahuasca has never been part of an FDA-approved clinical trial here on US soil. However, Dr McKenna, Charles Grob, MD, and a group of US and Brazilian researchers were invited to conduct observational studies on members of the União do Vegetal (UDV) church, where Ayahusca is taking as a sacrament and is a very important aspect of worship. Among their findings, Grob, et al. noted that ayahuasca-taking members of the church were actually healthier on a range of measures than a non-ayahuasca-taking comparison group. While these results were not interpreted as proof of some miracle drug, they did show that the substance was not medically harmful or toxic, suggesting significant potential as a therapeutic agent.
Since those early observational studies, organizations like MAPS and Heffter have proposed clinical trials of ayahuasca-assisted therapy for addiction, PTSD and other psychiatric conditions. While FDA approval remains elusive, Dr McKenna and others are hopeful we will be seeing some clinical trials here in the US sooner than later. In the meantime, clinics and organizations offer ayahuasca conferences and “retreats” in various parts of the world, including Peru and the Amazon. Importantly, protocols and therapeutic interventions using ayahuasca have not been developed, tested or approved yet. Many in the field are hoping what research has been done can continue so we continue to take additional steps toward these important goals.
- Ibogaine is the major active alkaloid of the Iboga plant, native to the African country of Gabon. The shrub is chewed and taken in ritual ceremonies of the Bwiti tribe, during which young adult community members are visited by ancestors during the 24-36 hour trance-like state. While not technically a “classical psychedelic”, ibogaine acts on multiple neurotransmitter systems including serotonin, dopamine, GABA, and others.
Ibogaine has developed a strong presence and following in the field of psychedelic-assisted addiction therapy, especially among people seeking treatment for opioid addiction. Organizations like GITA, the Global Ibogaine Therapy Alliance, are working to connect clinicians across the globe to coordinate and legitimize ibogaine-assisted therapy for addiction and other mental health conditions. Thus far, most of the published research is observational, though some clinical trials are in the works internationally.
Unfortunately, ibogaine has a not-insignificant mortality rate among users, with some citing figures of 1 in 300 patients. This is likely due to a cardiac problems that are not easily predicted, so careful monitoring and supervision is absolutely required. Risk factors for death may include having a previously diagnosed heart condition, using opiates in combination with ibogaine, and using the dried bark (iboga) instead of the extract (ibogaine). Considering the current attention being given to the “opioid epidemic”, it seems fair to wonder why we wouldn’t want to investigate any possible tool to address the issue of addiction.
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A Matter of Time
Other psychedelics like MDMA are seeing some significant progress in clinical trials and are incredibly close to gaining FDA approval for Phase 3 research, especially as a treatment for PTSD. It is hard to imagine why anyone would object to having more options for the treatment of severe and chronic psychiatric conditions. And yet, here we are in 2016 with legitimate research slugging along at a snail’s pace, thanks primarily to the US government’s refusal to fund or approve of psychedelic treatments.
For the moment, this means that we cannot say for certain which of these drugs work, why and for which conditions. It seems clear though that it’s just a matter of time before these questions are answered and the treatments themselves make their way to a clinic near you.
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