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Can psychedelic compounds play a part in drug dependence therapy?

  • Ben Sessa (a1) and Matthew W. Johnson (a2)
Summary

After a 40-year hiatus there is now a revisiting of psychedelic drug therapy throughout psychiatry, with studies examining the drugs psilocybin, ketamine, ibogaine and ayahuasca in the treatment of drug dependence. Limitations to these therapies are both clinical and legal, but the possibility of improving outcomes for patients with substance dependency imposes an obligation to research this area.

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Copyright
Corresponding author
Dr Ben Sessa, AddAction, 35 The Boulevard, Weston-Super-Mare BS23 1PE, UK. Email: bensessa@gmail.com
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Declaration of interest

None.

Footnotes
References
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1 James, W. The Varieties of Religious Experience: 263. Penguin Classics, 1983 (first edition 1902).
2 National Collaborating Centre for Mental Health. Alcohol-Use Disorders. Diagnosis, Assessment and Management of Harmful Drinking and Alcohol Dependence . NICE Clinical Guideline 115. British Psychological Society & Royal College of Psychiatrists, 2011.
3 Harkins, C, Morleo, M, Cook, PA. Evaluation of the Use of Alcohol Treatment Requirements and Alcohol Activity Requirements for Offenders in Cheshire (http://www.cph.org.uk/wp-content/uploads/2012/08/evaluation-of-the-use-of-alcohol-treatment-requirement-and-alcohol-activity-requirements-for-offenders-in-cheshire.pdf). Centre for Public Health & Cheshire Probation, 2011.
4 Miller, WR, Wilbourne, PL. Mesa Grande: a methodological analysis of clinical trials of treatments for alcohol use disorders. Addiction 2002; 97: 265–77.
5 Home Office. The Government's Alcohol Strategy. Cm 8336. TSO (The Stationery Office), 2012.
6 Hickman, M, Carnwath, Z, Madden, P, Farrell, M, Rooney, C, Ashcroft, R, et al. Drug-related mortality and fatal overdose risk: pilot cohort study of heroin users recruited from specialist drug treatment sites in London. J Urban Health 2003; 80: 274–87.
7 Connock, M, Juarez-Garcia, A, Jowett, S, Frew, E, Liu, Z, Taylor, RJ, et al. Methadone and buprenorphine for the management of opioid dependence: a systematic review and economic evaluation. Health Technol Assess 2007; 11: 1171.
8 World Health Organization Regional Office for Europe. The European Tobacco Control Report 2007. WHO, 2007.
9 Reus, VI, Smith, BJ. Multimodal techniques for smoking cessation: a review of their efficacy and utilisation and clinical practice guidelines. Int J Clin Pract 2008; 62: 1753–68.
10 Dyck, E. Psychedelic Psychiatry: LSD from Clinic to Campus. Johns Hopkins University Press, 2008.
11 Doblin, R. Dr Leary's Concord Prison experiment: a 34-year follow-up study. Psychoactive Drugs 1998; 30: 419–26.
12 Hendricks, PS, Clark, CB, Johnson, MW, Fontaine, KR, Cropsey, KL. Hallucinogen use predicts reduced recidivism among substance-involved offenders under community corrections supervision. J Psychopharmacol 2014; 28: 62–6.
13 MacLean, KA, Johnson, MW, Griffiths, RR. Mystical experiences occasioned by the hallucinogen psilocybin lead to increases in the personality domain of openness. J Psychopharmacol 2011; 25: 1453–61.
14 Halpern, JH. The use of hallucinogens in the treatment of addiction. Addiction Res 1996; 4: 177–89.
15 Bogenschutz, MP, Pommy, JM. Therapeutic mechanisms of classic hallucinogens in the treatment of addictions: from indirect evidence to testable hypotheses. Drug Test Anal 2012; 4: 543–55.
16 Krupitsky, EM, Grinenko, AY. Ketamine psychedelic therapy (KPT): a review of the results of ten years of research. J Psychoactive Drugs 1997; 29: 165–83.
17 Sessa, B. Shaping the renaissance of psychedelic research. Lancet 2012; 380: 200–1.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Can psychedelic compounds play a part in drug dependence therapy?

  • Ben Sessa (a1) and Matthew W. Johnson (a2)
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eLetters

The Psychedelic Experience: The Importance of 'Set' and 'Setting'

Matthew M. Nour
02 February 2015

We welcome the renewed interest in the therapeutic potential of psychedelic compounds. In their recent editorial, Sessa and Johnson echo the fervent research climate of psychedelics spanning the 1950s and 60s. They suggest that psychedelics may cause prolonged changes in subjects' personality and attitudes following mystical-spiritual experiences. This unique and exciting potential mechanism of action certainly warrants the current renaissance in psychedelic research, and has important implications for study design and subject selection. As we move towards re-exploring the clinical applications of psychedelics, however, we must appreciate that the phenomenology of the psychedelic experience is likely to depend not only on the drug's pharmacodynamic properties, but also on the makeup of the subject ('set') and the environmental context ('setting') in which the drug is administered.

Recent work suggests that the potential importance of 'set' in the psychedelic experience should not be overlooked. Genetic and neuroimaging evidence suggests that the serotonergic system has close links with inter-subject personality differences and vulnerability to psychiatric illness[1]. Relatedly, research with hallucinogenic compounds (that act via the serotonergic 5-HT2A receptor) has reported changes in personality traits and behavior[2]. Moreover, reports from individuals who have taken hallucinogenic compounds suggest that the quality of the experience (whether the 'trip' is 'good' or 'bad') has some connection to the attitude and particular psychological landscape of the individual[3]. Finally, a closer look at the psychological profile of subjects who volunteer for these studies reveals that they may not be representative ofthe general population, and in particular may be more 'open' to new experiences[2]. Together these ideas suggest that the effect of a hallucinogenic compound on an individual's experience has complex links with their neurobiological and psychological composition.

The quality of the psychedelic experience is also inextricably linkedto the environmental and social setting. In the late 1960s several studiesstrove to isolate the action of a drug from external influence including the use of concomitant therapy[4]. Their efforts generated less promising results than studies that, by design, emphasized the importance of the 'setting'[4]. An interesting perspective on the relation of setting to thepsychedelic experience is further highlighted by a study which found that sensory deprivation is antagonistic to the LSD experience[5]. Consequently, the relationship between the psychedelic experience and the 'setting' must be considered in experimental design. Even a structured test or interview can radically alter the resulting phenomenology[5].

We propose that a fruitful future research programme investigating the therapeutic potential of psychedelic compounds must take the complex interaction between 'set' and 'setting' into account in its subject recruitment and study design. By acknowledging this association future research will be in a position to understand the full breath of the psychedelic experience and its potential as a state with clinical applications. Although practically challenging, such a comprehensive approach will allow us to re-examine the perhaps premature assertions of the mid 1970s that psychedelics had no therapeutic applications[4].

*Both authors contributed equally to this work

References

1. Ebstein RP. The molecular genetic architecture of human personality: beyond self-report questionnaires. Mol. Psychiatry 2006;11(5):427-45.

2. MacLean KA, Johnson MW, Griffiths RR. Mystical experiences occasioned by the hallucinogen psilocybin lead to increases in the personality domain of openness. J. Psychopharmacol. 2011;25(11):1453-61.

3. Drugs Forum. The psychedelic crisis: bad trip. 2011. https://www.drugs-forum.com/forum/showwiki.php?title=The_psychedelic_crisis:_bad_trip (Accessed January 20 2015)

4. Oram M. Efficacy and Enlightenment: LSD Psychotherapy and the DrugAmendments of 1962. J. Hist. Med. Allied Sci. 2012;69(2):221-250.

5. Hoffer A, Osmond H. The Hallucinogens. Academic Press Inc; 1968.

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Conflict of interest: None declared

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Re: Can psychedelic compounds play a part in drug dependence therapy?

Oliver J Bashford, Specialist Registrar in Old Age Psychiatry
02 February 2015

Research into the therapeutic use of psychedelic agents for disorderssuch as addiction raises the possibility that psychiatry will open its mind and heart to a domain of human experience that has carried value and meaning for human beings for millennia, but which has been largely ignoredor forgotten by psychiatry for five decades: the psychedelic experience.

The psychedelic experience has been regarded by many communities as of such profound significance that the plants or fungi that induce it are considered to be religious sacraments. Examples include psilocybin mushroom use among the Mazatec people of Mexico and the use of iboga amongthe Bwiti practitioners of Gabon [1,2]. There are many such examples both contemporary and historical, and it has even been suggested that the earliest symbolic artwork in prehistoric cave paintings was inspired by psychedelic agents [3]. To regard the experience as simply a drug-induced confusional state is an entirely ethnocentric point of view.

There are parallels to be drawn with the recent introduction of mindfulness meditation to mainstream psychology. Mindfulness comes from the ancient tradition of Buddhism, and healing with psychedelics is found in the practices of ancient shamanistic religions.

It is refreshing that ideas from outside the conventional model of psychiatry are being taken seriously and explored with scientific rigour. After all, modern psychiatry and psychology are little more than a hundredyears old and there may well be much to learn from other, older traditionsin which human consciousness has been explored for a very long time. If politics permits it, hopefully effective evidence-based treatments will emerge from this research.

(1) Wasson RG. Seeking the magic mushroom. Life 1957; 49 (19): 100-102, 109-120

(2) Barabe P. [Religion of Eboga or the Bwiti of the Fangs]. Med Trop (Mars) 1982; 42 (3): 251-7 [Article in French]. English Translation by Gladstone WJ 1997 (http://www.ibogaine.desk.nl/barabe.html.Accessed 22/01/2015).

(3) Froese T, Woodward A and Ikegami T. Turing instabilities in biology, culture and consciousness? On the enactive origins of symbolic material culture. Adaptive Behaviour 2013; 21 (3): 199-214

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Conflict of interest: None declared

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