Psychedelics for the Treatment of Substance Use Disorders: A Narrative Review of the Literature.

Growing evidence from population surveys, observational studies, and clinical trials suggests that psychedelics may help treat substance use disorders and improve well-being, though methodological concerns limit the validity and generalizability of findings. Symptom reduction appears linked to pharmacological, spiritual, and interpersonal processes. The review calls for more transparent clinical research, larger studies tracking long-term outcomes, and greater investment in observational, naturalistic, and population-level research to address safety, real-world effectiveness, accessibility, and ethical issues, including respect for Indigenous and traditional communities.

Study at a glance

Abstract

There is an increasing interest in the use of psychedelics for the treatment of substance use disorders (SUDs) and to improve overall health and wellbeing. We aimed to update and complement research syntheses that have focused only on results from clinical trials by synthesizing the research across diverse methods to discuss implications from a broad and multi-faceted literature. We conducted a narrative review of research focused on substance use and SUDs and both classic and non-classic/atypical psychedelics published between 1990 and 2025, synthesizing the evidence across population/survey studies, observational research, and clinical trials. There is growing investment in clinical research on psychedelics, yet methodological concerns within and across studies present challenges to the validity and generalizability of results. Research across population/survey studies, observational studies, as well as clinical trials suggest that symptom reduction is associated with a range of pharmacological, spiritual, and interpersonal processes. Findings from population surveys and observational studies align with growing clinical evidence in support of the use of psychedelics in the treatment of SUDs, indicating a need for more research to improve generalizability, understanding of safety concerns, the role of psychotherapies, and ethical implications of giving psychedelics to vulnerable populations. There is a need for more transparency in clinical research design and reporting, as well as for larger studies that track long-term outcomes. Studies with diverse methodological approaches are important to fill in knowledge gaps concerning treatment safety, tolerability, real-world effectiveness, accessibility, and respect for religious, traditional, and Indigenous communities. We specifically encourage more investment in observational, naturalistic, population-level, and survey research that can provide broad public health data on psychedelic-related SUD treatments and/or highly contextualized and historicized data on treatment methods, delivery, and experiences.