Classic psychedelics in the treatment of substance use disorder: Potential synergies with twelve-step programs.

Classic psychedelics like psilocybin show promise for treating substance use disorders, and if larger trials confirm efficacy, psychedelic-assisted psychotherapy might be integrated into existing treatments such as cognitive behavioral therapy and twelve-step facilitation programs like Alcoholics Anonymous. Although AA has historically rejected medication-assisted treatments, the authors argue that classic psychedelics and their subjective experiences may be more compatible than conventional medications. They describe Bill Wilson's, the founder of AA, little-known experiences with psychedelics, suggesting aspects of psychedelic treatments could complement AA. A review of clinical trials evaluating psychedelics for substance use disorders is provided, along with discussion of potential large-scale impact if integrated into AA.

Study at a glance

Abstract

Several pilot studies have provided evidence supporting the potential of classic psychedelics like psilocybin in the treatment of substance use disorders (SUDs). If larger trials confirm efficacy, classic psychedelic-assisted psychotherapy may eventually be integrated into existing addiction treatments such as cognitive behavioral therapy, contingency management, and medication-assisted therapies. Many individuals seeking treatment for SUDs also join twelve-step facilitation (TSF) programs like Alcoholics Anonymous (AA), which are among the most widely available and accessed treatments for alcohol use disorder worldwide. For such individuals, engaging in classic psychedelic-assisted psychotherapy could be seen as controversial, as members of AA/TSF programs have historically rejected medication-assisted treatments in favor of a pharmacotherapy-free approach. We argue that classic psychedelics and the subjective experiences they elicit may represent a special, more compatible case than conventional medications. In support of this claim, we describe Bill Wilson's (the founder of AA) little known experiences with psychedelics and on this basis, we argue that aspects of classic psychedelic treatments could complement AA/TSF programs. We provide a review of clinical trials evaluating psychedelics in the context of SUDs and discuss their potential large-scale impact should they be ultimately integrated into AA/TSF.