Matthias Forstmann, Christina Sagioglou
preprint
After a long period of stagnation, research on psychedelic substances like LSD, psilocybin, and DMT has revived over the last decade, with major programs in Europe and the United States. This review summarizes recent insights into their potential for treating mental health disorders, effects on recreational users, and underlying neurological and cognitive processes. It covers the history of psychedelic research, objective and subjective effects, prevalence and correlates of use, and potential for harm. The review examines clinical benefits for major depression, anxiety, and substance use disorders, along with proposed neural and cognitive mechanisms. It also discusses effects on healthy subjects, including psychological wellbeing, personality changes, nature relatedness, and creativity, and concludes with long-term effects of single experiences.
Baneet Gill
A mixed-methods systematic review of eight studies (four quantitative, four qualitative) examined the effectiveness and experiences of using psychedelics to treat alcohol use disorder (AUD). Quantitative studies reported an overall increase in abstinence and a decrease in drinking days after treatment, while qualitative studies reported mostly positive experiences. However, the included studies were rated mostly 'poor' or 'moderate' quality, so results should be interpreted with caution. The small number of recent studies, small sample sizes, and heterogeneity of studies limit the strength of conclusions, highlighting the need for further research.
Nestor Girala
The efficacy of hallucinogenic drugs (ayahuasca, psilocybin, LSD, ketamine) in treating depression and addictions is accompanied by intense emotional states and mystical-type experiences, including feelings of oneness, transcendence, ineffability, and awe. These common psychopathological elements may mediate the drugs' therapeutic action. The paper reviews literature on subjective experiences during such treatments and compares them with other life-changing experiences, discussing the evolutionary value of these emotions for group cohesiveness and the recalibration of cognitions and emotions.
Mark A. Michaels
A client who is also the author documents a 10-week course of collaborative therapy that integrates EMDR, ketamine, MDMA, psilocybin, creative expression, and AI-assisted reflection and writing. Drawing on affect theory, mentalization, earned secure attachment, and Dabrowski's theory of positive disintegration, the paper analyzes how recognition of core affects, rupture-and-repair processes, and the reclamation of narrative agency contributed to rapid, positive change. Psychoeducation supported a deep exploration of these concepts. The case critiques traditional psychoanalytic framings, diagnostic overreach, and hierarchical therapeutic structures, arguing for a model emphasizing collaboration, agency, and narrative coherence. It also highlights the potential and limitations of generative AI as an adjunct in psychotherapy and narrative self-reclamation.
Michael Palmieri
Psychedelic-assisted therapy is moving toward clinical legitimacy in the United States, with the FDA granting Breakthrough Therapy designations to psilocybin and MDMA and major research investments underway. However, the legal framework for malpractice liability in this field remains undeveloped. The article identifies three structural challenges: the standard of care is unclear because the profession lacks settled credentialing and practice standards; causation analysis is complicated when treatment intentionally alters a patient's evaluative framework; and damages calculations face a paradox when identity transformation may later be viewed as beneficial. The article argues these are permanent structural features, not transitional problems, and proposes doctrinal adaptations such as prospective consent architectures and tiered standard-of-care frameworks.
Michael Palmieri
American informed consent law assumes that a patient's values and decision-making framework remain stable from the moment they authorize a treatment through the period when they experience its effects. Psychedelic-assisted therapy, using compounds like psilocybin and MDMA, deliberately alters patients' values, self-concept, and evaluative frameworks as a therapeutic goal, breaking that continuity. This article argues that when a treatment transforms the cognitive architecture through which risk is assessed, standard consent doctrines—materiality, causation, and capacity—fail. The author proposes a dynamic consent model with pre-session identity-impact disclosures, staged reaffirmation checkpoints, integration-phase consent validation, and longitudinal documentation reforms.
Çağrı Özkurt
preprint
A re-analysis of 12 randomized controlled trials on psilocybin for depression found moderate evidence of publication bias, with a bias-corrected effect size about 41% smaller than originally reported. The original analysis reported a large effect (g = 0.90), but after accounting for selective reporting using Robust Bayesian Meta-Analysis, the effect dropped to about 0.53, with a credible interval that includes zero. This evidence of bias disappeared when open-label studies were excluded, suggesting expectancy-driven effects rather than suppressed negative results. The findings do not overturn the original conclusions but indicate greater uncertainty than previously thought.
Edward S. Adams
This article examines how the cannabis industry is regulated, tracing its origins, history, and flaws. It then compares the cannabis and psilocybin industries, arguing that the cannabis regulatory model should not be copied for psilocybin. Instead, the author proposes customized regulatory approaches that address psilocybin's distinct features, aiming to create a safe, effective, and well-regulated market.
Minsu Yoo, Sofia Sakopoulos
The commercialization of psychedelics like psilocybin, LSD, and MDMA for mental health treatment blurs the line between impartial science and profit-driven industry. Based on in-depth interviews with stakeholders, the study reveals how venture capitalists not only fund research but also provide regulatory and industry knowledge, creating ethical dilemmas for scientists. Researchers' reluctance to disclose personal psychedelic experiences during interviews signals a shift from an illegality paradigm to one of intellectual property. The findings suggest that ethical dynamics in scientific practice must be reconsidered, particularly how public and private funders shape researchers' priorities.
Samuli Kangaslampi, Morten P. Lietz
preprint
Psychedelics have long been thought to enhance autobiographical memory, and revisiting such memories may be key to their therapeutic effects, yet modern research has largely overlooked this area. This review identifies six open questions: whether psychedelics boost autobiographical recall; whether recalling significant or traumatic memories is common during psychedelic experiences; whether they can produce false memories; how memories change when recalled and reconsolidated under psychedelics; what memories of the psychedelic experience itself are like; and whether autobiographical experiences under psychedelics are especially important for therapeutic outcomes. The authors present the limited current evidence for each question and propose how future studies could address them, emphasizing relevance for optimizing psychedelic-assisted therapies and avoiding harm.