Breaking Barriers: How Psychedelic-Assisted Therapy Offers Hope for Alcohol-Related Challenges

Excerpt from No Willpower Required: a neuroscience approach to change your habits with alcohol.

‍Disclaimer: In many regions, psychedelics are considered illegal, and their possession, sale, or use can lead to legal consequences. This chapter is intended for educational purposes and does not encourage or endorse any illegal activities.

This chapter may not be for everyone, and I know that. The treatment outcomes in this chapter vary based on several factors related to your alcohol use; quantity, frequency, duration, as well as the underlying reasons for drinking. Your interest in psychedelics may not even be related to alcohol. The aim here is to provide the information necessary to understand the benefits and risks of psychedelic-assisted therapies. It's about feeling drawn to this path for your own reasons, not because you were swayed by persuasive arguments. In the pages that follow, you'll discover both statistical evidence and personal narratives that suggest psychedelics could be more effective in treating alcohol dependence than any treatments currently approved by the FDA. 

At the time of this writing, we find ourselves amid a "psychedelic renaissance," a significant shift after decades of regulatory and societal restrictions that began in the 1970s. Many are unaware that the study of psychedelics for treating various mental disorders began in the 1950s, yielding some impressive patient outcomes. Unfortunately, this work was put to a stop by legislation and pushed into the underground for forty years. Now, with the support of organizations like MAPS, the Multidisciplinary Association for Psychedelic Studies, we're seeing a breakthrough in both the legalization and public perception. The shift is reopening critical work for individuals struggling with substance abuse disorders, PTSD, depression, anxiety, and trauma. We stand at the threshold of a transformative era in mental health care.

Psychedelics vs Psychedelic-Assisted Therapy

I think it’s important to make a clear distinction between using psychedelics and psychedelic-assisted therapy. While these medicines present incredible opportunities to treat chronic illness, they are not a magic pill. When we are talking about psychedelics in this chapter, I am not referring to getting a bag of mushrooms from your brother's old college roommate and seeing what happens. When I share my work with MDMA, the common response I will get is, “Oh, I’ve done ecstasy in college” or, “I did molly when I went to a concert.” I usually try to respond with a note of positivity, but these experiences are like comparing apples to oranges. I also did MDMA and Psilocybin in college, and I can tell you that while the medicines may be the same (depending on purity) the experience and outcomes are far from the same. 

When I am referring to psychedelics here, I am talking about the use under guided supervision, in a controlled environment, in conjunction with ongoing integration work. The combination of integration and psychedelics is where the magic can lead to transformation. The word “magic” is not hyperbole, because unlike other medicines that tend to mask symptoms, psychedelics indicate a long-term cure to chronic mental illness. The term integration work is not universally understood, and why should it be, it’s not a mainstream term. Let’s explore together further in-depth what it is that makes the psychedelic road so much different than any other approach to mental illness.

When we engage in psychedelic integration, it's important to understand that it involves more than just reflecting on our experiences. This process allows us to make sense of what we've encountered, particularly when dealing with complex emotional content. Psychedelic experiences can bring up deep-seated memories and insights, and integration is the key to incorporating all of this into our everyday lives.

Integration is a continuous journey of self-discovery and growth. It's not limited to a single event but it's an ongoing process where the experience furthers our personal development. Incorporating practices like meditation or mindfulness helps us stay connected to the knowledge from our psychedelic session. The ultimate goal of psychedelic integration is to turn the session into lasting change in how we understand ourselves, interact with others, and live our lives.

‍Early Studies: 

Acknowledgment: I want to extend my thanks to Dr. Rayyan Zafar of Imperial College London for his invaluable insights on psychedelic research for AUD. His permission to use elements of his work has significantly enriched this chapter, deepening our understanding of the subject.

Let’s talk about the history of Bill Wilson, a history that may surprise you. Wilson was the founder of Alcoholics Anonymous, and authored "Distilled Spirits," reflecting on his alcoholism journey. In 1934, he received treatment at New York State Hospital with various alkaloids and plants like belladonna and henbane, which are not typical deliriants.

This treatment induced an altered state of consciousness in Wilson, marking his first break from alcohol cravings and the cycle of withdrawal. This shift in consciousness, which changed his obsessive thoughts about addiction, was a turning point. As a result, Wilson persuaded the NIH in the U.S. to fund LSD research trials. In these trials, conducted during the 1950s and 60s, over 500 patients received a high dose of LSD.

The trial divided participants into two groups: 250 received a placebo, and 250 received LSD. The data showed an effect size of 2, indicating that those treated with LSD were twice as likely to reduce heavy drinking days compared to the placebo group, 60% of the LSD group showed improvement, compared to 38% in the placebo group. Medical statistics use something called the “number needed to treat,” metric to gauge an intervention's effectiveness. In comparison to current alcohol use disorder treatments like nalmethine and acamprosate, which require treating 20 patients for one to recover, all LSD's number needed to treat was merely six. 

This indicates that LSD is two to three times more effective than existing pharmacological treatments. A single high dose led to sustained reductions in alcohol misuse for up to six months and up to three months of abstinence. This highlights the potency of a single 12-hour treatment for individuals who have struggled with alcohol addiction for decades, marking an early phase of such research.

In the late 1970s and early 1980s, MDMA emerged as a novel psychotherapeutic tool. While these were primarily used in relation to addressing PTSD, it’s worth noting that PTSD and alcohol use can be linked. The medicine has a unique ability to create feelings of empathy, openness, and reduced fear. These early explorations laid the groundwork for its later use in treating conditions such as Post-Traumatic Stress Disorder (PTSD).

The use of MDMA in these therapeutic sessions was characterized by an increased sense of emotional connectivity between the therapist and patient. This facilitated a more profound therapeutic engagement, where patients could confront and process traumatic experiences in a supportive and emotionally open setting. Despite the lack of formal clinical trials, anecdotal reports from therapists suggested promising results where conventional therapy had limited success.

Unfortunately, the recreational use of MDMA or "Ecstasy” at the time led to increased legal pressure. In 1985, MDMA was classified as a Schedule I substance in the United States, effectively halting its legal use in therapy. This prohibition marked the end of this early exploratory phase of MDMA in psychotherapy.

Recent Studies: 

In 2015, the first modern clinical trial using psilocybin to treat alcohol abuse disorder was conducted. Participants received two high doses, spaced four weeks apart. This open-label trial focused on comparing pre- and post-treatment scores.

Results showed a significant decrease in drinking days, from about 45% to 10%, within four weeks, a trend that continued for up to 25 to 36 weeks (approximately six months). A notable finding was the reduction in craving scores, a crucial indicator of relapse risk. Initially, participants had an average craving score of 16 out of 20. The score dropped by 50% to 8 by week 36 after two sessions.

The study sought to understand the underlying reasons for these changes. One approach involved the Mystical Experience Questionnaire, assessing participants' experiences during their psilocybin sessions, including feelings of oneness, ego dissolution, and tranquility. The results indicated a correlation between the intensity of the mystical experience and a decrease in heavy drinking days. Higher mystical experience scores were linked to greater long-term reductions in alcohol consumption.

The strength of this correlation was significant, with those scoring highest on the Mystical Experience Questionnaire showing a 60% reduction in drinking days. This suggests the profound impact of the psychedelic experience itself on treatment outcomes.

A larger phase-two clinical trial at New York University found psilocybin to be twice as effective as a placebo in reducing heavy drinking days. This trial confirmed the lasting effects observed in the initial study, with a clear distinction between the placebo group and those receiving psilocybin treatment.

We now turn to the research on the effectiveness of MDMA and alcohol. Participants in the study consumed on average 130 units of alcohol weekly, equivalent to 15 bottles of wine or 5 liters of vodka. These individuals underwent detoxification before the trial, which involved three sessions of MDMA-assisted psychotherapy, incorporating elements of the MAPS protocol and motivational enhancement therapy (MET). 

Significant results were observed, with participants reducing their alcohol consumption from 130 units per week to approximately 18.7 units nine months post-detox. A substantial decrease in heavy drinking. The study also addressed concerns about the potential mood-lowering effects of MDMA, commonly referred to as “comedowns” or “Blue Tuesdays.” The research aimed to ensure that MDMA did not lead to depression in patients. Interestingly, the data showed an improvement in mood following MDMA administration, contradicting the belief that MDMA inevitably leads to a mood decline.

The study emphasizes the importance of context in drug use, suggesting that negative effects like comedowns are more associated with the environment of drug use (such as nightclubs and mixing substances) rather than the pharmacology of MDMA itself. This distinction between the clinical and recreational use of MDMA is highlighted, pointing out the crucial role of psychotherapeutic elements in MDMA therapy, which involves active trauma-based therapeutic engagement. This approach differs significantly from therapies involving psilocybin, which is more focused on an internal journey with therapeutic guidance provided mainly before and after the psychedelic experience.

Currently, there is significant interest in the therapeutic potential of drugs like ketamine, especially in the context of a phase 2 study conducted by Awaken, a UK-based company. This study combined ketamine with psychotherapy, demonstrating a mean abstinence rate of 86%. In contrast, the group that received a placebo and psychoeducation showed about a 70% abstinence rate. While the difference of 16% may not seem substantial, it is statistically significant. Compared to other clinical trials where a notable number of individuals do not respond to treatments, Ketamine emerges as one of the most effective and legally available psychedelic therapies at present. 

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Ketamine

Benefits: Reduces cravings, promotes introspection, and facilitates new perspectives on addiction.

Science: As an NMDA receptor antagonist, Ketamine promotes neuroplasticity and disrupts maladaptive thought patterns. It also offers rapid antidepressant effects.

Psilocybin

Benefits: Induces profound mystical experiences, increased self-awareness, and enhanced emotional processing.

Science: Psilocybin targets serotonin 2A receptors (5-HT2A), alters perception and cognition, facilitates introspection, and can help "reset" the brain's default mode network (DMN).

MDMA

Benefits: Increases empathy and compassion, addressing emotional and interpersonal addiction-related issues.

Science: MDMA boosts serotonin, dopamine, and norepinephrine, promoting feelings of closeness, trust, and emotional openness, helping individuals process unresolved emotions and traumas. 

DMT

Benefits: Induces intense, immersive experiences for personal insights and shifts in perspective.

Science: DMT acts on 5-HT2A receptors, like psilocybin, helping individuals confront their addiction and gain transformative insights.

5-MeO-DMT

Benefits: Induces deeply spiritual and mystical experiences, promoting personal growth and reevaluation of alcohol use.

Science: 5-MeO-DMT acts on 5-HT2A receptors and leads to shifts in values, priorities, and perspectives, allowing individuals to address the root cause of their addiction and make lasting changes in their behavior.

Microdosing

Benefits: Taking sub-perceptual doses of psychedelics (e.g., LSD or psilocybin) can enhance mood, cognition, and creativity without causing intense hallucinogenic experiences. This practice may help individuals develop healthier coping mechanisms and improve overall mental well-being, contributing to reduced alcohol consumption.

Science: The exact mechanisms of microdosing are not fully understood. Microdosing is believed to modulate the brain's serotonin system, improving mood, focus, and emotional resilience. These factors can support individuals in addressing underlying issues driving their addiction and developing healthier habits.

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Personal Experience

The saying, "If you want something you've never had, you must be willing to do something you've never done," has been a guiding principle in my life. I've shifted between being an observer and actively participating in my journey, consistently striving for growth and transformation.

In my younger days, I experimented in a recreational sense with psychedelics. However, those experiences have no comparison to my intentional and guided work with these medicines. I’d like to share some of those experiences, as well as the insights and results gained in my life. I’d like to note that the experiences below were spread out over the course of a five-year period. Between my work with medicine, I dedicated a great deal of time to research and integration. 

Finding the Spirit Within

I wanted to go down this exploration into the unknown parts of my psyche, I was drawn to it on my own accord. However, despite over a year of research, reading studies, and watching documentaries, I still had limited knowledge and no actual experience. This is in part a motivator here for me to overshare on this experience. So if you are considering psychedelics, you can learn from both statistical evidence and anecdotal stories. Please know that my experiences are unique to me, and others may and likely will report them as different. 

Through a series of friends, I was connected to what is referred to as a facilitator, or guide, that works with these medicines. I had an interest in the Ayahuasca experience. I didn’t have the depth of knowledge to know what would be the right path, but I knew I wanted a profound, life-changing experience. I was offered the opportunity to do a session with 5-MEO-DMT ((5-methoxy-N,N-dimethyltryptamine or O-methyl-bufotenin), known as Bufo or Toad . This was not Ayahuasca, although the naming has similarities N,N-Dimethyltryptamine, or DMT. They both invoke a mystical experience but with some key differences. The 5-MEO experience is fast-acting, fast to metabolize (wear off), and a much stronger journey. The entire journey lasts about 15-30 minutes. Although it’s short, there is no concept of time in that space. It could feel like minutes, hours, days, weeks, months, it really depends on the journey. 

The subsequent journey is challenging to put into words, and even harder not to sound a little crazy while doing it. It’s a little like a caveman stepping into a time machine, then coming back and explaining to other cavemen, with a limited vocabulary, what was seen. But here I go, hopefully sounding better than a caveman. The initial onset is very rapid, I was trying to make sense of it all. All senses and reality began to distort, with a sensation of rapid velocity. As it became more challenging, I reminded myself to trust, surrender, and let go. Once I did that, I emerged into a space of what I would describe as pure bliss and love. No cognitive thoughts, no longer identifying as “Mike, who grew up in Arizona, married with three kids.” Instead, it was a knowledge of existence. A sense of connectivity to everything that is, and ever was. It was a knowing, without thought, without a divided sense of self. I felt as if I had met my true self, essence, or subconscious, for the first time. 

What I experienced was ego death, a disintegration of the self, and emerged with newfound insights into my existence. I had begun my journey to this medicine with the hopes of unrooting my issues in life, anxiety, and issues with alcohol. However, what I emerged with was something completely different. All my life I have wanted to believe in God, but was never fully able to believe with true faith. I just had too many questions and doubts. This experience unequivocally changed that forever, I felt God. There is a saying, "The medicine will show you exactly what you need to know.” That day, which continues to this day, forever changed my spiritual connection and belief. 

I also noticed a loss of interest in alcohol in the subsequent days, weeks, and then months. The allure diminished, while my faith grew. Looking back, what I didn’t do enough of to get the most from that experience was integration. While I would journal and ponder that experience, I didn’t know how to process all the messages that were received and put them into greater action. For this reason, I emphasize the importance of integration. It’s often overlooked in value for those who start out, as the medicine is more appealing and new. 

Though 5-MEO-DMT was transformative for me, I recognize it might not be the best starting point for everyone. Particularly in regard to alcohol. While it offers deep spiritual insights and aids neuroplasticity and neurogenesis, it's not universally palatable. 

Opening My Heart

My experience with 5-MEO was transformational for my spirituality, but I still felt there must be something left to explore in my “real life.” I had questions; did I have trauma I was unaware of? Was there something I needed to explore related to the self-sabotaging habit I was repeating? This led me to be offered a chance to work with therapy-assisted MDMA. 

Before I share my experience, I’d like to explain what a typical session with this medicine looks like. Most people who have taken MDMA will be surprised by the dramatic difference in the experience in this format. What is unique to this medicine, is how the set and setting will change the effects. In a recreational setting, the effects are also euphoric, feelings of love and empathy are enhanced. However, when you introduce a calm setting, set your intentions, and use things like eye coverings and strategic music related to your emotions, the experience is enhanced. You go very internal, and the intensity can be modulated. I find with my eyes covered, and I am settled into the music, that the intensity can be an eight or nine out of ten. In this state, I have vivid visions, which are very psychedelic in nature. However, if I find them to be too intense, I can remove the eye coverings, sit up, and interact with my guide, the intensity can then be lowered to a two or three on the scale. This allows me to go in and out as needed, and process specific experiences as they come to me. 

In my first session, I set the intention to find the root of my self-sabotaging behaviors. The effects came on gently, I found my mind in an almost daydream-like state of drifting in my thoughts and mind. I found myself observing my now wife, Priscilla. She was in a celestial form, floating with her long curly hair as an extension of her power. This drew me into a long contemplation about our relationship. We had been together for fourteen years, and had three children together, but were on a path to separation at that time. The medicine allowed me to connect new pathways and observations around our relationship. What I realized was that I was 99.99% fully committed, but because I had my own issues with the contract of marriage, that .01% was causing the major problems in our relationship to continue to grow. I was able to view our relationship through her perspective and understand with empathy, instead of defensiveness. After that one session of MDMA, our relationship took a 180-degree turn. We no longer fought, we began to grow as a couple again. We had a deeper love and respect than ever before. Shortly after, we were engaged, had a beautiful celebration of our love, and are now happily married. I attribute this session to saving my relationship and providing a loving home for my three children to grow up in, with happily married parents. This marked the moment where I saw these medicines as not only life-changing but world-changing. That session not only changed the lives of Priscilla and I, but also our children, and their children, and so on. 

Flying Past Fears

About a year after my MDMA experience, I found myself wanting to continue that work. However, it was inaccessible to me at the time. Ketamine, which is legal, appeared like it could be the next best thing in my mind. I thought of it as a milder medicine I could try. However, I was incorrect in thinking it was milder; it was just different. 

You have to be mindful when choosing a Ketamine clinic. The background of those running them, including their bedside manner, will impact the experience. I was aware of this in my research. Some offices have a gurney approach, that’s to say, they wheel patients in and out as fast as possible. It’s the white fluorescent lights, white lab coat, and treated like any other medical procedure. This was not the type of experience I was looking for. I was able to find an office in Scottsdale that had a wonderful bedside manner, the office walls were decorated in murals, and the rooms had cosmic lighting and essential oils. 

The Ketamine is administered through an IV as an infusion and lasts about an hour. I was in a reclined chair, given eye coverings and music designed for the experience. One thing that I have noticed when it comes to Ketamine, is that people have very distinct reactions, some have mild meditative-like experiences, while others may have profound psychedelic experiences. I am the latter in this case. The medicine came on rather slowly, but I soon found myself in a space that looked much like the multiverse in a Marvel movie. I was floating in the universe with stars, exploding neon colors, flying like Superman between outer space, walking through ancient temples, space and time folding, but I still had this fear lingering. At one point I found myself wrapped in a cotton candy-like cloud. It was soothing, calm, and I felt safe. However, I could see off into the distance at one point, something difficult that I needed to address. I didn’t want to, I wanted to stay comfortable. Eventually, though, I couldn’t avoid it being there. Like Superman, I decided to fly at it straight on. But what happened was a surprise, it blew right past me. It told me that I didn’t need to take problems on directly all of the time, and when that happened all of my fears evaporated. I then settled into the medicine even further with this thought, “Take me as far as we can go.”

I was able to be the observer without fear, judgment, or difficulty. I could physically feel new connections and pathways in my mind forming. Even the feeling that negative ones were being removed. There was less cognitive processing, and more of a “knowing” throughout the session. After the session, I took plenty of time to rest and sit with my thoughts. A noticeable sensation I had was this feeling that I was in a plastic state with my mind and habits; like that fresh coat of snow I had mentioned before. One of the problems that I was dealing with, was ruminating thoughts about my health and death. I had a few medical issues recently, and it had taken over my everyday thoughts. However, before the treatment, I took a long test assessment for PTSD symptoms, which can happen for a variety of reasons. Not all PTSD is related to trauma with a capital T, it can develop and grow from smaller traumas. To my surprise, I was showing symptoms of PTSD. 

In the days and months to follow, I experienced an increase in mood and confidence and a decrease in general anxiety. More specifically, my ruminating thoughts over my health had completely gone away. A month after my session, I took the same PTSD test again. My improvement down to the exact percentage, was 100% improvement. I found that fitting because that’s exactly how I felt, 100% better. 

Caution and Proper Guidance

It's crucial to emphasize that using psychedelics to address habits and alcohol should be done under the guidance of trained professionals, in controlled therapeutic settings. While the benefits can be significant, these substances also carry potential risks and should be approached with caution and proper supervision.

Educate Yourself and Go Deeper

For those interested in psychedelic research, the Multidisciplinary Association for Psychedelic Studies (MAPS) is a primary resource. Established by Rick Doblin, MAPS focuses on the research and development of medical, legal, and cultural contexts for people to benefit from the careful use of psychedelics. Their website, https://maps.org, offers access to a range of studies, publications, and updates in this field.

Another significant resource is the work of Dr. Rick Strassman. His book, "The Psychedelic Handbook," provides an in-depth look at psychedelic research. Dr. Strassman's contributions over the last 30 years have been influential in the study of psychedelic substances. His insights on topics like neuroplasticity and neurogenesis are valuable for understanding the potential future directions of psychedelic research.

Summary

Four key areas have been identified as affected by psychedelic treatment: increased connectedness and acceptance decreased negative cognitive biases, reduced rumination and thought suppression, and increased openness. These factors are crucial in overcoming various dependence and mental health issues.

We are still in the early phases of the renaissance of psychedelics. It is my goal to share both clinical studies, backed by science, and anecdotal evidence of my own personal experience. 

The power of psychedelics to redefine your relationship with alcohol is an exciting and evolving area of research. With proper guidance and a commitment to self-discovery, you may find that these medicines can play a pivotal role in redefining your relationship with alcohol. 

Overview: 

• Psychedelics are emerging as potential treatments for mental health and addiction, with historical and new research supporting their therapeutic use.
• Personalized outcomes are noted, with psychedelics showing promise in studies where LSD reduced heavy drinking by 60% versus 38% for placebos.
• Structured, guided sessions in psychedelic-assisted therapy differ significantly from recreational use.
• Integration following therapy sessions is crucial for embedding the psychedelic experience into sustainable life changes.
• Recent trials indicate psychedelics like psilocybin can decrease drinking days from 45% to 10%, with a 50% reduction in craving scores.
• The therapeutic potential of psychedelics lies in their ability to induce neuroplasticity and facilitate profound experiences; for instance, a single psilocybin session led to a 60% reduction in heavy drinking days.
• Microdosing studies suggest sub-perceptual doses can improve mental well-being and contribute to habit transformation without intense hallucinations.
• Professional guidance is emphasized due to the powerful nature of psychedelics and the potential for misuse.
• Resources like MAPS offer a wealth of studies and publications, with current research suggesting twice the efficacy of psilocybin over placebos in reducing heavy drinking.

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