Here is the paper: (stay tuned for the story)
Future Directions for Addictions: Psychedelic Therapy
Jennifer Olson Selkirk College ADD 384
Meeting the Needs for People with Addictions (substitute PTSD, developmental trauma, depression, anxiety, and mental wellness)
The most promising treatment modality for addictions on the horizon is psychedelic-assisted therapy. Despite a lack of research in psychedelics for almost thirty years, there are encouraging results from recent studies that push this type of therapy to the forefront of clinical drug trials. In this paper I will discuss the reason why there was a hiatus of research in the use of psychedelics for addictions therapy, the effects of psychedelics on humans in clinical trials, and the profound changes experienced through psychedelic-assisted therapy.
An advocate for the responsible use of psychedelic plants known as the ‘Timothy Leary’ of the ‘90s, Terence McKenna prophesizes, “Psychedelics are illegal not because a loving government is concerned that you may jump out of a third story window. Psychedelics are illegal because they dissolve opinion structures and culturally laid down models of behaviour and information processing. They open you up to the possibility that everything you know is wrong.” (Brown, 2013). This opening up is precisely the necessary process needed to move past addictive behavior.
What are Psychedelics?
Psychedelics cause visual and auditory hallucinations and altered states of consciousness by activating serotonin receptors (“Psychedelics”, n.d.). Drugs in this class include psilocybin in magic mushrooms, mescaline in peyote (from cactus), and the synthetic drug Lysergic acid (LSD). Also included is dimethyltryptamine (DMT) which is found endogenously in the human body and in the traditional Amazonian spiritual medicine, ayahuasca (The Drug Classroom, n.d.). Psychedelics have been used as entheogens for centuries. The purpose of psychedelic entheogens is to induce any type of spiritual experience aimed at human development, different from using psychedelics solely for recreational use (“Entheogens”, n.d.).
What is MDMA?
Commonly known as ecstasy, E, or molly, the synthetic drug 3,4-Methylenedioxymethamphetamine (MDMA) works by increasing the activity of serotonin, dopamine, and noradrenaline in the brain (“MDMA”, n.d.). It is both a stimulant and a hallucinogen, and not included in the class of psychedelic drugs described above. For the purposes of this paper, I will include it in this discussion of drug-assisted therapy because it is at the forefront of clinical drug trials that can be used in treating trauma.
History of Psychedelic Therapy Research
Rick Doblin founded the Multidisciplinary Association for Psychedelic Studies (MAPS) in 1986 after the criminalization of MDMA. MAPS operate in the US, Canada, and other nations. In 2004, the US Food and Drug Administration (FDA) and Drug Enforcement Administration (DEA) approved the first clinical trial in the US for humans treating post-traumatic stress disorder (PTSD) with MDMA (Williams, 2017). MAPS studies have demonstrated MDMA’s value for treating PTSD in stage two trials which test the efficacy of the drug (Pollan, 2018). Research on psychedelics for therapeutic use was interrupted when the Richard Nixon administration signed the Controlled Substances Act in 1970 making psychedelics illegal and on the Schedule 1 list, which means no accepted medical use and a high potential for abuse (Slater, 2019). Up until then psychedelic drugs were readily available and used recreationally but gaining a negative reputation due to indiscriminate recreational use by the counterculture with a risk of dangerous effects. In 2000, Johns Hopkins School of Medicine obtained approval to research psilocybin in healthy volunteers. Since then, they have demonstrated positive therapeutic effects in relieving addiction which will be discussed in this paper (Johns Hopkins, 2019).
Effects of Psychedelics
Default Mode Network
The default mode network (DMN) is a midline region of the brain that is associated with our personal narratives (Buckner & DiNicola, 2019). It is the neurological basis for the self, how we think about others, remembering episodic memories, and envisioning the future, rather than the task being performed (Andrews-Hanna, 2012). An overactive DMN is associated with depression (Harris, 2019). Meditation and psychedelics suppress the DMN as seen in functional magnetic resonance imaging (fMRI) (Smigielski et al., 2019). This body of research both on the identification and functions of the DMN and its relation to creating a new narrative is preliminary in nature. Anecdotally, many users of dimethyltryptamine have reported the awareness of implicit memories surfacing during their drug-induced journeys. This helps them to re-organize their old narrative and create a new vision for their future (Jesso, 2015). Lewis (2015) states that based on neuroscience and personal experience, addicts need desire and a perspective shift to create lasting change. A break from the ongoing negative narrative in the DMN to vision a new perspective could be a fundamental key to this shift.
In an interview with Sam Harris (2019), Roland Griffiths PhD of Johns Hopkins Center for Psychedelic & Consciousness Research is astounded with the reports by 80-90% of participants rating their psychedelic journey as a top five most meaningful experience of their entire lives. The enduring salience of this therapy informs the participant’s life decisions going forward, reflecting on the positive valence of their experience on a daily basis. In another clinical trial at Johns Hopkins, they found that 80% of long-time smokers abstained from tobacco at six months after taking psilocybin-assisted cognitive behavioral therapy (Johnson, Garci-Romeu, Cosiman, & Griffiths, 2014). The results of these preliminary studies are encouraging, showing the possibility of long-term abstinence in an addict’s life.
Profound Shifts of Consciousness
Sam Harris and Rolland Griffiths PhD speak to the many profound shifts of consciousness experienced by users of psychedelics such as a loss of self, and unity with all beings (2019). They describe six mystical-type experiences they measure with the Mysticism scale that are commonly reported:
• Unity, the sense of interconnectedness with people and all things;
• The sense of the sacredness (awe) of these experiences;
• The noetic sense, more true or real than everyday waking consciousness;
• Deeply felt positive mood of joy, peace, and love;
• Transcendence of time and space where the past and the future collapse into the present moment and becomes either vast or endless;
• Ineffability, not able to describe with words (Griffiths, Richards, Johnson, McCann, & Jesse, 2008).
Bruce Alexander (2018) describes the human experience of dislocation and a lack of attachment as being the core reason for addiction. In the aforementioned study participants reported feeling interconnectedness, during the study and 14 months later, which would counteract this fundamental rupture in people with addictions.
Gabor Mate speaks to a lack of self-love shaped early in life, “The greatest damage done by neglect, trauma or emotional loss is not the immediate pain they inflict but the long-term distortions they induce in the way a developing child will continue to interpret the world and her situation in it. We create meanings from our unconscious interpretation of early events, and then we forge our present experiences from the meaning we’ve created. Mindful awareness can bring into consciousness those hidden, past-based perspectives so that they no longer frame our worldview” (2009, pp. 134). Adverse childhood experiences are synonymously linked to addictions (Strine et al., 2012). The experience of self-love reported by users of therapeutic MDMA (Sferios, 2018) can create a lasting change in these ‘long-term distortions’ that are created during traumatic childhoods.
Risks and Precautions
The greatest risk of taking psychedelics is the possibility of psychotic vulnerability to developing a psychosis like schizophrenia. At Johns Hopkins, they take the precaution of screening out candidates with a first or second-degree relative diagnosed with schizophrenia from participating in the study (Harris, 2019). Psychedelics, not including MDMA, are considered non-toxic and non-addictive. There is no risk of overdose or craving. A secondary risk of taking psychedelics is the experience of the ‘bad trip’. To prevent this experience in the Johns Hopkins clinical trials, there are eight-hours of therapeutic interviews with the participants prior to the psilocybin-therapeutic session. During the session, the candidate is supervised by a male and female sitter in a comfortable living-room setting. The set and setting of the experience are fundamental to the therapeutic intervention and prevention of ‘bad trips’. There are also integrative group therapy sessions after the psychedelic experience.
My vision is for publicly-funded residential treatment facilities providing professional psychedelic-assisted therapy in conjunction with out-patient services, including integration groups that meet weekly. Addiction treatment is an urgent need that can be satisfied by this low-cost and highly effective solution of therapy facilitated with psychedelics.
Alexander, B. K. (2018, March). Treatment for addiction: Why aren’t we doing better? Retrieved from http://www.brucekalexander.com/articles-speeches/treatmentarecovery/295-treatment-for-addiction
Andrews-Hanna, J. R. (2012). The brain’s default network and its adaptive role in internal mentation. The Neuroscientist, 18(3), 251-270.
Brown, D. J. (2013). The new science of psychedelics: At the nexus of culture, consciousness, and spirituality. (1st ed.). Vermont: Park Street Press.
Buckner, R. L., & DiNicola, L. M. (2019). The brain’s default network: updated anatomy, physiology, and evolving insights. Nature Reviews Neuroscience, 20, 593-608.
The Drug Classroom. (n.d.). Dimethyltryptamine. Retrieved November 28, 2019., from https://thedrugclassroom.com/video/dimethyltryptamine-dmt/
Entheogen. (n.d.). Retrieved November 28, 2019., from https://en.wikipedia.org/wiki/Entheogen
Griffiths, R. R., Richards, W. A., Johnson, M. W., McCann, U. D., & Jesse, R. (2008). Mystical-type experiences occasioned by psilocybin mediate the attribution of personal meaning and spiritual significance 14 months later. Journal of Psychopharmacology, 22(6), 621-632. doi:10.1177/0269881108094300
Harris, S. B. (2019). Roland Griffiths and psychedelic science In Waking Up Podcast [Audio podcast]. Retrieved from https://samharris.org/subscriber-extras/waking-course-psychedelic-science/
Jesso, J. W. (2015, December 11). Mindfulness, Trauma & Psychotherapy with Dr. Devon Christie[Video podcast]. Retrieved from Adventures through the mind website: https://www.jameswjesso.com/mindfullness-trauma-psychedelic-psychotherapy-w-dr-devon-christie-md-attmind-radio-ep-17/
Johns Hopkins Center for Psychedelic & Consciousness Research. (n.d.). About. Retrieved November 28, 2019., from https://hopkinspsychedelic.org/
Johnson, M. W., Garci-Romeu, A., Cosiman, M. P., & Griffiths, R. R. (2014). Pilot study of the 5-HT2aR agonist psilocybin in the treatment of tabacco addiction. Journal of Psychopharmacology, 28(11), 983-992. doi:https://doi.org/10.1177/0269881114548296
Lewis, M. (2015). The biology of desire. Toronto, Canada: Anchor Canada.
MDMA. (n.d.). Retrieved November 28, 2019., from https://en.wikipedia.org/wiki/MDMA
Mate, G. (2009). In the realm of hungry ghosts: Close encounters with addiction (1st ed.). Toronto, ON: Vintage Canada.
Pollan, M. (2018). How to change your mind: What the new science of psychedelics teaches us about consciousness, dying, addiction, depression, and transcendence (1st ed.). New York: Penguin Press.
Psychedelic. (n.d.). Retrieved November 28, 2019., from https://en.wikipedia.org/wiki/Psychedelic_drug
Sferios, E. (2018). MDMA and the science of re-creational psychedelics In Drug Positive Podcast [Video podcast]. Retrieved from http://drugpositive.org/mdma-and-the-science-of-re-creational-drug-use
Slater, L. (2018). Blue dreams: The science and the story of the drugs that changed our minds (1st ed.). New York: Little, Brown, and Company.
Smigielski, L., Kometer, M., Scheidegger, M., Krahenmann, R., Huber, T., & Vollenweider, F. X. (2019). Characterization and prediction of accute and sustained response to psychedelic psilocybin in a mindfulness group retreat. Scientific Reports, 9(14914), . doi:10.1038/s41598-019-50612-3
Strine, T. W., Dube, S. R., Edwards, V. J., Prehn, A. W., Rasmussen, S., Wagenfeld, M.,…Croft, J. B. (2012). Associations between adverse childhood experiences, psychological distress, and adult alcohol problems. American Journal of Health Behavior, 36(3), 408-423. doi:10.5993/AJHB.36.3.11
Williams, E. (2017). Towards breakthrough healing: A history and overview of clinical MDMA research. Retrieved from https://maps.org/news/bulletin/articles/420-bulletin-spring-2017/6618-towards-breakthrough-healing-a-history-and-overview-of-clinical-mdma-research