Psychedelics in Addiction and Mental Health Treatment

Psychedelics in Addiction and Mental Health Treatment

Daniel Greig and Kyle Lumsden

Mental health stigma is not isolated to our cultural perceptions of what it means for an individual to have mental illness. These understandings are perpetuated by the legal and institutional environments in which they are formulated. Barriers to treatment are perhaps the most detrimental factor as they directly contribute to the persistence of mental illness in our populations, while also reinforcing the idea that those with a diagnosis are victims to their conditions. It is common for those who are prescribed medication for their mental illness to spend months, and even years experimenting with chemicals until the way they relate to themselves and their psychiatrists meets an academically-approved status. Implicit in this approach to treatment is the outdated Freudian understanding of applied mind science as needing only to bring individuals to normal levels of general unhappiness. The big insight of positive psychology: this simply isn’t enough. There is a realm of human experience available beyond the statistical baseline of general dissatisfaction, and it is towards this flourishing and well-being that we should strive. Though many advances have been made in how psychology and psychiatry understand their subject matter, political interests are distorting the ways in which well-meaning individuals provide care to a vulnerable population. Fingers are often pointed at Big Pharma, but what allows this abstract entity to flourish can often go unrecognized: Drug Policy.

During the 1950s and 60s, there was much excitement in psychiatry over the discovery of the LSD molecule. For some, it was considered to be as important a discovery as the microscope was for biology. Research with LSD and similar substances were taken up with enthusiasm. Over 40, 000 people in North America were treated for a variety of addiction and mental health problems during this time. A good deal of this research took place in Canada, under the direction of Humphrey Osmond in Weyburn, Saskatchewan. While some of the experiments were lacking in modern methodology and controls, the results were promising. A meta-analysis of 6 studies from the 1960s showed that LSD had greater treatment efficacy for alcohol dependency than all other known treatment methods. Some studies had 80% one-year quit rates for alcoholics seeking treatment. It is worth noting that a recent pilot study on the efficacy of Psilocybin in treating addiction to tobacco also reached an 80% success rate. The next best treatment for tobacco only shows a 25% success rate at 6 months (with only a 7% quit rate with no treatment at all). At this time, there is a renaissance in research on psychedelics underway. Possible applications for psychedelic substances (Psilocybin, LSD, Mescaline and even MDMA) include end of life anxiety, depression and PTSD. For all these cases, they have proven to have significant success rates, and a negligible possibility for the occurrence of the dreaded “bad trip.” In fact, many of the patients treated with psilocybin have stated that the experience is one of the most meaningful in their entire lives. This is no small claim, especially when it comes from 67% of participants who rated the experience as within the five most significant experiences of their lives, as in this study from John Hopkins University. For some it was the most significant.

To many, the use of psychedelics to treat mental health is still considered shocking. In many senses, this distorted perception towards such a profound agent of change in the human psyche is evidence of the damage that political rhetoric can have on legitimate scientific inquiry. Studies done by researchers looking to disprove the early positive alcohol treatment results in the 1950s did their own studies where patients were strapped to a table and left alone, which indeed caused adverse effects. To engage in such malpractice for the purpose of manipulating statistics to the taste of political decision makers is nothing short of an appalling abuse of human rights. If anything, these studies proved nothing more than what was well known at the very beginning of psychedelic research… The importance of set and setting. ‘Set’ refers to the internal mood or psychological state of the person ingesting psychedelics and ‘setting’ refers to the physical environment the person is in. If a person is unprepared for a psychedelic experience and not in a warm and welcoming environment, much can go wrong. This is the root cause of the dreaded ‘bad trip.’ A cause that can be avoided with proper care. The psychedelic state makes one’s experience greatly malleable and sensitive to environmental context, of which the present state of mind and body is always an aspect. This property of the experience can allow a mental health care practitioner – or in the context of their original use, a shaman – to facilitate deeper changes in a person than is possible while the complex mechanisms that maintain and perpetuate the character of one’s suffering are fully engaged. Of course, this property can be misused and lead to a further fragmented psyche instead of a healed one. This makes it all the more important to allow those that need these medicines to access them in the appropriate environments with trained specialists as every risk becomes miniscule with the appropriate screening, support and supervision.

Psilocybin has been one of the most studied psychedelic medicines in the recent resurgence in research as it does not have the same stigma the War on Drugs saw fit to bestow upon LSD. In these studies, there have been no adverse effects, no long lasting psychological harm, no permanent flashbacks, brain bleeding or any other manifestation of whatever myths have spread over the last several decades. That magic mushrooms cause the brain to bleed is perhaps the most ridiculous of assertions that still circulates, considering that the research shows perhaps the exact opposite effect – reduced blood flow to the brain. Surprisingly, it also reduces overall activity. Average connectivity goes up – so there are more neurons connected at any given moment – but overall, there is less firing of these neurons. In this study, researchers point out that something much like this was described by Aldous Huxley’s famous metaphor of the brain as a ‘reducing valve’ of our everyday experience. In the Doors of Perception (an account of Huxley’s experience with mescaline under the supervision of Humphrey Osmond) he observes that there is much more in the world than is available to our perception… Our brain reduces the overall input, filtering out unnecessary information into the mundane world we interact with. Psychedelics, he says, minimizes the action of this reducing valve and makes apparent to our conscious awareness quite actual information about that which brings experience into existence – ourselves.

While we are still coping with the harmful impacts of 1960s counter-culture on psychedelic medicines (impacts with very real effects, such as the absurd cost of $12,000 / dose of psilocybin for researchers), the use of moral language in drug policy is slowly being deconstructed with the general acceptance that drug addiction is a disease of the brain. While this discourse is refuted by some (see this interview by Dr. Carl Hart, or the book Why Addiction is Not a Disease by Marc Lewis), it is at least a shift in the right direction. So far it seems the case that frequently prescribed medications – such as antidepressants, antipsychotics and addiction maintenance therapy drugs – are measurably more harmful to the body and mind (in the short-term and long-term) than psychedelics. Additionally, they are required chronically (conveniently meaning many more points of sale for pharmaceutical companies), whereas psychedelic medicines are only needed 2-3 times alongside regular psychotherapy sessions. Psychedelics have also been shown to reliably create lasting positive personality changes to a more profound degree than standard medications. When considered relative to effect per dose, the advantage that they have as a medicine over traditional psychiatric medications is astounding. To top it off? They’re safe, even in comparison to other acceptable risks in life unrelated to drug use. One researcher in the UK was in fact fired from his position as chair of the Advisory Council on the Misuse of Drugs for asserting that MDMA was less dangerous than horseback riding. In trying to disprove these sorts of findings, a right-wing research project in the Netherlands which was designed to evaluate the harm of magic mushroom use during periods of legalization actually found no widespread social or economic harm. The report reluctantly notes that magic mushroom use posed no measurable problem to public crime, public safety or health. In the period of 2001 to 2006, at least hundreds of thousands of doses were ingested each year, with 0 deaths and only 0.05% of all hospital visits reporting their use as a factor. In fact, population level studies have found psychedelic use correlated to reduced instances of suicide or suicidal thoughts, reduced psychological distress and reduced rates of recidivism (going back to jail after being released).

The 1971 UN International Convention on Psychotropic Substances classified psychedelics as schedule 1 drugs, which should mean that they have high rates of dependency and no medical use. Both of these assertions are plainly false and are a reflection of how the ignorance of International Conventions on drug policy have done nothing more than create barriers to the study of the brain and to the alleviation of human suffering. The existence of these barriers is exactly contrary to the purpose of there being international regulatory bodies. As a result, we are left with widespread misinformation, increased instances of dangerous practice with psychedelic medicines and the persistence of mental illness in many who may otherwise not need to suffer. Research from the early age of psychedelic exploration combined with recent pilot studies unequivocally show these medicines to be promising methods that should be explored to treat otherwise notoriously persistent conditions of mental health. The absolute prohibition of hallucinogens is irrational in theory and practice. Psychedelics are a medicine and should be used as such. Their effectiveness as an option in the treatment of mental health is too effective to ignore and to continue to do so is nothing short of withholding potentially life saving medicine from those of us beset by psychological suffering and addiction.

Current Research on Prevention

On January 26th 2016, CSSDP Okanagan, a fledgling chapter, hosted its first public information talk. Our guest speaker was Dr. Marvin Krank. He has extensive research experience in substance use, with a focus on use by adolescents. His presentation for us was, “In the age of rational drug policy, is prevention necessary.”

Dr. Krank first addressed the issue of the “War on Drugs,” and visited the point that this “war” causes great harm, with no real reduction in use. He also pointed out that the harm caused by this war has far-reaching impacts, from our own families and neighbourhoods to major conflicts around the globe. Additionally, Dr. Krank stated that many mistakes have been made, but there are mistakes made on the other side of the issue as well. He then went on to discuss that how we address use matters. Unrestricted access carries potential for great harm, and even how we as a society depict use has considerable consequences. Later in the talk, Dr. Krank touched on this when he urged the importance of minimizing commercialization, especially as it relates to youth-targeted advertising. In essence, Dr. Krank advocated for the need for an evidence-based approach to drug policy, with research findings regarding the etiology and consequences of substance use factored into how we, as a society, rationally deal with the reality of substance use.

Dr. Krank explained that his research focused on teens as they are at a developmental point in their lives where crucial neural and cognitive growth and changes are occurring. It is at this point in brain development when the frontal cortex and its executive functions, can be inalterably impacted by choices made when the individual is grappling with identity development and the need to be self-determining. He then went on to share findings from a study he conducted in the North and Central Okanagan regions of British Columbia. This study looked at 1,305 students in grades 7 to 9, and assessed how what they thought about substances early in adolescence impacted their use of them in later adolescence. In this study, youth were asked such questions as, “What do you expect to happen when you drink a moderate amount of alcohol,” and “How much would you like this outcome,” to get a sense of how the students thought about the risks and benefits associated with substance use. The study found that greater positive outcome expectancies were positively associated with substance use later in adolescence, and with an increased amount of use. In other words, Dr. Krank’s study found that later substance use can be predicted by earlier beliefs about substances and their use.

For background information, Dr. Krank referenced Dr. Daniel Kahneman’s work with dual processing approaches to understanding how the brain makes errors in judgement (Thinking Fast and Slow, 2011. MacMillan Press). This approach says that there are two systems at work in decision-making: System 1 being the “Associative Machine,” responsible for the automatic processing that occurs quickly, and usually below our level of awareness, and System 2, which involves executive functioning and working memory, and thus is a slower, more rational process. In System 1 processing, cognitive biases are found to be a common feature. These biases lead us to reach for the answers that are consistent with what we already believe, as well as to think that rare events are more common than they really are; for example, when we think that “everyone is having more ‘fun’ on the weekend than I am” (Facebook posts, anyone?). In Dr. Krank’s study, they found that the students who over-estimated social norms also showed more conformative behaviour, and experienced greater substance use. Dr. Krank added to this by pointing out that the adolescent brain, which is still developing its working memory and executive functions, relies even more on the default processing of System 1. This makes adolescents more vulnerable to cognitive biases and poor decision making.

Dr. Krank also covered the role of social learning in producing cognitive biases, such as occurs from exposures to parental and peer behaviour, and popular culture. This comes back to the commercialization issue. Dr. Krank discussed studies that considered the impact of alcohol advertisements on youth, whose findings confirmed that such exposures form automatic associations, and that alcohol use is correlated with exposure to advertisements. Further, researchers have found evidence that automatic associations can affect the influence of the social environment.

The significance of these findings speaks to prevention initiatives, specifically: drug literacy programs. It is important to consider that, improperly done, these programs can cause automatic associations to form and lead to outcome expectancies, thus increasing risk for substance use. He added that it is known that the use of facts to counteract myths about use does not maintain its benefit past 24 hours, and that both types of information create outcome expectancies. Dr. Krank urged that these programs need to be scientifically assessed for their usefulness, rather than taking for granted that educating youth about the perils of substance use works.

According to Dr. Krank, an important area for research is the role of social cognition in adolescent substance use. Perhaps this could reveal effective methods for targeting substance use cognition to counterbalance social influences. Dr. Krank also urged that we keep a strong check on youth–targeted advertisements of all substances as they become legal. Further, he suggested that promoting social activities and stress coping skills could play an important role in preventing substance use. In the end, Dr. Krank did stress that prevention efforts are still important even this coming time of, hopefully, rational drug policy.