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Psilocybin vs. Alcoholism

Taking one recreational drug as treatment for over-dependence on another is hardly intuitive, but a new study found that psilocybin, the psychedelic compound in magic mushrooms, could be a promising treatment for alcohol use disorder.

The research, published Wednesday in the JAMA Psychiatry and conducted by scientists at New York University, found that those given psilocybin-assisted therapy reduced heavy drinking by 83%, compared with a 51% reduction among those who received antihistamine placebo. Heavy drinking was defined as days with four or more drinks for women, or five or more drinks for men.

Eight months after the first psilocybin dose, close to half (48%) of those who had psilocybin stopped drinking altogether, twice as many as the 24% in the placebo group. The trial was double-blinded and relatively large for a psychedelics study, with 93 participants.

“Today’s study is a major breakthrough,” said Charles Marmar, chair of psychiatry at NYU Langone Health. Treating alcohol misuse is incredibly difficult, and the few existing medications have limited effectiveness long-term, he added.

Boris Heifets, who studies psychedelics at Stanford and was not involved in the research, agreed the results were impressive. “Alcoholism is hard to treat, so any success is noteworthy,” he added. Heifets consults for a company, Clairvoyant Therapeutics, which is also studying psilocybin as treatment for alcohol misuse.

Two patients involved in the trial heralded the treatment during an NYU press conference. “It definitely affected my life and I’d say it saved my life,” said Jon Kostas, 32, who lives in New York. “My greatest expectations were to be able to manage my cravings. This surpassed that. It eliminated my cravings.”

During the trial, participants had 12 psychotherapy sessions over 12 weeks, and had two daylong sessions under medication. Although the study was blinded, psychedelics have a noticeable effect on participants, who could likely tell whether or not they received placebo. “Most people were able to guess what drug they were able to receive,” said Michael Bogenschutz, director of the NYU Langone Center for Psychedelic Medicine and senior author on the study.

This was one of the major limitations of the study, along with an inability to evaluate effects in different subgroups, such as women or those with psychiatric comorbidity, or to understand how psychotherapy and psilocybin interact. Trial participants also had lower drinking intensity from the outset than at most alcohol use disorder studies, noted the paper authors, and the study didn’t provide information beyond the 32-week observation period, so doesn’t provide information about relapsing.

Based on the results, Bogenschutz said NYU would launch a multisite trial with more than 200 participants starting early next year and, depending on the results, planned to eventually submit the treatment to the Food and Drug Administration for approval. NYU also filed a provisional patent application based around the work, he added.

“One of the reasons is to prevent it from being grabbed by other people who might use it to get a monopoly and make it harder for people to receive this treatment,” he said. “This is about making this treatment available, if it’s shown to be effective, to as many people as possible to treat hard to treat disorders.”

Alcohol misuse kills around 95,000 people in the U.S. every year, according to the Centers for Disease Control, shortening lives by an average 26 years.

Although this is the first placebo-controlled trial for psilocybin as a treatment for alcohol use disorder, it is not the first time psychedelics have been studied as possible medication for this condition. During the ’50s and ’60s, researchers tested LSD as treatment for alcohol addiction, also finding promising results, though the studies didn’t meet the research standards of today.

“It suggested there was a pretty robust and consistent effect, even though they were a varied group in terms of their methodology,” said Bogenschutz. Following decades of prohibition on psychedelics research, these 50-something old studies were the starting point that NYU could build off. Though the standards were variable, they still provided supportive evidence. “It means something,” he added.

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