Psilocybin-occasioned mystical experiences have been linked to persisting effects in healthy volunteers including positive changes in behavior, attitudes, and values, and increases in the personality domain of openness. In an open-label pilot-study of psilocybin-facilitated smoking addiction treatment, 15 smokers received 2 or 3 doses of psilocybin in the context of cognitive behavioral therapy (CBT) for smoking cessation. Twelve of 15 participants (80%) demonstrated biologically verified smoking abstinence at 6-month follow-up. Participants who were abstinent at 6 months were compared to participants still smoking at 6 months on measures of subjective effects of psilocybin. Abstainers scored significantly higher on a measure of psilocybin-occasioned mystical experience. No significant differences in general intensity of drug effects were found between groups, suggesting that mystical-type subjective effects, rather than overall intensity of drug effects, were responsible for smoking cessation. Nine of 15 participants (60%) met criteria for “complete” mystical experience. Smoking cessation outcomes were significantly correlated with measures of mystical experience on session days, as well as retrospective ratings of personal meaning and spiritual significance of psilocybin sessions. These results suggest a mediating role of mystical experience in psychedelic-facilitated addiction treatment.

Since the 1970’s human research with psychedelics has been limited due to legal barriers and a lack of funding. However, a recent resurgence in human psychedelic research has demonstrated that in healthy individuals, the naturally occurring 5-HT2AR agonist psilocybin can elicit highly meaningful and spiritually significant experiences with lasting positive effects. Furthermore, a growing body of evidence suggests that when administered to well-prepared clinical populations in controlled settings, psilocybin and similar drugs may hold considerable therapeutic potential in the treatment of a variety of conditions including end-of-life anxiety, and smoking addiction.

Introduction & Overview

From the late 1950s through early 1970’s, serotonin 2A receptor (5-HT2AR) agonist psychedelics (i.e., classic hallucinogens) were examined as potential medications for the treatment of addiction. This research primarily focused on LSD for treatment of alcoholism, producing mixed results, likely due to methodological inconsistencies. However, a meta-analysis of six randomized controlled studies found that a single dose of LSD in the context of alcoholism treatment significantly decreased alcohol misuse at the initial follow-up assessment compared with non-psychedelic control treatments, with a large effect size.

• Some of the pioneering clinical work in this field was conducted in Saskatchewan, Canada by Humphry Osmond and Abram Hoffer, who treated more than 700 individuals suffering from alcoholism using a combination of LSD and psychotherapy. Their approach emphasized the subjective nature of the psychedelic experience as an important factor affecting treatment outcomes.

• Similarly, early researchers such as Walter Pahnke, William Richards, and Stanislav Grof focused on psychedelics unique ability to facilitate powerful, and sometimes spiritual or mystical-type experiences as a means of producing therapeutic benefit in addiction treatment as well as end-of-life anxiety.

In a controlled study examining LSD-facilitated treatment for opioid-dependent parolees, researchers found a statistically significant difference in biologically verified opioid abstinence at 6 months in the inpatient LSD treatment group, compared to a treatment-as-usual outpatient control group. Although, a potential confound was that the LSD group, but not control group, received residential treatment, the authors noted that the increased efficacy observed in the LSD condition may also have been due to the qualitative nature of the drug’s effects, described as, “cosmic, mystical, oceanic, peak, transpersonal, transcendental, etc. To the recipient they are experiences which seem to have ultimate metaphysical relevance, conversion-like experiences which, by definition, imply change”.

In an open-label pilot study conducted by the authors that was the first to examine the feasibility and potential efficacy of psilocybin as an adjunct in the treatment of smoking addiction, 12 of 15 participants (80%) demonstrated biologically verified 7-day point prevalence smoking abstinence at the 6-month follow-up.

Mechanism of Psychedelic-Facilitated Addiction Treatment

Investigators have speculated about the potential mechanisms of psychedelics in addiction treatment. At the biological level, such explanations have focused on the molecular and neurological actions of these drugs involving serotonergic, glutamatergic, and dopaminergic signaling, as well as local brain metabolic activity and functional connectivity among brain regions including the amygdala, thalamus, and anterior and posterior cingulate cortex. Effects of psychedelic-occasioned experiences on higher-order psychological constructs have also been implicated.

• For instance, reductions in craving and anxiety, increases in motivation and self-efficacy, and acute alterations in autobiographical recall and cognitive bias have been hypothesized to mediate potential efficacy of psychedelics in clinical treatment contexts.

• Furthermore, the ability of psychedelics to elicit mystical, transcendent, or peak experiences has also been proposed as a potential psychological mechanism in precipitating insight and behavior change.

The present article provides a secondary analysis of data from our psilocybin-facilitated smoking cessation treatment study. These analyses better characterize the mystical-type experiences occasioned by psilocybin and present additional subjective effects questionnaire data as well as excerpts from participants first-person accounts of these experiences. The purpose of this secondary analysis is to probe potential psychological mechanisms mediating treatment outcomes in psilocybin-facilitated addiction treatment.

Summary of Key Findings

 

The present results suggest that psilocybin, administered to drug-dependent individuals in the context of an addiction treatment program, is capable of occasioning “complete” mystical experiences at rates comparable to those previously exhibited in healthy volunteers. Participant’s open-ended comments about their psilocybin sessions were generally consistent with features of mystical-type experience (e.g., unity, sacredness). Although definitive conclusions about the role of psilocybin in this study’s smoking cessation outcomes cannot be drawn due to the open-label design and lack of control group, the mystical-type qualities of psilocybin sessions (measured the same day), as well as their personal meaning, spiritual significance, and impact on well-being (measured 7 days after these experiences) are significantly correlated with measures of smoking cessation treatment outcomes at 6-month follow-up.

• Furthermore, intensity of psilocybin session experiences was not significantly associated with smoking cessation treatment outcomes, suggesting that mystical-type effects specifically, rather than general intensity of subjective drug effects, are associated with long-term abstinence

Exactly how psychedelic-occasioned mystical experiences may elicit profound changes in addictive behavior is still not well-understood, though research and anecdotal reports have corroborated the occurrence of dramatic improvements in substance abuse after psychedelic-occasioned and spontaneously occurring mystical experiences.

• Other models, such as the “conversion experience”, and more recently “quantum change”, are related and perhaps overlapping frameworks describing similarly sudden, positive transformations in personality and/or behavior. However, these remain as poorly elucidated as mystical experience in terms of ultimate causes and mechanisms.

The association between psilocybin-occasioned mystical experience and higher order psychological constructs relevant across addictions (e.g., craving, temptation, self-efficacy), is consistent with prior research showing efficacy of psychedelics for treatment of alcoholism and opioid dependence. Perhaps the most exciting implication is that this drug class could be used to treat a wide variety of drug addictions, including smoking, alcoholism, and opioid dependence, as well as non-drug addictions (e.g., gambling addiction). Given the relatively low success rates of current addiction treatments, and the global morbidity and mortality associated with addictive disorders, further research into psychedelic-facilitated treatment of addiction is both timely and important.

Conclusion

The idea that a single discrete experience can result in lasting beneficial effects in an individual’s attitudes or behavior is highly unusual if not unprecedented within the modern biomedical paradigm, wherein curative or therapeutic processes are often conceptualized as occurring gradually (e.g., a course of medication to treat an illness). The hope is that this conceptualization may prompt further research into this potentially important class of treatments.