Available online 14 March 2015
Classic hallucinogens in the treatment of addictions
- doi:10.1016/j.pnpbp.2015.03.002
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Highlights
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- We review the use of classic hallucinogens in the treatment of addiction.
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- Controlled trials support the efficacy of high-dose LSD for alcoholism.
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- Pilot studies of psilocybin for nicotine and alcohol dependence suggested benefit.
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- Definitive studies of efficacy and therapeutic mechanisms remain to be done.
Abstract
Addictive
disorders are very common and have devastating individual and social
consequences. Currently available treatment is moderately effective at
best. After many years of neglect, there is renewed interest in
potential clinical uses for classic hallucinogens in the treatment of
addictions and other behavioral health conditions. In this paper we
provide a comprehensive review of both historical and recent clinical
research on the use of classic hallucinogens in the treatment of
addiction, selectively review other relevant research concerning
hallucinogens, and suggest directions for future research. Clinical
trial data are very limited except for the use of LSD in the treatment
of alcoholism, where a meta-analysis of controlled trials has
demonstrated a consistent and clinically significant beneficial effect
of high-dose LSD. Recent pilot studies of psilocybin-assisted treatment
of nicotine and alcohol dependence had strikingly positive outcomes, but
controlled trials will be necessary to evaluate the efficacy of these
treatments. Although plausible biological mechanisms have been proposed,
currently the strongest evidence is for the role of mystical or other
meaningful experiences as mediators of therapeutic effects. Classic
hallucinogens have an excellent record of safety in the context of
clinical research. Given our limited understanding of the clinically
relevant effects of classic hallucinogens, there is a wealth of
opportunities for research that could contribute important new knowledge
and potentially lead to valuable new treatments for addiction.
Abbreviations
- 5HT, 5-hydroxytryptamine (= serotonin);
- ASI, Addiction Severity Index;
- BDNF, brain-derived neurotrophic factor;
- BOLD, blood oxygen level-dependent;
- DMT, dimethyltryptamine;
- DOI, 2,5-dimethoxy-4-iodoamphetamine;
- DOM, 2,5-dimethoxy-4-methylamphetamine;
- DPT, N-N-dipropyltryptamine;
- FDA, Food and Drug Administration;
- GDNF, glial cell line-derived neurotrophic factor;
- LSD, lysergic acid diethylamide;
- mRNA, messenger ribonucleic acid;
- NAC, Native American Church;
- PTSD, post-traumatic stress disorder;
- VTA, ventral tegmental area
Keywords
- Addiction;
- Hallucinogen;
- LSD;
- Psilocybin;
- Substance use disorder;
- Treatment
- Corresponding author. Tel.:
+ 1 505 272 8428; fax: + 1 505 272 5572.
Copyright © 2015 Elsevier Inc. All rights reserved.
