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A recent study that found psilocybin therapy can help treat alcohol dependence has been making headlines in recent weeks. We spoke with Dr. Snehal Bhatt, chief of addiction psychiatry at UNM’s Health Sciences Center and a researcher involved in the study.
The Paper.: Why did you start studying psilocybin as an addiction treatment?
Bhatt: It’s been a long time coming. We started getting regulatory approvals back in 2013. It’s been nine years in the making. Even before that, our group did a pilot study—a proof of concept study—that was published in 2015. We know that alcohol use disorder affects people in very profound ways. There’s mortalities from motor vehicle accidents and liver disease, but also things like multi generational trauma.
New Mexico has had one of the highest if not the highest rates of alcohol use disorders in the country for almost two and a half decades now. And we have good treatment for it—effective psychotherapy, three medications that are approved by the FDA—but more is needed.
Back when I came here in 2009 as a fellow in addiction psychiatry, a big reason was to work on this project because Michael Bogenschutz was here at the time and ran the addiction psychiatry division. He was getting interested in this field. And I think he really drew upon a few things. One, is that there’s anthropological evidence. If you look at for example, members of the Native American Church who utilize peyote, they have very low rates of alcoholism. Similarly, if you look at some of the Mestizo religions in the Amazon, they may also have really low rates of alcoholism. But that’s a big stretch—to go from that to say that it’s the psychedelic that’s helping them, but it’s something to keep in mind.
The second thing was that there were all these studies done back in the ’60s looking at LSD to treat alcohol use disorder. More recently in 2012 a couple of researchers went back and did what’s called a meta analysis where they looked at six of these studies that were done in the ’60s and found that LSD was actually effective—significantly more effective than placebo in helping people to stop drinking.
So I think those were kind of the two big motivations to say, “Hey, maybe it’s worth looking at psychedelics again. There’s this great need; it’s affecting people. We need better treatments. There is this indication in literature that psychedelics could help.”
Regarding your most recent study, how did it come together and what were the methods involved?
Everyone that we recruited met the DSM-IV criteria for alcohol dependence, which basically means that they were drinking alcohol heavily and it was impacting their lives. Many of our participants were drinking four or five or more drinks over 50 percent of the days. So in a month, people were drinking heavily about 15 days out of the month. The primary goal was to evaluate efficacy and safety. Is this going to be helpful? And is it going to be safe in the larger population. If someone was already in active treatment, then we excluded them from the study, or if they’re on certain medications that could interact. And also if someone had really severe untreated psychiatric illness—particularly schizophrenia or a psychotic illness—they were excluded.
Every participant was paired up with two therapists. The active treatment was 12 weeks. Once they were in engaged in it, the treatment was 12 weeks of psychotherapy, interrupted by two sessions of medication administration at week four and week eight. After the first four weeks of therapy, there was one eight-hour medication session, then four more weeks of therapy, then a second eight-hour medication session, then four more weeks of therapy. And then they were followed for another six months without any active treatment to see if the effects lasted.
The only thing different between the two groups was that about half the people got psilocybin on their medication administration day and the other half got Benadryl.
The main thing we observed was at week 4—with 4 weeks of therapy, but no meds yet—both groups had reduced their heavy drinking days to about 25 percent—showing the importance of therapy. But by the end of the follow-up period, 32 weeks after the first med session, the people in Benadryl group were still drinking heavily about 25 percent of days, but the psilocybin group’s heavy drinking had dropped to under 10 percent—their heavy drinking days were reduced by 80 percent compared to when they started
The second major finding was just 6 months after end of treatment, about 25 percent of people in the Benadryl group were completely abstinent. By comparison, almost 50 percent in the psilocybin group were completely abstinent over this period.
And finally, no serious adverse events occurred in the psilocybin group. The most common side effects were headaches and transient blood pressure elevations that resolved without treatment. Only two people needed diazepam during their med sessions to address severe anxiety.
In what ways does this treatment differ from more conventional treatments?
Our current medications that are approved by the FDA for alcohol use disorder are taken daily on a prolonged basis. Psilocybin treatment lasts for just a couple of sessions and can hopefully lead to lasting improvements. The other big paradigm shift is that especially when paired with therapy, we know psilocybin is going to change the brain in some profound ways. There’s lots of biological data showing that would fit. But how? That’s the big question, right? How is the brain going to change or alter? With targeted therapy from people who are trained in it or, we can hopefully guide that process—that integration—towards making lasting changes by addressing the underlying things that might be driving the alcohol behavior. The FDA approved medications, well, they’re not really getting into addressing the traumas or the relationships or adverse childhood experiences that might be driving the process. We’re essentially using this medication to create an environment that can speed up the deep healing or processing.