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Psychedelic Therapy for Substance Use Disorders & Trauma

Psychedelic-assisted therapy for health concerns that are unresponsive to conventional treatment shows promise. There is compelling evidence that psychedelics are a breakthrough therapy for depression and can also be effective at treating addiction, chronic pain and mental health conditions like post-traumatic stress disorder (PTSD).

Addiction and Trauma

Trauma is widely recognized as a key factor in the development of substance use disorders. Experiencing a traumatic event can harm a person’s sense of safety, their sense of self and ability to regulate emotions to navigate relationships. One study of millitary personnel showed those who experienced trauma were more likely to develop a substance use disorder (SUD).

Post Traumatic Stress Disorder

Substance use may provide temporary relief from distressing emotions and disturbing memories. This can lead to a cycle of dependence in a maladaptive attempt to regulate, especially for those with untreated PTSD. Addressing addiction and PTSD is much more complex than treating either alone. Adherence to treatment is lower, as are positive outcomes.  

In order to effectively treat addiction, the underlying trauma needs to be addressed. This typically involves therapy and medication to help manage mental health. Those suffering with PTSD often have chronic physical health conditions, trouble with social functioning, and are at an increased risk of violence including suicide.

MDMA & Others

Ketamine-assisted therapy for PTSD and treatment-resistant depression has demonstrated to be rapid acting. This legal anaesthetic medication is now used to help suicidal patients. Iboga, an evergreen shrub native to Central Africa, has been used for its medicinal properties locally in ritual.  Clinical research shows that Iboga is an effective treatment for addiction.

MDMA-assisted therapy for PTSD has been in clinical trials since 2000 with Phase 3 trials now complete. The FDA has designated it a breakthrough therapy with 88% of participants demonstrating significant improvement after three sessions.

MAPS (Multidisciplinary Association for Psychedelic Research) sponsored this research which is now in final evaluation by an independent rater. With its completion, this will be the most advanced clinical research of psychedelic-assisted therapies.

Research on Psilocybin

Of all the psychedelics being studied for therapeutic purposes, psilocybin has the most compelling research for addiction, depression and end-of-life anxiety, as well as positive preliminary findings for disordered eating. Psilocybin has the highest safety profile and is tolerated well by patients.

Considerations Moving Forward

Safety is an important consideration when it comes to psychedelic therapy. The setting and support of trained professionals plays a key role in positive outcomes. Patient vulnerability and susceptibility are key aspects of safety. Psychotherapeutic practice standards before and after treatment need to be established. Health coverage plays a role in this.

In October 2022, Queen’s University published a Review of Psychedelic Medicine to highlight where the research is currently at. They advocate for observational, naturalistic, ethnographic, randomized controlled trials, and clinical modes of investigation to gather evidence.

Large phase 3 trials that include a placebo group and longer-term follow-up are needed.  Diversity and equity must play a central role in these studies. First Nations peoples have the right to autonomous healing and spiritual practices. Policy, education, and access must involve the participation of racialized, gender diverse and differently abled people.

Other areas of research to explore include traumatic brain injury and neurocognitive disorders. Barriers to further research include funding and access to controlled substances that are still illicit.