Psychedelic therapy with Anxiety and Addictions

What is Psychedelic Therapy?

It may seem odd, if not downright risky, to discuss the possibilities of using one drug (a Psychedelic or Hallucinogen) to assist in the recovery of those who might be suffering from addictions to other drugs. Of course if one's drug history involves abuse of psychedelics, such as Ketamine (Special K), then it would not be wise to commence their use again, even if such use might be legal. Though there are many jurisdictions where one or more of the therapies is legal, there are many where they are not, so obviously this is also an important consideration in choosing the right approach for you, which should typicality involve experienced and trained supervision.

However, there is increasing scientific evidence that the use of psychedelic therapy, by which I mean the use of psychedelics such as Psilocybin (Mushrooms), Mescalin (Peyote), LSD (acid), or Ketamine, can be very helpful with so-called "treatment resistant" disorders. The studies I am familiar with include encouraging results for PTSD, depression, and addictions of various kinds. My reading of the literature also suggests that other than PTSD, the jury is still out with respect to other anxiety disorders.

Psychedelic fall into two broad categories, Serotonergic (like Psilocybin and LSD) which affect our sensory apparatus and can famously make our experience more vivid and fascinating, and dissociative (like Ketamine), where in some sense we leave our immediate surroundings and enter another reality. I myself have had a few Ketamine sessions and can testify that at a somewhat lowish dose, I felt I was no longer in the room, and was in some larger psychic space, though I should add I could come back at any time by sensing back into my body.

After what we could call the hangover of unchecked psychedelic use in the 1960's, their use has been slowly creeping back in with so-called "treatment resistant" disorders. This description applies when every other mainstream treatment, medication, therapy, 12 step groups, etc., has not worked, and there are undoubtedly persons who fall into this category. Someone who is on their 5th rehab stay, for example, or a veteran still suffering from PTSD years after their military service has ended. Fortunately, though care and discretion need to be used, these drugs are very powerful, and there is increasing evidence for their effectiveness with at least some of these resistant disorders.

You may have noticed, in the US at least, depression clinics springing up that offer treatment for depression through Ketamine. There are several reasons for this: First, Ketamine, a repurposed anesthetic, has been in use for about 80 years, and has a good safety record, and lasts for about an hour, less than other hallucinogens. It can be prescribed "off-label" by any MD, as it was for me. Second, it turns out it is probably the fastest working antidepressant. Though several sessions may be needed to address long standing depression (including top-ups from time to time), it can work remarkably quickly for long standing depression; I believe IV Ketamine is often used in emergency rooms when suicidal patients are being treated.

For long standing addictions and PTSD, both thorny issues, there is evidence that Psilocybin or Ayahuasca can be helpful. These drugs are very powerful, an Ayahuasca trip for example, can last 12 hours and involve vomiting and other very unusual experiences, and should only be undertaken with the right supervision and knowledge of the nature of the treatment. There is a long tradition of its use among Amazonian peoples, and many suggest this it is most effectively used in this context. In any event, the results can be dramatic, and I encourage you to click on the link below for a Q&A about an extraordinary documentary that takes the viewer through the journeys of two veterans using Ayahuasca.

A trend that has been observed as part of the therapeutic reintroduction of these substances is what has come to be known as "micro-dosing." There is some evidence that taking a relatively small daily dose of one of these drugs can offer some of the benefits without having to go through long "trips". A favorite in this context is small amounts of Psilocybin and LSD for depression, though while the former is legal in some jurisdictions, use of LSD is only legal if supervised by qualified researchers and clinicians, to the best of my knowledge.

Again, any use of these substances carries not just legal, but experiential, risks, such as "bad trips" and the like, so they should only be used very carefully with the proper set and setting. Set means that our frame of mind going into the session should be well informed and freely chosen, and setting means a supportive environment where one is unlikely to be disturbed, and the experience can be processed both during and after the session.

'From Shock to Awe' documentary Q&A on PTSD

How might Psychedelics work?

There is a famous exchange of letters between Bill W., one of the founders of AA, and Carl Jung, the famous psychologist and one-time colleague of Freud's. They were discussing the role of spiritual experience in recovery from addiction, and Jung agreed with Bill's assertion of the necessity of a spiritual approach, and penned the memorable phrase, that for this process to be successful in helping free a person from addiction, it had to involve "ego deflation in depth."

I think what is being pointed to here is that addictions can be so powerful that only a radical change in personality function can clear the way for long lasting recovery - as the 12-Step saying has it, "your best thinking got you here." A piecemeal remedy of a small change here and there may not be enough, we may need something more akin to a small "death" of the old self and its self-destructive patterns, and the rebirth of a new self, which is also very much of a piece with a spiritual approach to life.

As the AA Big Book tells us, this spiritual transformation is more likely to be gradual (which we advocate here through Buddhist meditation), than one-off and dramatic, though that does happen, as it did with Bill W's famous "white light" experience when he was hospitalized (yet again) for alcohol related problems; in general, though, it is typically a slower process.

As you might imagine, this has been an area of great interest to researchers, using modern brain scanning methods with a view to giving us insight into not just the disorder itself, but the nature of the self, perception, memory, and so on. Scientists in the field of psychedelics are telling us that while many brain mechanisms are at work, there is a common theme of ego dissolution which has been hypothesized as a kind of fundamental re-wiring of old patterns, and which appears to us subjectively as a death-rebirth process.

Modern neurology posits two broad brain networks what constitute our sense of self, the "default mode" and the "act positive" mode. The default mode is pretty much what it sounds like, it is the internally focused state that arises any time we are not doing anything in particular, day-dreaming for example. The act positive mode is externally focused, when we have turned our attention to a task and are absorbed in that. The two modes are "negatively correlated" which means that they cannot exist together at the same time in our awareness; that is why, if we are ruminating about something and feeling stuck, getting up and attending to a task will, at least for a while, get us out of our heads and busy minds. The busy mind you encounter in meditation is the default mode in action.

The default mode includes positive and creative aspects, such as our imagination and fantasy, but also includes negative patterns of the self and nervous system over-activity, such as chewing on old cringey memories and struggling with negative ideas about ourself, and so on. It is this network and our historical sense of self that evidently gets disrupted and this over-activity reduced and possibly rewired, through psychedelic use, at least for a while, and I might add, the evidence is strong that meditation also accomplishes this, though more gradually, and in a more integrated way that will last.

Both meditation and a satisfactory psychedelic session calm down the default mode, and facilitate a shift from internal, self-focused narratives to a more open, present-moment awareness by reducing rumination. In fact, this is a good summary of what we are trying to accomplish with this website, advocating for this approach through sobriety and meditation, though very much like exercise, it takes some regular work, and also very much like regular exercise, the benefits for mental health can be significant!

Study highlighting altered self-experience and lasting positive changes