Novel Treatment Approaches for Substance Use Disorders: Therapeutic Use of Psychedelics and the Role of Psychotherapy

Abstract: The use of psychedelics in a therapeutical setting has been reported for the treatment of various diagnoses in recent years. However, as psychedelic substances are still commonly known for their (illicit) recreational use, it may seem counterintuitive to use psychedelic therapy to treat substance use disorders. This review aims to discuss how psychedelics can promote and intensify psychotherapeutic key processes, in different approaches like psychodynamic and cognitive behavioral therapy, with a spotlight on the treatment of substance use disorders (SUD).

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Psychedelics, also known as serotonergic hallucinogens, exert their main effects via stimulation of the serotonin 5-HT2A receptor. Not included in the use of the term psychedelics in this article are dissociative anesthetics (e.g., ketamine), empathogen-entactogen stimulants (e.g., MDMA; 3,4-methylenedioxy-meth-amphetamine), ibogaine, or new psychoactive substances (NPS, “legal highs”). The best known psychedelics are LSD (5R,8R-lysergic acid diethylamide), psilocybin, DMT (N,N-dimethyltryptamine), and mescaline (3,4,5-trimethoxyphenethylamine). These substances cause an altered state of consciousness, usually lasting several hours, with profound changes in perception, including hallucinations, synesthesia, altered experience of time and space, and strong activation of emotions and emotionally formative memories . In Europe, psychedelics are best known to be used in recreational settings, while overall lifetime-prevalence levels among young adults have been generally low and stable for a number of years between 1 and 2%. While their individual and societal harm ranks the lowest among many illegal legal substances, and their addiction/dependence potential seems negligible, most psychedelics are controlled under the Convention on Psychotropic Substances of 1971. It might therefore seem counterintuitive to use these substances to treat addiction.

However, in this article, the authors present psychotherapeutic frameworks and possible mechanisms of action, in order to show why and how addiction treatment with psychedelics may be beneficial, which has been suggested in a number of epidemiological and observational trials, clinical trials, metanalyses, and conceptual articles. There is growing evidence that psychedelics can be used to intensify psychotherapy processes in certain conditions, and thus serve as a non-specific augmentation of certain psychotherapeutic processes, which play a role in different forms of psychotherapy. We put a focus on psychodynamic therapy and CBT in this article for the high availability of empirical data in reported trials, as well as for their well-known historical and conceptional differences, which makes the similarities concerning the combination with psychedelic even more striking. High quality empirical data about other psychotherapies (e.g., hypnotherapy, group therapy) in psychedelic therapy is sparse though, and would be worth being further investigated....[FullArticle]