Chapter Ten – Psychedelics and substance use disorder treatment

The current chapter presents the literature evaluating the effects of classic psychedelic treatments on five substance use disorders: alcohol, tobacco, opioid, stimulant, and cannabis. Most work on psychedelics and substance use disorders was conducted for alcohol use disorder. A range of classic psychedelics (LSD, psilocybin, and ayahuasca) appear to be beneficial for facilitating both reduced drinking and abstinence. Small clinical trials have also shown promising initial results for both tobacco and opioid use disorders. In contrast, no trials have yet been conducted for stimulant and cannabis use disorders. Furthermore, the majority of studies described are naturalistic observational studies or correlational survey data. However, if such observational studies reflect causal therapeutic potential, these studies, combined with clinical trials, suggest potential broad transdiagnostic efficacy of psychedelics across multiple addictive drugs. The transdiagnostic effects of psychedelics are likely due to a combination of biological and psychological factors. Biologically, psychedelics appear to ameliorate deficits in brain areas involved in reward and emotional processing, which may reduce the risk of relapse. Psychologically, the insights gained during a psychedelic experience may reinforce personal motivations for sobriety and support subsequent behavior change. Overall, more work is needed to better characterize the potential benefits and limitations of psychedelic treatment for substance use disorders.