Can psilocybin help people with alcohol use disorder who wish to reduce their drinking, and if so, how? While such treatment might sound counterintuitive to some, past research has indicated the psychedelic drug’s promise in this area. A new study has just shed light on the how.
Researchers at the NYU Grossman School of Medicine published the study on January 1 in a special edition of the American Journal of Psychiatry. Broc A. Pagni, a postdoctoral psychiatry fellow, led a team that found psilocybin, given with psychotherapy, “elicited durable shifts in personality” among participants—specifically regarding personality traits which the researchers noted are associated with alcohol use disorder.
The new study was an analysis of participants in an earlier trial, published in 2022 and conducted by the same researchers. In that study, 95 patients were randomly divided into two groups—one receiving two doses of psilocybin, the other receiving a placebo. All participants also received therapy sessions before and after dosing. Those given psilocybin showed an average of about 14 percent fewer days of heavy drinking compared to the placebo group.
The new analysis concerned how the researchers used a personality test to assess each patient before beginning treatment, and again seven months after the last medication session. A total of 84 participants in the original trial completed the personality questionnaires. Those who received psilocybin showed “significant reductions in neuroticism,” which, the authors wrote, “were driven by decreases in the facets depression, impulsiveness, and vulnerability.”
“Across all participants, decreases in impulsiveness were associated with lower posttreatment alcohol consumption,” the authors concluded, “and an exploratory analysis revealed that these associations were strongest among psilocybin-treated participants who continued moderate- or high-risk drinking prior to the first medication session.”
“We were interested to know what the changes in personality might be, and it’s clinically relevant to drinking.”
Michael P. Bogenschutz, MD, who worked on both the new analysis and the initial study, explained why the team focused on personality changes.
“There’s a number of prior studies that show changes in personality following psilocybin administration,” he told Filter, and these cover a range of different populations. “That was something we knew when planning [the initial study]. We were interested to know what the changes in personality might be, and it’s clinically relevant to drinking because there are personality traits associated with addictive behavior. It’s possible that one of the ways psilocybin can be helpful is by causing personality changes that could make it easier for people to stop or cut down drinking.”
Amid reductions in neuroticism, impulsiveness and depresssion symptoms, patients who were given psilocybin showed increases in extraversion and openness—becoming more accepting of their thoughts and emotions.
The researchers also found a curious gender difference: Men who received psilocybin were more likely to experience increased positive emotions, while women were more likely to feel increased openness. It’s not yet clear what explains this.
Dr. Anthony Back, a professor at University of Washington School of Medicine in Seattle and a specialist in oncology and palliative care, was not involved in this research, but commented on how he views its significance.
“It’s more than fixing your alcohol problems or fear of death, there is something deeper going on, and more comprehensive in terms of how it affects you.”
“Psilocybin results in long-lasting personality change—it’s deeper than fixing one thing,” he told Filter. “It’s more than fixing your alcohol problems or fear of death, there is something deeper going on, and more comprehensive in terms of how it affects you.”
Back recently published his own research, showing how psilocybin had mental health benefits for health care workers impacted by traumatic situations during the COVID-19 pandemic.
This alcohol use disorder study is important, he explained, because it shows how psilocybin can lead to personality changes that impact other behaviors.
“Previous studies have shown that generally, people don’t change in these ways,” he said. “People’s personalities are quite stable, and it’s very hard to change them. Previous studies of mental health therapy have not shown the ability to change someone’s personality. That’s why for people with personality disorders, they’re regarded as a fixed problem that can’t be treated. However, these studies with psilocybin are showing changes in well regarded measures of personality traits that shows it actually is possible to change.”
A growing body of research—including, for example, on psilocybin for smoking cessation—has indicated psychedelics’ potential for a variety of substance use disorders. NYU’s Center for Psychedelic Medicine has announced that the same research team will next turn to patients with opioid use disorder, to see if psilocybin can also help them.
They’re planning the first controlled trial of psilocybin for opioid use disorder, Dr. Bogenshutz confirmed. It will focus specifically on patients who are taking methadone—which Bogenshutz and other experts consider a gold-standard treatment—but who also continue to use unregulated opioids like fentanyl.
“With the advent of these more highly potent opioids, even with methadone it’s become more difficult to help people become stabilized,” he said. “What we’re testing primarily is whether adding a single session of psilocybin treatment to the ongoing opioid treatment program will help them stop illicit opioid use. We’ll also measure [markers of] personality, cravings, positive and negative mood states and perceived self control.”
“It makes me very optimistic about psilocybin therapy for other forms of substance use disorders.”
To Dr. Back, these are all positive developments. “It makes me very optimistic about psilocybin therapy for other forms of substance use disorders,” he said. “My own sense is that people are basically medicating themselves because they’re in pain and suffering. If they can find ways after psilocybin therapy to deal with those issues, in ways that don’t harm them … that would be really good.”
One problem with the newly published research was that most patients correctly figured out whether they were given psilocybin or placebo, meaning the “double blind” study was not really so. It’s a widespread issue in psychedelic research: A placebo that doesn’t noticeably change your perceptions or make you hallucinate is unlikely to be convincing. This goes hand in hand with another limitation: that to measure personality changes, the researchers relied on self-reporting by participants—whose perceptions might have been colored by knowing whether or not they received the psychedelic drug.
Back faced a similar “unblinding” issue with his own study, but argues this “absolutely” does not negate the validity of the research.
“I think the functional unblinding is a methodological issue that we can figure out other ways to deal with,” he said, “such as by having assessments done by blinded raters. In my study, the raters who assessed symptoms of depression didn’t know which arm [a participant was in]. I get it’s a scientific issue that needs to be addressed, but I don’t think it’s a deal-breaker.”
Image (adapted) by Mohamed Hassan via Pxhere/Public Domain