• Psychedelic Medicine

Alcohol Addiction | +80 articles

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Can the psychedelic experience cure alcohol addiction?

by Mark Travers | Psychology Today | May 21 2019

Alcohol dependence is a major societal issue. Approximately 28% of American adults currently exhibit unhealthy alcohol consumption patterns, according to the National Institute on Alcohol Abuse and Alcoholism.

Although various therapeutic and pharmacological treatments have been developed to help people with alcohol addiction, in most cases, they fail to achieve a long-term reduction or cessation in patients' drinking. For instance, research suggests that while behavioral therapy combined with FDA-approved pharmacotherapies can temporarily reduce excessive drinking, approximately 70% of patients relapse after the first year of treatment.

But there might be hope on the horizon for chronic sufferers of alcohol use disorder. Researchers at Johns Hopkins University and the Erowid Center explored the effects of psychedelics on heavy alcohol users. Interestingly, they found significant and long-term reductions in alcohol use following psychedelic experiences.

To come to this conclusion, the researchers conducted an hour-long web survey. Using various online recruitment channels, the researchers invited individuals to participate who had overcome alcohol addiction after using psychedelics. Participants qualified for the study if they were 18 or older, fluent in the English language, met the diagnostic criteria for alcohol use disorder, and had "used psychedelics outside of a university or medical setting, followed by reduction or cessation of subsequent alcohol use."

343 participants met the qualifications laid out by the researchers and successfully completed the online survey. In the survey, participants were asked to report their prior and current alcohol use and to provide details regarding their psychedelic experience—such as substance used, dose, setting, and behavioral effects. Respondents, on average, indicated that they had been dealing with an alcohol problem for seven years and that they had not received prior treatment for alcohol addiction.

Regarding their psychedelic experience, most participants reported using either LSD or psilocybin (mushrooms). While doses varied, the majority of respondents reported using a moderate amount of the drug. And, most study participants indicated that it had been at least a year since their psychedelic experience.

Critical to the researchers' hypothesis, only 10% of respondents indicated that they initially used the psychedelic as a way to reduce their alcohol consumption. More than a quarter of participants, however, reported that the psychedelic experience contributed to a "change in values or life priorities, which [...] helped change their alcohol use." Some participants noted that the psychedelic experience changed their orientation toward the future such that the long-term benefits of abstinence outweighed immediate desires. Others cited an increased belief in their ability to abstain from alcohol use following the psychedelic experience.

One participant commented that the psychedelic experience “allowed me to feel whole again and forced me to reconnect with emotional trauma. It gave me insight into the nature of addiction and how it enslaves us—physically, mentally, and spiritually. Addiction numbs us to any kind of growth as a human being.”

Overall, almost all study participants indicated a significant reduction in alcohol consumption after the psychedelic experience—reducing consumption from approximately 26 to four drinks per week. In fact, 83% of participants failed to meet the clinical threshold for alcohol use disorder following the psychedelic experience. Not only did the psychedelic experience significantly curb people's drinking, but it also appeared to stave off relapse years after the psychedelic experience.

Benefits notwithstanding, it is important to keep in mind that this study cannot claim a cause-and-effect relationship between hallucinogens and reduced alcohol use due to the self-selected sample and the observational nature of the research. However, it is another signal that psychedelics may have wide-ranging pharmacological applications that scientists are only beginning to understand. Let's hope the dialogue continues.

 
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Four people give up heavy drinking after taking two doses of MDMA

by Sam Blanchard | 15 Jul 2019

A first-of-its-kind trial using MDMA alongside psychotherapy to try and stop alcoholism appears to have been successful, scientists revealed.

The small study of just four people managed to stop all of their 'harmful' daily drinking after eight weeks of therapy.

Two of the adults, who were all aged between 34 and 63, slipped up and had a single drink each, but the other two managed to stay completely sober.

Among them were a 54-year-old mother-of-three, a 34-year-old man with two children, a retired man who had been drinking for 30 years and a former heroin user.

The study combined weekly psychotherapy sessions with monthly sessions in which they took 99.9 per cent pure MDMA – the drug used to make ecstasy – and had therapy.

One said they felt more confident and 'energised,' another said 'everything is so much clearer,' while a third added 'a weight has been lifted off my shoulders.'

Scientists at Imperial College London devised the study and carried it out with the help of an NHS mental health trust in Bath.

It's the first study in ongoing research into whether the recreational drug can be used in a medical scenario to help people battling addictions.

Although the direct effects of the MDMA weren't being measured and the study was done to test the safety of the programme, the team say this paves the way for placebo trials to see if it is necessary for the psychotherapy to work.

Three of the people taking part had tried to quit drinking before the MDMA programme but never succeeded – this time they stayed clean for at least nine months.

One of the participants, a 50-year-old man, said: "A weight has been lifted off my shoulders. I haven’t felt like that for a long time. There are no nagging doubts."

"I’m getting my life back on track. Everything is so much clearer. It’s like a smog has been removed. I can see myself moving forward… It makes me think: why was I drinking that rubbish?"


One in four adults in England drink a harmful amount of alcohol, the researchers said, while around six per cent of men and two per cent of women are dependent.

Problem drinkers often have mental health issues such as past trauma or depression, and it could be these which MDMA helps to tackle.

Past research has found taking the drug helped people to directly engage with difficult topics or memories, or improved their motivation or confidence in their own ability to change.

MDMA is a popular drug for people to take in nightclubs and at festivals and it produces feelings of happiness and excessive affection for people around them.

People high on MDMA may feel uninhibited and able to talk about things they usually wouldn't, according to drugs website Frank.

This holds promise for its use in psychotherapy like that carried out in the trial.

Each of the participants had weekly hour-long therapy sessions with two experts – a consultant psychiatrist and a clinical psychologist.

And in addition to these, they had two sessions in which psychotherapy was combined with a 125mg dose of MDMA, with an optional extra 62.5mg after two hours.

According to online forums a standard party dose of the drug – known as a bomb, which is usually the powder wrapped in a cigarette paper to be swallowed whole – is around 125mg.

The patients were given the MDMA at 10am then kept in the centre overnight, with therapy lasting six to eight hours.

After nine months all four of the people had managed to quit their problem drinking, did not experience any cravings for MDMA nor any negative side effects.

One of them, a 34-year-old man, said: "The MDMA healed me inside and the drinking looks after itself... I'm in control of my decisions, I've got control back."

Another, a 54-year-old woman, said: "I feel energised... The treatment has worked for me, done me a lot of good. I've got a lot of confidence out of it. I'm calmer."

"It's given me what I wanted; to be cured, to not have the cravings, to look at life differently. I'm not so angry at everything."


She added: "Being under MDMA was beautiful. It showed me the real me; the me without alcohol."

And one added: "I’m able to identify better when I am dealing with my feelings and when I’m doing things well… Its going to take quite a while to get fully better."

"I don’t know how much of the changes I’ve made are due to the MDMA or due to the (non-drug) psychotherapy sessions."


The researchers said they would use the study as a springboard for further trials, and to devise one using a placebo drug to see if the MDMA actually has an effect. The results of the trial were published in the medical journal BMJ Case Reports.

MDMA has in the past been tested for use as therapy for people with post-traumatic stress disorder. And other psychedelic drugs are also being studied to see if they can bring mental health benefits, including ketamine, LSD and magic mushrooms for people with depression.

WHO WERE THE PEOPLE IN THE STUDY AND WHAT DID THEY SAY?

None of the participants in the study were identified but researchers revealed their life histories and comments.

Participant 1 was a 34-year-old man who had had a drinking problem for 10 years. He had tried to stop drinking multiple times but never succeeded, but manages to work full-time and has a wife and two children.

He said: "It's not about the drinking, the MDMA healed me inside and the drinking looks after itself…"

"I'm seeing things anew, nature for the first time… I'm in control of my decisions, I've got control back … Life is just good!"


Participant 2 was a 63-year-old man who had been abusing alcohol for 30 years. He is retired, married with no children and had never attempted to quit.

He said: "I’m pleased I’ve managed to get through both the MDMA sessions… The overall package (of the MDMA therapy course) has been put together well… I went into it expecting to feel strange."

"It’s called Ecstasy, but it was not an ecstatic feeling… This course is definitely a work in progress… I’m able to identify better when I am dealing with my feelings and when I’m doing things well."

"It's going to take quite a while to get fully better… I don’t know how much of the changes I’ve made are due to the MDMA or due to the (non-drug) psychotherapy sessions."


Participant 3 was a 54-year-old mother-of-three who has tried inpatient detox but failed. She has been drinking for 20 years and said she was neglected as a child and has had unstable adult relationships.

She said: "Better than other treatments, including inpatient detox. I enjoyed every moment of it. Thrilled to be part of the study."

"I feel energised… The treatment has worked for me, done me a lot of good. I’ve got a lot of confidence out of it. I’m calmer."

"It’s given me what I wanted; to be cured, to not have the cravings, to look at life differently. I’m not so angry at everything… Being under MDMA was beautiful. It showed me the real me; the me without alcohol."


Participant 4 was a 50-year-old man with a 30-year drinking problem. He has tried to stop drinking multiple times but never succeeded. He started drinking at 15 and has used LSD, ecstasy and heroin in the past.

He said: "A weight has been lifted off my shoulders. I haven’t felt like that for a long time. There are no nagging doubts. I’m getting my life back on track."

"Everything is so much clearer. It’s like a smog has been removed. I can see myself moving forward… It makes me think: why was I drinking that rubbish?"

"I was just being stupid, idiotic, killing myself. There’s no reason to be doing that… Taking part in this study has helped me focus more on life and my goals… An uplifting experience that I would recommend to anyone."


 
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Using ketamine to treat alcohol addiction

by Stephen Buranyi | VICE

Problem drinkers in the UK could one day have access to a new, fast-acting treatment to help them cope with the difficult first few weeks of sobriety: ketamine.

In a new trial taking place at the University of Exeter and University College Hospital in London, researchers are using small shots of the tranquilizer alongside standard psychotherapy treatments to see if it can help treat alcoholism.

"Current effects of treatments for alcoholism are at best modest, about three quarters of people return to drinking after 6 months, so there is a dire need for new treatments," said Celia Morgan, professor of psychopharmacology at the University of Exeter, and one of the lead researchers on the study.

Ketamine has already been shown to be an effective treatment for depression, something that's done a lot to rehabilitate its reputation. As an antidepressant it's unique in that it acts very quickly, with patients often reporting an improvement in their mood over just one or two days.

That could make it ideal for treating recovering alcoholics, who often suffer from depression immediately after quitting.

"We know that in alcohol dependence, depression is a predictor of relapse in the first couple of weeks. So we're able to give people the ketamine package in the time at which they might be particularly susceptible to relapse," said Morgan.

The trial, which is funded by the UK government's medical research charity, will have participants take part in seven therapy sessions, three with shots of ketamine. Control groups will receive no drug and no therapy conditions. Ideally, the ketamine will act as a sort of stabiliser for depression, and possibly increase the power of the therapy.

"Experiments with animals show that ketamine may help form neuronal connections in the brain, and that could mean that in humans the therapy will be more effective or more likely to stick," said Morgan.

"There's new scientific evidence in animal models suggesting that their brains might be primed to learn more after taking ketamine," she said. "So it could help people who are stuck in a rut with alcoholism. It may prime your brain to take on new experiences from the world."

Morgan is not the only one pursuing this theory. Elias Dakwar, Professor of Clinical Psychiatry at Columbia University in New York, is currently recruiting patients for a similar trial that will use ketamine treatment alongside motivational therapy for alcoholism. "The way people's brains adapt to addiction is similar to that of depression," he says.

"People sort of forswear their own agency and self-efficacy, and there's a sense of resignation. The thinking on ketamine's effect on depression is that it reverses depression-related adaptation through neuroplasticity," said Morgan.

In other words, it could make the brain more ready to create new connections and move away from old patterns of behaviour, making it an ideal companion for therapy that's meant to help people re-evaluate and change their lives.

The ketamine doses Morgan plans to use are higher than those used in standard depression treatment, but they're not quite enough to cause the sort of total dissociation that has led some scientists to class ketamine as a psychedelic drug, and far less than the maximum safe dose as an anaesthetic.

"Were not going for the full-blown mystical experience," Morgan said. "Were looking at treatment we can do within the National Health Service as well; this is something that is funded by the government, so we are looking at things that are acceptable in that context."

Both trials are still in the early stages: Morgan's started in June and is set to run until 2017, and Dakwar's should wrap up next year. But if the results are positive, ketamines use could expand quickly. Alcoholism, like most addictions, is notoriously difficult to treat, with few effective drugs available. And according to the NHS, nine percent of men and four percent of women in the UK show signs of alcohol dependence.

"It's one of those really intractable disorders that people have been trying to find a drug therapy for some time," said Dr Dakwar.

https://motherboard.vice.com/en_us/a...ohol-addiction
 
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Ketamine 66% effective in reducing alcohol relapse

Beth Marsh, Lilla Porffy, Meryem Grabski, Will Lawn | the Guardian | 5 Feb 2018

Alcohol abuse still represents the fifth biggest risk factor for illness, death and disability. With current treatments often failing to prevent relapse in the long term, researchers are investigating the possibility of using ketamine combined with psychological therapy to help people stay dry, and not just for January. Despite its often cited use as a recreational drug, Ketamine is also the most widely used anaesthetic in humans. Administered appropriately in a controlled and safe medical environment, Ketamine may also have benefits in the treatment of drug problems.

Evidence for this originally came from a research group in Russia in the 1980s. In this study, patients who had alcohol problems were given 3 weekly Ketamine treatments in conjunction with psychological therapy. After one year, 66% of patients who underwent this treatment regime were abstinent, in comparison to 24% of patients who received treatment as usual, without any Ketamine. This abstinence rate is much greater than those documented with any other relapse prevention method.

Inspired by the promising results seen in Russia, we are now conducting the KARE trial (Ketamine for reduction of Alcoholic Relapse) at the University of Exeter and University College London. In this trial participants who have made the decision to abstain are administered ketamine once a week for three weeks. Participants also receive seven sessions of cognitive behavioral therapy to aid their quit attempt and are followed up for six months. Unlike the earlier study, this trial is placebo controlled, thus participants have an equal chance of receiving either Ketamine or a matched placebo as well as either cognitive behavioral therapy or alcohol education as a placebo for therapy. It is also double-blind, meaning neither the participant nor the researcher know whether the active treatment or a placebo treatment are administered. This controls for placebo effects and bias due to expectations of the researcher, putting the original findings to the test with a more rigorous research design.

Why might Ketamine help people stay sober? Recent studies have demonstrated that Ketamine has rapid and powerful anti-depressant properties, while people with alcohol problems often also experience symptoms of depression. The direction of the relationship between alcohol problems and depression is not clear, but depressive symptoms are thought to be a common trigger for relapse. Treating people who have alcohol problems with Ketamine, therefore, could help them to remain abstinent for longer by lifting their mood.

Furthermore, laboratory research has demonstrated that Ketamine promotes the growth of new neurons and connections in the brain. These processes are essential to learning and memory, and are suggested to be impaired in both depression and problematic alcohol use. Thus Ketamine might make people more receptive to new information and able to plan effectively for the future, which in turn may enhance the effect of psychological therapy.

We do not yet know how effective the Ketamine treatment will be. However, well-designed research studies, such as the KARE trial, could be critical in helping people achieve their abstinence goals.

https://www.theguardian.com/science/...hol-dependence
 
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Psilocybin cuts cravings and consumption in those with Alcohol Use Disorder*

by Pauline Anderson | Medscape | May 23, 2019

SAN FRANCISCO — Just two doses of the psychedelic drug psilocybin, taken over a period of 8 weeks, significantly reduced alcohol use and cravings in patients with alcohol use disorder, preliminary findings show.

In the first study to use modern clinical trial design to investigate the effects of a psychedelic in alcohol-dependent patients, investigators at New York University (NYU) School of Medicine in New York City found that use of psilocybin was significantly associated with fewer drinking days and fewer drinks per day, as well fewer cravings.

"Psychedelic research has the power, if performed in a rigorous way, to really change the face of psychiatry," study investigator Kelley Clark O'Donnell, MD, PhD, a resident in the Department of Psychiatry at NYU School of Medicine, told Medscape Medical News

Growing interest in psychedelics

These findings contribute to a growing body of research into the use of psychedelic drugs for the treatment of psychiatric conditions.

The multisite, double-blind, randomized controlled trial assessed the effects of psilocybin-assisted psychotherapy on 180 alcohol-dependent patients. Alcohol dependence was determined on the basis of DSM-IV criteria.

Psilocybin is a naturally occurring serotonergic psychedelic. As with lysergic acid diethylamide (LSD), another psychedelic drug, it is a 5HT2A receptor agonist.

Psilocybin is among the most studied psychedelic drugs. One of the reasons the investigators chose it for the current study is that its duration of action (6 to 8 hours) enables treatment to be conducted on an outpatient basis, said O'Donnell.

In contrast, LSD's duration of action can be up to 12 hours, which would necessitate an overnight hospital stay.

Participants were randomly assigned to receive psilocybin 24–40 mg/70 kg or the antihistamine diphenhydramine 50–100 mg in two dosing sessions.

Diphenhydramine (multiple brands) was chosen as the control drug because it has no effect on addiction but still might "make people feel a little woozy," said O'Donnell.

All patients received two types of psychotherapy. One combined motivational interviewing and cognitive-behavioral therapy. "The other was specific to the psychedelic experience and involved talking about the things patients might expect and doing a life review," said O'Donnell.

"Patients received the medication at week 4 and at week 8 and attended therapy sessions in between doses — two doses a month apart," said O'Donnell.

Patients completed the Mystical Experience Questionnaire (MEQ) 8 hours after each medication session. The MEQ "is a measure of how intense the medication session was," said O'Donnell.

Life-changer?

O'Donnell presented preliminary results from 56 participants (32 men and 24 women) who had completed the first 12 weeks of trial. The mean age of the participants was 46 years (25 – 65 years); the mean education level was 7 years.

The mean number of drinks per day was 5. The participants' mean percent drinking days was 75. The mean number of drinks per drinking day was 8.

Because the study is ongoing, the researchers had to maintain the blindedness of the study. For the preliminary analysis, researchers divided the patients into two groups, high-MEQ and low-MEQ, on the basis of median MEQ score.

There was no difference in daily alcohol consumption between high-MEQ and low-MEQ groups at baseline and immediately before the first medication session.

However, at week 12, a month after the participants had taken the second medication, alcohol use was significantly reduced in the high-MEQ group compared to the low-MEQ group.

Among participants in the high-MEQ group, the percentage of drinking days was significantly lower compared to the low-MEQ group (19 vs 40), and the number of drinks per drinking day was less (3 vs 7).

The high-MEQ group reported significantly lower alcohol cravings. There was no significant difference between the groups on measures of depression or anxiety.

"Regarding the question as to whether the study would be truly blinded if participants who take psilocybin have a mystical experience," O'Donnell said: "We would expect that if you feel nothing, then probably you did not get psilocybin, and if you had a huge experience, then probably you did. So although the study is technically blinded, there are going to be people for whom the study is essentially unblinded or blinded only in name."

She noted that it's possible for patients to have a "spontaneous experience" without taking a psychedelic.

"The Alcoholics Anonymous literature is full of people having that 'coming to God' moment that really triggers their recovery," she said.

Promising findings

O'Donnell, who was one of the study therapists, said that for some cases, she couldn't tell whether a patient had received psilocybin or not.

Psilocybin may reduce alcohol dependence by restructuring the way patients view the world. "It might change what your orientation is to yourself and to others and to the drinking," said O'Donnell.

She described the new findings as "promising," but noted that alcoholism is "a highly chronic illness." However, even for those who relapse, this new approach may offer hope.

"If we can get people to engage in treatment, and if we can form a good rapport with them, then it's possible that even those who do relapse in future might come back into treatment and the trajectory would be different," said O'Donnell.

Psilocybin has been studied in the treatment for other addictions, including addiction to tobacco, as well as for other psychiatric conditions, such as depression and anxiety. O'Donnell's group is about to begin recruiting for a multisite trial of psilocybin in the treatment of major depressive disorder.

Other psychedelics are being studied for various psychiatric conditions. A large phase 3 trial is investigating the use of MDMA for treating PTSD.

Next big research trend

Commenting on the research for Medscape Medical News, Sagar V. Parikh, MD, professor of psychiatry, University of Michigan, Ann Arbor, said that research into psilocybin and related drugs is "the next trend" in psychiatry.

"It's very early days, but I think there's enough science there to show something," he said.

Parikh noted that research on psychedelics dates back several decades. Indeed, a book published in the 1960s by a precursor of the Center for Addiction and Mental Health in Toronto, Canada, focused on the use of LSD in the treatment of alcoholism. "Research is revving up again," he said.

He emphasized that the findings from this new study are very preliminary. "I'm hesitant to get too excited when it's the first study or two," he said.

He noted the current "tremendous treatment gaps" for alcohol use disorders. "None of the treatments we have are that effective, and they all rely on somewhat similar mechanisms," he said.

"What's exciting about psilocybin is that there is some science to back it up," he said. "From the basic science studies, psilocybin causes some long-term changes in small areas of the brain that are relevant to mood disorders and perhaps to addictions."

"Psychiatric research using psychedelic drugs is still at beginning stages, so it tends to concentrate on the most prevalent disorders, such as alcohol dependence, depression, and anxiety,"
said Parikh.

"Since it's so hard to do research in this area, and expensive, people are concentrating on these big-ticket items," he said.

*From the article here :
 
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Eight in ten alcoholics in England relapse within three years.

MDMA treatment could reduce alcoholism relapse, study suggests

by Helena Blackstone | The Guardian | 19 Aug 2019

The first study looking into the use of MDMA to treat alcohol addiction has shown the treatment is safe and early results show encouraging outcomes from the approach, scientists have said.

Doctors in Bristol are testing whether a few doses of the drug, in conjunction with psychotherapy, could help patients overcome alcoholism more effectively than conventional treatments. Those who have completed the study have so far reported almost no relapse and no physical or psychological problems.

In comparison, eight in 10 alcoholics in England relapse within three years after current treatment approaches. Dr Ben Sessa, an addiction psychiatrist and senior research fellow at Imperial College London, and who led the trial, said: “With the very best that medical science can work with, 80% of people are drinking within three years post alcohol detox.”

Eleven people have so far completed the safety and tolerability study, which involves nine months of follow-ups. “We’ve got one person who has completely relapsed, back to previous drinking levels, we have five people who are completely dry and we have four or five who have had one or two drinks but wouldn’t reach the diagnosis of alcohol use disorder,” Sessa said.

Most addiction is based on underlying trauma, often from childhood, explained Sessa. “MDMA selectively impairs the fear response,” he said. “It allows recall of painful memories without being overwhelmed."

“MDMA psychotherapy gives you the opportunity to tackle rigidly held personal narratives that are based on early trauma. It’s the perfect drug for trauma-focused psychotherapy.”


The first stage of the new study was designed to show the therapy is safe. Further research, which compares results with a randomised control group who receive a placebo instead of MDMA, will be needed to back up the treatment’s effectiveness.

After preliminary screening, including medical and psychological tests, the participants are given an eight-week course of psychotherapy. In weeks three and six, they are given a powerful dose of MDMA.

Sessions are conducted in a hospital with a psychiatrist and a psychologist present. Participants are given the drug and then spend eight hours with the specialists, mostly lying down, wearing eyeshades and headphones.

“We let them lead the sessions as to where they want to go. What comes up comes up, so it’s not very guided by the clinicians,” said Sessa.

After the MDMA-assisted sessions, patients stay overnight and are telephoned every day for a week to collect data on sleep quality, mood and potential suicide risk. Significantly, this data has shown no evidence of drug withdrawal or comedown symptoms from the MDMA.

“There is no black Monday, blue Tuesday, or whatever ravers call it. In my opinion, that is an artefact of raving. It’s not about MDMA,” said Sessa, referring to recreational users of the drug, which is often associated with clubbing.

“If there was a craze of people going around abusing cancer chemotherapy drugs, you wouldn’t then think: ‘Oh well, it’s not safe to take cancer chemotherapy when doctors give it to you,’” said Sessa. “Scientists know it’s not dangerous. The Sun newspaper thinks it’s dangerous because the tiny number of fatalities that occur every year all get on their front page.”

MDMA was used as a legal prescription drug to enhance the effectiveness of psychotherapy in the US from the 1970s to 1985 and in Switzerland up until 1993. In recent years, MDMA therapy has been studied extensively as a treatment for post-traumatic stress disorder (PTSD).

Speaking at Breaking Convention in London over the weekend about a study published earlier this year, Rick Doblin, founder of the Multidisciplinary Association for Psychedelic Studies, said: “61% no longer have PTSD – that’s after two month’s follow-up. But more importantly, after one year of follow-up, people still keep getting better.”

David Nutt, professor of neuropsychopharmacology at Imperial College London, who was also involved in the study, said the research had faced financial barriers that meant it took two years to set up because of the “profound” legal constraints of working with a schedule 1 drug. “Unfortunately, it’s very difficult to get money for this from government funding. But we have a scientific credibility that will allow charitable funders to support us,” said Nutt.

 
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LSD and psilocybin vs alcoholism*

by Rich Haridy | New Atlas | May 20 2019

A newly published study examining the use of psychedelics in non-clinical settings to treat alcoholism is suggesting a great number of individuals see a reduction in problematic alcohol consumption following strong doses of LSD or psilocybin. The research supplements a compelling body of evidence revealing the intriguing anti-addiction potential of classic psychedelics, and rekindles interest in a strong vein of research from the 1950s and 1960s.

Before LSD escaped the laboratory to hit the streets and become a generation-defining recreational drug in the 1960s, it was the focus of an impressive volume of medical research in the 1950s. By the time the drug was ultimately criminalized and declared taboo in legitimate research circles over the 1970s, it is estimated more than 40,000 patients had been treated with it in clinical settings, and more than 1,000 research papers had been published.
LSD and alcoholism

Prior to the great psychedelic research freeze that set in by 1980, LSD as a treatment for alcoholism was one of the more heavily investigated psychedelic research topics. One of the most important figures in the field across the 1950s was an English psychiatrist named Humphrey Osmond. After struggling to further his research into LSD and mescaline in London, Osmond moved to Canada in 1951 to begin a rich stretch of research into the clinical uses of these mind-altering drugs.

As well as coining the term "psychedelic" at a medical conference in 1956, Osmond was responsible for administering the dose of mescaline to author Aldous Huxley that resulted in his book entitled The Doors of Perception, considered one of the most culturally influential early writings on psychedelic drugs. Osmond's work with LSD and alcoholism turned out to be as important and influential as his other successes.

In 1953 Osmond and his research team first tested LSD as a treatment for alcoholism on two patients. The idea was that a large single dose of LSD could generate a profound experience that breaks the personal habits that lead to excessive drinking. The initial experiment only worked in one of the two patients, with the successful subject immediately stopping drinking for at least six months (the length of the study's follow-up period).
The thirteenth step?

Over the next few years, Osmond treated more than 700 chronically alcoholic patients with LSD and ended up with around a 50 percent overall success rate. One of Osmond's most compelling studies took place in the late 1950s with a cohort of subjects from the group Alcoholics Anonymous. This cohort was comprised of individuals that had failed the famous 12-step program, and again Osmond hit his 50 percent success rate, this time with a 12-month follow-up period.

Years later it was revealed that Osmond had entered into a comprehensive correspondence across the late 1950s with Bill Wilson, the co-founder of Alcoholics Anonymous. Wilson, himself having been treated with LSD therapy for depression, was excited by the potential of the mind-altering drug.

One of the key stages in the AA process is the necessity of undergoing a spiritual experience that propels the alcohol user into recovery. Wilson wondered whether LSD could effectively help induce that necessary experience.

Wilson's wife was later quoted as saying at one point there was serious consideration given to include LSD as a step in the AA program. However, others in the organization bristled at the idea of one drug being used to stop the chronic consumption of another. The group was after all dedicated to the idea of sobriety. Osmond noted that Wilson's embrace of the potential of LSD caused a variety of scandals in the AA community.

And now ... in the 21st century

A 2012 meta-review encompassing several well-conducted randomized, controlled clinical trials from the late 1960s and early 1970s found a consistent successful trend in every study conducted, verifying a single dose of LSD can be beneficial in cases of chronic alcohol abuse. That meta-study revealed 59 percent of all patients responded positively to a single LSD dose.

A recent study examining anecdotal uses of psychedelics for alcoholism in non-clinical settings found even higher success rates. This research collected survey data from 343 people who found major reductions in alcohol use following psychedelic experiences. Only 10 percent of the survey group claimed to take psychedelics with a specific aim of reducing alcohol use, yet 83 percent reported major improvements no longer meeting the diagnostic criteria for alcoholism following a psychedelic experience.

Although there is a solid volume of modern study beginning to re-investigate clinical uses of LSD, many researchers are looking more closely at psilocybin, the psychoactive component in magic mushrooms. Both LSD and psilocybin act on the brain in somewhat similar ways, but psilocybin may be a little more useful to scientists in clinical conditions. It is much easier to control dosage with psilocybin and it results in experiences that are shorter in duration compared to LSD.

An exciting Phase 2 clinical trial is currently underway investigating psilocybin as a treatment for alcohol dependence. Led by the NYU School of Medicine, the trial will include an active placebo, so subjects in the control group will be adequately blinded, and involve two treatments around a month apart. The follow-up period is set for almost one year, with a primary outcome measure to track alcohol consumption following the treatment.

Alcohol use disorders are inarguably a major health problem, with one study finding around 12 percent of American adults face alcohol dependence problems at some point in their lives. It may be several years before this modern research leads to clinically useful outcomes but it is exciting to see an entire field kick back into gear after sitting dormant for decades following the legal and social prohibitions of the 1970s, 80s and 90s.

*From the article here :
 
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Effectiveness of extended release naltrexone in reducing alcohol cravings

Crèvecoeur-MacPhaila, Cousins, Denering, Kim, Rawsona

• UCLA examined the proportion of patients who returned for additional doses of naltrexone and their outcomes.
• Reductions were reported in alcohol cravings and use behaviors during treatment and at the two follow-ups (30 and 60 days).

Changes in cravings to drink alcohol and alcohol use behaviors were examined among 337 patients who were administered extended-release naltrexone in conjunction with psychosocial treatment in community-based substance use disorder treatment programs. Cravings and use behaviors were assessed at multiple time points (baseline; weeks 1, 2, and 3 after the first dose; monthly after the first four assessments; and at 30- and 60-days after the last dose). A total of 863 doses were administered and the majority of patients (65 percent) took more than one dose. Alcohol craving scores decreased from 19 to 6 after the first dose of naltrexone. Days of primary alcohol use at admission were reduced at discharge. At the first follow-up, 80% reported no alcohol use and 78% reported no alcohol use at the second follow-up. The expected side effects were reported but the medication was well tolerated and there was no relationship between side effects and subsequent dose. Results indicated that use of the medication naltrexone may be related to significant decreases in alcohol craving and use while a patient is in treatment, as well as at 30- and 60-days after the final dose.


Extended-release naltrexone for alcohol dependence

Hartung, McCarty, Fu, Wiest, Chalk, Gastfriend

Through improved adherence, once-monthly injectable extended-release naltrexone may provide an advantage over other oral agents approved for alcohol and opioid dependence treatment. The objective of this study was to evaluate cost and utilization outcomes between naltrexone and other pharmacotherapies for treatment of alcohol and opioid dependence. Published studies were identified through comprehensive search of two electronic databases. Studies were included if they compared naltrexone to other approved medicines and reported economic and healthcare utilization outcomes in patients with opioid or alcohol dependence. We identified five observational studies comparing 1,565 patients using naltrexone to other therapies over 6 months. Alcohol dependent naltrexone patients had longer medication refill persistence versus acamprosate and oral naltrexone. Healthcare utilization and costs was generally lower or as low for naltrexone-treated patients relative to other alcohol dependence agents. Opioid dependent naltrexone patients had lower inpatient substance abuse-related utilization versus other agents and $8170 lower total cost versus methadone.

 
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How to quit drinking alcohol with psilocybin mushrooms

by Ashley Michaud | Sociedelic | Oct 30 2019

"There's incredible potential here."

The day I made the decision to quit drinking I was listening to the JRE Podcast, I remember how empowered I felt in making the decision to get sober for just a brief moment, right before the fear took over. Fear was telling me that I was going to fail at this again, that this was who I was and not the observer listening to this bullshit. But then, I did the damn thing anyway, I set the goal to quit drinking alcohol.

I was working on my landlord’s patio stones as a form of payment because I couldn’t keep working in the Hospitality Industry if I had any chance of getting sober – thank god he was supportive and gave me the support and shelter I needed to make this happen. I remember there was a case of Kokanee beer in the fridge still because I had just moved from British Columbia to Ontario, once the patio steps were complete, I grabbed one, sat on the new steps and cracked it open with my feet up. I had one sip and remembered; “I made a decision to quit drinking, this is why I came here” and questioned “wtf am I doing?”

I felt I was in over my head but had this drive inside of me to be a winner, to win this game I was playing with my addiction to alcohol. I started working my body out by doing 2h of Kundalini Yoga per day, HIIT workouts and running laps around my neighbourhood. I began to eat healthier foods and hydrate my muscles – did you know it takes about 3 weeks to rehydrate your brain after a night of heavy partying?

The most influential thing to keep me sober was the lectures I listened to by Terence McKenna on Psilocybin Mushrooms. He spoke a lot about the Heroic Dose (5g of dried Psilocybin Mushrooms). Seeing as mushrooms have never killed anyone (neither has cannabis) and I had already experimented with magic mushrooms several times at parties, I challenged my self to do this ‘Heroic Dose” in a sacred setting and with intention during a 24h fast, one special afternoon.

I took my dose in the form of tea with cannabis, as the mushrooms started to work, I felt like a fungus and kind of queasy, so I lit up a pre-rolled joint that was sitting on my table and walked out of my place towards the beach barefoot. I sat there, then laid there and then walked through the forest trail back home. When I closed my eyes, I could see tunnels swirling through my mind but I held myself back from exploring them further, which was okay according to the mushrooms that were quiet entertaining in other ways too.

I received many downloads that night including a new understand of the fractal effect we each expierence in this world. I learned what family karma was that night and that my victim mindset was not going to serve me in the future. I also felt a sense of forgiveness come pouring out of my heart and into the places it needed to go. I felt free and connected in a way that’s indescribable by words.

About four hours later I found myself on my couch ready for bed and inspired to Be The Change I wished to manifest. While I did continue to practice with Terence McKenna’s Heroic Dose this trip alone empowered me to maintain my sobriety, reconsider my self worth and many beliefs that were due for an update. I also was inspired to follow in the McKenna brothers’ footsteps and plan a trip to Columbia, South America which is a story for another time!!!

Sending you much love and gratitude on your Sociedelic journey, Ashley Michaud.

 
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Albert Hofmann

Ketamine could help cut alcohol consumption by rewiring memory

by Catherine Offord | Nov 27, 2019

Preliminary findings from a clinical trial of heavy drinkers suggest that the drug can weaken certain memories tied to the reward of imbibing, although the mechanisms aren’t fully clear.

The anesthetic drug ketamine could be used to rewire heavy drinkers’ memories and help them cut down on alcohol consumption, according to a study published yesterday in Nature Communications. In a clinical trial of people who reported consuming around 590 grams of alcohol—equivalent to nearly two cases of beer—per week on average, researchers found that a procedure that involved administering the drug while people were thinking about drinking durably reduced consumption.

While it’s not clear how the method works at a neurological level, the study represents “a really exciting development,” Amy Milton, a behavioral neuroscientist at the University of Cambridge who was not involved in the work, tells STAT. She adds "the findings mark the first time it’s been shown in a clinical population that this can be effective.”

The study was designed to manipulate the brain’s retrieval and stabilization of memories—in this case, those linking the sight and thoughts of alcohol to the reward of drinking it, study coauthor Ravi Das, a psychopharmacologist at University College London, tells Science News. “We’re trying to break down those memories to stop that process from happening.”

To do that, the team asked 30 of the participants to look at a glass of beer, followed by a sequence of images of alcoholic and non-alcoholic drinks. On the first day of tests, the session ended with participants being invited to drink the beer. On the second day, after viewing the beer and images, the screen cut off, and instead of drinking the beer, participants were given a shot of ketamine.

Among various functions, ketamine blocks NMDA receptors—key proteins in the brain’s reward pathways—so the researchers hypothesized that administering the drug during memory retrieval would help weaken participants’ associations between the sight or contemplation of alcohol and the reward of drinking it. Their results somewhat support that hypothesis. Nine months following the several-day trial, the volunteers reported cutting their drinking back by half.

“To actually get changes in [participants’] behavior when they go home and they’re not in the lab is a big deal,” Mary Torregrossa, a neuroscientist at the University of Pittsburgh who was not involved in the work, tells Science. But she notes "it’s not clear whether it was the ketamine or some other part of the procedure that led to the effect."

Another 60 participants, split into two control groups, received slightly different procedures that involved either beer or ketamine and still showed, on average, a 35 percent decrease in alcohol consumption after nine months. The participants themselves were recruited to the study through online ads—meaning that the researchers may have selected for people already interested in reducing consumption.

Whatever the mechanisms behind the effect, the results so far suggest the method is worth investigating, David Epstein, an addiction researcher at the National Institute on Drug Abuse, tells Science News. “If a seemingly small one-time experience in a lab produces any effects that are detectable later in real life, the data are probably pointing toward something important.”

 
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One ketamine shot could help heavy drinkers cut down

by Ana Sandoiu | Medical News Today | Nov 29 2019

New research finds that the combination of a single shot of ketamine and a memory retrieval technique can significantly reduce alcohol cravings and harmful drinking behavior among people who drink heavily.

Approximately 88,000 people die from alcohol-related causes each year in the United States.

According to recent estimates from the National Institutes of Health (NIH), more than 26% of adults aged 18 years and above are likely to have engaged in binge drinking in the past month, with 6.7% engaging in heavy alcohol use.

Overall, more than 14 million adults are living with alcohol use disorder in the U.S., and only a small percentage of them are getting treatment.

There are currently only three approved medications that can help treat alcohol use disorder, and none of them can cure the condition.

Now, a small experimental study of 90 people suggests that ketamine holds promise as a better, more effective treatment for harmful drinking behavior.

Ravi Das, from the clinical psychopharmacology unit at University College London (UCL) in the United Kingdom, is the lead author of the Nature Communications paper that details the findings.

Drinking and the brain's reward system

Das and colleagues started from the neuroscientific framework that explains addiction in terms of reward-seeking behavior.

In this explanatory framework, addictive drugs undermine the normal, reward-centered learning processes.

Addictive drugs rely on learned associations between drug-related cues — such as the smell or sight of a cigarette or a glass of beer — and the reward that is the drug.

"Learning is at the heart of why people become addicted to drugs or alcohol," explains Das. "Essentially, the drug hijacks the brain's inbuilt reward-learning system so that you end up associating environmental 'triggers' with the drug. These produce an exaggerated desire to take the drug."

"Unfortunately, once these reward memories are established, it's very difficult to relearn more healthy associations, but it's vital in order to prevent relapse,"
Das says.

Experimenting with ketamine and memories

In the new experiment, 90 heavy drinkers received a glass of beer, which they could only drink as a reward after completing a task. The researchers asked the participants to rate their urge to drink and their anticipated pleasure.

The aim of this process was to make the participants retrieve the reward memories that they associated with beer drinking. The participants were heavy beer drinkers who regularly drank 30 pints of beer a week, on average, which is five times the recommended limit in the U.K.

Removing the highly anticipated reward is key for undermining retrieved reward memories, so the researchers allowed the participants to drink the beer on the first day, but they unexpectedly took it away on the second day.

Under these circumstances, the brain would usually try to restabilize the memory, explain the researchers. However, ketamine stops this restoring process by blocking a brain receptor that is key for reorganizing and reconsolidating memories — the N-Methyl D-Aspartate Receptor (NMDAR).

Das and team gave a third of the participants a ketamine shot on the second day, after taking the beer away from them.

Another group received a placebo, and the last group received ketamine but without having undergone the initial memory retrieval process.

Ketamine is a 'simple, accessible approach'

At a 10-day follow-up, the experiment revealed that the people who received ketamine and underwent memory retrieval craved alcohol significantly less and drank a lot less than other study participants. They also reduced their weekly number of drinking days.

Experiments using a small sample of beer revealed that these participants were less inclined to drink it, enjoyed it less, and were less likely to continue drinking than the participants in the other two groups.

The effects lasted across 9 months. "We found that heavy drinkers experienced a long-term improvement after a very quick and simple experimental treatment," reports the study's lead author.

"This is the first demonstration of a very simple, accessible approach, so we hope that with more research into optimizing the method, this could be turned into a helpful treatment for excessive drinking, or, potentially, for other drug addictions." - Ravi Das

However, the authors emphasize that the research is experimental and not a clinical trial. The study's senior author, Prof. Sunjeev Kamboj, also from UCL's clinical psychopharmacology unit, comments on the various uses of ketamine and the significance of the study.

"Ketamine is a safe, common drug that is being explored for multiple psychiatric uses, including depression, while other researchers are also exploring other ways it could help with problem drinking," Kamboj says.

Indeed, Medical News Today recently reported on research showing that ketamine can successfully relieve depression in a clinical setting.

"An advantage to our study," continues Prof. Kamboj, "alongside the pronounced, long-term effect on drinking, is that it's based on a strong understanding of how the drug is working in the brain to achieve its effect."

 
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Psychedelic Therapy for Alcohol Dependence*

by Balázs Szigeti | Drug Reporter | 4 Apr 2016

Here we take a look at a meta-analysis of using LSD therapy to treat alcoholism. Meta-analysis means that the study pools together data derived from multiple trials and re-analyses the combined evidence. The advantage is that the combined evidence reduces the statistical uncertainties, and permits more robust conclusions than any of the individual studies in isolation.

To study the effectiveness of LSD therapy for alcohol dependence, the authors had to first find the records of the relevant clinical trials. Most of the trials were either non-randomised or open label (patients knew whether they are in the control group or not). The standards for clinical trials have been raised since the sixties, and these practices are nowadays considered serious methodological flaws. Thus, the authors excluded these papers from their meta-analysis, and only included studies with randomised controlled trials, where the control group received some form of active treatment. Six eligible trials have been identified. Among these trials, several studies lacked a detailed description of how the patients were recruited, so selection bias could not be completely eliminated. Two of the trials, moreover, have a risk of bias as treatment allocation was only concealed until the end of the LSD session (before the follow-up sessions, patients knew whether they were in the treatment or control group). These are legitimate concerns, and they weaken the conclusion of the meta-analysis.

536 patients participated in the trials, with 325 (61 percent) randomly assigned to LSD treatment, and the remainder assigned to the control groups. In all of the trials, a single oral dose of LSD was administered. The median dose was 500ug, an extremely high dose in terms of recreational use (a typical blotter paper contains 120ug, although there are wide variations). The control conditions included active placebo, for example d-amphetamine, and very low doses of LSD (up to 50ug). Each of the trials had multiple follow-up sessions, where it was assessed whether the patient's alcohol problem had improved or not. The follow-up sessions were pooled together to form three time-categories: short (2-3 months), medium (6 months) and long term (12 months) follow-ups.

To summarise the effectiveness of the LSD treatment and the control groups, the odds ratio was calculated (at each follow-up session). Without getting too technical, the odds ratio is the quotient of the odds that a patient has improved in the treatment group and the probability that a patient has improved in the control group. If the odds ratio is > 1 then the treatment is favoured over the control and the higher its value is, the more effective is the treatment compared to control.

The difference between the LSD and control groups was statistically significant at the short- and medium-term, but not at the long-term follow-up. Looking at the odds ratios for different follow-up times, two observations should be made. The odds ratio suggests that LSD treatment is effective, but with its benefit diminishing with time. To account for the success, one study was quoted as saying that, it was rather common for patients to claim significant insight into their problems, to feel that they had been given a new lease on life, and to make a strong resolution to discontinue their drinking. This statement seems to reinforce the hypothesis behind LSD therapy. As for the diminishing benefits, one of the papers commented that most alcoholics report a waning of the initial inspiration, euphoria, and good intentions gleaned from the LSD experience when they are again confronted with the former stress and difficulties of their lives. To transfer the benefits to the long term, researchers have suggested extending the LSD treatment to multiple sessions, where each session is separated by a few months. In theory, the repeated LSD experiences could reinforce the will to quit. One could also, however, argue that the repeated LSD sessions would not be as motivating as the first one, as the patient gradually becomes more familiar with the experience.

An important question to ask is how the results of LSD therapy compared to the results of other treatments? To address this question, the authors compared the effectiveness of LSD with Naltrexone, Acamprosate and Disulfiram treatments, all of which are common prescription medicines to help with alcohol addiction. The full statistical analysis would require much more technical detail, but in summary, it can be said that LSD compared favourably against all of these alternative drug treatments.

Most trials made little effort to prepare the patients for the psychedelic experience. Typically, there was a brief orientation session, but there was rarely an in-depth discussion of LSDs effects. The authors point out that 8 patients (out of the 325, 2 percent experienced temporary adverse reaction to LSD (e.g. anxiety). Given the very high dosages and the lack of preparation, this is a somewhat surprisingly low number.

Conclusion

LSD would appear to be an effective treatment for alcohol dependence in the short and medium term, but the positive effects are diminished after 12 months. Despite the weakening effect, and the legitimate criticisms over possible bias of the trials, this meta-analysis provides evidence that argues for further research. Future studies could address whether repeated doses might extend the initial euphoria to long-term change, and whether the combination of LSD therapy with more conventional approaches could lead to lasting benefits. Furthermore, the trials used different doses of LSD; more empirical data is needed, in order to refine the dosage that maximises the benefits and minimises the adverse reactions. It remains to be seen whether scientists will be allowed to investigate these questions.

*From the article here :
https://drogriporter.hu/en/dose-of-s...ol-dependence/
 
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Columbia University Medical Center

New research shows ketamine may help alcoholism*

by Deborah Brauser | MedScape | 13 Feb 2020

New research suggests a single infusion of ketamine combined with counseling may help alcohol-dependent patients curb their drinking.

In a pilot study of 40 participants, those who were randomly assigned to receive intravenous (IV) ketamine plus outpatient motivational enhancement therapy showed greater abstinence rates, longer time to relapse, and fewer heavy drinking days than those who received MET plus midazolam.

The findings support a UK study published in November that showed that a single dose of IV ketamine plus therapy that focused on reactivating drinking-related "maladaptive reward memories" reduced drinking urges and alcohol intake more than just ketamine or a placebo infusion alone.

"I think the take-home message is that behavioral treatment can be helpful, but there are vulnerabilities that can get in the way," current study investigator Elias Dakwar, MD told Medscape Medical News.

"It's an important area of research to understand in order to make behavioral treatments more effective; and ketamine appears to have the properties to address those vulnerabilities," Dakwar said.

The study was published in the February issue of the American Journal of Psychiatry.

Real-world approach

Pathologic alcohol use is responsible for an estimated 4 percent of all deaths globally, yet current interventions for alcohol use disorder have limited efficacy, the researchers note.

New treatments with innovative mechanisms would be valuable,” they added.

Previously, research offered 'promising results' with the use of ketamine for cocaine use disorder, including increased motivation to quit and decreased craving,” Dakwar noted.

"Those results led us to think about how ketamine might be helpful for other substance use disorders, especially given the overlap in clinical vulnerabilities and epidemiology," he said.

The study from the UK researchers was conducted in 90 patients with harmful drinking behavior but who had not been diagnosed with alcohol use disorder.

Dakwar noted that this was "a nontreatment study. None of the people there had alcohol use disorder; they were heavy drinkers. Also, the effects there were fairly modest.”

"My interest was how to integrate ketamine into a clinical, real-world framework that could be helpful for people,"
he added.

The study included 40 participants (53 percent women; 70 percent white; mean age, 53 years) with alcohol dependence whose average consumption was five drinks per day.

All entered a 5-week outpatient program of MET, which involved engaging in strategies to promote motivation and self-directed change.

During the program's second week, the participants were randomly assigned to received a 52-minute IV infusion of ketamine 0.71 mg/kg, or the benzodiazepine midazolam 0.025 mg/kg.

This ketamine dose was selected because it was the highest dose tolerated by participants in preliminary studies," the researchers reported.

"Midazolam was chosen as the active control because it alters consciousness without any known persistent...effect on alcohol dependence," they add.

The "timeline follow back method" was used to assess alcohol use after treatment. Abstinence was confirmed by measuring urine ethyl glucuronide levels with urine toxicology tests.

Other measures included use of a visual analogue scale, the Clinical Institute Withdrawal Assessment, and the modified Perceived Stress Scale.

Primary outcome met

Results showed that 47 percent of the ketamine group and 59 percent of the midazolam group used alcohol during the 21 days after treatment infusion; 18 percent and 41 percent, respectively, had a heavy drinking day.

For the primary outcome measure of alcohol abstinence, the 'quadratic effect of time was significant,' as was time-by-treatment interaction.

Although the model-estimated proportions of alcohol abstinence remained stable for the ketamine group for 21 days post infusion, the proportions decreased significantly for the control group.

The odds of having a heavy drinking day did not change significantly after treatment for the ketamine group, but increased significantly with each postinfusion day for the midazolam group.

For the ketamine group, time to relapse was also significantly longer.

There were no significant differences between the groups in rates of withdrawal, craving, or stress sensitivity.

A new direction?

The most common adverse events after treatment were sedation, seen in 12 members of the midazolam group and in eight members of the ketamine group; and headache, seen in four and six members, respectively.

Although two ketamine-group members experienced mild agitation for up to 1 hour post infusion, no incidents of persistent psychoactive effects were reported in either group.

"These preliminary data suggest new directions in integrated pharmacotherapy-behavioral treatments for alcohol use disorder," the investigators write.

However, a larger patient population will be needed in future research in order to replicate these promising results," they added.

Dakwar noted that the time to first drink after treatment was comparable between the groups.

"But what was different in the ketamine group was that they didn't continue drinking after that first drink. They didn't initiate heavy drinking, they didn't relapse, they were able to bounce back and stay with the program," he said.

"It was surprising but still consistent with the central hypothesis that ketamine provides this opportunity for setting the foundation for the requisite commitment so that once things become difficult, they're still able to maintain recovery," Dakwar said.

"Provocative findings"

In an accompanying editorial, Sanjay Mathew, MD, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, and Rebecca Price, PhD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania, note that "ketamine's effects on abstinence were robust in this trial."

"It is also noteworthy that, in spite of recruiting from a population of patients with active and significant substance use history (a group that has routinely been excluded from ketamine trials in depression), no participant showed evidence of new drug-seeking behaviors,"
Mathew and Price wrote.

*From the article here :
 
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Psychedelics may hold considerable potential in treating of alcoholism, study

by Eric Dolan | PsyPost | 21 Jun 2019

The use of psychedelic drugs may lead to reductions in problematic alcohol use, according to preliminary research published in the Journal of Psychopharmacology.

“Psychedelics appear to have the ability to induce a behavioral and mental plasticity, which is a way of saying they can serve as profound behavior change agents when applied in the right settings and framework,” said study author Matthew W. Johnson (@drug_researcher), an associate professor at Johns Hopkins University School of Medicine.

“They have potential to treat addictions, broadly defined. This is informed by early research with LSD as well as with reports regarding sacramental use of psychedelics by indigenous cultures and syncretic religions. Now the current study suggests that such anti-addictive effects for alcohol might be at play in the general population.”

Through online advertisements, the researchers recruited 343 individuals who had used a classic psychedelic drugs. The advertisements specifically sought participants who had “overcome alcohol or drug addiction after using psychedelics.”

The participants completed a survey that included several measures to assess their past alcohol use and misuse. The survey also collected demographic information and data about the psychedelic experience to which they attributed their alcohol use cessation or reduction.

The researchers found that most of the participants met the criteria for severe alcohol use disorder in the year prior to their psychedelic experience, but a large majority no longer met the criteria after the experience.

Most of the participants said the psychedelic experience in question was the result of a moderate or high dose of either LSD or psilocybin.

Eight out of 10 participants rated the psychedelic experience among the 10 most personally meaningful experiences of their life, while about 4 in 10 rated it among the 10 most psychologically challenging experiences.

The researchers also found that participants who reported more mystical-type effects and a greater overall intensity during their psychedelic experience tended to report bigger changes in their alcohol use.

“Public funding should be made available for conducting rigorous trials examining psychedelics in the treatment of addiction. Thus far, no NIH funding has been devoted to therapeutic human studies with psychedelics, despite a decades-long safety record and signs of promising effects,” Johnson told PsyPost.

The findings indicate that these substances hold “considerable potential” for the treatment of alcohol use disorder, the researchers wrote in their study.

But like all research, the study includes some limitations. For instance, the sample was likely supportive of psychedelic use in general and the results could be affected by recall bias.

“There are very real risks to psychedelics, but these can be squarely mitigated with well established safety procedures in clinical research. The major question is whether results hold up in much larger controlled studies,” Johnson said.

This research should not encourage folks to try this at home. There are risks to these compounds.”

The study, “Cessation and reduction in alcohol consumption and misuse after psychedelic use,“ was authored by Albert Garcia-Romeu, Alan Davis, Roland Griffiths and Matthew Johnson.

 
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Ketamine psychedelic therapy and alcohol addiction

Depression among addicted, alcoholic and people in recovery is extremely common.

Some in the treatment community are excited about the potential of Ketamine treatment.

Because the patient does not have access to the medication, abuse and dependence is a remote possibility.

Evgeny Krupitsky, MD, PhD, has been researching the treatment of alcoholism and addiction with ketamine since the 1980s and hopes to extend his research to encompass post-traumatic stress disorder in the near future. In 1985, he developed ketamine psychedelic therapy - which was initially merely a method for increasing suggestibility and enhancing aversive treatment for alcoholism - publishing his first report on the method in 1992.

He found that ketamine induced total abstinence in 66 percent of his alcoholic patients (versus 24 percent of the non-psychedelic control group) for as long as a year. He observed improvement in personality profile, positive transformation of self-concept and emotional attitudes to various aspects of self, positive changes in life values, and improved spiritual development in the ketamine group. What is the contribution of the psychedelic experience to this improvement? Krupitsky posited nine factors:

1. Stable, positive psychological changes.
2. Personality growth and self-cognition.
3. Important insights into existential problems and the meaning of life.
4. Transformation of one’s “life value system.”
5. A change of view of one’s self and the world around.
6. Insight into life and death.
7. A rise of creative energies.
8. Broadening of spiritual horizons.
9. Harmonization of a person’s relationships with the world and with other people.

In 1991, another Soviet psychiatrist, Igor Kungurtsev MD, who had initially worked with Krupitsky and later immigrated to the United States, published a summary of his own experiences treating alcoholism with ketamine.

Although, like Krupitsky, he initially felt that ketamine simply made alcohol aversive in a purely behavioral way, he radically changed his approach following a series of ketamine self-administrations and instead It is gratifying to see that NIMH is following MAPS’ lead in supporting the treatment of psychiatric disorders with psychedelic drugs adopted a transpersonal model for therapy in order to better utilize the profound mystical experiences induced by ketamine. He found that successful treatment of alcoholism with ketamine was correlated with a changed spiritual outlook in the same way that 12-step programs also achieve success by changing addicts’ spiritual outlook, albeit in a non-psychedelic manner.

There are also suggestions that ketamine might be useful in the treatment of heroin withdrawal. In one recent study, 58 opiate-dependent patients were given “ultra-rapid detox” under general anaesthesia with either ketamine or placebo saline infusion. The ketamine group had noticeably better control of withdrawal symptoms, although there was no difference in abstinence between the two groups four months later.

Another study found that one ketamine-assisted psychotherapy session was significantly more effective than active placebo in promoting abstinence. In this study of the efficacy of single versus repeated sessions of ketamine-assisted psychotherapy in promoting abstinence in people with heroin dependence, 59 detoxified inpatients with heroin dependence received a ketamine-assisted psychotherapy (KPT) session prior to their discharge from an addiction treatment hospital, and were then randomized into two treatment groups.

Participants in the first group received two addiction counseling sessions followed by two KPT sessions, with sessions scheduled on a monthly interval (multiple KPT group). Participants in the second group received two addiction counseling sessions on a monthly interval, but no additional ketamine therapy sessions (single KPT group). At one-year follow-up, survival analysis demonstrated a significantly higher rate of abstinence in the multiple KPT group.

Thirteen out of 26 subjects (50 percent) in the multiple KPT group remained abstinent, compared to 6 out of 27 subjects (22 percent) in the single KPT group. No differences between groups were found in depression, anxiety, craving for heroin, or their understanding of the meaning of their lives. It was concluded that three sessions of ketamine-assisted psychotherapy are more effective than a single session for the treatment of heroin addiction.


A big thank you to @sdxyln for the headsup on this article!
 
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MDMA a promising treatment for alcoholism*

by Rich Haridy | NEW ATLAS | 21 Feb 2021

A new study published in the Journal of Psychopharmacology is reporting on a landmark clinical trial exploring the potential for MDMA-assisted psychotherapy in treating subjects with alcohol use disorder. The small open-label trial is the first to test MDMA therapy as a treatment for addiction and the results suggest it is safe, well-tolerated and significantly more effective than any current treatment for alcoholism.

MDMA, was originally synthesized in Germany in 1912 but spent much of the 20th century as an unexplored footnote in chemistry journals. The drug was rediscovered by psychonauts in the 1960s, and psychotherapists quietly explored its therapeutic potential before its use spiraled into recreational circles, eventually becoming illegal in the early 1980s.

Over the past few decades, a small community of dedicated researchers has worked to legitimize the drug and re-establish its medical uses. Leading the way has been robust work showing the drug to be significantly effective treating PTSD. Now deep in Phase 3 clinical trials, MDMA-assisted psychotherapy for PTSD is just a year or two away from market approval in the United States.

For the last few years psychiatrist Ben Sessa and a team of UK researchers have been exploring the role of MDMA therapy in treating alcohol use disorder (AUD). In a newly published study the researchers report on the world’s first trial testing the novel treatment on patients suffering from addiction.

This small, proof-of-concept study recruited 14 subjects with AUD. The goal of this preliminary study was to establish a safety profile for the MDMA therapy in patients suffering from AUD, but an expansive nine-month follow-up period also allowed for a unique insight into the possible long-term efficacy of the treatment.

The trial used a protocol similar to that being explored by MDMA for PTSD research. The course of treatment spans eight weeks and comprises 10 psychotherapy sessions. Two of those sessions involve day-long MDMA treatments, while the other sessions are more traditional one-hour psychotherapy appointments.

In regards to tolerability and safety, the study reports no adverse responses to the drug were detected either during a treatment session or in the days following. In a fascinating side note, the study followed each subject’s acute mood state for seven days after each MDMA session.

Recreational MDMA users have for years frequently reported negative mood swings around two to three days after using the drug. Anecdotally referred to as "Terrible Tuesdays," pseudoscientific explanations have often suggested some kind of serotonin depletion can take hold in the days following MDMA use, causing a unique kind of depressive hangover.

The new research specifically addresses this anecdotal phenomenon and suggests when MDMA is delivered through a clinical therapeutic program this anecdotal post-drug hangover is not detected. Sessa hypothesizes this common recreational observation is more due to polydrug use and other confounding factors instead of the MDMA itself.

“No come-downs or post-drug affect drops for 7-days post MDMA,” Sessa notes on Twitter. “Blue Monday/Black Tuesday/so-called ‘Suicide Wednesday’ reported by ravers are myths due to confounding hangover factors; not MDMA.”

Although the primary goal of the trial was to understand safety issues with the MDMA therapy in AUD patients, the extensive follow-up period allowed for some compelling insights into how long-term drinking behaviors were affected.

Nine months after the trial only 21 percent of the cohort were drinking more than 14 units of alcohol per week. This compares to an average of 130 units of alcohol consumed per week by each patient before detox at the beginning of the study.

As this was not a placebo-controlled trial, the researchers did conduct a small adjacent study to look at how MDMA therapy compares to current gold-standard treatments for AUD.

Fourteen subjects were recruited and tracked for nine months following detox for this adjacent outcome study. A striking 75 percent were consuming more than 14 units of alcohol per week at the nine-month follow-up point. This data resembles the generally poor long-term outcomes for current AUD treatments, which register drinking relapse rates at around 60 percent one year after treatment and 80 percent three years later.

It is important to note this is still very preliminary research. A larger Phase 2b placebo-controlled trial run by burgeoning psychedelic biotech company Awakn Life Sciences is getting underway in the United Kingdom to more comprehensively explore the efficacy of MDMA therapy for AUD. Sessa, chief medical officer for Awakn, suggests this stage should take around three years.

In the meantime, prospective clinics around the world are preparing for MDMA/PTSD treatments to be approved, establishing the infrastructure necessary to administer multiple forms of psychedelic therapies for a variety of conditions, including psilocybin for depression. MDMA therapy for alcoholism may still be a few years away from clear clinical validation, but this proof-of-concept trial is as strong a first study as one could hope for.

*From the article here :
 
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Single Ketamine dose could help treat problematic drinking behavior*

by Shane O'Connor, MS | Psychedelic Science Review | 20 Jan 2020

New research suggests that ketamine can aid in reorganizing alcohol-related memories.

Ketamine has a long and varied history of medicinal use. Initially administered as an anesthetic, the compound also demonstrates therapeutic benefits in conditions such as treatment-resistant depression and substance use disorders, such as the overconsumption of alcohol. A recent study conducted at University College London provides an insight into how ketamine produces a rapid reduction in the reinforcing and motivational qualities of alcohol.​

The molecule and its effects

Ketamine is an antagonist (i.e., blocker) of the NMDA (N-methyl-D-aspartate) receptor in neurons. Typically, the brain’s primary excitatory neurotransmitter, glutamate, binds to the NMDA receptor. However, when ketamine blocks the receptor, glutamate can’t bind to it. This blocking results in the decrease in action potential conduction velocity. An action potential is a physiological process that facilitates the transmission of signals in neurons.

Conversely, traditional serotonergic psychedelics (mescaline, psilocybin, LSD) exert their psychedelic effects through their agonist or partial agonist activity at the serotonin 5-HT2A receptor. So when studied at a cellular/receptor level, ketamine does not resemble a psychedelic compound. However, ketamine may be viewed as a psychedelic in terms of subjective experiences associated with the drug.

Ketamine causes feelings of dissociation, also called an out-of-body experience. The dissociative quality of ketamine has led to its use as a recreational drug, often referred to as “special K.”​

Malleable memories

The University College study revolves around the concept that addiction, to some degree, is a memory disorder. Individuals learn to associate drugs or alcohol with the positive feelings they bring. Specific external cues, such as the smell or picture of a beer, can trigger those memories — and cravings. Such triggers lead to an expectation of drug reward. The encoding of connections between drug/alcohol-related cues and reward are termed maladaptive reward memories (MRM).

Previously, MRMs were thought to become long-lasting once stabilized- or consolidated – into long-term memory storage, promoting relapse even long periods of drug/alcohol abstinence. However, recent insights into the malleability of long-term memories may facilitate the rewriting of maladaptive memories. Reconsolidation involves the temporary reactivation and destabilization of long-term memories, in order to incorporate new information. Ketamine’s primary target, the NMDA receptor, is involved in the reconsolidation of memories.

By using ketamine to interfere with memory reconsolidation, it is theoretically possible to selectively target and weaken memories. The brief reconsolidation window of memory instability proposes a novel mechanism to rewrite MRMs, hopefully leading to fewer instances of relapse.

Study coauthor Ravi Das told sciencenews.org, “We’re trying to break down those memories to stop that process from happening, and to stop people from relapsing.”​

The study design

Das and his team selected a study group of 90 (55 men, 35 women) beer drinking participants. According to the Alcohol Use Disorders Identification Test (AUDIT), all participants exhibited problematic patterns of drinking. However, none of the participants were formally diagnosed with alcohol use disorder or were seeking treatment.

Participants were first shown images of beer and instructed to drink one in the lab. During the experiment, they rated their cravings for beer and enjoyment of drinking. After drinking the beer, participants reported on their urge to have another one.

When participants returned to the lab a few days later, they were divided into three groups. The first group was again presented pictures of beer to refresh their memories. To heightened memory recall strength, the researchers served the group beer but then withdrew it before participants could drink. The team carried out this maneuver to generate the element of surprise.

In contrast, the second group viewed pictures of orange juice rather than beer. Then participants in both of these groups received an intravenous (IV) dose of ketamine (350 ng/dl). A third group was shown pictures of beer but received no ketamine.

The following week, participants who had their beer memories refreshed before receiving ketamine reported a reduced urge to drink, a reduction that wasn’t as pronounced for the other two groups. Furthermore, the group that had their beer-drinking memories refreshed and received ketamine also reported drinking less.

Researchers also measured blood concentrations of ketamine and its metabolites during the reconsolidation window. This blood marker served as a surrogate for central ketamine availability. If blockade of memory reconsolidation was the process responsible for the observed decreases in drinking, blood ketamine & metabolite levels during the reconsolidation window should predict subsequent drinking in participants that were shown pictures of beer and received ketamine, but not the group that just received ketamine. This is precisely what the group observed. This observation is noteworthy as it represents a possible biomarker for treatment response in a reconsolidation model.

During the pilot studies conducted previous to this experiment, the lab observed that the efficacy of IV ketamine treatment was dose-dependent. Considering that ketamine is relatively safe even at full anesthetic doses, the authors recommended that future studies consider using higher doses of ketamine (up to full anesthesia). Higher doses would maximize NMDAR occupancy and memory interference.

Interestingly, nine months after the experiment, all participants cut their beer consumption approximately in half. This includes the group that received no ketamine. Such an across-the-board reduction may be a result of the shift in self-awareness associated with participating in a study. However, the important take away finding from this study is the initial drop in drinking amongst people who received ketamine while reminded of beer.​

Future perspectives for ketamine

The therapeutic repertoire of ketamine is ever-expanding. However, misuse of the drug also leads to adverse effects such as delirium and confusion. Moving forward, clinicians and scientists much weigh the costs-benefit when prescribing treatment with abuse potential such as ketamine. Preliminary studies such as the one described in this article demonstrate that even a single-dose administration of ketamine can reduce drinking behavior, limiting the potential for abuse and dependency. Furthermore, this paradigm of memory interference could extend to conditions such as Post-Traumatic Stress Disorder (PTSD).

*From the article here :
 
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Psychedelics may hold considerable potential for treating alcoholism, study*

by Eric Dolan | PsyPost | 21 Jun 2019

The use of psychedelic drugs may lead to reductions in problematic alcohol use, according to preliminary research published in the Journal of Psychopharmacology.

“Psychedelics appear to have the ability to induce a behavioral and mental plasticity, which is a way of saying they can serve as profound behavior change agents when applied in the right settings and framework,”
said study author Matthew W. Johnson (@Drug_Researcher), an associate professor at Johns Hopkins University School of Medicine.

“They have potential to treat addictions, broadly defined. This is informed by early research with LSD as well as with reports regarding sacramental use of psychedelics by indigenous cultures and syncretic religions. Now the current study suggests that such anti-addictive effects for alcohol might be at play in the general population.”

Through online advertisements, the researchers recruited 343 individuals who had used a classic psychedelic drugs. The advertisements specifically sought participants who had “overcome alcohol or drug addiction after using psychedelics.”

The participants completed a survey that included several measures to assess their past alcohol use and misuse. The survey also collected demographic information and data about the psychedelic experience to which they attributed their alcohol use cessation or reduction.

The researchers found that most of the participants met the criteria for severe alcohol use disorder in the year prior to their psychedelic experience, but a large majority no longer met the criteria after the experience.

Most of the participants said the psychedelic experience in question was the result of a moderate or high dose of either LSD or psilocybin.

Eight out of 10 participants rated the psychedelic experience among the 10 most personally meaningful experiences of their life, while about 4 in 10 rated it among the 10 most psychologically challenging experiences.

The researchers also found that participants who reported more mystical-type effects and a greater overall intensity during their psychedelic experience tended to report bigger changes in their alcohol use.

“Public funding should be made available for conducting rigorous trials examining psychedelics in the treatment of addiction. Thus far, no NIH funding has been devoted to therapeutic human studies with psychedelics, despite a decades-long safety record and signs of promising effects,” Johnson told PsyPost.

"The findings indicate that these substances hold considerable potential for the treatment of alcohol use disorder," the researchers wrote in their study.

But like all research, the study includes some limitations. For instance, the sample was likely supportive of psychedelic use in general and the results could be affected by recall bias.

“There are very real risks to psychedelics, but these can be squarely mitigated with well established safety procedures in clinical research. The major questions left are whether results hold up in much larger controlled studies, but those take a lot of money and time to conduct,” Johnson noted.

“This research should not encourage folks to try this at home. There are risks to these compounds.”

The study, “Cessation and reduction in alcohol consumption and misuse after psychedelic use“, was authored by Albert Garcia-Romeu, Alan K. Davis, Fire Erowid, Earth Erowid, Roland R Griffiths and Matthew W. Johnson.

*From the article here :
 
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MDMA-assisted therapy for alcohol addiction

by Ben Malcolm | Spirit Pharmacist | 28 Apr 2021

Alcohol Use Disorders (AUD) are the most common type of substance use disorders in the world. Beyond its sedative, euphoric, reinforcing, and short-lived effects, alcohol enjoys wide availability, social acceptance, and low cost, all of which may contribute to the global prevalence of AUD. In 2018, 14.5 million Americans had AUD and over a quarter of adults binge drank (NIAAA). Each year, approximately 95,000 people in the US die due to alcohol-related causes, making it the third-leading preventable cause of death. Treatment rates for AUD are abysmal, with around 7.3% of persons with AUD receiving treatment and less than 4% taking a medication for AUD. Current prescription options (naltrexone, acamprosate, disulfiram) for the treatment of AUD may have limited efficacy (acamprosate) and require abstinence from alcohol to avoid adverse effects (disulfiram) or chronic use for benefits (naltrexone). Unfortunately, current psychological and pharmaceutical regimes to treat alcohol addiction have poor long-term outcomes with high rates of relapse.

Classic psychedelics vs. MDMA in alcohol addiction

There is reasonable amounts of evidence from clinical trials suggesting that classic tryptamine psychedelic therapies with Lysergic Acid Diethylamide (LSD) and psilocybin are effective in the treatment of AUD (Krebs 2012, Bogenschutz 2015). Classic psychedelics have historically been known as ‘hallucinogens’ and may carry risks of adverse psychological effects associated with perceptual disturbances. MDMA is not a classic psychedelic and more aptly be termed an ‘enactogen’ than a psychedelic. These differences in effects could offer advantages in psychological safety as MDMA tends to produce an expansive and open emotional response, repression in fear or defense response mechanisms, mood enhancement, and reduction in anxiety - without producing significant perceptual disturbances. On the other hand, classic psychedelics are not known to be addictive substances or produce withdrawal syndromes and have low levels of physical risks, whereas MDMA is a stimulant amphetamine that has been associated with stimulant use disorders and short- and long-term adverse outcomes in non-clinical settings. Recently, clinical trials of MDMA-assisted psychotherapy for PTSD have shown significant improvement in patients’ symptoms and functioning (Mithoefer 2019). Since AUD and mental illnesses like PTSD are frequently associated, researchers are gaining interest into testing the effects of MDMA assisted therapy on AUD.

MDMA-assisted therapy for alcohol addiction

An initial pilot study based on a sample size of 14 participants between the ages of 18-65 years old who had met the criteria for moderate to severe AUD was recently completed in the UK. Over an eight-week course of recovery-based psychotherapy, participants received a total of 10 psychotherapy sessions. Participants were given MDMA in two of the sessions, which lasted six to eight hours each. Participants received an initial dose of 125 mg followed two hours later by a booster dose of 62.5 mg to prolong the effects of MDMA. The other eight sessions consisted of one-hour psychotherapy sessions.

The main goal of the study was to assess if MDMA-assisted psychotherapy can be delivered safely and be tolerated by patients with alcohol addiction post-detoxification. Researchers then followed up with the participants for nine-months to assess how their drinking behavior, mental wellbeing, quality of life and psychosocial functioning changed over time following MDMA therapy. The findings led researchers to gain insight into the potential long-term benefits of MDMA therapy for AUD.

The study reported no adverse responses to the MDMA treatment, and the treatment was well-tolerated by all participants. Participants also showed a significant decrease in alcohol intake nine months after treatment since the beginning of the study. Prior to detoxification, participants were drinking the equivalent of 62 standard glasses of wine per week. By the end of the trial, participants consumed an average of about 9 standard glasses of wine per week.

Come down or afterglow? Post-use effects of MDMA

Despite the infamous ‘come down’ related to neurotoxic effects reported by recreational ecstasy users characterized by irritability and depressive thoughts and behaviors, this was not observed in the study with AUD (Sessa et. Al 2019). The mood states of the participants in this trial were monitored daily for seven days following each MDMA session. Not only did participants experience no mood disturbances, all 14 participants actually sustained a positive mood. Across the board, participants experienced an overall reduction in their anxiety and depression throughout the duration of the study. This could be due to an ‘afterglow’ effect of MDMA assisted therapy or perhaps due to recent detoxification and successful reductions in alcohol use, which could conceivably also make participants feel much better in mind and body. For example, participants in clinical trials of MDMA-assisted therapy for PTSD did notice some side effects in the week after MDMA sessions (Mithoefer 2019).

Considerations for use of MDMA in persons with Alcohol Use Disorder

Persons included in the study had recently and successfully detoxified from alcohol prior to initiation of MDMA-assisted therapy. There are serious medical risks to abrupt discontinuation of alcohol in severely dependent users and MDMA could conceivably increase risks of seizures related to alcohol withdrawal syndromes, thus may not be appropriate for use during or for withdrawal. Persons with AUD may have medical complications such as liver cirrhosis that impairs the body's ability to metabolize MDMA or cardiovascular illnesses that increase risks associated with use. Persons with these illnesses were excluded from study participation.

Is MDMA addictive? Could it trigger a relapse?

There may be concern to considering use of MDMA for treatment of substance use disorders given it does have some reinforcing and addictive potential itself. MDMA works on the same reward systems in the brain that other addictive substances target and addiction to ‘ecstasy’ has been reported. However, due to the serotonin releasing properties and relatively weak effects on dopamine, there is likely less addictive potential to MDMA than amphetamine. Having some addiction potential in unsupervised settings could be considered a limitation of MDMA relative to classic psychedelics when considering treatment of substance use disorders. The risks of becoming addicted to MDMA from use in supervised clinical settings appears low and trials to date have not published any reports of addiction occurring. Similarly, use of other ‘club drugs’ like ketamine have positive evidence for ability to treat cocaine use disorders when used within the context of addiction recovery programs (Dakwar 2019). In sum, the physiological effects of MDMA are quite different than alcohol and despite being an amphetamine, its serotonergic nature and use within a therapeutic context helps alleviate concerns of MDMA addiction or relapse to alcohol from MDMA-assisted therapy.

Could MDMA-assisted therapy be a lifesaver?

Evidence from this pilot study suggests the volume of alcohol consumed in individuals with AUD decreases significantly after two sessions of MDMA-assisted therapy. It expands our knowledge of what MDMA-assisted therapy is capable of and encourages further exploration of ‘enactogens’ like MDMA alongside classic psychedelics like psilocybin and LSD for alcohol use disorders.

 
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The treatment has helped Grant, 53, stop drinking after years of struggle.

How Ketamine helped me kick my alcohol addiction

A new clinic believes that using psychedelic substances to aid psychotherapy can give hope to patients looking to change their lives

by Sharon Walker | The Telegraph | 15 March 2021

Psychedelic-assisted psychotherapy could transform the treatment of chronic mental health issues, offering new hope to patients suffering from the repercussions of childhood trauma or neglect, according to the leading psychiatrist behind a new mental health clinic which opens today.

The private Bristol clinic, run by Awakn Life Sciences, will offer ketamine-assisted psychotherapy for addiction and other mental health issues such as depression and anxiety.

“Many people are failed by the current treatments, especially when it comes to addictions,” says Dr Ben Sessa, psychiatrist and chief medical officer at Awakn.

“We have too many patients who are treatment-resistant and they remain with us (in and out of treatment) for life because there’s to much dependence on the biological model and SSRIs in psychiatry,” says Dr Sessa.

“What we’re offering with drug-assisted psychotherapy is hope, and often the chance to really tackle the rigid stuckness that many patients experience which is so often due to early trauma. When a child has been through this it sets up a blueprint for life and it’s very hard to treat because patients who have been traumatised become absolute experts at avoiding those memories. In ketamine-assisted therapy, we can help the patient get to the root cause of their problem and help them reflect and challenge those issues and move on. It’s going to be used in a number of applications but what underlies all of them is trauma.”

Though it is often branded as a horse tranquilliser, ketamine is far more commonly used in human medicine than in veterinary surgery. “It is the tranquilliser of choice when you don’t know a person’s medical history because it’s so safe,” says Dr Sessa. “As an anaesthetic it knocks the patient out but, 10 or 15 years ago, it was discovered that if you give a low dose that gives an altered state of consciousness and that’s how we are going to be using it in treatments.”

Although ketamine has been used by a small number of doctors to treat depression, this will be the first clinic to combine ketamine with psychotherapy.

Ketamine is also known as a party drug, popular at festivals for its euphoric trance-like effects, though more intense doses can lead to users falling into the “k-hole” with little control of their bodies and habitual long-term abuse has been linked with bladder issues. "Illegal street ketamine is often contaminated and bears little resemblance to the medical-grade ketamine used in therapy," says Dr Sessa.

The first clinical trial into ketamine-assisted psychotherapy, funded by the Medical Research Council, which is under review for publication, would seem to confirm that ketamine-assisted therapy could offer hope to those suffering from entrenched alcohol dependence.

While 75 per cent of patients who undergo alcohol detox generally relapse within a year, a randomised controlled trial of 96 patients with alcohol misuse disorder found that ketamine-assisted psychotherapy was associated with a 50 per cent reduction in relapse at six months, as well as a greater reduction in drinking compared to trial participants who received ketamine alone.

“Though there’s been lots of research on ketamine as an antidepressant, we were missing a trick by not harnessing the ‘ketamine experience,’” explains Prof Celia Morgan, who conducted the research. “How we think it works is by kickstarting the process of growing connections in your brain. In the hours and days following ketamine, we see an explosion of growth in the synapses between neurones in the prefrontal cortex. This manifests psychologically in a sense of awe and wonder. This is what we see in patients given ketamine; they’re much more awake and excited by life. This means that patients start therapy with the right mindset to make therapy most effective. We can give a few isolated doses of the drug but produce long-term change.”

Grant, 53, an events organiser from Glastonbury, was one of the patients randomly assigned to the ketamine-assisted psychotherapy group in the summer of 2019.

“I’d always been a fairly normal party drinker but, after my divorce five years ago, it escalated,” says Grant. “I was binge drinking two bottles of wine a night. Then getting up and doing a 16-mile run to try to offset the effects. But I was still putting on weight and not feeling great. It got to the point where I’d pour the booze down the sink, but then go out and buy some more.”

In the summer of 2018 Grant managed to give up alcohol for three months, but as soon as he drank again he was back to square one. “It was like a piece of elastic,” he says, “I just snapped straight back to it. I was desperate to be that person who can have a glass of wine with a meal, but that just isn’t me. I’m not that person.”

Grant experienced seven sessions of cognitive behaviour therapy, three of which were accompanied by ketamine infusions, over three weeks. “It’s been absolutely life-changing,” he says. “The ketamine was such a profound experience. It was as if my ego dropped away and I felt I was able to access a part of my unconscious where I hadn’t gone before. The therapy allowed me to look at issues from my youth. I wasn’t abused, but I had some issues that were damaging my relationships. I just came away thinking, ‘You’ve got to look after yourself,’ and haven’t drunk since. I don’t even think about it. There’s none of that nagging temptation. It’s given me a path back to how I was before I started drinking,“ he says. Grant has been sober for two years.

While ketamine is currently the only psychedelic drug that can legally be used in therapy, Awakn are researching the use of other psychedelics, such as MDMA-assisted therapy, which also reduced alcohol dependence.

Although currently only available privately, at the cost of £6000 for a nine week course of 11 therapy sessions, including four ketamine infusions, Dr Sessa hopes that psychedelic-assisted psychotherapy will eventually become available on the NHS and through private medical insurance.

 
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