Psychedelics as Medicines for Substance Abuse Rehabilitation : Evaluating Treatments with LSD, Peyote, Ibogaine and Ayahuasca

Michael Winkelman

Current Drug Abuse Reviews, 2014, 7, 101-116

 

Abstract :

Substances known as psychedelics, hallucinogens and entheogens have been employed in ethnomedical traditions for thousands of years, but after promising uses in the 1950’s and 1960’s they were largely prohibited in medical treatment and human research starting in the 1970’s as part of the fallout from the war on drugs. Nonetheless, there are a number of studies which suggest that these substances have potential applications in the treatment of addictions. While these substances are generally classified as Schedule I, alleging no established medical uses and a high drug abuse potential, there is nonetheless evidence indicating they might be safe and effective tools for short term interventions in addictions treatment. Evidence suggests that the psychedelics have a much greater safety profile than the major addictive drugs, having extremely low levels of mortality, and producing little if any physical dependence. This paper reviews studies evaluating the use of LSD, peyote, ibogaine and ayahuasca in the treatment of dependencies and the possible mechanisms underlying the indications of effectiveness. Evidence suggests that these substances help assist recovery from drug dependency through a variety of therapeutic mechanisms, including a notable “after-glow” effect that in part reflects their action on the serotonin neurotransmitter system. Serotonin has been long recognized as central to the psychedelics’ well-known phenomenological, physical, emotional and cognitive dynamics. These serotonin-based dynamics are directly relevant to treatment of addiction because of depressed serotonin levels found in addict populations, as well as the role of serotonin as a neuromodulators affecting many other neurotransmitter systems.

Keywords : Ayahuasca, entheogens, hallucinogens, ibogaine, LSD, peyote, psychedelics, psychointegrator.

 

INTRODUCTION

The substances known as psychedelics, hallucinogens, entheogens, psychointegrators and sacred medicines have been employed in ethnopharmacologies for thousands of years [1, 2]. While there was a brief renaissance of their use in psychiatry in the 1950’s and 1960’s, these substances have been largely excluded from human research and treatment since their broad international prohibition in the 1970’s. Nonetheless, there has emerged significant evidence that a number of these substances have important applications in the treatment of a variety of conditions, including addictions (see [3], Vol. 2 for review articles).

While it might seem somewhat incongruous to treat addicts with substances which are generally classified as Schedule I substances (alleging no medical uses and a high drug abuse potential), there are nonetheless many forms of evidence that suggest they are both reasonable and effective treatment for many conditions. First, the psychedelics have a much greater safety profile than the other major drugs, legal and illegal [4]. Even if we include the vast range of illicit use there is very little mortality associated with their use. Perhaps the greatest risk from the use of the psychedelics is from people thinking they can fly from the upper stories of buildings while under the influence [5]. Furthermore, the psychedelics produce little if any physical dependence [6]. And in contrast to the idea that these drugs might provoke additional addictive behaviors among susceptible populations, there is evidence that they reduce substance abuse, an “after-glow” effect that often appears to allow addicts to easily remain drug free for a period of several weeks to months after administration of psychedelics.

This afterglow effect appears to reflect action on the serotonin neurotransmitter system, which constitutes another significant reason for their use in addictions treatment. Since the 1960s the principal effects of the psychedelics have been recognized as derived from their effects on the serotonergic neurotransmitter system (see 7-10 for reviews). While psychedelics activate other neurotransmitter systems, it is the effects on serotonin neurotransmission that underlie psychedelics’ well-known phenomenological, physical, emotional and cognitive dynamics. These serotonin-based dynamics are directly relevant to treatment of addiction because of depressed serotonin levels found in addict populations, as well as the role of serotonin as a neuromodulators affecting many other neurotransmitter
systems.

A variety of forms of evidence indicate the possible effectiveness of psychedelics such as LSD, peyote, ibogaine and ayahuasca in the treatment of substance abuse. These four substances appear to constitute the bulk of the research on the use of psychedelics in addictions treatment, although there are some indications that psilocybin and ketamine also have useful applications 1 . This paper first reviews the evidence regarding their effects when used as drug abuse treatment strategies, followed by consideration of the possible mechanisms through which therapeutic effects might be achieved. This is followed by an assessment of the support for their use as treatments according to the phases of evaluation typically used by the Food and Drug Administration (FDA) of the United States government to evaluate novel remedies.

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