LSD: An uncommon treatment for a common problem

Many people, very possibly including you, associate psychedelics with the hippie counterculture of the 1960s in the United States. LSD, or “acid,” is one such psychedelic that began to be widely used during this decade, and was subsequently banned and listed as a Schedule 1 substance by the U.S., meaning it is considered to have a high abuse risk and no safe, accepted  medical use (Belouin & Henningfield, 2018). LSD likely gained this negative reputation due to the dissolution of society and challenge to authority that it appeared to cause. In a recent book on the science of psychedelics, Michael Pollan notes that during the 1960s, when psychedelic use was increasing in popularity, tens of thousands of American students began dropping out of school, and young men were refusing to go to war. People were also being admitted to hospitals for so-called “LSD-induced psychoses,” causing panic (Pollan). Essentially, LSD use seemed to be undermining authority, disrupting societal norms, and leading to the spread of misinformation about the dangers of the drug. Unsurprisingly, this trend was not received well in the United States, and LSD quickly became a very stigmatized substance.

Despite this widespread stigma and disapproval by the government, LSD was not always perceived in this way. In fact, after its discovery, researchers began experimenting with it to determine its potential for therapeutic use. A particularly popular therapeutic use of the psychedelic in Canada and the U.S. was in the treatment of alcoholism, and even the founder of  Alcoholics Anonymous, Bill Wilson, supported its use, and (unsuccessfully) attempted to bring LSD therapy into the A.A. treatment program (Pollan). The therapeutic use of LSD and other psychedelics all but disappeared after the counterculture era of the ‘60s, but how warranted was the banning of these substances? Was there really enough scientific evidence to justify the disposal of a treatment that had the potential to help so many people?

I completely understand if you’re skeptical about the therapeutic potential of a hallucinogen, but let’s take a deeper look before you decide.

The first questions you might be asking are, how prevalent of an issue is alcoholism really, and  aren’t there already treatments for it? Why would we need to introduce an alternative treatment, especially one that is so stigmatized and currently illegal? 

In response to the first question, 14.5 million Americans ages twelve and older had alcohol use disorder, or AUD, as of 2019 (NIAAA). Sadly, over 400,000 of these individuals are under the age of 18, and only about 7.2 percent of everyone over age 12 with AUD received any form of treatment for it in the year prior. The disorder also has serious consequences, on personal, societal, and financial levels. Alcohol is the third-leading preventable cause of death in the United States, killing around 95,000 Americans each year (NIAAA). Alcohol misuse is also a significant risk factor for a variety of health issues, ranging from liver disease and stroke to sleep disorders and various cancers. Beyond the sickness and death that AUD causes, it costs the United States an estimated $249 billion annually. 

So, alcoholism is clearly a prevalent issue in our society, but aren’t the currently available treatments enough to curb the problem?

I would argue that this question is up for serious debate. First off, in 2019, less than four percent of people diagnosed with AUD were prescribed an FDA-approved medication to treat it (NIAAA). Furthermore, there are currently only three medications that have been approved by the FDA as treatments for alcoholism, and they can have very unpleasant side effects (Verywell Mind). To be fair, naltrexone, one of these three medications, has been shown to be relatively effective; outcomes for individuals treated with naltrexone are 12-19% better than those treated with a placebo (Kranzler & Kirk, 2001), and patients who receive naltrexone, behavioral therapy, or both show a substantial reduction in drinking after treatment (Anton et al., 2006). However, the AUD medication acamprosate does not appear to be effective, with or without behavioral therapy (Anton et al., 2006), and other barriers to using medication for AUD treatment, such as reluctance to take medications, side effects, medication cost, and concern over medication addiction, are common (Mark et al., 2003). Somewhat encouragingly, intensive outpatient rehabilitation programs help 64% of patients achieve and maintain abstinence from alcohol at a 6-month follow-up post-treatment (Bottlender & Soyka, 2005), but the same barriers, and cost in particular, still apply to this form of treatment. 

This brings us to the question of why LSD might be promising alternative AUD treatment.

To first ease any concerns, despite the common worry about the dangers of using LSD, in actuality it has shown “no evidence of serious prolonged physical side effects” (Pollan). As for treatment for alcoholism using LSD, even though research on the topic decreased after the drug was declared a Schedule 1 substance, enough evidence exists to suggest that LSD is, in fact, an  effective treatment. A series of randomized trials showed that LSD treatment for alcoholism had significant benefits up to 6 months after treatment, and maintained abstinence 3 months after treatment (Krebs & Johansen, 2012). Additionally, 59% of LSD-treated patients compared to 38% of control patients show reliable improvement in drinking behavior at both 1-2 months and 6 months post-treatment (Morgan et al., 2017). In both of these cases, improvement in alcohol misuse was no longer significant at 12 months post-treatment, but LSD treatment had a significant beneficial effect in the short- and medium-term. Furthermore, self-reports by people with AUD who took moderate or high doses of LSD revealed that 83% of the participants no longer met criteria for AUD after their psychedelic experience (Garcia-Romeu et al., 2019). 

So… what does this all mean?

From what we know so far, LSD appears to be an effective treatment for alcoholism, albeit in the short-term. Yes, much more research is necessary, but psychedelic therapy has the potential to help treat an unfortunately common disorder, and should not be pushed by the wayside without consideration. So I urge you to keep an open mind, and consider the words of the founder of Alcoholics Anonymous: “I consider LSD to be of some value to some people, and practically no damage to anyone.”

References

Anton, R. F., O’Malley, S. S., Ciraulo, D. A., Cisler, R. A., Couper, D., Donovan, D. M., … COMBINE Study Research Group, for the. (2006). Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence. JAMA, 295(17), 2003. https://doi.org/10.1001/jama.295.17.2003

Belouin, S. J., & Henningfield, J. E. (2018). Psychedelics: Where we are now, why we got here, what we must do. Neuropharmacology, 142, 7–19. https://doi.org/10.1016/j.neuropharm.2018.02.018

Bottlender, M., & Soyka, M. (2005). Efficacy of an Intensive Outpatient Rehabilitation Program in Alcoholism: Predictors of Outcome 6 Months after Treatment. European Addiction Research, 11(3), 132–137. https://doi.org/10.1159/000085548

Garcia-Romeu, A., Davis, A. K., Erowid, F., Erowid, E., Griffiths, R. R., & Johnson, M. W. (2019). Cessation and reduction in alcohol consumption and misuse after psychedelic use. Journal of Psychopharmacology, 33(9), 1088–1101. https://doi.org/10.1177/0269881119845793

Kranzler, H. R., & Kirk, J. (2001). Efficacy of Naltrexone and Acamprosate for Alcoholism Treatment: A Meta-Analysis. Alcoholism: Clinical and Experimental Research, 25(9), 1335–1341. https://doi.org/10.1111/j.1530-0277.2001.tb02356.x

Krebs, T. S., & Johansen, P.-Ø. (2012). Lysergic acid diethylamide (LSD) for alcoholism: meta-analysis of randomized controlled trials. Journal of Psychopharmacology, 26(7), 994–1002. https://doi.org/10.1177/0269881112439253

Mark, T. L., Kranzler, H. R., Poole, V. H., Hagen, C. A., McLeod, C., & Crosse, S. (2003). Barriers to the Use of Medications to Treat Alcoholism. The American Journal on Addictions, 12(4), 281–294. https://doi.org/10.1111/j.1521-0391.2003.tb00543.x

Morgan, C., McAndrew, A., Stevens, T., Nutt, D., & Lawn, W. (2017). Tripping up addiction: the use of psychedelic drugs in the treatment of problematic drug and alcohol use. Current Opinion in Behavioral Sciences, 13, 71–76. https://doi.org/10.1016/j.cobeha.2016.10.009

Pollan, M. (2019). How to change your mind: the new science of psychedelics. Penguin Books.

T, B. (2021, February 18). Can a Prescription Help in Your Alcoholism Treatment? Verywell Mind. https://www.verywellmind.com/medications-for-alcoholism-67514.

U.S. Department of Health and Human Services. (n.d.). Alcohol Facts and Statistics. National Institute on Alcohol Abuse and Alcoholism. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics.  

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