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Psychedelics vs. Traditional Treatments —How Do They Stack Up for Mental Health Disorders? – Part 1

November 10, 2024 / Depressive Disorders, LSD, MDMA, Mushrooms / Psilocybin, Psychiatry & Medicine / By

The treatment landscape for mental health conditions has evolved significantly over the past decades, with selective serotonin reuptake inhibitors (SSRIs), benzodiazepines, and cognitive-behavioral therapy (CBT) being the primary therapeutic interventions. While these conventional approaches have demonstrated considerable efficacy and improved countless lives, clinical data indicates that a substantial portion of patients exhibit treatment resistance or experience relapse over time. 

This therapeutic gap has prompted researchers to investigate novel approaches, leading to renewed scientific interest in psychedelic-assisted therapy (PAT). The potential therapeutic applications of classical psychedelics such as psilocybin and LSD, as well as entactogens like MDMA, have garnered attention in contemporary psychiatric research. As clinical trials advance and mechanistic studies deepen our understanding of these compounds, the field moves forward in balancing hope with caution.

This review examines the distinct mechanisms, therapeutic potentials, and limitations of both conventional and psychedelic-assisted treatments, providing a comprehensive analysis of their roles in modern psychiatric care.

Psychedelic-Assisted Therapy vs traditional treatments – In a nutshell

Traditional Treatments Psychedelic-Assisted Therapy (PAT)
Primary Approaches SSRIs, benzodiazepines, cognitive-behavioral therapy (CBT) Psilocybin, LSD, MDMA, often combined with psychological support
Mechanism of Action Targets neurotransmitter systems (e.g., serotonin for SSRIs, GABA for benzodiazepines) Primarily acts on serotonin 5-HT2A receptors; impacts the default mode network (DMN)
Duration of Treatment Long-term, often months to years Short-term, typically involves 2-3 sessions over a few months
Therapeutic Effects Effective for symptom management, but may not address underlying trauma Facilitates neuroplasticity, may lead to psychological breakthroughs and sustained improvements
Side Effects Physical and emotional side effects (e.g., nausea, insomnia); potential dependency risks for benzodiazepines Low toxicity, but may cause psychological distress; requires controlled settings
Limitations Treatment resistance, relapse risk, and long wait times for psychotherapy Potential for adverse effects in vulnerable individuals, lack of long-term data
Implementation Widely available in healthcare systems, often requires ongoing adherence Requires structured setting and trained facilitators; typically includes preparation and integration phases

Mechanisms of Action: Different Pathways, Different Potentials

Traditional psychiatric interventions and emerging psychedelic therapies operate through distinct neurobiological pathways. Conventional treatments primarily target specific neurotransmitter systems: SSRIs treat depression by blocking serotonin reuptake in the brain, allowing more serotonin to remain active in neural synapses (IQWiG, 2024). Benzodiazepines reduce anxiety by enhancing GABA activity, which decreases overall brain cell excitability (Benzodiazepine Information Coalition, 2022). These pharmacological mechanisms typically require sustained administration to maintain therapeutic effects (Donald et al., 2021). CBT complements these approaches by promoting neuroplasticity through systematic modification of thought patterns and behaviors, leading to structural and functional changes in regions associated with emotional regulation (Nakao et al., 2021).

Psychedelic compounds exert their effects primarily through serotonin 5-HT2A receptor agonism (Vargas et al., 2023). This mechanism induces rapid alterations in neural connectivity and information processing (Smausz et al., 2022). Of particular interest is their impact on the default mode network (DMN), where overactivity correlates with various psychiatric conditions (Chou et al., 2023). Research indicates that psychedelics may temporarily disrupt DMN connectivity, potentially facilitating the formation of novel neural pathways. This neuroplastic effect, combined with the compounds’ ability to enhance emotional processing, provides a neurobiological basis for the acute and sustained therapeutic effects observed in clinical trials (Gattuso et al., 2022).

The distinct mechanisms of action between conventional treatments and psychedelic interventions present both advantages and limitations. Traditional approaches effectively target symptom management but may overlook underlying psychological trauma (IQWiG, 2024). PAT shows potential for deep neurobiological restructuring, yet the intensity of these interventions can be difficult and result in lasting negative effects for some individuals (Evans et al., 2023).

Treatment Protocols: Contrasting Continuous Care with Rapid-Acting Interventions

Building on the neurobiological foundations, treatment duration and efficacy present notable distinctions between conventional and psychedelic-assisted approaches. While traditional pharmacotherapy has proven effective for many individuals, it typically requires extended periods of administration, with patients maintaining antidepressant regimens for months to years (Hu et al., 2024). This prolonged treatment course often accompanies various side effects (NHS, 2021b). Additionally, resource limitations in mental health services frequently result in extended wait times for traditional psychotherapeutic interventions like CBT (PricewaterhouseCoopers, n.d.).

Emerging clinical evidence suggests that PAT may achieve therapeutic outcomes through significantly fewer interventions. Research with psilocybin in major depressive disorder demonstrates that a single 25mg dose, combined with psychological support, can produce substantial and sustained reductions in depressive symptoms (Raison et al., 2023). Similarly, MDMA-assisted therapy for PTSD has shown remarkable efficacy, with over 50% of participants no longer meeting diagnostic criteria after two sessions (van der Kolk et al., 2024). The treatment typically involves 2-3 guided sessions integrated with psychotherapy over several months (Mitchell et al., 2023).

The intensity of psychedelic experiences may pose challenges for some individuals, potentially inducing anxiety or distress, particularly when compared to conventional treatments like SSRIs or talk therapy which typically have more predictable response patterns. While the shorter treatment duration offers an attractive alternative to traditional long-term therapeutic approaches, the long-term implications of PAT require more thorough investigation.

Emotional Breakthroughs and Psychotherapeutic Integration

The therapeutic mechanisms of conventional and psychedelic treatments further diverge in their capacity to facilitate psychological breakthroughs. Psychedelic compounds can induce altered states of consciousness that enable patients to access and process repressed emotional content and trauma (Roseman et al., 2019). These experiences, when conducted in controlled therapeutic environments, often represent critical junctures in the treatment process.

Conventional therapeutic approaches primarily emphasize symptom management and gradual cognitive and behavioral modification (Stein et al., 2022). While traditional psychotherapy facilitates emotional understanding, it rarely produces the acute psychological insights characteristic of psychedelic experiences. MDMA-assisted therapy demonstrates this distinction, with patients reporting to process traumatic memories with reduced emotional activation (Morgan, 2020), potentially achieving therapeutic outcomes that conventional methods find challenging to replicate.

PAT functions not as a standalone treatment but as a catalyst within a comprehensive therapeutic framework (Brennan & Belser, 2022). The process involves three key phases: preparation, the psychedelic experience, and integration therapy (Mitchell et al., 2023). This structured approach, combined with careful consideration of patients’ psychosocial resources and support systems, is essential for optimizing therapeutic outcomes and minimizing risks.

Side Effects and Safety Concerns

Treatment modalities demonstrate distinct safety profiles and contraindications. SSRIs commonly induce physiological and emotional side effects, including nausea, insomnia, and sexual dysfunction (NHS, 2021). Long-term benzodiazepine use presents risks of dependency and cognitive impairment (NHS, 2024). While CBT exhibits minimal adverse effects, accessibility limitations and duration requirements pose practical constraints (NHS, 2022).

Psychedelic compounds demonstrate favorable physiological tolerability, with substances like psilocybin showing low toxicity and minimal addictive potential (National Institute on Drug Abuse, 2024). However, psychological risks emerge particularly in non-controlled settings (Barber et al., 2023). Adverse psychological reactions require careful therapeutic management to maintain safety parameters (Brooks, 2018).

Research indicates specific risk factors in PAT, including potential psychotic episodes in vulnerable individuals (Simonsson et al., 2023). Recent data suggests 16% of participants experience decreased psychological well-being four weeks post-treatment, with elevated rates among those with personality disorder diagnoses (Marrocu et al., 2024). Personality traits, particularly neuroticism, further influence treatment outcomes in both conventional and psychedelic interventions. While high neuroticism correlates with increased acute adverse effects in PAT, these individuals often report enhanced long-term outcomes (Mason et al., 2020). Similarly, conventional treatments consistently demonstrate reduced efficacy in individuals with high neuroticism scores (Mulder, 2011).

Implementation of PAT requires comprehensive screening protocols to identify contraindications and optimize patient selection. Clinical settings provide essential safeguards, resulting in predominantly positive therapeutic outcomes with minimal adverse effects (Williams et al., 2021). Further research is needed to better understand how individual differences, particularly personality traits, influence treatment responses. This knowledge would enable more precise patient selection and personalized treatment approaches, ultimately enhancing safety and therapeutic efficacy.

Durability of Therapeutic Effects: Comparing Long-Term Outcomes Across Treatment Modalities

Potential long-term therapeutic efficacy represents a significant advantage of PAT. Clinical trials demonstrate sustained symptom reduction across multiple conditions: psilocybin for depression (Gukasyan et al., 2022), MDMA for PTSD (van der Kolk et al., 2024), and ketamine for treatment-resistant depression (Murrough et al., 2013). These outcomes contrast with conventional treatments’ requirement for continuous medication administration without addressing underlying pathological mechanisms.

The potential for achieving substantial therapeutic change within limited sessions warrants methodological consideration. While preliminary data indicates promising results, psychedelic research in psychopharmacology is still in its beginning. Current limitations include a lack of longitudinal and follow-up studies, resulting in an incomplete understanding of delayed adverse effects and individual response variations.

Where Do We Go from Here?

Current evidence necessitates a balanced evaluation of PAT. While contraindications and methodological challenges persist, clinical trial data demonstrates significant therapeutic potential, particularly for treatment-resistant conditions including PTSD, depression, and substance use disorders (Belouin & Henningfield, 2018). These novel interventions may address limitations inherent in conventional treatment approaches.

The evolution of psychiatric medicine suggests an integrative framework incorporating both established and emerging therapeutic modalities. Psychedelic compounds, when administered within structured clinical settings, represent a promising pharmacological class that may complement existing treatment paradigms (Yaden et al., 2024). This integration has the potential to advance therapeutic mechanisms beyond symptom management toward sustained psychological transformation, directly addressing underlying trauma and promoting long-term healing.

The successful implementation of psychedelic-assisted therapy (PAT) requires a multi-faceted approach encompassing patient screening, preparation protocols, and integrated aftercare support. Critical research priorities include understanding neurobiological mechanisms, identifying reliable biomarkers for treatment response, and examining interactions with concurrent therapies. While current evidence supports PAT’s potential, limitations in longitudinal data and study population diversity constrain its broader clinical application. Ko et al. (2022) highlight the need for expanded research across diverse demographic groups to establish standardized safety protocols and treatment guidelines. Future studies should focus on systematic outcome assessment, monitoring of adverse effects, and analysis of population-specific treatment responses to optimize clinical effectiveness and safety standards.

The emerging evidence base supporting PAT’s therapeutic potential, combined with increasing institutional support and methodological refinement, indicates a promising direction for psychiatric medicine. As research continues and treatment guidelines evolve, these interventions may significantly expand the therapeutic options available to clinicians and patients, potentially transforming the landscape of mental health treatment.

References

  1. Barber, G. S., & Dike, C. C. (2023). Ethical and practical considerations for the use of psychedelics in psychiatry. Psychiatric Services, 74(8), 838–846. https://doi.org/10.1176/appi.ps.20220525
  2. 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
  3. Benzodiazepine Information Coalition. (2022, July 27). Mechanism of action – Benzodiazepine Information Coalition. https://www.benzoinfo.com/mechanism-of-action/
  4. Brennan, W. & Belser, A. B. (2022). Models of Psychedelic-Assisted Psychotherapy: A Contemporary Assessment and an Introduction to EMBARK, a Transdiagnostic, Trans-Drug Model. Frontiers in Psychology, 13. https://doi.org/10.3389/fpsyg.2022.866018
  5. Brooks, M. (2018, July 20). Psilocybin “Bad trips” underscore need for research safeguards. Medscape. https://www.medscape.com/viewarticle/874136?form=fpf
  6. Chou, T., Deckersbach, T., Dougherty, D. D., & Hooley, J. M. (2023). The default mode network and rumination in individuals at risk for depression. Social Cognitive and Affective Neuroscience, 18(1). https://doi.org/10.1093/scan/nsad032
  7. Donald, M., Partanen, R., Sharman, L., Lynch, J., Dingle, G. A., Haslam, C., & van Driel, M. (2021). Long-term antidepressant use in general practice: a qualitative study of GP’s views on discontinuation. Br J Gen Pract., 71(708), e508-e516. https://doi.org/10.3399/BJGP.2020.0913
  8. Evans, J., Robinson, O. C., Ketzitzidou Argyri, E., Suseelan, S., Murphy-Beiner, A., McAlpine, R., Luke, D., Michelle, K., & Prideaux, E. (2023). Extended difficulties following the use of psychedelic drugs: A mixed methods study. PLOS ONE, 18(10). https://doi.org/10.1371/journal.pone.0293349
  9. Gattuso, J. J., Perkins, D., Ruffell, S., Lawrence, A. J., Hoyer, D., Jacobson, L. H., Timmermann, C., Castle, D., Rossell, S. L., Downey, L. A., Pagni, B. A., Galvao-Coelho, N. L., Nutt, D., & Sarris, J. (2023). Default Mode Network Modulation by Psychedelics: A Systematic Review. Int J. Neuropsychopharmacol., 26(3): 155-188. https://doi.org/10.1093/ijnp/pyac074
  10. Gukasyan, N., Davis, A. K., Barrett, F. S., Cosimano, M. P., Sepeda, N. D., Johnson, M. W., & Griffiths, R. R. (2022). Efficacy and safety of psilocybin-assisted treatment for major depressive disorder: Prospective 12-month follow-up. Journal of Psychopharmacology, 36(2). https://doi.org/10.1177/02698811211073759
  11. Hu, Y., Xue, H., Ni, X., Guo, Z., Fan, L., & Du, W. (2024). Association between duration of antidepressant treatment for major depressive disorder and relapse rate after discontinuation: A meta-analysis. Psychiatry Research, 337, 115926. https://doi.org/10.1016/j.psychres.2024.115926
  12. Institute for Quality and Efficiency in Health Care (IQWiG). (2024, April 15). Depression: Learn More – How effective are antidepressants? InformedHealth.org – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK361016/
  13. Ko, K., Knight, G., Rucker, J. J., & Cleare, A. J. (2022). Psychedelics, Mystical Experience, and Therapeutic Efficacy: A Systematic review. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.917199
  14. Mason, N. L., Dolder, P. C., & Kuypers, K. P. (2020). Reported effects of psychedelic use on those with low well-being given various emotional states and social contexts. Drug Science Policy and Law, 6, 205032451990006. https://doi.org/10.1177/2050324519900068
  15. Mitchell, J. M., Ot’alora G., M., van der Kolk, B. et al. (2023). MDMA-assisted therapy for moderate to severe PTSD: a randomized, placebo-controlled phase 3 trial. Nat Med, 29, 2473–2480. https://doi.org/10.1038/s41591-023-02565-4
  16. Morgan, L. (2020). MDMA-assisted psychotherapy for people diagnosed with treatment-resistant PTSD: what it is and what it isn’t. Annals of General Psychiatry, 19(33). https://doi.org/10.1186/s12991-020-00283-6
  17. Marrocu, A., Kettner, H., Weiss, B., Zeifman, R. J., Erritzoe, D., & Carhart-Harris, R. L. (2024). Psychiatric risks for worsened mental health after psychedelic use. Journal of Psychopharmacology, 38(3), 225–235. https://doi.org/10.1177/02698811241232548
  18. Mulder, R. T. (2011). The influence of personality on the treatment outcome of psychopathology. Word Psychiatry, 10(2), 115-116. PMID: 21633687
  19. Murrough, J. W., Perez, A. M., Pillemer, S., Stern, J., Parides, M. K., aan het Rot, M., Collins, K. A., Mathew, S. J., Charney, D. S., Iosifescu, D. V. (2013). Rapid and longer-term antidepressant effects of repeated ketamine infusions in treatment-resistant major depression. Biological Psychiatry, 74(4), 250-6. https://doi.org/10.1016/j.biopsych.2012.06.022
  20. Nakao, M., Shirotsuki, K., & Sugaya, N. (2021). Cognitive-behavioral therapy for management of mental health and stress-related disorders: Recent advances in techniques and technologies. Biopsychosocial Medicine, 15(1), 16. https://doi.org/10.1186/s13030-021-00219-w
  21. National Institute on Drug Abuse (2024, June 24). Psilocybin (Magic Mushrooms) | National Institute on Drug Abuse. https://nida.nih.gov/research-topics/psilocybin-magic-mushrooms
  22. NHS (2021, December 8). Side effects – Selective serotonin reuptake inhibitors (SSRIs). https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/medicines-and-psychiatry/ssri-antidepressants/side-effects/
  23. NHS (2022, November 10). Overview – Cognitive behavioural therapy (CBT). https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/cognitive-behavioural-therapy-cbt/overview/
  24. NHS (2024, September 30). Side effects of diazepam. https://www.nhs.uk/medicines/diazepam/side-effects-of-diazepam/
  25. PricewaterhouseCoopers. (n.d.). “Waiting times” in mental healthcare. https://www.pwc.nl/en/insights-and-publications/services-and-industries/public-sector/social-determinants-of-health/waiting-times-in-mental-healthcare.html
  26. Simonsson, O., Goldberg, S. B., Chambers, R., Osika, W., Simonsson, C., & Hendricks, P. S. (2023). Psychedelic use and psychiatric risks. Psychopharmacology. https://doi.org/10.1007/s00213-023-06478-5
  27. Stein, D. J., Shoptaw, S. J., Vigo, D. V., Lund, C., Cuijpers, P., Bantjes, J., Sartorius, N., & Maj, M. (2022). Psychiatric diagnosis and treatment in the 21st century: paradigm shifts versus incremental integration. World Psychiatry, 21(3), 393-414. https://doi.org/10.1002/wps.20998
  28. Raison, C. L., Sanacora, G., Woolley, J., …, & Griffiths, R. R. (2023). Single-Dose Psilocybin Treatment for Major Depressive Disorder A Randomized Clinical Trial. JAMA, 330(9), 843-853. https://doi.org/10.1001/jama.2023.14530
  29. Roseman, L., Haijen, E., Idialu-Ikato, K., Kaelen, M., Watts, R., & Carhart-Harris, R. (2019). Emotional breakthrough and psychedelics: Validation of the Emotional Breakthrough Inventory. Journal of Psychopharmacology, 33(9). https://doi.org/10.1177/0269881119855974
  30. Smausz, R., Neill, J., & Gigg, J. (2022). Neural mechanisms underlying psilocybin’s therapeutic potential – the need for preclinical in vivo electrophysiology. Journal of Psychopharmacology, 36(7), 781-793. https://doi.org/10.1177/02698811221092508
  31. van der Kolk, B. A., Wang, J. B., Yehuda, R., Bedrosian, L., Coker, A. R., Harrison, C., Mithoefer, M., Yazar-Klosinki, B., Emerson, A., & Doblin, R. (2024). Effects of MDMA-assisted therapy for PTSD on self-experience. PLoS ONE 19(1). https://doi.org/10.1371/journal.pone.0295926
  32. Vargas, M. V., Dunlap, L. E., Dong, C., Carter, S. J., Tombari, R. J., Jami, S. A., Cameron, L. P., Patel, S. D., Hennessey, J. J., Saeger, H. N., Mccorvy, J. D., Gray, J. A., Tian, L., & Olson, D. E. (2023). Psychedelics promote neuroplasticity through the activation of intracellular 5-HT2A receptors. Neuroscience, 379, 6633. https://doi.org/10.1126/science.adf0435
  33. Williams, M. L., Korevaar, D., Harvey, R., Fitzgerald, P. B., Liknaitzky, P., O’Carroll, S., Puspanathan, P., Ross, M., Strauss, N., & Bennett-Levy, J. (2021). Translating psychedelic therapies from clinical trials to community clinics: building bridges and addressing potential challenges ahead. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.737738
  34. Yaden, D. B., Berghella, A. P., Hendricks, P. S., Yaden, M. E., Levine, M., Rohde, J. S., Nayak, S., Johnson, M. W., & Garcia-Romeu, A. (2024). IUPHAR-review: The integration of classic psychedelics into current substance use disorder treatment models. Pharmacological Research, 199, 106998. https://doi.org/10.1016/j.phrs.2023.106998

Dutch Psychedelic Practices Shaped by Culture and Law

October 31, 2024 / Humanities & Art / By

From the Field: Lessons from psychedelic practices in the Netherlands is a blog series based on my qualitative research at the Rijksuniversiteit Groningen in collaboration with the OPEN Foundation. The study focused on the conception and practice of safe and beneficial use of psychedelics in group settings in the Netherlands: more specifically in counterculture, ayahuasca ceremonies and truffle retreat centers. Based on interviews with experienced practitioners, the series highlights and connects diverse aspects of psychedelic practices, from cultural influences through ethics to sensory stimuli.

Part 1: Lessons on Psychedelic Harm Reduction with PsyCare NL – From the field
Part 2: Dutch Psychedelic Practices Shaped by Culture and Law (current post)

As I delved into psychedelic research, it surprised me how few studies paid attention to experienced practitioners and the established practices they follow. To date, most research is concerned with future clinical therapeutic applications. In fact, the image of psychedelics as medication for mental health issues has by now become so prevalent, that the faculty did not see how psychedelics could be relevant for a thesis in Cultural Leadership. While psychedelics may become prescribed medications in the future, they have a rich cultural past and present. They stand at the heart of multiple indigenous cultures, the counterculture of the 1960’s and contemporary events like Burning Man; they were inspirational to the creation of numerous artworks in all artistic genres. And they are central to the lives of certain individuals and communities, here in the Netherlands too. 

Pairing with OPEN, we wanted to get an idea of how the current Dutch scenery looks like. As the field grows and more practices appear, we were wondering which existing group practices around the use of psychedelics are facilitated in the Netherlands (Q1). In addition to this bird’s-eye view, we dived deeply into the details of psychedelic practices with the help of well-known and esteemed practitioners. Our focus was on how facilitators envision and practice safe and beneficial use of psychedelics (Q2). To answer the first question, a survey was sent to the members of OPEN (n=112), inquiring about the practices they know and how they can be classified. For the second question, 60-90 minute interviews were conducted with facilitators. This article reviews the study itself, its main theoretical framework, set and setting, and the general Dutch context – the setting in which the practices and the study take place.

Academic approaches and muddy realities of psychedelic practices

In the academy, we strive to be exact: research questions need to be specific, categories methodically outlined, concepts accurately defined. To me, one of the fascinating things about psychedelics is that they do not fit neatly into any ontological box. They stand at various conceptual intersections, like body and mind, science and spirituality, individual and community, and highlight the boxes themselves. What we see is a reflection of our own thinking patterns in our striving to make sense of the world. In other words, we are constantly reminded that the map is not the territory. 

Being aware of this tension, my questions related to a psychedelic ‘practice’, in its simplest definition – the usual way of doing something. Instead of using ontological labels, like ‘recreational’, ‘therapeutic’ and ‘spiritual’ use in the survey, I opted for real-life vocabulary: psychedelic parties and events, retreat centers and ceremonial settings. The survey results confirmed my hypothesis that these were the three most prevalent ones in the Netherlands. Subsequently, interviews were conducted with eight experienced facilitators: three ayahuasca ceremony leaders, two retreat guides and three prominent figures in a psychedelic countercultural institution. Albeit my efforts to avoid definitions, I still had three supposedly distinct categories in my head. 

As the interviews unfolded, the outlines of these categories started getting blurry. For example, practices employed by the ayahuasca practitioners proved to be very different from one another, ranging from shamanic traditions to Western psychology frameworks. So the joint label ‘ayahuasca ceremony’ seemed to convey very little information beyond the drinking of ayahuasca. Some ceremonies shared more elements with retreat centers’ practices than with each other. So how can practices be distinguished from one another? What are the most important elements? This was the focus of one question in the survey. Respondents were given options like ‘the type of substance’, ‘the philosophy behind the practice’, ‘the setting’, and had to rate their significance to classification. So, for example, if ‘the type of substance’ was rated as the highest, it would make sense to have ‘ayahuasca ceremony’ as a separate category. However, the results only made things more complex: all suggested options were rated as almost identically important for the definition of practices and their classification.

The more I learned, the less sense it made to try and define the practices, certainly by relating to their differences. In addition to diversity between facilitators, many of them talked about changes within their own practice over time, so even the best of classifications was bound to lose its accuracy shortly in this vibrant and newly-awakened field. ‘Take your eyes off the map!’ I had to remind myself, ‘how does the territory look like?’ Then something appeared: some elements were brought up by all (or most) interviewees. So I chose to focus on the commonalities between practices, in a unifying rather than separative approach. Which elements are shared by all practices? What makes them so special that they were highlighted by all facilitators, and how do they contribute to safe and beneficial use of psychedelics?

The Dutch psychedelic Context: Sociocultural Set and Setting

Before taking that trip, let us pause to observe the context of the practices and the study. According to the theory of set and setting, psychedelic experiences are shaped by the setting in which they take place: the physical environment with all its components, and by the mindset of the person taking them, including their intentions, personality traits, etc. This is also true for ordinary human experience, since as Gregory Bateson noted, the phenomena of context and meaning are closely related. But during psychedelic experiences, these connections are enhanced. While many think of set and setting as immediate parameters confined in space and time, the concept has been broadened to include one’s sociocultural context and even the collective one. They can be thought of as different scales of influence on one’s experience. Taking the ayahuasca ceremony example, the ceremony itself would be part of the immediate set and setting, as well as where it is held, the other participants, my intentions and my mood on that day. On another scale, my cultural background plays a tremendous part: am I Dutch? Indigenous? How does my culture frame hallucinations? When I go back home after the ceremony, can I discuss my experience with family and friends? What language would be used to describe it? How does my culture conceive of reality? 

Legal entanglements

Where substances other than (psilocybin containing) truffles are concerned, illegality is part and parcel of the set and setting, influencing people’s experiences and the practice as a whole. This is why many retreat centers use truffles, offering both facilitators and participants a legal setting. When I was discussing challenging situations with a retreat guide, they shared a story about a participant who felt unsafe, as if held against their will. A worried friend and some misunderstandings ended in the police being called. When they arrived, it appeared that everyone was safe, the participant was free to leave, and no illegal activity was being committed. Had this happened during an ayahuasca ceremony, the exact same situation could have had significant consequences for the facilitators, the institution they represent and the hosting ground.

The legal situation has practical implications which go far beyond the rare ‘what if’ scenario. Operating in a legal environment, retreat centers often publish educational material on their websites, and their ‘about’ section can include the names, photos and bios of the team. With a few exceptions, facilitators of ayahuasca ceremonies typically work ‘underground’: the ayahuasca-related content is hidden on a password-protected part of their website, if they even have one. Some work with newsletters, carefully distributed among trusted individuals. General non-drug-related descriptions have to be used for payments; finding locations can be tricky. Above ground, producers of countercultural events often relate to drugs as the three wise monkeys: “see not, hear not, speak not”; the mushrooms on the invitation are only decorative.

Prohibition has consequences for participants’ safety as well. In counterculture, it concerns the limitation of prevention and harm-reduction practices. Some festivals, like Boom in Portugal, offer participants drug-testing services. This is because drugs may be cut using other, sometimes dangerous chemicals. If a pattern is discovered, all festival participants receive a message to their phone, alerting them of potential harmful drugs on the terrain. While drug-test services are available for the public all over the Netherlands, they are prohibited on festival grounds. The recently founded PsyCare NL is a new development in the field. Based entirely on volunteer work, the bottom-up harm reduction initiative supplies a safe haven for festival-goers in need.

Participants’ safety in the ceremonial setting benefits from well-informed facilitators and ethical practices. In an unregulated sea, where every facilitator is an island, this becomes difficult even for the best-intentioned practitioners. Here as well, it is mitigated by a bottom-up Dutch initiative. Liaan makes place for ayahuasca ceremony leaders to meet, share their experience, raise questions and doubts, and learn from each other. In the absence of formal guidelines, the network allows them to create professional standards inside the community.

Let’s talk about [beep]: conducting ethical research

Legal entanglements have consequences for research and education as well. To abide by the EU GDPR, survey respondents were asked not to include names or other personal information of practitioners and institutions involved with psychedelics. Only publicly available information, like websites, was allowed. This obviously had an effect on our ability to answer question 1, which existing group practices around the use of psychedelics are facilitated in the Netherlands, for any underground practice had to remain underground.

Most interviewees – facilitators with years, often decades of experience – preferred to preserve their and their institutions’ anonymity. Ultimately, the university’s Ethics Committee required that anonymity be granted to all interviewees without exception. My initial intention to present and discuss the research results with some of the interviewees in an OPEN online event proved unrealistic for that same reason. Instead, I am writing this series, in which my voice is the only one heard.

Culture is not your friend: The works of public image

During preparatory conversations with interviewees, it became clear that none of them were afraid of criminal consequences. Dutch drug policy and law enforcement are considered relatively tolerant. Festivals even work collaboratively with the police, with a mutual understanding that psychedelic drugs do not pose a threat to the safety of visitors. But practitioners know that cultural bias can be stronger than both science and the law. Alcohol is probably the best drug to demonstrate that. The WHO recently published that “2.6 million deaths per year were attributable to alcohol consumption, accounting for 4.7% of all deaths”, and yet not only is alcohol legal, it is completely socially-accepted, it is the norm.

During my PsyCare training last summer, the head of the First Aid services explained that they consider the festival a low profile event. Typically, his team might have to treat two serious medical cases during a five-day long festival, whereas at an average city marathon some 50 people might be rushed to a hospital. Comparing this statement against the public image of psychedelic festivals and that of sport events organized by municipalities, blew me away. But what hit me even harder was my colleagues’ and my own surprise at this, which demonstrated just how powerful public images can be; and that being knowledgeable and even working in the field does not spare you their effect. In a recent episode of Psychedelics Today, Rick Doblin talks about why he thinks Lykos and MAPS failed to get FDA approval for MDMA-assisted therapy for PTSD. A big part of it was their assumption that science was more important than culture, underestimating the impact of media and public opinion on the FDA.

Regulation is also conducted by civil bodies deterred by the stigma around drugs. Among the interviewees, one institution was afraid of losing its permit if the municipality associated it with drugs. Another had already lost its bank account due to the same reasons, and feared losing their new one, or worse, being blacklisted by all banks in the Netherlands. At the same time, the Dutch government is making impressive steps towards regulating therapeutic use of MDMA, and perhaps other psychedelics in the future. If psychedelic-assisted therapies become legal, it will surely help in changing public opinions around these substances. However, if they are prescribed as medications and boxed in a clinical setting, most of the study participants might remain in illegal territory rather than becoming the leading voices of this change.

These trends do not exist in a vacuum. They are part of even larger cultural contexts: Dutch, European and Western culture(s), and ultimately the world in which we live in. Dutch practices are part of similar psychedelic practices taking place in other parts of the world and in other times in history. Currently, they are hosted against the backdrop of neoliberalism, capitalism, globalization, secularization, the climate crisis, technology and digital culture, the mental health crisis, and what John Vervaeke described more globally as the meaning crisis. Keeping this broad gaze in mind, the coming articles will zoom into the practices themselves. They will focus on the role of music, nature, sensory stimuli (or lack thereof), agency, care and community; the seemingly separate components shared by all the studied practices.

Do Psychedelic States merely create comforting delusions?

October 17, 2024 / Philosophy & Religious Studies, Psychology / Leave a Comment / By

Chris Letheby’s “Philosophy of Psychedelics” explores the relationship between the philosophy of psychedelics and the mechanisms of psychedelic therapy.

Through this curation of a few sections from chapters 7 and 8 of Letheby’s work, the reader is invited to think along.

The Comforting Delusion Objection to Psychedelic Therapy

Central to Letheby’s book is the provision of an appropriate response to the ‘Comforting Delusion Objection to psychedelic therapy’ — it says that psychedelics induce their salutary psychological effects mainly by inducing metaphysical beliefs that are comforting but probably false.

Is it the case that psychedelics merely create comforting delusion? Are therapeutic outcomes a result of false metaphysics? Let’s take a step back.

a transient and dramatic experience that Uncovers New Modes of Perception and Being

Source: Unbinding the self — Philosophy of Psychedelics by Chris Letheby, Chapter 7 — p. 124-5

Letheby starts this chapter by pointing to the aim of many psychiatric treatments:

“Many psychiatric disorders feature deleterious changes to self-related beliefs and many treatments aim at “resetting” these beliefs — at changing them for the better.”

“Phenomenologically speaking, the interpersonal world simply is threatening, or the self simply is powerless: they are not merely believed to be so.”

Psychedelics’ ability to induce a transient and dramatic experience may become relevant in a similar therapeutic process of shifting habitual beliefs and identity:

“Through radically altered forms of self-experience, subjects discover the contingency, mutability, and stimulatory nature of their own sense of identity and habitual modes of attention. They learn directly that there are other ways of being and other ways of seeing because their ordinary ways of being and seeing result from a malleable modeling process.

By disrupting the neurocognitive substrates of the brain’s high-level beliefs, psychedelics can change this situation transiently but dramatically resulting in:

1. Subjects experiencing new phenomenal worlds inconsistent with and previously precluded by those beliefs.

2. As a corollary, the beliefs themselves become phenomenally opaque as their representational nature becomes more vividly apparent.”

Hallucination or Revelation? Navigating the Epistemic Uncertainty of Psychedelic States

Source: Epistemology — Philosophy of Psychedelics by Chris Letheby, Chapter 8 — p.160-2

However, how can one be certain that these newly experienced phenomenal worlds are something to be learned from?

”Some psychedelic users claim sincerely to encounter genuinely existing disembodied entities, spirit realms, and transcendent Grounds of Being.”

Should those claims simply be rejected?

“On principled philosophical grounds, naturalists reject these claims as arising from compelling drug-induced hallucinations — misrepresentations of reality.”

“The key to understanding the epistemic profile of the psychedelic state comes from Andy Clark’s dictum that prior knowledge in the predictive brain is always both constraining and enabling.”

  1. “Certain epistemic benefits available in the sober state become unavailable, such as rational and critical thought and the ability to deploy much prior knowledge.
  2. Others unavailable in the sober state become available — principally, the opportunity to access information otherwise filtered out by overweighted priors, as well as the ability to represent certain kinds of information in novel and epistemically useful formats.”

is a sense of certainty epistemically justified?

”A second guiding principle comes from Jennifer Windt’s observation that ‘phenomenal certainty — the experience of persuasion or knowing — is not the same as epistemic justification’.”

“Having a psychedelic experience in which some proposition P seems true, accompanied by a strong phenomenal feeling of certainty, does not constitute sufficient justification for believing that P is true.”

Chris Letheby’s Conclusion “Epistemic Innocence”

“Many psychedelic states are, in Lisa Bortolotti’s parlance, epistemically innocent. This means that despite having real epistemic flaws, they also have significant epistemic benefits that are not available by any alternative means. In sum, psychedelics’ overall epistemic profile is neither as dire as some skeptical naturalists might assume, nor as pristine as some entheogenic enthusiasts would like.

Lessons on Psychedelic Harm Reduction with PsyCare NL – From the field

October 31, 2024 / Humanities & Art / By /

“From the Field: Lessons from Psychedelic Practices in the Netherlands” is a new blog series stemming from my qualitative research at the Rijksuniversiteit Groningen in collaboration with the OPEN Foundation. The study focused on the conception and practice of safe and beneficial use of psychedelics in group settings in the Netherlands—specifically in the counterculture, ayahuasca ceremonies and truffle retreat centers. Based on interviews with experienced practitioners, the series highlights and connects diverse aspects of psychedelic practices, such as cultural influences, ethics, philosophical beliefs, rituals and sensory stimuli. This article is based on my personal experience as part of a new PsyCare NL team, launched last summer (2024) at a festival in the Netherlands.

The Launch of PsyCare NL: Safe Psychedelic Substance Use at Festivals

The PsyCare facility is a calm, safe, cozy and grounding environment for participants in need, playing a crucial role in prevention and harm reduction at festivals where psychedelic substances are commonly used. Visitors are welcomed by experienced psychedelic peer support “sitters” with a deep understanding of mind-altering substances and a relaxed, non-judgmental approach towards difficult and challenging experiences. Ideally, a team is composed of sitters with different professional backgrounds, gender, personality and language skills to ensure the most appropriate support for all visitors.

PsyCare NL was restarted by Cato de Vos following years of volunteer work with international psychedelic support services like Kosmicare at Boom Festival. Developed with her colleague and friend Raoul Koning (who, like Cato, is part of the OPEN team), the pilot was implemented with a team of 11 members. In total, we received 41 guests over three days. Most cases were drug-related and, typical to a festival environment, involved a variety of drug types and doses, with a dominance of LSD. Other cases involved general agitation or overwhelming feelings from the festival. Some guests could not communicate their feelings or which substances they had consumed (if any). Looking back at the stats reveals strong diversity in other parameters as well, such as how guests arrived at PsyCare or for how long they stayed.

So, how can you help someone through a challenging experience with such a wide variety of cases?

Creating a Safe Haven: The Role of Psychedelic Support Services

With the exception of medical issues—which are determined by the First Aid team—we hardly followed any strict protocols. There are handy guidelines, training and even manuals for this complex and challenging work, but much of it is carried out in an intuitive manner. Like humor or the psychedelic experience itself, this sort of knowledge does not lend itself easily to words and numbers. Nevertheless, in this article, I will highlight essential aspects of PsyCare practice as they emerged from our collaboration with First Aid, feedback from guests and visitors and my own experience as a participant-observer and part of the team.

the core of psychedelic Harm Reduction: Being Present

Being present is probably the single most important element of PsyCare, and it begins with the place itself. The festival production supplied us with a Moroccan tent and a yurt, which we made cozy and aesthetic. With mattresses spread around, warm lighting and decoration, PsyCare became both a part of the festival and a peaceful haven away from it. This already had an effect, as by-passers stopped to take a look inside and ask about PsyCare. Some mentioned that they were relieved to know it’s there. 

Festivals with an established PsyCare tend to offer a 24 hour per day service. In this pilot, our official opening hours were from 16:00 to 8:00, with the night hours (1:00-6:00) being the busiest. In practice, we never said ‘no’ to someone in need, and at 10:30 in the morning we welcomed our first guest. We often remind our guests that drug effects are temporary, or as the wise old saying goes: “this too shall pass”. Yet different drugs – and people – require different amounts of time. Guests’ duration of stay throughout the pilot varied from 5 minutes to 14 hours, with an average stay of 3 hours per guest.

Being present in space and time extends to the personal. Often the most meaningful thing you can do for someone who is overwhelmed is just to be there; to stay with them through this difficult moment, fully present with your attention, patience and calm, no matter what comes. Applied within the PsyCare team as well, mutual care and team spirit were vital to the success of the pilot. 

    Community Values: “Psychedelic Peer Support”

    Festivals in this counterculture make room for spontaneity, experimentation, rule-bending and non-conformist behavior. PsyCare emerged from within this community and seems to share with it some core values that came up during my interviews, like non-judgment. In PsyCare, this is applied as refraining from value judgments of people’s experiences, behaviors, thinking processes, or beliefs. Each person’s freedom and autonomy are respected—a principle overridden only in case of imminent risk to oneself or others.

    Embracing Equality and Non-Hierarchy

    The principle of equality, or non-hierarchy, is another unique feature of PsyCare stemming from counterculture. As volunteers in their own community, PsyCare sitters do not operate from a position of superiority or authority in relation to visitors. They are temporarily holding space for temporary “guests”, as their name suggests. This approach carries a multitude of implications. For example, a guest can bump into their sitter from yesterday at the bar or on the dancefloor. Furthermore, yesterday’s sitter can become today’s guest. Accepting such potentialities involved conscious discussions among the team: how do we ensure guests’ privacy? Are we ‘sitters’ outside our shifts? What does this mean in practice?

    On the last evening of the festival, I met a guest with whom I spent three hours in the PsyCare tent. Our guideline in such cases is to let the guest determine what happens. They smiled at me and stretched their arms for a hug. We chatted and danced together for a bit, and then they moved on. For me, this short incidental encounter on the dancefloor supplied closure and reinforced our positions as fellow festival-goers.

    Such liminal cases are exactly where non-judgement and non-hierarchy shine, and have the power to turn an otherwise awkward or embarrassing situation into a meaningful, connecting and supportive event.

    Awareness of Shame and Vulnerability

    Coming to PsyCare requires admitting to being in need, a feeling which can be challenging for many in itself. Guests may realize that they have taken more than they can chew or even completely lost control. Exposing “weakness” is never easy, but in small communities where many people know each other, shame can become a real barrier. Considering these complexities, any authoritative position, even of ‘a professional’ or a ‘responsible adult,’ is unlikely to contribute to PsyCare as a safe haven. This is why, where other emergency services typically wear a uniform, we wore our regular (low-key) festival clothes and a name tag with a little heart on it.

    Early on in the festival, I was called to check on a disoriented person and try to bring them to the PsyCare facility. Despite their highly confused condition, I managed to establish trust and we were quickly holding hands on our way to the PsyCare tent. At the same time, a First Aid worker in uniform approached us and asked if everything was alright. The guest’s state of mind changed instantly. They released their hand from mine, flinched and asked anxiously: “Did I do anything wrong?”

    Following this case, we came to an agreement with the First Aid staff that they remove their jackets before entering PsyCare, notwithstanding their white uniform was chosen for its non-intimidating character. This policy was found useful by both teams.

    Embracing Care: The Heart of PsyCare

    Here is how Ann Shulgin described the ideal MDMA therapist back in 1995:

    “[S/]he has to be able to feel something very close to love for the person [s/]he is guiding. There should be real caring and it cannot be simply an intellectual concern for the client’s welfare; it must be deeper than that, at the gut level.”

    The relatively long experience with mind-altering substances in counterculture is often disregarded or looked down upon by academics, even those studying psychedelics. Some of it is pure stigma, but there is also a genuine conflict of approaches. As PsyCare sitters, we benefit from ‘subjective’ experiences at least as much as from ‘objective’ facts. Both theory and metaphor were used in our training and we followed values and approaches more than rules and protocols. Above all, PsyCare takes place in a vibrant, dynamic and sometimes chaotic setting, which is almost the opposite of a ‘controlled environment.’

    The fear of intellectual uncertainty and making mistakes cannot be entirely avoided, but PsyCare consciously makes room for other ways of knowing. To describe positive attributes of an effective sitter, our training instructor Daan Keiman, who leads OPEN Foundation’s upcoming education programme in psychedelic therapy, shared the following metaphor:

    If a person is immobile, shut, or stiff like a rock, we should be soft and fluid like water. If they are floating and formless like water, we would have to be their rock.

    Furthermore, presence and care ought to be practiced delicately: sitters do not attempt to pull guests out of their experience but offer them a hand to grab on. Curiously, it’s the little things that have the greatest impact: a welcoming smile, a cup of tea, a blanket, holding someone’s hand, offering a hug, listening to their story, laughing with them.

    In one word: Care.

    An attuned caring presence can turn loneliness into a feeling of being held, and a nightmare into a meaningful experience. Like ‘love’, ‘care’ might be difficult to define or even comprehend intellectually; but luckily, this is not necessary in order to give it. Being in a festival setting, I could not help but think of it in terms of the dance floor: there are no steps, but if you listen carefully to the music and let it guide you, there will be a dance.

    Continuing the Conversation on Psychedelic Support in Recreational Settings

    A broader look at PsyCare will be discussed in an upcoming OPEN event (3.10.24) moderated by PsyCare NL founder Cato de Vos and featuring international Psychedelic Support Services experts Amanda Guzinska (PsyCare UK) and Valerie Beltrán (Zendo Project). Click below to register.

    The FDA’s Decision on MDMA-Assisted Psychotherapy: A Call for Pragmatism and Scientific Rigor

    September 13, 2024 / MDMA, Policy, Law & Economics / 1 Comment / By

    On behalf of the OPEN Foundation.

    10 min reading time

    The recent decision by the US Food and Drug Administration (FDA) to withhold approval for MDMA-assisted psychotherapy (MDMA-AT) has sent ripples of disappointment and frustration throughout the scientific, psychedelic and therapeutic communities. This decision, issued via a Complete Response Letter to Lykos Therapeutics, effectively delays access to a promising treatment for millions of patients suffering from Post-Traumatic Stress Disorder (PTSD) by years. At OPEN, we feel compelled to express our concerns, while also proposing a path forward: one that emphasizes both rigorous scientific validation and compassionate pragmatism.

    Disappointment in the FDA’s Decision to Restrict Access to Mdma-at

    The FDA’s decision represents a significant setback for those advocating innovative approaches in mental healthcare. MDMA-AT has shown remarkable potential in treating PTSD, a condition that remains notoriously difficult to treat with existing therapies. The evidence presented by MAPS (Multidisciplinary Association for Psychedelic Studies) and Lykos Therapeutics (formerly MAPS PBC) demonstrates substantial improvements in PTSD symptoms among patients treated with MDMA-AT. These findings are not only statistically significant but also clinically meaningful, offering hope to those for whom traditional therapies have failed.

    The FDA’s decision, while ostensibly rooted in a commitment to safety and efficacy, ultimately restricts access to a treatment that could transform and even save lives. For patients who have exhausted all other options, this decision feels like a denial of hope. 

    Surprise at the Divergence from the Dutch State Committee Report “Beyond Ecstasy”

    What is particularly surprising is the stark contrast between the FDA’s decision and the conclusions reached by the Dutch State Committee on MDMA. Based on the same body of evidence, the Dutch committee (consisting of scientists, psychiatrists, legal experts, drug prevention and harm reduction specialists) arrived at a radically different conclusion: MDMA-AT is promising, effective, relatively safe and warrants more scientific research to further explore its therapeutic potential.

    The committee even concluded that based on the relatively low potential for harm, MDMA could be down-scheduled: moving the compound from List 1 to List 2 of the Opium Act. Finally, the Committee advised the Dutch government to start a naturalistic study to allow patients access to this new therapy form, while also allowing scientists to collect more data on an ongoing basis, all the while gaining important clinical experience in delivering this novel treatment form. These diverging perspectives raise important questions about the interpretation of scientific data and the role of cultural and institutional factors in regulating novel therapeutic approaches. 

    The Dutch committee’s recommendation reflects a nuanced understanding of both the risks and benefits associated with MDMA-AT. They recognize that while methodological and ethical concerns remain, the potential therapeutic benefits of MDMA-AT cannot be ignored. This discrepancy between the FDA and the Dutch committee highlights the need for international dialogue and collaboration in the evaluation of novel therapies.

    Want to learn more about the Dutch State Committee Report? Click here.

    Acknowledging Methodological Concerns In MDMA Assisted Psychotherapy

    At the moment, the specific reasons why the FDA rejected the approval of MDMA-AT are not yet publicly available, but we presume these concerns are likely based on the report from the FDA’s scientific advisory panel. These concerns are not without merit. The methodological issues raised, particularly those related to expectancy and placebo effects, are valid and warrant careful consideration. In randomized controlled trials (RCTs), both the MDMA and control groups have shown dramatic improvements, raising the possibility that nonspecific factors may be contributing to the observed outcomes. The contribution of these nonspecific factors to treatment outcomes is not unique to MDMA-AT, but is of concern in the evaluation of any psychoactive medicine. It is also crucial to note that the magnitude of improvement in the MDMA group far exceeds that of the control group, suggesting that the effects of MDMA-AT are not merely due to placebo or breaking blind. Placebo effects, while powerful, tend to diminish over time, whereas the benefits of MDMA-AT have been sustained in many cases. This durability is a critical factor in assessing the therapeutic potential of MDMA and underscores the need for further research to refine our understanding of its mechanisms of action.

    Questions that need to be addressed

    In our view, specific open questions that need to be addressed in future research include:

    1. Role of Expectations: What is the role of patient expectations in the therapeutic benefits associated with MDMA-AT?
    2. Blinding Integrity: How many participants are able to accurately guess their treatment assignment, and how does this impact the study outcomes?
    3. Prior Experience with MDMA: Does the therapy work equally well for patients with and without prior experience with MDMA?
    4. Control Conditions: Could alternative control conditions with experiential components, such as breathwork, be equally effective as MDMA in improving PTSD symptoms?
    5. Non-Responders: What are the characteristics of patients who do not respond well to MDMA-AT, and how can their outcomes be improved?
    6. Therapist-Client Interactions: What checks and balances are necessary to ensure the standardization and careful conduct of therapist-client interactions in MDMA-AT? 
    7. Proper aftercare: How can we ensure appropriate, sensitive, and durable aftercare for patients who may struggle for a substantial period after having undergone MDMA-AT (or placebo-assisted therapy)? 

    These questions highlight the need for further evaluating the efficacy of MDMA-AT and underscore the need for open science practices, including transparent reporting and rigorous study designs, to address these issues.

    Addressing Ethical Concerns

    Ethical concerns surrounding MDMA-AT are significant and need to be taken very seriously,  particularly regarding the risks related to boundary violations. We are acutely aware of the need for rigorous training, careful monitoring and adequate supervision of both therapists and patients involved in MDMA-AT. This is particularly true when these therapies do become approved, and will be rolled out at a large scale, to more diverse groups of patients. The therapy should only be conducted in controlled environments by qualified professionals who adhere to the highest standards of care. This includes official oversight of relevant professional associations, ideally with a thorough understanding of the nature of – and specific risk factors related to – psychedelic-assisted therapies.

    A more difficult issue revolves around the standardization of the psychotherapeutic component of MDMA-AT. While some argue that standardized psychotherapy is essential to ensure consistent and safe treatment across different settings, others propose getting rid of psychotherapy altogether, while a third group suggests that common factors – like therapeutic alliance – are the defining feature, and that the specific form of psychotherapy is less important. 

    What we can be sure of, is that as the demand for MDMA-AT grows, there will be an increasing need for well-trained therapists who can deliver this therapy responsibly. The establishment of clear guidelines and protocols is imperative to mitigate risks and protect patient safety.

    The Impact of the FDA’s Decision on the Legal Landscape & Future Research on MDMA-aT

    The FDA’s likely requirement for a third phase-3 trial presents a serious hurdle to the timely approval of MDMA-AT. The time and costs involved in conducting such a study are substantial, and will require additional fundraising. It is likely that this will postpone the availability of MDMA-AT in the USA by years. This delay is particularly concerning given the urgent need for effective treatments for PTSD, a condition that affects millions of people worldwide.

    The implications for Europe are uncertain. It remains unclear whether the results of a future phase-3 trial in the USA will be leveraged to apply for marketing authorisation from the European Medicines Agency (EMA) as well. Theoretically, another phase 3 trial could also partially take place in Europe (there are trained and experienced MDMA-AT therapists sites in multiple European countries), thereby overcoming the EMA’s wish to have studies conducted in Europe. If Europe is not included, and the EMA does require additional data, this will further delay the availability of MDMA-AT in Europe, leaving many patients without access to this potentially life-changing treatment.

    A Pragmatic Approach: Naturalistic Studies and Early Access

    In light of these challenges, we propose a pragmatic approach that balances the need for rigorous science with the urgent need for patient access to MDMA-AT. Specifically, we support the recommendation of the Dutch State Committee on MDMA to initiate a naturalistic study in which patients are given MDMA-AT by qualified therapists in specialized treatment settings.

    Such a study would provide valuable data on the real-world effects and risks associated with MDMA-AT, while also offering patients access to a therapy that they might otherwise seek in the so-called ‘underground’ or ‘grey’ circuit. A naturalistic study has the dual benefit of providing potential relief to suffering patients while advancing our understanding of the roll out of MDMA-AT in a controlled and ethical manner.

    Furthermore, implementing this approach in the Netherlands could position the country as a leader in psychedelic science and innovative mental healthcare. It would enable us to gather valuable real world data, understand the complexities of offering such a therapeutic innovation in the real world, and, importantly, ensure that an increasing  number of qualified therapists can gain experience conducting MDMA-AT, putting in place structures, protocols, and guidelines to enable a smooth rollout when MDMA-AT eventually becomes a mainstream therapy.

    Conclusion: Balancing Rigor with Compassion In Psychedelic Science

    In sum, the OPEN Foundation believes that the FDA’s decision overlooks the immediate needs of patients who stand to benefit from MDMA-AT. We recognize the importance of rigorous science in establishing the safety and efficacy of this therapy, but we also advocate a pragmatic approach that allows for early access through naturalistic studies. Only by adopting this dual strategy can we ensure that MDMA-AT is administered safely and responsibly, while also collecting the data necessary to satisfy regulatory requirements. Ultimately, the goal of such an approach would be to minimize harm, maximize patient benefit, and pave the way for MDMA-AT to become a valuable tool in the treatment of PTSD.

    We call on regulatory agencies, researchers, and clinicians to work together in the spirit of collaboration and innovation, to bring this promising therapy to those who need it most.

    Looking back on ICPR 2024 – the leading interdisciplinary conference on psychedelic research

    September 13, 2024 / Anthropology & Sociology, Biology & Ethnobotany, Ethics, Humanities & Art, Neuroscience, Pharmacology & Chemistry, Philosophy & Religious Studies, Policy, Law & Economics, Psychiatry & Medicine, Psychology, Technology / By

    It’s been 2 months since the leading conference on psychedelic research in Europe, ICPR 2024, took place in Haarlem, the Netherlands. Despite having taken steps to integrate it all, the OPEN foundation team has accepted that we still lack the words to convey what the whole event felt like and meant to us.

    Pia Dijkstra – Minister of Healthcare, The Netherlands – Opening ICPR 2024

    From combating prejudice and stigma back in 2007 to having not one but two subsequent Ministers of Healthcare lining up to inaugurate ICPR, our mission to advance psychedelic research to benefit science, healthcare and society has come a long way.

    At ICPR 2024, we had it all, from Minister from the Netherlands, Pia Dijkstra’s moving opening speech to the heartfelt realities shared by trial participants Maryam Zahra Jabir and Patty B., the Wet Blanket Award for presentations representing rigor and critical thinking’ awarded to Dr. Jamila Hokanson, M.D, MBA, the kind of deep thinking showcased by Leor Roseman, Erik Davis’ magnificent storytelling and accompanying visuals, the important discussions around decolonization curated by Yogi H., and so so so much more.

    Access ICPR 2024 talk recordings & more

    Become a member

    You might imagine why the OPEN Foundation & ICPR team was unable to attend most talks on-site. Yet, via the high-quality recordings (more on this will follow), we didn’t miss out. What we saw was consistently great.

    Immense effort went into crafting ICPR’s mind-blowing programme. And no doubt those efforts have been worth it. ICPR embodied the true spirit of interdisciplinarity: from clinical trial design, neuroscience, archaeology, integration, psychotherapy, adverse events, spirituality, literary analysis—it was all there.

    The programme and ICPR 2024 fulfilled their purpose: to gather and facilitate conversation and connection between open-minded, committed, curious, and caring individuals whose collective perspective creates a critical and constructive narrative for what psychedelics mean moving forward in 21st-century Europe.

    Vibrant lunch breaks @ICPR

    We are honored and humbled by the ICPR 2024, the progress in the field of psychedelic research and therapy, and what lies ahead. Lastly, gratitude. Gratitude, for our co-creation, persists. Fortunately so, as it’s our fuel to do our part in this ongoing process of integrating psychedelics safely and responsibly into healthcare and society.

    Thank you,
    The OPEN & ICPR team

    And please, a big applause for….. the rockstar volunteers who made ICPR 2024 possible!

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    Key Insights from the Dutch state commission MDMA Report: Beyond Ecstasy

    September 13, 2024 / MDMA, Policy, Law & Economics / 1 Comment / By

    In a landmark moment for drug policy, the Dutch State Commission on MDMA has released its highly anticipated report, “Beyond Ecstasy“. Spanning over 200 pages, this document explores the multifaceted dimensions of MDMA, including its recreational use, potential therapeutic benefits, and broader implications for public health and policy. We aim to provide you with the key highlights of this thorough examination aimed at guiding the Dutch government in its future decisions regarding MDMA.

    Context of the Dutch State Commission on mdma

    The formation of the State Commission on MDMA was a response to a coalition government promise to re-evaluate the drug’s status within the Dutch Opium Act. The commission, which included experts from various fields such as addiction psychiatry, criminology, emergency medicine, and drug prevention, worked from April 2023 to May 2024. This multidisciplinary approach ensured a holistic understanding of MDMA’s impact.

    report presentation by wim van den brink, md, phd

    Wim van den Brink, professor of Addiction Psychiatry at the Amsterdam University Medical Centers presented the report 2 days after its release at the ICPR conference in Haarlem, June 2024.

    Discover more talks from ICPR 2024 talks, symposia, lectures & Q&A!

    the Potential of MDMA assisted therapy

    A central aspect of the report is its exploration of MDMA’s potential therapeutic benefits, particularly in the treatment of PTSD. The commission reviewed existing research and concluded that MDMA-assisted therapy shows promise for patients with treatment-resistant PTSD. 

    efficacy and Safety in Treating PTSD

    The report discussed current research and clinical trials, highlighting the effectiveness of MDMA-assisted therapy in treating PTSD. To ensure safety and efficacy of MDMA-assisted therapy, the report highlights the importance of context.

    “MDMA-assisted therapy has shown significant promise in the treatment of PTSD, particularly for patients who have not responded to traditional therapies. This could represent a major advancement in psychiatric treatment”  — MDMA /// Beyond Ecstasy Report

    “The therapeutic use of MDMA must be conducted under strict medical supervision to ensure safety and efficacy.” — MDMA /// Beyond Ecstasy Report

    Need for Further Research: state commission Proposing a Naturalistic Study in the Netherlands

    “Further research is needed to explore the long-term effects and potential applications of MDMA in various psychiatric and neurological conditions.” — MDMA /// Beyond Ecstasy Report

    To facilitate the use of MDMA in therapy to treat PTSD, the commission proposes a large naturalistic study in the Netherlands. This study would help gather more data and refine treatment protocols. Wim van den Brink highlighted, “A large naturalistic study will provide the necessary data to support the safe and effective use of MDMA in clinical settings”

    education and training to meet the need

    “Investing in training programs and specialized centers is essential for the successful implementation of MDMA-assisted therapy.” — MDMA /// Beyond Ecstasy Report

    Establishing specialized centers and training therapists are critical steps for implementing MDMA-assisted therapy. While some qualified therapists are already available, more are needed to meet the potential demand. 

    Prevalence and Risks of Recreational MDMA Use

    “The prevalence of MDMA use in the Netherlands is among the highest in the world, yet the number of MDMA-related deaths remains relatively low, highlighting a unique consumption pattern and harm reduction practices in place” — MDMA /// Beyond Ecstasy Report

    The second central theme of the report is the prevalence and associated risks of recreational MDMA use in the Netherlands. Despite the high prevalence, the report highlights that the frequency of use and the number of pills consumed per session are relatively low compared to other countries. This pattern may contribute to the lower number of MDMA-related deaths observed in the Netherlands.

    The Dutch approach to drug policy heavily emphasizes harm reduction, which is reflected in the safety measures implemented at events where MDMA use is common. As noted in Wim van den Brink’s presentation at ICPR 2024, who emphasized the importance of “set and setting” in minimizing harm during MDMA use, factors such as the availability of care facilities, water, and first aid services at events significantly reduce the risks associated with MDMA use. 

    The report calls for improved postmortem evaluations to better understand the exact causes of MDMA-related risks. Currently, the lack of comprehensive postmortem studies makes it difficult to determine the precise role of MDMA in fatalities, especially when other substances or external factors might be involved.

    Public Health and Drug Policy

    The report emphasizes a public health-focused approach to drug policy, advocating harm reduction overcriminalization. It criticizes the current lack of a cohesive national drug policy and calls for an integrated prevention program. The importance of targeted drug education and continuous monitoring of drug trends is also highlighted.

    “The Dutch drug policy should remain primarily aimed at public health, avoiding the criminalization of users. Prevention strategies must be evidence-based, focusing on harm reduction rather than punitive measures.”  — MDMA /// Beyond Ecstasy Report

    to conclude

    The Dutch State Commission on MDMA’s report “Beyond Ecstasy” is a pivotal document that could shape the future of drug policy and medical treatment in the Netherlands. By addressing the risks and potential benefits of MDMA and MDMA-assisted therapy, the report aims to provide a framework for policymakers.

    As the Dutch government considers these recommendations, patients in need, therapists, researchers and the general public will be paying attention. At OPEN Foundation, we are hopeful that this may be a step toward responsible, safe, and beneficial integration of psychedelics into society and healthcare.

    Psychedelic Assisted Therapy for Treating Addiction – Part 2

    September 13, 2024 / Psychology, Substance Use Disorder / By

    Psychedelic Assisted Therapy for Treating Addiction – Part 2

    Read part 1 here

    Introduction

    In recent years, there has been an increasing interest in the potential of psychedelic therapy as a novel approach for the treatment of addiction. This interest stems from a growing body of research exploring the therapeutic effects of psychedelic substances on addictive behaviors, particularly psilocybin and LSD. In his past seminar titled “Euphoria: The New Science of Addiction and Psychedelic Therapy,” Dr. Rayyan Zafar, a prominent researcher in the field, delves into the key insights and findings spanning from observational studies, clinical trials, and historical investigations with psychedelics in addiction treatment. Dr. Zafar sheds light on the historical context, scientific progress, and prospects of psychedelic therapy in addiction treatment. This blog post aims to summarize and analyze the key takeaways from Dr. Zafar’s seminar, providing readers with a deeper understanding of the evolving landscape of addiction treatment and the role of psychedelic therapy within it.

    Key Takeaways from “Euphoria: The New Science of Addiction and Psychedelic Therapy”

     

    Comprehensive Review of Psychedelic Therapy in Addiction Treatment


    Dr. Zafar’s past seminar offered an in-depth examination of the potential of psychedelic therapy in treating addiction, drawing on a diverse range of research sources. The exploration begins with historical studies dating back to the mid to late 1900s, shedding light on the origins of psychedelic research and its developmental trajectory. Both classic (e.g. psilocybin, LSD, and DMT) and non-classical psychedelics (e.g. 6-MeO-DMT, ketamine, and MDMA) were discussed but due to the limited scope of this article, only the classic ones, psilocybin and LSD, will be highlighted. 

    The first realization of the powerful effect of LSD on mood and cognition in 1943 presumably marked the beginning of a modern era in which psychedelic drugs could be used to treat certain mental and behavioral conditions. From the 1940s and early 1970s, classic psychedelics were actively researched in humans as both a pharmacological tool to understand its effects on the mind and brain and as a therapeutics. Collectively, LSD was seen as a promising treatment for numerous serious mental health disorders such as depression, alcoholism, and other substance use disorders (Hofman, 1980). Furthermore, it has a favorable safety profile and had profound short-term psychological effects (Krebs). This led to a potential breakthrough in the treatment of various mental illnesses, including different forms of drug addiction (Belouin). 

    Between the late 1950s and early 1970s, approximately 40,000 patients worldwide suffering from various mental disorders, including substance use disorders, received treatment with psychedelics such as LSD, mescaline, and psilocybin, are documented over 1000 publications (Grinspoon). A key finding was that psychedelics are well-tolerated and induce a low risk of adverse side events (online event).

    A controlled study investigating LSD’s efficacy in adjunction to psychotherapy in treating heroin addiction was influential. It was revealed that 33% of 36 participants in the treatment group (n= 73) maintained a abstinence after one year compared to the control group with a mere 5% success rate. However, only 5% maintain complete abstinence after the fulfilling the treatment program (Savage, 1973). Furthermore, a meta-analysis collected data about LSD in alcoholism from six randomized controlled trials that were published in the 1960s with over 500 participants and showed that LSD doubled the odds that patients would be abstinent at first follow-up, as defined by (OR = 2.07). Yet, this was not seen after a year (Krebs). 

    Even though there is quite a large amount of historical data showing a positive trend toward the therapeutic role of psychedelics in addiction treatment, the evidence from these studies remains inconclusive due to methodological inconsistencies. More specifically, these inconsistencies encompassed deficiencies in study design, such as the lack of proper controls, blinding, follow-up protocols, statistical analyses, and the utilization of validated assessments, as evaluated through contemporary research standards (Rucker). 

    Groundbreaking Investigations into Addiction Treatment with Psychedelic-assisted Therapy

    The widespread use of psychedelics in the 1960s fueled a counterculture movement, prompting a political backlash and leading to increased regulatory controls by the FDA. This culminated in the establishment of the Controlled Substances Act (CSA) in 1970 under Richard Nixon, effectively halting psychedelic research (Belouin). However, efforts to explore the therapeutic potential of psychedelics resumed in the 1990s with renewed scientific interest and advanced research methodologies (Belouin; Zafar).

    Dr. Zafar provided an overview of the latest findings from these investigations, illuminating the favorable prospects of psychedelics in addiction recovery. Ongoing clinical trials exploring the potential therapeutic role of psychedelics in addiction cover a diverse spectrum of substances and addiction types, ranging from alcohol and tobacco to methamphetamine and gambling addiction. Due to the limited scope of this article, only psilocybin in alcohol and tobacco will be highlighted. These trials aim to expand upon initial findings and set the stage for larger-scale studies that would ultimately secure regulatory approval. 

    The promising results of earlier research on psychedelics and alcohol addiction have prompted a modern replication open-label study examining psilocybin-assisted treatment for alcohol dependence (Bogenschutz et el., 2015). In the little sneak preview of last week, the study of psilocybin in conjunction with Motivational Enhancement Therapy (MET) was discussed. The figure illustrates the change in percent drinking days and percent heavy drinking days. The blue line in the graph represent the % of drinking days while the red line represent the % heavy drinking days. After the first administration with psilocybin, both percent drinking and heavy drinking days were statistically significant lower than baseline in all the follow-up points. 

    To explore the relationship between the intensity of the psilocybin-induced experience with changes in drinking behavior, the acute effects of psilocybin were measured by the Mystical Experiences Questionnaire (MEQ). It was also found to correlate with changes in drinking behavior, craving, and self-efficacy (Bogenschutz, 2015). 

    The mystical experiences induced by psilocybin are characterized by immediate sensations of unity, sacredness, a sense of understanding beyond ordinary knowledge, positive mood, transcendence of notions of space and time, and an inability to adequately describe the experience (e.g., ineffability; Griffiths, 2006). These dimensions seem to be common across ages, cultures, ethnicities, and genders (online seminar Johnson). The hallmark of the mystical experience lies in the profound sense of being influenced by forces greater than oneself, often accompanied by intense emotions, sparking enduring and transformative changes in one’s life (Miller). 

    To build upon the findings of the study of Bogenschutz et al. (2015), the research group investigated psilocybin in a so-called phase 2 double-blind randomized clinical trial (Bogenschutz, 2022). On one hand, it was observed that the psilocybin group had lower percentage  in heavy drinking days and mean daily alcohol consumption (number of standard drinks per day) compared to the group that was given diphenhydramine as a control. On the other hand, the percentage of drinking days was not statistically reduced (29 in psilocybin group vs 43 in control groups). However, important limitations need to be pointed out. There were some methodological issues that could lead to a higher risk of making incorrect inferences about the data.This study is currently undergoing replication in larger phase III trials across multiple centers, advancing toward creating more data regarding the efficacy of the psychedelic drug and potential marketing authorization for this indication (Zafar).

    The effects of psilocybin have also been investigated in conjunction with CBT for the treatment of tobacco addiction. In this open-label study, individuals were given two to three moderate to high doses (20 and 30 mg/70kg) of psilocybin (Johnson, 2017). Results based on urinary and breath analyses showed that 60% of the group did not smoke after one year of follow-up. This is a seemingly big difference compared to the 35% of what is usually observed in traditional tobacco treatment paradigms (Cahill, 2014). In the acknowledgment of the lack of drawing definitive conclusions based on open-label studies and the lack of a control group, a randomized comparative efficacy study has been performed and the results remain yet to be published. 

    Future Applications with Neuroimaging Techniques

    Various neuroimaging techniques are able to provide insights into the neurobiological mechanisms of psychedelic therapy and how these relate to clinical outcomes in the treatment of addiction. These techniques include functional magnetic resonance imaging (fMRI), positron emission tomography (PET), and single photon emission computed tomography (SPECT) scans and enable researchers to map changes in both brain activity and connectivity, offering a deeper understanding of addiction mechanisms and treatment outcomes. Despite the relative scarcity of literature on the neurobiological mechanisms of psychedelics in addiction, recent studies have shed light on potential pathways such as reward, inhibitory control, and stress (Hayes).

    Neuroimaging studies are invaluable in identifying biomarkers associated with substance dependence. These biomarkers serve as an objective measurement of bodily activity and, thus, aim to elucidate the mechanisms and conditions under which treatments prove effective. For instance, PET and SPECT, have enabled researchers to delve into the molecular dynamics of addiction within the living human brain. These methods have unveiled specific neuroreceptor biomarkers associated with different subclasses of addiction. Take, for example, the findings regarding dopamine receptors in alcohol and stimulant use disorder (Nutt et al., 2015), opioid receptors in cocaine (Gorelick et al., 2005), and opioid dependence (Williams et al., 2007). Such insights have not only paved the way for a deeper understanding of addiction pathology but also presented novel targets for therapeutic intervention. 

    Furthermore, by utilizing radioligands, neurotransmitter release studies have offered valuable insights into the dynamics of neurotransmission in addiction. The dopamine system has been widely implicated in addiction theory (Nutt, 2015; Zafar). In addiction, specifically, a blunted dopamine release in a brain region called the nucleus accumbens has been observed after a drug was given. When investigating the effect of psychedelics on addiction, it has been suggested that there is a potential link between psychedelics and dopamine release (Martin et al., 2024; Vollenweider et al. 1999). Yet, so far neurochemical studies have been done in non-humans and futher research is warranted (Nutt, 2015).

    Dr. Zafar discusses that advanced multimodal neuroimaging techniques are necessary to directly assess the effects of psychedelic therapy on neurotransmission and brain function in individuals with addiction. For example, multimodal imaging studies combining PET and fMRI have proposed that psychedelic therapy may lead to increases in endogenous dopamine levels in addiction disorders, potentially reflecting improved brain function and treatment outcomes. One of his future scientific endeavors will investigate using fMRI and EEG to investigate differences between pre-and post-administration with psilocybin. Ultimately, these advances ultimately pave the way for more personalized and efficient approaches to address substance dependence (Moeller).

    Addressing Challenges and Knowledge Gaps

    While the collective data on psychedelics and addiction suggests a positive trend toward reducing substance use, and cravings, and fostering abstinence compared to conventional treatments, several critical knowledge gaps and controversies persist, necessitating further exploration and clarification. Besides the limitations associated with naturalistic, observational, open-label, and animal studies, we will highlight some knowledge gaps that are critical to address when exploring psychedelics and addiction. Indeed, when one door closes, another hundred seem to open.

    One of the main remaining questions is: “What mediates the long-term effects of psychedelics?”. 

    The enduring psychological and behavioral changes observed after psychedelic use may be partly influenced by the immediate, often subjectively positive effects of 5-HT2A receptor agonists, which are occasionally described as mystical or transcendent (Bogenschutz 2015; Calder; Griffiths 2006, 2008, 2011; Johnson 2017; Rothberg; Tap; Yaden). Griffiths (2011) even found that psilocybin can affect the Big Five personality traits, typically considered stable, by increasing openness. Similar associations between greater mystical experiences and improved outcomes were observed in psychedelic-assisted therapy (PAT) for smoking cessation (Johnson, 2017). The findings suggest that psilocybin-assisted treatment has lasting impacts beyond the drug’s immediate effects, with participants ranking their psilocybin experiences as some of the most personally significant and spiritually impactful, correlating with higher smoking cessation rates (Johnson 2017).

    While these studies did not explicitly focus on spirituality, the findings raise questions about its role in the effects of psychedelic drugs on addiction. The emotion of awe is suggested as a crucial mechanism driving mystical experiences during psychedelic-assisted psychotherapy (Kan). Awe fosters feelings of interconnectedness and unity, which are central to the transformative effects of psychedelic therapy (Griffiths, 2008). Data indicates that more profound mystical experiences increase the likelihood of smoking cessation (Johnson, 2017). However, not all mystical experiences lead to lasting change, and individuals may return to their previous state. Future randomized, placebo-controlled clinical trials with multiple follow-up assessments are necessary to establish causality and determine the clinical significance of these mechanisms.

    Another remaining question concerns the use of a particular therapeutic framework when psychedelics are administered to individuals with addiction. The literature is clear that psychotherapy plays a crucial role in addiction treatment, but it remains unknown what the right amount and particular type of psychotherapeutic intervention and relapse prevention is best. Some studies indicate that group therapy alongside psychedelic use may enhance group connectedness and interpersonal understanding, potentially promoting prosocial behavior (Ponomarenko). While mystical experiences often foster profound connections with others and the universe, solo settings remain prevalent, though both solo and group therapies have shown no significant differences in mental health perceptions (Byrne).

    Another remaining question is “How do psychedelics impact the neural circuits implicated in addiction?” Answers to these questions can give insights into how to optimize the development of psychedelic-assisted therapies. Psychedelics may disrupt networks associated with addiction and enhance connectivity across the brain, fostering neuroplasticity and facilitating the relearning of behaviors (Carhart-Harris; Calder; Nutt 2023; online event; Tap). However, understanding these neuroplasticity mechanisms remains limited, with studies primarily conducted on animal models and cell lines (Calder)

    Become a member if you would like to know the details of the past online seminar about psychedelics and addiction!

    Conclusion 

    In conclusion, the field of addiction treatment is undergoing a profound transformation with the exploration of psychedelic therapy. Early research indicates that psychedelics like psilocybin and LSD show a positive trend in reducing addictive behaviors, supported by both historical and somewhat by modern clinical trials. By leveraging cutting-edge techniques, neuroimaging studies, researchers can elucidate the underlying mechanisms of psychedelic interventions and tailor treatments to individual needs. Despite the promising data, methodological inconsistencies and knowledge gaps remain, necessitating further rigorous research. Looking ahead, the future of psychedelics and addiction holds some promise, fueled by groundbreaking research, innovative treatment modalities, and a growing understanding of the complex interplay between neuroscience, psychology, and pharmacology. 

    By Gwendolyn Drossaert


    Become a member to get access to recordings of past and upcoming live online events with leading experts in psychedelic research and therapy.

    References

    1. Belouin, S. J., & Henningfield, J. E. (2018). Psychedelics: Where we are now, why we got here, what we must do. Neuropharmacology, 142, 7-19.
    2. Bogenschutz, M. P., Forcehimes, A. A., Pommy, J. A., Wilcox, C. E., Barbosa, P. C., & Strassman, R. J. (2015). Psilocybin-assisted treatment for alcohol dependence: a proof-of-concept study. Journal of psychopharmacology, 29(3), 289-299.
    3. Bogenschutz, M. P., Ross, S., Bhatt, S., Baron, T., Forcehimes, A. A., Laska, E., … & Worth, L. (2022). Percentage of heavy drinking days following psilocybin-assisted psychotherapy vs placebo in the treatment of adult patients with alcohol use disorder: a randomized clinical trial. JAMA psychiatry, 79(10), 953-962.
    4. Byrne, K. J., Lindsay, S., Baker, N., Schmutz, C., & Lewis, B. (2023). In naturalistic psychedelic use, group use is common and acceptable. Journal of Psychedelic Studies, 7(2), 100-113.
    5. Carhart-Harris, R. L., & Nutt, D. J. (2017). Serotonin and brain function: a tale of two receptors. Journal of psychopharmacology, 31(9), 1091-1120.
    6. Cahill, K., Stevens, S., & Lancaster, T. (2014). Pharmacological treatments for smoking cessation. Jama, 311(2), 193-194.
    7. Calder, A. E., & Hasler, G. (2023). Towards an understanding of psychedelic-induced neuroplasticity. Neuropsychopharmacology, 48(1), 104-112.
    8. Cameron, L. P., Tombari, R. J., Lu, J., Pell, A. J., Hurley, Z. Q., Ehinger, Y., … & Olson, D. E. (2021). A non-hallucinogenic psychedelic analogue with therapeutic potential. Nature, 589(7842), 474-479.
    9. Griffiths, R. R., Johnson, M. W., Richards, W. A., Richards, B. D., McCann, U., & Jesse, R. (2011). Psilocybin occasioned mystical-type experiences: immediate and persisting dose-related effects. Psychopharmacology, 218, 649-665.
    10. Griffiths, R. R., Richards, W. A., Johnson, M. W., McCann, U. D., & Jesse, R. (2008). Mystical-type experiences occasioned by psilocybin mediate the attribution of personal meaning and spiritual significance 14 months later. Journal of psychopharmacology, 22(6), 621-632.
    11. Griffiths, R. R., Richards, W. A., McCann, U., & Jesse, R. (2006). Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance. Psychopharmacology, 187, 268-283.
    12. Grinspoon, L., & Bakalar, J. B. (1979). Psychedelic drugs reconsidered (Vol. 168, pp. 163-166). New York: Basic Books.
    13. Hayes, A., Herlinger, K., Paterson, L., & Lingford-Hughes, A. (2020). The neurobiology of substance use and addiction: evidence from neuroimaging and relevance to treatment. BJPsych Advances, 26(6), 367-378.
    14. Johnson, M. W., Garcia-Romeu, A., & Griffiths, R. R. (2017). Long-term follow-up of psilocybin-facilitated smoking cessation. The American journal of drug and alcohol abuse, 43(1), 55-60.
    15. Gorelick, D. A., Kim, Y. K., Bencherif, B., Boyd, S. J., Nelson, R., Copersino, M., … & Frost, J. J. (2005). Imaging brain mu-opioid receptors in abstinent cocaine users: time course and relation to cocaine craving. Biological psychiatry, 57(12), 1573-1582.
    16. 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.
    17. Lingford-Hughes, A., Reid, A. G., Myers, J., Feeney, A., Hammers, A., Taylor, L. G., … & Nutt, D. J. (2012). A [11C] Ro15 4513 PET study suggests that alcohol dependence in man is associated with reduced α5 benzodiazepine receptors in limbic regions. Journal of Psychopharmacology, 26(2), 273-281.
    18. Martin, D. A., Delgado, A., & Calu, D. J. (2024). The psychedelic, DOI, increases dopamine release in nucleus accumbens to predictable rewards and reward cues. bioRxiv, 2024-03.
    19. Miller, W. R., & C’de Baca, J. (2001). Quantum change: When epiphanies and sudden insights transform ordinary lives. Guilford Press.
    20. Moeller, S. J., & Paulus, M. P. (2018). Toward biomarkers of the addicted human brain: Using neuroimaging to predict relapse and sustained abstinence in substance use disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 80, 143-154.
    21. Nutt, D. J., Lingford-Hughes, A., Erritzoe, D., & Stokes, P. R. (2015). The dopamine theory of addiction: 40 years of highs and lows. Nature Reviews Neuroscience, 16(5), 305-312.
    22. Nutt, D., Spriggs, M., & Erritzoe, D. (2023). Psychedelics therapeutics: what we know, what we think, and what we need to research. Neuropharmacology, 223, 109257.
    23. Ponomarenko, P., Seragnoli, F., Calder, A., Oehen, P., & Hasler, G. (2023). Can psychedelics enhance group psychotherapy? A discussion on the therapeutic factors. Journal of psychopharmacology, 37(7), 660-678.
    24. Rothberg, R. L., Azhari, N., Haug, N. A., & Dakwar, E. (2021). Mystical-type experiences occasioned by ketamine mediate its impact on at-risk drinking: Results from a randomized, controlled trial. Journal of Psychopharmacology, 35(2), 150-158.
    25. Rucker, J. J., Iliff, J., & Nutt, D. J. (2018). Psychiatry & the psychedelic drugs. Past, present & future. Neuropharmacology, 142, 200-218.
    26. Savage, C., & McCabe, O. L. (1973). Residential psychedelic (LSD) therapy for the narcotic addict: a controlled study. Archives of general psychiatry, 28(6), 808-814.
    27. Stokes, P. R., Benecke, A., Myers, J., Erritzoe, D., Watson, B. J., Kalk, N., … & Lingford-Hughes, A. R. (2013). History of cigarette smoking is associated with higher limbic GABAA receptor availability. Neuroimage, 69, 70-77.
    28. Vollenweider, F. X., Vontobel, P., Hell, D., & Leenders, K. L. (1999). 5-HT modulation of dopamine release in basal ganglia in psilocybin-induced psychosis in man—a PET study with [11C] raclopride. Neuropsychopharmacology, 20(5), 424-433.
    29. Yaden, D. B., Berghella, A. P., Regier, P. S., Garcia-Romeu, A., Johnson, M. W., & Hendricks, P. S. (2021). Classic psychedelics in the treatment of substance use disorder: potential synergies with twelve-step programs. International Journal of Drug Policy, 98, 103380.
    30. Williams, T. M., Daglish, M. R., Lingford-Hughes, A., Taylor, L. G., Hammers, A., Brooks, D. J., … & Nutt, D. J. (2007). Brain opioid receptor binding in early abstinence from opioid dependence: positron emission tomography study. The British Journal of Psychiatry, 191(1), 63-69.
    31. Online event
    32. Tap, S. C. (2024). The potential of 5‐methoxy‐N, N‐dimethyltryptamine in the treatment of alcohol use disorder: A first look at therapeutic mechanisms of action. Addiction Biology, 29(4), e13386.
    33. Zafar, R., Siegel, M., Harding, R., Barba, T., Agnorelli, C., Suseelan, S., … & Erritzoe, D. (2023). Psychedelic therapy in the treatment of addiction: the past, present and future. Frontiers in Psychiatry, 14, 1183740.

    Dutch Minister Pia Dijkstra to Open Interdisciplinary Conference on Psychedelic Research

    November 6, 2024 / Policy, Law & Economics / By
    pia dijkstra dutch minister of healthcare

    Dutch Minister Pia Dijkstra to Open Interdisciplinary Conference on Psychedelic Research

    The Dutch minister of Medical Care, Pia Dijkstra (D66), will inaugurate the sixth edition of the Interdisciplinary Conference on Psychedelic Research (ICPR) on June 6th. We are excited about the growing support by the Dutch government for psychedelic-assisted therapy, a field gaining significant momentum across Europe.

    pia dijkstra dutch minister of healthcare

    Previously held by Ernst Kuipers, the role of Minister of Medical Care has passed to Dijkstra, who continues the support for research into the therapeutic potential of psychedelics.

    Under Kuipers, the Dutch government had already shown a commitment to leading in this innovative area. Kuipers stated that the Netherlands should be at the forefront of psychedelic research. He also contributed to a report commissioned by the Dutch research funding organisation ZonMw that offered a first glimpse of the potential psychedelic research landscape in the Netherlands. Lastly, he allocated 1.6 million euros of funding to psychedelic research.

    The shift in leadership, while maintaining support for psychedelic research, underscores a broader acceptance and interest in psychedelic research among politicians, thanks to increasing evidence of its effectiveness. The upcoming ICPR and Pathways to Access Summit promises to further explore these possibilities, continuing the Netherlands’ influential role in this important field of medicine.

    For more insights into psychedelic-assisted therapy and the critical perspective of OPEN’s director Joost Breeksema & Ernst Kuipers, check out the video below. (in DUTCH)

    EUROPEAN SUPPORT

    You might wonder whether this support for psychedelic-assisted therapy is only reserved to the small and progressive country of the Netherlands. But this is certainly not the case. In the past year, support has been gaining momentum and is expanding towards the scale of European support. 

    Recently, Joost Breeksema, the executive director of the OPEN Foundation chaired the meeting at the European Parliament to launch PsyPal – a 6.5 million EU-funded multi-site research consortium with over 19 different partners, including OPEN Foundation, that seeks to alleviate suffering from existential distress in patients with a incurable illness through the use of psilocybin.

    Only a few days later, Breeksema participated in a two-day workshop at the European Medicines Agency to explore the views of stakeholders and experts on the therapeutic potential of psychedelics, providing further clarity on defining the safe and effective use of psychedelics, informing on regulatory challenges associated with the development and evaluation of psychedelic medicines, and defining areas for which further regulatory guidance is required.

    towards safe and responsible integration of psychedelic-assisted therapy

    As thrilling as it is to witness the rapidly increasing support for psychedelic-assisted therapy, a critical perspective and patience are the keys to shaping a future where psychedelic therapy can be integrated safely and responsibly for the benefit of science, healthcare and society.

    For the moment, we look forward to welcoming you to the sixth edition of ICPR, which will be held from June 6 to June 8 at the PHIL in Haarlem, the Netherlands.

    co-create the future pathways to access in Europe

    The full-day Pathways to Access Summit (Paths) convenes key stakeholders from Europe and beyond to explore the opportunities and challenges around the development, approval, and eventual integration of psychedelic medicines into mainstream European health care. Join us in co-creating the future of psychedelic medicine.

    Beyond Physics: Exploring Consciousness with Bernardo Kastrup’s Analytical Idealism

    October 22, 2024 / Philosophy & Religious Studies, Scienitific Discipline / By

    Feature image by Alina Grubnyak on Unsplash

    “Life is the extrinsic appearance of a dissociative process in a universal consciousness.”

    -Bernardo Kastrup

     

    Meet Bernardo Kastrup

     

    bernardo kastrup live online event with question and answer
    Recording will become available to OPEN members

    Are you ready to flip the script of reality and dive deep into a world that is purely mental and not so much physical? Meet the founder of Essentia Foundation , PhD. Bernardo Kastrup.  Blending neuroscience and philosophy, his captivating ideas are embedded in the concept of analytical idealism. Brace yourself for a mind-bending journey beyond the confines of conventional thought. Bernardo Kastrup lectured and joined the conversation at an online community event at OPEN Foundation. Discover upcoming events here. At the bottom of this post, you can find an in-depth interview with Bernardo Kastrup, OPEN Foundation and Drug Reporter.

    The next lines aim to give you a general understanding of his ideas about the reality of the mind and eventually bridge analytical idealism with psychedelic experiences.

    Does our perception align with reality?

    Let’s start by taking your eyes away from the screen and observing what you perceive in the world around you. The wall in your room, the trees in the park, the clouds in the sky or the sounds of the birds. Intuitively, we believe that what we perceive accurately reflects the world outside of us – a mirrored image of the external world in our consciousness.

    If this were true – we would have a fully transparent window into the world outside – we would all drown in what the analytical idealist Bernardo Kastrup calls “an entropic soup”.  To understand that metaphor it is important to grasp the general concept of entropy.

    What is Entropy?

    Entropy is a fundamental concept in thermodynamics that is often described as the measure of randomness or disorder of a system. Imagine a brand new deck of cards that has never been shuffled. This represents low entropy because there is not a lot of randomness. Now think about shuffling this deck of cards. We created a high entropic state that is not very organized but rather chaotic. Let us keep this concept in mind when we dive deeper into the concept of analytical idealism.

    “The entropic soup”:  the world looks nothing like what we perceive

    From the perspective of “the entropic soup”, the world around us is highly entropic because it’s full of complexity, randomness, and disorder. Think about all the diverse and chaotic phenomena we encounter every day: from the unpredictable weather patterns to the bustling traffic on city streets, to the entangled interactions of living organisms in highly complex ecosystems. According to the second law of thermodynamics, if we perceive the world as it is, including the immense chaos and disorder, our brains would all drown in a hot, entropic soup. Consequently, through evolution, our brains learn to make sense of the world by using a simplified “user interface” or a “dashboard” that can help us navigate and make sense of a highly chaotic environment. Like a dashboard in a pilot’s cockpit that depicts the wind strength by representing it on a dial with an arrow (see picture below). The dial does not show the wind itself but is rather a representation of the wind. Bernardo states that “the world in itself looks nothing like what we perceive. We are merely using a virtual user interface to make sense of the chaos outside. More about that later. First, we will investigate mainstream ideas of consciousness and the world.

    Pilot making sense of the world with the help of a dashboard.

    Foto by William Topa, unsplash

     

    The limitation of physicalism: The hard problem of consciousness

    According to physicalism, all there is can be described in quantities. Physical relations and matter are the basis of everything. Therefore, the reality of the mind and the world itself – in the eyes of a physicalist  – can be fully explained by abstract quantitative mathematical relationships. Hence, the mind including all of its rich qualities, such as the experience of rain on your skin or the smell of freshly baked cookies, is caused by physical brain activity.   

    However, Bernado Kastup does not agree with this view and states “There is something very wrong with this story that brain activity generates conscious experience.” Indeed, cognitive neuroscientists have still not solved the “hard problem of consciousness” (as defined by David Chalmers). The question remains how can a purely quantitative, physical entity give rise to complex qualitative experiences?

    Bernardo suggests we imagine a scenario where a scientist has all the knowledge about the brain’s structure, its neurons, and how they interact. They know everything about brain activity when a person sees the colour red – the firing of neurons, the release of chemicals, and so on. However, no matter how much they understand about the brain’s physical processes, they still can’t explain why seeing the color red feels the way it does to the person experiencing it. This inability to explain subjective experience purely in terms of physical processes is what constitutes the hard problem of consciousness.

    Perhaps it is necessary to shift our world paradigm to allow answers to this problem. One proposed solution may be Bernardo Kastrup’s analytical idealism.

    What is analytical idealism?

    Contrary to physicalism, in the philosophical perspective of idealism, reality is fundamentally mental or dependent on consciousness. In other words, the external world and its phenomena are products of mental constructs or perceptions. Similarly, analytical idealism is embedded in idealism and posits that the essence of the universe is an “intrinsic view”, suggesting that reality fundamentally resides in subjective experience. Analytical Idealism  is rooted in and driven by post-enlightenment principles such as conceptual parsimony, coherence, internal logical coherence, explanatory capability, and empirical sufficiency.

    How does analytical idealism explain consciousness and reality?

    While physicalism states that brain activity causes experience, analytical idealism argues that brain activity is just the depiction of experience. To understand Kastrup’s argument, one needs to take a few steps back and briefly review the basic assumptions that analytical idealism is based on.

    Kastrup emphasizes that there are three empirical givens that we can be fully certain about:

     1) There is experience.

    Before we start to theorize, all we have is experience.  

    2) Brain function is a perceptual experience

    For example, a neurologist who perceives the image created with a brain scanner.

    3) The brain is made of what we colloquially call and perceive as “matter”.

    Importantly, whatever we call matter, whatever it is, it underlies both the brain and the universe and thus creates space for a kinship between them. 

    Building on these statements, analytical idealism states that brain function is what one’s inner conscious life looks like when it is observed by a neuroscientist through a brain scanner. Consequently, Bernardo Kastrup emphasizes that brain function does not generate a conscious inner life, because this leads to the “hard problem of consciousness”. Rather, he elaborates that conscious inner life is intrinsic; it is the essence that can be observed from an outside perspective with the help of a brain scanner. In other words, a brain scan is merely the representation of conscious inner life, but it is not consciousness itself.

    The universal consciousness with multiple personalities

    Bernardo Kastrup’s analytical idealism conceptualizes and builds upon one universal consciousness. To introduce this idea, the philosopher often uses the analogy of Dissociative Identity Disorder (DID). DID is a psychiatric condition that involves the presence of two or more distinct personality states (also known as “alters”) within the same individual. Using this analogy, he argues that we are dissociated alters of universal consciousness. Because of dissociation, we believe to be individual minds. With that being stated, all that lies beyond our dissociative boundary constitutes a broader “universal consciousness” and thus is mental by itself.

    How do we make sense of the world according to analytical idealism?

    One important concept in the theory of analytical idealism is “impingement”. Imagine you had a stressful fight with your housemate, partner or friend just before work. During work, you have to function, which is why your mind automatically compartmentalizes the stressful event and “parks it” to set it aside. According to Kastrup, this is a kind of “deliberate light dissociation. Your mind as a whole did not stop to feel the emotions, they are just more in the background, dissociated from your executive ego. However, you notice that you are easily irritable or disorganized during your work. The stressful event can still influence the ego despite the creation of a dissociative boundary. In other words, the mind outside of the boundary impinges across the dissociative boundary on the ego within.

    What happens outside of our dissociative boundary are ideas and emotions that impinge on our mental dissociative boundary and result in us perceiving the world outside. Kastrup explains that the dissociative boundary “forms a screen on which outside mentation impinges, or is projected as perceptions”.

    The dashboard in the pilot’s cockpit is the extrinsic appearance of the world outside as represented by dials measuring wind, temperature, etc. Similarly, the “perception is the extrinsic appearance, as represented in an alter`s dashboard of dials, of the ideas and emotions in universal consciousness”.

    Model displaying how we are all dissociated alters with dissociative boundaries of a larger, shared universal consciousness.

    Created with biorender.

    How do neural correlates of psychedelics substantiate the argument of analytical idealism?

    Psychedelic experiences are often perceived as one of the most profound experiences of a user’s life. People often report that psychedelics induce a rich altered state of consciousness with enhanced senses and deep insights. Interestingly, the intense psychedelic experience does not correlate with increased brain activity, but neuroscientists show that rather the opposite holds! Psychedelics reduce overall brain activity. Especially, from the perspective of physicalism this is surprising. The argument of physicalism assumes that brain activation is the cause of subjective experience, so how is it possible that lower brain activity can give space for an enriched experience?

    Psychedelics reduce dissociation and increase entropy

    Kastrup explains that the reduced brain activity, induced by psychedelic substances, represents reduced dissociation. In other words, brain activity measured by brain scans is a picture of this dissociation process. Psychedelics reduce dissociation which correlates with a richer, more intense and profound experience due to the alleviation of dissociation itself. By reduction of dissociation, the dissociative boundary becomes more permeable, which allows the transpassing of elements from beyond the boundary to reach the alter within. We experience trance, the trespassing of mental elements across dissociative boundaries, while our brain activity is largely reduced.

    Model displaying that psychedelics (here psilocybin-containing mushrooms) can make the dissociative boundary more permeable.

    Perhaps, as Kastrup suggests, the increased connection to the world outside and other people, as perceived during a psychedelic experience may reflect the reduction of dissociation, which brings us closer to “universal consciousness” and the other alters by allowing the crossing of mental entities from beyond the boundary that surrounds our alter.

    Bernardo argues that the end of life is the end of the dissociative process. By reducing dissociation we may get into a similar state like death. If psychedelics reduce dissociation, this should elicit an experience similar to death. Indeed, psychedelics can induce the experience of “ego death”  (dissolution of the sense of self) and have been found to share similarities with near-death experiences, which is consistent with Kastrups theory. This observation may further substantiate this theory.

    Conclusion

    In conclusion, Bernardo Kastrup’s analytical idealism presents a thought-provoking perspective on the nature of reality and consciousness. By challenging the traditional paradigms of physicalism (and others), Kastrup offers a framework where consciousness is not merely an emergent property of brain activity but is fundamental to the fabric of existence. Through concepts like dissociation and impingement, he elucidates how our perception of the world is shaped by our mental processes, bridging neuroscience with philosophy. Furthermore, Kastrup’s exploration of psychedelic experiences provides intriguing insights into the relationship between consciousness, brain function, and the dissolution of ego boundaries. Overall, Kastrup’s ideas invite us to reconsider our understanding of reality, consciousness, and the interconnectedness of the universe in a manner that transcends conventional thought.

     


    Previous online event hosted by OPEN Foundation. See upcoming events here. Subscribe to our newsletter to get updated on events.

    Interview with Bernardo Kastrup, PhD at ICPR 2022, hosted by OPEN Foundation.

     

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