Increasing use of Psychadelic Drugs in Therapy. Healthy? Useful? I'm not so sure.
I would like to share some controversial information on the increasing acceptance of psychadelic drugs in the treatment of mental disorders and mental disturbance, and the research indicating possible benefits, research being popularized by the media. I'm not so sure about this at all, and I will present my own opinion toward the end of this blog post (it's clearly labeled). So, if you don't have more than a few minutes to read this, scroll down for that, and for hyperlinks to the articles that inspired me to write this post.
Psychiatric medications have been in use for many years, and are no longer been confined to use in mental institutions, or for people who have severe mental illnesses. Prozac in particular changed the way we look at psychiatric medication, and normalized its use as something taken for a "chemical imbalance" leading to depression or mood instability (although this is sometimes a bad explanation).
The acceptance of psych meds is more than widespread. Now, 25% of American women take some sort of psychiatric medication, although most of them are on small doses of antidepressants or antianxiety medications. Have you noticed that even the language used for medical psychiatric treatment has changed? We used to call them "drugs," but now we call them "medications."
However, illegal drugs are still quite stigmatized, usually for good reason. They don't just affect the user. Meth destroys lives and families. Heroin overdose deaths, as well as those from cocaine laced with fentanyl, are an epidemic in my region. Many children are in foster care because of a parent's drug use (even creating the term "meth orphans"). Having a parent who is a drug user is classified in trauma research as an "Adverse Childhood Experience" (ACE) and it has the same effect on the child's life outcomes as sexual abuse or physical abuse. The ACE study is so well-known and accepted, with regard to this and other conclusions, that I don't even need to quote it here. You can Google it if you want.
But what if some currently illegal drugs can change lives for the better? Should we stigmatize this? Many legal medications have ruined lives even when prescribed correctly. Let's skip the role of well-meaning doctors in the opioid epidemic, and move straight to mental health. For instance, many of my trauma clients have been placed on benzodiazepines like Valium, Klonapin, and Xanax due to anxious symptoms. However, these drugs are addictive, and truly a band-aid fix compared to treating the trauma with a research-proven trauma therapy, for instance EMDR (which I use daily) or Prolonged Exposure (which I respect). What if research proves that some currently illegal drugs can assist and strengthen the outcomes of proper therapy, and are more effective or safer than addictive drugs that happen to be legal? I would prefer that my clients take psych medications only if they enable participation in therapy, but this isn't to say I am against their use at all. Very often, a more stable client can participate in therapy much more effectively. The reverse is true, and doctors often miss the boat here: even with mental illnesses that will likely need medication for life (e.g. schizophrenia, bipolar I and II), therapy is indicated for good outcomes.
In light of this, let me ask a hypothetical question. Note: I am not saying at all that I believe in the clinical use of currently illegal drugs in a mental health setting. But let's ask. Why are ineffective and sometimes harmful medications accepted for the treatment of PTSD, when some research is showing that, when used by a trained professional in a controlled setting, some currently illegal drugs are effective and safe in treating mental illness, including PTSD? As I said above, I'm not so sure about this regardless of the research, and you probably aren't either. Research is often performed by people who have a vested interest in the outcome they want, and research is rarely replicated now. So let's explore it some more.
There is certainly a black-and-white area. Here is an example. Meth, crack, heroin, cocaine--these things are never going to help anyone. Cocaine is used as a dental anesthetic, but that's about it. I am even doubtful about "medical marijuana," as I have seen so many kids throw their lives away, with marijuana use as a big part of that. You may disagree. But here's a better example. Many of my clients, usually clients with PTSD and childhood trauma, use marijuana on a daily basis--not to get high, and not because they want to, but because they have tried dozens of medications prescribed by doctors, and nothing else reduces their symptoms but the marijuana. However, these clients, when I ask them, report that they would much rather not have to use marijuana to "cope" with symptoms, if they could be cured. Effective trauma therapies can cure PTSD and developmental trauma--completely. Symptom reduction is not a bad thing, but why not aim higher, for a cure?
Here comes the grey area. There is a lot of research now into the use of LSD, MDMA ("ecstasy"), and psilocybin (the chemical in "magic mushrooms") for therapeutic purposes, such as dealing with grief, end-of-life issues, PTSD, and other disturbances. Some research suggests that their use can not only help with coping, but can be part of a total cure. None of that research has shown negative, unhelpful, or dangerous results. Let's take it apart, because as I mentioned, I'm still not sure. As I said, I am very skeptical of research, especially when it involves controversial topics and isn't replicated.
To be even more clear: understand that it is very well-established that the outcome of scientific research is most accurately predicted by the theoretical orientation of the researchers!!! It can even be an unconscious, unintentional bias. And rarely are research studies repeated by others. Verifying other scientists' research by trying to replicate their results used to be considered a noble and respectable task. But everyone wants something that will put them in the news, because that's what gets the grant money. Also, there's a quote most people know: "There are lies, [darn] lies, and statistics." Statistics can be bent to show mostly anything--I know this as a chemistry minor in college.
The primary article inspiring this blog post (link at bottom) is from Denver, CO, where psychadelics are legal for personal use, but still illegal for therapeutic use (Odd, right? Legal in an environment where there is no control). I have a lot of connections in Oregon, where I was trained in EMDR both for Certification (two-year training after the 4-month Basic Training) and through Approved Consultant (another two years, to take a teaching role). In Oregon, therapists can use psychadelics, and I therefore have some direct stories about their use in therapy. So let's talk about Oregon.
In Oregon, psychadelics (usually psilocybin, I am told) are used to facilitate EMDR trauma therapy, by helping clients who are either having a hard time bringing up their trauma at all, or who are having a hard time with major anxiety when bringing up their trauma. As well, psychadelics are being used to treat rare traumatic-origin dissociative disorders that make EMDR therapy very difficult and very long. I have had extensive training in dealing with all of these issues and treat these the normal way. What are the risks and benefits of making things easier (possibly) with psychadelics?
Well, it's usually presented in the news as "no risks," and "big benefits"--just like "medical marijuana," even though there are only a few real scientific studies on any of it, the majority of evidence being anecdotal--personal stories reported by therapists or doctors. Is it "clickbait"? What's the real story?
MY OWN OPINION (and links to the articles)
We can't know the full story, as proved above. What I believe is that even if there are no clinical risks demonstrated, real science uses long-term studies to examine the outcomes over 10 or 20 years. Do the results last? Are there risks later in life? We don't know. I am not making a political statement, but like the COVID-19 vaccine, the research on psychadelics (even on pregnant women) has been rushed through, and the legalization of psychadelics for therapy seems inevitable in states that progressively legalize drugs. While this is perfectly understandable for the COVID-19 vaccine, with so many deaths, it's still not real science in either case. When there are perfectly good therapies available for treating every disorder mentioned in these articles, why use psychadelics based on just a few studies, especially with no long-term studies?
While I am a fan of psychiatric medications that improve therapy outcomes, such as mood stabilizers to increase the effectiveness of trauma therapy, I only approve of medications that have been thoroughly studied, regardless of "approval." Thalidomide and Accutane were approved quickly and turned out to have terrible birth defects with children of pregnant women. This does not seem to be true of psychadelics, but I do have a family member who by long-term use of the psychadelic MDMA (ecstasy), now has incurable blackouts. He can't have a job. Yet MDMA is currently a major subject of study for use in therapy.
I'm not YET saying that I disagree with the use of mental health psychadelics, but I'm dead against it until I see real science used to prove the validity of beneficial effects, or safety, especially long-term safety. And these results need to be replicated multiple times. That's real science. That's why your flu vaccine is safe.
Also, I have read often that the use of psychadelics in "curing" trauma disorders has simply desensitized clients to their PTSD. EMDR, however, which I use, goes far beyond this, to address the core beliefs involved in trauma, entirely curing the trauma by eliminating triggers, and leaving the client with a feeling of personal achievement and great strength. Why use desensitization with psychadelics when there is a research-established method for PTSD (or another disorder) that has been proven to work perfectly well without them, in the case of EMDR, by over 44 (Forty Four!!!) studies. Many of these are long-term, establishing the effectiveness of the method, and this is true with other treatments also.
At the end of the day, it's a political choice if certain drugs are legal for personal or clinical use (please vote), but my opinion is that clients should question any method that is not yet proven to be safe and effective in the long-term, especially when working with drugs that are currently illegal for a reason in most states.
Links to the articles (click on them to see them):