Performance Enhancing Drugs for Talk Therapy

Last year two of my clients showed up to therapy high on marijuana. I spotted their red puffing eyes from a mile off and asked directly (hopefully non-judgementally) if they were high. I can’t really go into the details of why they were high for therapy, but both expressed a reason along the lines that they thought it would improve the therapy experience.

Psychoactives for Therapy

The United States Food and Drug Administration (FDA) panel met on Tuesday last week to discuss the use of MDMA (Methyl​enedioxy​methamphetamine, street name Ecstasy) as an adjunct treatment for Post Traumatic Stress Disorder (PTSD). This meeting was greeted internationally as a new high point in the advocacy of medical uses for psychoactive drugs.

The drug manufacturer, Lykos Therapeutics, proposed MDMA treatment on the basis of research which compared patients with PTSD who were randomly assigned to low, high or no-dose MDMA groups. All patients received concurrent psychological therapy. The researchers found that about half of the MDMA patients no longer met criteria for PTSD after the trial.

Australia has led the way with the use of illicit drugs for the treatment of PTSD. Last July, the Therapeutic Goods Administration (TGA) approved the use of MDMA and psylocibin (the hallucinogenic chemical in magic mushrooms) for treatment of PTSD in combination with talk therapy.

The use of psycho-active drugs with therapy has a long history. In the 1950’s Alcoholics Anonymous (AA) founder Bill W experimented with lysergic acid (LSD) and advocated it as a therapeutic method for alcoholics to reduce ego barriers and to get in touch with a higher power. Bill W received pushback from his organisation, and subsequently left its governing body, probably in part to continue his experimentation.

In the 1960’s the popularity of LSD exploded. Harvard University psychologist, Timothy Leary, was the most ardent advocate of the use of LSD for therapeutic methods. Leary conducted the Concord Prison Experiment, in which soon-to-be-released prisoners were given psylocibin and group therapy. The results of the experiment revealed that recidivism rates of these prisoners dropped by more than half.

Leary was fired from Harvard for his drug advocacy, and he ceased serious scientific work. In his post-academic life, he became a counter-cultural, anti-establishment hero to the hippy movement. The connection between psychedelic use and the counter cultural movement of the time alarmed mainstream society. As the hippy moment came to a crashing end in the early 70’s there was an increased concern about the impact of hallucinogens on mental health and societal disruption.

From the 1970’s onward research and interest in psychedelics as treatments ebbed to a nadir.

Return of Hallucinogens

The rise of the internet has led to a renaissance for psychedelic substances. Tech entrepreneurs such as Steve Jobs openly spoken about their psychedelic experiences. Uber popular podcaster, Joe Rogan, is a current advocate of the use of psychedelics as mind-opening substances.

When medicinal cannabis became legal in the state of California in 1996, a door was reopened for illicit drugs as treatment. Since the 1990’s, many jurisdictions around the world have legalised marijuana, usually firstly medicinally, then subsequently for general use. Cannabis is prescribed for chronic pain conditions which often have a significant psychological overlap. Anecdotally many people have reported the benefit of cannabis for PTSD and other psychological conditions, despite the evidence not agreeing with this.

Greater acceptance of cannabis has paved the way for the acceptance of psychedelic substances. Researchers in reputable institutions around the world are now trialling MDMA, LSD and psylocibin to explore benefits for psychological uses.

So, how did the MDMA meeting on Tuesday go?

The FDA panel voted 9-2 that the MDMA/talk therapy treatment is not effective for PTSD. They also voted 10-1 that any benefits of the MDMA/Talk therapy don’t outweigh its risks. This outcome was backed by the American Psychiatric Society. Serious issues were raised with the research methods and with the generalisability of the outcomes in community settings.

So, a roadblock for now. But no doubt US researchers will be watching Australia to see how our experiment with these powerful psychoactive substances goes.

Maybe we will forge ahead to a brave new world of psychedelic-assisted therapy. Or maybe history will repeat with a return to the censorious 70’s-90’s.

Science and Drugs Don’t Mix?

Why do we keep going down this path of seeking to medicalise psychedelic or psychoactive substances?

Obviously making money is behind much of the drive to validate these chemical-based treatments. Pharmaceutical companies stand to make a motza, especially if (or more likely when) these drugs take the same path as cannabis to full legalisation.

A less cynical reason is that many individuals have had profound, awe-inspiring experiences when high. They feel helped by the drugs, and they want others to be helped too. People like Bill W, Timothy Leary and Joe Rogan, want to spread the good news of psychedelics to the world.

But Bill W and Timothy Leary eventually ceased trying to integrate psychedelics into a scientific paradigm. And maybe these drugs just don’t fit in the reductionistic, “objective” worldview of scientism. My own belief about psychoactive drugs is that they are very powerful, and potentially life changing. But far from medical approval giving them their due respect, I feel it trivialises them.

Many peoples around the world have made space for hallucinogenic or euphoria-inducing substances within their culture. Usually, these societies integrate these substances into their religious/spiritual understanding of themselves and the world. A shaman often serves as a guide to shepherd the user through their experience.

In place of the shaman, the modern world inserts the white-coated doctor with his materialistic, scientific philosophy. And these substances will probably work just fine as a treatment with the sort of person who wants their ego dissolved in the presence of a high priest of science. But for many, a medicalised setting just won’t do for the divine.

These substances are most likely to be effective with the very people who eagerly sign up for the research trials. People who are open to new experiences, and who have high levels of trust toward the treatment provider and to the treatment itself. To generalise this to the general public would be a mistake.

So, what about my clients who come to therapy high?

They are looking for an ego-dissolving, transcendent experience in the wrong place. The place for these experiences is a spiritual one. Psychologists work out of the medical model. We can work with spiritual people, but we can’t and shouldn’t facilitate contact with the divine.

See your priest or shaman for that.

Speak Your Mind


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