Most smokers can attest to always looking to kick the habit, and now research is exploring the linkage between psilocybin and smoking cessation. Johns Hopkins researchers report 15 study participants taking psilocybin, the active hallucinogenic agent in “magic mushrooms.” achieved an 80 percent abstinence rate over six months, compared to an approximate 35 percent success rate for patients taking verenicline, considered to be an effective drug for smoking cessation. In this article, we look at research into role of mystical experiences, facilitated by psilocybin, and smoking cessation.
Psilocybin-occasioned Mystical Experiences in the Treatment of Tobacco Addiction
The article below is part of Frshmind’s “Psychedelic Science Snapshot Series” where Frshminds reviews the latest in psychedelic research.
Original authors: Albert Garcia-Romeu, Roland R. Griffiths, and Matthew W. Johnson
Summarized by: Emily Fewster
History of Psychedelic Treatment for Addiction
During the 60s, classical psychedelics were explored as a potential treatment option for addiction, with most research focusing on LSD for the treatment of alcoholism. Despite early results being mixed, likely due to methodological inconsistencies, a meta-analysis of six studies found that a single dose of LSD significantly decreased alcohol misuse at the initial follow-up assessment compared to non-psychedelic control treatments (Smart et al., 1966). In Saskatchewan, Humphry Osmond and Abram Hoffer treated more than 700 individuals suffering from alcoholism using a combination of LSD and psychotherapy (Chwelos et al., 1959; Sarett et al., 1966; Dyck, 2006). Like other early researchers such as Walter Pahnke, William Richards, and Stanislav Grof, their approach emphasized the unique ability of the subjective experience induced by psychedelics, sometimes spiritual or mystical in nature, to facilitate powerful therapeutic effects (Pahnke et al., 1970; Kurland et al., 1971; Grof et al., 1973; Pahnke & Richards, 1966). Extending further than alcoholism, one study examined LSD-facilitated treatment for opioid-dependent parolees. A statistically significant difference was found in biologically verified opioid abstinence at 6 months in the inpatient LSD treatment group, compared to a treatment-as-usual outpatient control group (Savage & McCabe, 1973). Despite only the LSD group receiving residential treatment, the authors noted that the benefits may also be from the subjective experience of the drug, describing it as “cosmic, mystical, oceanic, peak, transpersonal, transcendental, etc. To the recipient they are experiences which seem to have ultimate metaphysical relevance, conversion-like experiences which, by definition, imply change” (1973). This echoes the opinions of early researchers mentioned above.
However, a lot of promising psychedelic research was halted due to the legal and financial barriers that arose during the 70s and Nixon’s “War on Drugs” campaign (Nutt et al., 2013). It was not until very recently that psychedelic research experienced a resurgence of interest. Specifically, psilocybin (the main psychoactive compound found in magic mushrooms) has been shown to be capable of triggering highly meaningful and spiritually significant experiences, with lasting positive effects (Griffiths et al., 2011; Griffiths et al., 2008; Griffiths et al., 2006; (MacLean et al., 2011). These effects have also been explored in well-prepared clinical populations to aid in smoking cessation, with one open-label pilot study finding that 12 of 15 participants (80%) demonstrated biologically verified smoking abstinence at a 6-month follow-up (Johnson et al., 2014). Though these results should be interpreted with caution due to the fact researchers and participants were not blind to drug treatment conditions and no control group was employed, it should also be noted that the most successful current treatments generally show far less efficacy, with typical abstinence rates below 35% at 6 months (Cahill et al., 2014; Mottillo et al., 2008).
Smoking Cessation with Psilocybin
The present article provides a secondary analysis of data from the previously mentioned smoking cessation study (Johnson et al., 2014) in order to better characterize the mystical-type experiences elicited by psilocybin. The purpose of this is to explore potential psychological mechanisms mediating treatment outcomes in psilocybin-facilitated addiction treatment. The fifteen participants (10 males) were physically and psychiatrically healthy adult smokers who were not regularly taking any psychotropic medications, who met minimum daily smoking criteria (≥10 cigarettes/day), who had multiple past unsuccessful quit attempts, and still desired to quit smoking. On average, participants reported smoking 19 cigarettes/day for
31 years, with an average 6 previous lifetime quit attempts. They then met weekly for a 15-week smoking cessation treatment intervention, with moderate (20mg/70kg) and high (30mg/70kg) dose psilocybin sessions occurring in weeks 5, and 7 respectively, and an optional third high dose session in week 13. This treatment intervention included cognitive-behavioral therapy (CBT) based largely on the Quit for Life program (Marks & Sykes, 2002; Sykes & Marks, 2001), mindfulness training ( Brewer et al., 2011), and guided imagery exercises (Zernig et al., 2008). The Target-Quit Date (TQD) was set for week 5 of treatment so that it was concurrent with the first psilocybin session. Afterwards, study treatment facilitators met weekly with participants to discuss psilocybin session experiences, encourage the use of CBT techniques, and to provide support for smoking abstinence. Biological samples were collected at each weekly meeting to assess smoking status, and psychological measures were administered at multiple points throughout the intervention and at 6-month follow-up (see below).
Data Collection: Measuring Smoking Status
Smoking Biomarkers: Two biomarkers of recent smoking were used to assess participants’ smoking status weekly from study intake (week 1) through end of treatment (week 15), and again at 6-month follow-up. Breath carbon monoxide was measured using a Bedfont Micro III Smokerlyzer, which is able to detect smoking within approximately the past 24 hours. Urine samples were also collected to assess levels of cotinine, a metabolite of nicotine, which can identify smoking within approximately the past six days.
Timeline Follow-back (TLFB): A widely used retrospective measure of daily substance use (Sobell & Sobell, 1992). At intake as well as during each following study visit participants provided TLFB self-report data regarding the number of cigarettes they smoked daily since their last visit. Questionnaire on Smoking Urges (QSU): A measure of smoking craving with subscales assessing intention to smoke, desire to smoke, anticipation of positive outcome, and relief of withdrawal (Tiffany & Drobes, 1991). QSU data were collected at study intake, weekly post-TQD, and at 6-month follow-up.
Smoking Abstinence Self-Efficacy Scale (SASE): A two-dimensional measure assessing confidence to abstain from smoking, and temptation to smoke in 20 hypothetical situations (e.g. ‘With friends at a party’) (DiClemente et al., 1985). SASE data were collected at study intake, weekly post-TQD, and at 6-month follow-up.
Hallucinogen Rating Scale (HRS): Assesses subjective effects of hallucinogens in six domains: intensity, somaesthesia, affect, perception, cognition, and volition (Strassmen et al., 1994). The HRS was administered at the end of each psilocybin session (approximately 7 hours after capsule ingestion), and participants were instructed to respond with reference to their experience during that particular session day.
Mysticism Scale: Originally designed to assess the occurrence of mystical experience across an individual’s lifetime (Hood, 1975), the mysticism scale includes a three-factor structure assessing dimensions referred to as introvertive, extrovertive, and interpretation (Hood et al., 2001). For this study, the Mysticism scale was adapted to ask about participants’ experiences during a specific psilocybin session, and was administered at the conclusion of each session.
States of Consciousness Questionnaire (SOCQ): Previously used to characterize the subjective effects of psilocybin (Griffiths et al., 2011; Griffiths et al., 2006), including 43 items dedicated to evaluating mystical experience as quantified by Pahnke and Richards (Pahnke & Richards, 1966;, Pahnke 1969; Richards, 1975), who described mystical experience as exhibiting these key features: a sense of unity (i.e. loss of [internal] boundaries within the self, or [external] boundaries between self and environment); transcendence of time and/or space; ineffability and paradoxicality (i.e. that the experience is difficult to describe or conceptualize); a sense of sacredness or awe; a noetic quality (i.e. sense of direct knowledge of ultimate or higher reality); and deeply felt positive mood (e.g. joy, peace, love). The SOCQ was administered at the end of each psilocybin session, and specifically asked that participants respond regarding their experience during that session day.
Ratings of Personal Meaning, Spiritual Significance, and Well-being: One week after each psilocybin session participants were asked to rate the personal meaning, spiritual significance, and impact on well-being or life satisfaction attributed to their most recent session. Participants were also asked to rate these retrospectively with reference to their cumulative psilocybin experiences during the final treatment meeting, as well as providing open-ended comments on their session experiences in their own words at that time.
Six participants (40%) reported at least one challenging psilocybin experience characterized by feelings of fear, fear of insanity, or feeling trapped. However these effects were eased with the help of staff, and had resolved by the end of the sessions. Aside from these transient negative effects, no clinically significant adverse events occurred during the study treatment (Johnson et al., 2014). Thirteen of the 42 psilocybin sessions (31%) were categorized as “complete” mystical experiences as characterized by previous research (Source). Ten of the 13 “complete” mystical experiences occurred during high dose (30mg/70kg) sessions, and 9 of 15 participants (60%) had a “complete” mystical experience during at least one psilocybin session.
In order to determine correlates of smoking cessation success, Pearson’s correlations were calculated among participants’ change scores on smoking-related measures (i.e. smoking biomarkers, TLFB, QSU, and SASE), mean ratings of personal meaning, spiritual significance, impact on well-being, and mean scores on the States of Consciousness Questionnaire (SOCQ), Mysticism scale, and HRS intensity subscale. The HRS intensity subscale was included in these analyses to test the hypothesis that smoking cessation would be more strongly related to mystical-type effects of psilocybin rather than overall intensity of drug effects. Significantly higher urine cotinine levels were found at study intake among participants who were still smoking at 6-month follow-up compared with those who were abstinent at 6 months. The remaining smoking-related measures (i.e. breath CO, TLFB, QSU, SASE) showed no significant between-group differences at study intake.
SOCQ scores, ratings of personal meaning, spiritual significance and impact on well-being were significantly higher among smoking-abstinent participants compared with those who continued smoking at 6 months. However, scores on the Mysticism Scale and HRS Intensity subscale showed no significant differences between groups. As expected, significant correlations were found between change scores of all smoking related measures. Likewise, mean scores on SOCQ were significantly correlated with mean Mysticism scale, HRS Intensity subscale scores, mean ratings of psilocybin sessions’ spiritual significance, and impact on well-being. However, SOCQ mean scores were not significantly correlated with average ratings of personal meaning of psilocybin sessions. Significant correlations between mean SOCQ scores and change scores of QSU craving, and urine cotinine were found. Furthermore, average ratings of psilocybin sessions’ personal meaning exhibited significant correlations with change scores of breath CO, urine cotinine, TLFB daily smoking, SASE confidence to abstain, and SASE temptation to smoke. Mean ratings of spiritual significance were significantly correlated with change scores of urine cotinine, SASE confidence to abstain, and SASE temptation to smoke. Finally, mean ratings of psilocybin sessions’ impact on well-being and life satisfaction were significantly correlated with change scores of urine cotinine, TLFB daily smoking, SASE confidence to abstain, and SASE temptation to smoke.
Mystical Qualities of Psilocybin Correlated with Measures of Cessation
These results suggest that when administered to a drug-dependent sample in the context of an addiction treatment program, psilocybin is capable of inducing “complete” mystical experiences, with participants’ open-ended comments being generally consistent with previously defined features. Despite definitive conclusions unable to be drawn due to the open-label design and lack of control group, rendering these findings as preliminary, the mystical-type qualities of psilocybin sessions as well as their personal meaning, spiritual significance, and impact on well-being were significantly correlated with measures of smoking cessation treatment outcomes at 6-month follow-up. Furthermore, intensity of psilocybin session experiences were not significantly associated with smoking cessation treatment outcomes, suggesting that mystical-type effects rather than general intensity of subjective drug effects are associated with long-term abstinence.
The fact that mystical experiences can be safely and reliably induced in both healthy and clinical populations with classical psychedelics allows for the ability to study them with scientific rigor. Though research into the acute and long term effects of these experiences is still in the early stages, the results of this study as well as previous ones provide a compelling look at a type of experience that may hold diverse therapeutic applications, and provide insights that help to further our understanding of neuroscience. Interestingly, the authors note that a psychedelic-induced peak or mystical experience is almost like “inverse PTSD”, where PTSD induces lasting and detrimental effects from an adverse event and psychedelic-induced peak experiences seem to produce lasting and beneficial effects from a single, or very few, experiences. Both result in lasting changes to behaviour and, presumably, the brain. Although mystical-type effects were associated with positive treatment outcome, other aspects of the experience that were not examined may have played a causal role in abstinence, consistent with the fact that not all long-term abstainers had “complete” mystical experiences, and not all participants who had “complete” mystical experiences went on to quit smoking. Future research will benefit from larger and more diverse samples, as well as consideration of other (i.e. non-mystical) drug effects that may be mediating treatment outcomes. Given the relatively low success rates of current addiction treatments, and the global morbidity and mortality associated with addictive disorders, this further research is both timely and important.
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