recent headline-making clinical trial showed that a combination of psilocybin (found in magic mushrooms) and psychotherapy was able to reduce signs of alcoholism compared to placebo.
Let’s look at how the study was conducted and what the findings mean. I also want to explore the study’s broader context: how the results connect to animal research looking into the brain mechanisms underlying psilocybin’s anti-addiction effects. We’ll also consider the subjective experiences reported by patients who have undergone psilocybin-assisted psychotherapy to treat their alcoholism.
Before diving into the study, let’s distinguish between the addictive and dependency liability of different drugs and examine the societal costs of heavy drinking.
How alcohol addiction works
When you have an alcoholic drink, you’re ingesting the psychoactive drug ethanol, one of the most widely consumed intoxicants.
As with other psychoactive drugs, its effects are dose-dependent: You will have a very different experience on low, medium, and high doses. At low doses your experience may be pleasant and uplifting. At high doses, the opposite.
Many people make the mistake of thinking about drugs in binary terms: They are addictive, or they are not. All drugs exist on a spectrum of habit-forming potential, each with its own risk of addiction and dependence. Addiction is the tendency to want to keep taking a drug even after its rewarding effects taper off and despite negative consequences, leading to compulsive drug-seeking. Dependency is when you experience negative withdrawal symptoms in the absence of a drug, which you will naturally want to avoid.
Some drugs are addictive but carry little risk of dependency. Cocaine is an example. Roughly one in five people who consume cocaine with regularity will develop compulsive drug-seeking behavior, but most will not experience withdrawal in the drug’s absence. Some drugs can induce dependency without addiction, such as caffeine. Others are highly addictive and cause strong dependency. Think fentanyl.
Addictive drugs, including cocaine and opioids, share a common property of increasing dopamine signaling within specific reward-related brain circuits. Drugs like caffeine do not.
Alcohol: the damage done
Compared to more highly addictive drugs, alcohol’s addictive potential is relatively low. It also carries with it the risk for dependency, which can be severe in the heaviest drinkers. Alcohol is one of the only drugs for which death is a possible side effect of withdrawal (another example is benzodiazepines), although this only happens in a subset of the heaviest drinkers who attempt to quit suddenly.
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