Can Psychedelic-Assisted Therapies Be a New Solution For Addiction Problems?

Speaking from first-hand experience, losing a loved one to the battle with addiction is soul-crushing. Yet, addiction remains a global problem that impacts individuals, families, and society at large. In the US alone, approximately 22 million people have a substance use disorder. In the most recent data published by the Centers for Disease Control and Prevention, more than 101,000 individuals died from a drug overdose in the latest 12-month period on record.

Despite the treatment options available today, studies show that only 15% of individuals successfully avoid relapse one year after treatment, and substance-related deaths continue to rise, pointing to the urgent need for an effective, science-backed approach. While there is a long and promising history of psychedelics being used for personal enlightenment, and for the treatment of a wide swath of mental health issues including addiction, the plural of anecdote is not data. And as promising as the potential for psychedelic-based treatments for addiction are, it is incumbent upon industry players to follow assumptions with hard data and empiricism. Thus, Entheon is conducting extensive clinical research into how psychedelic-assisted therapy, and specifically DMT, can significantly improve the odds of individuals seeking to recover from addiction disorders.

Exploring the Benefits of DMT

Known as a classical psychedelic, DMT is the psychoactive element of the traditional ayahuasca brew, exerting many of its subjective, visual, and potentially therapeutic effects via the brain’s serotonin system, which we know is crucial to regulating mood and other biological functions. However, unlike other psychedelics such as psilocybin and LSD, the DMT molecule possesses significant potential therapeutic advantages when administered in a medical setting, including:

• Shorter session length (30 to 60 minutes): DMT occurs naturally in humans and many other mammals and is very well metabolized by the human body, with both a short activation time and duration of experience.
• Therapeutic flexibility: DMT is more controllable, with the ability to end a session quickly if clinically necessary or titrate/adjust the dose if required.
• Higher patient throughput: Shorter sessions mean therapists will have the ability to help more patients.
• Potentially less time needed in psychedelic state: Patients can achieve results without enduring the long “trips” often associated with LSD or other psychedelics.

DMT’s short duration of effect could be especially useful when we consider that many of those suffering from mental health and addiction disorders may possess trauma. Psychedelics can be powerful and transformational, but for those who have particularly challenging trauma, the psychedelic experience may become distressing, overwhelming, or retraumatizing. Continuously infused DMT may mitigate these potential harms by allowing for very rapid offramps. Given the pharmacokinetics of DMT, we have the ability to stop that experience and an individual can return to a functional baseline within about 15 minutes, whereas longer-form psychedelics like psilocybin or LSD can require several hours for drug effects to subside. The avoidance of prolonged distress and potential traumatization is a principal factor in Entheon’s selection of DMT for the specific treatment of substance use disorder populations.

Entropy and Addiction

Entropy, or increased spontaneous brain activity, could be considered crucial for those seeking to recover from a mental health or addiction disorder. The administration of serotonergic psychedelics, such as DMT, induce entropy, which can lead to a “pivotal mental state,” a construct developed by Robin Carhart-Harris and Ari Brouwer in which the brain is thought to become hyper-plastic, which can result in rapid and deep learning processes¹. This brain state is thought to spur on psychological transformation, capable of breaking an individual out of deep ruts of habituation and pathology, introducing new ideas and perspectives that ultimately lead to new behaviors, thus increasing the likelihood of eliminating or correcting patterns of addiction.

Treating addiction with psychedelic intervention is a very promising area of research, even if currently still limited. Historically, LSD treatments were found effective in treating alcoholism; numerous observational studies, anecdotal reports, and ceremonial use point to successful outcomes of psilocybin and ayahuasca in treating addiction. Additionally, a 2014 Johns Hopkins psilocybin trial for those suffering with nicotine addiction showed abstinence rates of 80% over the course of 6 months. Despite positive evidence that psychedelics can have a positive impact on addictions, the goal is to convert assumptions into empirical data; to analyze, improve, and standardize the DMT molecule in a scientific way; and make it a more effective tool for physicians to treat patients with addictions.

Advancing Psychedelic Medicine and Neurophysiology

But where equally exciting work lies is understanding what it is about the psychedelic experience that is truly beneficial to those suffering from addiction. We believe that a focus on neurophysiological biomarkers related to brain activity, as measured by EEG, is going to be promising. Looking at brain activity before, during and after a psychedelic treatment, we hope to see neurophysiological markers related to psychedelic effect and treatment efficacy. A biological marker associated with recovery is a potentially useful tool for validating treatment effect, as well as post-treatment monitoring to determine whether an individual maintains a positive outcome. The addition of biomarkers supplements a process that is otherwise reliant on the patient’s subjective verbal analysis, and gives physicians additional insight to inform the patient’s long-term treatment program.

This integrative approach of leveraging the unique pharmacokinetic profile of DMT with research of genetic biomarkers to predict drug selection and patient response, as well as EEG biomarkers to guide therapeutic programs while tracking efficacy over time, has the potential to not only provide personalized treatment of addiction disorders, but pave the way for psychedelic psychiatry across various drugs and treatment indications.

Timothy Ko is the CEO of Entheon Biomedical.

The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Addiction Professional, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.

Reference

¹ Brouwer, A., & Carhart-Harris, R. L. (2021). Pivotal mental states. Journal of Psychopharmacology, 35(4), 319–352. https://doi.org/10.1177/0269881120959637