Beyond the High: Navigating the Integrity and Dangers of Psychedelic-Assisted Psychotherapy
The novel union of psychedelic substances with psychotherapy, known as psychedelic-assisted psychotherapy (PAP), constitutes a groundbreaking approach to the treatment of mental health conditions such as post-traumatic stress disorder (PTSD) and treatment-resistant, severe depression. The innovative blend of psychedelics with psychotherapy indicates a transformative and exciting era in treating complex mental health issues. Using microdoses of MDMA and psilocybin, PAP ignites transformative shifts in cognition, emotion, and insight, often achieving what months of traditional therapy aspire to in someone or a handful of sessions, with emerging research indicating sustained remission (The Lancet). At this pivotal point in psychotherapy advancement, the advocacy for approval balances the significant therapeutic potential of these treatments against the risk of endorsing recreational misuse. There is a dire need for an essential effort to maintain the integrity of the treatment, ensuring that the acceptance of psychedelic therapies in the medical community does not inadvertently validate non-therapeutic misuse and consumption.
In the nuanced debate surrounding psychedelic-assisted therapy, a critical examination of the medical versus recreational use of microdosing these drugs is paramount to maintaining the integrity of these treatments. According to recent studies, the therapeutic potential of psychedelics, such as psilocybin and MDMA, is significant, particularly for those suffering from conditions resistant to traditional treatments (Johnson et al., 2016; Mithoefer et al., 2018). MDMA, specifically, harnesses the potential to increase the action of various neurotransmitter systems such as serotonin, dopamine, and oxytocin (Barber, G. S., & Aaronson, S. T.). Overall, studies show the drug tends to cause a chemical imbalance that subjects the patient to suffer through PTSD. This extraordinary feat is undermined by the potential overtaking of recreational misuse. For example, the growing trend of microdosing among young professionals in Silicon Valley seeking creative and cognitive enhancement illustrates the alluring potential for the abuse of drugs (Topsfield, J; Grind, K, & Bindley, K). On top of battling this rising trend, the movement towards acceptance and rigorous scientific inquiry aims not only to validate the therapeutic benefits of psychedelics but also to safeguard against the normalization of their non-medical use. As the dialogue continues to evolve, the challenge remains to balance the promise of psychedelic-assisted therapy with the responsibility of preventing misuse, ensuring that the medical community’s endorsement does not inadvertently validate recreational consumption.
Psychedelic substances have transitioned from religious sacraments to subjects of scientific study. It’s believed psychedelics were used to alter brain connections to expand awareness in ancient Greek and Mexican cultures (Heath, N). Though modern medicine uses these substances to break cycles of depressive thoughts, the significance of mind expansion and hallucination has been a subject of culture for centuries. Now, often associated with free-spirited, the 60s, anti-war progressive movements, it is imperative to navigate carefully to avoid disillusionment and misuse that could overshadow psychedelics’ therapeutic value. The journey of marijuana legalization serves as a cautionary tale. Initially championed and demonized for its legalization, the narrative surrounding marijuana’s healing medicinal properties quickly veered towards celebrated recreational use, set in motion by the nature of capitalism. In states where it’s legal, marijuana has woven itself into the fabric of consumer culture; dispensaries and local shops have seized the opportunity presented by the drug’s marketability. This shift not only diluted the drug’s medicinal integrity but also built a stigma around the consumers. Historically, as a product of systemic American oppression, marijuana consumers were seen as thugs and criminals mostly of ethnic descent. The good outweighed the bad and a great political divide came about in the discourse on the potential of recreational use. Now, there is a lazy, hippie, earthy stigma to the drug that erodes any discussion of the medicinal benefits it harnesses. Drawing from this experience, it is crucial for the acceptance of psychedelic therapies to maintain a clear distinction between their medical application and potential recreational allure. We do not currently have the infrastructure or bandwidth to dispense this issue. Ensuring that the conversation and regulations surrounding psychedelics remain anchored in their therapeutic potential will be vital in preserving their legitimacy and efficacy as tools for mental health treatment. Moving away from the capitalization and monetization of psychedelics is crucial to not falling prey to the same pitfalls that have complicated marijuana’s medical perception.
The language and framework surrounding psychedelic-assisted psychotherapy’s rise in popularity and authenticity are crucial in manipulating the public perception to be primarily medical. The intense illnesses that are subject to these treatments should be cautionary enough to veer away healthy people from recreational use. However, the allure of the drugs and positive connotations to recreational use are fueled by the mass miseducation and capitalism in which social discourse follows. In an article published by The Lancet, it is discussed that the colloquial, street names for these drugs such as ‘shrooms, when referring to psilocybin, and E or X when referring to MDMA are harmful to the public perception of the drug, further romanticizing it. Instead, the authors suggest the primary implementation of referring to these agents by their chemical names. Additionally, the journey, or “trip”, that is highly sought after by these experimental individuals should be referred to as a “therapeutic state of altered consciousness” to call it like it is and promote the association of the altered state to be primarily therapeutic. It is important to echo this advancement as a tool, in hopes of avoiding the creation of a misinformed trope that encourages people to use these drugs, outside of a medical setting, just because they are approved by the FDA.
At a time when the FDA may approve PAP soon, it is important to lead with cautionary information on the dangers of at-home usage to negate a recreational celebration. It is critical to flood research and American discourse on these drugs with highly medical and therapeutic connotations, as well as side effects. Aided microdosing involves an extensively personalized, controlled environment, designed to emulate a comforting, home-like setting, which is pivotal for the safety and effectiveness of the treatment. Here, the administration of sub-hallucinogenic doses of MDMA and psilocybin combines the biological effects of drugs with psychotherapy. This contrasts sharply with the unpredictable nature of recreational use, where the absence of medical supervision and the right surroundings can lead to adverse outcomes (Johnson et al., 2016; Mithoefer et al., 2018). Alone, these drugs can and are being heavily abused, and paired with counter-cultural undertones lacking beneficial and practical context, the probability of recreational misuse is high. Without precautions, there are a multitude of harmful effects that can fall upon a user such as increased impulsivity, long-term serotonin production issues, derealization, paranoia, psychosis, and being the bridge to other harmful illegal substances. We, as a society, can not lose sight of the purpose of this therapy; to settle the imbalance of chemicals in the brain, causing these grave mental health conditions.
Additionally, there is a small pool of medical trials that these positive, long-term effects stem from. Many professionals are on the skeptical side of the dilemma arguing that there is not enough research and highlighting “the potential for adverse experiences in some patients, leading to exacerbated psychological challenges, commonly referred to as so-called ‘bad trips’” (The Lancet). Like normalizing any drug, the production and access become a complicated risk that can involve the illegal obtainment of forms of the drugs that are laced with dangerous substances such as opioids (Ho Tai Way). While the potential for these treatments to become recognized therapies is promising, it’s crucial to prevent a societal shift that could mistakenly deem it safe for individuals to self-administer these drugs at home for conditions like depression or PTSD. For example, Ho Tai Way, a recovery treatment center for women that facilitates these treatments expresses concern that “Recreational use of psychedelics can also trigger trauma which is difficult to manage alone” (Ho Tai Way). Therefore, clear communication about the resources and strict guidelines for access to these treatments are essential to maintain the integrity and efficacy of these treatments.
In conclusion, as we stand on the brink of potentially integrating psychedelic-assisted psychotherapy into mainstream mental health care, it’s imperative that we navigate this new frontier with both optimism and caution. By drawing clear lines between therapeutic use and recreational misuse, and preserving focusing on the profound benefits these treatments can offer, we can revolutionize the way we approach mental health disorders. This is not just an advancement in medical science; it’s a step toward a more compassionate and effective form of care for those who have long struggled in silence. As this journey unfolds, our collective commitment to integrity, education, and careful regulation will be key in unlocking the full potential of psychedelic therapies, ensuring they serve as a beacon of hope and healing for generations to come.
References
Barber, G. S., & Aaronson, S. T. (2022, September 21). The Emerging Field of Psychedelic Psychotherapy — PMC. NCBI. Retrieved March 9, 2024, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9553847/
Cohen, S. (2023, December 12). Do psychedelics have a role in psychiatric treatment? UCLA Health. Retrieved March 9, 2024, from https://www.uclahealth.org/news/do-psychedelics-have-role-psychiatric-treatment
Grind, K., & Bindley, K. (2023, June 27). Magic Mushrooms. LSD. Ketamine. The Drugs That Power Silicon Valley. The Wall Street Journal. Retrieved March 9, 2024, from https://www.wsj.com/articles/silicon-valley-microdosing-ketamine-lsd-magic-mushrooms-d381e214
Grinspoon, P. (2021, June 22). Back to the future: Psychedelic drugs in psychiatry. Harvard Health. Retrieved March 9, 2024, from https://www.health.harvard.edu/blog/back-to-the-future-psychedelic-drugs-in-psychiatry-202106222508
Heath, N. (2022, August 20). Direct access to God or the work of the devil? The long history of psychedelics in religion. ABC. Retrieved March 9, 2024, from https://www.abc.net.au/news/2022-08-21/religion-psychedelic-renaissance-peyote-magic-mushrooms-lsd/101346594
Psychedelic-Assisted Psychotherapy. (2023, November 22). Psychology Today. Retrieved March 9, 2024, from https://www.psychologytoday.com/us/therapy-types/psychedelic-assisted-psychotherapy
Psychedelic Integration Therapy: Recreational vs. Therapeutic Use. (n.d.). The Ho Tai Way. Retrieved March 9, 2024, from https://thehotaiway.com/psychedelic-integration-therapy/
Rubin, E., & Zorumski, C. (2023, March 15). Destigmatizing the Medical Use of Psychedelics. Psychology Today. Retrieved March 9, 2024, from https://www.psychologytoday.com/us/blog/demystifying-psychiatry/202303/destigmatizing-the-medical-use-of-psychedelics
Schenberg, E. E. (2018, July 5). Psychedelic-Assisted Psychotherapy: A Paradigm Shift in Psychiatric Research and Development. NCBI. Retrieved March 9, 2024, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6041963/
Topsfield, J. (2022, July 23). How microdosing LSD is leading scientists to tackle ‘creative enhancers of choice’. The Sydney Morning Herald. Retrieved March 9, 2024, from https://www.smh.com.au/lifestyle/health-and-wellness/microdosing-scientists-tackle-psychedelic-trend-becoming-creative-enhancer-of-choice-20220720-p5b390.html
Tupper, K. W., Wood, E., Yensen, R., & Johnson, M. W. (n.d.). Psychedelic medicine: a re-emerging therapeutic paradigm. NCBI. Retrieved March 9, 2024, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592297/
