Psilocybin Plus Psychotherapy Associated With Reductions in Drinking Among Adults With Alcohol Use Disorder

There is growing interest in the prescribing of psychedelic medications to treat substance use disorder. Researchers conducted a double-blind, placebo-controlled, randomized trial of psilocybin compared with placebo (diphenhydramine) among 93 people aged 25–65 with alcohol use disorder and ≥4 heavy drinking days in the 30 days prior to enrollment. Medication was administered in weeks 4 and 8 of the study; both groups received 12 sessions of psychotherapy during the first 12 weeks of the study.

• Approximately 90% of participants correctly guessed their treatment group.
• In the 32 weeks after the first medication dose, the psilocybin group reported 10% heavy drinking days versus 24% in the placebo group.
• Compared with the placebo group, participants receiving psilocybin had significantly lower mean drinks per day (mean difference, 1.09 drinks), higher rates of abstinence, and greater reductions in WHO risk scores. Differences in drinking days were non-significant.
• Although there were more adverse events in the psilocybin group (e.g., headache), there were only 3 serious adverse events, all of which were in the placebo group.

Comments: Treatment with psilocybin and psychotherapy resulted in substantial reductions in most drinking measures compared with a diphenhydramine control, with no serious adverse events associated with psilocybin. Most participants could guess their treatment group, suggesting a possible source of bias in the results. Additional research should clarify the effects of psilocybin independent of psychotherapy, the duration of effects over longer follow-up periods, and explore effects among higher-risk populations.

Timothy S. Naimi, MD, MPH

Reference: Bogenschutz MP, Ross S, Bhatt S, et al. Percentage of heavy drinking days following psilocybin-assisted psychotherapy vs placebo in the treatment of adult patients with alcohol use disorder: a randomized clinical trial. JAMA Psychiatry. 2022;79(10): 953–962.