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Editorial Introduction Editorial Current Drug Abuse Reviews, 2013, Vol. 6, No. 1 1 Editorial The Potential of Psychedelics as a Preventative and Auxiliary Therapy for Drug Abuse The Aim and Scope of this issue is focused on reviews of literature chiefly pertaining to "classic" psychedelic compounds (LSD, psilocybin, etc.) and “non-classic” psychedelics (Salvia divinorum and MDMA), with a strong focus on research in humans and/or animal models of addiction. From a recounting of the historical use of psychedelics, particularly in ethnobotany, psychiatry and psychology, to studies examining the effects of these drugs as an auxiliary therapy for addiction and other pathologies associated with chronic and/or traumatic stress, this issue presents a comprehensive analysis of psychedelics and their potential as therapeutic agents either as a part of psychotherapy or as a pharmacotherapy. I would like to thank Bentham Science Publishers for giving me the opportunity to raise awareness, under scientific scrutiny, of the therapeutic properties of these compounds after an extended pause of more than 30 years. I would also like to thank all the authors and anonymous referees that are the basis of this special issue, and K. Linnae Ponté and Mary Rose Bufalino for their unconditional help. The Population Intervention for Chronic Disease Prevention Program also deserves special acknowledgement for their support and focus on pursuing solutions that treat and prevent major chronic diseases. Hector Vargas-Perez (Guest Editor) Department of Molecular Genetics University Of Toronto Terrence Donnelly Centre for Cellular and Biomolecular Research 160 College St, Rm 1130 Toronto Ontario M5S 3E1 Canada E-mail: [email protected] Introduction Psychedelic-Assisted Psychotherapy for the Treatment of Addiction There is a profound unmet need to develop more treatment options for individuals with substance abuse disorders. Psychedelic- assisted psychotherapy represents a promising treatment for addiction. After being suppressed for over 30 years, psychedelic psychotherapy research is beginning to make a comeback. Researchers worldwide are using psychedelics to investigate the neuroscience of non-ordinary states of consciousness and spirituality and as potential treatments for (psychological) conditions such as posttraumatic stress disorder (PTSD) and anxiety related to end-stage illnesses. Much of the focus of this new era of research is on the treatment of addiction, and this volume presents the most compelling work being done in this area. The treatment of addiction is one of the oldest areas of psychedelic research, dating back to 1950s studies that used LSD to combat alcoholism. These early studies have long been cited as evidence that psychedelics can effectively treat addiction, and a retrospective meta-analysis recently confirmed that LSD did in fact significantly reduce alcohol consumption up to six-months after what was often just one LSD session. Scientific research into classic psychedelics such as LSD and psilocybin was discontinued by the early 1970s, but their underground use continued. Other consciousness-altering drugs have shown to be effective treatments for addiction in clinical settings, but research has nearly always been suspended due to political forces. A series of studies in Russia beginning in 1985 used ketamine to mitigate alcoholism and heroin addiction and showed promising results. For many years, the only research with psychedelics in the entire world involved the treatment of addiction with ketamine. Perversely, the Russian government discontinued the promising addiction treatment research in the 1990s once ketamine started being used recreationally in Russia. Today, research on the treatment of addiction using psychedelics is happening once again with a variety of substances such as psilocybin, ayahuasca, and ibogaine, all of which are represented by articles in this special issue. 2 Current Drug Abuse Reviews, 2013, Vol. 6, No. 1 Editorial Included in these pages is an observational study documenting the use of ayahuasca to treat addiction in a First Nations community in Canada. The MAPS-funded study, coordinated by Philippe Lucas, followed twelve participants as they underwent four days of group counseling with two expert-led ayahuasca ceremonies. The study demonstrated decreased use of alcohol, tobacco, and cocaine as well as significant improvements in hopefulness, empowerment, and mindfulness. Two other traditional medicines, ibogaine and salvia divinorum, are also represented as Thomas Kingsley Brown and Jose-Luis Diaz respectively document the history of the study and use of these substances. Lisa Jerome, Shira Schuster, and Berra Yazar- Klosinski consider the role that MDMA might play in the treatment of substance abuse. In his manuscript, Michael P. Bogenschutz considers the use of psilocybin and other classic hallucinogens to combat addiction. There are multiple frameworks for understanding how psychedelic therapy can alleviate substance abuse. Some psychedelics may reduce symptoms of co-morbid psychiatric conditions, thereby providing individuals with a greater opportunity to address their problematic substance use. For example, MDMA has proven effective in treating PTSD, a condition often self-medicated with drugs and alcohol. Psychedelics can be effective for addressing and resolving the traumatic experiences that can underlie addictive behavior. By working through past experiences, individuals are able to come to terms with their life instead of using drugs to suppress their trauma. Early approaches to the treatment of addiction, in particular to the treatment of alcoholism, used the disease model of addiction as a guiding framework. The disease model, which focuses on the biological causes of substance abuse, has some merits in that it helps to de-stigmatize addiction and addicts and to promote treatment instead of incarceration. But the disease model underemphasizes the element of choice, a key component of treatment, and thereby also underemphasizes the role of therapy that addresses that component. In addition, treatments relying on the disease model usually have complete abstinence as their goal. But abstinence is not necessarily the best way to measure the success of addiction treatment. Gradual improvement is possible by using some drugs to reduce consumption of other drugs, for example, using marijuana to help reduce alcohol consumption. Rather than using abstinence as a measure of success, the goal of psychedelic therapy is to improve people’s lives on average, to help them come to grips emotionally and psychologically with what they are doing and make choices to act differently in the future. Some psychedelics may fit well in a disease model context of addiction treatment. For example, ibogaine seems to help people with opiate withdrawal. However, there is another aspect of psychedelic therapy, its spiritual component, which the disease model cannot account for. Psychedelics have the potential to create a deep mystical experience of connection from which individuals can draw strength. A spiritual experience can offer resilience in how someone in recovery responds to life stressors, because they feel more connected to life itself. Based on that connection, they can move forward in their lives feeling more supported. An important point to make, however, is that the spiritual experience is not more important than acknowledging one’s one personal psychodynamics. However, because so many people have seemingly lost touch with the spiritual, it may be the root where people are longing to feel connected. Psychedelics that are effective for alleviating substance abuse, notably ibogaine and ayahuasca, are not usually seen as addictive, but unfortunately our culture criminalizes substances that produce non-ordinary states of consciousness. On the other hand, ketamine has been used in the treatment of heroin addiction and alcoholism but is also the most addictive of all the psychedelics. Ketamine can bring repressed psychic material to light for purposes of integration but can also provide a reliable escape from biography, this world and the body, for those who seek such escape. People can too easily delude themselves into thinking that the unusual nature of ketamine’s disembodied consciousness invariably offers a deeper, more spiritual experience, which is possible but unlikely if used for purposes of escape. The idea that psychedelics can be helpful in combating drug abuse is in opposition to the notion that psychedelic drug use is inherently wrong. Instead, it supports the idea that problems related to drug use have more to do with how the drug is used, who uses it, and for what reasons, rather than the drug itself. This volume will contribute to legitimizing the field of psychedelic substance abuse treatment research in the hopes that eventually funding agencies such as the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism will feel comfortable supporting this research. This will happen only once we have honest drug education where we can show that psychedelics, like other drugs, have both benefits and risks. Bill Wilson, one of the founders of Alcoholics Anonymous, tried LSD in the 1950s after he was sober and thought that it had tremendous potential for the treatment of addiction. Bill believed that people needs to hit bottom before they will make the necessary changes in their life. Psychedelics can precipitate the psychological sense of hitting bottom, and allow one to see the consequences of the choices that they make, when the individual still has a viable support system along with the energy and willpower to make the necessary choices to change their life. Yet the potential that Bill W and the pioneering LSD/alcoholism/heroin addiction researchers saw in LSD-assisted psychotherapy was not realized and got swept away in the cultural backlash. This volume makes a major contribution to the scientific foundations of the growing interest in taking another look at the healing potential of psychedelics carefully used in the treatment of drug abuse and addiction. Rick Doblin Founder and Executive Director Multidisciplinary Association of Psychedelic Studies (MAPS) www.maps.org .
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