LSD Treatment for Alcohol Abuse: Krebs-Johansen Study

LSD Treatment for Alcohol Abuse: Krebs-Johansen Study. You may not have noticed it, but there’s an ongoing ‘renaissance’ of research interest in the use of powerful hallucinogens to treat intractable addictions and other psychiatric disorders.

In the 1950s, psychiatrists began to promote using psychedelics by to treat schizophrenia and other conditions, and research into the medical uses of these psychoactive drugs began to take off. But funders pulled the plug on research, following political pressures that came with the advent of the War on Drugs in the United States during the Nixon administration and the ensuing spread of its dogma of prohibition to the rest of the world.

But in the last decade or so, a new generation of researchers cropped up, interested in harnessing the therapeutic benefits of now illegal, but powerful, mindbenders. A few of the new experiments that have met some success in the treatment of drug, tobacco and alcohol dependency are for: ecstasy, known chemically as 3,4-methylenedioxymethamphetamine or MDMA to treat post-traumatic stress disorder, the ayahuasca vine from the Amazon for drug and alcohol dependency, and even psilocybin — the active ingredient in hallucinogenic mushrooms — for smoking cessation.

Even Alcoholics Anonymous co-founder Bill Wilson was said to be an early advocate of LSD treatment for alcohol abuse. In his official AA biography, Pass It On, he writes about taking LSD and finding that it facilitated a mind-expanding and spiritual state similar to the one that motivated him to stop drinking in the first place.

He writes: “It’s a generally acknowledged fact in spiritual development that ego reduction makes the influx of God’s grace possible…I consider LSD to be of some value to some people, and practically no damage to anyone.”

So the treatment of alcoholism using the powerful hallucinogen LSD — lysergic acid diethylamide — isn’t as unconventional as it may appear.

In fact, a new meta-analysis of clinical trials done in the late 1960s and early 1970s showed that a single dose of LSD helped alcoholics abstain from the bottle for the short and medium term. In general, the researchers say, the reported benefits from LSD lasted three to six months.

The retrospective analysis — the first-ever quantitative meta-analysis of LSD–alcoholism clinical trials– was done by Harvard neuroscientist Teri Krebs and clinical psychologist Pål-Ørjan Johansen from the Norwegian University of Science and Technology in Trondheim. Their findings are published in the March 9 issue of the Journal of Psychopharmacology.

“Alcoholism was considered one of the most promising clinical applications for LSD,” explains Dr. Johansen. This was what motivated them to sift through thousands of records to find data on randomized, double-blind trials that compared one dose of LSD to a placebo, he reveals.

Dr. Johansen says the problem with most studies done then was that there were too few participants, and this limited statistical power. “But when you combine the data in a meta-analysis, we have more than 500 patients and there’s definitely an effect,” she says.

In most studies analyzed by the two researchers, alcoholics given a single dose of LSD were almost twice as likely as those given a placebo to report less alcohol use at first follow-up. Specifically, of 536 participants from six trials the percentage of alcoholics that reported lower levels of alcohol misuse were:
• 59 percent of those receiving LSD
• 38 percent of those who received a placebo

“The effectiveness of a single dose of LSD compares well with the effectiveness of daily naltrexone (reVia, Vivitrol), acamprosate (Campral), or disulfiram (Antabuse),” Dr. Krebs and Dr. Johansen say. Those are the drugs currently approved by the Food and Drug Administration to treat alcoholism.

“We were surprised that the effect was so clear and consistent,” says Dr. Krebs. “Given the evidence for a beneficial effect of LSD on alcoholism, it’s puzzling why this treatment approach has been largely overlooked,” the two researchers write.

The researchers also found that the differences between LSD and control groups were statistically significant from two months to six months after treatment. But they found that there was no longer a measurable improvement in those who had taken LSD on year later.

“But given the persistence of alcoholism, it’s perhaps more surprising that the effects of one dose of LSD lasted up to six months than it’s that it would ‘wear off’ a year later,” notes TIME health writer Maia Szalavitz in a report on the study.

Precisely because the effects don’t seem and are unlikely to be long-lasting, Dr. Krebs and Dr. Johansen suggest that further studies should be done to explore the benefit of using LSD in weekly or monthly treatment. More research is also needed to determine if some subgroups may gain more of a benefit and to find out if various doses have alternative effects.

Since LSD is known to have long-lasting effects on the personality, the authors say that treatment for alcoholics may make use of shorter-acting psychedelics like dimethyltryptamine (DMT) found in many tropical trees and plants, psilocybin and mescalin, found in the Central American peyote cactus.

The researchers also say that overall, there were few adverse events reported and the heterogeneity between trials was negligible. The findings also appear consistent with many reports of clinical experience and other trials, they say. The median dose of LSD used in those trials was 500 mcg.

How does LSD work? But the study didn’t delve into how psychedelics make alcoholics abstain — especially after a single dose — remains unclear.

What is known, though, is that LSD and its chemical cousins share structural similarities with the neurotransmitter serotonin — the neurotransmitter in the brain that’s vital for memory, feeling pleasure, mood, sleep and appetite. These psychedelics mimic serotonin in that they also bind to the same receptor sites in the brain. But that’s where the similarity ends. Studies show that hallucinogens trigger chemical cascades that differ from those triggered by serotonin. At the same time, LSD also acts on other receptors in the brain.

Some researchers speculate that LSD works because it changes perception — patients in the clinical trials said they felt they were given a new lease on life. Subsequently, they made strong resolutions to stop drinking.

This explanation is backed up by Dr. Roland Griffiths, a behavioral biologist at the Johns Hopkins University School of Medicine in Baltimore, Maryland who is investigating the influence of psilocybin on smoking cessation. Sometime, he explains, psychedelics trigger unique, insightful experiences that can help bring about enduring positive changes in mood, attitude, and then behavior.

Indeed, how LSD works to treat addiction must be understood on both biological and psychological levels by studying both human behavioral responses as well as brain chemistry.

“Psychedelics probably work in addiction by making the brain function more chaotically for a period — a bit like shaking up a snow globe — weakening reinforced brain connections and dynamics,” surmises Dr. Robin Carhart-Harris, a psychopharmacologist at Imperial College London who has researched how psilocybin could treat depression.

Commenting on the retroactive meta-analysis, Dr. Matthew Johnson says, “This is impressive and important work.” A psychiatrist at the Johns Hopkins University, Dr. Johnson is now running a small trial looking at the effectiveness of psilocybin to treat nicotine addiction.

“Although this meta-analysis doesn’t replace the need to test the approach in new, well-designed and rigorous clinical trials, it puts some more muscle behind the interpretation that the older literature shows hints that psychedelic therapy might really help addiction,” he ends.

Context matters
Context also matters, TIME writer Szalavitz points out. “Studies show that the psychedelic experience is very sensitive to context, which is why the CIA used the drug as an interrogation aid while hippies viewed it as vehicle for bring about worldwide peace and love,” she writes.

In some of the trials reviewed by Dr. Krebs and Dr. Johansen, Szalavitz explains, LSD didn’t work because it was used to “break down” alcoholics’ egos in an attempt to create a spiritual awakening. In one such unsuccessful trial, patients were actually strapped to their beds and were confronted and humiliated extensively with the goal of revising their personalities.

This turned out to be counterproductive, she reports, because new research now shows that trying to annihilate people emotionally is dangerous and can lead to long-term damage — even when it’s done without a powerful hallucinogen.

What’s more, “in addiction research, however, it’s important to temper enthusiasm and keep from overselling psychedelic ‘cures’,” notes Szalavitz.

She recounts how a heroin addict, Howard Lotsof discovered in 1962 that an African drug, ibogaine, could produce an intense and often emotionally exhausting trip, even as it reduced or even got rid of withdrawal symptoms from heroin.

Finding that he was able to remain heroin-free, Lotsof went on to patent the use of ibogaine to treat multiple addictions and spent the rest of his life advocating for more research on the drug.

He also shared his experience with his fellow addicts. But while they reported the same lack of withdrawal symptoms and no longer felt a physical need for heroin, they still didn’t quit. This suggests that addiction goes beyond physical dependence, craving and withdrawal.

“Psychedelic experience — like all other intense life events –may offer the potential for growth and change,” she points out. “How people respond, however, depends on far more than a drug,” she concludes.

Dr. Ken Checinski, a consultant addiction psychiatrist and independent researcher based in London agrees.

While the results of the new meta-analysis are exciting, he says no pharmacological treatment should be seen as a magic bullet.

He also points out that modern therapeutic techniques have improved and can be just as effective. “The included LSD trials pre-date the use of psychological techniques such as motivational interviewing and cognitive behavior therapy,” he says.

In cognitive therapy, therapists help people who struggle with addictions to identify the negative views they have of themselves, how they interpret their experiences negatively and how they feel hopeless about their future. Then, they are taught how to combat these negative thinking patterns, and replace these with ways of thinking that are more positive. This helps them rely less on drugs to cope with life’s struggles, helping break their vicious cycles of addiction.

LSD Treatment for Alcohol Abuse: Krebs-Johansen Study. Posted 17 March 2012.