Many people are aware of the recent resurgence of interest in psychedelics, from new studies in depression to Prince Harry’s use to deal with his psychological problems. What is less well-known is that psychedelics are now being used to treat addiction, especially alcoholism. And that has a long history.
In 1933, the founder of AA, Bill Wilson, achieved his abstinence as a result of a psychedelic experience, and when LSD was made available for research in the Fifties, he helped persuade the US government to fund six trials in alcoholism. These revealed that just one or two LSD doses as part of a traditional abstinence-based programme doubled the outcomes. This effect lasted for many months and was much greater than any subsequent medicine developed for alcoholism.
We need to remember the banning of illegal drugs was driven by moral concerns rather than real harms
Currently LSD is still banned under the UN Conventions so is not available for clinical practice, however another compound with psychedelic effects, ketamine, is. This is an old anaesthetic that has over 40 years’ clinical safety data that has recently been re-purposed for use in treatment resistant depression. However, some 20 years ago a Russian psychiatrist, Professor Evgeny Krupitsky, began to use it to treat alcohol and other addictions with some success. This work in alcoholism has recently been developed in the UK by Professor Celia Morgan at the University of Exeter, who found powerful efficacy of just three ketamine treatments given with an abstinence-target psychotherapy.
The success of this study led to it being exclusively licensed by Awakn Life Sciences, a biotech company that also has several Awakn Clinics throughout Europe with two in the UK (Bristol and London), where it is now being used on a regular basis. As this use is outside of ketamine’s anaesthetic licence (so-called “off-licence” use) there is a need to get it approved specifically for alcoholism so that any treatment centre can use it. To achieve this, the UK National Institute for Health and Care Research and Awakn have together funded a larger multi-centre phase three study to be run by Professor Morgan that will start soon. What is remarkable is that just a few treatments can lead to enduring changes in behaviour with prolonged abstinence or very significantly reduced days of harmful drinking.
It may seem paradoxical that illegal drugs can be used to treat addiction, but we need to remember that the banning of them was largely driven by political and moral concerns rather than reflecting their true harms. Recent brain research has shown how these drugs work. They share a very special property of disrupting the brain circuits that drive persistent behaviours such as addiction. This means they also have potential for the treatment of behavioural addictions such as gambling or pornography, as well as those to alcohol and other drugs. Thus they represent the most exciting breakthrough in the treatment of addiction for many decades.
David Nutt is a professor at Imperial College London and CRO of Awakn
