Welcome to the final chapter of the DIRT FROM THE ROOTS series, your monthly blog for discovering new perspectives on interesting, insightful, and obscure topics within the mental health and psychology fields. It has been a pleasure to educate everyone on these subjects, and my hope is that you at least found some interesting and maybe even helpful!
Not to worry, I am not going anywhere, but will be changing the overall format and approach to the blog. This month we will conclude our two part series on the exciting but unorthodox topic of psychedelic therapy.
TOPIC OF THE MONTH PSYCHEDELIC THERAPY PART II:
HOW DOES IT WORK?
“To understand nature as a teacher, we must first realize that we are nature.”
— Dr. Rachel Lovie, Ph.D.
Now that we have covered the history of psychedelic substances, we can properly discuss the more interesting part, which is how they can be applied to our modern views of holistic care. To continue right where we left off, I feel it is important to begin with a reiteration that the goal is not necessarily to make these substances akin to coffee or other daily or even weekly used compounds, but rather to view it more like a similar fungal-based medicine in penicillin– an intensive solution for intensive problems. The goal of psychedelic therapy is again in some ways opposed to the regimen around taking other substances such as opioids, as the aim is entirely focused around long lasting changes that remain far after the client is actively feeling the effects of the chemicals.
With this being said, one way to abstractly look at the broad goals of the concept is to say we are trying to separate the consciousness from the vessel that is the body. I can’t blame you if your first reaction to this is to feel it is a bit “woo-woo”, but consider it this way: one of the few things we can say with certainty about trauma, scientifically, is that the largest and most impactful detriment comes not often from the conscious awareness of what happened, but from the subconscious “leftovers” which the body retains from this experience.
Therefore… Even in the most intensive therapy, we will always be “fighting against” our brain’s natural tendency to cling endlessly and without reconsideration to traumatic past experiences in a way that is very, very difficult to overcome due to this subconscious body barrier. For many people who have experienced successful results via psychedelic therapy, the common and profound reaction to these compounds of compartmentalizing perception of body from perception of consciousness/mind/soul has provided the most clearcut and tangible way to be able to consider things from viewpoints that previously felt unperceivable.
A second thing to keep in mind is that there is still a difference between recreational psychedelic usage and psychedelic therapy– while certainly a self-driven therapeutic psychedelic experience is possible and perhaps the best option for some, it is paramount to indicate that using psychedelic drugs without any form of therapeutic processing would not be considered psychedelic therapy. While the effects raise the availability of our emotional resilience to discuss deeply-ingrained issues, this does not mean they “magically” just fix all of our issues. One interesting metaphor would be looking at a parallel to skydiving– some may do it over and over purely for the thrill, but others may do it a few times to overcome a fear and see a positive change in the rest of their life going forward. The end goal of psychedelic therapy is obviously aimed closer to the latter. Another way to view it would be seeing it as a temporary firefighter suit; running into a burning building is obviously too hot to enter and successfully achieve goals without taking too much personal damage, but with careful application of strategy and a tool used to greatly increase resistance and resilience, we can do seemingly impossible things.
Perhaps most concisely, the goal of psychedelic therapy is essentially to increase neuroplasticity and help us create new neural connections, a major and possibly now-executable way to truly heal from trauma unlike any method we have been using in mainstream mental health previously.
DIFFERENT FORMS OF PSYCHEDELIC THERAPY
While we will focus on the two currently most prevalent actual substances in a minute, we will first review a larger list of specific psychedelic therapy approaches as well as substances that are used in psychedelic therapy. The most notable part of this list is that it is largely untapped, and therefore important to keep in mind that many of these compounds may have completely evolved usage in just a decade or so.
There are 5 predominant approaches to psychedelic therapy at this time:
1. Psychedelic-Assisted Therapy:
this would describe the most official way to receive services, as there are currently legal routes to receive ketamine-assisted therapy from a licensed professional. A qualified therapist guides you through the experience in this approach. We would be safe to assume that once prevalence becomes more and more common, this will become the standard approach to administering psychedelic therapy.
2. Psychedelic Travel:
essentially a way to do psychedelic-assisted therapy by traveling to states or areas where services can be legally provided. Travel can be done either by the clinician or the client. Currently, it would be far more likely to see the latter just due to the limited and specific places that treatment is deemed legal.
3. Psychedelic Retreats:
also known as psychedelic tourism, this would describe something such as attending an ayahuasca ceremony or spiritual retreat that is centralized around psychedelic experiences. While this can be very helpful, this approach also poses the most safety risk as there may be crucial resources missing or unregulated aspects to consuming the substances. If one is approaching psychedelic therapy from this angle, it is very important to have full understanding and awareness around both the safeguards and credibility of any psychedelic retreat or tourist activity.
4. Self-Directed:
again, this can work for some, but overall entails much greater risk due to lack of a qualified professional and susceptibility towards having an overly internal perspective turn things towards a “bad trip”, or undesirable sensory disintegration. An individual who is trying to process from an exclusively internal perspective may also be missing out on external ideas which may be crucial in connecting ideas or challenging pre-existing patterns.
5. Microdosing:
one of the more common approaches of psychedelic therapy is known as microdosing, or taking very small (5-10% of a “typical” dose) amounts of a substance for a mild but noticeable effect. Unlike other strategies, clients may consume small amounts of psychedelics 2-5 times per week in efforts to increase overall wellbeing at a minute but more constant level. While we are just seeing the tip of the iceberg of understanding like every other facet of psychedelic therapy, this is where you may be surprised to hear that this strategy… so far does NOT work any more effectively than placebo in most studies. Fortunately, the desired effects of microdosing have shown statistically proven evidence when clients instead took a full dose at a much less frequent rate.
REDUCING RISKS WITH PSYCHEDELIC THERAPY
In addition to the knowledge that we have gained, there are also obviously important risks to consider as well. While we have mentioned the concerns around those who have schizophrenia-rooted or bipolar disorders as far more at risk of psychosis and further mental harm when taking psychedelic drugs, there are additional risks involved as well.
Given the newly legal and restricted history of the compounds, not much is known about the physical risks of psychedelic drugs. While some have shown to raise both blood pressure and heart rate, they are considered safe in the context and dosage at which they have been studied. Though doctors have thus far concluded there is no risk of cardiovascular issues in controlled settings, there are more questions to be answered in regards to just how safe and how something such as microdosing, or taking the drug regularly, may change that. It is also believed that those with epilepsy could potentially trigger a seizure due to the substantial brain alteration effects from psychedelics, as 1.5% of people have reported this unwanted effect. Another risk that has been discovered is that those with specific TBIs may also face intracranial pressure with substances such as ketamine. A final potential issue that has been observed and spans across more than just certain conditions is HPPD (Hallucinogen Persisting Perception Disorder), which causes an individual to experience psychedelic symptoms even after the “trip” has ended. While treatment is generally very optimistic, some may find that this leads to some kind of distress and the condition can sometimes last for long periods of time.
Additionally, certain medications may create harmful interactions that should be clear to anyone considering psychedelic usage. Large amounts of psilocybin may create serotonin syndrome in combination with MAOIs, and potentially certain SSRIs as well. Ketamine’s sedative type effects may be harmfully prolonged in combination with other sedatives, and altogether I would say it is a requirement to consider potential issues in drug interactions long before considering actual consumption.
From the broadest viewpoint, the simple perception shifts and large, overwhelming experiences involved in psychedelic usage may become problematic if not processed in full, and could be harmful to individuals who are using the substances in uncontrolled settings or do not have adequate safeguards to potential distress caused by warped perceptions. While unavoidable, the increasing mainstream acceptance of psychedelic drugs could also lead to more usage amongst youth prior to full brain development. Though an unofficial measurement, a simple way to look at this is that there is definitely greater risk to those who are not psychologically prepared for the experience, and the more common that usage becomes, it is an unfortunate double edged sword opening the door for more use without awareness of potential consequences.
But concurrently… Psychedelic drugs are presently considered one of the safest drug classes, most notably because the risk of lethal overdose and addiction is extremely low. Given the nature of how the chemicals work on the brain, daily use at moderate or larger doses will actually lead to feeling no effect from the drug, making it much more difficult to form addictive pathways. This being stated, it is still paramount to understand the potential risks before embarking and hopefully incorporate some kind of safeguard to help with issues around integration, prevention, and precaution. While some of these negative effects can be mitigated, it is most important to be proactively educated on what risks will continue to remain present around psychedelic usage.
KETAMINE THERAPY: HOW DOES IT WORK?
KETAMINE-ASSISTED THERAPY refers to a treatment that utilizes low doses of ketamine, a dissociative-class drug that creates sedative effects at large doses but psychedelic-emulating effects at lesser ones. Treatment is used to manage mental disorders, most prominently PTSD, depression, and anxiety disorders. It is currently the most widely available substance utilized for psychedelic therapy.
The way that this works, from a simplistic perspective, is that the low dose of ketamine creates a short-lived but intense subjective experience in the individual during the initial consumption. This experience becomes what is known as an “afterglow”, which is best described as a mild shift in perception that lasts up to weeks after initial dose and typically initiates a positive change in affect, insight, motivation, cognition, behavior, and/or mood. While the initial experience is very powerful and may be responsible for the ‘afterglow’, this stage of the therapeutic process is perhaps the most important in regards to processing.
Like many psychiatric medications, the exact science of what is happening is still to be fully determined. But what can be inferred from ketamine treatment scientifically is that the experience seems to increase neuroplasticity and create new, healthy thought patterns. Another unofficial but anecdotal account that I have heard from multiple individuals is the idea that the dissociative effects at a low dose can be perceived as clear separation of mind and body, leading to increased resilience and tenacity when facing interpersonal trauma. This unique perspective can be extremely helpful, particularly to a brain that has never conceptualized it in full before.
While we have seen plenty of overwhelmingly positive effects, we have also seen many situations where ketamine treatment has either been neutral or detrimental, and unfortunately there are not as many clear correlations that would equate to bipolar/schizophrenia predispositions to look towards as a root. One thing that can be done to guarantee mitigation of risks would be looking at ketamine-assisted therapy as a LATER treatment option for conditions, as while it may very well be the most effective solution for certain individuals, there is probably still therapeutic value in first attempting more traditional methods such as talk therapy.
At the very least, I would recommend anyone who is going to try, well, any sort of medication treatment to have a full understanding of their motive and evidence of other solutions not working before actually engaging. From a purely logical standpoint, it would also make sense that someone who had thorough understanding of their mental issues would be better prepared for the post-therapy integration phase than someone who has not considered this angle and finds the experience too intense or too hard to make sense of.
At the end of the day, it is also crucial to remember that this was the first legal form of treatment solely due to ketamine possessing just a schedule III drug classification. While that is meant in no way to devalue the potential benefits of ketamine-assisted therapy, it is also important to at least highlight that legal logistics rather than evidence-based science was the motive for this becoming the first substance to be used in psychedelic therapy.
PSILOCYBIN THERAPY: HOW DOES IT WORK?
Another good way to look at psychedelic therapy in contrast to traditional medicine is that while the latter intends to artificially create a mental “environment” of neurotransmitters that can be manually entered via finding the right dosage… the former intends to structurally change the internal cognition patterns. With traditional medication, mental stability unfortunately must require continual intake of the medication and, just to make it that much more difficult to attain, builds tolerance quickly, requiring larger and larger doses. I reiterate here that one of the largest benefits of psychedelic treatment is that it actually requires LESS ACTUAL DRUG INTAKE than most any other medication-based therapy, and tends to have longer effects.
Psilocybin— better known as magic mushrooms or 'shrooms'– therapy is largely focused around this concept of having large experiences that can permeate into the overall worldview of an individual and remain fixtures of a changed perception, rather than just providing acute relief. What makes this substance a little more unique is the wide range of ways that subjective experience can go. While ketamine does necessitate a similar approach, it also works via a more sedative type effect that creates further consistency in reported experiences, making for a more understandable and universal prognosis and expectation around treatment. However, taking a full dose of psilocybin creates a reaction that is best described as mystical, profound, intensely emotional, or spiritual, and therefore this highly subjective experience requires further subjective processing. While no actual tangible science can show why there is effectiveness, studies do show strong correlation to improved quality of life over extended periods after engaging in psilocybin therapy– and in the end, it may be far more insightful to look at this from a qualitative perspective rather than a quantitative one.
An additional consideration here as compared to ketamine-assisted methods is how the actual therapy experience interacts with the individual experience. A common preparation concept for psychedelic usage that goes far back into illegality is known as “set and setting”, which basically indicates that the perceptions of safety and comfort while taking psychedelic drugs are paramount to what kind of result comes from it, and can determine the prognosis of the entire experience. For example, taking a large dose of mushrooms and going to a crowded DMV may result in extreme negative emotions and fear, while the same person taking the same dose at home with trusted friends may have a wildly more positive and insightful experience. This principle continues into the therapeutic realm, and therefore one of the initial points of conversation and alternating perspectives is around the value of having a guide/therapist/professional present for psychedelic therapy, and further how that other individual can maximize the value. It is still unclear if benefits of psilocybin are present regardless of whether some other person is present, though it is clear that comfort and safety should always be present if one is going to take a psychedelic drug.
Psilocybin-assisted treatment is scheduled to be available in Colorado by late 2024.
ADDITIONAL AND UPCOMING PSYCHEDELIC THERAPIES
Although psychedelic drugs remain near-fully illegal, here are a few other substances that you may hear about should this therapeutic school of thought continue to show more and more positive results.
Here are some substances that are believed to have potential medicinal usage in psychedelic therapy:
Ketamine (LEGAL NOW)-- used to alleviate depressive symptoms and better integrate understanding and ease symptoms of PTSD and other trauma.
Psilocybin (LEGAL IN CO end of 2024)-- used to alleviate both depressive and anxiety symptoms, better integrate understanding and ease symptoms of PTSD as well as neurodivergent conditions, success in smoking cessation as well as substance abuse disorders and eating disorders.
MDMA (ILLEGAL)-- used to help with end-of-life issues, PTSD, and neurodivergence
LSD (ILLEGAL)-- used to help with end-of-life issues, anxiety, depression, neurodivergence, psychosomatic diseases, and addiction
Mescaline (ILLEGAL IN US, BUT COULD BE MEDICALLY LEGAL BY 2026)-- has shown evidence of helping with both depression and addiction
Ibogaine (ILLEGAL IN US, BUT COULD BE MEDICALLY LEGAL BY 2026)-- possesses an immeasurable but interesting description of having “anti-addictive qualities” from many who have used it, this traditional african herb is seen as particularly effective when treating addictions. This specific compound may also be a viable counter to criticisms that psychedelic therapy is focused around pleasure-seeking or hedonistic behaviors– it is not typically reported to be an enjoyable experience and perhaps counterintuitively, has the most common response of the individual taking it to… not… want to do any more substances, typically for months to years. The leading hypothesis is that this essentially resets dopamine receptors to a pre-addictive level, and were that to be true then scientifically, this would become an extremely groundbreaking solution.
DMT (ILLEGAL IN US, BUT COULD BE MEDICALLY LEGAL BY 2026)-- used to improve emotional wellbeing and outlook on life, increased empathy and selflessness, and reduction of depression and anxiety. Known as “the spirit molecule” for effects that have been described as intensely hallucinogenic to a point where it is common for individuals to feel they were in another dimension, spoke to non-human entities, or comparable vivid psychedelic experiences, the extreme shift in perception can be seen as an exponentially more subjective experience than we discussed around psilocybin and therefore likely requires a more comprehensive therapeutic approach.
CONCLUSION
What I feel should be most prevalent in all considerations of whether psychedelic usage should be a facet of humanity is simply their natural availability to us, our seemingly fruitful history using them medicinally, and the fact that we can observe other species doing the same thing for some kind of benefit. While certainly all substances come from native elements of the earth at some level, and on the opposing end while certainly any substance can become harmful if misused, the overall perception of utilizing natural psychedelic drugs for remedial purpose towards mental ailments does not logically make any less sense, at least to me, than discovering that ginger root has great remedial purpose for stomach pain.
In my opinion, the fact that there is so much stigma and fear over even considering this approach becomes almost silly when compared to very legal synthetically created opioids that have so much hard evidence of direct harm that we have determined we are now in a crisis due to them, the growing amount of addiction rates in the population despite these “anti-addictive” drugs being counterproductively banned, and hell, honestly just the extremely unnatural and detrimental culture of being on very man-made screens and similar technology for anywhere from 5-20 hours per day. While the consequences of errant psychedelic usage may be very large for some, we are quick to forget that fentanyl is very effective for surgeries when used properly, is very much legal and regulated, and yet was still gravely responsible for 106,700 deaths in 2021. The amount of overdose deaths from psychedelic usage is so low and unclear if there are any that were not caused by other drugs that there is no statistic on it.
While psychedelic therapy may not be an end-all, be-all cure for mental health, the fact that such a cure does not exist in the world is kind of one of the messages that one may ultimately get from therapy, in general. Whether you feel that you may be more or less inclined towards the concept after reading through these two blogs was not necessarily the goal here as much as just to educate on how this approach actually does work and hopefully clarify the intentions and motivations of the concept itself.
Perhaps in a most apropos way to conclude the topic… the end goal was really just to gain new perspectives on the approach, as the power of reframing things might be a lot more impactful than you might think.
WHAT’S COOKING FOR NEXT MONTH
THE REJECTION PROTECTION CLUB CHAPTER 1: THE MYSTERY OF NEURODIVERGENCE
Next month we will begin a new series with a focus on neurodivergence and how to live life with or around others who may have developmental disabilities. We will begin with a review on ‘neurodivergence’ and try to separate what has been overused and politicized from what is actually helpful
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