Can Psychedelics Treat Addiction? with Dr. Albert Garcia-Romeu

Albert Garcia-Romeu, Ph.D. is an Associate Professor of Psychiatry and Behavioral Sciences at the Johns Hopkins School of Medicine. His research examines the effects of psychedelics in humans, with a focus on psilocybin as an aid in the treatment of addiction. He earned his doctorate in psychology in 2012 from Sofia University in Palo Alto, CA where he studied self-transcendence, spiritual experiences, and their relationship to mental health. Dr. Garcia-Romeu has authored numerous peer-reviewed articles, chapters, and commentaries on psychopharmacology and mental health, and has been interviewed widely in popular media. He is Associate Director of the Johns Hopkins Center for Psychedelic and Consciousness Research.

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Transcript

SPEAKER_01 0:00

Welcome to the Thriving with Addiction Podcast, where we explore how recovery is not just about surviving, but about truly living. Each week we'll dive into the times, stories, and strategies that help people and families heal from addiction and build healthier, more resilient lives. I'm your host, Dr. John Avery. Let's get started. I'm John Avery and welcome back to Thriving with Addiction. Today we're joined by Dr. Albert Garcia Romeo L, is an associate professor of psychiatry and behavioral sciences at the Johns Hopkins School of Medicine, where he is also the Associate Director of the Center for Psychedelic and Consciousness Research. This research examines the effects of psychedelics in humans with a focus on psilocybin as an aid in the treatment of addiction. He earned his doctorate in psychology in 2012 from Sophia University, where he studied self-transcendence, spiritual experiences, and their relationship to mental health. Al, welcome. Hey, thanks. Well, really lucky to have you here. And and your bio sort of speaks a little bit to maybe how you got into this field of studying psychedelics with your interest in spirituality. But walk me through how you ended up in this interesting space.

SPEAKER_00 1:21

And it was certainly not a planned excursion. But I had a lot of interest when I was studying psychology in undergraduate, which was a long time ago at Tulane University. But then when I was also doing more humanities-related work, um, philosophy of mind, consciousness studies, um, and also um studying different world religions, particularly some of the contemplative traditions, um, you know, Eastern religions like um Buddhism, Taoism, uh Hinduism, and you know, lots of uh uh meditation types of practices that were involved. Um, you know, there had already been some crosstalk between those, but um, they seemed very disparate, you know, when we're talking about mind and um consciousness, if you will, from uh the sort of Western psychological and neuroscientific standpoint, and what all these other traditions were talking about in, you know, um contemplative practice and meditation. And so that really just got me thinking about, you know, what the nature of mind and consciousness were and uh how these things uh could be conceptualized in different ways. Um, and that also kind of opened up an interest in altered states of consciousness, and that was uh uh specifically kind of uh opened up by doing some meditation practice myself, you know, when I was uh undergraduate, and that was something that got me interested in the area as well uh from a firsthand standpoint. Um, so that kind of opened the door to some of what I ended up doing, but um, there are a lot of other things that I think contributed to that. Um, you know, spending uh a good amount of time outdoors in nature, um, that uh kind of opened up uh certain types of transcendent types of experiences I would have when I was out there. Um that was a big uh piece of it for me. And and also at the time I had been reading a lot of Maslow and um reading about peak experiences and how he kind of conceived them in terms of their relationship to self-actualization. Um, that kind of brought all these different pieces together uh such that I became interested in what it meant for people to have experiences that they felt were uh transcendent or beyond their normal sense of self. And, you know, what types of mental health impacts those experiences could have. Uh and I knew that, you know, during meditation, people could uh experience things like that. In nature, people could experience things like that. Uh, and of course, you know, with uh psychedelic substances, people can have those types of experiences. And, you know, they're not always uh all positive. They can lead some people into uh psychotic reactions or, you know, delusional thinking or uh a lot of lots of other issues. Um, but there are also um, you know, documented cases and uh instances in which people report uh these experiences can be quite uh pivotal in terms of their uh thinking and uh sometimes making positive changes uh for their physical and mental health. And that kind of goes hand in hand with uh some of these ideas around, for instance, recovery from addiction, where you know people can have these very uh sometimes these very profound experiences, um, what they might consider spiritual or at least very meaningful to them, which can often lead to some behavioral changes or changes in the way that they uh relate to a particular substance or the you know substance use in general. Um, so kind of a long convoluted path with you know a lot of different pieces that came together. Um, but I was fortunate because I went to is sort of outside of the mainstream um graduate program, which was uh then called the Institute of Transpersonal Psychology. And so that was a place where we could really ask these types of questions, and everyone who was there was um, you know, uh required to do body-based practice like uh yoga or aikido, as well as doing other types of um, you know, kind of more didactic coursework around psychology. And so it really lent itself to um doing these types of uh inquiry around experiences that were kind of outside the norm uh of everyday experience and you know what those might mean and and how we could use them in therapy.

SPEAKER_01 6:12

Was there some personal experiences that led you to explore this route as well?

SPEAKER_00 6:17

Absolutely. I would say, you know, a couple of them that really stuck out was in one of my uh it was I think called Matter and Consciousness or something like that, in one of my philosophy classes. Um, the graduate student uh who was kind of the TA started a meditation club uh at Tulane that year. And so I started going to the meditation club, uh, which was in our chapel, which is a very uh pretty building there. Um, and we would practice various different forms of meditation. And I thought, you know, um, starting with certain types of like anapana, mindfulness of the breath, things like that, you know, they were compelling and interesting. Um, but I really kind of got blown out of the water when I was um first exposed to and first sat and did uh what they call a meta loving kindness meditation practice, which I'd never read about or didn't have any real experience with. But when we sat there and actually did it, um I had uh very much of this sort of timeless, spaceless uh type of experience, um was very much filled with emotion, uh positive emotion. Uh, you know, found myself crying even and uh was not expecting that, you know, to to do that, you know, on a Tuesday evening, just sort of sitting with a group of uh students and you know in this chapel. Um and so that was one of you know one of those experiences that kind of hit you know home to me that this could be an important thing to look at, and certainly that it could be healing or therapeutic in its own right.

SPEAKER_01 7:55

I studied philosophy and religion in college and then you know went on to study addiction and be an addiction psychiatrist. And throughout my journey, my friends, family, and even a lot of my mentors were like, What are you doing? This is not, you know, this is not the path to to take. And you know, there's a lot of stigma towards studying these experiences. Did you ex encounter that? It sounds like you were very lucky at Sophia University. Um, but but it there must have been some well, how did people respond to you as you explored all this?

SPEAKER_00 8:24

Uh well, you know, I think my thankfully my family and my teachers were supportive. I mean, uh, I had uh a lot of support along the way. And I also had my own like mental health struggles, a lot of depression and some substance use issues myself and uh, you know, a lot of people around me. Uh it was kind of, you know, one of the things that I ended up doing, and I guess this is kind of part and parcel to the you know work that I'm doing now was uh, you know, after undergraduate, I didn't really know what I wanted to do. And so I was working in odd jobs, including in, you know, bartending and working in the service industry, and you know, being around that in Miami, certainly there's a lot of uh, you know, alcohol and and drug use. And seeing that also kind of uh just reignited my interest in how certain people seem to have no problems with that, and they kind of got on with their lives. And other people it was very clear that they kind of would get into these um really deleterious cycles and that they would not necessarily be able to get themselves out of that. And also noticing, you know, that I also had a predilection to that, and I could potentially see myself getting caught in these cycles if I didn't do something about it. Right. It really kind of uh spurred me to move on to going to graduate school. And so I think that um, you know, although it was a non-traditional career path, um, again, it it uh I had a lot of support from my family and and I had a lot of really good mentors like the whole way through, including once I arrived at graduate school, where, you know, I was working with people who had been, you know, studying altered states of consciousness, um, and uh, you know, studying psychedelics in the 1960s, like Jim Fatiman, Charles Tart. So these were people that had actually brought a fair amount of academic uh credibility to this type of work. Uh, and they took me under their wing and were very uh supportive there as well. So I I got lucky, I guess, um to be able to do this. Um, but yes, I was kind of coloring outside the lines in a lot of ways. Like you said, it wasn't um a clear cut path forward. And and I, you know, I didn't even really know where I was headed. I was mostly just following what uh seemed interesting to me.

SPEAKER_01 10:45

But it it sounds like it was also sort of healing for you, that process. And that was my experience too, that that going through it, you learned a lot about yourself and why you struggled, why family struggled, and it makes the work we do even more meaningful.

SPEAKER_00 10:57

Yeah, that's right. And you know, I think as any good um program for, for instance, psychologists, you know, would uh require that you go through a good amount of psychotherapy yourself, right? Um, just to sort of learn the ropes from both sides of this of the couch. Uh and being, you know, in that, going through that process and you know, working with a cohort of other therapists in training, uh, many who are now uh you know still really close friends of mine and also great therapists in their own right and you know, doing lots of important work out there. Um it was a journey, you know, and it wasn't just a journey about um learning, you know, reading books and uh uh you know stimulating knowledge, but it was also about self-reflection and understanding, you know, oneself and um, you know, how how you sort of end up with certain types of patterns or or problems and and you know how to use that information to help other people as well.

SPEAKER_01 11:57

Well, I'm glad you tackled all this and and help us understand your main area of of research, these psychedelics. What what what are psychedelics to start for those that sort of have a vague idea from the media or from uh movies? Uh what what are we talking about with psychedelics?

SPEAKER_00 12:12

Well, believe it or not, you know, psychedelics is still kind of a fraught term in terms of like what exactly is a psychedelic. Um, I like to go back to the sort of historical source, which is specifically uh, you know, British psychiatrist uh by the name of Humphrey Osman. And this was in 1956 and 1957, uh, when he was already doing very early work with um LSD and Mescaline. Um and he was out in Saskatchewan in in Canada, uh, and he had been investigating these drugs. He thought that it would be possible that um he could get people who were in the throes of alcoholism specifically to have a sort of simulated rock bottom experience by giving them like a high dose of LSD or mescaline, and by kind of having this terrible experience with this drug, um, that maybe it could kind of help them come around and make some behavioral changes. So this was sort of some of the working hypothesis that he had at the time. And again, this is you know right early on in the field. Uh, but what he found instead was that actually these people were often coming back and reporting these really insightful experiences and very meaningful experiences, and sometimes experiences that they describe as feelings of interconnectedness and you know, revealing sort of new uh thoughts and and insights about themselves. And so this sort of forced him to reckon with the fact that these drugs, at least at that time, were really most often referred to as psychotomimetics. You know, so there were hallucinogens or psychotomemetics. Um, there were drugs that would cause people to hallucinate or have psychosis. At least that's what people thought at that time. And Osman said, no, you know, people are finding new parts of themselves and they're having sort of new insights when they're under the influence of these substances. And so that uh caused him to sort of suggest the term psychedelic, meaning it would help uh reveal what was in the psyche uh or uncover what was already there in the mind. And so that was a word that he proposed in 1957, um, specifically to talk about these drugs, LSD, mesculin. Um, around that time, psilocybin was uh first uh sort of documented in the scientific literature in the West as well. And so this would also kind of count among those uh what we call now classic psychedelics. Um and these are uh substances that they definitely function on the serotonin system. Um, this specific activity at serotonin IIa receptor seems to be particularly important. Um, but there's also a whole lot of other drugs in that have sort of gotten thrown under this bigger umbrella of psychedelics. And so you've likely heard of others like MDMA, um, which is often also referred to as ecstasy or Molly, um, drugs like ibogaine, uh, you know, ketamine. Um, so lots of other drugs that from a pharmacological standpoint work a little bit differently, um, uh have also sort of fallen in with this whole class of what people call sort of loosely psychedelics. Um, but often, you know, the the word can be really meant to talk about a class of experience that people can have as well. Uh, and that really relates to this sense of altered perception, altered sense of time, and altered sense of self. And so that's really why all these drugs are often lumped together, because many of them can induce similar types of experiences that people would have, where their sense of time, their sense of self, um, their thinking and their emotions are are deeply shifted temporarily. Uh, and during that time, uh, there appears to be a window in which it allows them to step outside of some of their normal patterns and potentially reevaluate those and possibly even make some changes in those patterns. Uh, and so that's really what uh we've been studying. And so it's those substances like psilocybin, uh, LSD, um, you know, mescaline, uh, as well as you know, the experiences that they induce uh that you know we kind of study in this uh field of psychedelic medicine.

SPEAKER_01 16:42

Right. And before we talk about sort of the benefits and risks in the clinical setting and and targeting specific conditions, what are the benefits and risks for people to just experiment casually out in the world and and maybe even talk a little bit of how that might differ from how they're used in clinical settings?

SPEAKER_00 17:01

So people have used psychedelic substances, especially these naturally occurring psychedelics, for it seems to be thousands of years. You know, we have archaeological records showing uh people have been using psilocybin-containing mushrooms. So, you know, they're found in all these mushrooms that grow all over the world. Um, but also uh mescaline, which is derived from different types of cacti like uh peyote or san pedro, um dimethyltryptamine or DMT, which is a close cousin to psilocybin, um, is also found in a number of different plants and uh animals, and um has been used in admixtures like ayahuasca, uh, in indigenous cultures. So for a long time, people have used these. Um, and in terms of what the kind of risks and benefits uh were in those settings, they're not particularly well documented, you know, from a scientific standpoint. Um, there was a really interesting project that was done uh back in the 90s, kind of going down to look at um indigenous practitioners who you and people who would use these uh substances regularly as part of their religious life. And really what they found was just that there didn't seem to be any negative impact. In fact, if anything, they appeared to be as healthy or healthier than people uh around, you know, the same areas. And this was, I believe, done in Central or South America, uh, showing that, you know, those folks um seemed to be operating at a good or better level than people who didn't use ayahuasca. Um, but you know, from a sort of more recreational standpoint, uh people have certainly used these drugs for a very long time. And really a lot of that kicked off in the US and you know, in the West, I would say, in the 1960s, when uh, you know, bands like The Beatles and Pink Floyd and The Doors uh were coming into popularity, uh, and you know, they were using these drugs, and you know, it really became kind of swept up in the countercultural movement. Um you know, nowadays there's a sort of a whole new zeitgeist and uh scene around these and you know their use. Um, but the studies that we've done, at least you know, on a relatively small scale, we're talking in you know, maybe in the hundreds, but also epidemiological data, which um, you know, often is coming from tens of thousands or more people, uh, seem to indicate that for some people who are using these out there in the world, there can be mental health benefits, including things like reduced risk of addictions to things like uh tobacco or opioids, um, potentially reduced uh risk of suicidal ideation. Um, you know, uh there was just a paper published in the clinical setting um related to that, but I'll I'll save that for later. Um, and you know, even in the the sort of smaller scale prospective longitudinal studies that we've done, which have been in, you know, hundreds of people, um, when we sort of follow their trajectory and measure before they use any um psychedelics like in this case psilocybin, um, and then afterwards, the majority of these people on average are showing what you would think of as salutary effects like reductions in depressed mood, reductions in anxiety, um, improvements in cognitive flexibility, improvements in emotional regulation. Uh, so these seem to be the types of benefits that some people can experience when they're using these substances outside of a more clinically oriented setting. Uh, but there are a lot of caveats that uh isn't are not always captured when you're looking at the averages or the aggregate data, um, because there are often, you know, some, at least in one of the big studies that I published, uh, I think it was in the ballpark of about nine, ten, eleven percent of people who um ended up having some pretty serious problems, uh, you know, uh mood issues, um, you know, other types of relational issues that they feel like they stem from their experiences using psilocybin recreationally. So there's always some subset of people for whom these experiences can uh not only not be beneficial, but could potentially be harmful. And so that's also something that's really both interesting for us to study and and try to understand more, um, but also so that from a clinical standpoint, we understand who are not good candidates to receive these types of treatments should they, you know, become available.

SPEAKER_01 21:38

So it sounds like potential benefits and maybe lower risk even than some other substances that that a lot a lot of people use. But some of the risks are for people with mental health issues. And then what about the risk for addiction, frank addiction to these?

SPEAKER_00 21:52

Yeah, well, I mean, I'll turn the question to you, right? You're an addiction uh psychiatrist and you see patients with uh with substance use disorder. I imagine. So like how often do you would you say you've seen in your career people who come in and say, you know, I'm addicted to this LSD, I need to get off of it, or I'm addicted to the psilocybin, these psilocybin mushrooms, and I can't stop using them.

SPEAKER_01 22:17

I'd say it's pretty rare. And I think the the numbers show show something similar. But I tend to see more in my addiction practice, addiction psychiatry practice is people that have some mental health struggles, you know, psychosis or bipolar. That seems to have been made worse by their use, I'd say. And then I get a lot of questions from family members saying, like my teenager has started, you know, experimenting, or my you know, everyone in the PTA is using chocolate bars that have a little bit of license in them. I mean, what do you say to those groups too?

SPEAKER_00 22:51

You know, I would say that buyer beware, because you know, there have been studies that are published showing that what's out there if you're buying these chocolates like in places where they may be available on a counter, um, is not always what is purported to be in there. Uh that includes sometimes our research chemicals that we don't have good knowledge about their safety and toxicity, um, as well as the dose, you know, maybe quite different than what's expected. Um and the other issue, I would say, is that both around the risk, they are real, and they're uh, you know, real risks to the people, as you noted, you know, who may have a predisposition um either latent, which they're not even aware of, or you know, one that they they may have had some experiences with, things like manic episodes, um, psychotic uh, you know, uh episodes, um, or you know, even prodromal types of features of those, which can be uh triggered or exacerbated by some of these drugs. And it doesn't necessarily have to be a large high amount, you know, using these high doses. Right. It's possible that repeated low dose administration could lead to that. And actually, one of my colleagues here, uh I think it was uh Dr. Paul Kim, who published a nice case series about this um not long ago, where you know people ended up having the types of problems that you noted around uh psychotic illness or bipolar mood um that seemed to have been kicked off by or at least uh you know exacerbated by some psychedelic use, including microdosin. The other big thing that I say about microdosin, which I think is important to highlight and emphasize, is that there has not been a controlled clinical trial uh showing that it has any significant benefit in terms of mental health. Uh and so there have been studies, for instance, using microdoses of LSD and people with ADHD. There's been other studies of psilocybin mushrooms uh microdosing in people with depression. Um, and these have not shown to be any better than placebo in those types of studies. There haven't been a ton of them. Uh, and you know, it's quite difficult still to do these types of research studies. It's expensive and uh and so on. But um, you know, the studies that have been done with the you know randomization and placebo control and rigorous sort of design in place have not shown that it actually is helpful. So um, you know, because of all those things, I tend to err on the side of you know being cautious around, you know, uh people using these these substances uh kind of casually in those ways, and particularly because uh, you know, there's also obviously legal ramifications.

SPEAKER_01 25:40

Aaron Powell What about in the clinical setting now? Even though yeah, some concerns about use out in the community, there's a ton of excitement uh in this in the clinical space. Tell me what you've you've found and and what we should know in terms of both mental health and addiction.

SPEAKER_00 25:55

Yeah, well, there has been a lot of work that has been focusing, and this has been, you know, now decades in the making of uh research uh focusing on the use of drugs like psilocybin, uh MDMA, LSD, um, you know, within sort of a structured setting uh to help people that are dealing with a number of different mental health conditions, and that would uh include things like major depression, uh generalized anxiety, uh, and substance use disorders. You know, those I would say have been uh some of the biggest areas of interest where you've seen a lot of evidence accumulating, um, you know, oftentimes slowly and little by little, but we're kind of getting to this uh breaking point where it appears that we may see some of these uh drugs actually approved as new medicines within a relatively short amount of time, meaning you know, they may become available for doctors, like you to prescribe to patients uh and you know, to administer in a therapeutic manner. And so I think that's gonna be uh both very interesting and very exciting uh because it represents uh potential sea change in terms of how we're able to treat uh certain conditions, and some of which have been very uh you know recalcitrant to treatment. And, you know, I think addictions and meat disorders are two of the big areas um that are um, you know, uh uh of most interest at the moment. So yeah, stay tuned because I don't really know how things are going to unfold over the next few months or years, but um, having kind of kept my finger on the pulse now for some time, uh, you know, I s I would say there's uh quite a bit of excitement, uh, even more so than I've seen, you know, since I started in a field, which is like 14 or so years ago.

SPEAKER_01 27:50

So and how are these substances given in the clinical setting? What what if a patient comes into one of the research studies? What do they expect?

SPEAKER_00 27:58

Well, we have a whole process that we go through, and you know, we would hope that should these become FDA approved, that there will be a similar type of uh, you know, wraparound care that's in place. Uh, but there's normally a sort of screening for eligibility where we would look for those things that might rule you out in terms of safety. If you have cardiovascular problems, uh if you have a history of psychosis or bipolar mood, or you have the uh family history of some of these issues, um, you know, that can often be a red flag that perhaps this is not a good candidate to get a high dose psychedelic treatment. Um, you know, once we kind of get through that and we find that, you know, this person seems to be safe, um, we would do a course of preparation where that's usually several weeks of counseling without any sort of drug on board, um, but mostly just talking about what to expect and forming treatment goals and, you know, getting a good sense of the patient's sort of life history and their symptom burden and, you know, what they would like to work on and get uh relief from. Uh, and that would move into the drug dosing, where there's typically anywhere from one to three high doses administered of a drug like psilocybin or LSD or MDMA. Um, and those those administrations are usually spaced out by several weeks from one another. Uh, and you know, during those uh drug dosing sessions, people are usually uh kind of lying down on a couch. They're not really being uh talked to very much. Uh so we we wouldn't be doing a sort of therapeutic intervention during the uh drug experience, or really uh asking people to have an introspective experience where they may lay down for six hours and listen to music and sort of just reflect on what they're feeling and what's going through their minds. Uh and you know, uh once that's over and people are typically releasing the care of like a friend or family member, um, then there's this uh period uh of aftercare, uh often referred to as integration. Um, but really it's it's a period where people are coming back and uh talking about what, if anything, kind of came up for them during these experiences. Um, I know there's a sort of uh misperception that they're all that you know people will often have these uh mind-blowing uh you know experiences that are incredibly insightful. But there's a lot of different, there's a lot of variance how people respond to these substances and how sensitive they are to the doses that we administer. And so that needs to sometimes be calibrated somewhat. Dose may need to go up more or not. Um, but regardless, you know, the the next several weeks in aftercare is a period of sort of reflection, meaning making, and continued support, you know, towards uh those therapeutic goals that had been set forth in the preparation period. And so even if a person feels like they didn't have an experience that was incredibly productive, um, you know, the therapist is still there to help them uh make meaning of what they're going through and also to support any sort of progress that they are interested in making. And if that's you know around substance use or around mood, um, you know, trying to find ways to capitalize on the therapy uh during that window. Um and you know, that's the kind of general model that we use um with this high-dose psychedelic therapy. Um, but it has shown now, you know, in a number of different studies, um, to have this significant antidepressant effect, uh, significant uh anxiolytic effect, uh, and also to really help people who are struggling with things like alcohol, tobacco, and cocaine, um, in terms of you know increasing their uh both their abstinence or their likelihood of becoming abstinent, uh, or reductions in their in their uh regular use. So that's really what the clinical evidence to date has suggested, and the reason why I think there is so much excitement and why this is sort of uh under consideration right now seriously is a potential new treatment paradigm.

SPEAKER_01 32:16

Right. And the data is pretty strong, right? That really especially for um mental health, maybe PTSD mood, um, and then for alcohol and and some other substances that it it really improves outcomes.

SPEAKER_00 32:29

Yeah. I mean, there are now, you know, a number of these randomized controlled trials, there are still problems, and I think you know, it's good to be aware of those. Um, it's almost impossible to really do a placebo-controlled study with these. Right. Um, because you know, if you're laying on a couch uh for an hour and you took a pill, you will know if you have a you know a feeling of these subjective drug effects, which tend to be very profound with the high doses that we use, or if you're just feeling nothing, in which case, uh often that can lead to what we call a nocebo effect, meaning not only are they uh, you know, not getting a response, but they're so disappointed they didn't get this treatment that they want they, you know, they were interested in trying that their depression or their anxiety may even you know become worse to some degree. Uh and so it's it's really hard at this point to parse out um you know all of the clinical impact of these drugs because of these methodological difficulties. But you know, regardless, the of data that has been accumulating uh really does kind of point to this uh signal of efficacy and and you know shows relatively good safety uh you know in these uh well-controlled contexts. And so with that, you know, you are seeing you know these now phase three clinical trials emerging with hundreds of patients where you do see this um you know statistically significant and you know, in uh many cases clinically significant signals that uh you know, somebody who receives a single dose of psilocybin, for instance, with uh a few weeks of talk therapy may be six or more times more likely to quit smoking, for instance, than uh someone who received an FDA-approved treatment like nicotine patches with counseling. And so when you look at those data, I think it's very makes a very compelling case for considering uh, you know, whether these should be available to people. Uh and particularly given that when given in these types of settings, we have a very good safety record.

SPEAKER_01 34:38

Right. And in terms of what's what makes it effective, how uh and it may be hard to tease this out, but how much is sort of the experience that one has versus what it's doing to the brain uh or not?

SPEAKER_00 34:51

Yeah, and yeah, that's a great question. And it's one that we don't know uh the answer to. It would be nice if we can say, well, it's you know, 40% of the experience and 60%, you know, that it's inducing some neuroplasticity in the prefrontal cortex or something. But the the real problem is we at least to date have not been able to sort of separate out the two, um, because when people get the drug, whatever it's doing in their brain is often, you know, inducing these types of experiences. We can use other drugs like benzodiazepines or anesthesia, uh, which people have used to try to basically make people unconscious of the effect. The problem with that is you know, you have now complicated polypharmacology going on where the combination of the drugs may be doing something to sort of render the you know key ingredients or the you know um signaling cascades that may be happening uh ineffective. Uh and so it's hard to tell even from those types of very sophisticated experiments, you know, where the magic is happening or, you know, what is the therapeutic um mechanism at play. Uh one of, you know, some of the data that we have definitely point to an importance for the relationship between the person who is overseeing the treatment, whether they're therapist or facilitator, um, and the the person who's going through the treatment, the patient or the client. Uh and so that relational component uh does seem to add to the outcomes in terms of therapeutic improvement. Um, but at least the data that we have now suggests that there is some relationship between the types of experiences that people have when they're on the substance and the therapeutic improvement they see afterwards. Um, and so that's definitely uh, you know, appears to be a part of it. Um, and you know, the other stuff that's happening from a biological standpoint is also um, you know, really interesting and uh still being investigated heavily. But you know, we're seeing that the brain, in terms of its uh activity, is changing, you know, across multiple different levels uh and different types of uh data that have been collected in this area using MRI, EEG, um uh pet imaging, uh, and even in uh animal models where you're able to more uh at a fine grain, you know, uh investigate things like uh synaptic density, um, the appearance of new uh dendrites, uh, and basically connections between neurons that seem to be forming, at least in these animal models. Um, and then you know, you take that along with all this other data that's accumulated on changes in um brain activity related to MRI, an EEG, and it starts to paint a picture of uh, you know, a drug that's having a biological impact on the brain that could be having these reverberating and persisting uh effects that could last weeks or months, uh and interacting with, you know, this sort of therapeutic component that could potentially help support that process or uh even amplify some of the therapeutic uh benefits. So that you know is my best sort of uh crack at explaining how we think this works right now. Uh but again, you know, that's something that's changing rapidly. Uh we just uh finished a textbook for American Psychiatric Association, which will be coming out in July. And uh that was a frustrating experience because, you know, just in the time that it took us to put the book together, um, you know, so much new work has come out. And so it's like stuff that you want to include, but you have to wait until the next edition, I suppose.

SPEAKER_01 38:45

Well, I'm I'm excited to see what comes next. And I'm also reassured that we're in such steady hands as your hands. I think your personal experiences and your thoughtfulness make you such a unique person to really lead the charge in all of this.

SPEAKER_00 39:00

Well, I wouldn't say I'm leading the charge, but there's a lot of people working on this, you know, here at Hopkins, but all over the the world, I mean, it seems at this point. We're really excited to see that work is happening in places like the Czech Republic, in Australia, you know, uh work is happening in Europe, in Denmark, uh, UK, uh, and you know, obviously all over the US as well. Uh, and so I yeah, I agree with you though. I'm very excited to see sort of where the field goes and uh how this unfolds in the coming years, especially as it relates to, you know, whether or not we're gonna be able to see improved treatment outcomes for these patients that are out there suffering now uh and who aren't necessarily getting uh the relief that they're seeking from the available treatments.

SPEAKER_01 39:47

Well, thanks so much for educating us on all this, and thanks for spending the time with uh me today.

SPEAKER_00 39:52

My pleasure. Thanks very much for having me.

SPEAKER_01 39:54

Thanks for listening to the Thriving with Addiction Podcast. If you found today's episode helpful, please follow and subscribe wherever you listen to your podcast and share it with someone who might benefit. You can also connect with me on Instagram, LinkedIn, and YouTube, or visit thriving with addiction.com to learn more. Stay tuned for next week's episode and remember Thriving is content.