Psychedelic Therapy: A Complete Guide to Hallucinogen Use for Potential Improved Health
There’s growing buzz around the use of psychedelics to treat health conditions like depression, anxiety, post-traumatic stress disorder (PTSD), and addiction.
Given the expanding catalog of psychedelic studies, the development of university-based research programs, governmental approval of a type of ketamine for depression, and an increase in the number of therapeutic centers around the country, you may be wondering if these drugs could support you, too.
While the emergence of psychedelic therapy may sound promising, it’s a complex arena with a controversial history, evolving legalities, and uncertain health applications. In short, the use of psychedelics for therapeutic purposes is still under scientific evaluation, and most hallucinogen use remains illegal at the U.S. federal and state levels.
Read on to learn more about what we know about psychedelics, including their potential health benefits, the risks they can pose, and more.
Researchers believe that psychedelics work in two ways. Firstly, by changing both your brain, and then by altering your perspective, says Matthew Johnson, PhD, a professor of psychiatry and behavioral sciences at Johns Hopkins Medicine in Baltimore.
Neuroplasticity, which refers to brain changes, happens when a person is exposed to hallucinogens (or similar drugs, like ketamine and MDMA). Some hallucinogens, like LSD and psilocybin, hit a serotonin receptor called 5-HT2a in the brain. This affects how the brain communicates with itself during what’s colloquially known as a trip.
“It seems that there are radically different ways in which the brain operates and organizes,” says Dr. Johnson. “Areas of the brain that normally don’t sync with each other now communicate more, and areas that normally talk to each other do not,” he explains. This may create an environment where new neural connections form new ways of thinking.
The integration component is also key for successful treatment, notes Johnson. Through the integration phase, your therapist may help you process what you experienced in a healthy way. This can reinforce what you learned and assist you in readjusting to life after your treatment.
In the United States, psychedelic therapy is not federally standardized. You may find it performed in a multitude of settings, both legally (in a licensed clinic, the parameters of which vary by state and city, or in a medical trial) and illegally (any non-FDA-approved hallucinogen administered outside a legal environment).
Everyday Health is not in any way condoning the illegal use of psychedelic drugs for therapeutic or recreational purposes.
For psychedelic therapy, it’s best practice to work with a licensed mental health therapist who has knowledge of these substances, and who will remain with you and guide you along the journey — from prep, to substance administration, to integration after treatment. Psychedelic therapy should be administered by a medical professional in a clinic or location designed for supervised administration of these substances.
You’ll have to do some research on your own, since there are currently no formal U.S. state or federal regulations on how psychedelic therapy is practiced. You should start by looking at the legalities in your state. Don’t seek out any psychedelic-assisted therapy from someone who is offering therapy using an illegal substance, even if they have proper mental health credentials.
The exact protocol of your session will depend on the psychedelic drug and your healthcare goals. There are several basic approaches to psychedelic therapy. Here are some of them.
This is where a qualified therapist guides you through the psychedelic experience. Right now, ketamine assisted therapy is the only psychedelic-like legal substance assisted therapy available nationally to the public. That said, you can find research centers that are conducting controlled trials in psychedelic-assisted therapy with a variety of psychedelics for specific conditions.
Some people travel to other countries to have a psychedelic experience with substances such as with ayahuasca. There are still legal and safety risks involved, since you may not have access to a medical professional who can help you manage adverse reactions. Experts don’t generally recommend these experiences.
“There are credible cases of people using [psychedelics] by themselves, but it’s not the safest way to approach it, and the likelihood of the treatment being effective is not nearly as high,” says Johnson.
Some people have praised microdosing for reducing anxiety, and improving focus, mood, and creativity, among other benefits. While there have been some positive anecdotal accounts, recent studies have not found a difference between microdosing and placebo, says Charles Grob, MD, an investigator at the Lundquist Institute and a professor of psychiatry and biobehavioral sciences and pediatrics at the David Geffen School of Medicine at UCLA in Los Angeles. “In spite of the enthusiasm for microdosing, there’s a lack of definitive proof that it’s effective,” he says.
Research is ongoing, but at present only ketamine is used legally in mental health therapy across the United States. Studies have examined the potential health benefits of a range of psychedelics in clinical trials, though not all have been studied extensively. Some include:
First of all, it's important to understand the limitations of psychedelic therapy. Much more research needs to be done, says Dr. Grob. “Until very recently, it was unacceptable to even consider psychedelics as having treatment potential. There is still a lot to learn and a lot of work to do,” he says.
With that in mind, here are some potential health benefits.
Ketamine is indicated for treatment-resistant depression, or someone who has “failed” conventional treatments, like SSRI medication, says Mailae Halstead, a therapist with Behavioral Wellness Clinic in Tolland, Connecticut, who specializes in ketamine-assisted therapy and psychedelic integration. “Ketamine [may] alleviate depressive symptoms so that patients might be able to do the things they need to do to keep depression at bay, such as a regular movement practice or cognitively reframe negative biases and self-talk,” she explains.
Ayahuasca was specifically linked to enhanced emotional well-being compared with other hallucinogens, even among those who had used it just once. Participants claimed that psychedelics led to transformative experiences and insights that shifted their mindsets and attitudes, as well as leading to enhanced selflessness and a drive to help others. The authors point out that these substances appear to be most effective in infrequent doses to initiate change within one’s self, rather than taking them long term to level out one’s mood. Of course, not all outcomes seemed positive. One in eight people reported experiencing harm from psychedelics, and it’s important to note this is survey data based on self-reporting, rather than an actual experimental or clinical trial.
More research is needed to better understand all the risks of psychedelic therapy. There is much to learn and study relating to how psychedelics may interact with medications, including mental health medications, as well as other drugs, so be sure to tell your treatment provider all the medications and drugs you take.
In addition, there are risks, both legal and health and safety, no matter how or why you use psychedelics. Some people may choose to do this in an underground setting, when an illegal psychedelic is given in a therapeutic or nontherapeutic setting which further increases the potential risks.
“People want help and are willing to try things out of desperation, but they can end up at the mercy of unethical [practitioners]. I encourage everyone to be careful, whether in the U.S. or abroad,” says Joe Tafur, MD, an integrative family physician working in collaboration with Daytryp Health and the Ocotillo Center for Integrative Medicine in Phoenix.
Should someone experience a medical event mid-session, you want to be confident that the person administering the drug will call for help without fear of legal repercussions, adds Johnson.
“If you go out of the United States, you want to be very careful. It’s a very vulnerable position to put yourself in, being in another country where you might not know the language or the culture,” says Dr. Tafur, who is also the author of The Fellowship of the River, which explores the role of spiritual healing in modern healthcare.
This is why the movement to create legal pathways for these substances, whether through therapeutic or spiritual pathways, is so important, says Tafur. “We want to find ways to bring this aboveboard so we can make sure we have ways for people to explore this safely,” he says.
If you’re interested in pursuing psychedelic therapy of any kind, talk to your doctor first. In addition, know the dose and purity of the substance you will be taking in a clinical setting, ensure you work with a licensed therapist before, during, and after treatment, and identify where the closest hospital is in case you need medical intervention.
Not everyone is a candidate for psychedelic therapy. Your therapist should go over your medical history with you in depth before you embark on a treatment regimen.
If you are traveling to another state for treatment, get clearance from your doctor before doing so. “There are medical conditions to take into account before you have an experience like this,” says Grob. A psychedelic-assisted journey can be stressful and taxing for your heart, and psychedelics tend to increase your heart rate and blood pressure. For these reasons, if you have unstable hypertension, you will be ruled out as a candidate. An arrhythmia (irregular heartbeat) is also a concern: “[In this case,] your cardiac function needs to be monitored carefully [during therapy],” he says.
It may feel intimidating to approach your doctor about psychedelic therapy, but it’s vital you consult your healthcare provider to find out if you, medically, are a candidate before pursuing treatment.
“Any experience will be safer if you go to the doctor and make sure your heart health is good, and they’re confident you don’t have a predisposition to schizophrenia. Those are the two most important things to screen out,” says Johnson.
Initially, you could approach your primary doctor, specialist, or psychiatrist with a phrase like: “I have some questions about psychedelics, are you open to discuss this with me?” Further questions about the potential role of psychedelic therapy could include the following:
In addition, ask yourself if you have the right support in place to go through psychedelic therapy, says Tafur. Ideally, you would speak with your current conventional therapist, as well as the therapist who will be guiding you through psychedelic therapy.
“You might have a very transformative experience, but without adequate support, either personally in your community or professionally through a therapist, it can be tough to go through something like that alone,” he says. For one thing, the treatment might be less effective and could be psychologically stressful, Tafur explains.
It’s important that you find a practitioner who has taken continuing education in psychedelic therapy. They’ll be able to assist you in determining if this is right for you. Some therapists are also certified psychedelic-assisted psychotherapists (PAPT), which means they underwent a yearlong training program offered through the Integrative Psychiatry Institute (IPI). IPI also offers ketamine medical provider online training for healthcare providers. The program is run with the American Society of Ketamine Physicians, Psychotherapists & Practitioners, a nonprofit. In addition, the IPI has a directory of providers who have their PAPT. This is a place to start, but you should still talk to a particular provider about their experience, how they offer the therapy, and other medical providers they work with to administer the treatment.
Anxiety and paranoia are common side effects of psychedelics, and an established rapport between the therapist and patient may help the patient feel safe throughout the experience, says Johnson. “Therapy really needs a monitored session, otherwise you could take something that could be a therapeutic experience and turn it into something hellish, where no learning occurs,” he adds.
The New York City clinical psychologist Lisa Morse, PhD, found that continuing education in psychedelics was relevant for her practice after she had a handful of patients ask her opinion on them.
“I realized I had a responsibility to understand more. Without this education, we’re really not in a position to help patients on this issue,” she says. So, she took a course in psychedelic therapy, which included information on specific drugs, harm reduction, and more. Dr. Morse now feels she’s somewhat more equipped to provide guidance, as patients “consider and evaluate their options, in a nonjudgmental way, that’s never advocating they break the law,” she says.
For providers who are interested in learning more on psychedelics, Morse recommends Fluence, a continuing-education platform in psychedelic-assisted therapy and integration.
If your provider is still unsure of what to say or you don’t feel heard, you may consider a second opinion to get medical advice and clearance to move forward in a safe, informed manner. For example, you might seek out an integrative doctor or integrative psychiatrist who may be more experienced with discussing psychedelic therapy or could refer you to a doctor who is.
Psychedelic therapy has the potential to be of great value [to some patients], says Grob. “However, it’s imperative that we go about understanding these compounds in the right way, which means under controlled conditions with the right personnel,” he says.
That means seeking out an experienced facilitator (a licensed therapist or doctor who can administer psychedelics legally) who will screen you ahead of time to make sure that you’re an appropriate candidate for treatment, says Grob.
Right now, outside of clinical trials, ketamine therapy is the only psychedelic-like treatment available legally on a federal level in the United States. If you move forward with psychedelic-assisted therapy, there are three main stages you’ll go through with a trained professional.
After receiving an evaluation and clearance for psychedelic-assisted therapy, you will start preparation. In a series of sessions, the therapist will go over what you need to know, including how long treatment will take, what you might feel, potential side effects, and what you might feel coming off, and after the drug. In the preparation stage, it’s also important to discuss what you hope to get out of the experience. That can set the stage for what happens during the medication portion: “We find that the ‘substance’ of the intention often manifests during the course of the treatment session,” says Grob.
This is when you will receive the psychedelic, which may be done intravenously, intranasally, intramuscularly, or orally, and varies by drug. The length each session lasts also differs by drug and therapist protocol. You’ll also need to plan time before and after treatment for prep and observation, which varies by patient. “The facilitator needs to be present the entire time,” says Grob. The therapist should gently guide you along your journey and make it feel like a safe space.
These are nondrug sessions with your therapist to talk about and interpret your experiences, gauge your progress and functionality, as well as discuss any adverse effects from the medication, says Grob. Integration is a key component of care, but some ketamine centers are medical only, and only offer the medication or infusion. In that case, you should seek out a qualified therapist as an adjunct to help you transition after treatment.
Integration sessions look just like a typical psychotherapy session, adds Halstead. You’ll focus on meaning-making, as well as setting up practices that will improve your mental well-being. During these integration sessions, you can also capitalize on the increased neuroplasticity from treatment, which can reinforce your learning. Overall these integration sessions can increase the efficacy of treatment.
Costs for psychedelic therapy vary depending on the clinic. We will focus on the cost of ketamine therapy, since it’s the current option that’s federally legal in the United States.
While Spravato is a prescription medicine that may be covered, in part, by insurance, the company also has savings programs available to defray the cost.
Ketamine centers, or ketamine given in a therapist’s office, may also be partly covered by insurance. Costs to you depend on your copay or deductible, according to your benefits. Aside from insurance, costs vary depending on several factors, Halstead points out, which can include:
Typically, if insurance does provide coverage, they will only do the preparation and integration sessions. They will not pay for the medicine itself, says Halstead. Again, check your benefits and have a conversation with the center about the cost for each stage of therapy. This can add up to thousands of dollars, she says.
A Google search of ketamine infusion centers shows that a one-hour ketamine infusion (of which you may need several) varies depending on provider, location, and services offered. For example (note, these are for illustrative purposes and not an endorsement):
No matter where you go, inquire about your financial options, as sliding scales, payment plans, and other available programs that may help reduce costs. If you are part of a psychedelic clinical trial, then you would not need to pay. Ideally, as research evidence mounts, psychedelic therapy will include more substances and be better covered by insurance.
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