New qualitative research sheds light on how psychedelic-assisted treatment can help defeat tobacco addiction.
The study, published in the Journal of Psychopharmacology, sought to identify some of the potential psychological mechanisms that lead to smoking cessation in people who received psilocybin, the active compound in so-called magic mushrooms.
“Cigarette smoking is today a huge public health scourge and although there are some effective treatments (e.g., better than placebo), these still don’t work for most people in the long term and there is huge scope for improvement,” explained Tehseen Noorani of Johns Hopkins Bloomberg School of Public Health and Durham University.
“An open-label pilot study had impressive results in the treatment of cigarette smoking addiction with psilocybin-assisted psychotherapy, and we wanted to understand better how it worked – commonly referred to as the ‘mechanisms of change’. One way to do this is to draw upon participants’ experiences, to identify themes in perceived mechanisms of change.”
“For psychedelics-assisted psychotherapy to be feasible at scale, we need to understand how to streamline the protocol without compromising safety or efficacy, and qualitative investigation can be crucial for this.”
“Personally, I was really excited by the use of psychedelics, which can occasion deeply meaningful experiences, for disrupting something as notoriously stubborn as cigarette addiction,” Noorani added.
“I was also interested in the challenge of parsing out the complexity of the research protocol itself – including substantial levels of care, a deep concern by researchers and the clinical team in the lives of participants, extended follow-on support and the expectations that come from the reputation of Johns Hopkins, which is an elite research institution.”
For their study, the researchers interviewed 12 individuals who had participated in a previous study on psilocybin-facilitated smoking cessation. In the original study, the participants received cognitive-behavior therapy along with two or three psilocybin treatment sessions.
The interviews were conducted an average of 30 months after the initial psilocybin sessions.
“Participants reported that psilocybin sessions led to psychological insights, experiences of interconnectedness, feelings of awe and curiosity and reduced withdrawal symptoms, all of which helped them successfully quit smoking,” Noorani told PsyPost.
“When well-prepared and supported, psilocybin sessions reliably produced profound insights, which can be divided into narrower reasons why participants smoked, and broader insights into their identities, their lives and the world.”
“Some participants described these as not so much ‘radically new’ insights but the returning to awareness of something that they already knew, or felt they once knew.”
Nine of the 15 participants had effectively quit their smoking habit, two relapsed and started smoking again, while one participant stopped smoking aside from an occasional cigarette at parties. But the participants reported benefits besides kicking their addictions.
“Smoking was one of the least important consequences of study involvement – participants reported many other sustained improvements in their lives, including enhanced aesthetic appreciation, openness to experience and engagement in the community,” Noorani explained
“The multiple study components were perceived to work synergistically to help people quit smoking. The careful preparation of participants and considered facilitation of sessions was vital, as was the trust in the team and rapport, for participants to explore their smoking addiction and to fully relax into their psilocybin experiences.”
“The way the protocol was formulated appeared to work well to dislodge smoking addiction,” Noorani said. “Participants reported how profound psychedelic experiences were engrossing for days afterwards, displacing withdrawal symptoms such as cravings during this time period. A further incentive to refrain from resuming smoking in the short term came from participants knowing that this would disqualify them from their second psilocybin session (usually scheduled for two weeks after the first one).”
“In line with many recent studies, psilocybin was not considered addictive by any participants in the study.”
The study — like all research — has some limitations.
“A key question is what weighting to give to the different factors, such as the psilocybin experiences, the support from the study team, the cognitive behavioral therapy-informed preparatory meetings and the follow-up care,” Noorani remarked.
“We need to investigate the meaningfulness of psilocybin experiences apart from how ‘mystical’ experiences score. Unlike the latter, meaningfulness can grow both across psychedelic sessions and beyond them.”
“A major caveat is that this was the retrospective investigation of an open label trial – we need to investigate participant experiences in a larger trial with a control arm to understand and disambiguate the processes by which psilocybin is useful in a smoking addiction cessation intervention.”
“It’s an open question how far these results might generalize beyond the participant demographics set by the inclusion criteria. Another question concerns ways of improving upon the therapeutic components of the study, including the preparatory session format, the optimal number of psilocybin sessions and the design of the follow up care.”
“It will always be tricky to test certain variables bearing in mind that, for example, omitting the involvement of supportive guides or follow-on care may be unethical,” Noorani added. “It might be worth pointing out that some may dismiss qualitative research as ‘merely’ subjective, but the analysis of subjective experience is a very robust approach, and can often offer insights that qualitative research cannot — in particular when we don’t know what the right questions to ask are.”
The study, “Psychedelic therapy for smoking cessation: Qualitative analysis of participant accounts“, was authored by Tehseen Noorani, Albert Garcia-Romeu, Thomas C Swift, Roland R Griffiths, and Matthew W Johnson.