A study of U.S. Special Operations Forces Veterans participating in an ibogaine and 5-MeO-DMT treatment in Mexico showed that participants treated with these psychedelic substances showed a significant reduction in alcohol misuse 1 month after the start of the treatment. These effects persisted 6 months later and there was also a strong reduction in symptoms of posttraumatic stress disorder. The study was published in Military Psychology.
Participating in a war is a traumatic experience. Even for the highly trained personnel, elite soldiers chosen because of their outstanding physical and psychological resilience, exposure to combat situations, injuries and isolation have a profound adverse effect on health and well-being. To cope, many military veterans resort to drinking alcohol. Alcohol is the most misused substance by military personnel.
As a consequence of war experiences and psychological trauma caused by them, many veterans develop posttraumatic stress disorder or PTSD. The most well-known symptoms of PTSD include intrusive memories of the traumatic event(s), the so-called flashbacks, bad dreams and frightening thoughts. Symptoms also include higher pain tolerance, emotional numbing and many others. Available treatments for PTSD and alcohol misuse are limited in their effectiveness.
“As a trauma psychologist, I have spent several years working directly with children, adolescents, and adults (including veterans) exposed to atrociously traumatic experiences,” said study author Stacey Armstrong, a clinical psychologist and postdoctoral scholar at the Center for Psychedelic Drug Research and Education at The Ohio State University.
“In my clinical practice, it is essential that I utilize gold-standard, evidence-based treatments to address the functional impairment that often results from these events. However, while providing direct care to clients, many of whom were highly distressed, it became clear that too many were not responding to the established treatments. As I delivered these services, I became aware of and interested in the promising evidence from psychedelic-assisted therapy.”
“As I faced the shortcomings of the current treatments and learned of possible emerging treatments, I began to evaluate how I could best help people impacted by trauma. That ultimately led me to pursue research full-time because I believed I could positively impact more lives through scientific pursuits. Given the prevalence of PTSD and other co-occurring mental health conditions like alcohol misuse among United States Military Veterans (USMV), pursuing possible benefits of psychedelic-assisted therapy among this specific population was a prominent topic of interest for me.”
Armstrong and her colleagues analyzed data from a clinical treatment program carried out in Mexico. The data came from 45 U.S. Special Operations Forces Veterans who were undergoing treatment using ibogaine and 5-MeO-DMT and who were referred to this program through word of mouth. Ibogaine is a hallucinogenic compound derived from the roots of a West African shrub. 5-MeO-DMT, also known by its street names — “five-methoxy” — is a psychedelic substance found in a number of plant species, but also in Colorado river toads.
All study participants were male. A bit below 50% of them had more than 6 deployments in their career. Almost 90% of them served in the U.S. Navy.
The participants first underwent screenings to make sure that there were no substances in their body or any other conditions that would make the treatment unsafe. After that, they learned about ibogaine’s effect and discussed their treatment intentions. Participants who passed the screening were given an oral dose of ibogaine hydrochloride of 10 mg/kg.
The day after, participants were encouraged to journal the process and integrate their experiences. Sessions with psychologists followed. On the final day, participants had a second preparatory sessions and then received 5-MeO-DMT. They were administered at least three inhaled doses (5mg, 15mg and 30mg) and additional doses (30mg, 45mg) if they did not experience the desired effects.
Participants completed psychological assessments before the start of the treatment at the treatment site, and again 1 month, 3 months and 6 months after the treatment. They completed assessments of alcohol use (the Alcohol Use Disorders Identification Test-Concise), posttraumatic stress disorder symptoms (the Posttraumatic Stress Disorder Checklist), and cognitive symptoms (the Neurobehavioral Symptom Inventory). The researchers also collected participants’ demographic data and military history.
Results of the screening showed that 29% of participants used alcohol in a way that constituted moderate-risk drinking, 29% were categorized as high-risk drinkers, and 42% screened positive for severe-risk drinking. One-month after the treatment, there was a large reduction in both alcohol drinking and severity of PTSD symptoms. This reduction remained even 6 months after the treatment. There was also a significant and very large improvement in cognitive functioning after treatment that remained after 6 months.
“Overall, I hope the average person takes away that combined ibogaine and 5-MeO-DMT assisted therapy appears to show noteworthy improvements in alcohol misuse among Special Operations Forces Veterans. Further, many of the veterans also experienced improvements in debilitating trauma (e.g., avoidance) and cognitive symptoms (e.g., poor concentration) after psychedelic-assisted therapy,” Armstrong told PsyPost.
“While I am less surprised at the results of this one specific study, I continue to be struck by the impressive results coming from the psychedelic-assisted therapy literature at large. The longitudinal outcomes, although limited, regularly demonstrate significant and robust outcomes for many people with a variety of treatment-resistant mental health concerns, including PTSD.”
However, although there was a large overall improvement, some veterans continued to engage in risky drinking. At 1-month follow-up, 24% were abstinent, 33% were engaging in non-risky drinking, and 42% were still risky drinkers. At 3-months, the number of abstinent and non-risky drinkers decreased, and the number of risky drinkers increased to 56%. At 6-months, only 16% were abstinent, 31% were engaging in non-risky drinking, and 53% were still risky drinkers.
The researchers found no differences in demographics and pre-treatment clinical characteristics between those who stopped drinking and those who did not. However, those who stopped drinking also tended to have a reduction in PTSD symptoms and improvements in cognitive functioning 1 month after treatment.
The study contributes to scientific knowledge on ways to treat PTSD and alcohol drinking in trauma survivors. However, it should be noted that participants for this study were highly self-selected for participation, were additionally screened before being admitted to treatment, and came from a special group of people – Special Operations Forces Veterans. Additionally, they all knew that they were undergoing treatment. Due to this, treatment effects observed are mixed with placebo effects. Results on people without these characteristics and in a double-blind study might not be the same.
“Like all research, there are caveats and limitations to this project,” Armstrong said. “First, because the data was collected in a naturalistic treatment setting, where veterans self-selected into the treatment, there are no control groups or standards to which we can compare the results to ensure the psychedelic-assisted therapy is causing the observed improvements. Further, because veterans self-select into the treatment program, this introduces bias.”
“Second, the psychedelic-assisted therapy evaluated in this study is combined ibogaine and 5-MeO-DMT, which creates complications because we cannot identify the benefits of each psychedelic, if there are any. Lastly, we cannot generalize our findings to other groups, like the broader veteran population, because our sample did not reflect the makeup of U.S. veterans at large.”
“While this study provides evidence that supports using a specific psychedelic-assisted therapy among Special Operations Forces Veterans to treat alcohol misuse, PTSD, and problematic cognitive symptoms, it also leaves us with many questions,” Armstrong continued. “First, utilizing randomized controlled trials to compare ibogaine to 5-Meo-DMT and to placebo/control groups is imperative to understand further what unique benefits each substance contributes to improved mental health and wellbeing of Special Operations Forces Veterans.”
“Additionally, while many studies, such as this one, follow participants for many months post-treatment, we must follow participants for longer periods of time to determine just how robust these treatments are and if any adverse events occur beyond the time limits of our research protocols. Further, the psychedelic-assisted therapy assessed in this manuscript was just one of many different substances showing promising evidence.”
“Evaluating other medication-assisted therapies (e.g., ketamine, psilocybin) among Special Operations Forces Veterans is necessary to determine which treatment is most beneficial for whom, and for which mental health conditions,” Armstrong explained. “Lastly, it is important to add that many individuals experience more than one traumatic experience in their life. Therefore, we must continue to monitor Special Operations Forces Veterans who experience symptom reduction after psychedelic-assisted therapy to evaluate how they respond to future traumas, if experienced. For instance, observing if they return to substance misuse or continue to remain resilient, is an important question we must evaluate.”
“The current state of the evidence for psychedelic-assisted therapy warrants cautious optimism,” Armstrong added. “Continued rigorous science is at the heart of advancing our understanding of psychedelics and their ability to help people struggling with mental health and substance misuse, a public health crisis.”
“Rigorous science is also critically dependent on funding and support, especially at the state and federal levels. Yet, because psychedelics are identified as a Schedule I Controlled Substance, the funding and support at the state and federal levels are lacking. To safely advance the science at a pace that reflects the possible potentials psychedelic-assisted therapies may provide humanity, we must continue to advance reform, rescheduling, and access.”
The study, “Prospective associations of psychedelic treatment for co-occurring alcohol misuse and posttraumatic stress symptoms among United States Special Operations Forces Veterans”, was authored by Stacey B. Armstrong, Yitong Xin, Nathan D. Sepeda, Martín Polanco, Lynnette A. Averill, and Alan K. Davis.
