![[Adobe Stock]](https://sp-ao.shortpixel.ai/client/to_webp,q_glossy,ret_img,w_750,h_375/https://www.psypost.org/wp-content/uploads/2025/08/psychedelic-face-750x375.jpg)
People with alcohol use disorder who were still abstinent three months after psilocybin-assisted therapy tended to describe their first psychedelic session differently than those who had returned to drinking, according to a study published in the Journal of Affective Disorders. In interviews the day after their first dose, much of the talk about an inner dialogue, rethinking habitual patterns, and committing to change came from people who stayed abstinent, while talk focused on sensations, visions, and emotions came mostly from those who later drank. The exploratory findings suggest that how people engage with a psychedelic experience may be related to treatment response.
Psilocybin is a psychedelic substance that can temporarily alter perception, emotions, and patterns of thinking. In psychedelic-assisted psychotherapy, the drug experience is combined with preparation and follow-up sessions. The follow-up, or integration, sessions are intended to help participants make sense of what they experienced and connect it with their goals for recovery.
Previous studies have suggested that psychedelic therapy may help some people with alcohol use disorder, but it remains unclear why some participants improve more than others. Researchers have proposed that personal insights, emotional processing, changes in self-perception, and new approaches to coping may all contribute, but earlier interview-based studies of psilocybin for alcohol use disorder included only a handful of participants.
Led by Maria Garcia Garcia of Nîmes University Hospital and the University of Montpellier in France, the team analyzed recordings from the first integration session in the Psilocybin Alcohol Depression trial. In that randomized trial, recently detoxified patients received two psilocybin sessions three weeks apart, at either a high dose or a very low dose, alongside an intensive relapse prevention program.
The analysis included the 20 participants who received the high, 25-milligram dose. All had alcohol use disorder and continuing depressive symptoms, and they had a median age of 49 years; 11 were male and nine were female. Before dosing, participants took part in preparation sessions that included mindfulness exercises and setting personal intentions related to alcohol, which were read aloud at the start of the psilocybin session.
The integration sessions took place the day after the first dose. Eleven participants were abstinent from alcohol three months later, meaning they had not had a drink in the previous four weeks, while nine were not.
The sessions were transcribed and analyzed with software that uses an automated method to sort passages into groups based on the words they share, without the researchers specifying the groups in advance. The transcripts contained 127,760 words and were divided into 3,700 short segments. The software sorted 88.27% of these segments into two main language patterns.
The first pattern, which represented 44% of the classified segments, focused on sensory and emotional features of the psychedelic experience. Participants discussed physical sensations, visual experiences, emotions, and the setting of the session. This pattern came mostly from people who were not abstinent three months later.
The second pattern represented nearly 56% of the classified segments. It focused on inner dialogue, rethinking familiar ways of behaving, making commitments, working with the intentions set during preparation, and revisiting the role of alcohol in participants’ lives. This pattern came mostly from participants who remained abstinent, as well as from those with more trauma symptoms or greater sensitivity to social rejection.
The authors described the second pattern as involving “active cognitive processes, characterized by an inner dialogue.” They emphasize that this dialogue was something participants described having during the psilocybin session itself, often while freely recounting the experience, rather than something generated during the interview. One participant who remained abstinent recalled: “I told myself I don’t need alcohol to feel okay. I have people I love, and I have people who love me.”
A follow-up analysis comparing the words used by abstinent and non-abstinent participants painted a similar picture. People who stayed abstinent more often mentioned family members, pleasant emotions, and new ways of handling situations that used to trigger drinking. Those who returned to drinking more often mentioned negative emotions, physical pain, disappointment, and attempts to push unpleasant feelings away.
Difficult experiences were not necessarily a bad sign. Fear was the one negative emotion linked to abstinence, and it tended to appear when participants described facing old fears using coping strategies taught during preparation, such as holding a meaningful object. The authors suggest that what mattered was how people handled difficult content, not whether it appeared.
Notably, none of the participants directly described a mystical experience, and talk about the intensity of the experience was not more common among those who stayed abstinent. The authors suggest that preparation, including work on personal intentions, may help encourage the kind of inner dialogue that was linked to abstinence.
The study has some limitations. With only 20 participants, the findings are preliminary, and each language pattern was driven heavily by a handful of people. The analysis was exploratory and examined text segments rather than treating each participant as a separate statistical observation. Therapist questions were also included in the transcripts, so the conversations reflected an interaction rather than participants’ words alone.
The study also cannot show that inner dialogue caused abstinence. Participants received a second psilocybin session and continued an intensive relapse prevention program after these interviews, so the early differences might not have held up without the full course of treatment. The authors describe inner dialogue as a possible therapeutic mechanism to be tested in future studies rather than a proven one.
The study, “Insights from the psychedelic experience integration session: Verbatims differentiate 3-month abstinence in alcohol use disorder with depressive symptoms,” was authored by Maria Garcia Garcia, Dahbia Belahda, Carine Graux, Chris Serrand, Noé Igounenc, Felix Sergent, Thibault Mura, and Amandine Luquiens.