Seattle Met
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By Haley Shapley
Image: Artur Kornakov/unsplash.com, Ian Dewar Photography/shutterstock.com, and Seattle Met Composite
Like most doctors, Nathan Sackett got into medicine because he wanted to help patients get better. The only problem? He chose addiction as his specialty, a notoriously difficult area to see improvement in.
“It is a challenging field,” says Sackett, an acting assistant professor of psychiatry and behavioral sciences at the University of Washington School of Medicine. “A lot of people struggle with substance use, and our ability to treat those use disorders is very, very limited.”
In an effort to change that, Sackett is now heading up a study to explore the potential therapeutic value of the psychedelic compound found in mushrooms, psilocybin. Last year, Washington legislators passed Senate Bill 5263, which allowed the state to establish an advisory board and task force to provide advice and recommendations on developing a regulatory framework for access to psilocybin. The bill mandated this current study.
Beginning in the fall, the team at UW will enroll 30 to 40 veterans and first responders who have both post-traumatic stress disorder and alcohol use disorder. Studying this high-risk population should provide valuable insights into psilocybin’s potential effects. “Current studies have not explored patients with comorbid conditions, but the reality is very few people just have a substance use disorder in the absence of some other difficulty,” Sackett says.
The trial will be conducted in a controlled environment, with psychotherapy sessions before and after. Two therapists will be present while participants undergo their psychedelic experiences. The group will be split in two, with half receiving a placebo in the first round. The participants who initially receive a placebo will then be given a chance to undergo the test treatment.
If the results are promising, the state may decide to join Colorado and Oregon in regulating access to psychedelics.
Although he’s a clinician at heart, Sackett started doing research because he felt like he couldn’t sustainably stay in the field unless he had more robust treatment options for his patients. He says his clinical practice keeps him motivated to keep pushing forward on the research side. While the jury’s still out in his mind on the applicability of psychedelics for addiction, he suspects based on his observations in a clinical environment that they have a lot of potential.
Sackett’s theory is that psychedelics may increase someone’s motivation to engage in treatment, which is a difficult undertaking. “Behavioral change is a hard thing,” he says. “I’m super educated about the necessity to floss my teeth twice a day. There’s no reason I shouldn’t, but do I floss twice a day? No. It’s a tall order to regulate your emotional state, and psychedelics could interrupt that cycle of difficulty.”
The state funding for this study is helpful, as it’s not one a pharmaceutical company would typically sponsor. Psychedelic psychotherapy also doesn’t fit well into our current medical system. It’s essentially two interventions in one, which complicates the implementation, and each session takes six to eight hours. “Most clinics aren’t set up with that in mind, and most clinics get paid by volume,” Sackett says. “An eight-hour session is daunting for a lot of administrators and policymakers for how that would fit into a delivery model. I suspect we’ll come up with solutions in the near future, but we’ll need buy-in from a lot of different stakeholders.”
Image: Courtesy UW Medicine
In the wake of the Covid-19 pandemic, there’s been an increase in the demand for mental health services and growing awareness of their need. In the most recent National Survey on Drug Use and Health from the US Department of Health & Human Services, 48.7 million people aged 12 or older, or 17.3 percent of the population, had a substance use disorder in the past year.
With that increased awareness has come a greater research interest in seeing what psychedelics can offer from a therapeutic perspective. So far, the most robust evidence exists for the use of MDMA for PTSD, followed by psilocybin for treatment-resistant depression. Sackett says psychedelics for substance use is a close third, and there’s also interest in its potential benefits for traumatic brain injuries, dementia, obsessive-compulsive disorder, and eating disorders. “We’re still in the early phase of trying to understand how they may be effective and if they’re effective at all,” he adds.
Those looking for magic mushrooms to actually be magic may be disappointed. “There’s a captivating idea that if one has a problem with substances that a substance will solve that problem, but one of the points I make with a lot of my patients is they’re not a magic bullet,” Sackett says. “There’s not a single intervention that’s going to save the day. Psychedelics are only as good as the therapeutic process they exist in.”
In the end, fighting an addiction takes a tremendous amount of work. But if, as Sackett theorizes, psilocybin can break down some of the barriers in motivation to completing that work, they may be part of the solution for his patients he’s been hoping for.
Haley Shapley is the wellness columnist for Seattle Met. She’s the author of Strong Like Her: A Celebration of Rule Breakers, History Makers, and Unstoppable Athletes and the forthcoming Night Owl: Staying Up Late in a World Built for Early Birds.
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Mushrooms May Not Be Magic, But They Could Be Therapeutic – Seattle Met
