As the US faces a massive addiction epidemic, the public health spotlight has focused on addiction and potential treatments. I talked with Peter Hendricks, an Associate Professor and Clinical Psychologist at UAB Birmingham School of Public Health, and Department of Health Behavior about his research on cocaine addiction, and his trials to use psilocybin as a possible intervention. Professor Hendricks also delves deeper into his theories on how psilocybin’s positive effects on the patient correlate to the fundamental human experience of “awe.”

 

What is the focus of your research?

I’m interested in the treatment of addiction. For the particular trial we’re discussing – the objective is to evaluate the feasibility and potential efficacy of psilocybin-facilitated psychotherapy for cocaine dependence.

Tell us more about how the drug is administered?

Everybody in our study first meets with me and my postdoctoral fellow, Sarah Lappan, a couples and family therapist. We meet with our participants for four sessions of at least two hours each. We’re primarily attempting to establish rapport, and also administer a manualized treatment for cocaine dependence that’s cognitive and behavioral in nature. The goal is to introduce strategies that assist our participants in coping with the urge to use cocaine.

We administer the drug in a very carefully controlled medical setting – a CRU (Clinical Research Unit) in the hospital with a team of nurses and a physician on call. Psilocybin is quite safe, especially among participants who have been carefully screened, but it’s always better to be safe than sorry. Participants arrive at 8am and leave by 3-4pm. The period of drug action is about 5-6 hours.

This often strikes our participants as amusing – they arrive, have these profound experiences, and then go back home to their everyday lives. It reminds me of the proverb, “Before enlightenment, chop wood, carry water. After enlightenment, chop wood, carry water.”

We then see participants the following day to make sure everything is OK. During four more sessions over the next month or so, we make sure our participants have the skills to be successful in coping with the urge to use cocaine. Note that the purpose of this clinical trial, like most clinical trials, is not to approximate what might ultimately take place in the real world, but to determine whether or not there might be a beneficial effect of the experimental treatment.

Could you tell me more about how you believe “awe” is central to the effectiveness of these treatments?

Well, we are, of course, still in the process of evaluating the effectiveness of these treatments. Preliminary data appear very promising, but we shall see if our hypotheses are supported. In any event, there is a lot of interesting and important work on potential neurobiological mechanisms of action of psilocybin. However, since I’m trained as a clinical psychologist, I’m especially interested in how this drug is subjectively experienced, and why these subjective experiences might be beneficial.

Anytime we have a thought or emotion there’s a neurobiological correlate. You might say, for example, that when I had my first child, it was one of the most meaningful experiences of my life. However, it would be reductionist to say that electrochemical changes in my brain explain why this experience was meaningful. That’s certainly not a complete explanation of the transformative nature of this event.

So, I’m interested in the psychological level of explanation, which isn’t incompatible at all with the neurobiological level of explanation. I realized that in the first wave of research with psychedelics, the psychological explanations seemed to fall short. There was some notion of resolving unconscious conflict, but this psychodynamic explanation largely does not comport with contemporary, leading psychological theories of change. There was also some notion that the psychedelic experience is akin to transformative religious experiences. I certainly think that there’s something to this notion – there’s something akin to a religious transformation taking place. But the question is: what exactly is taking place during these religious-like transformations?

Where did your research take you?

I started to search the literature and as I read more about the emotion awe, I came to a working hypothesis: at the center of the mystical experience is awe, wherein one is in the presence of something so great, so large, that it requires they completely reorder their mental structures – completely change the way they view reality.

Awe promotes the small self, the sense that we are all smaller components of a unitive whole, that we are all one. It orients our view away from the individualistic and toward the collectivistic.

I think awe is an extremely important emotion. As a society we probably need more of it; more people who are willing to subordinate their own needs for the good of the social collective. In some ways, you might argue that a number of societal problems stem from humans prioritizing their own needs over those of the group. For instance, take global climate change. Consider the progress we could make if some thought more macroscopically about how their actions will affect not just their bottom line, but the livelihood of others, including future generations.

How does this relate to addiction?

Consider the case of cocaine addiction – those who are addicted to cocaine have often pursued this drug at the expense of relationships and careers and that which they hold to be most meaningful. During and after the mystical experience, it may be that they come to the realization that they have pursued this hedonic desire at the expense of the social collective, including family and friends and others they hold dear. You then see a dramatic shift in orientation – away from pursuit of this drug, and toward becoming a better citizen. It starts with abstinence but often becomes more than just that.

What about addiction makes it an especially good application for psychedelics?

I’ve worked in addiction since 1999 and the sad fact is that most of our treatments don’t work very well. Tobacco addiction claims half a million American lives every year. We lose more people to smoking than all the soldiers we lost in WWII. Alcohol dependence claims the lives of nearly 100,000 Americans every year.

I’m focusing on cocaine dependence, another serious threat to the public health. There have been at least 50 pharmacotherapies tested for cocaine dependence and nothing has yet been shown to be effective. I think we owe it to the people who are struggling with this addiction, their families and their loved ones, to pursue all potential avenues for treatment.

I realize some people may feel uncomfortable about a drug that alters consciousness and occasions mystical-type experiences. But I think the bottom line is the outcome – if we can develop a more effective treatment for cocaine dependence, who cares how and why – the bottom line is that it works.

I wouldn’t call myself a “psychedelic advocate” or “psychedelic psychotherapist.” I’m a clinical psychologist interested in treating addiction. I do think the mechanisms of action here are absolutely fascinating. But, ultimately it’s about improving the quality of addiction treatment. Addiction impacts millions of people across the globe, and there are a lot of people who are suffering. Everyone should be invested in improving our interventions, and that’s what this is all about.