What does the future hold for abstinence-based recovery? There is new wave of medication on the horizon to treat addiction which includes the psychedelics: ketamine, MDMA & psilocybin. Currently in the UK there are mainstream clinical trials in which alcoholics are treated with MDMA. In 2021 this will be a licensed treatment and may be much more widely available option.

1. Psychedelics as medicine
New kid on the block or old hat?
iCAAD 2019
Dr Sarah Flowers, Addictions Psychiatrist, Life Works
Charlotte Parkin, Psychotherapist,
Harley Street & Fenchurch Street

2. Presenter disclosure
+ Dr Sarah Flowers
̶ Priory Healthcare: Life Works, Visiting Consultant
̶ OneMed Hove, Visiting Consultant
̶ Sussex Partnership NHS Trust, Consultant Psychiatrist
+ Charlotte Parkin
̶ Priory Wellbeing Centre Fenchurch
̶ Priory Wellbeing Centre Harley Street

3. Recommended reading

4. Dr Sarah Flowers - a little about me…
+ Lewes 1979 – 1997
+ London 1997 – 2003
+ Addiction 2004
+ AA 2006
+ NHS Addiction Consultant 2011
+ Party Drug Clinic 2013
+ NAT AA 2015
+ Life Works 2019+

5. Charlotte Parkin - a little about me…
+ Northamptonshire 1979 – 1997
+ Bristol, Modern History 1997
+ Media and Communications 2001 – 2013
+ Integrative Counselling 2013
+ Priory Hospital North London ATP 2014
+ Priory Wellbeing Centre Fenchurch Street 2015
+ Harley Street and Fenchurch Street 2018
+ Current work 2019+

6. This session may trigger cognitive dissonance…

7. Transparency: a sober look at psychedelics
+ Where I’m approaching this from – represent ambivalence
+ The 28-day programme and abstinence approach
+ No current research/clinical involvement in this field
+ No sponsorship

8. Contents
1. The definition of a psychedelic drug
2. How psychedelics are being used at present
3. Historical perspective
4. Outline of the psychedelic psychotherapy process
5. Why might psychedelic drugs be suited to recovery from addiction?
Proposed mechanisms of action
6. Examples of psilocybin, MDMA and ketamine from 3 doctors
7. The psychedelic-mystical experience as treatment and comparison with 12-
step recovery
8. Discussion regarding risks, benefits and attitudes towards their use in the
addiction field

9. 1. Psychedelic: ‘mind-revealing’

10. 2. Underground and overground

11. 3. Historical perspective

12. Second to third wave
Humphry Osmond
+ Spring Grove, Maryland
1970s
+ Many psychiatrists and
therapists active in the
field, some to this day
The Harvard Psilocybin
Project
+ 1971 “the most
dangerous man in
America” and Schedule 1
Psychedelic science
+ 1990s Johns Hopkins and NYU:
psilocybin and end of life cancer
+ MAPS since 1986
+ UK: Bristol, Imperial and Oxford
+ Dr Carhart-Harris: psilocybin for
depression. Psilocybin/
escitalopram

13. 2019

14. 4. Psychedelic-psychotherapy
A. Selection and preparation
B. Session: medicine-guided,
psychotherapeutically-supportive
C. Integration

15. A. Selection and preparation
Psychic vulnerability Flight instruction
In and through difficult
experience:
+ Ego death
Suggestions:
+ TLO
+ Holding lightly
Collecting experience
Trust and rapport
“to trust unconditionally
with one’s mind”
Ego strength
Adequate: set, setting, dose
Intentions
Set: “a conscious decision
that in this set, with these
people, with the preparation
I’ve had, with the proper
dosage and purity of this
substance, I choose to be out
of control”

16. B. Psychedelic session
+ 8 hours
+ Two trained therapists
̶ Empathic, respectful, genuine
̶ Focused, non-anxious, competent
+ Constant presence
+ Room
+ Eye masks and music
+ Download
+ Medically administered
̶ Dose (purity and strength)
̶ Monitored
̶ Supported

17. Psychedelic phenomenology
+ Perceptual changes
+ Panic, paranoia, confusion rare
+ Psychodynamic content
+ Visionary/archetypal experiences
+ Unitive-mystical experiences
1. Ineffable and paradoxical
2. Transcendence of time and space
3. Intuitive
4. Sacred
5. Deeply-felt positive mood
6. Unity

18. Self-actualisation
1. They perceive reality efficiently and can tolerate
uncertainty
2. Accept themselves and others for what they are
3. Spontaneous in thought and action
4. Problem-centred (not self-centred)
5. Unusual sense of humour
6. Able to look at life objectively
7. Highly creative
8. Resistant to enculturation, but not purposely
unconventional
9. Concerned for the welfare of humanity
10. Capable of deep appreciation of basic life-
experience
11. Establish deep satisfying interpersonal
relationships with a few people
12. Peak experiences
13. Need for privacy
14. Democratic attitudes
15. Strong moral/ethical standards
Maslow 1954

19. C. Integration
+ Stage 1: Reporting
- no integration
+ Stage 2: Making
meaning and skills
+ Stage 3: Distilling
actions

20. 5. Relevance to addiction
+ Presentations due to psychedelics
+ Understanding of recovery: how do these drugs work?
+ Treatment of addiction
̶ Greater mystical experience associated with greater abstinence
• LSD for alcohol: Osmond 1950/60s
• Ketamine for alcohol and opiates: Krupitsky 1990s
• Smoking and psilocybin: Johnson contemporary
• Psilocybin for nicotine: Bogenshutz contemporary
̶ 3 contemporary examples:
• Roland Griffiths: Phase-three clinical trials for MDMA and psilocybin
• Ben Sessa: MDMA for alcoholism in Bristol (BIMA)
• Rupert McShane: Ketamine for treatment-resistant depression
+ Treatment of dual diagnosis
̶ Ketamine to be licensed for treatment-resistant depression later this year. Psilocybin next?
̶ Trauma: MDMA, likely available for trauma therapy 2021

21. Drug harms
Nutt et al, Drug harms in the UK: a multicriteria decision analysis, Lancet 2010: 376: 1558-65

22. Mechanisms of action: psilocybin and the dorsal node network
REBUS
RElaxed
Beliefs
Under
pSychedelics
Robin Carhart-Harris, 2018

23. Mechanisms of action: homological scaffolds
Homological Scaffolds in Brain Functional Networks - Petri et al. 2014

24. Mechanisms of action: psilocybin and plasticity
Calvin Ly et al. Cell Reports, 2018

25. Mechanisms of action: trauma and MDMA
+ Attachment basis
+ MDMA as an
antibiotic for
trauma “perfect
tool for trauma
therapy”
+ Empathy and
stimulation also
key
Fear , Tr auma and t he Developing Br ain:
The Prefrontal Cortex versus The Amygdala
MDMA

26. Commonalities and reservations

27. 6. Three clinical/academic psychedelic doctors
Roland Griffiths, John
Hopkins
+ Psilocybin and depression in
terminal cancer
+ Psilocybin for smoking
cessation
+ Psilocybin in long-term
meditators
Ben Sessa, Bristol
(BIMA)
+ MDMA for alcohol
Rupert McShane, Oxford
+ Ketamine for treatment-
resistant depression
FDA approved

28. Roland Griffiths: psilocybin
254 participants in >600
sessions
+ Tobacco
+ Cancer
+ Meditators
“As a scientist, if you can create
conditions in which 70% of
people have had one of the
most meaningful experiences of
their lives then that is
incredible”

29. Ben Sessa, Bristol: MDMA for alcoholism
+ Bristol MDMA Alcohol Study
(BIMA)= open label safety
and tolerability study
+ 2 MDMA sessions (125mg,
and 62.5mg) with 8 weeks
of psychotherapy
+ Physical observation
throughout
www.youtube.com/watch?v=I96cnUacLg0

30. Rupert McShane, Oxford: ketamine for depression
+ New class of rapid-acting antidepressant
+ SWAP (Substances with Abuse Potential)
+ Approved and licensed clinics
+ Psychiatric Intervention Clinic
+ Intravenous then oral
+ Reliance vs. dependence
+ Esketamine, Spravato
+ No psychotherapy
+ Regulation:
̶ Controlled drug (no TTO)
̶ Registry (Jannsen)
̶ Risk of dependence with off-label use

31. So if this is a legitimate paradigm, how do I integrate it?

32. Who might this work for?

33. 7. Interface

35. My takeaway
+ Not a replacement for therapy
+ Not ego vs. spirituality
+ Not a modality conflict
+ Not an abstinence debate
+ Always comes back to be ‘needing to be seen’/attachment

36. Legality and stimga
+ Therapists’ psychedelic experience
+ Societal attitudes – ‘hippy’
+ Competition:
̶ Expert role
̶ Financial

37. The future
+ We may be at the cusp of a new era of
psychedelic medicine: the reset
button
+ Psychedelic medicine may be
restricted:
̶ High cost
̶ Not suitable for everyone
̶ May not be great enthusiasm amongst
psychiatrists or therapists
̶ Unlikely to be accepted in the wider
recovery community
̶ Peer support/community and ongoing
psychedelic use (underground/
overground)

38. 8. Discussions
Treatment and interface
+ Treatment centres
+ As medication-assisted
recovery via NHS
̶ Antidepressants
̶ Naltrexone
̶ Buprenorphine
Diversion and iatrogenic
dependence
+ Ketamine in depression
market projected at $1
+ Aggressively marketed
+ General psychiatrists have
variable addictions
experience
+ Need for SWAPS registry
(perhaps like clozapine)
Research and understanding
+ Era of psychedelic science
+ “Mystical experiences are
biologically normal and relate to
the nature of consciousness”
+ May reveal knowledge that is
applicable to sober recovery

39. Questions?

40. + Maslow, A. H. (1971). Self-actualization. Big Sur Recordings.
+ Rogers, C. R. (1963). The concept of the fully functioning person. P
sychotherapy: Theory, Research & Practice, 1(1), 17.
+ Bowlby, J. (2012). A secure base. Routledge.
+ Bowlby, J. (2008). Attachment. Basic books.
+ Carhart-Harris, R. L., & Friston, K. J. (2010). The default-mode,
ego-functions and free-energy: a neurobiological account of Freudian
Ideas. Brain, 133(4), 1265-1283.
+ Dambrun, M., & Ricard, M. (2011). Self-centeredness and selflessness: A theory
of self-based psychological functioning and its consequences for happiness.
Review of General Psychology, 15(2), 138-157.
+ Deci, E. L., & Ryan, R. M. (2008). Self-determination theory: A macrotheory of
human motivation, development, and health. Canadian psychology/Psychologie
canadienne, 49(3), 182
+ Fonagy, P. (2018). Affect regulation, mentalization and the development of the
self. Routledge.
+ Gerhardt, S. (2004). Why love matters: How affection shapes a baby's brain.
Routledge.
+ Millière, R. (2017). Looking for the Self: Phenomenology, Neurophysiology and
Philosophical Significance of Drug-induced Ego Dissolution. Retrieved from
https://www.frontiersin.org/articles/10.3389/fnhum.2017.00245/full
+ Sessa, B. (2017). The Psychedelic Renaissance: Reassessing the Role of
Psychedelic Drugs in 21st Century Psychiatry and Society. Muswell Hill Press.
+ Pollan, M. (2018). How to Change Your Mind: The New Science of Psychedelics.
Allen Lane.
Bibliography
+ Maté, G. (2011). In the realm of hungry ghosts: Close encounters with addiction.
North Atlantic Books
+ Moss, A. C., & Dyer, K. R. (2010). Psychology of addictive behaviour. Macmillan
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+ Neff, K. (2003). Self-compassion: An alternative conceptualization of a healthy
attitude toward oneself. Self and identity, 2(2), 85-101.
+ Orford, J. (2001). Excessive appetites: A psychological view of addictions. John
Wiley & Sons Ltd.
+ Siegel, A. M. (2008). Heinz Kohut and the Psychology of the Self. Routledge.
+ Scott, G., & Carhart-Harris, R. L. (2019). Psychedelics as a treatment for
disorders of consciousness. Neuroscience of Consciousness, 2019(1), niz003.
+ Grof, S. (1996) . Realms of the Human Unconscious: Observations from LSD
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+ James, W. (1983). The Varieties of Religious Experience: A study in Human
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+ Richards, W. (2018). Sacred Knowledge: Psychedelics and Religious Experiences.
Columbia University Press.
+ Dyck, E. (2008). Psychedelic Psychiatry: LSD from Clinic to Campus. Johns
Hopkins University Press
+ Strassman, R. (2000). DMT: The Spirit Molecule: A Doctor's Revolutionary
Research into the Biology of Near-Death and Mystical Experiences. Park Street
Press.

41. Contact Details
Dr Sarah Flowers
Priory Healthcare: Life Works Direct Contact
enquiries@lifeworkscommunity.com SarahFlowers@nhs.net
drsarahflowers.com
Charlotte Parkin
Priory Wellbeing Centre Fenchurch Priory Wellbeing Centre Harley Street
fenchurch@priorygroup.com harleystreet@priorygroup.com