The smoking cessation pilot study in which this man took part—his name is Charles Bessant, and he has been abstinent now for six years—was directed by Matthew Johnson, a protégé of Roland Griffiths’s at Johns Hopkins, where the study took place. Johnson is a psychologist in his early forties who, like Griffiths, trained as a behaviorist, studying things like “operant conditioning” in rats. Tall, slender, and angular, Johnson wears a scrupulously trimmed black beard and oversized retro-nerd black glasses that make him look a little like Ira Glass. His interest in psychedelics goes back to his college days, when he read Ram Dass and learned about the Harvard Psilocybin Project, but never did he dare to imagine he would someday have a job working with them in a laboratory.
“I had it in the back of my mind that someday I wanted to do research with the psychedelic compounds,” he told me when we first met in his Hopkins office, “but I figured that was a long way off in the future.” Yet soon after Johnson arrived at Johns Hopkins to do a pharmacology postdoc in 2004, “I found out that Roland had this super hush-hush project with psilocybin. Everything lined up perfectly.”
Johnson worked on the lab’s early psilocybin studies, serving as a guide for several dozen sessions and helping to crunch the data, before launching a study of his own in 2009. The smoking study gave fifteen volunteer smokers who were trying to quit several sessions of cognitive behavioral therapy followed by two or three doses of psilocybin. A so-called open-label study, there was no placebo, so they all knew they were getting the drug. Volunteers had to stop smoking before their psilocybin session; they had their carbon-monoxide levels measured at several intervals to ensure compliance and confirm they remained abstinent.
The study was tiny and not randomized, but the results were nevertheless striking, especially when you consider that smoking is one of the most difficult addictions to break—harder, some say, than heroin. Six months after their psychedelic sessions, 80 percent of the volunteers were confirmed as abstinent; at the one-year mark, that figure had fallen to 67 percent, which is still a better rate of success than the best treatment now available. (A much larger randomized study, comparing the effectiveness of psilocybin therapy with the nicotine patch, is currently under way.) As in the cancer-anxiety studies, the volunteers who had the most complete mystical experiences had the best outcomes; they were, like Charles Bessant, able to quit smoking.
After interviewing cancer patients confronted with the prospect of death, people who had had epic journeys in which they confronted their cancers and traveled to the underworld, I wondered how the experience would compare when the stakes were lower: What kinds of journeys would ordinary people simply hoping to break a bad habit have, and what kinds of insights would they return with?
Surprisingly banal, it turns out. Not that their journeys were banal—psilocybin transported them all over the world and through history and to outer space—but the insights they brought back with them were mundane in the extreme. Alice O’Donnell, a sixtyish book editor born in Ireland, reveled “in the freedom to go everywhere” in the course of her journey. She grew feathers that allowed her to travel back in time to various scenes of European history, died three times, watched her “soul move from her body to a funeral pyre floating on the Ganges,” and found herself “standing on the edge of the universe, witnessing the dawn of creation.” She had the “humbling” realization that “everything in the universe is of equal importance, including yourself.
“Instead of being so narrowly focused, moving through this little tunnel of adult life,” she found that the journey “returned me to the child’s wider sense of wonder—to the world of Wordsworth. A part of my brain that had gone to sleep was awakened.
“The universe was so great and there were so many things you could do and see in it that killing yourself seemed like a dumb idea. It put smoking in a whole new context. Smoking seemed very unimportant; it seemed kind of stupid, to be honest.”
Alice imagined herself throwing out lots of junk from her house, emptying the attic and the basement: “I had an image of tossing everything over the ledge, all the stuff I didn’t need anymore. It’s amazing how you can whittle things down to the few really important things that are necessary for survival. And the most important thing of all is the breath. When that stops, you’re dead.” She emerged from her journey with the conviction “that you should cherish your breath.” She has not had a cigarette since her psilocybin journey. Whenever she feels a craving, she goes back in memory to her session “and thinks of all the wonderful things I experienced, and how it felt to be on that much higher plane.”
Charles Bessant had his epiphany while on a similarly “higher plane.” Bessant, a museum exhibit designer in his sixties, found himself standing on a mountaintop in the Alps, “the German states stretching out before me all the way to the Baltic.” (Wagner was playing in his headphones.) “My ego had dissolved, yet I’m telling you this. It was terrifying.” He sounded like a nineteenth-century Romantic describing an encounter with the sublime, at once terrible and awe inspiring.
“People use words like ‘oneness,’ ‘connectivity,’ ‘unity’—I get it! I was part of something so much larger than anything I had ever imagined.” We were speaking by phone on a Saturday morning, and at one point Bessant paused in his account to describe the scene before him.
“Right now, I’m standing here in my garden, and the light is coming through the canopy of leaves. For me to be able to stand here in the beauty of this light, talking to you, it’s only because my eyes are open to see it. If you don’t stop to look, you’ll never see it. It’s the statement of an obvious thing, I know, but to feel it, to look and be amazed by this light” is a gift he attributes to his session, which gave him “a feeling of connectedness to everything.”
Bessant followed up on our conversation by e-mail with a series of clarifications and elaborations, striving to find the words equal to the immensity of the experience. It was in the face of this immensity that smoking suddenly seemed pitifully small. “Why quit smoking? Because I found it irrelevant. Because other things had become so much more important.”
Some volunteers marveled themselves at the simultaneous power and banality of their insights. Savannah Miller is a single mom in her thirties who works as a bookkeeper for her father’s company in Maryland. Possibly because she spent her twenties tangled in an abusive relationship with a man she describes as “a psychopath,” her trip was painful but ultimately cathartic; she remembers crying uncontrollably and producing tremendous amounts of snot (something her guides confirmed really happened). Savannah gave little thought to her habit during the journey, except toward the end when she pictured herself as a smoking gargoyle.
“You know how gargoyles look, crouched down with their shoulders hunched? That’s how I felt and saw myself, a little golem creature smoking, pulling in the smoke and not letting it out, until my chest hurts and I’m choking. It was powerful and disgusting. I can still see it now, that hideous coughing gargoyle, whenever I picture myself as a smoker.” Months later, she says the image is still helpful when the inevitable cravings arise.
In the middle of her session, Savannah suddenly sat up and announced she had discovered something important, an “epiphany” that her guides needed to write down so it wouldn’t be lost to posterity: “Eat right. Exercise. Stretch.”
Matt Johnson refers to these realizations as “duh moments” and says they are common among his volunteers and not at all insignificant. Smokers know perfectly well that their habit is unhealthy, disgusting, expensive, and unnecessary, but under the influence of psilocybin that knowing acquires a new weight, becomes “something they feel in the gut and the heart. Insights like this become more compelling, stickier, and harder to avoid thinking about. These sessions deprive people of the luxury of mindlessness”—our default state, and one in which addictions like smoking can flourish.
Johnson believes the value of psilocybin for the a
ddict is in the new perspective—at once obvious and profound—that it opens onto one’s life and its habits. “Addiction is a story we get stuck in, a story that gets reinforced every time we try and fail to quit: ‘I’m a smoker and I’m powerless to stop.’ The journey allows them to get some distance and see the bigger picture and to see the short-term pleasures of smoking in the larger, longer-term context of their lives.”
Of course, this re-contextualization of an old habit doesn’t just happen; countless people have taken psilocybin and continued to smoke. If it does happen, it’s because breaking the habit is the avowed intention of the session, strongly reinforced by the therapist in the preparatory meetings and the integration afterward. The “set” of the psychedelic journey is carefully orchestrated by the therapist in much the same way a shaman would use his authority and stagecraft to maximize the medicine’s deep powers of suggestion. This is why it is important to understand that “psychedelic therapy” is not simply treatment with a psychedelic drug but rather a form of “psychedelic-assisted therapy,” as many of the researchers take pains to emphasize.
Yet what accounts for the unusual authority of the rather ordinary insights volunteers brought back from their journeys? “You don’t get that on any other drug,” Roland Griffiths points out. Indeed, after most drug experiences, we’re fully aware of, and often embarrassed by, the inauthenticity of what we thought and felt while under the influence. Though neither Griffiths nor Johnson mentioned it, the connection between seeing and believing might explain this sense of authenticity. Very often on psychedelics our thoughts become visible. These are not hallucinations, exactly, because the subject is often fully aware that what she is seeing is not really before her, yet these thoughts made visible are nevertheless remarkably concrete, vivid, and therefore memorable.
This is a curious phenomenon, as yet unexplained by neuroscience, though some interesting hypotheses have recently been proposed. When neuroscientists who study vision use fMRIs to image brain activity, they find that the same regions in the visual cortex light up whether one is seeing an object live—“online”—or merely recalling or imagining it, off-line. This suggests that the ability to visualize our thoughts should be the rule rather than the exception. Some neuroscientists suspect that during normal waking hours something in the brain inhibits the visual cortex from presenting to consciousness a visual image of whatever it is we’re thinking about. It’s not hard to see why such an inhibition might be adaptive: cluttering the mind with vivid images would complicate reasoning and abstract thought, not to mention everyday activities like walking or driving a car. But when we are able to visualize our thoughts—such as the thought of ourselves as a smoker looking like a coughing gargoyle—those thoughts take on added weight, feel more real to us. Seeing is believing.
Perhaps this is one of the things psychedelics do: relax the brain’s inhibition on visualizing our thoughts, thereby rendering them more authoritative, memorable, and sticky. The overview effect reported by the astronauts didn’t add anything to our intellectual understanding of this “pale blue dot” in the vast sea of space, but seeing it made it real in a way it had never been before. Perhaps the equally vivid overview effect on the scenes of their lives that psychedelics afford some people is what makes it possible for them to change their behavior.
Matt Johnson believes that psychedelics can be used to change all sorts of behaviors, not just addiction. The key, in his view, is their power to occasion a sufficiently dramatic experience to “dope-slap people out of their story. It’s literally a reboot of the system—a biological control-alt-delete. Psychedelics open a window of mental flexibility in which people can let go of the mental models we use to organize reality.”
In his view, the most important such model is the self, or ego, which a high-dose psychedelic experience temporarily dissolves. He speaks of “our addiction to a pattern of thinking with the self at the center of it.” This underlying addiction to a pattern of thinking, or cognitive style, links the addict to the depressive and to the cancer patient obsessed with death or recurrence.
“So much of human suffering stems from having this self that needs to be psychologically defended at all costs. We’re trapped in a story that sees ourselves as independent, isolated agents acting in the world. But that self is an illusion. It can be a useful illusion, when you’re swinging through the trees or escaping from a cheetah or trying to do your taxes. But at the systems level, there is no truth to it. You can take any number of more accurate perspectives: that we’re a swarm of genes, vehicles for passing on DNA; that we’re social creatures through and through, unable to survive alone; that we’re organisms in an ecosystem, linked together on this planet floating in the middle of nowhere. Wherever you look, you see that the level of interconnectedness is truly amazing, and yet we insist on thinking of ourselves as individual agents.” Albert Einstein called the modern human’s sense of separateness “a kind of optical delusion of his consciousness.”*
“Psychedelics knock the legs out from under that model. That can be dangerous in the wrong circumstances, leading to bad trips and worse.” Johnson brought up the case of Charles Manson, who reportedly used LSD to break down and brainwash his followers, a theory of the case he deems plausible. “But in the right setting, where your safety is assured, it may be a good intervention for dealing with some of the problems of the self”—of which addiction is only one. Dying, depression, obsession, eating disorders—all are exacerbated by the tyranny of an ego and the fixed narratives it constructs about our relationship to the world. By temporarily overturning that tyranny and throwing our minds into an unusually plastic state (Robin Carhart-Harris would call it a state of heightened entropy), psychedelics, with the help of a good therapist, give us an opportunity to propose some new, more constructive stories about the self and its relationship to the world, stories that just might stick.
This is a very different kind of therapy than we are accustomed to in the West, because it is neither purely chemical nor purely psychodynamic—neither mindless nor brainless. Whether Western medicine is ready to accommodate such a radically novel—and ancient—model for mental transformation is an open question. In taking people safely through the liminal state psychedelics occasion, with its radical suggestibility, Johnson acknowledges that the doctors and researchers “play the same role as shamans or elders.
“Whatever we’re delving into here, it’s in the same realm as the placebo. But a placebo on rocket boosters.”
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• • •
THE WHOLE IDEA of using a psychedelic drug to treat addiction is not new. Native Americans have long used peyote as both a sacrament and a treatment for alcoholism, a scourge of the indigenous community since the arrival of the white man. Speaking at a meeting of the American Psychiatric Association in 1971, the psychiatrist Karl Menninger said that “peyote is not harmful to these people . . . It is a better antidote to alcohol than anything the missionaries, the white man, the American Medical Association, and the public health services have come up with.”*
Thousands of alcoholics were treated with LSD and other psychedelics in the 1950s and 1960s, though until recently it’s been hard to say anything definitive about the results. For a time, the therapy was deemed effective enough to become a standard treatment for alcoholism in Saskatchewan. Clinical reports were enthusiastic, yet most of the formal studies conducted were poorly designed and badly controlled, if at all. Results were notably impressive when the studies were performed by sympathetic therapists (and especially by therapists who themselves had taken LSD) and notably dismal when conducted by inexperienced investigators who gave mammoth doses to patients with no attention to set or setting.
The record was a complete muddle until 2012, when a meta-analysis that combined data from the six best randomized controlled studies done in the 1960s and 1970s (involving more than five hundred patients in all) found that indeed there had been a statistically robu
st and clinically “significant beneficial effect on alcohol misuse” from a single dose of LSD, an effect that lasted up to six months. “Given the evidence for a beneficial effect of LSD on alcoholism,” the authors concluded, “it is puzzling why this treatment has been largely overlooked.”
Since then, psychedelic therapy for alcohol and other addictions has undergone a modest and so far encouraging revival, both in university studies and in various underground settings.* In a 2015 pilot study conducted at the University of New Mexico ten alcoholics received psilocybin, combined with “motivational enhancement therapy,” a type of cognitive behavioral therapy designed expressly to treat addiction. By itself, the psychotherapy had little effect on drinking behavior, but after the psilocybin session drinking decreased significantly, and these changes were sustained during the thirty-six weeks of follow-up. Michael Bogenschutz, the lead investigator, reported a strong correlation between the “strength of the experience and the effect” on drinking behavior. The New Mexico results were encouraging enough to warrant a much larger phase 2 trial, involving 180 volunteers, which Bogenschutz is now conducting at NYU in collaboration with Stephen Ross and Jeffrey Guss.
“Alcoholism can be understood as a spiritual disorder,” Ross told me the first time we met, in the treatment room at NYU. “Over time you lose your connection to everything but this compound. Life loses all meaning. At the end, nothing is more important than that bottle, not even your wife and your kids. Eventually, there is nothing you won’t sacrifice for it.”