Neuroscientific models of addiction have progressed from simple dopamine-based explanations to more complex frameworks involving multiple brain circuits and systems. Recent evidence shows that addiction alters large-scale brain networks and that social, psychological, and developmental factors play a more central role than previously recognized. New treatments, such as psychedelic-assisted therapies, highlight the need for changes across biological, cognitive, and emotional levels. The authors argue that viewing addiction as a multilevel, interactive biopsychosocial process better accounts for differences in how addiction develops and resolves, and can guide more precise and effective interventions.
Using data from the 2023 U.S. National Survey on Drug Use and Health, lifetime use of mescaline or peyote was associated with lower opioid use disorder severity, while lifetime use of LSD, psilocybin, MDMA, or DMT was associated with higher severity. The link between mescaline/peyote use and lower severity appeared only among adults with high mental health impairment. The findings suggest that different types of psychedelic use have divergent relationships with opioid use disorder severity, and that mental health status may influence these associations.
Among a national sample of US adults, lifetime psychedelic use is associated with lower severity of opioid use disorder, but this relationship depends on broader substance-use patterns and mental health. The protective association appears specific to certain substance-use profiles and is mediated by mental health status. The findings suggest that psychedelic use alone does not uniformly reduce opioid use disorder severity; rather, the context of other substance use and psychological well-being shapes the association.
Classic psychedelics like psilocybin show promise for treating substance use disorders, and if larger trials confirm efficacy, psychedelic-assisted psychotherapy might be integrated into existing treatments such as cognitive behavioral therapy and twelve-step facilitation programs like Alcoholics Anonymous. Although AA has historically rejected medication-assisted treatments, the authors argue that classic psychedelics and their subjective experiences may be more compatible than conventional medications. They describe Bill Wilson's, the founder of AA, little-known experiences with psychedelics, suggesting aspects of psychedelic treatments could complement AA. A review of clinical trials evaluating psychedelics for substance use disorders is provided, along with discussion of potential large-scale impact if integrated into AA.