Psilocybin and MDMA in Couples Therapy: Investigating Treatment for Substance Use Disorders and Codependency

Abstract

Abstract Substance use disorders (SUDs) are increasingly common in the United States, and while this may be a dilemma for those using, it also inflicts problems for those around the user. In couples where drug abuse is present, negative codependent characteristics can arise independently in the non-user, having a damaging effect on the couple dynamic. This is a narrative review to identify how psilocybin-assisted therapy (PAT) has been used to treat SUDs and 3,4-methylenedioxymethamphetamine (MDMA) for disorders like PTSD, examining how MDMA may also be able to treat codependency in a spouse uniquely afflicted by their counterpart’s addiction. When utilizing the combination of these two substances with couples therapy, a reduction of addictive characteristics in one client with a SUD may occur while also shifting codependent behaviors in the romantic partner. Clinical implications as well as limitations on current research are discussed along with further suggestions for psychedelic-assisted couples therapy [149].

In the evidence

This study is part of the evidence base for a synthesis in the library. Here is how each one recorded it.

• State of the evidence: MDMA for addiction ↑Supports

  Proposes that combining psilocybin-assisted therapy for substance use disorder with MDMA for a partner's codependency in couples therapy may reduce addictive and codependent behaviors.

  Synthesized October 22, 2026

Comparable studies

Other narrative reviews on MDMA for addiction, most cited first.