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 disorders with MDMA for codependency in couples therapy may reduce addictive behaviors in one partner and codependent behaviors in the other.

  Synthesized September 21, 2026

Comparable studies

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