High hopes? Precision psychedelic addiction medicine.
Rayyan Raja Zafar, Patrick Kleine, Danielle Kurtin, Matthew B. Wall, David Erritzøe
Frontiers in Psychiatry 2025 DOI: 10.3389/fpsyt.2025.1681795 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Theoretical or philosophical paper Peer reviewed |
|---|---|
| Topics | Addiction |
| Keywords | EEG PET Biomarker FMRI Precision psychiatry Psychedelic |
| Key points | Proposes that integrating translational neuroimaging biomarkers within psychedelic addiction research can shift addiction neuroscience toward a theragnostic framework, enabling personalized and precision-guided care. |
Abstract
Despite decades of neuroscience research and significant investment in addiction neuroimaging, clinical outcomes for individuals with substance use and behavioural addictions remain poor. Only 1.8% of people with substance use disorders receive effective treatment, highlighting a major disconnect between mechanistic understanding and clinical utility. This paper calls for a reorientation of addiction neuroscience, from a predominantly diagnostic focus toward a theragnostic framework, in which biomarkers are used to stratify patients, guide treatment decisions, and predict outcomes. We argue that the integration of translational neuroimaging biomarkers, particularly fMRI, EEG, and PET, within psychedelic addiction research offers a unique and timely opportunity to catalyse this shift. Psychedelic compounds such as psilocybin represent a new class of therapeutics capable of engaging neuroplasticity, reward and emotional processing, and cognitive control networks central to addiction pathophysiology. We review how acute and pre-post neuroimaging paradigms can index pharmacodynamic effects and longer-term treatment response and propose a roadmap for embedding biomarkers in early and late phase clinical trials. Drawing on ongoing studies at the Centre for Psychedelic Research at Imperial College London, we outline how multimodal biomarkers are being co-developed alongside clinical trials in gambling and opioid use disorders to identify biotype-specific responses and build a deeply phenotyped treatment population. We argue that these biomarkers, if validated, could serve as regulatory-grade tools for drug theragnostic co-development, mirroring successful models in oncology and neurology. Importantly, we emphasise that realising this vision will require robust multi-stakeholder collaboration, including academia, industry, regulatory agencies, funders, healthcare systems, and patient groups alongside dedicated investment to build a scalable theragnostic infrastructure for addiction research and medicine. In conclusion, psychedelic therapy offers more than symptomatic relief, it presents a vehicle for transforming how we diagnose, treat, and understand addiction. By embracing theragnostic principles and prioritising biomarker integration, addiction medicine has the potential to move towards personalised and precision-guided care.
Comparable studies
Other theoretical and historical papers on addiction, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Psychedelics as Medicines: An Emerging New Paradigm General population | 2016 | Theoretical or philosophical paper | |
| Restructuring reward processing with Mindfulness-Oriented Recovery Enhancement: novel therapeutic mechanisms to remediate hedonic dysregulation in addiction, stress, and pain. | 2016 | Theoretical or philosophical paper | |
| Ayahuasca’s entwined efficacy: An ethnographic study of ritual healing from ‘addiction’ | 2017 | Theoretical or philosophical paper | |
| Hypotheses Regarding the Mechanisms of Ayahuasca in the Treatment of Addictions | 2012 | Theoretical or philosophical paper | |
| Biosynthesis of an Anti-Addiction Agent from the Iboga Plant. | 2019 | Theoretical or philosophical paper |
Citations in the library
Cites 61
- Neural correlates of the LSD experience revealed by multimodal neuroimaging. Proceedings of the National Academy of Sciences April 11, 2016
- Psilocybin for treatment-resistant depression: fMRI-measured brain mechanisms. Scientific Reports October 13, 2017
- Psychedelic effects of psilocybin correlate with serotonin 2A receptor occupancy and plasma psilocin levels Neuropsychopharmacology January 26, 2019
- Broadband Cortical Desynchronization Underlies the Human Psychedelic State Journal of Neuroscience September 18, 2013
- Increased spontaneous MEG signal diversity for psychoactive doses of ketamine, LSD and psilocybin Scientific Reports April 19, 2017
and 56 more in the library