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Psilocybin for addiction

Studies whose primary subject is both Psilocybin and Addiction, with an evidence synthesis read across the most-cited and most recent of them.

State of the evidence

Synthesized

Synthesized from 23 studies in the library · AI-generated, grounded in the abstracts below

Found by searching the library for Psilocybin, magic mushrooms, psilocin, psychedelic mushrooms, Addiction, substance use disorder, then ranked by relevance.

Psilocybin-assisted therapy shows promising but preliminary evidence for reducing alcohol and tobacco use. In alcohol use disorder, a large placebo-controlled trial found roughly a 14-point reduction in heavy drinking days, and a meta-analysis found moderate short-term advantages over controls plus higher odds of abstinence, though only one drinking measure remained superior at longer follow-up. Tobacco pilot data show high abstinence rates (80% at 6 months) but come from small open-label studies, and an open-label extension found drinking reductions faded after about a month. The main caveats are small samples, few RCTs, heterogeneous and partly non-durable effects, and likely difficulty blinding participants.

Evidence by study

Direction is which way each study's own result points, not our rating of the study. All 25 matching studies were reviewed; the 23 that directly address the question are shown here.

What the directions mean
Supports:
the study found the intervention worked, or its hypothesis held.
Opposes:
it found the opposite, no benefit or a harm.
No effect:
no significant difference either way.
Mixed:
effects in both directions within the same study.
Unclear:
the abstract does not report a direction.
Study Design Sample size Direction Finding
Psilocybin-assisted treatment for alcohol dependence: A proof-of-concept study 2015 single-group proof-of-concept study 10 Supports Abstinence did not increase before psilocybin but rose significantly after administration, with gains largely maintained to 36 weeks and no significant treatment-related adverse events.
Pilot study of the 5-HT2AR agonist psilocybin in the treatment of tobacco addiction 2014 open-label pilot study 15 Supports Twelve of 15 participants (80%) showed seven-day point prevalence abstinence at 6-month follow-up, a rate the authors note exceeds typical cessation therapies, though the open-label design precludes definitive efficacy conclusions.
Percentage of Heavy Drinking Days Following Psilocybin-Assisted Psychotherapy vs Placebo in the Treatment of Adult Patients With Alcohol Use Disorder 2022 RCT 95 Supports Psilocybin plus psychotherapy produced 9.7% heavy drinking days over 32 weeks versus 23.6% with active placebo plus psychotherapy, a significant reduction.
Classic psychedelics: An integrative review of epidemiology, therapeutics, mystical experience, and brain network function. 2019 integrative review Supports Reviews report promising results for classic psychedelics in treating addiction and end-of-life distress, alongside associations between naturalistic use and positive mental health outcomes.
Psilocybin-Occasioned Mystical Experiences in the Treatment of Tobacco Addiction 2015 open-label pilot study 15 Supports Twelve of 15 participants (80%) had biologically verified abstinence at 6 months, and abstainers scored higher on psilocybin-occasioned mystical experience than non-abstainers, with no difference in general drug intensity.
Psychedelics as Medicines: An Emerging New Paradigm 2016 theoretical paper Supports Argues that psychedelics may exert therapeutic effects by destabilizing brain network hubs and enabling network resetting, citing preliminary evidence of efficacy in tobacco and alcohol addiction.
Psychedelics reopen the social reward learning critical period 2023 experimental study in mice Supports Psychedelics reopen the social reward learning critical period in mice, with a time course proportional to human subjective effects, mediated by oxytocin-dependent plasticity and extracellular matrix reorganization.
Dynamic coupling of whole-brain neuronal and neurotransmitter systems 2020 observational neuroimaging study Unclear Demonstrates that 5-HT2A receptor stimulation with psilocybin causally explains functional brain effects, which the authors suggest may help explain its promise in depression, anxiety, and addiction.
Psychedelics not linked to mental health problems or suicidal behavior: A population study 2015 observational cohort 135095 No effect Lifetime psychedelic use was not significantly associated with increased likelihood of past-year mental health problems, suicidal thoughts or attempts, depression, or anxiety.
Psychedelic therapy for smoking cessation: Qualitative analysis of participant accounts 2018 qualitative follow-up study 12 Supports Participants described vivid insights into self-identity and reasons for smoking, persistent interconnectedness and awe, and preparatory counseling and study rapport as key to achieving abstinence.
Psychedelics as anti-inflammatory agents 2018 review Supports Reviews evidence that 5-HT2A agonists produce anti-inflammatory effects in animal and cellular models and may offer a new treatment strategy for inflammatory disorders.
Persisting Reductions in Cannabis, Opioid, and Stimulant Misuse After Naturalistic Psychedelic Use: An Online Survey 2020 cross-sectional survey Supports Reports self-reported reductions in problematic cannabis, opioid, and stimulant use after naturalistic psychedelic use, while noting the design cannot establish causality.
Psychedelic Drugs in Biomedicine 2017 review Supports Summarizes preclinical and pilot clinical data suggesting psychedelics are promising treatments for addiction, depression, and anxiety, while noting many open questions on mechanism, safety, and efficacy.
DARK Classics in Chemical Neuroscience: Psilocybin 2018 review Supports Notes that preliminary studies show psilocybin has potential for treating alcohol and tobacco addiction, among other conditions.
Clinical Interpretations of Patient Experience in a Trial of Psilocybin-Assisted Psychotherapy for Alcohol Use Disorder 2018 case series within a double-blind placebo-controlled trial 3 Supports Describes three participants' individualized, vivid experiences of catharsis, forgiveness, self-compassion, and love, with lasting shifts in self-perception and relationship with alcohol.
Efficacy and safety of psilocybin-assisted therapy for alcohol use disorder: A systematic review and meta-analysis 2026 systematic review and meta-analysis 202 Supports Across six trials, psilocybin-assisted therapy produced significant within-group drinking reductions and moderate short-term advantages over controls, with only percent drinking days still superior at longer follow-up and higher odds of maintaining abstinence (OR 2.78); adverse events were mostly mild and transient.
643. A mechanism-informed clinical trial of psilocybin-assisted therapy for opioid use disorder: rationale and neurobiological framework 2026 clinical protocol Unclear Describes a planned phase II trial proposing that psilocybin-assisted therapy may address reward dysregulation, anhedonia, and social deficits in opioid use disorder, with time to return to opioid use as the primary outcome; no results are reported.
Psilocybin-Assisted Therapy for Alcohol Use Disorder: A Systematic Review of Clinical Evidence 2026 systematic review Mixed Three eligible studies showed reductions in heavy drinking days and an acceptable safety profile, but findings on abstinence and relapse prevention were mixed, with some studies reporting no significant differences from controls.
Psilocybin-assisted psychotherapy for substance use disorders as a complex intervention: A systematic review of efficacy, mechanisms and psychotherapeutic frameworks 2026 systematic review Supports Across 17 studies, psilocybin-assisted psychotherapy was associated with reduced substance use, higher abstinence rates, and improved well-being, though findings were heterogeneous and trials combining repeated high-dose sessions with extended psychotherapy reported the most sustained benefits.
Safety, Efficacy, and Blinding Integrity of Psilocybin-Assisted Therapy for Substance Use Disorders: A Systematic Review of Randomized Controlled Trials 2026 systematic review protocol Unclear Describes a planned review restricted to RCTs examining efficacy, safety, and blinding integrity of psilocybin-assisted therapy for substance use disorders; no results are reported.
Epigenome-wide association study of psilocybin-induced methylome changes in alcohol use disorder. 2026 longitudinal placebo-controlled pilot with epigenome-wide association study 37 Mixed Primary endpoints of abstinence duration and mean alcohol use were not reached, but psilocybin was associated with methylation changes in TLE4 and RASGRP4 and co-methylation modules related to reductions in depressive symptoms and drinking behavior.
Methamphetamine-Fentanyl Polysubstance Administration Produces Social Deficits and Corticolimbic Stress-Reward Circuit Adaptations. 2026 experimental study in rats Opposes Withdrawal from methamphetamine-fentanyl reduced social preference, and psilocybin did not restore sociability at the time point examined, though it altered CRHR1 expression in the medial prefrontal cortex depending on drug history.
Safety and Efficacy of Psilocybin-Assisted Therapy for Alcohol Use Disorder: Open-Label Extension of a Phase II Randomized Controlled Trial 2026 open-label extension of a Phase II RCT 59 Mixed A single open-label psilocybin administration with four hours of therapy was well tolerated and reduced percent drinking days at one month, but this returned to baseline by months two through four, while craving, self-efficacy, and treatment readiness improved one week after psilocybin.

Points of agreement

  • Multiple clinical studies report reductions in alcohol or tobacco use after psilocybin-assisted treatment.
  • The largest placebo-controlled alcohol trial and a meta-analysis both find short-term advantages over control conditions.
  • Safety profiles in controlled settings are generally described as acceptable, with mostly mild and transient adverse events.
  • Several reports link outcomes to the subjective or mystical quality of the psilocybin experience rather than drug intensity alone.
  • Reviewers consistently describe the evidence base as preliminary and limited by small samples and few RCTs.

Conflicts

  • The meta-analysis finds higher odds of maintained abstinence, while a systematic review reports mixed abstinence findings with some studies showing no difference from controls.
  • The placebo-controlled trial shows a substantial heavy-drinking reduction, but the open-label extension finds drinking reductions fading by two to four months.
  • The epigenome-wide pilot did not reach its primary abstinence and alcohol-use endpoints, contrasting with positive primary outcomes in other alcohol trials.
  • A rat study found psilocybin did not restore social preference after polysubstance withdrawal, at odds with the social-reward rationale for psychedelic therapy.

Gaps

  • Durability of drinking and smoking reductions beyond several months is unclear and inconsistent across studies.
  • Blinding integrity is largely unexamined; a planned review flags functional unblinding as a concern.
  • Most clinical evidence concerns alcohol and tobacco; opioid, methamphetamine, and cocaine use disorders have little or no outcome data.
  • Optimal dose, number of sessions, and psychotherapy framework are not established.
  • Samples are small and highly selected, limiting generalizability to broader treatment populations.
  • Mechanisms linking subjective effects, neuroplasticity, and behavior change remain speculative.
Browse these studies in the library

Common questions

What does the research agree on about psilocybin for addiction?
  • Multiple clinical studies report reductions in alcohol or tobacco use after psilocybin-assisted treatment.
  • The largest placebo-controlled alcohol trial and a meta-analysis both find short-term advantages over control conditions.
  • Safety profiles in controlled settings are generally described as acceptable, with mostly mild and transient adverse events.
  • Several reports link outcomes to the subjective or mystical quality of the psilocybin experience rather than drug intensity alone.
  • Reviewers consistently describe the evidence base as preliminary and limited by small samples and few RCTs.
Where do studies on psilocybin for addiction conflict?
  • The meta-analysis finds higher odds of maintained abstinence, while a systematic review reports mixed abstinence findings with some studies showing no difference from controls.
  • The placebo-controlled trial shows a substantial heavy-drinking reduction, but the open-label extension finds drinking reductions fading by two to four months.
  • The epigenome-wide pilot did not reach its primary abstinence and alcohol-use endpoints, contrasting with positive primary outcomes in other alcohol trials.
  • A rat study found psilocybin did not restore social preference after polysubstance withdrawal, at odds with the social-reward rationale for psychedelic therapy.
What is still unknown about psilocybin for addiction?
  • Durability of drinking and smoking reductions beyond several months is unclear and inconsistent across studies.
  • Blinding integrity is largely unexamined; a planned review flags functional unblinding as a concern.
  • Most clinical evidence concerns alcohol and tobacco; opioid, methamphetamine, and cocaine use disorders have little or no outcome data.
  • Optimal dose, number of sessions, and psychotherapy framework are not established.
  • Samples are small and highly selected, limiting generalizability to broader treatment populations.
  • Mechanisms linking subjective effects, neuroplasticity, and behavior change remain speculative.
How we analyze this

This synthesis reads the 15 most-cited and 10 most recent studies whose primary subject is Psilocybin for addiction, up to 25 in all. The most-cited set anchors the established evidence, and the recent set surfaces work that is too new to have gathered citations yet.

A study qualifies only when Psilocybin for addiction or a known alias appears in its title or keywords, so broad reviews that mention it only in passing are left out. Each study is read from its abstract, strongest evidence first, and the summary reports the direction of the results along with any conflicts and gaps.

The full method, including what a person does and does not review, is on the methods page.

Ask your own question in the Research Synthesis Tool

185 articles · 55 from the last two years · 1,260,564 participants across 57 studies reporting sample size

Common study designs

review 59 narrative review 7 systematic review 17 randomized controlled trial 11 theoretical or philosophical paper 6

Research volume by year

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181 studies whose primary subject is psilocybin for addiction since 2009

Studies about psilocybin for addiction per year, 2009 to 2026, peaking at 34 in 2025 Bar chart: one bar per year, taller where more studies were published that year. 0 20 40 2010 2015 2020 2025
2026 is partial
Show the numbers
Studies about psilocybin for addiction per year, 2009 to 2026, peaking at 34 in 2025
Year Studies
2009 1
2010 1
2011 0
2012 0
2013 2
2014 1
2015 4
2016 4
2017 4
2018 7
2019 4
2020 10
2021 20
2022 20
2023 24
2024 28
2025 34
2026 17

Research

Synthesize the evidence →

Psilocybin-assisted therapy for alcohol use disorder: A systematic review of randomized controlled trials

Pharmacotherapy in Psychiatry and Neurology November 6, 2026 Kirolos Eskandar, Kerolos Shahat

To critically synthesize randomized controlled evidence on the efficacy, relapse prevention, durability, and safety of psilocybin-assisted therapy in adults with alcohol use disorder (AUD), distinguishing alcohol-consumption reduction, abstinence, and relapse outcomes.PubMed, Scopus, Web of Science, and the Cochrane Library were searched without date or language restrictions.Three randomized...

DOI: 10.17219/fpn/242405 (opens in new tab) Full text (opens in new tab)

Psilocybin, cognitive stability and drinking reduction in co-occurring alcohol use disorder and depression: a pilot secondary analysis of a randomized, placebo-controlled trial

medRxiv October 29, 2026 Ceyda Sayalı, Eli Weisman, Frederick Streeter Barrett preprint

Background. Change in cognitive control is a candidate transdiagnostic mechanism of psychedelic therapy. One account predicts that, once acute effects resolve, psilocybin shifts control toward flexibility while sparing inhibition and working memory. A motivational account (PRISM) predicts that psilocybin increases the willingness to exert control rather than the ability to do so. We tested both...

DOI: 10.64898/2026.10.27.26366630 (opens in new tab) Full text (opens in new tab)

Efficacy and safety of psilocybin-assisted therapy for alcohol use disorder: A systematic review and meta-analysis

Journal of Psychopharmacology October 8, 2026 Gianluca A. Florineth, Anna L. Boeker, Tobias Bracht et al.

Background: Psilocybin-assisted therapy (PAT) has emerged as a promising intervention for alcohol use disorder (AUD), yet contemporary clinical evidence has not been systematically synthesized to validate its clinical utility and safety profile. Methods: Contemporary clinical trials of PAT for AUD were identified systematically from PubMed, PsycINFO, and Scopus by two independent reviewers....

DOI: 10.1177/02698811261490221 (opens in new tab)

643. A mechanism-informed clinical trial of psilocybin-assisted therapy for opioid use disorder: rationale and neurobiological framework

The International Journal of Neuropsychopharmacology September 9, 2026 Orla Mallon

Abstract Background Opioid Use Disorder (OUD) is associated with substantial morbidity and mortality, with relapse remaining common despite the availability of opioid agonist and antagonist pharmacotherapies. Scotland continues to experience a disproportionate burden of drug-related deaths relative to other parts of the United Kingdom and Europe, reflecting the ongoing clinical and public...

DOI: 10.1093/ijnp/pyag040.113 (opens in new tab)

Psilocybin-Assisted Therapy for Alcohol Use Disorder: A Systematic Review of Clinical Evidence

Psychoactives August 30, 2026 Laura Schäffert, Human-Friedrich Unterrainer

Background: Alcohol use disorder (AUD) remains a leading contributor to global morbidity, yet conventional treatments often yield suboptimal outcomes and high relapse rates. Psilocybin-assisted therapy has re-emerged as a potential intervention for substance use disorders, but its effectiveness and safety in AUD specifically remain to be comprehensively evaluated. Objective: To review and...

DOI: 10.3390/psychoactives5030022 (opens in new tab)

Psilocybin-assisted psychotherapy for substance use disorders as a complex intervention: A systematic review of efficacy, mechanisms and psychotherapeutic frameworks

Journal of Psychopharmacology August 17, 2026 Lana Strika-Bruneau, Chérine Elhssaini, Baptiste Fauvel et al.

Background: Psychedelic-assisted psychotherapy (PAP) shows promise for substance use disorders (SUDs), yet the respective contributions of pharmacological, experiential, psychotherapeutic, and contextual factors remain insufficiently understood. Objective: To synthesize contemporary clinical evidence on PAP for SUDs, with particular attention to therapeutic frameworks, dosing strategies,...

DOI: 10.1177/02698811261473436 (opens in new tab)

Safety, Efficacy, and Blinding Integrity of Psilocybin-Assisted Therapy for Substance Use Disorders: A Systematic Review of Randomized Controlled Trials

Open Mind June 26, 2026 Max Courtney preprint

Substance use disorders (SUDs) represent a persistent global public health burden for which existing pharmacological and behavioral interventions show limited long-term efficacy across various patient populations (Sinha, 2011). Psilocybin-assisted therapy (PAT) has reemerged as a promising therapeutic treatment approach and has had renewed clinical interest with a growing amount of research...

DOI: 10.17605/osf.io/n4y2w (opens in new tab) Addiction Blinding Randomized controlled trial Adverse effect +10

Epigenome-wide association study of psilocybin-induced methylome changes in alcohol use disorder.

Translational Psychiatry May 26, 2026 Marvin M. Urban, Lea Zillich, Nathalie M. Rieser et al. 1 citation

The serotonergic hallucinogen psilocybin has shown potential as a treatment for psychiatric conditions like alcohol use disorder (AUD) and depression in clinical studies. Epigenetic mechanisms, including DNA methylation, are hypothesized to contribute to its lasting therapeutic benefits. In this exploratory study, we present the first methylome-wide analysis of psilocybin-induced changes in a...

DOI: 10.1038/s41398-026-03961-3 (opens in new tab) Full text (opens in new tab)

Therapeutic Potential of Psilocybin in Alcohol and Opioid Use Disorders: A Promising Role for Psychedelics

Pharmaceutical Sciences April 30, 2026 Elmira Zolali, Lance R Mcmahon, Samuel Obeng

Please don't use dangerous characters * Last Name Please don't use dangerous characters * Email Address Please enter a email address * Comments Please don't use dangerous characters * Security code The entered code is invalid. Generate New Image Type the code from the image Abstract View: 388 Your browser does not support the canvas element. yearsJanFebMarAprMayJunJulAugSepOctNovDec...

DOI: 10.34172/ps.026.43663 (opens in new tab) Full text (opens in new tab) Psilocybin Hallucinogen Alcohol Opioid +3

Methamphetamine-Fentanyl Polysubstance Administration Produces Social Deficits and Corticolimbic Stress-Reward Circuit Adaptations.

Research Square April 23, 2026 Leah M Salinsky, Joshua L Fox, Kyra C Diaz et al. preprint

Polysubstance use involving psychostimulants and opioids is increasingly prevalent and associated with elevated overdose risk, relapse vulnerability, and poor treatment outcomes. However, the neurobehavioral consequences of opioid-stimulant use remain poorly understood. We evaluated whether repeated methamphetamine-fentanyl polysubstance treatment disrupts social preference during withdrawal,...

DOI: 10.21203/rs.3.rs-9306429/v1 (opens in new tab) Full text (opens in new tab) Addiction Psilocybin Crhr1 Fentanyl +6

Clinical trials

All psilocybin for addiction trials →