Are Psychedelics Addictive? Plus 4 More Psychedelics Questions Answered
Key takeaways:
Psychedelics are substances that have shown promise for treating several mental health conditions. But except for ketamine, psychedelics are still illegal in the United States.
There’s some evidence that psychedelics may have a lower risk of addiction compared to other illegal drugs. But we need more research in this area.
Psychedelics may have fewer risks when used in a healthcare setting, as part of psychedelic-assisted therapy.
Table of contents
Psychedelics, also known as hallucinogens, are a class of mind-altering drugs. They can have an affect on mood, thoughts, and perceptions. Some can also make people see or hear things that aren’t real. Some examples include ketamine, psilocybin, and ayahuasca.
Most psychedelics have been illegal in the United States for the past 50 years. But recently, there’s been a renewed interest in psychedelics. Some of these drugs may be helpful for treating certain mental health conditions, like PTSD and anxiety.
But as researchers look for benefits, they’re also hoping to learn more about the risks of using psychedelics. This includes whether they cause addiction. So far, the answer is mixed.
1. Are psychedelics addictive?
Possibly, but it doesn't seem to be common with most psychedelics.
Addiction (substance use disorder) is a health condition where a person uses a substance, despite it leading to major problems in their life. Addiction can happen with many different substances — including hallucinogens. When this happens, it’s called hallucinogen use disorder (HUD).
HUD doesn’t seem to occur very often with most psychedelics (the biggest exception is PCP). In one large survey on hallucinogen use in the U.S., fewer than 1 out of 100 people who used psychedelics in their lifetime had HUD. But so far, there’s not enough information to say for sure.
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The risk of HUD seems to be higher with ketamine and MDMA than with classic psychedelics. This may be due to the fact that classic psychedelics don’t affect dopamine levels in the body, but ketamine and MDMA do. Dopamine is a chemical in the brain that controls pleasure. Most addictive drugs affect dopamine levels.
Some psychedelics, like LSD, can also lead to tolerance. After several days of repeated LSD use, your body may no longer respond to it — no matter how much you take. This can make frequent, long-term use less appealing. But tolerance can also cause a person to use more of a substance over time to get the same effect. This can be dangerous for recreational users.
The abuse of psychedelics may be less common when used in a healthcare setting or as part of psychedelic-assisted therapy (PAT). In fact, PAT may even help treat addiction to alcohol, nicotine, or other substances. Research into the role of PAT and addiction is ongoing.
Remember — just because something isn’t addictive doesn’t make it safe. There are still side effects and risks to psychedelics you should be aware of.
2. What drugs does psychedelic-assisted therapy use?
Right now — except for ketamine — psychedelics can only be used as part of a research study. But this may change soon, as individual states (like Oregon) and even the federal government pave the way for more widespread access.
Psychedelics fall into two main categories: Classic psychedelics, and entactogens/dissociative drugs.
Classic psychedelics
Classic psychedelics work mostly on serotonin receptors in the brain. Serotonin is a chemical messenger that plays a role in many body functions, including mood.
Classic psychedelics include:
Psilocybin: the psychedelic chemical in certain mushrooms (“magic mushrooms”)
Lysergic acid diethylamide (LSD): a synthetic psychedelic based on a type of fungus, known as ergot, that grows on grains. It’s also referred to as “acid.”
N,N-dimethyltryptamine (DMT): a psychedelic compound found in a wide variety of plants. Small amounts of DMT are also naturally present in our bodies. It’s best known as an active ingredient in ayahuasca tea.
Mescaline: a psychedelic chemical found in certain types of cacti, like Peyote.
Entactogen and Dissociative psychedelics
There are other substances used in PAT that work a little differently from classic psychedelics. These include:
3,4-methylenedioxymethamphetamine (MDMA): a synthetic substance developed in Germany to help control bleeding. It’s classified as an entactogen, which means it can increase self-awareness and empathy. It has fewer hallucinatory effects than classic psychedelics. MDMA is the active ingredient in “ecstasy”.
Ketamine: is the only FDA-approved psychedelic — but not for mental health disorders. It’s only currently approved for use as an anesthetic. But some healthcare providers use it off-label for treatment-resistant depression. Ketamine is a dissociative medication that causes psychedelic effects at high doses. “Dissociative” means it can make you feel disconnected from your body. Ketamine is often referred to as “Special K.”
3. What are psychedelics used to treat?
Right now, ketamine is the only psychedelic legally available for medical use. It’s FDA approved as an anesthetic. Some providers also choose to use it as an off-label treatment for depression, anxiety, and other mental illnesses. A version of ketamine called esketamine (Spravato) was also FDA-approved in 2019. It’s used for treatment-resistant depression.
Other psychedelics aren’t legal to use yet. Doctors cannot use them to treat any health conditions — though this might soon change.
Researchers are currently investigating whether psychedelics could be helpful for:
Depression. Certain psychedelics, like MDMA, might improve symptoms of depression, especially when used with therapy. Several clinical trials are looking at psilocybin for depression treatment. Ketamine is also shown to benefit treatment-resistant depression.
Post-traumatic stress disorder (PTSD). Psychedelics may be helpful in the future for trauma-related disorders. MDMA-assisted therapy in particular seems to have good potential for treating PTSD. It may soon be approved by the FDA.
Anxiety. There’s some evidence that psychedelics might be helpful for certain anxiety disorders.
Addiction. As mentioned, psychedelics may be helpful in treating substance and alcohol use disorders.
Eating disorders. The use of PAT for eating disorders is still new, but early evidence is promising.
4. What are the possible side effects of psychedelics?
All psychedelics can have side effects. Some possible general side effects of psychedelics are:
Altered sense of reality
Difficulty thinking or concentrating
Loss of coordination
Nausea and vomiting
Changes in heart rate and blood pressure
Feeling drowsy or trouble sleeping
Extreme emotions — both pleasant and unpleasant
In some cases, psychedelics can also cause more serious, long-term problems. This could include:
Hallucinogen Persisting Perception Disorder (HPPD). HPPD is a condition where people can experience ongoing changes in perception (or “flashbacks”). This can continue even after hallucinogens have worn off. Though HPPD is rare, it can happen after just one use.
Substance-induced anxiety disorders. Using psychedelics can cause substance-induced anxiety disorders. This type of anxiety is usually temporary, but using the substance again can trigger it.
Unintended harm to self or others. Psychedelic substances aren’t usually harmful on their own. But there have been reports of serious injury or death while under their influence. They can alter reality in a way that leads to unintended dangerous behavior. This is especially true if they’re taken in an unsafe or unsupervised environment.
Serotonin syndrome. This happens when there’s too much serotonin activity in your body. It may be more likely if psychedelics are combined with antidepressants that also affect serotonin (like SSRIs).
A recent review found that the risks of psychedelic use may be somewhat exaggerated. For example, a study of 20 different illegal drugs (including psychedelics) found LSD and psilocybin to be two of the least dangerous.
That being said, the risk of side effects increases when using psychedelics without medical guidance. The oversight of a healthcare provider can help prevent drug interactions and improper dosing. Supervised use is also preferred to risky environments that can lead to more serious issues.
5. How do I know if psychedelic treatment is right for me?
PAT is generally reserved for people who have not responded to other treatments for their mental health condition.
There are several other factors to consider:
Legal status. Most psychedelics are still illegal in the U.S., though this might change in the future. Currently, ketamine is the only legal psychedelic outside of a research setting. Psilocybin will also be available in certain Oregon counties starting in 2023 — but only for supervised clinical use.
Finding a trained therapist. There are very few mental health professionals that provide psychedelic treatment. The Multidisciplinary Association for Psychedelic Studies offers a directory of providers. Psychable offers another list of psychedelic specialists and clinics.
Medical background. People with certain health conditions may need to be more careful with psychedelics. These include:
Heart conditions
Hypertension or hypotension (high or low blood pressure)
Personal or family history of psychotic or bipolar disorders
Pregnancy
Taking certain medications, especially antidepressants
The bottom line
Psychedelics have become popular in recent years as a potential treatment for certain health conditions. But the truth is, we still have a lot to learn. So far, there’s some evidence that most psychedelics have a lower risk for addiction, especially when used in a healthcare setting. But more research is needed before we fully understand the pros and cons of using psychedelics as medicine.
Why trust our experts?
DISCLAIMER: Keep in mind that psychedelic treatment is only legal in some states under limited circumstances, but not in others. It is still illegal under federal law.
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