In brief
- A randomized, double-blind trial with 93 participants compared psilocybin against an active placebo, both accompanied by psychotherapy, for alcohol use disorder.
- During the follow-up period, the psilocybin group reduced heavy drinking days by more than half compared to the placebo group (9.7% vs. 23.6%).
- These are promising but early-phase results: the sample size is small, the clinical context included professional support, and maintaining the blind is difficult. It is not an approved treatment or a cure.
The idea of using psychedelics to help those struggling with alcohol is not new; researchers experimented with LSD as early as the 1950s and 60s. What is different now is the methodology. In 2022, the journal JAMA Psychiatry published the first randomized, placebo-controlled clinical trial to test psilocybin—the molecule found in magic mushrooms—combined with psychotherapy to treat alcohol use disorder. The primary result was notable, as are its limitations.
The study
The work, led by Michael P. Bogenschutz and his team (at New York University, among other centers), is a phase 2, double-blind, randomized, active-placebo-controlled trial. It involved 95 adults between the ages of 25 and 65 diagnosed with alcohol use disorder, 93 of whom were included in the primary analysis. All participants received 12 weeks of structured psychotherapy. The difference lay in two long sessions during weeks 4 and 8: half received psilocybin, while the other half received diphenhydramine, an antihistamine used as an active placebo (it produces some sedation, making it harder to guess which group one is in). Consumption was tracked over 32 weeks.
What was found
The primary measure was the percentage of heavy drinking days. In the psilocybin group, it was 9.7%; in the placebo group, it was 23.6%. This represents roughly half the number of problematic days, with a mean difference of 13.9 percentage points (95% confidence interval: 3.0 to 24.7) and a statistical significance of p = 0.01. Average daily alcohol consumption was also lower in those who received psilocybin. Regarding safety, the authors recorded no serious adverse effects attributable to psilocybin within the controlled environment of the trial, which included trained staff and prior screening of participants.
What it means (and what it doesn’t)
The finding is encouraging and consistent with what is being observed in other conditions, such as treatment-resistant depression. However, it should be interpreted with caution. First, it is an early-phase trial with a small sample size: 93 people are not enough to confirm a treatment, and replication in larger studies will be necessary. Second, the effect does not come from an isolated pill, but from a package: screening, preparation, two multi-hour sessions with therapists present, and subsequent integration sessions. Disentangling how much the molecule contributes versus the psychological support is one of the great open questions.
There is another important methodological caveat: maintaining the “blind” with psychedelics is difficult. Many participants intuit whether they have taken the active substance due to its subjective effects, and that expectation can influence the results. The authors acknowledge this. Furthermore, those who participated did so voluntarily and with motivation, within a safe clinical framework; this is not equivalent to self-administration without screening or support, which carries different risks—ranging from difficult psychological experiences to interactions with other health conditions.
From a harm reduction perspective, an honest reading is twofold. It is neither a “miracle” nor a substance to be demonized: the evidence suggests that, in a well-designed therapeutic context, psilocybin can open a window of change for people who have not found relief with standard approaches. At the same time, this remains ongoing research. In most countries, including Spain, psilocybin is not approved as a medicine and its possession is regulated; that is an objective fact of the legal framework, not a moral judgment on those who research or consume it. The reasonable approach, today, is to follow phase 3 trials closely and not confuse a promising signal with a treatment recommendation.
Source
- Bogenschutz MP, Ross S, Bhatt S, et al. Percentage of Heavy Drinking Days Following Psilocybin-Assisted Psychotherapy vs Placebo in the Treatment of Adult Patients With Alcohol Use Disorder: A Randomized Clinical Trial. JAMA Psychiatry, 2022. DOI: 10.1001/jamapsychiatry.2022.2096
Educational content written from a harm reduction perspective and with respect for individual freedom. It is not a substitute for advice from a healthcare professional and is not intended to encourage or condemn any drug use.
