With 18.5 million Americans struggling with substance use disorders, also known as addiction, there is no question that the USA has a drug epidemic. Today, overdoses, drug and alcohol related deaths, and drug and alcohol related hospitalizations are higher than they’ve ever been. Micro dosing using psychedelics is one proposed solution, and one that has gained significant traction over the last 60 years. In fact, microdosing to avoid alcohol or heroin has been used as far back as the 1960s, where artists like Jimi Hendrix famously failed to make it work.
Today, it’s been popularized by the media, by groups like the Psychedelics in Recovery (PiR) group, and by people looking for an easy way out of drug and alcohol use disorder.
Microdosing is the concept of taking a tiny dose of a substance, usually a psychedelic. This psychedelic can be LSD, psylocibin, MDMA, and others. The point is that it is taken at such a tiny dose as to have very small or even no noticeable effects and to use that to maintain a long-term habit. Supposedly, this drug habit, can help users to move away from cravings, to experiencing life, to finding joy in life without drugs or alcohol.
That’s also been researched by multiple very serious medical organizations. For example, the John Hopkins Center for Psychedelics and Consciousness Research has led multiple studies to that effect. For example, in one such study, 15 people underwent 3-6 weeks of CBT with three doses of psilocybin. At 6 months, a blood and urine analysis showed that 80% had been abstinent at least 7 days before the blood test. This was indicative of long-term recovery but as patients were informed of the upcoming blood test, the trial results are not as valid as from a random controlled test. At a second, 12-month follow-up, 60% had been clean for at least the previous 7 days.
That’s significantly higher than the average 35% success rate of using Cognitive behavioral therapy to treat smoking use disorder. However, with the small sample size of just 15 persons and the limited follow-up with warning to the individuals being tested, the study is of little validity.
MDMA is also proposed as a treatment method for alcohol use disorder. However, this study proposes MDMA as a therapy treatment, helping alcoholics to open up and share about experiences and trauma – rather than as a “cure” for cravings and addiction. Here, MDMA-assisted psychotherapy is proposed to help alcoholics to deal with trauma in ways that they could not while entirely sober.
Psychedelics are drugs which have often severe impacts on the mind and body. Most psychedelic medications impact the serotonin receptors in the brain, resulting in changes in how the body regulates, in changes to sleep, in changes to emotions, and in changes to the reward circuit. In fact, many hallucinogens take effect because they mimic the effects of serotonin. This can cause significant reduction in serotonin production inside the brain – resulting in the same emotional blunting and “down” periods experienced by heavy alcohol or amphetamine abusers. Over the long-term, daily users risk periods of withdrawal and struggling to experience full emotion following cessation of psychedelics. That’s without considering the switch from the “high” emotional output of being on those drugs to the “normal” emotions of being off them. So, someone quitting a psychedelic used as maintenance therapy is very likely to feel bad or to feel apathetic, which could lead to relapse.
Psychedelics are also far from safe for many users. In fact, even during the study by John Hopkins Medical Center, a significant portion of participants experienced high anxiety. Individuals with schizophrenia, bipolar disorder, and borderline personality disorder are especially sensitive to this. Taking a hallucinogenic could greatly exacerbate issues, cause anxiety, and kick-off manic or psychotic episodes.
Proponents argue that it’s possible to fully screen candidates and to give out psychedelics in a medical setting. However, many of the people using psychedelics to microdose are doing so outside of clinical settings. Most never see a doctor. Instead, they hear advice on the internet and follow up on it, often with the help of friends or a local group into the practice. This results in a high risk of poor screening and a high risk of poor side effects. Individuals with risk factors for anxiety can experience negative anxiety highs for months following a single dose.
One of the largest proponents against microdosing to “cure” substance use disorder is that there is no cure. Addicts have a history of chasing the next thing that will make them feel better. Chasing a psychedelic or microdosing strategy feels much like a continuation of the same process. People who don’t stop to change habits or build better coping mechanisms will always be at the whim of a drug that makes them feel better. So, even if psychedelics do aid in cessation for some users, they cover the symptoms and not the problem.
Essentially, if you’re using microdosing to cover the symptoms of cravings, withdrawal, or a need for added stimulus in your life, you’re at the mercy of those drugs as soon as that microdosing stops being enough. That’s important, considering people build up tolerance to psychedelics in the same way they do to other drugs. In order to maintain the same effects, you have to increase dosage over time, eventually resulting in physical dependency. While the addiction profile for most psychedelics is very low, the risk is still there. More importantly, without having sought out rehab and addiction treatment for an existing addiction, chances are, you’ll turn back to your drug of choice when the microdosing stops being enough.
In conclusion, psychedelics may have some impact on how people experience and take drugs. They may have some impact on cravings. And they may have some impact on therapy and how it is perceived. However, it is important to only ever seek out medical treatment of this kind in a medical setting. People receiving microdosing must be screened to ensure they can do so without risking crippling anxiety. And, they must take on cognitive behavioral therapy and other measures to correct underlying behavioral and emotional problems. Otherwise, you risk relapsing, after tolerance has gone down. Psychedelics are a drug like any other drug and they should not be started lightly. If you find yourself thinking you can take them and keep everything under control, that might very well be the addict behaviors talking. And that’s important to recognize, acknowledge, and deal with before looking for cures or easy ways out.