An online survey of tobacco smoking cessation associated with naturalistic psychedelic use

Converging lines of evidence suggest that serotonin 2A receptor (5-HT2A R) agonist psychedelics may assist in treating addictive behaviours. Observational and anthropological reports have linked ceremonial use of psychedelics to recovery from addiction, while meta-analytic and experimental data from earlier decades and recent psilocybin studies indicate possible therapeutic effects such as reduced substance misuse, durable increases in personality openness, and highly rated personally meaningful or spiritual experiences. Neurobiological findings—including changes in default mode network activity and altered amygdala and anterior cingulate reactivity—provide plausible mechanisms for lasting psychological change. Johnson and colleagues previously reported an open-label pilot suggesting promising psilocybin‑assisted smoking cessation outcomes, but that study’s uncontrolled design limits causal inference. This study aimed to characterise naturalistic reports of tobacco smoking cessation or reduction attributed to non‑clinical use of serotonergic psychedelics. Using a retrospective, anonymous online survey, the investigators sought to describe outcomes (sustained abstinence, persistent reduction, or relapse), identify psychological and contextual factors associated with longer abstinence, and test the hypothesis that more personally meaningful or spiritually significant psychedelic experiences would be linked to greater smoking cessation success. The survey was intended to complement laboratory research by identifying conditions and self‑reported mechanisms associated with persisting smoking change following psychedelic experiences in non‑laboratory settings.

An anonymous online survey was conducted via SurveyMonkey between September 2013 and May 2014. Recruitment used social media and websites frequented by people interested in psychedelics (for example, Erowid and Shroomery). Advertisements solicited individuals who had "quit or reduced smoking after a psychedelic experience." Inclusion criteria required participants to be aged 18 or older, English fluent, and to report quitting or reducing cigarette smoking (even temporarily) after use of a serotonergic 5‑HT2A R agonist (psilocybin, LSD, morning glory seeds, mescaline, peyote, San Pedro, DMT, or ayahuasca). The reference psychedelic experience had to have occurred at least 12 months prior to survey completion. Participation was uncompensated and informed consent was provided by choosing to complete the survey. The survey (approximately 40 minutes) collected demographics, current non‑psychedelic drug use, lifetime psychedelic use, smoking history (including cigarettes per day prior to the reference experience and number of previous quit attempts), and retrospective and current assessments of withdrawal and craving. Participants categorised their outcome as sustained abstinence (quit), persisting reduction (reduce), or temporary reduction followed by relapse (relapse). Detailed information about the reference psychedelic experience—substance, setting, intention, adverse effects, and other behavioural changes—was obtained, and respondents retrospectively rated the personal meaning and spiritual/mystical nature of that experience. Standardised instruments were administered with retrospective framing for the pre‑experience period when appropriate: the Fagerström Test for Cigarette Dependence (FTCD) referring to the 6 months prior to the reference experience, the Questionnaire on Smoking Urges (QSU) completed both retrospectively and for the present, the Toronto Alexithymia Scale (TAS‑20), the MEQ30 (Mystical Experience Questionnaire) completed with respect to the reference experience, and the Tellegen Absorption Scale (trait absorption). Participants also endorsed potential mechanisms they believed contributed to smoking change. For analysis, participants were grouped into quit, reduce, and relapse. Continuous variables were tested for normality (D'Agostino‑Pearson); normally distributed data were compared with one‑way ANOVA and non‑normal data with Kruskal‑Wallis tests. Categorical variables used chi‑square tests, with sparse categories combined when necessary. Post hoc pairwise comparisons used Tukey or Dunn methods as appropriate. A Spearman correlation examined the relationship between MEQ30 and trait absorption. Analyses were exploratory and no correction for multiple comparisons was applied. Statistical work used GraphPad Prism. From 1,273 survey completers, exclusions for non‑serotonergic drugs, inconsistent responses, and reference experiences <12 months reduced the final analytic sample to 358 participants.

After exclusions, the final sample comprised 358 participants drawn from 27 countries, most commonly the United States (69.6%), Canada (7.5%), and the United Kingdom (7.0%). Recruitment sources were dominated by Erowid (65.1%). Lifetime use of psilocybin mushrooms (95.3%) and LSD (88.8%) was common, typically 2–5 lifetime occasions among users. Categorised smoking outcomes were: 137 participants (38.3%) reporting complete smoking cessation since the reference psychedelic experience (quit group), of whom 102 (74.5%) reported >2 years’ abstinence; 100 participants (27.9%) reporting a persisting reduction in smoking (reduce group), with a mode decreasing from 300 cigarettes/month before to ≤1 cigarette/month after the experience and 62 of these reporting >2 years of reduced smoking; and 121 participants (33.8%) reporting a temporary reduction followed by relapse, with a modal time to relapse of 3–6 months. Only 30 of 358 respondents (8.4%) reported having a premeditated intention to quit or reduce smoking before the reference psychedelic experience. Between‑group comparisons showed no significant differences in demographics (age, sex, race, education), prevalence of self‑reported psychiatric diagnoses, number of prior quit attempts, years smoking, or retrospective FTCD cigarette dependence scores. Significant differences were observed for alexithymia (TAS‑20, p = 0.006), cigarettes per day prior to the reference experience (p = 0.03), confidence to abstain (p < 0.001), and current craving on the QSU (p < 0.001). Dunn post hoc tests indicated higher alexithymia scores in the relapse group relative to the quit group; the relapse group had smoked more per day prior to the reference experience than the reduce group; and confidence to abstain was higher in the quit group than in the reduce and relapse groups. Current craving was greatest in the relapse group, intermediate in the reduce group, and lowest in the quit group. Age at the reference psychedelic experience differed across groups (p = 0.007), with the relapse group younger on average (mean age 22) than the quit (24.1) and reduce (23.7) groups. Duration of the longest prior quit attempt also differed: 53% of longest prior quits in the quit group lasted ≤2 weeks compared with 37% in the reduce group and 28% in the relapse group. Ratings of withdrawal symptoms after the psychedelic‑associated change compared to previous quit attempts indicated that most somatic symptoms were rated similar in severity, whereas affective symptoms (restlessness, depression, irritability, craving) were largely rated as much less severe following the psychedelic experience. Endorsed mechanisms of change emphasised psychological shifts: "changing life priorities/values" (88.5%), "changing orientation toward the future" (85.2%), and "strengthening belief in one’s ability to quit" (79.1%). A large majority (93.9%) characterised the reference experience as personally meaningful, with 60.1% placing it among the 10 most meaningful experiences of their lives; 78.5% characterised it as spiritual/mystical and 45.0% rated it among the five most spiritually significant experiences. Significant between‑group differences were found for ratings of personal meaning (p = 0.03) and spiritual significance (p = 0.004): the relapse group rated their reference experience as less personally meaningful and less spiritually significant than the quit group, and less spiritually significant than the reduce group. MEQ30 total scores did not differ significantly between groups (near‑significant p = 0.06) although the relapse group scored lowest. A positive correlation was observed between MEQ30 and trait absorption (r = 0.44, p < 0.001). Additional reported outcomes included reductions in alcohol use (42.5%) and other drug use (27.9%) attributed to the reference psychedelic experience. Regarding adverse effects, 78.5% reported no negative effects, 9.5% were unsure, and 12.0% reported negative effects typically limited to acute anxiety/dysphoria or transient physical discomfort; adverse effect rates did not differ significantly between groups.

Johnson and colleagues interpret the findings as descriptive evidence that some individuals attribute sustained smoking cessation or long‑term reductions to non‑clinical serotonergic psychedelic experiences. The sample showed heterogeneous outcomes—sustained abstinence, persistent reduction, and temporary reduction followed by relapse—and was composed largely of young, White males who typically used psychedelics recreationally or for psychological exploration without a premeditated intention to quit smoking. The investigators note that these naturalistic reports are consistent with laboratory and anthropological data suggesting psychedelics can occasion meaningful or spiritual experiences and may have anti‑addictive effects. Group differences highlighted candidate factors related to long‑term abstinence: higher retrospective ratings of personal meaning and spiritual significance of the psychedelic experience were associated with sustained abstinence, supporting the hypothesis that spiritual or meaningful experiences may mediate smoking cessation. The relapse group’s higher pre‑experience cigarettes per day and younger age at the reference experience were also discussed as possible explanations for poorer outcomes. Reported attenuation of affective withdrawal symptoms after the psychedelic‑associated change—compared with previous quit attempts—suggests a mechanism involving reduced negative mood and craving; the authors link this to serotonergic pharmacology at 5‑HT2A and possibly 5‑HT1A receptors and to neural changes observed in prior research. The investigators emphasise several limitations that constrain causal inference and generalisability. The retrospective, self‑selected online sample is vulnerable to recall bias and cannot verify reported substance identity, purity, or dose. Exclusion of negative cases (instances where psychedelic use did not change or worsened smoking) means prevalence or efficacy cannot be estimated. The omission of a question quantifying cigarettes per day after the reference experience limited precise measurement of reduction magnitude in the reduce group. Multiple comparisons were not corrected for, raising the possibility of Type I error. Finally, the predominantly White, college‑educated male sample may not generalise to broader populations. Despite these limitations, the authors suggest that—together with pilot laboratory findings—serotonergic psychedelics warrant further controlled investigation as potential adjuncts in the treatment of tobacco and other substance use disorders, particularly when used within structured therapeutic contexts and combined with behavioural therapy.