Major life changes following psychedelic use: A retrospective survey among people using psychedelics naturalistically

Aday and colleagues situate this study within growing evidence that psychedelic drugs — including classic psychedelics (e.g., psilocybin, LSD), empathogens (e.g., MDMA), and dissociatives (e.g., ketamine) — can produce enduring psychological and belief changes after relatively few exposures. The authors note that clinical trials and naturalistic research have documented long-term effects on depression, anxiety, substance use, spirituality, cognitive flexibility, and belief systems, and that anecdotal and case-report material describe more global "major life changes" (for example, career or relationship changes) that are not routinely captured by standard adverse-event reporting or outcome measures used in psychedelic trials. To address this measurement gap, the study developed the Psychedelic-related Major Life Changes Questionnaire (P-MLCQ) to characterise domains of major life change potentially attributable to psychedelic experiences and to assess how people appraise those changes. The investigators then administered the P-MLCQ in a retrospective survey of people reporting naturalistic psychedelic use to describe prevalence, valence, and demographic or use-related predictors of psychedelic-related major life changes.

This was a retrospective, cross-sectional online survey conducted as part of a larger project on naturalistic psychedelic use. Participants were recruited between 17 September 2023 and 31 October 2023 via emails, social media, psychedelic-related newsletters and listservs, and in-person advertisement at Entheofest (an advocacy event). All respondents were required to be aged 18 or older and provide informed consent; the University of Michigan Institutional Review Board deemed the study exempt. The final sample comprised 581 participants. Demographic data collected included gender identity, age, education (reported as categorical levels and converted to years for regression), and race/ethnicity (multiple selections allowed). Frequency of psychedelic use was assessed by asking participants how often they had used each psychedelic in the past five years, with an eight-level response scale ranging from "not in the past 5 years" to "more than once per week"; a composite frequency score was constructed by summing these scores across queried substances. The key outcome instrument was the P-MLCQ, which asked whether a psychedelic experience had ever influenced the respondent to make a major life change across ten domains: Occupation/line of work, Sexuality, Marital status or partner change, Social activities, Hobbies, Values, Goals, Religion/spirituality, Political views, and Eating habits/diet. For each endorsed domain, participants rated how they felt about the change on a five-point scale from 1 (very negatively) to 5 (very positively). Analyses were primarily descriptive. The investigators reported proportions endorsing each P-MLCQ item and calculated the total number of domains endorsed per participant (0–10). A two-tailed Pearson correlation examined the association between composite frequency of psychedelic use and total number of endorsed major life changes. Group differences by gender were tested with an independent-samples t-test. Finally, a stepwise linear regression (with gender, education, and race as candidate predictors) explored demographic predictors of the total number of psychedelic-related major life changes; education was entered as years of education in the model.

The sample (N = 581) reported multiple recruitment sources: email (40.8%), social media (27.2%), Entheofest (12.6%), and other channels. Gender composition was 50.8% women, 44.2% men, 2.9% non-binary, 0.7% trans-women, 0.3% trans-men, 0.7% other, with 0.3% missing. Participants' ages ranged from 18 to 85 years (mean = 44, SD = 15). Educational attainment was high: 13.1% Advanced Professional or Doctorate, 29.1% Master's degree, 26.5% Bachelor's degree, with the remainder holding lower levels of education. The sample was predominantly Caucasian/White (78.7%), with smaller proportions identifying as Hispanic/Latino (4.6%), African American/Black (3.6%), Asian (3.3%), Aboriginal/First Nation/Native American (3.1%), Other (1.4%), and Native Hawaiian/Pacific Islander (0.2%). Regarding major life changes, 482 of 581 participants (82.96%) reported at least one life change that they attributed to a psychedelic experience. On average participants endorsed 3.29 major life changes (SD = 2.60). Overall appraisal of these changes was strongly positive: mean valence rating was 4.64 on the 1–5 scale (SD = 0.61). Across all endorsed changes, 94.35% were rated as "somewhat" or "very" positive, 4.81% neutral, and 0.84% "somewhat" or "very" negative. Planned predictor analyses found a positive correlation between composite frequency of psychedelic use over the past five years and total number of psychedelic-related major life changes (r = 0.34, p < .001). An independent-samples t-test showed no statistically significant difference in the total number of endorsed changes between men (mean = 3.16, SD = 2.45) and women (mean = 3.39, SD = 2.71), t(544) = 1.01, p = .16. In the stepwise regression exploring demographic predictors, education entered the model and yielded a significant improvement, F(1, 519) = 7.97, p < .01; higher education was associated with fewer endorsed major life changes (reported β = -0.137, p < .01). No other demographic variables remained in the final model.

Aday and colleagues interpret their findings as consistent evidence that psychedelic experiences can be followed by major life changes in a range of domains. Most respondents (82.96%) reported at least one psychedelic-related major life change and the average respondent endorsed about three such changes. Participants' retrospective appraisals were overwhelmingly positive, with fewer than 1% of changes evaluated negatively. The researchers highlight a dose-dependent relationship: greater frequency of psychedelic use was associated with a larger number of reported major life changes. The discussion situates these results alongside a large international ayahuasca survey that reported similar prevalence and patterns of life-change endorsements, including relationships with frequency of use and inverse associations with education. The authors suggest several possible mechanisms linking psychedelics to major life changes, including enduring increases in openness to experience, subjective ‘‘insight’’ or identity shifts, and heightened context sensitivity associated with neuroplasticity frameworks. They also note the possibility of "false insights" that could lead to maladaptive changes. Clinical and ethical implications are emphasised. The investigators argue that potential for fundamental changes to values, relationships, occupation, sexuality, and spirituality should be addressed in informed consent for psychedelic trials and clinical practice. They note that some major life changes may be intertwined with therapeutic processes (for example, a move from avoidance to acceptance that enables previously avoided life changes) and that the degree of life change has been proposed by some as an index of psychotherapeutic success. At the same time, the authors flag the contested and sensitive nature of belief and political changes and note the potential for coercive or nefarious uses in social contexts. Several limitations are acknowledged. Recruitment likely oversampled people with positive orientations toward psychedelics, given the channels used and voluntary participation, and the sample was not representative; thus the findings cannot be used to estimate population prevalence. The survey was retrospective, raising the possibility of recall bias. Frequency scores were aggregated across multiple psychedelic substances, preventing analysis of substance-specific effects. The study did not assess how reported life changes affected others or objective functioning, so positive self-appraisal may not capture downstream harms to dependents or to participants themselves. Despite these caveats, the authors present the P-MLCQ as a step towards systematically capturing psychedelic-related major life changes and suggest its incorporation into future clinical and naturalistic studies to refine understanding of these outcomes.