Personal Psychedelic Use Is Common Among a Sample of Psychedelic Therapists: Implications for Research and Practice

CONCLUSION

There are three main findings from this survey study of psychedelic therapists working on a Phase II clinical trial of psilocybin therapy for MDD. First, respondents were overwhelmingly white-identified, predominantly women, and most had a doctoral degree as well as some prior didactic or experiential training in psychedelic therapy. Second, the vast majority reported personal experience using psychedelic compounds, with psilocybin being the most commonly used. Third, respondents were highly optimistic about the efficacy of psilocybin therapy for treating MDD. In terms of demographics, the sample was generally consistent with the characteristics of non-psychedelic psychotherapists in the US, who tend to also be disproportionately women (63%), white (83.7%), and middle-aged (M = 43.7 years). Facilitators of color may be particularly underrepresented in our sample given that people of color have been disproportionately targeted by law enforcement for substance use in the US; that is, non-white facilitators may have been less comfortable taking the survey and disclosing their use. The lack of diversity among trained facilitators represents a systemic issue for the field of psychedelic therapy, and likely contributes to the racial homogeneity of study participants typically found in psychedelic clinical trials. The proportion of therapists with a doctoral degree tended to be higher than that typically found in non-psychedelic psychotherapy; however, this likely reflects rules of the sponsor for the study (i.e., there must be a licensed PhD/PsyD or MD in each therapy pair). It is important to note that four participants did not have formal psychotherapy graduate training but had pursued other relevant training experiences. This is an important issue for the scalability of psychedelic therapy, as a looming bottleneck for the field is the limited number of therapists available who are trained to provide the treatment. Bachelor's-level clinicians, or those with relevant community-based training experiences, may be a means for expanding access to these treatments and increasing diversity of psychedelic therapists. Finally, participants who provided harm reduction services at a festival, community, or other social setting found the experience to be important for preparing to be a psychedelic therapist, suggesting this may have potential to be a useful training experience for trainees looking to enter the field. This sample of psychedelic therapists had considerable experience using classic psychedelic drugs and related hallucinogens themselves, with 28/32 (88%) endorsing use of a classic psychedelic and all but 1 participant trying at least 1 hallucinogen-related substance. This figure differs from the general population lifetime rate of psychedelic use, which tends to be around 10-15%; although, several recent studies have indicated that usage seems to be increasing. Only 1/4 individuals without previous classic psychedelic experience had previous psychedelic training, making these individuals unique and relatively psychedelic-naive candidates to provide the treatment. Given their paucity of experience in the field, these individuals may represent interesting case studies in understanding the role of experiential learning with psychedelics. In terms of intentions, personal development and spiritual growth were the most common reasons reported for substance use, particularly with the classic psychedelics. However, most participants also reported intentions related to having fun and curiosity-in line with the findings of Roberts et al.and Dollaron the general population of psychedelic users. Although the role of intentions has often been noted as being critical to the acute experience and subsequent outcomes among psychedelic users, there has been limited research prospectively testing the relationship between intentions and drug effects. Nonetheless, our results add to a growing body of literature suggesting a distinct set of intentions among psychedelic users. Overall, participants were highly optimistic about the efficacy of psilocybin therapy for MDD, with all but two participants believing that it was "moderately" or "substantially" more effective than placebo. A high degree of belief in efficacy among this sample was anticipated given that participants self-selected to work on a psychedelic trial and to fill out a survey about their own psychedelic use. Participants' views regarding efficacy contrast starkly with those held by non-psychedelic mental health professionals. For instance, Davis and colleagues 61 found that only 22.2% of clinical psychologists said that they were open or favorably disposed toward psychedelic therapy. A study of American psychiatrists revealed that 42.5% moderately or strongly agreed that psychedelics show promise in treating psychiatric disorders. The discrepancy in belief in efficacy between clinical psychologists and psychiatrists is consistent with other research indicating that psychiatrists report the highest familiarity and willingness to incorporate psychedelics into therapeutic practice among mental health professionals, and intuitively unsurprising given that psychedelic therapy is a drug-based intervention. A comparison between those with and without previous experience providing pharmacotherapy in our dataset did not support this hypothesis; although, the limited number of individuals with pharmacotherapy experience (n = 9) limits interpretability. There are a number of limitations and lines of future research that are important to consider with this study. First, the response rate among the contacted Usona facilitators was low, leaving a small sample size and potentially unrepresentative group. This prompts consideration about the continued negative connotation surrounding exploration of non-ordinary states of consciousness carried in professional and academic environments. The "War on Drugs" created a culture of labeling psychedelic substances as stigmatized drugs and propagated systemic negative stereotypes related to any activities that involved the use of psychedelics for recreational, religious, or therapeutic purposes. One interpretation of the low response rate is that only a small proportion of the practitioners working as psychedelic facilitators felt comfortable answering questions-anonymously and confidentially-about their personal experiences with psychedelic substances, but other explanations such as the lack of compensation for participating in the study may also be relevant.. In any case, it is challenging to understand the potential contribution that personal use may have on developing competency for psychedelic facilitators if professionals do not feel safe discussing how their lived experiences may inform their work. Another limitation is that this study only examined psychedelic therapists associated with Usona's Phase II clinical trial, and the findings may not generalize to all psychedelic therapists, particularly those solely working in the unregulated underground market. Additionally, although we did not find a statistically significant relationship among transformative experiences with psilocybin and belief in efficacy, the small sample size and ceiling effects related to both measures may have contributed to the null relationship found here. Another general consideration is that given that all six participants who did not complete the survey stopped when prompted to answer questions regarding their personal use, an intuitive hypothesis is that they did so to avoid possible legal repercussions related to sharing this information. If so, this suggests that perhaps other therapists did not even start the survey because of this concern and that our results could have underestimated the prevalence of psychedelic use among our population of interest. Lastly, it is worth noting that researchers and clinicians must keep a vigilant eye on the past to inform the future-Timothy Leary's personal use and exuberance led some to doubt his scientific rigor and infamously contributed to his dismissal at Harvard University in the 1960s. Today, personal use among professionals continues to affect the public's perception of one's work, and will be an area that must be carefully navigated as the field increasingly enters the public eye. Given the high stakes and hope being invested into the field, it is a duty for professionals to maintain a high level of clinical equipoise and allow no exceptions to standards for research or clinical care. Although experiential learning is valued across many professional disciplines, including psychotherapy, it is not in physician training and there are distinct concerns that must be taken into consideration in the context of psychedelic therapy. Personal experience with psychedelics may help professionals empathize and better understand the nature-and possibly mechanisms-of psychedelic treatment. On the other hand, normalizing, expecting, or requiring personal use among practitioners may also introduce bias into the field and limit who can be in the conversation due to issues related to contraindications and subsequent accessibility. Additional research is needed to examine the role of personal experience in therapist competency and address issues related to generalizability. Nonetheless, the findings presented here are the first to empirically delineate characteristics of psychedelic therapists, and establish fertile groundwork for future study.