Kenneth Blum, Kai-Uwe Lewandrowski, Morgan P Lorio, Alireza Sharafshah, Alexander Pl Lewandroski, Albert Pinhasov, Abdalla Bowirrat, Igor Elman, Marco Lindeau, Álvaro Dowling, Rafaela Dowling, Joao Paulo Bergamaschi, Rossano Kepler Alvim Fiorelli, Sérgio Luís Schimidt, Catherine A Dennen, Kavya Mohankumer, Rajendra D Badgaiyan, Mark S Gold, Kyriaki Z Thanos
Current therapeutic modalities for AUD remain severely underused. Policy should focus primarily on integrating and improving patient access to existing multimodal approaches, such as pharmacotherapy in primary and telehealth care, and behavioral supports such as AA. While psychedelics do present an intriguing prospect, the priority should be implementing what works now while rigorously testing what may enhance care in the future.
AIM: The aim of this perspective article is to evaluate the potential of Psychedelics in the management of Alcohol Use Disorder (AUD) vis-a-vis pre-existing therapeutic modalities and to elucidate practical directions for policy in AUD Addiction medicine, supported by scientific evidence, while prioritizing safety and accessibility.
METHODS: We performed a narrative synthesis of past and current literature and incorporated findings from randomized controlled trials (RCTs), meta-analyses, and policy reports in relation to pharmacological and psychedelic-assisted treatments for AUD. PubMed was utilized for this search.
RESULTS: While there is budding interest in psychedelics- LSD, MDMA, Psilocybin- existing evidence supporting their efficacy in treating AUD is sparse and in some studies require more evidence in terms of study types (placebo controlled blind) and methods, with high expectancy bias and limited follow-up periods. On the contrary, current FDA-approved medications such as Naltrexone, Acamprosate, and Disulfiram are aimed at minimizing relapse, moderating craving, and promoting continued abstinence. However, the clinical application of these drugs is alarmingly low at 2%. Policy measures such as telehealth-based prescribing, long-acting formulations, and potential over-the-counter access to naltrexone may improve treatment accessibility and reduce stigma. Psychedelics may be considered during the management of treatment-resistant AUD, but should be limited to methodologically sound clinical trials until clear safety and efficacy are demonstrated.
CONCLUSION: Current therapeutic modalities for AUD remain severely underused. Policy should focus primarily on integrating and improving patient access to existing multimodal approaches, such as pharmacotherapy in primary and telehealth care, and behavioral supports such as AA. While psychedelics do present an intriguing prospect, the priority should be implementing what works now while rigorously testing what may enhance care in the future.