A qualitative analysis of participant expectations and experiences of psilocybin-assisted psychotherapy for methamphetamine use disorder

Participants perceived psilocybin-assisted psychotherapy as an acceptable and meaningful intervention for methamphetamine use disorder

This qualitative study (n=12) of participants in an open-label pilot trial of psilocybin-assisted psychotherapy for methamphetamine use disorder in Sydney found that participants perceived the intervention as acceptable, with transformation often occurring through confronting challenging experiences during the psychedelic session (“leaning into the obstacle”) leading to new understandings of self and relationships and reduced salience of methamphetamine use, with therapeutic alliance seen as critical to positive outcomes.

“Background and aims

There is an urgent unmet need for novel treatments for methamphetamine (MA) use disorder. We explored the qualitative experiences of people participating in a study of psilocybin-assisted psychotherapy (PAT) to treat MA use disorder.

Design and setting

Qualitative study of participants enrolled in a single arm, open-label pilot study of PAT for MA use disorder delivered in an outpatient stimulant treatment program setting in Sydney, Australia.

Participants

Twelve participants were interviewed before starting PAT and then again one month following PAT.

Measurements

Pre-PAT interviews explored participants' experiences of MA use and expectations of receiving PAT. Post-PAT interviews explored participants' experiences of PAT, with a focus on phenomena related to the acute subjective effects of psilocybin, the perceived effects of PAT on MA use, self-perception, beliefs, values, behaviours, interpersonal relationships and spirituality, and acceptability of the intervention. Interviews were audio recorded, transcribed verbatim and analysed using an inductive qualitative approach.

Findings

While participants generally hoped to have positive outcomes from study participation, their expectations were generally tempered and realistic. Their trial experiences of PAT were often characterised by new understandings of themselves, their narrative histories and interpersonal relationships, all of which were frequently prompted by leaning into vividly presented challenging experiences within the psychedelic experience. This volitional attitude of ‘leaning into the obstacle’ emerged as a key theme, meriting exploration for its potential to expose the subjective dimension of the psychedelic mechanism of effect. Resolution of this obstacle was associated with a reduction in the salience of methamphetamine. Therapeutic alliance was seen as critical to positive outcomes and was achieved through high levels of concentrated therapeutic attention and intersubjective intimacy between participant and therapist.

Conclusions

Interviewed participants in a study of psilocybin-assisted psychotherapy (PAT) for methamphetamine use disorder perceived PAT as an acceptable intervention. Transformation in understandings of self and interpersonal relationships and subsequent reduced salience of methamphetamine use often occurred through confronting psychic obstacles in the context of high levels of therapeutic support from study therapists.”

Notes

Subjective experience is central: Qualitative findings highlight that how participants make sense of the psychedelic experience, especially confronting difficult internal material plays an important role in the therapy’s perceived impact.

Therapeutic relationship shapes outcome: The supportive setting and therapist presence aren’t just “logistics” they are integral to how participants process and integrate the experience.

Insight into future trials: These themes can help optimize preparation and integration components of psilocybin studies for MAUD, which might strengthen outcomes in larger controlled trials.

Brett, J., Lea, T., Knock, E., Albert, S., Acheson, L., Siefried, K. J., & Job, S. A qualitative analysis of participant expectations and experiences of psilocybin‐assisted psychotherapy for methamphetamine use disorder. Addiction. Read Paper

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