Psilocybin motivates personality changes among adults with alcohol use disorder
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Key takeaways:
- Psilocybin-assisted therapy fostered reduced neuroticism and increased extraversion and openness among those with alcohol use disorder.
- Lower impulsivity was linked to reduced alcohol intake after treatment.
Psilocybin-assisted therapy induced positive personality changes in adults with alcohol use disorder, which may help to improve long-term outcomes by limiting traits that encourage relapse such as impulsiveness, according to study results.
“Since impulsiveness has long been linked to both excessive drinking and relapse after treatment, the personality changes brought about by psilocybin-assisted psychotherapy may help those recovering from alcohol dependence remain resilient to internal and external stressors known to trigger relapse,” Broc Pagni, PhD, a postdoctoral fellow and cognitive neuroscientist in the department of psychiatry at NYU Grossman School of Medicine, said in a press release.
Previous research has demonstrated that serotonergic psychedelics can promote significant shifts in personality and improve mental health, researchers wrote in the study, which was published in American Journal of Psychiatry.
Further, patients with alcohol use disorder (AUD) often exhibit atypical personality structures, possessing heightened neuroticism and impulsiveness and reduced conscientiousness and agreeableness. Researchers theorize that these traits drive the addictive cycle and impede the efficacy of treatment.
This motivated Pagni and colleagues to perform a secondary analysis of a randomized, double-blind, placebo-controlled trial to investigate how psilocybin-assisted therapy impacts the personality traits of patients with AUD.
The trial included 84 participants (approximately 77% white) who received two doses of psilocybin (n = 44; women, n = 18) or active placebo (diphenhydramine; n = 40; women, n = 17) 4 weeks apart in conjunction with 12 weeks of psychotherapy. Participants were followed for 36 weeks.
The researchers measured personality changes from baseline to week 36 using the revised self-report NEO Personality Inventory. The system is based on the five-factor model of personality, which includes neuroticism, extraversion, openness, conscientiousness and agreeableness. Drinking-related behaviors — quantified using the Timeline Followback — served as the primary outcome of the original study.
On average, participants reported being alcohol-dependent for 31.56 years (standard deviation [SD] = 11.47) and met 5.25 of seven criteria for alcohol dependence. They reported an average of 52.57% (SD = 30.32) heavy drinking days within the past month.
The researchers reported that the two treatment groups appeared similar for gender, age, weight, ethnicity and annual income at baseline. However, at baseline, the psilocybin group was higher in conscientiousness and the placebo group was higher in openness.
From pretreatment to posttreatment, Pagni and colleagues found that the psilocybin group experienced decreased neuroticism (mean factor scores, 91.11 vs. 84.2) and increased extraversion (104.55 vs. 108.64) and openness (129.45 vs. 134.34); these changed were significant relative to the placebo group. However, agreeableness and conscientiousness were not significantly affected by treatment.
According to comparisons with normative personality scores, these trait changes were tending toward normalization, except for openness, which exceeded normal scores at baseline and 36 weeks.
Additionally, women experienced significant increases in conscientiousness and openness, whereas men experienced a significant increase only in extraversion. Further research is needed to illuminate the reasons behind these differences and their clinical implications, Michael P. Bogenschutz, MD, professor in the department of psychiatry at NYU Grossman School of Medicine and director of the NYU Center for Psychedelic Medicine, said in the release.
Further, the researchers conducted secondary analyses which showed that reductions in neuroticism were prompted by decreases in depression, impulsiveness and vulnerability. On the other hand, increases in openness were motivated by increases in fantasy and feelings.
Notably, decreased impulsivity was linked to reduced alcohol consumption after treatment in all participants. The researchers also performed an exploratory subgroup analysis, which revealed that this association was most significant among participants who exhibited moderate to high levels of drinking prior to the first medication session.
Pagni and colleagues observed several limitations to this study, including their reliance on self-reported data and potential systematic biases introduced by baseline group differences. Also, most participants were able to guess whether they received psilocybin or placebo, Bogenschutz said.
“Our findings suggest that psilocybin-assisted therapy could serve as a valuable adjunct to conventional treatments for AUD and other psychiatric disorders,” the authors wrote.
“While these relationships warrant further exploration, it is conceivable that psilocybin-induced changes in specific personality domains may heighten awareness of maladaptive behaviors and bolster the therapeutic alliance, thereby enhancing patients’ receptivity to feedback and their ability to engage in other evidence-based psychotherapies.”
The researchers plan to investigate whether the psilocybin-related personality observed among participants with AUD will also occur among individuals with opioid use disorder.
Reference:
- Psychedelic drug therapy may address mental health concerns in people with cancer & addiction. https://nyulangone.org/news/psychedelic-drug-therapy-may-address-mental-health-concerns-people-cancer-addiction. Published Jan. 2, 2025. Accessed Jan. 7, 2025.
Perspective
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What personality traits are associated with development and persistence of psychiatric disorders, whether depression or addiction? And what is the effect of treatments on these factors? There is a robust literature suggesting that personality factors including impulsivity, neuroticism and a bias toward negative thinking (“glass half empty”) increase both the risk of developing such disorders and the risks of worse outcomes. Unfortunately, conventional treatments often have limited effects on these personality dimensions.
What about psychedelics, which are purported to increase brain plasticity and to rewire aberrant brain networks? Do they normalize these personality dysfunctions?
This study explores personality changes in people with alcohol use disorders following treatment with the psychedelic drug psilocybin. In the study, 84 adults with AUD were randomly assigned to receive psilocybin (n = 44) or placebo (n = 40) plus 12 weeks of psychotherapy and followed for 9 months. Results show that participants treated with psilocybin had personality changes including lower neuroticism and increased openness and extraversion, with decreased impulsivity and increased emotional openness. Furthermore, they found that people who had lower impulsiveness appeared to drink less after psilocybin treatment. These intriguing findings suggest that psychedelics may not only alleviate symptoms of DSM5 disorders, but may also lessen abnormal personality features, which could then mediate further improvement of such symptoms.
One of the mysteries of psychedelic treatments is that a single dose or a small number of doses appear to have lasting effects on symptoms of disorders long after the drug has left the body. It is possible that at least some aspect of lasting effects on disorder may be a result of impact on personality traits, which may improve outlook, stress responses and interpersonal relations.
Also of note, however, is the possibility that the personality-changing effects of psychedelics might be unwanted, so these might be seen as beneficial therapeutic responses, or as unwelcome and lasting side effects. It will be interesting to see the personality effects of psychedelics including psilocybin, 5MEO-DMT and LSD in a variety of disorders, which can be derived from current ongoing studies of depression, addiction, anxiety disorders and other conditions.
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