Last July Diane spoke with Financial Times columnist Edward Luce about his book, "The Retreat of Western Liberalism." A year later, we have invited him back for an update.
Millions of Americans suffer from post-traumatic stress disorder, including hundreds of thousands of veterans. Yet standard drug and therapy treatments have mixed success rates. Some cases of PTSD are considered untreatable. But researchers are seeing dramatic results from therapy that uses psychedelic drugs to treat PTSD, depression and addiction. Therapy involving substances like Psilocybin and MDMA, better known as ecstasy, show 80 percent success rates years after treatment. Diane and a panel of guests discuss new research on drugs that have long been considered dangerous and illicit.
- Tom Shroder Author and editor. His non-fiction books include: "Acid Test," "Old Souls," and "Fire on the Horizon: the Untold Story of the Gulf Oil Disaster."
- Dr. Michael Mithoefer A psychiatrist practicing in Charleston, South Carolina. He divides his time between clinical research and outpatient clinical practice specializing in treating post-traumatic stress disorder.
- Nicholas Blackston Marine veteran, served in Iraq. He was a participant in a drug trial for the treatment of post traumatic stress disorder.
- Dr. James Giordano Scholar-in-residence and chief, Neuroethics Studies Program at the Pellegrino Center for Clinical Bioethics at Georgetown University Medical Center
MS. DIANE REHMThanks for joining us. I'm Diane Rehm. Psychedelic drugs such as LSD and ecstasy have long been considered dangerous and illicit, but new medical research indicate these drugs can help treat post traumatic stress disorder, addiction and depression. With me in the studio to talk about both benefits and risks of psychedelic drug therapy, Tom Shroder. He's author of a new book titled, "The Acid Test: LSD, Ecstasy and the Power To Heal."
MS. DIANE REHMDr. James Giordano at Georgetown University Medical Center and joining us from a studio in Charleston, South Carolina, Dr. Michael Mithoefer. He's a researcher and clinician. I'm sure many of you will want to join us. Give us a call at 800-433-8850. Send an email to email@example.com. Follow us on Facebook or send us a tweet. And welcome to all of you.
MR. TOM SHRODERThank you. It's a pleasure.
DR. JAMES GIORDANOThank you, Diane.
DR. MICHAEL MITHOEFERThank you.
REHMGood to have you all here. Tom Shroder, if I could start with you, why this new interest in LSD and these other psychedelic drugs?
SHRODERWell, our culture was really traumatized when psychedelics became a explosive drug of abuse in the 1960s and the reaction was really an overreaction and it had the sort of tragic side effect, which was that for 15 or 20 years before that, psychedelics had been seen as a revolutionary drug in psychiatry. It was being used successfully among thousands of patients by hundreds of psychiatrists to treat all sorts of psychiatric problems.
SHRODERAnd they'd been having terrific success and then, when abuse started to explode in the '60s, the reaction was to really stomp down on it, to declare it a schedule one drug, which is on the par of heroin to make it completely illegal, which, of course, did very little to stem the tide of abuse. However, it was incredibly effective in shutting down research almost entirely.
REHMInteresting. Dr. Mithoefer, there in South Carolina, you treat patients with PTSD. Why did you decide to begin using MDMA, this so-called ecstasy?
MITHOEFERWell, I guess the primary motivating factor was realizing that the treatments we have for people with PTSD while sometimes very effective are still inadequate for a large number of people with PTSD as you said in the introduction. So based on the anecdotal reports and some published reports of the use of MDMA as a therapeutic tool, before it became illegal, it made sense that this might be a useful catalyst to psychotherapy.
MITHOEFERSo I thought it was very important that we pursue it with rigorous clinical trials.
REHMAnd tell me what kind of success you believe you've had.
MITHOEFERWell, we're still in relatively early trials, but we've been doing this for 10 years now. And in our first study, we treated people with treatment-resistant PTSD who had all had previous psychotherapy and medications, usually a lot of both, had had PTSD for an average of more than 19 years and when they had three MDMA-assisted -- either two or three MDMA-assisted session a month apart, 83 percent of them no longer had PTSD compared to...
REHMAnd how long did that last?
MITHOEFERFor most people, when we did a follow-up an average of three and a half years later, for the majority of people, the benefits had lasted.
REHMInteresting. Dr. Giordano, I gather you have some concerns about the use of these drugs.
GIORDANOWell, I think that both Dr. Mithoefer and certainly Tom's book suggests that these concerns are warranted in some cases, but I think they both doing the work -- what I would consider to be both rightly and goodly. Let me briefly explain. The key that Dr. Mithoefer suggested is sometimes we see these effects and these are long term patients whose PTSD was pretty much intractable.
GIORDANOThe question then becomes can we understand more about the mechanisms of PTSD and related disorders, both through the use of drugs like MDMA, which would then suggest when, where and whom and perhaps who not to use MDMA as a therapeutic agent. So I think we really do have a useful opportunity, but we have to seize upon it correctly and do it ethically in a sound way.
REHMBut if you've got an entrenched situation, nothing else has worked, why not give it a try?
GIORDANOWell, I don't think there's any reason in the world why not to give it a try, all things considered and all things equal. I think the important point that both Tom and certainly Dr. Mithoefer and other studies recently have shown is selecting the right patients to be able to be MDMA or Psilocybin candidates, I think is equally important so as to avoid any potentially adverse effects, even though we're going in with a single or triple or double dose of either MDMA or related drug is very, very important to determine what the constellation or long term effects might be in a brain that already may be disrupted neuro-chemically and perhaps even anatomically by the long term effects and ravages of the disorder.
REHMTom Shroder, I know these trials have been approved by the FDA. Is that correct?
SHRODEROh, yes, yes.
REHMAnd so they're all above board. So what do you make of Dr. Giordano's concerns?
SHRODERWell, I think that the modern trials that have started recently, the FDA-approved trials, have a protocol that tries to make those assurance, just as the doctor suggested. It screens the patients. It tries to make sure that the patients who do it do not have prior history of psychiatric problems and -- I mean, of psychosis or anything serious like that. And it also tests their, you know, makes sure that they don't have any physical problems that -- because one of the effects of MDMA is it elevates the metabolism and it elevates the temperature.
SHRODERSo people have to pass a sort of health exam before they do this. But I think one of the things about these drugs that is interesting is that in therapy, their effect is not like penicillin when it's treating an infection. You give a patient penicillin and your infection's gone. The patient has no conscious awareness of the healing effect. But with MDMA and the reason why it's called assisted therapy is because the healing is going on consciously in the patient's mind.
SHRODERThe MDMA allows the PTSD patient to deal with these incredibly painful, emotionally painful, memories in a way that they aren't able to. Very often people say they feel protected and their fear response is actually diminished. And then, it also allows them to have insights about why they, you know, why they are reacting the way they are to the trauma and very often, those insights are what really heals them.
REHMHave you been present as individuals have been given these drugs and witnessed the reactions?
SHRODERWell, in a way, I have because when I was writing "Acid Test," the people who were undergoing therapy permitted me to watch their videotapes. Because it's a research project, the sessions are entirely videotaped so I watched maybe 100 hours of videotape of these sessions. And they're really amazing to watch. A lot of times, you won't think anything is happening because they'll have on eye shades and they'll be listening to earphones, listening to music on earphones.
SHRODERAnd they'll just be lying there for 30, 40 minutes. But when they tell you what was going on in their head, it's really quite remarkable. They're having, like, visions and realizations. You know, some people say they're like -- the insights were just coming so fast. And I was gonna say that, like, for instance one woman who said, you know, I felt like I was lost in this battlefield and I saw no way out and when I did the MDMA, I almost, like, lifted high above the battlefield.
SHRODERAnd there was still a battlefield down there, but I could see that there were paths out. And just knowing that there was a pathway that could get me out of this, I was able to work on that after the drug was completely gone.
REHMDr. Mithoefer, have you seen the same kinds of reactions?
MITHOEFERYes. Those videotapes were from our research and it's remarkable how often people have images that describe the therapeutic process that's happening. For instance, one person said they had this experience of their service record files being brought to them and the message they go internally was I need to go through these files with you and then re-file them correctly.
MITHOEFERAnd I thought that was a beautiful description of the idea that memories -- the idea about memory reconsolidation, the fact that a traumatic memories get stored in a way that they're associated with a lot of emotional pain and if they can be brought up, discussed, processed in a safe setting where the person isn't overwhelmed by fear, which is one of the things that MDMA helps with, then when they're restored, reconsolidated, they're stored without that emotional trigger that's characteristic of PTSD.
MITHOEFERSo this veteran described that process through his images, probably without knowing about the science behind it.
REHMDr. Michael Mithoefter, he's a psychiatrist practicing in Charleston, South Carolina. Also here in the studio, Tom Shroder, author of a new book titled, "Acid Test," and Dr. James Giordano of the Georgetown University Medical Center. Short break and right back.
REHMAnd welcome back. As we talk about the use of previously banned drugs like magic mushrooms, LSD, ecstasy, now being used in really tough cases of PTSD and depression, certainly being tested under FDA approval by Dr. Michael Mithoefer. He's a psychiatrist practicing in Charleston, South Carolina. Dr. James Giordano of Georgetown University Medical School has some concerns about it. Tom Shroder is an author and editor. His latest book all about these experiments is titled, "Acid Test."
REHMHere's an email from Mike who says, "I've suffered from recurrent depression for 20 years. Earlier in life, I experimented with peyote, mescaline and LSD no more than a handful of times. I've watched this line of research now for some time. Doesn't the inevitable fear in a hallucinogenic trip trigger a worsening of the serious anxiety associated with depression and PTSD?" Dr. Giordano?
GIORDANOComing at this from a neuroscientific perspective, one of the things we have to do is we have to look at the psychiatric literature and also look at the broad use of any one of these compounds in a variety of very specific settings. If you have a patient who is presenting with high levels of fear, high levels of agitation, we have to consider what might be underlying neurological chemistry that's going on.
GIORDANOThen what we want to do is match the drug to the proverbial bug. Is this drug, whatever it may be, going to be the right treatment to be able to change the underlying chemistry and mechanisms that then reduce those problematic symptoms? In some cases, we see almost problematic effect because what we think the drug is going to work, it does not. This is sometimes referred to as drug paradox or paradoxical outcomes.
GIORDANOBut I think the issue here is whether or not these types of drugs that are known to induce a hallucinogenic trip may actually worsen, as our caller writes in, the nature of the experience for them. MDMA, ecstasy, is less of a concern than some of the other more potent hallucinogenic drugs like LSD and mushrooms. So I think, once again, what our caller -- what our emailer is suggesting is the right drug for the right reason and pre-selection and symptomatic concerns are huge here.
REHMDr. Mithoefer, how do you go about then selecting who should be treated here, even experimentally, and who should be screened out depending on the problem, the chemistry of that person's make-up?
MITHOEFERWell, before I answer that, can I make another comment about this, if you don't mind?
MITHOEFERI think I agree with what Dr. Giordano said. I think another important point is unlike many medicines, the effect of these drugs is influenced very heavily by the mindset and the preparation going into the session and the setting of the session so that if something really difficult comes up in the session, which it usually does, in people with PTSD especially, if there's proper support and preparation for helping the person actually stay and process that experience, it can make all the difference in the end result...
MITHOEFER...whether they're left with a lot of anxiety or not.
REHMSure. Now, go back to the screening.
MITHOEFEROkay. Well, we're -- we have a long way to go before being able to screen the specific biochemistry of that individual. That'll be great when we get to that point. As it is now, we screen out people who, as Tom said, have history of psychosis or bipolar type 1 disorder. We do include people that have had depression or other anxiety disorders. And then we screen out people that have any serious medical problem like cardiovascular especially because MDMA does elevate blood pressure and pulse.
MITHOEFERAnd so, it could be dangerous for somebody with underlying cardiovascular disease and also for people with certain psychiatric problems. So that is very important. Like anything else in medicine, it has potential risks as well as potential benefits and it needs to be done carefully.
SHRODERCan I make a point about the anxiety?
SHRODERThe -- the anxiety -- the possibility of an extreme anxiety reaction on these drugs is the best reason for people not to try to self-experiment with these drugs. However, the history of this kind of clinical use shows that very often the difficulties that come up that without professional medical presence there could spin out of control into a really bad reaction that actually in therapy sometimes those are exactly -- those difficult moments are exactly the opening for psychiatric breakthroughs.
SHRODERAnd I think that when I was listening to the tapes for my book, I saw that over and over again was that these critical moments where anxiety would spike suddenly became these huge un-leavenings of people opening up and making these tremendous realizations that have great healing effect.
REHMBut that at the same time, what is it that's going to be there to comfort that person?
SHRODERWell, that's why they need -- that's why they need the presence of a very experienced and qualified therapist.
GIORDANOSo I think what we're really seeing, Diane, is something of a sea change. And both of my colleagues are alluding to this. Part of it is the difficulties with contemporary psychiatry and the way it is practiced literally in the field. We have many of the same problems with the classical antidepressant drugs. The drugs are exceedingly effective. They're doing what they're supposed to do. They are safe drugs. But what you then see is the change in the patient as such that their behaviors, their thoughts need to occur within a supervised environment.
GIORDANOWe take a look at a drug like ecstasy, for example, the half life is anywhere between three and six hours. What's happening during that period of time as the drug may begin to taper and the effects change? So what we're really saying is these drugs should not be used cavalierly and it sort of reinstitutes the importance of psychiatry as a practice to be that site where these drugs are administered, to be that site where the treatment is given. And it can't be done more broadly in general medical practice.
REHMAnd certainly it doesn't sound as though, Dr. Mithoefer as suggesting of this sort.
GIORDANOOh, no. No, no, in fact, just the opposite.
GIORDANOI think what my two colleagues are really suggesting here is that these drugs may also provide a leg up into a whole new saddle to ride psychiatry to a new place that suggests this is the practice that has to be able to deal with the psychiatry and neurology, certainly not within the confines of, let's say, general medicine.
REHMBut isn't the concern, Tom, that someone hearing this program who might be suffering from PTSD who does not have access or thinks he does not have access to a psychiatrist or entry into one of these studies might take this stuff on his own.
SHRODERYes, and that would be a mistake. But also, as -- this comes up a lot in connection with this research because when you have these really positive results, people think, oh, good drugs.
REHMSure, I'll go ahead and do it.
SHRODERFirst of all, these drugs will never be the sort of thing where a doctor, a psychiatrist writes you a prescription and you go down to the CVS...
SHRODER...and get it filled. That's not going to happen. What happens is that the prescription will be for the therapy in a clinic with a therapist. So, you know, so -- but also, you know, when somebody who is very high up in the -- in the sort of drug control apparatus of the government once was presented with this and they said, you know what, on the internet there are all these websites devoted to recreational use of these drugs. So people -- it's out there. People know about it.
SHRODERAnd it's not like this will be the first temptation that anybody has to make the mistake of doing it alone without...
REHMAll right. I want to take a call here, because this seems like a very important question from Steven in Clearwater, Fl. Hi, you're on the air.
STEVENHi, Diane. Yes, I talked to the gentleman you've talked with. I think I've sent every psychiatrist and doctor in the country an email trying to get help. I've been suffering from depression for 54 years and I'm 54. So I think it's been a long time. And I'm just finding it very, very difficult to get some kind of help here in America with somebody like me who's been doing the research. I went to Guatemala. I tried Ibogaine but it was not assisted and I had some of these visions -- this vision he speaks about, fearful visions.
STEVENBut it wasn't -- it wasn't a clinical setting, but yet it wasn't under a therapeutic setting where somebody was assisting me through the process. Someone was looking over -- someone was looking over me, but they weren't, okay, what he see and how can we assist you with it.
REHMYeah. So I gather, Steven, you've been trying to get into trials and...
STEVENYes, ma'am, I have.
REHM...found that impossible. Dr. Mithoefer, how limited are these trials? How many are actually going on around the country?
MITHOEFERWell, they're quite limited at this point. So I can understand Steven's frustration. Our study that we're doing now in Charleston is with veterans, firefighters and police officers. And that's limited to we're going to enroll a total of 26 people. There's a study smaller than that that is going on with the same sponsor in Boulder, Co and also studies with people we're collaborating with in Israel and Canada. But that's it.
MITHOEFERAnd we -- at this point, we have had more than 600 veterans from around the country call us, interested in the study. So it's -- it's a sad fact that the need is great. And at this stage of research, it moves -- moves quite slowly.
REHMSo, Dr. Giordano, hearing the plight of this man, what would you say to him? I mean, clearly, you're not going to recommend that he go and do this on his own. But apparently, he's tried lots of approaches and it sounds to him as though this approach could work and he can't find a way to get himself in.
GIORDANOIt's a system problem. I mean, I think that the patients like our caller and certainly many others have experienced many of the frustrations in trying to gain access not only to the medical system but specifically the type of advanced psychiatry that would allow them to get the benefits that cutting edge neurology and neuroscience can afford through psychiatric practice. It's difficult. Many patients don't, for example, have an equi-parity clause on their insurance that allow them to get just this type of deep-dive psychiatry.
GIORDANOSo they're actually being excluded not only from things like clinical trials, but from the level of deep supportive care that would occur under the milieu of psychiatry. So I -- I empathize.
REHMAnd you're listening to "The Diane Rehm Show." Tom, how do these psychedelic drugs work differently from, say, the normal drugs for depression like Paxil or Zoloft?
SHRODERWell, in general, the drugs that are prescribed now treat the symptoms of depression. And psychedelic drugs, I made this illusion how they don't -- they don't work like penicillin, but rather they help the patient have almost like religious type experiences. And religious experiences are one of the really most notable aspects of them is that the conversion experience, which is that a person completely changes through one experience. And so not often like one experience, often it's several insights during the sessions.
SHRODERBut people are really changing. And let me just bring up this -- at Johns Hopkins, they recently published the results of a study where they gave psilocybin, which is the magic mushrooms...
SHRODER...to people who were hardcore smokers who've been trying to quit for years and never had been able to quit. And that experience changed them in a way so that -- and what they -- most of them said was that instead of putting their short-term pleasure, suddenly their long-term well-being was more important to them. This was a total change in personality brought about by this drug experience that they had. And they got an 80 percent success rate. It was a small sample. There were 15 people. But 12 of 15 people...
REHMThat's pretty good.
SHRODER...was not smoking -- yes. And specially since that the state of the art in smoking cessation is 35 percent. So this is really remarkable. And the fact that it's a -- it's the experience that changes people, changes their behavior, changes their values is a really remarkable aspect of these drugs.
GIORDANOSo let me -- let me comment on what Tom is saying, because he makes a very, very good point. If we can even refer out to all of our listeners, no one really knows what's going on in their own brain. They know how they feel, they know what they think and they can experience things. But the underlying chemistry of that is really not transparent to us. I think what's important to understand is how these drugs work on a neurochemical level.
GIORDANOWhat do they do in the brain? And what we know that ecstasy does is it produces a very large release of a nerve chemical called serotonin, and then there a whole host of downstream effects, if you will, that occur in the brain and in the body. Well, for many of these patients, the actual nature of their disorder is that that particular chemical system has been disrupted. And many of the drugs that we've used in psychiatry, the typical antidepressant an anti-anxiety drugs, do not have the potency of effect that an agent like ecstasy does.
GIORDANOBut this is also the double-edged sword. It's that potency of effect. So partly it is, in fact, exactly what Dr. Mithoefer is alluding to and certainly what Tom pointed out in his book. It's finding the right patient with the right disorder to get the right drug at the right dose.
REHMTom Shroder, have you yourself experimented with these drugs with or without supervision?
SHRODERWell, like many people of my age, I'm 60 years old, I did experiment with psychedelic drugs when I was in college. And I had enough experiences to understand the possible lasting good that that experience could do even though it was unsupervised, even though it was illegal, I can't deny the fact -- I mean, I -- I had an experience once where as I ate some mushroom, which we found in cow pastures outside of University of Florida where I went. And as the mushrooms took effect, I began to get more and more anxious about these things in my life, both near-term things and long-term things.
SHRODERAnxious and fearful. And that became the -- I felt it as a huge weight on me, almost so that I couldn't breathe. And then I had this vision of myself and it was like this giant boulder weighing me down. And yet, I was holding the boulder to myself. And I suddenly, in a flash of insight, I realized, all you have to do is open your arms and the boulder will fall away. You can just left them go.
REHMTom Shroder, he is the author of a new book. It's titled, "Acid Test: LSD, Ecstasy and the Power to Heal." Short break. And your calls when we come back. Stay with us.
REHMAnd we're back talking about the use of psychedelic drugs to treat many medical conditions, for example, PTSD, also some addictions like smoking. Joining us by phone from Paducah, Kentucky, Nicholas Blackston. He's a Marine veteran who served in Iraq. He suffered from post traumatic stress disorder until he received treatment involving the use of ecstasy. And I want to welcome you, Nicholas, and thank you for your service.
REHMI know you served in Iraq twice about 10 years go. When you returned, tell us about your experience with PTSD.
MR. NICHOLAS BLACKSTONWell, right after returned from my last appointment, from Ramadi, didn't really notice anything. It was about six months afterwards since I'd got back I had started noticing some symptoms. I was very hyper vigilant, always on alert and I was suffering from depression, anxiety, night terrors, night sweats, you name it.
MR. NICHOLAS BLACKSTONI went to the deployment health center while I was still in the Marine Corps and they diagnosed me with PTSD and started giving me Zoloft and Seroquel and I would get like an hour therapy session every, like four to six weeks which really wasn't enough. That was towards the end of my four-year contract that I had in the Marine Corps and once I got out, I started having problems again when I started school.
MR. NICHOLAS BLACKSTONSo I got with the VA and started getting help again, therapy and same medicine and I was just -- the medicine just made me like a zombie. It just helped me -- I already had a problem, I guess, with pushing the issue down and it just kind of helped me push it down even more.
REHMSo I gather you then volunteered to take part in Dr. Mithoefer's clinical trial using MDMA. Tell us about what you experienced.
BLACKSTONWell, the most profound thing was during my first session. I found that the medicine really helps you bring, I guess, your memories, those traumas back to the surface without any fear 'cause normally you would have the fear of them coming up and you having some of those panic attack or anything like that in public. So you push things down. And was able to bring things up and I had an experience where I -- pretty much a vision where I'd seen this Marine Corps self of mine all demented in face and he was chained up in a cage.
BLACKSTONAnd I went forward and unchained that and said, you know, I forgive you and if you want to rip me apart, I understand, 'cause I pushed you down here. And it was just this forgiving moment and it was in my mind, but I felt it all over my body. It was just something really had changed.
REHMCan you tell me how many session you went through?
BLACKSTONI had a total of six sessions. My first three, they found out I was having the medium dose because it was a double-blind study and so I had the option to stay in for another three and get 125 milligrams.
REHMAnd now, how do you feel?
BLACKSTONOh, well, now it's been -- I was finished in 2012 and I feel great, obviously. One of the biggest things that I'm happiest about is I'm about to have a child and I finally feel like -- I feel like I have it together enough to be able to carry out that task, you know.
REHMYeah. Lots of responsibility with a coming of a child. So you are not in therapy anymore. You're not taking any more medication?
BLACKSTONNo. I'm not on any therapy or doing anything with the VA or not on any drugs.
REHMBut I gather the drugs did not actually take away the memories. You still have them.
BLACKSTONYeah. There's nothing that could really erase those things that you see in war, but I no longer -- I guess I'd say, I'm no longer haunted by them. They're no longer coming up unwanted. I no longer -- I can talk about them. I can tell stories about them and I can really feel like it's in the past. As in before, when you would tell these stories, the PTSD makes you be there again and it can be painful, so...
REHMDid you ever, at any time, during your treatment feel a great deal of fear or even hysteria?
BLACKSTONWhenever I had taken the 125 milligram dose, I had a pretty intense experience with anxiety. I felt like my body was on fire and I was getting taken apart and then put back together. And I realized, in that moment, the power of my breath and I breathed and breathing through that, it just -- it helped me realize that my fears seemed to manifest things worse, make things a lot worse. And when I breathe through my fears, you know, the anxiety would go down and go away. That's one of the biggest tools that I've taken away from all this is being able to breathe through these moments.
BLACKSTONSo I still have the, you know, these images and everything, but I've learned a lot of tools and techniques from my therapy that allow me to function.
REHMAnd were some of the professionals involved in Dr. Mithoefer's study standing by as you went through these expressions of fear or anxiety?
BLACKSTONYes. Before I had ever even taken the medicines, we'd do therapy sessions before, just talking, you know, getting to know you. And they were with me the whole time during pretty much all day because you end up staying the night there, too, and then talking to them in the morning and then you're released. And under the medicine, and they weren't my parents, but they had that feel, it's really important that they make you feel comfortable enough to -- if you did want to cry or you did want to act out, I mean, they were there for you.
BLACKSTONThey created this vessel of healing. That's really essential because like they were talking about earlier, doing it outside of that, out of clinical research is really not a good idea 'cause you don't have that setting that creates that...
REHMIndeed. Nicholas Blackston, he's a Marine veteran who served in Iraq, came back with PTSD and was treated with some of these hallucinogenic drugs. Nicholas, congratulations on your forthcoming child, whether it's a boy or a girl.
BLACKSTONOh, it's a girl.
REHMIt's a girl. And let's hope she's wonderfully healthy as you...
BLACKSTONThank you very much.
REHM...seem to be. Thank you. And turning now to you, Dr. Mithoefer, you clearly did some pre-interviewing and pre-studying with Nicholas and I'm sure as you have with all your clients.
MITHOEFERYes, absolutely. And as Nick is saying, we meet with people ahead of time and in the case of the studies I'm doing, it's my wife and I are co-therapists. And that's an important part of it. We think it's helpful to have a male-female therapy team and she's been extremely important in all this research. And so we really do get -- it's a fairly short time, but we get to know people ahead of time and really talk about the way to approach what's coming up, including using the breath to help stay with difficult experiences rather than move away from them.
MITHOEFERAnd then, we do -- the follow-up is also very important, that Nick's alluding to. You know, people spend the night in the clinic. We meet with them the next day and then we talk to them every day on the phone for a week. We meet with them three more times over the next month between sessions because the MDMA can stir things up. People do have these very dramatic insights during the sessions sometimes and also they can have waves of emotion coming after the session that's really important to help them continue to process what's come up.
REHMAll right. Let's take another call from Bob in Tahlequah, Oklahoma. Hi, Bob. You're on the air.
BOBHello. What an important discussion you're having today.
BOBVery important. I hope it continues. Yeah, keep breathing. My father passed away three years ago. He was a bioenergetics therapy and he worked with breath quite a bit. My question is, specifically, could this therapy be used with treatment of alcoholism?
REHMWhat do you think, Tom Shroder?
SHRODERWell, yes. In fact, the history of psychedelic therapy, the early history, was very involved with the treatment of alcoholism. There was a researcher in Canada who had great success and who came to many of the same conclusions that they came to in that recent tobacco cessation study. And, in fact, it had been so successful that the government of Canada in 1960 issued a statement that said it was no longer experimental, but it was an accepted treatment for alcoholism.
REHMAny comment, Dr. Giordano?
GIORDANOWell, you know, again, I think it really depends on understanding the underlying mechanism of alcoholism. It is an addictive disorder in some cases. There's a set of variants that occur with regard to the type of alcoholism and brain chemistry. And, again, we go back to the use of the right drug. Certain hallucinogens, for example, Psilocybin, mushrooms have, in fact, been shown to be somewhat affective in treating certain types of alcoholism and very effective in treating others.
GIORDANOSo I think here, it's also a question of making sure that we understand what the drug does...
GIORDANO...and the nature of the disorder.
REHMAll right. Here's an email from Diane who says, "How do we argue to our teens that these drugs are illegal because they're harmful when they hear about these types of therapies? I've mentored at-risk teens who thought drugs were their answer to block pain and depression." And perhaps you went through the same thing, Tom.
SHRODERWell, I think that we have to say that, you know, like any powerful medicine, you wouldn't be self-prescribing powerful medicines for a range of illnesses to yourself and it's really -- this is something that really requires a doctor's supervision. And I think that, you know, there are some serious consequences that can come for -- especially for young people who think that they can take this into their own hands.
REHMDo you want to comment, Dr. Giordano?
GIORDANOI do. I think the important thing here to understand is also that these drugs are scheduled not because of their inherent harm, but because of their abuse potential and when we're dealing with youngsters, certainly we have problems with impulse control. Circumstances may not be the same as in the clinic and that's a very, very important caveat.
REHMAnd you're listening to "The Diane Rehm Show." Dr. Mithoefer, here's a question for you from Paul who says, "I was sexually abused for nine years, from age 8 to 17. My psychiatrist has told me I have PTSD caused by that abuse. Would I be a good subject for that research?"
MITHOEFERPotentially, yes, although not our current study because our current study is limited to veterans, fire fighters and police officers. However, in our first study, the results of which we were talking about, it was mostly people with rape or childhood sexual abuse and we found that we had very good results with people with that kind of trauma. So I think, in principle, this is the kind of thing that could be a candidate.
REHMCould be of help. All right. And to Dmitri in Wallingford, Connecticut. Hi, you're on the air.
DMITRIHi. My name is Dmitri. I'm 20 years old and I've experimented with psychedelics throughout all my life. I did mushrooms when I was 15 years old and I have no doubt of the therapeutic benefits and the life-changing epiphanies that can happen while under the influence of these drugs, especially from Psilocybin. My question is, what in the political climate, in the medicinal political climate, has allowed this discussion and these tests to go on today and not maybe when the research was being studied in the '70s? How come it is today and right now that this -- what permits it?
SHRODERWell, that's a -- a big part of my book is about this and that's what is a small group of people who weren't willing to go underground with what they believed to be the tremendous potential benefits of these drugs, battled for basically 30 years to overcome extreme prejudice among governing authorities against these drugs in order to persuade the FDA -- and Michael Mithoefter was part of this -- and it took -- let me just say that these drugs are not being evaluated by authorities the way any other drug -- let's say a drug was just invented and it got these kind of promising results.
SHRODERIt would get tremendous support with -- we have as many as half a million veterans coming back from Iraq and Afghanistan with life-threatening PTSD symptoms and the current treatments just aren't doing enough. And here's a treatment that appears to be incredibly promising at the very least and the Department of Defense has not contributed a single dime to this research.
REHMAnd you want to see it made far more widely available through specialized clinics.
SHRODERWell, I want to see the research to be put on a fast track and hurried through rather an lingering. And it would take a minimum of, I would say, 10 years, maybe more at the current rate and the people who are doing it, they're doing things like -- they're doing indie go-go campaigns to raise, you know, tens of thousands of dollars when, you know, the Pentagon has enough money in its couch cushions to fund this research and speed it along.
REHMAll right. One last quick question. I know that Johns Hopkins is also researching Psilocybin to treat depression in cancer patients.
SHRODERYes, yes. And depression and anxiety in people who have terminal cancer diagnosis.
REHMBut you, Dr. Giordano, have some ethical concerns about this.
GIORDANOWell, I mean, they're not necessarily ethical concerns. They're practical concerns as well. I mean, I think the use of these types of hallucinogenic agents in terminal patients produces what is sometimes referred to as terminal euphoria. For the right patient, once again, this is exactly the circumstance we want. What we're afraid of is broad scale use where these individuals are now seeking these drugs illicitly.
REHMAll right. We'll have to leave it at that. Very interesting discussion, however. And I want to thank you, Dr. James Giordano, Tom Shroder, for your book "Acid Test" and Dr. Michael Mithoefer in South Carolina. Thanks for listening all. I'm Diane Rehm.
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