This Is Your Mind on Mushrooms
To put a human face on the potential of psychedelic drugs to address mental health disorders—and in the process change or even save lives—psychiatrist Michael Bogenschutz, the director of NYU Langone Health’s Center for Psychedelic Medicine, likes to share the story of a man named Jon Kostas. In 2015, when Bogenschutz first met him, Kostas was 25 years old and had a very severe binge drinking disorder, regularly consuming, in his own estimation, upwards of 20 alcoholic beverages in a single sitting. “He’d been in inpatient rehabs, he’d been on every medication, and still he felt—and his physicians really felt—that he was drinking himself to death,” says Bogenschutz. “He just couldn’t stop.”
Desperate for a solution, Kostas enrolled in a study that Bogenschutz and his colleague Stephen Ross—the center’s associate director and, like Bogenschutz, an addiction psychiatrist by training—were conducting to investigate whether psilocybin, the active ingredient in magic mushrooms, could be used as a treatment for alcohol use disorder. Kostas received two doses of the psychedelic drug—under medical supervision—over the course of three months, sandwiched between a dozen sessions of psychotherapy. “And ever since that first medication session, he has not had another drink,” says Bogenschutz. “He reported that his craving was completely gone and that he doesn’t even think about drinking.”
Not every patient in the study, which was published in the journal JAMA Psychiatry, had such a dramatic and immediate transformation, but the results were incredibly promising. In the double-blind randomized clinical trial of 93 men and women with alcohol use disorder, half of whom received psychotherapy plus psilocybin and half psychotherapy plus an active placebo medication (in this case, a big dose of antihistamine), the psilocybin group decreased their heavy drinking days by 83 percent following the trial, compared with 49 percent in the control group. “Both groups decreased their drinking by roughly half during those first four weeks of psychotherapy, before getting the study medication,” Bogenschutz explains. “But then the psilocybin group cut their drinking again by about half after receiving medication, while the other group continued to drink just about the same.” Remarkably, eight months after the first dose, almost half (48 percent) of those who received psilocybin stopped drinking altogether compared with 24 percent of the placebo group. Now Ross and Bogenschutz are testing the protocol in a much larger study, with 216 participants.
“We know the effects of the high dose of a psychedelic like psilocybin enhances the ability of the brain to change. At the same time, people have these experiences that they interpret as being profoundly healing,” says Bogenschutz. “They carry with them a memory of an experience that continues to support and organize their efforts to change, because they can remember what it was like to feel at peace and to feel freed from their addiction.”
The idea of using what most of us know only as a recreational drug to treat addiction to what is essentially another recreational drug might sound counterintuitive. But the practice is far from new. From the 1940s through the early ’70s, researchers treated more than 40,000 subjects for mental health disorders with LSD. But for many years afterward, the data from those studies disappeared from mainstream scientific discourse. “There was this huge body of research that was hidden in plain sight,” says Ross. “Psychedelics had been an important part of psychiatry for three decades, and yet, in all of my years of medical school, fellowship, and training, the subject had never once come up.”
That omission is not particularly surprising, given the troubled history of psychedelic drugs—a class of psychoactive substances that have the power to alter consciousness—in Western medicine, which includes not only potential breakthroughs but questionable ethics, covert operations, and even government cover-ups. Indigenous cultures have used psychedelics, most notably plant-derived drugs like peyote and ayahuasca, in religious ceremonies and healing rituals for millennia. But modern psychiatry’s first introduction to psychedelics didn’t come until 1943, when Swiss chemist Albert Hofmann, while studying a grain fungus called ergot, combined one of its components with an ammonia derivative and then unwittingly ingested the compound: lysergic acid diethylamide. The accidental dosing—possibly by absorption through his fingertips—launched him on what is widely considered the world’s first acid trip, and, soon after, Hofmann’s Sandoz Laboratories began manufacturing what became known as LSD, sending samples to research facilities around the world. At first, scientists thought studying LSD could help them learn more about schizophrenia, since the drug can induce the sorts of hallucinations associated with the disease. But participants in early experiments reported an unexpected side effect: taking LSD had helped them quit drinking. “Starting in the 1950s, it was hailed as a wonder drug for treating alcohol use disorder,” says Ross. “There were entire American Psychiatric Association conferences devoted to it.”
But at the same time, there was more sinister psychedelic research underway. In 1953, the CIA launched Project MKUltra, an attempt to weaponize psychedelics. Over the course of 20 years, the agency experimented on volunteers and, in a particularly disturbing turn, unsuspecting citizens to determine whether LSD could erase memories and be used for the purposes of mind control and psychological torture. Among the people who first tried the drug as volunteers in those studies were One Flew Over the Cuckoo’s Nest author Ken Kesey, the Grateful Dead’s Robert Hunter, and Beat poet Allen Ginsberg. Afterward, all three became vocal proponents of what became known as acid, ushering in an era of widespread recreational use.
Soon, academic research also began to go off the rails. In 1960, psychologist Timothy Leary started working with psychedelics at Harvard after a transformative experience taking magic mushrooms in Mexico. For three years, he ran studies in which he took the drugs alongside his subjects—a huge scientific taboo—and allegedly pressured undergrads to partake. In 1963, when word of his practices reached the administration, the university fired Leary and his colleague Richard Alpert, who later became known as the spiritual teacher Ram Dass. Leary continued to promote the use of psychedelics and, in 1967, at the Human Be-In, a gathering of an estimated 30,000 hippies in San Francisco, famously told the crowd that it was time to “Turn on, tune in, drop out,” which became the unofficial motto of the countercultural revolution. In the years that followed, Washington became increasingly incensed by Leary and the psychedelic-fueled movement that was springing up around him. In 1970, after a protracted legal battle, Leary was incarcerated for marijuana possession. That same year, Congress passed the Controlled Substances Act, wide-ranging legislation that enacted stiff penalties for the possession of psychedelics and a host of other drugs. In 1971, President Nixon declared drug use “public enemy number one” in his famous war on drugs speech, and not only was scientific research into psychedelics shut down, but also, says Ross, its very existence was “buried in the history books” for the better part of a generation.
Ross first started learning about psychedelic medicine only in 2006—mostly, he says, through serendipity. He was running an inpatient psychiatric unit at NYU when his colleague Jeffrey Guss (GSAS ’05) happened to mention that he was traveling to a conference commemorating Hofmann’s 100th birthday. “I thought, ‘Why would doctors want to celebrate the man who discovered LSD?’ ” recalls Ross, who at the time was familiar with the substance only as a dangerous recreational drug with the potential to induce psychosis. “But it piqued my interest, so I started looking into the history.”
By that point, mainstream medicine was finally ready to give psychedelics a second look. In the 1990s, psychiatrist Rick Strassman obtained permission from the FDA and DEA to study a psychedelic called dimethyltryptamine, better known as DMT. Over the next decade, psychedelic research groups were established at Johns Hopkins, UCLA, and NYU, where psilocybin’s potential to treat psychological and emotional distress in patients with life-threatening cancer was assessed in the NYU Psilocybin Cancer Anxiety Study.
That landmark study, which Ross coauthored with Guss and NYU psychologist Anthony Bossis (GSAS ’91), whose work focuses largely on palliative care, was published in the Journal of Psychopharmacology in 2016. As in the alcohol use disorder study, patients received a combination of therapy and carefully orchestrated and monitored dosing sessions. “There was a lot of preparation and psychotherapy before we ever did a dosing session,” says Ross of the study design. “We wanted to know how cancer had affected the patients emotionally and existentially; we reviewed their life, looking at achievements and challenges and coping mechanisms, important people and important events. And then we prepared them for the session, going over what would happen and how we would keep them safe.”
On the day of the dosing sessions, participants were asked to state their intention for the treatment before reclining on a sofa made up like a bed. “There was preselected music playing on headphones, and we gave them eyeshades and asked them to focus internally,” says Ross. “And then they tended to have these experiences that were strange and interesting, often challenging. After six or seven hours, we sat them up and started talking about what happened. Often patients reported having transformative, mystical-type experiences that were highly meaningful—among the most spiritual of their lives.” And afterward, despite their health challenges, many reported feeling a profound and lasting sense of peace, some with their fears of cancer recurrence having disappeared completely. As study participant Dinah Bazer recalls, “I saw my fear. All of my fear turned into anger—I will not be eaten alive by this fear. And once that happened, the fear was gone. I felt that I was bathed in love. Just all-encompassing love.”
Says Ross: “These were terminally ill patients for whom life had lost meaning. Their cancer was this horrible trauma, and, coming into the study, many said they wished they were dead already.” After a single dose of psilocybin, 80 percent of the 29 subjects saw relief from emotional distress that lasted more than six months. And in the researchers’ long-term follow-up study with a subset of participants from the original trial, they found that the effects persisted nearly five years after that single dose. Those who received the psilocybin-assisted therapy overwhelmingly—71 to 100 percent—attributed positive life changes to it and rated it among the most personally meaningful experiences of their lives.
“It was such an epiphany for me,” explains study participant Gail Thomas. “To feel separate and to feel alone is just a falsity. Because it’s not how it is. That’s very comforting, and I’ve felt that way ever since. Understanding that death will happen and being fully aware of its reality enables you to have a happier life. I’m one of the luckiest unlucky people—I was unlucky that I got cancer, but I was lucky that I was chosen to be in this study. And it did change my life.”
For Ross, the experience of working with cancer patients was, he says, “very rewarding and moving. To see them get better so quickly and see it last really motivated me to do more.” This past July, he received the first grant ever from the National Cancer Institute to do a much bigger study involving 200 patients with advanced cancer using psilocybin-assisted psychotherapy to treat anxiety, depression, and existential distress. At the same time, NYU researchers are looking into other possible applications for psychedelics. The cancer anxiety study—which spawned the country’s only psychedelic psychotherapy training program—was the first to find that psilocybin can function as a rapidly acting antidepressant, with effects lasting for several months or even years. Out of that finding grew a recently completed multicenter study, with NYU serving as the lead site, that looked at using psilocybin to treat major depression. Depending on what the data shows, the FDA could approve psilocybin as a treatment for that disorder sooner rather than later.
“Major depression is probably the leading application in terms of FDA approval,” says Ross. “It’s exciting because depression is arguably one of the most disabling brain-based illnesses in the world, and it’s very common. The current treatments we have work only to a degree; at least 30 percent of people with depression don’t respond at all to them. So there is a lot of room for novel therapeutics.”
Now, after half a century, the federal government—the largest single source of funding for scientific research—finally seems ready to reconsider the merits of psychedelics. In October 2021, the National Institutes of Health awarded the first federal grant in 50 years to study a psychedelic drug as a possible treatment. NYU Langone Health will be one of three sites for the trial, which is led by scientists at Johns Hopkins and will investigate whether psilocybin can help people quit smoking.
The timing of this psychedelic research revival couldn’t be better, according to Bogenschutz, who says he is also very interested in studying psychedelics as a possible treatment for opioid addiction. “With COVID and other stresses and the fragmentation and lack of connection that people experience with the way the world works today, more people are turning to drugs and alcohol,” he says, pointing out that, in addition to the opioid crisis, addiction to stimulant drugs is also on the rise. “It really costs people a lot of their years, and we really have very limited treatments.” The hope? That while mushrooms might not actually be magic, they might just be something almost as elusive: efficacious medicine for mental health.
Illustrations by Tim McDonagh