A common psychedelic may help alcoholics stay on the wagon, according to a meta-analysis of studies from the late '60s and early '70s.
Those given a single dose of lysergic acid diethylamide (LSD) were almost twice as likely as controls to report less alcohol use at first follow-up (P=0.0003), Teri S. Krebs, PhD, and Pal-Orjan Johansen, PhD, of Harvard and the Norwegian University of Science and Technology in Trondheim, reported online in the Journal of Psychopharmacology.
"Given the evidence for a beneficial effect of LSD on alcoholism, it is puzzling why this treatment approach has been largely overlooked," they wrote.
Known for its profound effects on the mind, LSD was once studied for potential benefits in treating alcoholism. Some trials, largely conducted in the late 1960s and early 1970s, showed that the hallucinogenic drug could help prevent patients from relapsing into alcohol abuse.
Research fell off after the drug's complicated social and political history made it difficult to get grants approved, the researchers explained.
So Krebs and Johansen reviewed and analyzed the old literature -- a total of six studies with 536 patients conducted between 1966 and 1970.
The median dose of LSD used in those trials was 500 mcg.
Analysis showed that those given LSD were significantly less likely to have reported using alcohol at first follow-up than controls (OR 1.96, 95% CI 1.36 to 2.84, P=0.0003).
A far greater proportion of those on LSD reported improvement at first follow-up compared with controls (59% versus 38%, P=0.0003), the researchers said. They found that the number needed to treat to achieve any improvement in drinking was 6, to maintain abstinence was 7.
Short- and medium-term benefits didn't persist, however. There was a higher likelihood of treatment response with LSD three and six months after treatment (OR 1.85 and OR 1.66, respectively, P=0.01 for both), but not at 12 months, they reported.
In the three trials that reported on abstinence from alcohol, the researchers saw benefits immediately and up to three months after treatment (OR 2.07, 95% CI 1.26 to 3.42, P=0.004 and OR 1.80, 95% CI 1.07 to 3.04, P=0.03), but the effects weren't significant at six months.
In a sensitivity analysis for the primary outcome of improvement on alcohol misuse at first follow-up, the beneficial effects of LSD remained significant (P≤0.02).
But none of the secondary outcomes -- alcohol misuse at short- and medium-term follow-up and abstinence at first and short-term follow-up -- were significant after removing the trial with the most favorable effect of LSD in each respective analysis, Krebs and Johansen said.
Overall, there were few adverse events, the heterogeneity between trials was negligible, and the findings appeared consistent with many reports of clinical experience and other trials, they reported.
They said the effectiveness of a single dose of LSD compared well with that of daily naltrexone (ReVia), acamprosate (Campral), or disulfiram (Antabuse), based on prior research.
Research has also shown the drug to be safe and nonaddictive, although it could carry acute psychiatric adverse events such as anxiety and confusion, they added.
Despite the evidence, LSD as a treatment for alcoholism has been largely overlooked, they said. That could be because of underpowered randomized controlled trials, other methodological issues, and unrealistic expectations from investigators who discounted moderate or short-term effects.
Its effects may be tied to the way LSD changes perception, as some patients said they felt they were given a new lease on life, and subsequently made strong resolutions to stop drinking.
Because the effects are unlikely to be long-lasting, Krebs and Johansen suggested exploring the benefits of weekly or monthly treatment with LSD. They also called for further data on whether certain subgroups may gain more of a benefit, and whether various doses have alternative effects.
It may also be worthwhile to consider shorter-acting psychedelics such as mescaline, psilocybin, or dimethyltryptamine for alcohol dependence, they said.
Primary source: Journal of Psychopharmacology
Krebs TS, Johansen PO "Lysergic acid diethylamide (LSD) for alcoholism: meta-analysis of randomized controlled trials" J Psychopharm 2012; DOI: 10.1177/0269881112439253.