Alcohol can have a huge impact on individuals and society in general. David Nutt’s comments about alcohol causing more overall harm than any other drug are well publicised, as are statistics about the global burden of disease (alcohol contributes to about 4% of total mortality and about 5% of disability adjusted life-years).
Helping large numbers of people recover from alcohol dependence will have a huge beneficial impact on society, so researchers and funders are always interested in new and novel approaches to treatment. One therapy that was used many years ago is LSD (lysergic acid diethylamide), although this treatment has not been based on formal systematic review and meta-analysis. Of course, LSD has now been shown to have significant and unpredictable psychological side effects, making it an unethical treatment in the view of many.
Researchers from the Norwegian University of Science and Technology in Trondheim have recently published what they claim is the first quantitative evaluation of the effectiveness of LSD for alcoholism, based on data from randomised controlled clinical trials. They searched the PubMed and PsycINFO databases for studies dating back to 1943 and found over 4,000 trials which they sifted through to identify 9 papers for inclusion in their meta-analysis.
Perhaps not unsurprisingly, the trials all date from the late-60s and early-70s and include a total of 536 adults. Participants were almost all male inpatients seeking treatment for alcoholism. The review excluded patients with schizophrenia or psychosis.
As is often the case with trials from this period, the researchers did not describe their methods in detail, so it’s hard to be absolutely certain about the reliability of the results. Overall, the authors of the new review described 2 of the trials as having ‘high risk of bias due to inadequate blinding of patients or staff’ and 2 other trials as having a ‘high risk of bias due to incomplete outcome data’.
The doses of LSD given in the trials ranged from 210 mcg (3 mcg/kg) to 800 mcg, with a median dose of 500 mcg. Control groups were given low-dose LSD (25 mcg or 50 mcg), d-amphetamine (60mg), ephedrine sulphate (60 mg), or non-drug control conditions.
Here’s what they found:
- LSD had a beneficial effect on alcohol misuse in every trial
- On average, 59% of LSD patients and 38% of control patients were improved at follow-up using standardised assessment of problem alcohol use
- There was also a similar beneficial effect on maintained abstinence from alcohol
- The positive effects of a single LSD dose (reported both in these and in other, non-randomised trials) lasts at least 6 months and appears to fade by 12 months
The authors commented:
Given the evidence for a beneficial effect of LSD on alcoholism, it is puzzling why this treatment approach has been largely overlooked.
This review suffers from a number of weaknesses, not least the fact that there was very little follow-up of patients in the trials, to assess what impact the LSD treatment had on them. Only one study included multiple review sessions assessing the individual’s experiences of taking the drug; the other five studies provided either only one brief review session or no review session at all. A number of adverse effects were reported in the trials themselves (agitation, acting “bizarrely”, having a seizure or having other “unspecified” adverse reactions), but the longer-term psychological impact was not assessed.
These days there are numerous psychological and drug treatments for alcoholism, so it seems slightly bizarre that we would once again consider using an illegal drug with well known psychological side effects in this population.
Krebs TS, Johansen P. Lysergic acid diethylamide (LSD) for alcoholism: Meta-analysis of randomized controlled trials (PDF). J Psychopharmacol 0269881112439253, first published on March 8, 2012 as doi:10.1177/0269881112439253.