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Rick Barnett could always tell psychedelics were different—even when he was much more, shall we say, indiscriminate with drugs. Now as an addiction specialist helping others through their recovery, he sees a role for psychedelic medicine at every stage of the process, which even he admits is a pretty controversial view.

We asked Rick why psychedelics can be so effective in treating substance use disorders, whether certain medicines are better for specific addictions, and why community support can make or break a person’s recovery journey.

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What led you to specialize in addiction treatment, and how did psychedelics become part of that story?

I got into addiction treatment because I was somebody who had trouble with alcohol and drugs when I was a kid. I always wanted to work as a mental health clinician; I wanted to be a psychiatrist even when I was using. That obviously steered me off the path for a while, but once I got sober and went back to school, it was a natural fit to work with people struggling with addiction because I'd been through it myself.

When I was in active addiction, I used a lot of psychedelics at a very young age. But even then, those experiences always stuck with me as being positive, unlike my other substance use. When I got sober though, I labeled psychedelics as negative. I couldn't be like, “Well, acid's fine. I can just do acid.” It wasn't part of my inculcation into the recovery world that psychedelics could be involved in the process.

That changed about five or six years ago when Michael Pollan's book came out. I was like, “Hell yes. This is exactly my story.” Psychedelics were coming back as a healing modality, and here I was as a practicing psychologist now. I just jumped in with both feet.

As someone in recovery yourself, how do you think about using psychedelics to address substance use disorders? What helps people work through that seeming contradiction?

I'm of the belief that psychedelics can play a role in helping people find a path to recovery or enhancing their recovery process wherever they are in their addiction. If they're in active addiction, I think psychedelics can help. If they're in early recovery, which is a very controversial, vulnerable time, I think psychedelics can help. And if they’re in long-term recovery—even abstinence-based—I still think, used appropriately, psychedelics can help.

One thing that's important across the board, regardless of where somebody is in their addiction or recovery process, is community. Having community support is super important, especially if you're going to introduce psychedelics into long-term recovery, because a lot of people come from a traditional abstinence-based recovery process. I think the 12-step culture and program is wonderful and can harmonize well with psychedelics, but it has to be done thoughtfully. Otherwise you risk cutting off connections to others.

What's different is the preparation and integration process at each stage. We know that with intentional psychedelic experiences, there's a preparation stage, an experience or administration session, and then integration. That process looks different depending on where somebody is in their addiction or recovery.

What does the current research tell us about how psychedelics help with addiction? What are the mechanisms that makes them effective?

Psychedelics are disruptors. They interfere with our normal consciousness, our way of being in the world. We hear about the default mode network, the salience network, the executive network—all these different ways our brains typically function. Introduce a psychedelic, and that all gets jumbled up. For someone with addiction, depression, OCD, anxiety, or trauma, psychedelics disrupt these patterns and present an opportunity for change.

With addiction specifically, I think the social-emotional-spiritual aspect of psychedelics can hit home pretty hard. Whether the addiction is related to trauma or just sensation-seeking, psychedelics can restore trust in oneself, other people, and nature. To reconnect in those ways is so important for recovery because typically, people with addiction decided at some point that people were unreliable. Maybe dad didn't show up at the baseball game, or mom was drunk all the time. So they find substances or behaviors they can rely on instead.

I think psychedelics can interrupt that learning that happened back then. These experiences can restore people’s sense that they really can trust themselves and others. Then they can turn back to the world of people, nature, or a higher power.

Your practice includes work with various behavioral addictions. Do you see a role for psychedelics in addressing things like, say, phone addiction or problematic sexual behavior?

I think there are nuances involved in all the different addictions, and it's important to know what the differences are. There have been several attempts at trying to come up with a unified theory of addiction or some sort of across-the-board common denominator, but in my opinion, we haven’t gotten there.

That said, the nature of psychedelics allows us to look at ourselves, our beliefs, our behaviors differently, and I think that can have an impact on all types of addictions. I don't know if you can target certain psychedelic molecules to certain types of addictions in any meaningful way.

One exception, maybe, is ibogaine. Ibogaine is particularly interesting because pharmacologically it's similar in some ways but also different in many ways from other psychedelic drugs. Something about how it interacts with opioid receptors makes it very compelling for both opioid use disorder and stimulant use disorder. It does have slightly higher cardiac risks, but with proper protocols, those risks can be managed.

What changes would you like to see in how we approach psychedelic-assisted addiction treatment?

I wish collectively we'd have a little bit more of an open mind about it. Look at how we’ve handled the opioid epidemic. Since 2002, we've had this massive campaign promoting buprenorphine and methadone as life-saving medications. Those medications have their place, but almost 25 years later, we still have an opioid crisis, a drug addiction crisis, and an alcohol use disorder crisis. We're so ready to promote buprenorphine and methadone. Why aren't we putting that kind of energy into the psychedelic tools we have sitting right here? People are dying, and lives can be saved.

In my opinion, there is more than enough research on psilocybin and MDMA alone to move forward with more access for more people. I don't care if that's through decriminalization, medicalization, therapy contexts, or community support contexts. I'm kind of agnostic about that. A lot of medical professionals feel it's only safe in a medical setting with therapy, but that's not the only model. Especially for addiction, people just need access and sometimes they don't want to go to a doctor's office or hospital.

That's why I want to mention psychedelicsinrecovery.org. It's a group where people can openly discuss how they're using psychedelics as part of their recovery journey in a very supportive and loving way. For people who like the 12-step culture but can't find a home there anymore because they're using psychedelics, it's become an invaluable resource and community.

Want more from Rick?

Connect with him on LinkedIn, or learn more about his therapy and alcohol or drug counseling services.

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DISCLAIMER: This newsletter is for educational and informational purposes only and is not intended as a substitute for professional medical advice. The use, possession, and distribution of psychedelic drugs are illegal in most countries and may result in criminal prosecution.