LSD and psilocybin for alcohol use disorder

1. Introduction

Version followed: the Bogenschutz and Forcehimes psychotherapy model for psilocybin-assisted treatment of alcohol dependence, as used in the NYU/University of New Mexico double-blind trial (NCT02061293; NYU IRB protocol s14-00614; Bogenschutz et al., JAMA Psychiatry 2022). It combines Motivational Enhancement and Taking Action (META, an MET/CBT treatment) with Preparation, Support and Integration (PSI) sessions. Two other published frames are noted as variants: the Copenhagen QUANTUM Trip Trial (MI, ACT and guided-imagery-and-music elements) and the Zurich relapse-prevention trial (brief BRENDA-based therapy). Historical LSD trials (pooled by Krebs and Johansen, 2012) are described only as history and are not for use.

Sources. Drawn from the trial protocol: the week-by-week session calendar of the double-blind trial, who was offered the open-label session, and the therapist stance during medication sessions (protocol text and schedule; minor errors in week numbers are possible). Also drawn on: the number of META and PSI sessions before each medication session and the STORC expansion (Bogenschutz & Forcehimes 2017); the sources the META manual draws on and its workbook "menu of strategies"; that the 2017 paper names "a values card-sort" but not the card set; the Zurich trial's session structure (secondary summary only); and the US federal Schedule I status of LSD, psilocybin and psilocin (DEA 2022). Not confirmed from a primary text: details in the JAMA Psychiatry 2022 paper and supplement beyond what the protocol and abstracts give, the Zurich session contents, the workbook contents and which card set was used. No NYU/UNM touch policy appears in the protocol, the 2017 model paper or the 2018 debriefing paper. Those parts stay [uncertain] or [synthesis].

Important framing. This is a research protocol, not an approved treatment. None of the sources cited here reports psilocybin as approved for alcohol use disorder (AUD) anywhere (as of June 2026). The drug component is run only inside regulated trials or licensed programmes, by medical staff. This guide gives no drug quantities, routes, schedules or administration details. What a psychotherapist can use now: (a) the psychotherapy and safety frame, if working inside an approved trial or programme; (b) the non-drug META components, which are standard MET/CBT for AUD; (c) harm-reduction and integration support for clients who have used psychedelics elsewhere. [source: Bogenschutz & Forcehimes 2017; NCT02061293 protocol; Drug Science 2026]

Core idea of change (as the authors frame it). Motivational and cognitive-behavioural therapy for drinking runs alongside one or more medication sessions with psilocybin. The psilocybin experience is held to produce intense, often meaningful experiences that can strengthen motivation, shift how the person relates to alcohol, and bring commitment to change. The therapy then turns that motivation into a concrete plan. The authors call the mechanisms speculative. In the pilot, the intensity of the first session's effects predicted later drinking reduction, lower craving and higher abstinence self-efficacy. Qualitative analysis of debriefings found several change processes: mystical-type experience, ego-dissolution, a changed relationship to alcohol, change talk and commitment, and the resolution of dysphoric experiences. [source: Bogenschutz & Forcehimes 2017; Bogenschutz et al. 2015 abstract (UNM repository); Nielson et al. 2018]

Legal and regulatory status (as of the sources' dates). Psilocybin and LSD are controlled substances in the main jurisdictions. Clinical use happens through research approval or special-access routes. Drug Science (June 2026) reports the following:

Oregon and Colorado (US) have state-regulated psilocybin frameworks.
New Mexico's Medical Psilocybin Act (2025) lists substance use disorders among its qualifying conditions; it does not name AUD specifically.
Utah runs a hospital-based pilot for treatment-resistant conditions.
The Czech Republic has allowed specialist-prescribed, individually prepared psilocybin since 1 January 2026, for defined indications.
Germany runs a compassionate-use programme for treatment-resistant depression only.
Switzerland grants individual exemptions to authorised physicians.
New Zealand has a ministerial-approval pathway.
Australia and Canada have limited federal access routes.

US federal status. LSD, psilocybin and psilocin are Schedule I under the federal Controlled Substances Act. The DEA defines Schedule I as a high potential for abuse, no currently accepted medical use in treatment in the United States, and a lack of accepted safety for use under medical supervision. [source: DEA, Drugs of Abuse 2022 edition] The state frameworks listed above cover psilocybin only. The regulatory sources cited here do not cover LSD outside the US [uncertain for other jurisdictions]. Check the current law where you practise before any involvement. [source: Drug Science 2026; Krebs & Johansen 2012 on historical regulatory barriers]

2. Framework

Overall format (NYU/UNM double-blind trial). About 12 weeks of manualised outpatient psychotherapy, with two day-long medication sessions at weeks 4 and 8. [source: UNM repository abstract of JAMA Psychiatry 2022] Each medication session has its own preparation beforehand and a debriefing the next day. The control condition was an active placebo with the same psychotherapy. Follow-up ran to 32 weeks after the first medication session (week 36), using Timeline Followback. The open-label pilot (10 participants) had 14 sessions over 12 weeks: 12 non-drug psychotherapy sessions plus the medication sessions. In the pilot, abstinence did not rise during the 4-week pre-medication therapy phase but rose after the medication session. [source: NCT02061293 protocol; Nielson et al. 2018; UNM repository abstract of the 2015 pilot]

Week-by-week calendar (protocol schedule and text). Week 0 is the start of the psychosocial treatment; randomisation happens just before the first medication session. Week numbers follow the protocol's schedule figure and text; minor errors are possible [uncertain on detail].

Weeks −4 to −1: screening. Weeks −1 to 0: baseline assessment.
Weeks 0–1: META 1 and 2.
Weeks 2–3: PSI preparation 1 and 2.
Week 4: first medication session, with the PSI therapists present. Next day: PSI debriefing.
Weeks 5–6: META 3 and 4.
Week 7: PSI preparation for the second session.
Week 8: second medication session. Next day: PSI debriefing.
Weeks 9–10: individualised META sessions. Week 12: a combined META/PSI session ends the treatment phase.
Assessment visits: screening, baseline, and weeks 4, 5, 8, 9, 12, 24 and 36 (week 36 is the end of blinded follow-up).
After week 36 (the end of the blinded phase), the protocol schedule adds a further open-label medication session at week 38, with PSI preparation before it and debriefing after it, META/PSI sessions in the extension, and assessments at weeks 39, 42 and 54. The protocol's aims state that every participant who met interim safety criteria was to be offered this extra session. A participant who had declined the second blinded session, but had no clinically significant adverse effects from the first, could also take part. [source: NCT02061293 protocol, Specific Aims, section 3.3.8.1.3 and schedule of events]
Earlier design: the 2017 model paper describes up to three medication sessions. It schedules two preparation sessions before the first and one before each later session, and puts the first two META sessions in the month before the first medication session. [source: Bogenschutz & Forcehimes 2017]

Two strands, delivered by a two-therapist dyad.

META (alcohol-focused): MET sessions first, then CBT-based planning sessions, then individualised modules. The first four META sessions are highly structured and later ones are individualised. The META manual was written for this protocol. It draws on materials from earlier multisite trials (Miller, 2004; Miller, Zweben, DiClemente & Rychtarik, 1992; Obert & Farentinos, 2000). Patients receive a workbook with a menu of strategies, and the protocol mentions pull-out teaching modules with worksheets. Neither the manual nor the workbook is public, and no title is given [uncertain on contents]. [source: Bogenschutz & Forcehimes 2017; NCT02061293 protocol]
PSI (medication-focused): preparation sessions, presence during medication sessions, and next-day debriefings.

Phases and goals (version followed):

Screening and consent. Medical, psychiatric and substance-use eligibility; informed consent from a trained investigator.
Motivational phase (META 1–2 in weeks 0–1, then PSI preparation 1–2 in weeks 2–3). Goals: build rapport; elicit the person's own motivation; give personalised feedback; explore values and the gap between values and drinking; take a life history; prepare for the medication session.
Medication session and next-day debriefing. Goals: a safe, supported, inward-focused experience; then making sense of it and linking it to drinking.
Action phase (META 3–4, weeks 5–6). Goals: turn motivation into a CBT treatment plan built on the STORC cycle (Situations, Thoughts, Organic patterns, meaning physical sensations and emotions, Responses, Consequences), linked to the values work and the medication-session experience. [source: Bogenschutz & Forcehimes 2017]
Second medication session (week 8, with preparation in week 7). Each later medication session has its own preparation session (revisit topics, revise plans, agree the session plan within protocol limits) and a debriefing the next day. The 2017 design allowed up to three medication sessions. The trial gave two blinded sessions, and the protocol figure shows a later open-label session at week 38. [source: Bogenschutz & Forcehimes 2017; NCT02061293 protocol]
Individualised META sessions to the end of treatment (weeks 9–12). Pull-out modules (self-help involvement, mindfulness, exercise, social-network change, alternative reinforcement, referral to further treatment). The plan is revised each session. [source: Bogenschutz & Forcehimes 2017; NCT02061293 protocol]

Criteria for moving between phases (from the protocol):

To a medication session: eligibility confirmed; preparation completed; on the day, a negative breath alcohol and drug screen, an acceptable withdrawal score and vital signs, and a pregnancy test where applicable. Participants are asked to try to stay abstinent the week before.
To discharge after a session: a structured mental status examination shows no residual risk (persisting perceptual changes, delusions, suicidal or homicidal ideation). A briefed friend or relative takes the person home and stays overnight. If risk remains, therapists stay until symptoms resolve or refer to emergency psychiatric services.
To a further medication session: none is given if adverse events suggest it would be risky, if significant negative effects persist, or if the participant declines. Psychosocial treatment continues either way. [source: NCT02061293 protocol]

Staffing (protocol).

Therapists hold at least a master's degree (or are training for one), and at least one team member is a physician.
Dyads are mixed-gender where possible, and never both of the gender opposite the patient.
A substitute therapist must have met the participant at least twice before.
A study clinician can be reached by phone at all times. [source: NCT02061293 protocol; Bogenschutz & Forcehimes 2017]

Variant frames.

QUANTUM Trip Trial (Copenhagen; Jensen et al., BMJ Open 2022 protocol). Population: DSM-5 AUD with ICD-10 dependence. Contact: one preparation session, a medication session day (about 8 hours from start to discharge), one integration session the next day (more if needed), and at least four MI sessions. Elements from MI, ACT and guided imagery and music. Two therapists (lead and assistant). [source: Jensen et al. 2022]
Zurich relapse-prevention trial (Rieser et al., eClinicalMedicine 2025; NCT04141501). Population: patients who had completed inpatient, outpatient or self-managed withdrawal treatment in the six weeks before enrolment. Structure: two preparation visits; one 8-hour outpatient medication session with two staff present, one of them a psychiatrist; and three integration visits. In total this was about 5.5 hours of psychotherapeutic contact, plus online surveys at 3 and 6 months. An MRI scan was done during the medication session, and the authors suggest it may have interfered with the therapeutic process. Therapy: semi-structured sessions based on BRENDA (MI and CBT principles), adapted for psychedelic-assisted therapy. The opened summary does not describe the contents of individual sessions [uncertain]. Results: no significant difference in abstinence at 4 weeks or 6 months. Blinding largely failed: about 92% of participants and 97% of therapists guessed allocation correctly. The full paper is not drawn on here, so details come from a secondary summary [uncertain]. [source: More Blossom summary of Rieser et al. 2025]

Historical LSD trials: history only, not for use. Krebs and Johansen (2012) pooled six randomised trials run between 1966 and 1970 (536 adults, mostly male inpatients). Sites were Toronto; VA hospitals in Palo Alto, Topeka and Sheridan; Mendota State Hospital; and the Maryland Psychiatric Research Center (Pahnke, Kurland, Unger, Savage, Grof). LSD was embedded in inpatient programmes such as therapeutic communities, group therapy and milieu therapy.

How they were run: preparation ranged from none to extensive (one trial aimed at a peak experience). Some patients were not told what drug they received. Sessions were mostly observation with brief reassurance; only three trials offered active guidance. Some patients were left alone during drug effects. Aftercare was minimal.
What was found: improvement in alcohol misuse at first follow-up (59% vs 38%), lasting to about 6 months but not significant at 12 months.
Adverse events: acute reactions included agitation, bizarre behaviour and one seizure in a patient with a history of withdrawal seizures. In one trial, about a third of patients had brief vivid re-experiences within a year, typically after drinking.
Why research stopped (per the authors): underpowered trials, unrealistic expectations that discounted modest effects, and the political history of LSD, which made regulatory approval harder.

This guide describes none of these regimens for use. [source: Krebs & Johansen 2012]

3. Guiding principles

Therapeutic intention. Enrol only people who want to change their drinking; the authors say others are unlikely to benefit. Practical: confirm a change goal before preparation starts, and keep returning to it. [source: Bogenschutz & Forcehimes 2017; protocol]
MI spirit throughout. Motivational interviewing style runs through every session, including preparation and debriefing. Practical: evoke, reflect and affirm rather than interpret or advise. Listen for change talk and reinforce it. [source: Bogenschutz & Forcehimes 2017; Nielson et al. 2018]
Non-directive support during the medication session. The aim is to help the person use the session, not to deliver directive therapy. Practical: say little; offer reassurance, grounding or redirection only when needed. [source: protocol; Bogenschutz & Forcehimes 2017]
Inward focus and surrender. Participants are encouraged to "trust, let go, and be open" rather than control the experience. Practical: teach this stance in preparation, then cue it during the session. [source: protocol, verbatim phrase]
Do not force it. Debriefing therapists reminded participants that "you can't force that." Practical: balance openness against pushing past readiness, especially before later sessions. [source: Nielson et al. 2018]
Set and setting are part of the treatment. A warm, homelike room, a standardised music programme, eyeshades, personally meaningful objects, and an agreed plan. Practical: prepare the room and the person with equal care. [source: protocol; Jensen et al. 2022]
Rapport and trust before medication. The authors state that preparation takes several hours across several sessions. Practical: do not compress preparation, and do not swap in a therapist the participant hardly knows. [source: Bogenschutz & Forcehimes 2017; protocol]
Integration into action. The experience matters through what it changes in values, goals and drinking behaviour. Practical: tie every debriefing back to drinking and to the treatment plan. [source: Bogenschutz & Forcehimes 2017; protocol]
Careful selection and medical cover. Exclude people at raised psychiatric, family-history or medical risk. A physician must be available, and emergency medication must be held by medical staff. Practical: the psychotherapist does not make medical decisions; escalate to the study physician. [source: protocol; Bogenschutz & Forcehimes 2017]
Consent to touch is set in advance. QUANTUM agrees touch during preparation and does not change it during the session; alternatives include a pillow or imagined touch. [source: Jensen et al. 2022] The NYU/UNM protocol, the 2017 model paper and the 2018 debriefing paper contain no touch policy and do not mention physical contact. The protocol describes session conduct as "supportive and non-directive": brief check-ins, reassurance, support, grounding and redirection, and verbal reorientation and reassurance if the person becomes distressed. [source: NCT02061293 protocol; Bogenschutz & Forcehimes 2017; Nielson et al. 2018] Whether the NYU/UNM trial allowed touch is not stated [uncertain]. Practical: agree the touch plan in writing beforehand, with consent checked again before any contact and the person free to withdraw it at any time; touch is never sexual; treat any uncertainty as no touch. [synthesis]
Two-person presence. Two therapists stay throughout; breaks are staggered so one is always in the room. Practical: never leave the participant alone. Krebs and Johansen flag leaving patients alone as a historical weakness. [source: protocol; Krebs & Johansen 2012]
Expect several change processes. No single mechanism is assumed. Practical: stay curious about whatever the person brings, including difficult content. [source: Nielson et al. 2018]
Fidelity and supervision. The treatment is manualised. Therapists are trained, certified on a simulated case, supervised weekly, and rated on recorded sessions. Practical: work only within a supervised protocol; outside one, keep to non-drug MET/CBT and harm reduction. [source: protocol]

4. Intervention inventory

Interventions 4.1–4.14 are the NYU/UNM protocol components; 4.15–4.16 are the variant-trial components; 4.17–4.19 are what a clinician outside a trial can do. The psychotherapist runs the psychological parts. Anything medical (examination, vital signs, ECG and laboratory tests, rescue medication, discharge sign-off) belongs to medical staff and is named here only so you know it exists. [source: NCT02061293 protocol]

4.1 Eligibility screening (team task; the therapist's psychiatric part)

Purpose / when: Before anything else, to exclude people at raised risk.
Steps:
1. Confirm the inclusion criteria: an alcohol dependence diagnosis on structured interview, a wish to stop or cut down, no current formal AUD treatment (12-step attendance is allowed), recent heavy drinking, capacity to consent, and a friend or relative who can take the person home and stay overnight.
2. Run a structured diagnostic interview, a family-history interview and a cognitive screen.
3. Screen out the psychiatric exclusions: schizophrenia-spectrum or bipolar disorder; current major depressive episode; current PTSD; current suicidality or a serious past attempt; a first- or second-degree relative with schizophrenia or schizoaffective disorder, or a first-degree relative with bipolar I.
4. Screen out the substance exclusions: hallucinogen use disorder, any hallucinogen use in the past year, or extensive lifetime use; recent dependence on cocaine, stimulants, opioids or cannabis; current non-medical use of cocaine, stimulants or opioids.
5. Check withdrawal on a standard withdrawal scale. Refer significant withdrawal for detoxification and reassess afterwards.
6. Medical staff check the medical exclusions (seizure disorder, significant liver, cardiac or cerebrovascular disease, uncontrolled hypertension, ECG abnormalities including QTc prolongation, pregnancy or lactation) and medications with interaction potential (e.g. antidepressants, antipsychotics, stimulants, lithium, anticonvulsants, AUD medicines).
7. Record any other exclusions: legal problems that could lead to imprisonment, and an investigator judgement of high risk of an adverse emotional or behavioural reaction. [source: NCT02061293 protocol] QUANTUM adds: history of delirium tremens or withdrawal seizures; significant neurological disease or head injury with prolonged loss of consciousness; recent AUD or serotonergic medication; other substance use disorders except nicotine. [source: Jensen et al. 2022]
Example language (illustrative): "Some of these questions are about your family's mental health history. They matter because certain conditions in close relatives raise the risk of a difficult reaction, so I need to ask carefully."
Watch for: under-reporting of hallucinogen use or of a family history; withdrawal symptoms presented as anxiety; ambivalence about the change goal. It is working when exclusions are documented clearly and the person understands why they matter.

4.2 Informed consent

Purpose / when: At screening, done by a trained investigator who knows hallucinogens and the protocol.
Steps:
1. Explain that this is research, including the chance of receiving the active placebo.
2. Describe the possible physical and psychological effects, including distressing ones.
3. Describe the rules: the companion, no driving home, staying under observation, abstinence before sessions, and that the person may withdraw at any time.
4. Explain the right to decline further medication sessions while continuing therapy.
5. Check understanding with teach-back [synthesis]. [source: protocol; Jensen et al. 2022 on placebo expectations] The protocol's detailed consent wording is not reproduced here [uncertain].
Example language (illustrative): "You might not get psilocybin; half the people get a comparison medicine. Either way, all the therapy sessions are the same, and you can stop the medication part at any point and keep the therapy."
Watch for: consent driven by hope of a cure; pressure from family members. It is working when the person can state the risks and the placebo possibility in their own words.

4.3 META 1: motivational interview with personalised feedback

Purpose / when: The first alcohol-focused session, to draw out the person's own motivation.
Steps:
1. Open MI conversation about drinking and its place in the person's life.
2. Give structured feedback from the baseline assessment: drinking compared with population norms, consequences reported, and motivation scores. Present it neutrally and ask for the person's reaction.
3. Reflect and summarise change talk.
4. Close with a summary of reasons for change and an open question about next steps. [source: Bogenschutz & Forcehimes 2017; protocol]
Example language (illustrative): "Here's where your drinking sits compared with other adults your age. What do you make of that?"
Watch for: defensiveness when feedback is delivered as a verdict. It is working when the ratio of change talk to sustain talk rises, and readiness ratings rise.

4.4 META 2: values card sort and values–behaviour discrepancy

Purpose / when: The second META session, to locate motivation in what the person values, including spiritual values.
Steps:
1. The person sorts value cards into levels of importance. The 2017 paper says only "a values card-sort" and does not name the card set [uncertain]. A widely used public-domain option is the Personal Values Card Sort from the University of New Mexico (Miller, C'de Baca, Matthews & Wilbourne, 2001). It has 83 value cards plus blank cards for the person's own values, sorted into very important, important and not important to me. The trial's use of this set is not stated. [source: Bogenschutz & Forcehimes 2017; CASAA Personal Values Card Sort]
2. Explore the top values: what each means and how it shows in daily life.
3. Ask how drinking fits with, or gets in the way of, each top value.
4. Reflect the discrepancy without pushing it.
5. Keep the list of values; it is used again in planning (4.12) and in debriefing (4.11). [source: Bogenschutz & Forcehimes 2017; protocol]
Example language (illustrative): "You put 'being a dependable father' at the top. How does drinking fit with that, or not?"
Watch for: values chosen to please the therapist. It is working when the person names a specific gap in their own words.

4.5 PSI Preparation 1: orientation, life review, rapport

Purpose / when: The first medication-focused session, before any medication session.
Steps:
1. Give an overview of how the study runs and its rationale.
2. Take a detailed life review: history, relationships, losses, spiritual or religious background, prior altered states.
3. Gather the person's values and build rapport.
4. Note material likely to come up in the medication session, such as grief or trauma [synthesis]. [source: protocol; Bogenschutz & Forcehimes 2017]
Example language (illustrative): "I'd like to understand your life story, not only the drinking. Things from your past sometimes come up during the session, and it helps if we've already met them together."
Watch for: trauma material that may need stabilisation first (current PTSD is excluded). It is working when the person speaks openly and trust in the dyad is evident.

4.6 PSI Preparation 2: expectations, effects, difficult reactions, ground rules

Purpose / when: Shortly before the first medication session.
Steps:
1. Review motivation and expectations, and clarify the person's intention for the session.
2. Describe the range of possible physical and psychological effects in general terms.
3. Teach how to meet distressing reactions: turn towards the experience rather than away; breathe; use the therapists as an anchor.
4. Invite the person to bring personally meaningful items, such as photographs or objects.
5. Agree the ground rules: staying in the room, safety, staying for the full observation period, the companion, the touch plan (see 4.15), and how the person can signal for help.
6. Address questions and concerns. [source: protocol; Bogenschutz & Forcehimes 2017; ground-rule examples partly synthesis]
Example language (illustrative): "If something frightening appears, the advice is to move towards it and get curious, to trust, let go and be open. We'll be right here. If you need us, just say so or raise your hand."
Watch for: rigid expectations of a particular experience; fear of losing control; catastrophic beliefs about "going crazy". It is working when the person can describe in their own words what to do if things get hard.

4.7 The two-therapist dyad

Purpose / when: The structure of the whole course.
Steps:
1. Assign a META therapist (alcohol work) and a PSI therapist (medication work). Both attend medication sessions. The META therapist may join PSI sessions; the PSI therapist may run preparation and debriefing alone.
2. Pair genders as the protocol requires (see staffing above).
3. Coordinate the two strands every week, so that medication-session material feeds into the META plan.
4. Have the team covered by a physician. [source: Bogenschutz & Forcehimes 2017; protocol]
Watch for: the participant splitting the two therapists ("the good one") [synthesis]. The authors note that the roles overlap in practice.

4.8 Conduct during the medication session

Purpose / when: Throughout the medication day, to keep the person safe and supported.
Steps:
1. Prepare a warm, homelike, non-clinical room, with the emergency procedures (SOPs) in place.
2. Before the session, medical staff run the day-of checks (breath alcohol, drug screen, withdrawal rating, vital signs, pregnancy test where applicable).
3. For most of the session the participant lies down with eyeshades and listens to the standardised music programme on headphones.
4. Both therapists stay in the room, taking breaks in turn so one is always present.
5. Make brief check-ins on mental state. Vital signs are taken at set intervals by protocol staff, alongside therapists' monitor ratings.
6. Offer reassurance, grounding (a calm voice, an orienting statement) or redirection inward when needed; if the person becomes distressed, start with words that reorient and reassure. [source: NCT02061293 protocol] The published NYU/UNM materials do not address physical touch [uncertain]. Use touch only if a written touch agreement exists under your own protocol, with consent checked before and during contact [synthesis; see the touch principle in section 3].
7. Cue the inward stance: "trust, let go, and be open".
8. As effects subside, allow more conversation about content and meaning. [source: protocol; Bogenschutz & Forcehimes 2017]
Example language (illustrative): "You're safe. We're both here. Let the music carry you and see what's there." Or: "It's okay to feel this. Breathe, and stay with it."
Watch for: rising agitation; attempts to leave; paranoid content; physical distress. Escalate medical concerns to the physician at once. It is working when the person can settle back into the experience after reassurance.

4.9 End of session, mental status check and discharge

Purpose / when: After the acute effects have passed, before the person leaves.
Steps:
1. Allow unhurried talk about the experience.
2. A clinician carries out a structured mental status examination: appearance, behaviour, speech, thought process and content, affect, cognition, judgement and insight, with direct questions about persisting perceptual changes, delusions, and suicidal or homicidal thoughts.
3. Brief the companion, who takes the person home and stays overnight.
4. If risk remains, stay until symptoms resolve, or refer to emergency psychiatric services.
5. Confirm 24-hour contact details. [source: protocol; Bogenschutz & Forcehimes 2017]
Example language (illustrative): "Before you go, I'll ask some routine questions to check how your mind is settling. Is anything you saw or heard still going on now?"
Watch for: lingering perceptual changes; elation with impulsive plans (for example, deciding to confront someone that night); emerging suicidal thoughts.

4.10 Written account of the experience

Purpose / when: The evening after the medication session, to fix the experience in memory for debriefing.
Steps:
1. Ask the person to write freely about what happened and what it meant, and to bring it to the debriefing.
2. Tell them not to worry about accuracy; Nielson et al. note that recall shifts over time and that integration matters more than precision. [source: protocol; Nielson et al. 2018]
Example language (illustrative): "Tonight, write down whatever you remember: images, feelings, any messages you took from it. No need to make it neat."

4.11 Next-day debriefing (integration)

Purpose / when: The day after each medication session. Usually both therapists attend; phone sessions and sessions with one therapist also occurred.
Steps:
1. Safety first: a mental status check and follow-up of any adverse events, including persisting effects.
2. Invite a detailed, open-ended account, using the written account.
3. Explore meaning: changes in how the person sees themselves, relationships, values, spirituality, and their relationship to alcohol.
4. Always ask how the experience bears on drinking and the wish to change (the protocol requires this in every debriefing).
5. Elicit change talk and commitment language, and reflect it back.
6. Process dysphoric parts with curiosity, looking for meaning.
7. Recall what the person said during the session, to aid memory.
8. Address stigma: whom they will tell, and how. [source: protocol; Nielson et al. 2018; Bogenschutz & Forcehimes 2017]
Example language: reflecting meaning back, as in Nielson et al.: "You really feel like you got that message..." (verbatim excerpt). Illustrative follow-up: "How does that connect with your drinking, if at all?" Or: "What would you want to do differently this week because of it?"
Watch for: fear left over from ego-dissolution (fear of losing one's identity); over-reliance on the experience ("I'm cured"); anxiety about disclosing to others. It is working when commitment statements and specific intentions appear and can be carried into the plan.

4.12 META 3–4: treatment plan using the STORC cycle

Purpose / when: After the first medication session, to turn motivation into action.
Steps:
1. Review the change goals and the medication-session experience.
2. Map typical drinking episodes on the STORC cycle: Situations, Thoughts, Organic patterns (physical sensations and emotions), Responses, Consequences. [source: Bogenschutz & Forcehimes 2017]
3. From the workbook's menu of strategies, negotiate strategies that break each link: avoiding or changing situations, challenging thoughts, coping with craving, alternative responses.
4. Tie each strategy to a value from META 2 and, where relevant, to an insight from the session.
5. Write the plan down and agree when to review it. [source: Bogenschutz & Forcehimes 2017; protocol] The 2017 paper confirms a workbook "that includes a menu of strategies", but the workbook is not public. The strategy examples above are paraphrased from the published description [uncertain on detail].
Example language (illustrative): "Let's take last Friday. What was the situation, what went through your mind, what did your body do, what did you do, and what happened next?"
Watch for: plans that are too vague; a person whose motivation is already high wanting to skip planning. In the pilot many were highly motivated after the first session, so the authors expanded the goals-and-strategies work. It is working when there are specific, rehearsed strategies for the person's highest-risk situations.

4.13 PSI preparation before any further medication session

Purpose / when: Before each later medication session, where the protocol includes one.
Steps:
1. Revisit all the earlier preparation topics.
2. Review what happened last time and what the person would like this time.
3. Revise the plan, and agree the session plan with the person within protocol limits.
4. Recheck eligibility and safety, including any adverse events since the last session. [source: protocol]
Example language (illustrative): "Last time you pulled back when the grief came up. How would you like to meet that if it comes again?"
Watch for: pressure to get a "bigger" experience; fear after a difficult first session. Declining is always allowed.

4.14 Individualised META sessions and progress monitoring

Purpose / when: The remaining weeks, to consolidate change.
Steps:
1. Choose pull-out modules to match the plan: self-help or mutual-aid involvement, mindfulness, exercise, social-network change, alternative reinforcement, and referral to further treatment.
2. Revise the plan every session.
3. Track drinking with Timeline Followback and motivation with readiness rulers. The trial also measured abstinence self-efficacy, craving and consequences with licensed questionnaires; these are not reproduced here.
4. Plan for after the programme ends. [source: protocol; Bogenschutz & Forcehimes 2017]
Example language (illustrative): "Since your friends all drink at the pub, would it help to look at who else you could spend Saturdays with?"
Watch for: fading effect over time. Krebs and Johansen found the historical LSD benefit was no longer significant at 12 months, which supports continuing care [synthesis]. It is working when heavy drinking days fall and stay down at follow-up.

4.15 QUANTUM variant: preparation with ACT, guided-imagery elements and a touch agreement

Purpose / when: Preparation session in the Copenhagen protocol.
Steps:
1. Discuss expectations, including the chance of receiving placebo.
2. Take the person's history and explain the expected effects.
3. Explore experiential avoidance (ACT): how the person pushes away difficult feelings, and how drinking may serve that function.
4. Run a standardised exercise informed by guided imagery and music. The exact script is not given in the sources cited [uncertain].
5. Agree touch explicitly. The agreement is not changed during the session; alternatives are a pillow or imagined touch.
6. Alongside: at least four MI sessions to strengthen commitment. [source: Jensen et al. 2022]
Example language (illustrative): "Would you want a hand on your shoulder if things get hard, or would you rather we didn't touch you at all? Whatever we decide now, we'll stick to on the day."
Watch for: consent to touch given only to please the therapist. If in doubt, treat the answer as no.

4.16 QUANTUM variant: session-day stance

Purpose / when: The medication day in the Copenhagen protocol.
Steps:
1. Two therapists (lead and assistant) stay throughout in a living-room-like space.
2. They take an "intermediate stance": present and practically helpful (for example, holding the person's phone, looking after food, drink and bathroom needs) without directing the experience.
3. Use a curated music programme that follows the phases of intensity, and encourage the person to turn inward and "follow the music".
4. The person does not leave the facility during the session. Discharge is to a designated adult, or the person stays overnight at the patient hotel.
5. One integration session the next day, with more as needed. [source: Jensen et al. 2022] The Zurich trial used two preparation visits, a single medication session and three integration visits of semi-structured BRENDA-based therapy. The content of each visit is not described in the sources cited [uncertain]. [source: More Blossom summary of Rieser et al. 2025]

4.17 Harm-reduction assessment for clients using psychedelics outside trials [synthesis]

Purpose / when: A client with AUD says they plan to take, or have taken, psilocybin or LSD outside a regulated setting. Your role is assessment, education and referral, never facilitation.
Steps:
1. Assess without judgement: intention, setting, who else is involved, and expectations.
2. Screen against the trial exclusions (4.1): personal or family history of psychosis or bipolar disorder, current depression or suicidality, cardiac or seizure history, and current medications. Explain in general terms why these matter.
3. Explain that combining any psychedelic with alcohol, or taking one during alcohol withdrawal, is outside every trial frame. People with withdrawal-seizure history were excluded, and the historical trials recorded a seizure in such a patient. Advise medical review of withdrawal risk, and of any medication interactions, with their prescriber or pharmacist.
4. Safety-plan: a sober, trusted person present; no driving; a plan for crisis help; and what to do if distress persists afterwards.
5. Point to legal options: trials, or regulated programmes where they exist.
6. Document the conversation and your advice. Never give or discuss quantities, sources or methods.
Example language (illustrative): "I can't help you plan to take it, but I can help you think through whether it's risky for you, and what to do if it goes badly."
Watch for: psychedelic use as a substitute for other treatment; a person who meets exclusion criteria; new or increased substance use.

4.18 Integration support after an outside experience [synthesis, adapted from the published debriefing approach]

Steps:
1. Check safety and current mental state, including persisting perceptual change.
2. Invite an open account.
3. Explore meaning, as in 4.11.
4. Link the account to drinking goals using MI.
5. Turn the insight into a STORC-style plan (4.12).
6. Refer for psychiatric assessment if psychotic, manic or severe anxiety symptoms persist. [source for method: Nielson et al. 2018; Bogenschutz & Forcehimes 2017; application outside trials is synthesis]
Example language (illustrative): "What from that night do you want to keep hold of, and what does it mean for the drinking?"

4.19 Responding to historical LSD claims [synthesis]

Purpose / when: A client cites LSD "curing alcoholism" in the 1960s, or took part in historical or underground sessions.
Steps:
1. Give balanced facts: pooled trials showed short-to-medium-term improvement that faded by 12 months; the trials had methodological weaknesses; some patients were not told what they were given or were left alone.
2. Make clear these regimens are not for use.
3. For people who took part in or were harmed by past sessions, assess re-experiencing (in one trial, re-experiences often came after drinking) and any distress about consent, and offer trauma-informed support. [source for facts: Krebs & Johansen 2012]

5. Handling problems

Low or wavering motivation (stuck client).

The authors say people without a change intention are unlikely to benefit. Before preparation, return to MET: feedback, values discrepancy, readiness rulers. Do not schedule a medication session to "create" motivation. [source: Bogenschutz & Forcehimes 2017; synthesis for the sequencing advice]

High motivation after the session, but no plan.

The pilot found many participants highly motivated after the first session. The authors responded by expanding META goal-setting and strategy work. Move quickly to STORC planning (4.12) while motivation is high. [source: Bogenschutz & Forcehimes 2017]

"I'm cured" (over-attribution to the experience).

Affirm the insight, then ask what will protect it in high-risk situations. Review the evidence on fading effects. Keep the plan and follow-up in place. [synthesis; fading effects: Krebs & Johansen 2012]

Overwhelm or a dysphoric reaction during the session.

Verbal reorientation and reassurance, grounding, and redirection inward.
Remind the person of the preparation plan (move towards the experience; the therapists are here).
If agitation or psychotic features persist, or there is danger to self or others, the study physician decides on protocol rescue medication.
Check for physical causes of high blood pressure (anxiety, pain, withdrawal) and escalate chest pain, breathlessness or focal weakness at once. [source: protocol] The psychotherapist does not choose or give medication.

Persisting effects after the session (perceptual change, anxiety, depersonalisation, suicidal thoughts).

Run the mental status check at discharge and again at debriefing.
Stop further medication sessions where risk is raised.
Keep psychosocial treatment going.
Refer to psychiatric emergency services if needed. [source: protocol] Re-experiences after drinking were documented in the historical LSD trials; ask about them explicitly. [source: Krebs & Johansen 2012; question advice is synthesis]

Fear left over from ego-dissolution, or distress about meaning.

Explore it with curiosity and help the person find meaning; normalise it as a reported phenomenon.
Do not impose a spiritual interpretation. The person's own framework leads [synthesis]. [source: Nielson et al. 2018]

Wanting to decline a further medication session.

Declining is always allowed. Therapy continues unchanged. Explore the reasons with MI, without persuading. [source: protocol; synthesis for the MI framing]

Non-adherence (drinking before a session, missed visits, positive breath or drug screens).

The day-of checks gate the session. Postpone, and treat the lapse as STORC material rather than as failure.
Significant withdrawal leads to referral for detoxification. [source: protocol; synthesis for the clinical framing]

Ruptures and splitting within the dyad.

Name the rupture and repair it in MI style.
Coordinate the two therapists' messages every week.
Keep substitutions to therapists the participant already knows (the protocol requires at least two prior meetings). [source: protocol; the rest is synthesis]

Touch and boundaries.

Agree touch beforehand and never change it during the session; use alternatives such as a pillow or imagined touch.
Two therapists are present throughout.
Document every touch. Any request for more intimate contact is declined and discussed at debriefing and in supervision. [source: Jensen et al. 2022; protocol; documentation and supervision advice is synthesis]

Stigma and disclosure.

Participants worried about telling others. Rehearse what to say and to whom, and weigh the support they could gain against possible judgement. [source: Nielson et al. 2018; rehearsal is synthesis]

Expectancy and blinding problems.

In Zurich, about 92% of participants and 97% of therapists guessed allocation correctly. Prepare people for the possibility of placebo and treat disappointment as clinical material. [source: More Blossom summary of Rieser et al. 2025; Jensen et al. 2022; synthesis]

Client using outside a trial.

Use 4.17 and 4.18.
Be clear about your role: harm reduction and integration, not facilitation.
Know your local law and your professional body's guidance [synthesis]. Document carefully.
If the client also has suicidal ideation, follow standard suicide-risk assessment and safety planning. [synthesis]

Co-occurring conditions that excluded people from trials (PTSD, current depression, bipolar disorder).

These people are outside the evidence base. Offer standard evidence-based AUD treatment and treat the co-occurring condition. [synthesis]

Loss of effect over follow-up.

Plan continuing care, mutual-aid links and booster sessions. The historical LSD benefit faded by 12 months. [source: Krebs & Johansen 2012; synthesis for the plan]

Sources

Web sources:

Papers cited:

Bogenschutz MP, Ross S, Bhatt S, et al. (2022). Percentage of heavy drinking days following psilocybin-assisted psychotherapy vs placebo in the treatment of adult patients with alcohol use disorder: a randomized clinical trial. JAMA Psychiatry. The session calendar above follows the trial protocol.
Bogenschutz MP, Forcehimes AA, Pommy JA, et al. (2015). Psilocybin-assisted treatment for alcohol dependence: a proof-of-concept study. Journal of Psychopharmacology.
Rieser NM, Bitar R, Halm S, et al. (2025). Psilocybin-assisted therapy for relapse prevention in alcohol use disorder: a phase 2 randomized clinical trial. eClinicalMedicine.

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