The last known experience at a Department of Veterans Affairs clinic with psychedelic-assisted therapy began in 1963. That was the year President John F. Kennedy was assassinated. “Surfin’ USA” topped the music charts and American troops had yet to be deployed in Vietnam.
At the time, the federal government was a hotbed of psychedelic research. The CIA explored the use of LSD as a mind control tool against adversaries. The US military tested the drug’s potential to incapacitate enemies on the battlefield. And the VA used it in an experimental study to treat alcoholism.
But the rise of recreational drug use, including hallucinogens, sparked a fierce political backlash and helped spark the War on Drugs, which, among other things, ended an era of research into the potential psychedelic therapy.
Nearly six decades later, a handful of clinicians have brought psychedelic therapy back into the veterans’ healthcare system. If their studies show promising results, they could mark a major step in the quest to both legalize and legitimize psychedelics and make them widely available for clinical use.
I spoke to four of the government researchers conducting studies on the use of MDMA, often called ecstasy, and psilocybin, to treat mental illnesses that have resisted current therapies for many veterans. The researchers addressed their motivations, apprehensions and hopes for the future of medicinal psychedelics.
Dig into memories like an archaeologist
Dr Shannon Remick, 34, has the military in her blood – having been raised by an army mother, navy father and navy stepfather. This familiarity with the armed forces is part of what drove her to become a psychiatrist at the VA, where she discovered that a significant number of veterans with post-traumatic stress disorder were unresponsive to conventional treatments.
Last October, she likely became the first clinician since the 1960s to administer psychedelics as medication to a patient in a VA clinic. The 10 patients in his study at the Veterans Affairs Clinic in Loma Linda, Calif., are veterans with PTSD who volunteered to undergo three sessions of MDMA in hopes of exploring the underlying roots of their distress.
Dr. Remick said it was crucial to build rapport and trust with patients during conventional therapy sessions before MDMA trips. Before a patient takes the pill, they set a calming mood by doing a breathing exercise, reading a poem, or having a veteran hold a personally meaningful object. MDMA sessions themselves, she said, are often self-directed, with the therapist doing more listening than talking.
The goal is to put patients in a state where they can examine and reflect on traumatic memories with less fear and aversion than they normally feel. She likened the process of making sense of painful moments from the past to sorting through an archaeological dig, a delicate process of discovery and understanding.
“We are alongside and with the patient as he explores some sort of excavation site,” she said. “At the end of the day, it’s not up to us to point fingers and say, ‘Hey, look at this,’ because what I see might not be the same from their angle.”
MDMA therapy caused him to postpone his retirement
Approaching her 60s a few years ago, Dr. Rachel Yehuda began contemplating retirement. She has been a prolific researcher and clinician for over three decades, studying, among other things, how intergenerational trauma affects the children of Holocaust survivors.
“I was proud of our work, but it didn’t lead to practical solutions for treating trauma survivors,” said Dr. Yehuda, professor of psychiatry and neuroscience at Mount Sinai’s Icahn School of Medicine and director of mental health at the VA Clinic in the Bronx.
But in recent years, Dr. Yehuda, now 62, has become fascinated with the revival of psychedelic-assisted therapy and has postponed his retirement. In early 2020, she began seeking permission to treat veterans suffering from PTSD with MDMA.
His study, which began in January and will include around 60 participants, will examine whether three sessions of MDMA are more effective than two in reducing symptoms of PTSD.
Dr. Yehuda said MDMA trips can be powerful catalysts for healing. She underwent one in 2019 as part of training for therapists – an experience she called eye-opening.
“It really made me realize what you’re supposed to do in psychotherapy,” she said. “I never really understood what it means to have a breakthrough.”
But she cautioned that researchers still have a lot to learn about the types of patients who will benefit from this treatment, the role therapists should play and the potential dangers.
“The opening process has to be done with the right therapists,” she said.
Studying whether MDMA can mend strained marriages
In her 23 years of treating veterans and studying the strengths and weaknesses of conventional PTSD therapy, Dr. Leslie Morland has recognized that standard treatments often fail to address the challenges veterans face. faced at work and at home.
Her quest to find more holistic interventions led her to develop a study examining whether MDMA can make couples therapy more effective.
“A lot of our servicemen learn to disconnect emotionally in order to be effective in combat,” said Dr Morland, 52. “And then we bring them back and say, ‘Now we need you to open up with our talk therapy.’
People with PTSD often have trouble connecting with intimate partners. Veterans who see improvement in symptoms often experience setbacks when they return to dysfunctional home environments, Dr. Morland said. According to the VA, veterans with PTSD have historically had intimacy issues and have more marital and parenting issues than veterans without the disorder.
Although no one has formally studied MDMA use with veterans and their partners, clinical studies with civilians have shown that the drug can alter relationship dynamics, Dr. Morland said.
“It helps to strengthen bonds and increase empathy,” she said.
In a clinical study she plans to launch later this year, Dr. Morland plans to recruit eight veterans in San Diego who have strained marriages and guide them through two sessions of MDMA that will be supported by talk therapy. The goal is to give couples the tools they need to understand and meaningfully address the causes of discord.
“How do they work together to really support the improvements that have been achieved in therapy? ” she says.
Psilocybin as therapy for methamphetamine addiction
Between 2010 and 2019, drug overdose death rates among veterans increased by 53%, killing more than 42,000 people. Deaths from psychostimulants, including methamphetamine, were particularly high, increasing by 669%.
Reliable treatment options are scarce, which has kept the relapse rate high.
These high mortality and relapse rates motivated Dr. Christopher Stauffer, 41, to treat meth-addicted veterans with psilocybin at a VA residential program in Portland, Oregon. The study will begin recruiting participants in the near future.
Psilocybin – the psychoactive ingredient in magic mushrooms – has shown great promise as an experimental drug treatment.
Dr. Stauffer said his research and clinical practice with civilians has shown him that patients often gain a new understanding of the impulses driving their addiction during a psilocybin session. A patient in a previous study compared the addiction to feeling trapped in a dense jungle.
“The psilocybin was like a machete,” Dr. Stauffer said. “They were able to kind of chart a path to connect with the people around them who were important relationships.”
Dr. Stauffer’s upcoming psilocybin study will compare the outcomes of 30 meth-addicted veterans who were admitted to a residential rehab program. Half will receive a combination of conventional therapy and two sessions of psilocybin while the other half will only receive conventional therapy.
In a second study, Dr. Stauffer will test whether MDMA can improve group therapy for veterans with PTSD by making participants more emotionally open and supportive of each other.
“Group dynamics can potentially really heal in ways that individual therapy cannot,” he said.
Dr. Stauffer said this new era of psychedelic research feels both retro and cutting edge.
“It’s brand new to a lot of people and yet it’s been around longer than most of our psychiatric drugs,” he said. “But it feels like we’re approaching it this time with a lot more knowledge and a lot of more rigorous research practices that didn’t really exist in the 1950s and 60s.”