A qualitative study published in the journal Psychology of Addictive Behaviors has shed new light on the inner experiences that drive psilocybin-assisted therapy to reduce harmful drinking — offering some of the clearest first-person evidence yet of how the treatment works, not just that it does.
At a glance
- Psilocybin-assisted therapy: Researchers at NYU, UC San Francisco, and Fluence interviewed 13 participants from an earlier clinical trial who had significantly reduced harmful drinking after psilocybin treatment.
- Alcohol use disorder: The study, published by the American Psychological Association, found that psilocybin helped participants process suppressed emotions, develop self-compassion, and feel a renewed sense of connection — all of which had been eroded by long-term alcohol use.
- Psychedelic therapy research: The authors note that study participants were mostly white with an average annual income of $144,000, meaning findings may not yet apply to the communities most burdened by substance use disorders.
What the participants actually experienced
Most of the 13 volunteers described a childhood and adult life shaped by difficult emotions they had learned to manage through alcohol. Drinking, they said, had initially worked — dulling social anxiety, numbing distress, smoothing over feelings they had no other tools to handle.
But alcohol also isolated them. Participants described how it “inhibited a sense of connection with self and others as well as meaning and belonging.” Their inner lives, many said, were dominated by self-blame, guilt, resentment, and intrusive self-critical thoughts.
Psilocybin broke that pattern — sometimes dramatically. Participants used words like “catharsis” and “emotional rollercoaster” to describe their sessions. Several said the treatment helped them access and release emotional pain that had been locked up for years, pain that had driven them to drink in the first place.
Self-compassion as the turning point
One of the study’s most striking findings is how central self-compassion became for participants. The researchers, writing in the paper, found that “the acute states during the psilocybin sessions were described as laying the foundation for developing more self-compassionate regulation of negative affect.”
In plain terms: people who had spent years punishing themselves with self-critical internal voices found those voices quieted — or at least more manageable — after the psilocybin experience.
The authors concluded that psilocybin appears to increase what they call the “malleability of self-related processing,” loosening shame-based thought patterns and improving the ability to regulate difficult emotions without reaching for alcohol.
Many participants also reported a deepened sense of spiritual insight and learned mindfulness practices that helped them mentally step back from overwhelming thoughts — the kind that had previously sent them toward a drink.
The setting mattered as much as the substance
Participants were consistent on one point: the controlled setting and the presence of trained therapists were not optional extras. They were “essential elements in facilitating the psychological safety needed to examine and resolve psychological stuck points,” the paper notes.
This has real implications for how psilocybin treatment gets designed and delivered as more jurisdictions move toward regulated access. The study suggests that “a highly structured setting along with a strong therapeutic alliance, supportive therapy, and community-based aftercare support may be needed to transform rigid coping strategies into vehicles for healing and to manage strong cravings and prevent relapse.”
Co-author Elizabeth Nielson, co-founder of Fluence, said qualitative research like this “gives us a direct understanding of the lived experience of psychedelic therapy clinical trial participants, from their perspective and in their own words” — and adds a layer of texture to the quantitative data that clinical trials alone cannot provide.
A promising tool, not a cure
The researchers are careful not to overstate what the study shows. Cravings did not disappear entirely for all participants, and the authors are explicit that psilocybin is not a panacea. The differences in how people responded could help future researchers refine dosage, setting, therapeutic support, and follow-up care.
The equity gap in the research is also a serious limitation. The participant group was predominantly white with a high average income — far from representative of the populations carrying the heaviest burden of substance use disorders. “Black, Indigenous, and People of Color have been vastly underrepresented” in psychedelic research, the authors write, “even as the multigenerational effects of centuries of racialized policies burden them with high rates of trauma and other mental health sequelae.” Addressing that gap, they argue, is an ethical imperative — not just a methodological one.
Still, the study adds meaningful evidence to a growing body of research. At the federal level, the National Institute on Drug Abuse has been soliciting proposals for research initiatives exploring how psychedelics could treat addiction, with plans to provide $1.5 million in funding for relevant studies. The journal Psychology of Addictive Behaviors, where this study appeared, is published by the American Psychological Association — one of the field’s most respected peer-reviewed outlets.
The research also arrives as Oregon’s psilocybin program moves forward with its first licensed service centers, and as Colorado develops its regulatory framework for legal psychedelic access under a voter-approved initiative. Each step in that policy direction makes the question of how psilocybin-assisted therapy works — not just whether it works — more urgent and more consequential.
Read more
For more on this story, see: DoubleBlind Magazine
For more from Good News for Humankind, see:
- Alzheimer’s risk cut in half by drug in landmark prevention trial
- U.K. cancer death rates down to their lowest level on record
- The Good News for Humankind archive on mental health
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