The Use of Psychedelic Drugs in the Treatment of Severely Disturbed Children: A Review

Psychedelic Treatments in Adolescent Psychopharmacology: Considering Safety, Ethics, and Scientific Rigor

Interest in psychedelic therapies for adults is rapidly growing, with substances like 3,4-methylenedioxymethamphetamine for posttraumatic stress disorder, psilocybin for treatment-resistant depression, and lysergic acid diethylamide for generalized anxiety disorder showing promise. However, research on these therapies in children and adolescents is limited, with no recent trials. Despite this lack of scientific exploration, adolescents may still experiment with these substances for both recreational and therapeutic purposes as accessibility continues to increase. This raises significant concerns, as adolescents are a vulnerable population requiring heightened caution and safety measures. Therefore, we advocate for structured, safe, and well-controlled exploration of psychedelic therapies in adolescents.

Psychological effects of psychedelics in adolescents

This study aimed to investigate differences in long-term psychological effects, acute subjective effects, and side effects associated with psychedelic use in adolescents (aged 16-24), compared with adults (aged 25+). Data from two observational online survey cohorts was pooled, involving adolescents (average age 20.4 ± 2.2, N = 435) and adults (average age 36.5 ± 9.7, range = 25-71, N = 654) who self-initiated a psychedelic experience and were tracked via online surveys from a pre-experience baseline to four weeks post-use. Self-reported measures of well-being were collected one week before, and two and four weeks after psychedelic use. Acute subjective drug effects, dosage and contextual variables pertaining to the setting of use were measured on the day after the session. Repeated-measures analyses of covariance, t- and z-tests, as well as exploratory correlational and regression analyses tested differences in psychological changes, acute drug effects, and side effects between the two groups. Psychological well-being significantly improved in adolescents two and four weeks following psychedelic use, with a clinically relevant mean change score of 3.3 points (95% CI: 1.1-5.5). on the Warwick-Edinburgh Mental Wellbeing Scale [F(1.8, 172.9) = 13.41, η 2G = .04, p < .001], statistically indistinguishable from changes in adults. Acute subjective effects differed between the age groups; adolescents reported significantly higher challenging experiences and ego-dissolution. In adolescents, visual symptoms related to "hallucinogen persisting perceptual disorder" (HPPD) were reported at a higher prevalence than in adults (73.5% vs. 34.2%, p < .001) but were reported as distressing by only one adolescent participant. To our knowledge, this is the first prospective study to examine the psychological effects of psychedelic use specifically in adolescents. Statistically significant improvements in psychological well-being and other domains of mental health were observed, consistent with effects seen previously in adults, providing tentative evidence for the potential utility of psychedelic interventions in adolescents. However, differences in acute subjective effects, specifically the less positive role of ego-dissolution experiences for long-term changes in adolescents, as well as a higher prevalence of HPPD-related symptoms suggest that special considerations might be required when assessing psychedelic treatment design and risks.

Human hallucinogen research: guidelines for safety

There has recently been a renewal of human research with classical hallucinogens (psychedelics). This paper first briefly discusses the unique history of human hallucinogen research, and then reviews the risks of hallucinogen administration and safeguards for minimizing these risks. Although hallucinogens are relatively safe physiologically and are not considered drugs of dependence, their administration involves unique psychological risks. The most likely risk is overwhelming distress during drug action ('bad trip'), which could lead to potentially dangerous behaviour such as leaving the study site. Less common are prolonged psychoses triggered by hallucinogens. Safeguards against these risks include the exclusion of volunteers with personal or family history of psychotic disorders or other severe psychiatric disorders, establishing trust and rapport between session monitors and volunteer before the session, careful volunteer preparation, a safe physical session environment and interpersonal support from at least two study monitors during the session. Investigators should probe for the relatively rare hallucinogen persisting perception disorder in follow-up contact. Persisting adverse reactions are rare when research is conducted along these guidelines. Incautious research may jeopardize participant safety and future research. However, carefully conducted research may inform the treatment of psychiatric disorders, and may lead to advances in basic science.

Flashback to the 1960s: LSD in the treatment of autism

Between 1959 and 1974, several groups of researchers issued reports on the use of d-Lysergic Acid Diethylamide (LSD) in the treatment of children with autism. This paper reviews that literature to consider how the authors justified these studies, as well as their methods, results, and conclusions. The justification for using LSD was often based on the default logic that other treatment efforts had failed. Several positive outcomes were reported with the use of LSD, but most of these studies lacked proper experimental controls and presented largely narrative/descriptive data. Today there is renewed interest in the use of psychedelic drugs for therapeutic purposes. While this resurgence of research has not yet included children with autism, this review of the LSD studies from the 1960s and 1970s offers important lessons for future efforts to evaluate new or controversial treatments for children with autism.

Psychotherapy with hallucinogenic adjuncts from a learning perspective

A number of well-controlled studies have indicated that hallucinogen-assisted psychotherapy is both safe and effective. Following an historical overview, psycholytic and psychedelic therapy approaches are reviewed in terms of rationale, technique, applications, and outcomes. A new theoretical approach stemming from a learning orientation is offered as a conceptual basis for beneficial use of hallucinogens in psychotherapy. As a technology, the hallucinogens have not yet found acceptance as a useful therapeutic adjunct in the United States.