"Addictive"

The U.S. National Institute on Drug Abuse adopts a distinctly psychiatric point of view on what drug addiction is. Their web page entitled "What is drug addiction?" defers directly to DSM5, and features lots of colorful pictures of brain scans. Hence, the U.S. Government officially endorses the orthodoxy, that this is a brain issue, a proper medical science issue: medical doctors must be in charge, and health insurance must pay.

But the brain is not what gets treated for addiction; or at least, the brain is not treated directly. Psychiatrists are not brain doctors, neurologists are. Google searches will bring up lots of information about the "neurology of addiction," but it's all theoretical, undemonstrated in the real world. There are no neurologists to go to for drug addiction, they might get paid to research it, but not to treat it. You go to psychiatrists, psychologists, or other "mental health professionals" or "substance abuse professionals" for actual treatment. The treatment is for behavior, emotions, cravings, and thinking, not for any specifically defined brain mechanisms or pathology.

Those professionals who do treat drug addiction come with a plethora of impressive sounding academic credentials and licenses, from clinical neuropsychologists to social workers to twelve-step facilitators. The only medical doctors in the crowd are psychiatrists, who fiddle with a lot of drugs that will randomly and unpredictably (mostly badly) affect your brain, and electricity that will damage it so you can't remember things. A new category may soon be psychedelic therapy facilitators, who will say psychedelic drugs are "non-addictive", and promote them to cure addiction.

But people who use psychedelics can become psychologically addicted to the altered perceptions and mystical revelations that come with "tripping." Repeated LSD use quickly causes tolerance, requiring a frequent user to take increasingly larger doses for the same effect. MDMA ("Molly"/"Ecstasy") is notorious as a "highly addictive drug" for its production of extreme psychological dependence. But LSD and Molly are leading candidates as "treatment" of addiction, including alcoholism. Of course, this is awkward for branding of psychedelic therapy facilitators.

Addiction is a highly variable phenomenon. For example, some people actually enjoy cold turkey withdrawal from nicotine (I did, 40 years ago). Others suffer such nagging torture that they literally cannot quit smoking without complicated help. This variability in addiction may be true with most drugs. I've known psychiatric patients who stopped whole cocktails of psychotropics with no obvious problems, and others who went crazy just trying to taper off a single SSRI antidepresssant.

But psychedelics are unpredictable by a whole higher order of magnitude, and not only for possible addiction. The informed consent task is completely different or impossible, because risks of a "bad trip" depend on so many factors that will never be clinically controlled, and benefits are mostly extolled and sought by the public as mystical or spiritual breakthroughs. Only MAPS tries hard to establish some modicum of what they think might pass for "science" with the FDA, so there can be enough money in "Psychedelic Assisted Therapy (PAT)" to pay for lawyers who will defend against sexual abuse lawsuits.

It is tempting to predict that psychedelic drugs will be the death of psychiatry as a medical specialty. If the APA and British RCP (Royal College of Psychiatrists) make the mistake of hitching their wagons to the ongoing "psychedelic renaissance," they'll risk turning themselves into Timothy Leary apostles. They might as well just climb aboard that painted bus to the destination, "FURTHER."

The death of psychiatry will be good, but collateral damage will be terrible: more people will take psychedelics. Practical military and intelligence establishments won't be duped into killing innocents again, but we may see a fresh crop of Jim Joneses and Charlie Mansons.

And the sexual abuse will give therapy itself a bad name.