In a groundbreaking clinical trial, a team of scientists from London Imperial College is investigating the ability of psilocybin, the active ingredient in psychedelic “magic” mushrooms, to treat problem gambling.
Beginning early this month, the government-funded study will see neuropharmacological researchers treat a small cohort of five gambling disorder patients with a high dose of synthetic psilocybin in a clinical setting.
In an interview, lead researcher Rayyan Zafar, PhD, told Bonus the study is a world-first:
Nobody has ever given psilocybin to anyone with gambling addiction before in a clinical trial. It represents a new frontier of research looking at behavioral addictions more broadly.
In addition to Zafar, the scientists undertaking the study from Imperial’s Centre for Psychedelic Research and Neuropsychopharmacology include former UK government drug czar and professor David McNutt, Dr. Matt Wall, and Dr. David Erritoze.
Ultimately, the team aims to test psilocybin’s safety and therapeutic potential to aid those experiencing gambling disorder.
The hope is that findings will contribute to the development of drug treatments available to patients in the UK through the National Health Service (NHS) and, hopefully, beyond.
Psychedelics Show Therapeutic Promise
In recent years, research has shown psychedelics may offer innovative treatment options for conditions including:
In clinical studies, psilocybin, in particular, seems to induce brain plasticity, essentially allowing rewiring of the brain’s circuitry. Researchers have proposed this opens up an opportunity to break old habits and introduce new ways of thinking following a therapeutic psilocybin experience.
As a result, the team believes psilocybin may also aid in treating gambling disorders by helping people break addictive patterns.
As they’re currently understood, Zafar said, addictions involve a dysfunction in the brain’s reward system.
Typically, reward pathways light up for things that feel good. For example: acing a test, winning a competition, or indulging in a favorite treat.
With addiction, however, the addictive trait hijacks the reward system, and the brain puts more value on related activities.
Zafar said when they scan problem gamblers’ brains, they show “excessive activation” of those pathways when exposed to gambling. That kind of dysfunction is part of what the team thinks might drive compulsive behaviors.
With this study, researchers will scan the participants’ brains before and after the psilocybin therapy to see if the treatment affects reward processing.
Looking for changes in the way the brain fires will be critical, said Zafar.
Does the brain change? And does that relate to changes in the clinical outcomes? Is it that the patients who recover the best are the ones whose reward systems change the most? Or is there something else?
“Peak Mystical Experiences” Earn Best Outcomes
Although the study kicked off this month, Zafar said patient selection won’t happen until early next year. First, there are ethical and regulatory hurdles to clear.
Once they have the patients, however, the process of psychedelic therapy is largely universal.
A therapeutic psilocybin treatment starts with prep.
Prep is the point where the patient meets the therapist, learns what to expect, and hears the benefits and risks of a psychedelic journey. They also prepare mentally, writing down intentions or topics they want their unconscious to explore during the treatment.
Next comes the high-dose psychedelic experience.
Blindfolded, patients go on what Zafar called an “internal journey.” Two therapists are on hand to help if things get unsettling, though patients are encouraged to embrace whatever comes up.
The best outcomes, said Zafar, follow the most intense trips.
They may have hallucinations or visualizations, realizations, moments of insight, they might have challenging experiences, but whatever happens, it’s part of the experience.
They’ll definitely be reaching what we call “peak mystical experiences.” We’ve actually found patients who have the greatest mystical experiences have the best outcomes. So we really want to push people into that zone.
After the psychedelic experience, said Zafar, the unpacking, or integration, begins.
That’s where we sit with them, get them to recount what happened during the trip, help them try and make their own conclusions about why certain things came up. A lot of it is about deferring autonomy to the individual to make sense of what happened, and we kind of act as armbands.
What they don’t want is to put ideas in people’s heads, he said.
We just want to give them the tools to figure out what happened and how they can use these new ways of thinking.
Benefits Outweigh Known Risks
With all medicine, risks are associated with any treatment, said Zafar.
But, by now, there’s enough psilocybin research to know that overall, it’s well-tolerated in patients, even those with severe mental health diagnoses, he added.
Still, he said, don’t try this at home.
We have very few concerns because we do it in a very safe and clinically effective way.
Appropriately done, added Zafar, the possibilities of psilocybin and psychedelics are profound.
He said addiction has the highest treatment gap for mental health disorders, and the numbers are even smaller for behavioral addictions like gambling.
Only around 10% of people with addiction actually receive treatment. So there’s a massive need to develop effective treatments and increase the uptake.
In the UK, only about 3% of people with a gambling addiction are in touch with specialist services. That means 97% of the population who suffer from a gambling addiction don’t see a doctor or specialist.
Currently, there are no licensed drug interventions for gambling disorders. So, there is potential to develop pharmaceuticals to aid in treating gambling addiction and improve recovery chances.
About a year from now, when data from all five patients is analyzed, they’ll know if they’re on the right track. If so, said Zafar, they plan to expand the study.
Psychedelic Research Gaining Ground
The first human trial of psilocybin treatment for gambling addiction is a step forward.
Unfortunately, funding for psychedelic research is minimal, particularly at the government level.
In this case, the Centre’s funding followed its groundbreaking research on the positive effects of psilocybin and talk therapy on depression. Another study exploring psilocybin versus Escitalopram for depression showed secondary outcomes favored psilocybin.
The UK Research and Innovation (UKRI) fund investment is hopefully a sign attitudes toward psychedelic science are changing, added Zafar.
Support like this is a big step forward for psychedelic research in the UK, and we hope this will catalyze more of the same in the future.
Funding is, unfortunately, a sticking point for other researchers intent on studying psilocybin’s potential to treat gambling disorders.
In May, Pedro Romero spoke at the 18th International Conference on Gambling and Risk Taking at the University of Nevada, Las Vegas (UNLV), highlighting his upcoming PhD research on psilocybin-assisted therapy for gambling disorder through the University of Gibralter’s Centre of Excellence in Responsible Gaming (CERG).
The industry veteran is a “seasoned” safer gambling expert, previously holding senior roles at gaming operators like Bally’s and 888Holdings and safer gambling charities in the UK, including Gordon Moody and Betblocker.
Romero is also a trained psychologist and psychodynamic and CBT counselor with a long clinical experience in private practice and different settings.
He told Bonus he was discouraged by the high relapse and drop-off rates for those in treatment for pathological gambling and wanted to help research alternative and more effective treatments.
Hindsight is 20/20
Then, about four years ago, Romero read Michael Pollan’s How to Change Your Mind and became interested in the potential of psychedelic-assisted therapy. He recalled a few anecdotal cases where clients experienced significant improvements after attending psychedelic retreats.
In hindsight, he became curious about the connection.
At the time, I didn’t think much about it and treated the experience in the same way that you analyze a dream. But, after reading the book, I became very intrigued about the potential of these treatments.
Fast Forward, Romero’s “midlife crisis” PhD research through CERG aims to dig deeper into the potential of psychedelics to help people affected by problematic gambling. However, they still need additional financial support to proceed with the study.
Funding for Psychedelic Studies Lacking
In some ways, Romero’s research plans are similar to the study about to be underway by Imperial’s research team.
In other ways, they look quite different.
While the UK team will administer the psilocybin dose in a clinical setting, Romero’s study will happen in a retreat environment in the Netherlands. In that setting, he won’t be administering the psilocybin, just collecting the data.
Otherwise, the process would be much the same. Romero will collect data about the participants beforehand. At this time, it’s looking like participants, likely about 12 of them, will come from a pool of veterans experiencing gambling harm.
Retreat participants will then go through prep, dosing, and integration in a retreat setting, and Romero will collect follow-up data afterward. However, brain imaging will not be part of the data collection in this case.
Romero is waiting for the retreat to obtain the funding to get the study off the ground. Donors have pledged about 50% of what’s needed to fund the first cohort.
The minute the funding comes in, they will start recruitment.
People need better therapies, Romero said. And he believes that psychedelics can deliver healthier outcomes for gambling and other addictions.
My hunch is probably around 60% will see an improvement, 50 to 60%. This is phenomenal compared with the result you’re getting with all types of therapy.