How to Become a Psychedelic Therapist: From Clinical Trials to Integration Therapy and Everything in Between

Michelle Janikian

More people than ever are curious to try psychedelics for mental health and personal growth. But even though “psychedelic-assisted therapy” is going mainstream, the actual substances, like psilocybin, MDMA, LSD, and ayahuasca are still Schedule I substances in the U.S. Yet despite their illegality, doctors and therapists are regularly getting inquiries from their clients about psychedelics for addiction, PTSD, depression, and more. So, what can professionals do to start working with psychedelics – legally?

Path One: Legally Facilitating Psychedelic Journeys 

At the moment in the US, the only way for clinicians to legally facilitate psychedelic experiences with MDMA or psilocybin is in a clinical trial (we’ll get to substances like cannabis and ketamine below). These trials are being held at select universities in the US, like Johns Hopkins, NYU, and others. Each substance requires their own training by the different organizations that sponsor these trials. In the case of MDMA, that training is provided by the Multidisciplinary Association for Psychedelic Studies (MAPS), and for psilocybin, it’s provided by either Compass Pathways or the Usona Institute, depending on the trial.

MAPS is currently training physicians (MDs, DOs, psychiatrists, and other “eligible prescribers”) as well as licensed therapists to work on phase 3 clinical trials using MDMA for PTSD and to form therapy pairs to open potential “expanded access” sites in the near future. MAPS training consists of five parts, beginning with an online course, which covers the basics from their treatment manual as well as recent scientific research and study protocols.

For part B, trainees attend a 7-day in-person retreat with “senior MDMA-assisted psychotherapy researchers,” which is often Michael and Annie Mithoefer. “[the Mithoefers] are really the core people that have been doing this since the beginning,” says Angie Leek, MA, LMFT who completed Parts A and B of the training in 2019.“Even if I never get to do this work – which I hope I do – but even if not, it was phenomenal,” elaborates Leek. “It influenced my clinical work without being able to do the MDMA part, for sure.” 

Then, parts C, D, and E become more hands-on and include days of experiential learning with an opportunity to have an MDMA session, a day of role-playing, and then, supervision and evaluation of trainees’ first few sessions.

While getting trained to work with MDMA may seem simple and straightforward, the problem is that the training isn’t free. In fact, it’s out of budget for many, especially on a therapist’s salary. For instance, because Leek doesn’t live near a clinical trial site, she has decided not to complete training until the future of the therapy is more concrete. Until then, she can’t afford to keep paying out of pocket. She tells Psychedelics Today she paid $3,500 for the first two parts of the training, and she was told completing all 5 parts costs $7,000. As of now, MAPS has not announced training costs for 2020. Interested clinicians can apply for MAPS MDMA training here.

To work with psilocybin, professionals are trained by either Compass Pathways or the Usona Institute, however (as far as I can tell) training to work with either of these organizations is not currently open to the public. At the moment, only research professionals at universities hosting this research can currently be trained to work with psilocybin.

It’s also important to note that both MDMA- and psilocybin-assisted therapies are on track to become legal, FDA-approved medications for specific conditions in the near future. The FDA has granted both substances “breakthrough therapy status” which fast-tracks them for approval. According to MAPS’s Director of Communications, Brad Burge, MDMA is expected to be approved for the treatment of PTSD by 2021. Yet, in an email, Burge tells Psychedelics Today that MDMA could become available for expanded access in as soon as a few months.

The expanded access program, also known as “compassionate use”, gives patients with life-threatening conditions the right to obtain and use unapproved drugs and medical devices outside of clinical trials. In early 2019, MAPS applied for expanded access for MDMA to treat PTSD, considering the high risk of suicide those with treatment-resistant PTSD face, and it’s expected to pass in early 2020. Therefore, many trained MDMA-assisted therapists and prescribing physicians could be needed very soon to open expanded access MDMA sites around the US.

Which is why another route many in this field consider is applying to the California Institute for Integral Studies (CIIS) Center for Psychedelic Therapies and Research. This one-year long certificate program is an in-depth study on psychedelic-assisted therapy and research, taught by the leading experts in the field, including Anthony Bossis, Rick Doblin, Charles Grob, and Michael and Annie Mithoefer. The program is only available to licensed professionals, like licensed family therapists, medical doctors, and registered nurses. Plus, acceptance into the program is competitive. According to an email CIIS sent to a recent applicant, they will be accepting a total of 75 students for their class of 2020, meaning one in four applicants will be admitted. 

The program is completely accredited and considered the most prestigious training for psychedelic-therapists, yet completing the certificate does not guarantee graduates the ability to work with psychedelic substances or even on clinical trials. After completing the certificate, graduates will still have to undergo training from organizations like MAPS, Usona or Compass, and pay for it themselves.

Path Two: Training in Trauma and Transpersonal Psychology

Before professionals jump right into psychedelic-assisted therapy training, there are a few schools of psychological thought and therapy modalities they can get familiar with that can inform their work with “non-ordinary states of consciousness”. 

For instance, although CIIS’s psychedelic therapy program may not be the best fit for everyone right now, two therapists we spoke to for this story received their master’s degrees from the university, and chose it for its focus on transpersonal psychology. 

Transpersonal psychology is a school of psychological theory that considers the spiritual and transcendent aspects of life alongside modern psychological thinking, and it has been used by professionals to help folks work through altered states for decades. If you’re interested in learning more, check out the books and articles by Stanislav Grof as well as educational programs at Sofia University and Naropa University

Another important area to be well versed in professionally before working with psychedelics is trauma. In fact, all the experts we spoke to for this story stressed the importance of training in different trauma modalities, especially somatic practices, as well as understanding and being comfortable with transference and projection. This level of comfort comes from both training in the subject matter and doing your own inner work. 

While some of the training programs we’ve listed cover these issues, both Leek and Saj Razvi of Innate Path recommended Peter Levine’s Somatic Experiencing training as an informational and trustworthy source of trauma and somatic therapy work. Other integration coaches and therapists have also recommended the Hakomi Institute, a body-centered, trauma-based psychotherapy method that helps people work with strong emotions through mindfulness and guided meditations. 

And of course, many in this field stress the importance of professionals doing their own inner work with psychedelics as an important aspect of training. While this can be contested in the community, it does seem like processing one’s own non-ordinary states of consciousness can help others do the same. For now, MAPS’s MDMA training does include an opportunity for clinicians to receive their own MDMA-assisted therapy session. While the CIIS program does not currently include any medicine work, they do incorporate opportunities for transpersonal breathwork and other drug-free forms of altering consciousness.

Path Three: Psychedelic Integration Therapy Training

Both therapists I spoke with for this piece, Robin Kurland, LMFT and Angie Leek, LMFT, told me they’d be interested in getting trained to facilitate psychedelic-assisted therapy in clinical trials, but haven’t found the whole process to be very accessible, especially considering the uncertainty of this work, it’s just not worth it to shell out over $10k for training. However, they both found a compromise in offering their clients “psychedelic integration therapy.” 

Unlike psychedelic-assisted therapy, integration therapists do not provide clients with any type of guided psychedelic trip. They can, however, help interested folks in preparing for and then integrating their psychedelic experiences by discussing what it means to them and how they can use any insights or realizations they had in their everyday lives. It’s a very new thing for licensed therapists to offer even though psychedelic therapists in clinical trials and underground have been providing clients with prep and integration sessions for decades. But with the increased interest in this work and in people trying substances on their own or at retreats abroad for healing, aboveground therapists have begun helping people navigate the sometimes tricky emotions that come before and after these peak experiences.

Training for psychedelic integration is limited but exists and is growing quickly. The organization Fluence, based in New York City, hosts accredited classes for interested clinicians, called “Psychedelics 101 and 102” taught by Elizabeth Nielson, Ph.D. and Ingmar Gorman, Ph.D. In their two-day long workshop, they cover everything doctors didn’t learn in medical school about psychedelics, from past and present research to harm reduction and how to help clients prepare for and integrate their sometimes troubling experiences. Gorman and Nielson are also hosting a 3-day long retreat this January 17-20, 2019 in the Catskills, New York called “Psychedelic Integration in Psychotherapy: A Retreat for Clinicians.”

There are also options for life coaches and other interested individuals who are not necessarily licensed doctors and therapists. One popular choice is Being True to You (BTTY), which offers a four month long, psychedelic integration coach training program that’s completely online for $3,500. 

Here at Psychedelics Today, our founders Joe Moore and Kyle Buller also host an online course for clinicians, therapists, and coaches looking to expand their knowledge of psychedelic research and provide psychedelic integration to clients. The next eight-week live online course is enrolling now and begins on February 6th, 2020. The first four weeks cover the basics, including the history of psychedelic research, safety tips like preparation and navigating the space, and an intro to Stanislav Grof’s transpersonal psychology framework. Then in weeks 5 through 8, classes get more specific to clinicians, and cover topics like how to support psychedelic-curious clients, how to help clients integrate their experiences, and how to navigate the legal and ethical considerations. 

MAPS is also a source of psychedelic integration education and has provided webinars as well as in-person training sessions in the past. This year, MAPS is planning another webinar series for April 2020 with a session on integration, Burge confirms. “Integration tends to be one of the most popular topics we address in our webinars, conferences, and educational materials,” Burge says.

Despite recent training offerings, many psychedelic integration therapists can still get frustrated by this work, mostly because it has to be substance-free at the moment. Kurland says she mostly worries about people taking mushrooms by themselves in less than ideal situations. “That’s really why I want to hurry and get the ball rolling with the FDA and have that certificate [from CIIS]. I would love to just be able to say, I’m going to sit with you and you’re going to be safe. I’m going to hold space for you and whatever comes up, we’re going to work through it and I’ll be there to hold your hand,” says Kurland. 

Path Four: Working with Legal Altered States of Consciousness: Cannabis, Ketamine, and Transpersonal Breathwork

A new option emerging in this field is working with legal or prescription substances, like cannabis and ketamine. Psychiatrists already have the ability to give ketamine to patients in their offices as an “off-label use” for treatment-resistant depression, PTSD, and other conditions. It’s becoming increasingly popular, with ketamine infusion clinics opening around the US. Naturally, there are a number of ketamine training programs emerging alongside. So many, in fact, that we decided to dedicate a whole future piece on ketamine-therapy training, so keep an eye out.

Then there’s cannabis, which many argue is psychedelic in its own right and is legal in a majority of states for adult or medical use. And there are two programs in Colorado taking advantage of that fact. The first was Medicinal Mindfulness; they offer group psychedelic cannabis ceremonies, 1:1 cannabis therapy sessions, and now, cannabis “trip-sitting” training for any interested party. 

There is also Innate Path, who began offering cannabis-assisted therapy to clients in 2018 in a very similar fashion to psychedelic therapy, and are now offering training to professionals. Innate Path co-founder and Director of Education, Saj Razvi tells me his cannabis-assisted therapists don’t actually give clients any weed, the client has to bring their own, which avoids any legal conflicts. This allows providers to practice psychedelic therapy before MDMA or psilocybin pass through the FDA, and if it catches on, has the potential to expand access drastically. 

Razvi explains the cannabis-assisted therapy modality he and his co-founders have been developing over the course of several years is very body-focused and influenced by his own work as an MDMA-assisted therapist in MAPS’s phase 2 clinical trials, as well as the work of Peter Levine and Eugene Gendlin, the theorist, and philosopher who inspired Levine. At Innate Path’s training workshops, they teach therapists their somatic method, transference work, and psychedelic-therapy principals, which they use for both ketamine and cannabis-assisted therapy.

Of course, there is also the option of working with non-substance induced altered states of consciousness. “Holotropic” or “transpersonal” breathwork is a non-ordinary state very similar or indistinguishable from the psychedelic experience for many. Developed by Stanislav and Christina Grof, they have their own training program called Grof Transpersonal Training (GTT) that teaches practitioners to facilitate and process breathwork experiences with clients. 

Dreamshadow Holotropic Breathwork is another group of trustworthy breathwork facilitators who offer an educational training program. Their founders, Lenny and Elizabeth Gibson, are colleagues and close friends of the Grof’s and are also who trained Psychedelics Today founders, Joe Moore and Kyle Buller, in this work.

Path Five: Trip Sitting

For clinicians and non-professional folk alike, getting trained to trip sit by MAPS’s Zendo Project is a great entry into the world of psychedelics. Zendo sets up shop at music festivals like Burning Man to provide a safe and tranquil place for people going through difficult psychedelic experiences to come and relax. They train sitters to be a calm and supportive presence for trippers without “guiding” their experience in any direction. 

Zendo hosts trip sitting training workshops around the US to prepare interested participants for volunteering at events, and is a great way to learn the basics of “holding space” and to get experience working with those under the influence of a psychedelic substance. Zendo also has great resources for interested folk, like webinars and their book, The Manual of Psychedelic Support.

All in all, there are many options for all skill sets and types of professionals to get involved in this work. While becoming a psychedelic therapist right now might be expensive, it is possible. For those who can’t budget the risk until this therapy becomes more available, there are plenty of other options with lower price tags. We hope this piece cleared up some misconceptions in the community and can help folks choose the right path for them.

We realize there are also underground training options but they can be unreliable and hard to vet, so we decided to only focus on aboveground options for this piece.

About the Author

Michelle Janikian is a journalist focused on drug policy, trends, and education. She’s the author of, “Your Psilocybin Mushroom Companion: An Informative, Easy-to-Use Guide to Understanding Magic Mushrooms – From Tips and Trips to Microdosing and Psychedelic Therapy”, and her work has also been featured in Playboy, DoubleBlind Mag, High TimesRolling Stone and Teen Vogue. One of her core beliefs is ending the prohibition of drugs can greatly benefit society, as long as we have harm reduction education to accompany it. Find out more on her website: or on Instagram @michelle.janikian.

Should Breakthrough Psychedelic Research Make Us Question Our Assumptions About Mental Illness?

By: Jonathan Dinsmore

Since the lifting of the irrational 30-year ban on psychedelic research around the turn of the millennium, scientists have been proving once again what researchers in the 50s and 60s had already begun to find: psychedelics are extremely promising treatment tools for some of the most prevalent and often treatment-resistant psychological disorders like depression, addiction, and PTSD. We truly live in very exciting times for psychedelic research.

Given the overall state of the world’s mental health, this research is sorely needed, and long-overdue. With the kind of success rates we’ve been seeing, with lasting relief sometimes from one or a few sessions, it’s reasonable to predict that these remarkable substances will play an increasingly important role in the treatment of many mental illnesses, and hopefully will also be sanctioned for safe use in other contexts, as well.

While their effectiveness is becoming more and more established, psychedelics’ “mechanism of action” is perplexing to many psychologists, particularly to believers in prevailing ideas about mental illness and treatment. They’re clearly working, but why or how are they working? What is the cognitive or neurological basis for their sometimes near-miraculous treatment success?

One thing that’s not yet being discussed enough is how the high success rate of psychedelic therapies can be seen as a challenge to dominant mainstream paradigms about psychiatric epidemiology (the study of what causes mental illnesses), particularly the reductionist biological chemical imbalance theory, and related ideas. While we’ve all heard psychedelics are working, the largely untold story is how the way they seem to work should cast doubt on prevailing theories of mental illness.

Reductionism in Psychology

Psychology today has become dominated by the idea that most common mental disorders, particularly mood disorders like depression, can be explained by reducing mental activity to things like chemical imbalances in the brain, a wrench in the neurochemical gears so-to-speak, which are generally more or less random and/or biologically predetermined. While the psychological sciences have acknowledged more recently that depression is more complex than that, the idea remains prevalent among psychiatrists, and the overall view of mental illness in general remains mechanical and biological.

In other words, scientific reductionism in psychology dominates the scene, and determines how mental illnesses are understood, and treated. Like the universe itself, according to philosophical materialism which many think of as “the scientific worldview”, mental illness is considered a random, meaningless occurrence, which is best controlled by adding new chemicals to the brain to offset the error, and perhaps implementing cognitive-behavioral changes through the efforts of the conscious, rational mind. We are biological robots in a meaningless universe, and mental illness is like a computer malfunctioning.

This has become the predominant model in the orthodox paradigm of psychiatry, yet many in the field have contested reductionist psychology from the beginning, whether on the grounds of being economically motivated by the pharmaceutical industry, or as part of a larger philosophical rejection of the cultural shift towards scientism. This has come to be known as the biopsychiatry controversy.

There are many reasons for objecting to biological reductionism in psychology, but the general idea is that a sizeable dissenting minority of psychologists believe reducing everything to brain chemistry and other scientifically measurable variables isn’t enough when it comes to understanding the human mind. Even in a purely materialistic universe, the inability to account for the role of emergent qualities in psychological health goes largely ignored, under this model. While this skepticism of the reduction of the psyche is a powerful intuition in itself, there are also good reasons for believing in the limitations of biopsychiatry on a rational basis, as well.

Psychology has a rich history of non-reductive theories which emerged from other types of methods of investigation, including the humanistic and depth psychology traditions, as well as transpersonal and contemplative approaches, to name a few. Could these now alternative theories of the mind help us understand the findings of the psychedelic renaissance; to go even further, could their legitimacy even be implied by psychedelic experiences, themselves?

Psychedelic Revelations of the Mind

It’s difficult to dive very deeply into studying psychedelics and their impact on the mind without running into ideas and phenomena that are heretical to the mainstream “scientific worldview”. This no doubt contributes to the apprehensiveness with which scientists and regulators have approached them. Some psychedelic researchers and other intellectuals have suggested non-reductionist theories about the positive effects of psychedelics, which most in the field of modern psychiatry reject a priori, such as psychodynamic or even transpersonal ideas.

These alternative perspectives often pertain to branches of psychology which recognize and deal with things outside the purview of biopsychiatry (meaning things that aren’t so easy to measure), and which aren’t taken seriously by materialism. These include phenomena such as the dynamic between the conscious and unconscious mind, and its importance to psychological well-being, and potentially transcendental components of the human psyche, or at least the importance of transcendental states of consciousness. Because they are difficult to measure and prove, all these are things which the biopsychiatry crowd usually relegates to the realm of pseudoscience, or speculative fancy, and denies their very existence.

Yet, in light of the therapeutic and transformative effect of psychedelics, these ousted theories do seem to be granted a rise in validity. This is not to say that the findings of cognitive neuroscience research into psychedelics are no longer relevant, but an honest assessment of the psychedelic experience in all it’s profound strangeness coupled with its therapeutic success should at least call reductive assumptions into question. If psychedelic experiencers and researchers observe the emergence of unconscious material, and mystical or other non-ordinary states of consciousness, and these seem to act almost like a miracle cure for many of our psychological ailments, why should we ignore what that implies about the ailments themselves?

Depths and Heights Encroaching

The problem (for reductive explanations) is that some of the findings of psychedelic research indicate that their unique action, which can sometimes bring almost overnight cures or at least long-lasting one-time treatments, may pertain to both the emergence of psychological content from the unconscious mind, and also their ability to take people to the heights of human mystical experience. Most people who have encountered psychedelics in culture know of the profound realizations or otherworldly qualities they’re said to have, and in the lab, they are not so different. What’s surprising to those totally disconnected from the very idea of spirituality is that they work so well.

It’s not uncommon to hear recipients of psychedelic therapy say things like, “It was like years of therapy in one night,” or therapists reporting that “Miracles are becoming — not mundane, but pretty normal around here.” Since psychedelics are being found to accelerate psychotherapy by allowing people to discover underlying issues which had been inaccessible to normal therapeutic practices, this arguably implies that there are unconscious elements that influence and perhaps cause mental illnesses, a view long held by depth psychology known as psychodynamics

Although the unconscious is not necessarily outright rejected by all cognitive scientists, some of whom have proposed a more reductive “New Unconscious”, it has generally been rebuked or deemphasized by the more science-oriented modern trend in psychiatry. The subjective psychedelic experiences of therapy recipients where unconscious material seems to be brought to the surface of consciousness, therefore, calls this rejection into question and deserves further investigation. This is compounded when some neuroscience indicates the validity of psychodynamic models, as well.

While psychedelics’ effects on the unconscious psychodynamics are only slightly explored in the literature, psychedelic mystical experience is a far more heavily researched topic, and its long-lasting psychological benefits have been a central point of the larger discourse around psychedelic research since the time of the Good Friday experiment, in 1962. Some have noted that the benefits of psychedelic mystical experience may relate to their ability to enhance the perception of meaning, another area where science remains agnostic beyond questionnaire measurements. The phenomenon of ego dissolution, where a person’s sense of self is temporarily obliterated to be born anew like a phoenix, also seems to be a major part of what creates these transformative effects.

Tracing from Cure to Cause

Although we typically approach illness by first investigating its cause and then using that knowledge to find its treatment, it is possible to do the reverse, when effective treatments already exist. We can learn more about the cause of a problem through what treats it best; in this case, a better understanding of the epidemiology of mental disorders may be derived from the very fact that the psychedelic experience treats or resolves them better than other methods, and this is most pointedly true in the case of depression.

The negative implications of psychedelics’ success for the chemical imbalance theory of depression aren’t difficult to see. Conventional biopsychiatry wisdom says that depression is a random chemical imbalance, although in more recent years they have broadened it to include “caused by a combination of genetic, biological, environmental, and psychological factors. (NIMH)” The ability of psychedelic mystical experiences to drastically improve or even cure depression, potentially by enhancing meaning, should be a clue that depression may have causes which are simply difficult to measure, and therefore not amenable to a scientific definition.

For instance, some have proposed that a major part of the epidemic of depression is something deeper than a mere chemical imbalance, but is instead a side-effect of a cultural swing towards the philosophy of materialism. Of course, many deny this connection, or even that materialism is inherently depressing, but it’s hard not to see this as straw-grasping. You don’t have to have a doctorate in philosophy to recognize that scientific materialism is dreary, as it basically tells us that we are little more than dust in the wind of a meaningless, purposeless, cold and cruel universe. To deny the inherent bleakness of this perspective is an exercise in futility; I won’t belabor the point here. What’s worse, this is now put forward as the intellectually orthodox worldview.

Naturally, this is not to say that scientific materialism and its intrinsic nihilism are the only reason that people get depressed; no doubt, various factors like economic disparity and poverty, political chaos, childhood development issues, and trauma play a huge part. Regardless, the fact that psychedelic experiences both help with depression and tend to make people more spiritually-minded should give the bio-centric psychiatrists pause. Just because it’s difficult to measure or explain, is it really so hard to see how psychedelics’ ability to show that we might be more than just space dust successfully treats people’s depression, and that this might shed light on a major cause or contributor to the disease itself?

A War of Ideas On the Battlefield of the Mind, and It’s Casualties

The point of critiquing reductionism in psychology is not that we should leave the psychiatric sciences behind us, but rather that a pluralism of methodologies and theoretical approaches have their place, in our quest to understand and heal the human mind. Measuring the activity and chemical levels of the brain during mental illness, or during the psychedelic experiences that seem to treat them, need not lessen or replace other theoretical systems, but instead can supplement them. It doesn’t have to be either/or.

This seems like a fairly pragmatic, diplomatic, and agreeable assessment, but unfortunately, psychology has become a casualty to a much larger ideological war of scientism against all things immeasurable. Psychology is merely one domain, one battlefield in this philosophical conquest, but a critically important one because so much of our suffering or well-being hinges on our having the best understanding of the human mind we can achieve.

One result of this parsing out of anything that can’t be scanned, measured, or repeated in a lab is that the default treatment for mental disorders has become (conveniently for pharmaceutical giants) psychoactive daily medications like antidepressants. We have reached a point in psychiatry where the central goal is essentially to chemically engineer the population’s neuro-soup, until all can be productive members of society, ideally in a way that is highly profitable. The fact that antidepressants aren’t really working comes as no surprise to those who never believed in the adequacy of biopsychiatry, in the first place.

While many seek refuge from guilt or blame in the biological definition of their mental illness, the reality is that understanding our illnesses to be more than just random neurochemical accidents, but perhaps fragmentations or distortions of the psyche which can be healed, can replace biological fatalism and reliance on daily doses of Xanax with hope and progress towards restored mental health. Psychedelics can help us make great leaps towards that brighter future, once we recognize and integrate the things they are showing us, and let go of our outdated ideological assumptions. 

About The Author

Jonathan Dinsmore is a writer and digital freelancer with a degree in psychology, and a passion for all things philosophy, science, spirituality, and psychedelics. 

Psychedelic Exceptionalism and Reframing Drug Narratives: An Interview with Dr. Carl Hart

By Sean Lawlor

Dr. Carl Hart is neuropsychopharmacologist and Chair of Columbia University’s Department of Psychology. His research, which focuses on the behavioral and neuropsychological effects of psychoactive drugs in humans, has been published widely in academic journals, and Dr. Hart has discussed his research on numerous shows including Democracy Now!, The O’Reilly Factor, and The Joe Rogan Experience.  His award-winning memoir, High Price: A Neuroscientist’s Journey of Self-Discovery That Challenges Everything You Know About Drugs and Society, charts Dr. Hart’s journey from childhood in a harsh Miami neighborhood to an academic life devoted to reframing society’s biased and harmful narratives around stigmatized drugs. 

At the 2019 Psychedelic Science Summit in Austin, TX, Dr. Hart addressed a crowd of psychedelic enthusiasts about concerning language he’s noticed in psychedelic-focused conversations. In this interview, Dr. Hart explains how these narratives create a “psychedelic exceptionalism” that perpetuates harmful narratives around drugs like heroin, methamphetamine, and crack cocaine, by extension demonizing people who choose to use such substances. In these transitional times, Dr. Hart reminds us of the importance to hold healthy criticism while always maintaining focus as humanitarians. 


SL: In your speech, you were less gung-ho about this psychedelic renaissance than other people. This was partly due to something called “psychedelic exceptionalism.” Can you speak about this?

CH: This term refers to the perspective that psychedelics are somehow better and more useful than other classes of drugs like opioids or stimulants. I was just trying to remind people that these are all psychoactive substances. They interact on receptors in the brain to produce their effects, and we shouldn’t be treating some drugs as if they’re special while other drugs are somehow evil. Drugs all carry some risk, and depending on how you define danger, they fall on different levels of the spectrum of risk, and benefits. 

SL: So, you’re responding to seeing people glorifying psychedelics while continuing to demonize substances that have been demonized since the War on Drugs, if not before? 

CH: That’s exactly it. It’s great to be enthusiastic about your drug of choice. But remember not to vilify other drugs. That puts people at risk, and it marginalizes people. I don’t think anybody really wants to do that.

SL: Can you say more about how that puts people at risk?

CH: When people talk about heroin being evil or dangerous in generalized ways, it stigmatizes that drug and, by extension, people who use that drug. Then, we have increased penalties, and we view those people as being defective for even using that drug. 

SL: A way of “othering” those people, putting them in a negative box. 

CH: That’s right. We did that with crack, and we did that with that methamphetamine. But you look at MDMA versus methamphetamine, and the chemical structures are not that different. But we have wildly different narratives about them. It’s just not warranted.

SL: What do you see as the roots of this exceptionalism?

CH: I think people think that they’re being strategic. Folks who want to increase the availability of psychedelics for medicinal reasons, for recreation — I think they feel that if they associate with stigmatized drugs, then that stigmatizes their drug of choice. They’re playing a political game, a numbers game — you could say they’re calculating this. But there are people who are really suffering, who don’t have a choice to calculate, and no one’s given us the right to play with people’s lives based on politics. What’s wrong is wrong, what’s right is right, and it’s wrong to vilify drugs and people. No matter what.

That’s why I try to keep the focus on doing what’s right as a human being, as a humanitarian. It’s just wrong to vilify people for wanting to alter their consciousness and the particular drug that they use, especially when you’re doing the same thing with another drug. That’s just inconsistent with respecting other people’s humanity. 

SL: I think a lot of people have seen friends and family die from opiates. You talk about how these deaths may be due to what they’re getting, how much fentanyl may be in there, etc. But if someone’s caught in cycles of addiction with drugs that have a higher overdose potential than, say, mushrooms, and a high dose of mushrooms could allow them to work on deeper issues fueling addictive cycles, how could that drug not be seen as more healing?

CH: Because there are all kinds of assumptions with that question that are flawed. First of all, it’s not up to me to decide what people choose to work on and what drug they use. If they choose heroin as opposed to mushrooms, that’s cool. That’s their decision as autonomous adults. And if we think heroin is uniquely more dangerous than mushrooms — well, if we’re talking about respiratory depression, yes, it certainly can be. But if we’re talking about paranoia at large doses, mushrooms are more dangerous.

When we look at the Swiss situation, with a regulated supply of heroin and all sorts of services, you don’t have the problems of overdose that we see in this country. So it’s not the drug. It’s the conditions under which the drug is being administered. 

Now, we do have people in our country who are dying from heroin or opioid-related overdoses. That’s a fact. But that has more to do with the stigma and the social conditions under which the drug is being taken. I am wholeheartedly in support of dealing with those issues, which are not that complicated. We could have a regulated supply of heroin. We could check the mixture to verify that people don’t have an adulterated drug. With mushrooms, you’re less likely to have adulterants in your compounds than you are with opioids. That’s a problem, but not of the opioid itself. That’s a problem of our supply.

SL: How about the problem of what’s underlying people’s addictions in general?

CH: That’s a whole different issue, that we have to figure out why people are addicted. People are addicted for a variety of reasons — and when I say “addiction,” I mean the DSM criteria for substance use. Those criteria have to do with people’s inability to inhibit, their lack of responsibility skills, or the conditions under which these drugs are available or not available. It has more to do with all of those things than, again, the drug itself. 

It’s true that opioids can produce a physical dependence, whereas other drugs are less likely to. But alcohol can produce a physical dependence that is deadly, and we do alcohol relatively well in this country. There are people who have problems with alcohol, but the vast majority of folks don’t. So, alcohol will remain legal. 

Whether it’s a drug or an activity like driving a car, people can and will get in trouble. It’s crazy to think we’re somehow going to prevent all negative possible outcomes of some activity. We can certainly take steps to minimize it. And we do. And we could do the same thing with drugs like heroin.

SL: You said something during a panel that elicited a strong response. I believe your quote was, “Heroin made me a better person.” I’m curious what that meant. 

CH: I don’t remember the context that I was saying that. But the point I was trying to make is simple. We have alcohol at receptions, for example, where alcohol functions as a social lubricant. The same can be true with a drug like heroin. 

Many of these psychoactive substances people use make them less anxious, more magnanimous — all of these kinds of things. That’s not a shocking statement. It’s only shocking for people infected with the Puritanism virus. Anybody who knows anything about drug use, particularly with opioids, knows they can enhance positive social interactions, and that’s why many people take them.

SL: You’ve said that only 25% of people who use heroin are addicted, which is different than the instant-addiction cultural narrative we’ve inherited.

CH: Yeah. But still, you don’t want people to become addicted. And when I say addicted, I mean the DSM criteria, not just physical dependence. People who take antidepressants, for example, have physical dependency. They can’t abruptly stop after taking antidepressants for a number of years. They have to be weaned off. The same is true with opioids. So when I say “addiction,” I mean that the person is distressed by their drug use and the consequences of their drug use, and they have disruptions in psychosocial functioning. 

That 25% still concerns me. But I think it has to do with the stigma associated with heroin. People have to hide their use and engage in tremendous risk because of how society sees heroin. In places like Switzerland, where heroin is available medically, you don’t see people engaging in disruptive behaviors to get it. They just go to the clinic and they get their daily doses. In many cases, these people work. They’re responsible members of society.

SL: If there’s a psychedelic correlate to these trends, I’d say it’s LSD. Microdosing is popular, but LSD carries the heaviest social stigma of any psychedelic. I hear far less people speak publicly about their use of it than mushrooms and MDMA, which have essentially been adopted as “good.” And LSD often appears at festivals, where you don’t know what you’re getting, and really bad stuff can happen.

CH: Exactly. You hit it on the head. We see that with all stigmatized drugs. People are more likely to take risks that decrease their likelihood of getting the drug they’re seeking, because people can replace them with more potent drugs. And that could be dangerous. 

SL: Do you see any effort in this psychedelic community to combat psychedelic exceptionalism?

CH: I have to tell you, I’m always disturbed when people identify themselves as a “psychedelic community.” That seems fucking bizarre to me. When you have all of these psychoactive substances, and people are taking them for similar reasons of altering consciousness, and then you have a line —  these drugs over here, these drugs over here — I just find it bizarre that people would even identify as such a thing. 

SL: Have you noticed that delineation more than me saying it right now? 

CH: Oh, yeah. I didn’t mean — you’re absolutely right. I’m just saying as a neuropsychopharmacologist, as somebody who’s interested in consciousness and having your consciousness altered by these substances, it just seems strange that people would have the audacity to include themselves in a single sort of community that delineates its boundaries in a way that excludes other people doing the same thing. 

SL: Yeah, that very language is a kind of exceptionalism, aligning with a “community” that uses drugs that are becoming less stigmatized and more popular.

CH: Yeah. It’s very disturbing. It’s just inconsistent with being a humanitarian.

SL: I’m thinking about how the War on Drugs set regulations in place that have disproportionately affected people from particular areas or particular races who tend to associate with particular drugs, and how that’s created, institutional divisions.

CH: But it’s not necessarily the laws. It’s the enforcement of the laws. The laws can be enforced in a way that hits across the various dimensions of society. But the laws are not enforced in that way. The enforcement of the laws seems to focus on specific communities of color, so enforcement is the problem. 

My expertise is in drugs, so I focus on that. But this is not unique to drug law enforcement. This is how we behave in this country in general. That’s why I try to help people to understand how their verbal behavior about one compound versus another contributes to a misperception that allows for disproportionate enforcement of the drug laws.

SL: What is your parting advice for people invested in this psychedelic renaissance? 

CH: I would ask that people think about the language they’re using for substances they like versus their language for substances that have been vilified. I ask that people think about the narratives that have been built around crack cocaine and heroin versus the narratives built around drugs like psilocybin and MDMA, and how wildly they conflict. Whether people are using heroin or MDMA, they’re seeking to alter their consciousness. They’re seeking intimacy with partners. They’re seeking the same things.

SL: Thank you for your time, Dr. Hart. I figured some biases and assumptions would come through my questions, but hopefully representing them here can help dismantle them for others who read it.

CH: I hope so. Thank you for doing this. And if you just remind people to think about other people’s humanity in the same way they think about their own, this won’t be an issue. If they think of people as being equal to them, this is not a problem. We all make mistakes, and that’s fine. But once you remember that no matter who you’re dealing with, they’re another person who deserves the same kind of respect you deserve, then it becomes easy.

About Sean Lawlor

Sean Lawlor is a writer, Naropa grad student, and practitioner of flotation therapy in Boulder, CO. His interest in non-ordinary states owes great debt to Aldous Huxley, Ken Kesey, and Hunter S. Thompson, and his passion for dreaming draws endless inspiration from Carl Jung and J.K. Rowling. 
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