Ibogaine And DMT Show Results In Treating A Notoriously Difficult Population

Among the potential uses for psychedelic therapy, treating veterans represents incredible potential – especially when evaluated against the at best mediocre efficacy of current treatments. We need better treatments for addressing post-traumatic stress disorder (PTSD) and substance use disorders (SUDs) such as alcohol use disorder (AUD), particularly in veteran populations.

A recent study evaluated ibogaine and 5-MeO-DMT as treatments for PTSD and risky alcohol use symptoms in United States (US) Special Operations Forces Veterans (SOFV).

 

Why?

Special Operations Forces (SOF) personnel are exposed to factors, including intense combat situations and longer time away from home, which increase their risk for traumatic brain injury (TBI) and developing post-traumatic stress disorder (PTSD). Veterans, including SOF personnel, often use alcohol to cope with the physical and mental toll of their experience. SOF personnel with combat-acquired TBI have a 2x higher risk for a drug or alcohol-related diagnoses compared to other veterans (Carlson et al., 2010).

So, what are the current treatments for addressing psychiatric symptoms in SOF personnel? How well do they work? (If you’ve been reading the Psychedelic Pulse, you can probably guess the answer to the second question already..) Current psychotherapies (“treatments that aim to help a person identify and change troubling emotions, thoughts, and behaviors” – NIMH) include:

• eye-movement desensitization and re-processing

• cognitive processing therapy

• prolonged exposure

• mindfulness-based interventions

• cognitive-behavioral therapy

• motivational interviewing

And, current pharmacotherapies include:

• selective serotonin reuptake inhibitors (SSRIs), such as Zoloft (sertraline)

• selective norepinephrine reuptake inhibitors (SNRIs), such as Cymbalta (duloxetine)

• tricyclic antidepressants, such as nortriptyline (Pamelor)

• mood stabilizers, such as carbamazepine (Tegretol, others)

Regardless of the specific treatment, effectiveness in SOF personnel is low. Treatment programs have high dropout rates, response rates are low even in those who remain engaged in treatment, and the complexity of symptoms often means that a treatment may address one or two trauma symptoms, but not addressing the whole patient.

SSRIs are notorious for sexual side effects, including libido loss and erectile dysfunction. It’s easy to dismiss these side effects as “not serious”, but they are among the most common reasons cited by patients as to why they wished to stop taking the drug.

 

Study Design and Methods

This study took place from 2019 to 2021 at a legal clinical psychedelic program in Mexico. Veterans were referred to the program via word of mouth and underwent a full physical and psychological screening with doctors prior to acceptance into the program, to ensure they were suitable candidates for treatment with psychedelics.

The treatment lasted a total of three days.

On day 1, participants learned about ibogaine and its effects, including possible side effects. They also wrote down their intentions for treatment. Then, participants approved for treatment received a 10 mg/kg oral dose of ibogaine, in a group setting with up to five others.

On day 2, participants were again encouraged to journal to help integrate and process their experience from day 1. Participants could also choose to join in individual or group (or both?) integration sessions with a psychologist.

On day 3, participants received a preparatory session on the effects of 5-MeO-DMT. They then received at least three inhaled doses (at strengths of 5 mg, 15 mg, and 30 mg), and could receive optional doses (30 mg and 45 mg) if needed for desired effects. After DMT effects subsided, the participants underwent a final integration session.

A total of 99 veterans participated in the study. The researchers used a pre-study survey, and sent follow-up surveys at 1-month, 3-month, and 6-month post-session. 86 participants completed the pre-survey and were eligible for data collection, but full data was only available from 45 participants. Some participants completed the pre-survey and 1-month survey, but did not return the 3-month and 6-month surveys, for example – and this would cause their data to be excluded from analysis.

You can read full details on data collection and analysis by checking out the full study.

 

Results and Conclusions

Prior to treatment:

• 29% of study participants screened positive for moderate-risk drinking

• 29% of participants screened positive for high-risk drinking

• 42% of participants screened positive for severe-risk drinking

SOF veterans who received psychedelic-assisted therapy saw a significant reduction in risky alcohol use symptoms.

The table below shows the percentage of veterans who responded to surveys and were identified as abstinent (not drinking alcohol), engaged in non-risky drinking, or engaged in risky drinking.

“But abstinence rates drop over time. What gives?”

Good eye! Yes, the percentage of participants who remained abstinent from alcohol dropped over time. There’s a troubling increase in those engaged in risky drinking between 1-month and 3-month post session. Based on my background, experience, and best clinical guess, I think this demonstrates a need for more than one session.

Remember, participants in this study underwent a single 3-day program in Mexico in which they received one dose of ibogaine and one dose of 5-MeO-DMT. The psychotherapy interventions, in my opinion, were not as intense as in other studies I’ve evaluated (check our archive for past psychedelic-assisted therapy studies that involved multiple 1:1 sessions with a trained therapist). I would love to see a study that involves more frequent psychotherapy, preferably with a therapist already seeing the patient.

Those who experienced a response (abstinent or non-risky drinkers) also had a significant reduction in PTSD symptoms one month following treatment. Those considered “non-responders” (engaged in risky drinking after treatment) did not experience a reduction in PTSD symptoms. PTSD symptoms were evaluated using the Posttraumatic Stress Disorder Checklist (PCL-5).

One limitation? These results are specific to SOF veterans, and should not be extrapolated to other populations. 87% of participants were white, and 100% were male. The median age was just under 43 years old. That doesn’t mean there’s reason to believe ibogaine or 5-MeO-DMT would act differently in different populations – quite the opposite. The positive results from this study should help fund further research applying these treatments in different populations – for example, female veterans experiencing similar symptoms.

Respondents were largely Caucasian/White (87.2%), non-Hispanic (89.5%), middle-aged (M = 42.88, SD = 7.88), and male (100%; Table 1).

 

Conclusion

Treatment with ibogaine and 5-MeO-DMT, combined with integration sessions and psychotherapy, caused significant improvements in PTSD symptoms and risky alcohol use among SOF veterans. The veterans who experienced improvement in risky alcohol use also experienced PTSD symptom improvement; on the other hand, if veterans did not experience a significant reduction in risky alcohol use, they also didn’t note a significant improvement in PTSD symptoms.

This is an interesting study approach, in that both ibogaine and 5-MeO-DMT were used sequentially as part of a treatment protocol. I’d expect to see similar studies conducted in the future, as we learn more about subtle differences amongst psychedelics. For example: using psilocybin first, followed by MDMA – perhaps a single psilocybin session could enhance the effects of MDMA in patients with trauma. There are so many possibilities, it’s dizzying.

I hope this review left you as excited as I am for the future of psychedelic-assisted therapy. If not? I’ll be back with another study to win you over soon 😉