In recent years, there has been a tremendous resurgence of interest in psychedelics. Research is underway on their therapeutic use, and they are being discussed in books, media, journals, and podcasts. At the same time, an increasing number of individuals in my office have shared their experiences with psychedelics and bring up questions about them in relation to mental health. I appreciate that people feel comfortable discussing whatever they wish with a psychologist. However, some hesitate to talk about this because they fear judgment from the psychologist or worry that the therapist may be obligated to report it to the authorities. I want my patients to feel neither judged nor treated differently for making unconventional choices in their lives, regardless of what those choices entail. If someone discusses substance use with me, I will not report it to any authority as long as there is no clear risk to someone's life. It should feel safe to talk about drug use with your therapist.
What are psychedelics?
Psychedelics are chemical substances, whether from nature or the laboratory, that affect the central nervous system in characteristic ways. The most common examples of psychedelics are psilocybin (found in mushrooms and truffles), lysergic acid diethylamide-25 (LSD), and mescaline (found in cacti). These three groups are chemically very similar and have similar effects on the nervous system, hence they are often called "classical psychedelics." Additionally, there has been a growing interest in other types of psychedelics, such as Dimethyltryptamine (DMT), found in the shamanic brew "Ayahuasca," traditionally used in the Amazon. In Norway, ketamine-assisted therapy is offered, and although ketamine is not a psychedelic per se, there are clear similarities in the way it is used and experienced by the patient. Another related substance, traditionally not called a psychedelic but researched for use in therapy, is MDMA. Common to all these substances is their potential to "open" consciousness and provide more access to underlying mental processes. They radically alter the experience of oneself and one's surroundings, which can be therapeutic but also overwhelming and challenging for some.
Risks and harm reduction
It is crucial for me to emphasize that I do not recommend anyone try psychedelics on their own in an attempt to improve their well-being. There are several reasons for this. Firstly, obtaining and using these substances in Norway is a criminal act. Aside from the potential legal consequences, it likely affects the user's mental framework in an unfavorable way. There is also a risk that the substance acquired may not be what one thinks it is; for instance, one might have picked the wrong mushroom or received a chemical resembling LSD or MDMA but not actually containing them. The latter risk can be reduced by using "test kits" that allow testing the contents of drugs. User experiences show that difficult experiences occur more frequently when one is ill-prepared and without adequate support, for example, being alone. These are substances with potentially extremely powerful effects that can be difficult to dose correctly, so it is essential to be well-prepared and have someone sober for help and support during the experience. There is reason to believe that those who are particularly vulnerable and unstable risk worsening their mental health by using psychedelics if given under unfavorable circumstances, without adequate preparation, support, and follow-up. Currently, only ketamine-assisted treatment offered by Norwegian doctors and psychologists meets these criteria. Those interested in ketamine-assisted treatment can learn more from EmmaSofia and Axon-Klinikken. It is possible to travel to treatment facilities abroad that offer guided psychedelic treatment, including in the Portugal, The Netherlands and Latin America. However, these places do not always have a sufficient level of safety measures and support to perform psychedelic therapy. For example, it is often provided in a group setting, with incomplete assessment and preparation for the experience, and varying options for integration and follow-up afterward. In most countries where this occurs, the activity is not closely regulated, meaning there are no clear guidelines, requirements, or licensing from authorities for psychedelic treatment, and the quality of the service can vary tremendously. Take the legislation in the Netherlands as an example, where psychedelic therapy is offered under a legal loophole. This leads to it being offered by both clinical psychologists and self-proclaimed healers. I would advise those considering trying psychedelics abroad to be very cautious and thorough when researching who offers this, and to consider the risk of falling ill abroad, especially if traveling alone. If you still plan to try this, make sure to educate yourself beforehand.
Integration of psychedelic experiences
If you have had experiences with psychedelics that you need to process with a professional, feel free to bring it up with me. In the literature, this is often referred to as 'integration,' which involves sharing and exploring challenges and insights arising during psychedelic experiences. It is about making sense of the feelings, sensations, and ideas one has experienced and how these can be integrated into one's person in their usual state of consciousness after the experience. Among those researching psychedelic therapy, integration following the experience is considered a crucial part of the therapy. In regular therapy, change usually occurs slowly, and new thoughts, ideas, and feelings emerge both gradually and suddenly but at a more 'normal' pace for the patient. In psychedelic therapy, a lot happens very quickly, and many may quickly suppress the insights and feelings experienced because it is challenging to maintain them in consciousness. If you receive help in integrating these, you can potentially achieve a more positive and lasting effect from psychedelic experiences. For those who have had very difficult experiences with psychedelics, it may be because what surfaced in consciousness was so challenging that fear dominated the experience. In such cases, integration may focus on attempting to rebuild a sense of safety.