Could Psilocybin Change The Way We Treat Addiction Forever?

Substance-use disorders (known as SUDs) affect nearly 40 million people worldwide and are responsible for millions of avoidable deaths each year. While traditional treatments like counselling, cognitive-behavioural therapy (CBT), and medications such as methadone or naltrexone help some, many people still find themselves trapped in a cycle of relapse and recovery. For example, in the case of opioid-use disorder, fewer than half of patients stay in treatment after one year, and most relapse within three.

A similar pattern is seen with alcohol-use disorder — highlighting the need for new, more effective approaches.

Could Psychedelics Be Part of the Solution?

Enter psilocybin — the active ingredient in magic mushrooms. Once locked away due to strict regulations, it’s now at the forefront of the much publicised “psychedelic renaissance.” Psilocybin is already recognized by the FDA as a breakthrough therapy for treatment-resistant depression. Researchers are now asking: Could the magic mushroom extract help with addiction, too?

What the Latest Review Found

A major new systematic review published in the June 2025 issue of Neuroscience & Biobehavioral Reviews takes a deep dive into this question. Led by Dr. Shakila Meshkat and an international team of addiction specialists, the review examined 231 papers, narrowing them down to 16 published studies and 26 clinical trials that focused specifically on psilocybin and various substance use disorders including alcohol, tobacco, opioids, and cocaine.

Here’s what they found:

Alcohol-Use Disorder (AUD): Seven studies showed that psilocybin-assisted therapy led to fewer heavy drinking days and higher abstinence rates. One neuroimaging study even suggested a “reset” in the brain’s reward system.

Tobacco-Use Disorder (TUD): In five studies, 60–80% of participants had quit smoking at long-term follow-ups. Interestingly, those who reported profound, “mystical” experiences during their sessions were more likely to stay smoke-free.

Other Addictions (e.g., opioids and cocaine): While still in early stages, initial findings show reductions in use and cravings.

Importantly, across all studies using proper medical screening and supervision, no serious side effects were reported.

It’s Not Just the Drug — It’s the Setting Too

One of the most valuable insights from this review is that wie psilocybin is used matters just as much as what dose is given.

High doses (around 20–40 mg per 70 kg of body weight) delivered in structured therapeutic environments, with preparation beforehand and integration afterward, produced the best outcomes. These sessions often led to what participants described as ego dissolution or a sense of oneness. Researchers believe may this help people re-evaluate deeply entrenched behaviours and beliefs.

As the authors put it, these profound experiences “appear to catalyse psychological insight and behaviour change, especially when psychotherapy harnesses that malleable window.”

Dr Amy Reichelt Weighs In

Dr. Amy C. Reichelt, a neuroscientist at Western University and co-author of the review, summed it up well:

“Treatments for substance use disorders represent an unmet need, particularly for those who do not respond to first-line, conventional treatments… This synthesis identified that doses of psilocybin that evoke mystical experiences were generally well tolerated and that significant reductions in reported substance use and increased abstinence rates were observed, particularly when combined with psychotherapy.”

Why Might Psilocybin Work?

From a biological perspective, psilocybin acts on the serotonin 2A receptors in the brain, promoting a kind of “network reset” that disrupts rigid, self-focused thinking. This is something that often underlies addiction.

Psychologically, the experience increases emotional openness and flexibility. This gives patients a rare opportunity to reconsider harmful behaviours and form new perspectives. When paired with therapies like motivational interviewing or CBT, this can lead to lasting change — both in the brain and in life.

Promise Meets Reality

While the findings are promising, researchers urge caution. Of the 16 studies reviewed, only one was a gold-standard double-blind randomized controlled trial. Most involved small groups (fewer than 30 people)that were not especially diverse — meaning the results may not be applicable to everyone.

Moving Forward: What Needs to Happen

Of course, many people enjoy psilocybin for recreational purposes. However when it comes to therapeutic use, here are a few takeaways from the review for clinicians and policymakers:

Combine psilocybin with therapy. The best results come when it’s used alongside structured psychological support, not in isolation.

Start with high-need patients. People who haven’t responded to conventional treatments—like long-term smokers or those with severe alcohol-use disorder — may benefit most.

Standardize dosing and preparation. A consistent approach to how psilocybin is administered would make future studies easier to compare and improve patient safety.

Ensure diversity in future trials. Research must reflect the real-world population, including people from different racial, gender, and economic backgrounds.

Can Mushrooms Transform the ‘Addiction Story?’

This review isn’t the final word on psilocybin and addiction, but it is a major milestone. By pulling together all the current research, the authors have helped reframe how we think about treating substance use disorders.

Psilocybin-assisted therapy appears to be reasonably safe, biologically novel, and potentially transformative — a rare combination in a field that’s seen little innovation in decades.

As Dr. Reichelt is keen to emphasize, the true promise of psilocybin emerges “when combined with psychological support programs.” The challenge now is to build those programs with care, integrity, and accessibility in mind.

For the millions of people still searching for a way out of addiction, this could mark the beginning of a new chapter; guided not just by science, but by hope.