Systematic research on the impact of psychedelic use on sexuality and intimacy remains limited. This study investigated reported effects of psychedelic use on various aspects of sexuality, gender, and relationships through an online survey of individuals who have used psychedelics (N = 581). Most participants (70.2%) reported perceived impacts of psychedelic experiences on their sexuality and/or sexual experiences, with 65.4% noting short-term effects during psychedelic experiences and 52.8% reporting long-term effects, although no individual effect was endorsed by most participants. A higher proportion of participants indicated that psychedelic experiences enhanced, rather than diminished, relationship quality, attraction to current partners, and sexual activities. Approximately 10% of participants reported that psychedelic experiences influenced their gender identity and/or expression, reporting increased authenticity, self-acceptance, openness, and freedom in self-expression, as well as altered experiences of sexuality and gender. One-quarter of women and one-eighth of men reported heightened same-sex attraction following psychedelic use, and one-third of those with other gender identities reported changes in sexual attraction. Higher proportions of participants reported dating multiple people, being polyamorous or in an open relationship, or being committed to only one person after their psychedelic experiences compared to before. Regression models identified various perceived effects associated with using large psychedelic doses, more frequent psychedelic use, lower household income, identifying as gender diverse, and especially younger age and identifying as women. Psychedelics may facilitate these changes via self-insight, greater connectedness with others, and increases in self-compassion, though further research is needed.
Psychedelic drugs are currently being explored for their therapeutic potential for a variety of health conditions. The recent increased public interest in psychedelics necessitates empirical investigation into motivations for use among users as well as how motivations may change over time. We asked a large sample of participants reporting naturalistic psychedelic use (N = 1221) about their motivations for using psychedelics initially (i.e. their first time) as well as currently. We found that motivations for psychedelic use change substantially over time, with initial use typically for recreation or exploration, and later use more for therapeutic or personal growth reasons, including managing mental health conditions, growing spiritually, connecting with nature, improving creativity, and managing trauma. These results highlight the distinct and shifting motivations for engaging in psychedelic use. Although the study was limited by a retrospective design, it is the first to show that motivations for using psychedelics may change over time, with initial use focused on recreation and curiosity but subsequent use more motivated by self-improvement (e.g. enhancing relationships and health). Future prospective designs and qualitative interviews may aid in further elucidating the mechanisms underlying these shifts in motivations over time.
Glynos, N., Reid, M.R., Aday, J.S., Kruger, D.J., Boehnke, K.F., Lake, S., & Lucas, P. (2025). Racial differences in naturalistic psychedelic use — Motivations for use, communication with health care providers, and outcomes. Journal of Psychoactive Drugs.
People of Color have been under-included in psychedelic-assisted therapy (PAT) research, and researchers have argued that systemic issues resulting in harms to communities of color like the War on Drugs and recurrent exposure to discrimination in healthcare settings may reduce their willingness to engage in PAT research. However, there are no empirical data regarding People of Color’s trust or willingness in using psychedelics with the support of trained healthcare providers. Therefore, we analyzed data from a psychedelic survey to explore interactions between People of Color and healthcare providers in North America. The sample included 3,547 White people, 448 People of Color, and 377 Multiracial people. A lower proportion of People of Color consumed psychedelics with the support of a trained provider but an equal proportion had disclosed psychedelic use to primary care providers. Further, People of Color were equally motivated to use psychedelics with a trained healthcare provider, used psychedelics to treat similar issues, and similarly reported psychedelics as effective with other groups. Our findings suggest that lack of trust may not fully explain the underrepresentation of People of Color in PAT research, and future studies should investigate other barriers to People of Color’s inclusion in PAT research.
Pouyan, N., Aday, J., Harte, S., Kaplan, C., Williams, D., Glynos, N., Herberholz, M., Kruger, D.J., Barron, J., Mashour, G., Clauw, D., Preller, K., Schrepf, A., & Boehnke, K. F. (2025). Pictorial Representation of Illness and Self Measure (PRISM): A putative transdiagnostic tool for evaluating therapeutic effects of psychedelic treatments. Journal of Psychopharmacology.
Background: Patients with refractory conditions often identify themselves with their illness, which affects multiple aspects of their lives. The Pictorial Representation of Illness and Self Measure (PRISM) is a tool used to assess the enmeshment of individuals’ perception of self with a particular medical condition, broadly termed self-condition enmeshment.
Aims: This study aimed to evaluate changes in PRISM scores and how these changes relate to symptom changes following naturalistic psychedelic use.
Methods: In this survey, we retrospectively assessed changes in PRISM scores in 297 individuals who self-engaged in naturalistic psychedelic use for therapeutic purposes. Participants also completed the Patient Global Impression of Change (PGIC) scale to report symptom changes resulting from their perceived most salient psychedelic experience (MSPE).
Results: PGIC scores indicated that the majority of participants with depression (95.4%), posttraumatic stress disorder (98.36%), and anxiety (94.87%) reported symptom improvement following naturalistic psychedelic use. There was a significant decrease in PRISM scores after MSPE compared to their PRISM scores before MSPE, indicating that individuals experienced a reduced identification of their identity with their condition following psychedelic use. PRISM change scores were also correlated with PGIC scores across all conditions, indicating that reductions in self-condition enmeshment were associated with symptom improvement.
Conclusions: Our results suggest that PRISM has transdiagnostic sensitivity for investigating the effects of psychedelics on self-perception. Interpretation is limited by convenience sampling, potential positive bias, retrospective reporting, and unclear doses and settings with the natural psychedelic use.
As usage of psychedelic drugs increases in some countries, and national and local authorities consider initiatives to legalize or decriminalize their access, there is need for rigorous investigation and multi-sector partnerships to understand and reduce potential psychedelic risks, communicate them more accurately, prevent them where possible, and support those who experience adverse events.
Psychedelic substances have shown preliminary efficacy for several neuropsychiatric disorders and are currently being investigated for chronic pain conditions. However, few studies have investigated outcomes of naturalistic psychedelic use among individuals with chronic pain, and none have assessed psychedelic-related changes in substance use patterns in this population. In a cross-sectional survey of adults with chronic pain (n = 466; 46.1% women), we investigated changed substance use patterns and self-reported outcomes on physical and mental health following use of a psychedelic. Most (86.3%; n = 391/453) indicated that they ceased or decreased use of one or more non-psychedelic substances because of psychedelic use, and 21.2% (n = 83/391) indicated that the decrease in use persisted for more than 26 weeks after psychedelic use. Alcohol (71.1%; n = 226/318) and prescription opioids (64.1%; n = 100/156) had the highest proportions for ceased/decreased use. Illicit opioids (27.8%; n = 22/79), and cannabis (21.5%; n = 78/362) had the highest proportions for increased/initiated use. Having a motivation to reduce one’s substance use was positively associated with ceasing/decreasing substance use. Perceptions of health outcomes following psychedelic use were broadly positive, and psilocybin was reported to be the most effective substance for both physical and mental health symptoms. Although limited by a cross-sectional study design, findings from this large sample merit future investigation into the benefits and risks of psychedelic use among individuals with chronic pain.
Introduction: Psychedelic substances have been used for centuries in various cultural and religious contexts, and more recently, in clinical research and therapy. There is a surge of interest in psychedelics, and psychedelic-assisted psychotherapy is becoming increasingly accessible. However, most individuals using psychedelics do so outside of therapeutic contexts. It is important to understand the adverse experiences that may occur with psychedelic use, as well as adverse events that may happen even in therapeutic contexts.
Materials and Methods: We conducted an anonymous online survey of individuals who self-reported past psychedelic use. We asked about the frequency of experiencing 12 different adverse experiences when using psychedelics, and if they or someone they know was the victim of inappropriate sexual contact by a psychedelic sitter, guide, or practitioner. Participants could also describe other adverse experiences.
Results: Among 1,221 participants, most reported having adverse experiences such as being frightened (74.3%), sadness (58.6%), feeling their body shake or tremble (54.3%), and loneliness (51.6%) during their psychedelic experiences. About half of participants reported having some other adverse experience, and one in ten participants had adverse physical reactions. About one-third of participants knew someone who was arrested for possession or use of psychedelics; 8% reported that they or someone they know was the victim of inappropriate sexual contact by a psychedelic sitter, guide, or practitioner; and one-quarter of participants knew someone who experienced a severe adverse event other than inappropriate sexual contact or arrest.
Conclusion: Despite beneficial effects, psychedelic experiences can also be challenging, distressing, or even harmful. Adverse events can increase the risks of psychological harm, legal problems, stigma, and public health issues. Therefore, it is essential to prevent, identify, manage, and treat adverse events during psychedelic experiences to ensure the safety and well-being of the participants and the facilitators, and create opportunities for “integration” even with unguided sessions.
Psychedelic-assisted therapy (PAT) has shown preliminary efficacy for psychiatric and physical health conditions. Although some people report naturalistic psychedelic use with so-called "underground" practitioners, little is known about PAT that occurs outside of controlled clinical settings or perspectives of these practitioners. We conducted an anonymous online survey of individuals who reported providing psychedelic support services (e.g. trip sitting and/or preparatory/follow-up psychotherapy) in naturalistic settings. We investigated demographics, including education and licensing, details about services provided, and reported client outcomes. Among 107 participants, 40.2% held a full or in-progress license and 44.9% had not obtained a relevant graduate degree. Almost all participants reported pre-screening clients before treatment, offering preparation, integration, and trip-sitting services, and most employed a range of therapeutic modalities, centering primarily on non-directive approaches. Participants reported that clients most commonly consumed psilocybin, and treated numerous conditions, primarily aligning with indications targeted in psychedelic clinical research. Perceptions of clients' symptom changes were largely positive, although a small proportion reported worsened personality disorder symptoms. Further research delineating client and practitioner perspectives of naturalistic PAT services is warranted, and such work may shed light on the benefits and risks specific to naturalistic PAT as well as inform best practices for practitioners.
Background and aims: Psychedelic-assisted psychotherapy (PAP) is currently being studied as a possible treatment option for multiple disorders. Despite promising safety and efficacy findings, the high costs of the current PAP model makes it questionable if the treatment will be scalable. Non-hallucinogenic psychedelic analogs have been developed as a potential cost-effective alternative, but it is unclear what psychedelic users perceive as a reasonable cost for treatment and whether they would be open to trying a non-hallucinogenic analog.
Methods: We queried a large sample of people using psychedelics naturalistically (N = 1,221) about their attitudes regarding the role of altered states of consciousness in PAP outcomes, costs of treatment, and their openness to trying a non-hallucinogenic psychedelic analog for treating a mental health condition.
Results: We found that most (76%) participants considered altered states of consciousness as very or extremely important to the therapeutic effects of psychedelics. Despite this, most (61%) were also moderately, very, or extremely likely to try a non-hallucinogenic substance if given the chance. Lastly, participants considered approximately $70–80 per hour to be a reasonable cost for various aspects of psychedelic services (e.g., preparation, integration, and dosing sessions).
Conclusions: Participants valued the role of altered states of consciousness in therapeutic changes attributed to psychedelics, but were still open to trying a non-hallucinogenic analog. Notably, the price participants considered to be a reasonable amount for PAP is well below current market projections. Future research is needed to address limitations of the study as well as to identify ways of lowering treatment costs.
This study aimed to characterize attitudes and identify gaps in trainee knowledge and education that may impact the field's readiness for the reemergence of psychedelic use in psychiatry. A two-part survey was sent out targeting medical and allied professional trainees who may interact with patients using or planning to use psychedelics therapeutically. Collected data for part one characterized demographics, sources of information, attitudes, experiences, and amount and type of education available about psychedelics in training programs. Part two was an assessment of psychedelic literacy, and predictors of trainee knowledge were analyzed. A total of 473 responses were obtained, 221 of which were unique, complete, thought to be authentic, and therefore included. Results indicated trainees had learned about psychedelics and related therapies from a wide variety of sources, most notably social media and word-of-mouth, which did not correlate with increased knowledge. There is limited structured education available, and although overall knowledge is low, participation in programming at home institutions did predict greater psychedelic literacy. As psychedelics are becoming increasingly available and research into their use in medicine advances, inclusion of relevant material in academic training programs will be essential to prepare future professionals to effectively educate and counsel patients.
Introduction: Recent research suggests that psychedelics may have potential for the treatment of various substance use disorders. However, most studies to date have been limited by small sample sizes and neglecting to include non-North American and European populations.
Methods: We conducted a global, cross-sectional online survey of adults (n = 5,268, 47.2% women) self-reporting past or current psychedelic use and investigated whether psychedelic use was associated with changes in use of other substances.
Results: Nearly three-quarters (70.9%; n = 3,737/5,268) reported ceasing or decreasing use of one or more non-psychedelic substances after naturalistic psychedelic use. Among those with previous use, 60.6% (n = 2,634/4,344) decreased alcohol use, 55.7% (n = 1,223/2,197) decreased antidepressant use, and 54.2% (n = 767/1,415) decreased use of cocaine/crack. Over a quarter of the sample indicated that their decrease in substance use persisted for 26 weeks or more following use of a psychedelic. Factors associated with decreased use included a motivation to either decrease one’s substance use or self-treat a medical condition. Importantly, 19.8% of respondents also reported increased or initiated use of one or more other substances after psychedelic use, with illicit opioids (14.7%; n = 86/584) and cannabis (13.3%; n = 540/4,064) having the highest proportions. Factors associated with increased substance use included having a higher income and residing in Canada or the US.
Discussion: Although limited by cross-sectional study design, this large observational study will help inform future studies aiming to investigate the relationship between substance use patterns and psychedelic use.
Survivors of adverse childhood experience are at elevated risk for psychological distress. In recent years, renewed interest in psychedelic medicine has highlighted the therapeutic potential of psilocybin for those who have experienced childhood adversity. However, recreational psilocybin use remains illegal and access to approved therapies is difficult. Such use provides an opportunity to explore the therapeutic potential of psilocybin for psychological distress among people with adverse childhood experiences. Therefore, we conducted an online survey to assess interest in, acceptability of, and experiences with psilocybin. We further explored whether the association between Adverse Childhood Experiences Questionnaire (ACEQ) scores and psychological distress was lower among those who had used psilocybin in the past three months. Results showed high levels of interest in and acceptability of psilocybin that did not differ across ACEQ scores. Results also showed that the effect of adverse childhood experiences on psychological distress was lower for people who had recently used psilocybin (p = .019). Taken together, these findings suggest that psilocybin therapy may be potentially acceptable and may feasibly help in supporting survivors of adverse childhood experiences with particularly strong benefits to those with more severe childhood adversity.
There is substantial public interest in psychedelics as potential treatments for psychiatric conditions. However, most psychedelics are criminalized under federal law in the USA, so it is unclear whether use occurs with clinical support. Our objective was to assess whether naturalistic psychedelic use occurs with clinical support, interactions between those using psychedelics and healthcare providers (psychiatrist, therapist, or primary physicians), and use characteristics. We conducted an online, anonymous, confidential, cross-sectional survey of adults reporting psychedelic use (N=1221) through a psychedelics advocacy event and social media between 9/18/2022 and 11/5/2022. We assessed participant disclosure of psychedelic use with their psychiatric care provider (PsyCP) and/or primary care provider (PCP), desire for provider support, access to support, and rate of taking prescribed psychoactive medications alongside psychedelics. Among participants with such care providers, 22% disclosed psychedelic use to their PCP vs. 58% to their PsyCP. Participants were less confident in PCP vs. PsyCP ability to integrate psychedelics into treatment. Common reasons for nondisclosure included stigma, inadequate provider knowledge, and legal concerns. 23% reported taking psychedelics on the same day as potentially interacting psychiatric medications (e.g., anxiolytics, antidepressants). Despite 81% of participants desiring therapist support during psychedelic experiences, only 15% had received such support. Our results show that psychedelic use is generally disconnected from primary and psychiatric clinical care. This disconnection may result in safety issues, including inadequate screening for contraindicated conditions, lack of support during emergent adverse events, and drug interactions. Enhanced clinical education and orienting drug policy towards known harms and benefits of psychedelics is needed.
Legal, scientific, and social landscapes for psychedelics are changing rapidly. Differences of opinion exist among key stakeholders regarding regulatory control, models of provisioning psychedelic therapy, and medicalization, decriminalization, and/or legalization policies. We assessed the policy preferences of people using psychedelics naturalistically (N = 1221) to understand how they aligned and differed with institutional entities and existing psychedelic policies. Three quarters of participants would support decriminalization and legalization. On average, participants completely supported individuals being legally able to grow and possess psychedelic plants and/or fungi for personal consumption. Trends included more support for natural over synthetic substances, self-production and consumption over gifting, gifting over sales, and administration of psychedelics with therapeutic support than without therapeutic support. Participants were concerned about pharmaceutical-like policy models, including patents of natural and synthetic psychedelic compounds. Participants were mostly from the State of Michigan, though geographical differences were minor. Those who identified as a psychedelic guide, educator, or therapist had small yet extensive differences from those who did not. As psychedelic liberalization continues to advance, it is critical for policymakers to consider these preferences to ensure laws provide safe and equitable access to these substances and appropriate medical support for their use.
Naturalistic psychedelic use among Canadians is common. However, interactions about psychedelic use between patients and clinicians in Canada remain unclear. Via an anonymous survey, we assessed health outcomes and integration of psychedelic use with health care providers (HCP) among Canadian adults reporting past use of a psychedelic. The survey included 2,384 participants, and most (81.2%) never discussed psychedelic use with their HCP. While 33.7% used psychedelics to self-treat a health condition, only 4.4% used psychedelics with a therapist and 3.6% in a clinical setting. Overall, 44.8% (n = 806) of participants were aware of substance testing services, but only 42.4% ever used them. Multivariate regressions revealed that therapeutic motivation, higher likelihood of seeking therapist guidance, and non-binary gender identification were significantly associated with higher odds of discussing psychedelics with one’s primary HCP. Having used a greater number of psychedelics, lower age, non-female gender, higher education, and a therapeutic motivation were significantly associated with higher odds of awareness of substance testing. We conclude that naturalistic psychedelic use in Canada often includes therapeutic goals but is poorly connected to conventional healthcare, and substance testing is uncommon. Relevant training and education for HCPs is needed, along with more visible options for substance testing.
The Canadian Psychedelic Survey was a cross-sectional online survey of adults (n = 2393, mean age = 3 8.8 +/- 13.1, 56.3% women) who self-reported past or current psychedelic use. We investigated whether psychedelic use was associated with self-reported changes in the use of other substances. Participants reported substantial changes, with 43.8% (n = 651) decreasing or ceasing alcohol use, 42.5% (n = 272) ceasing or decreasing antidepressant use, and 42.4% (n = 200) decreasing or ceasing cocaine use. The highest rates of increased use (10.9%; n=151) and initiation (3.5%, n = 7) were for cannabis and amphetamines, respectively. The most common reasons for psychedelic substitution were feeling more connected with self (72.4%, n = 653), others (54.4%, n = 491), and nature (54%, n = 487), as well as feeling less anxious or depressed (59.5%, n = 537). Factors associated with reduction in any substance use included motivation to treat a medical condition, number of psychedelics used, and younger age. This real-world evidence should be rigorously investigated in future studies.
There is a remarkable surge of interest in psychedelics, including new stakeholders and greater media attention. There is a need to examine the information-seeking behavior of people using psychedelics naturalistically, given the importance of preparation and harm-reduction. We examined sources of information for people using psychedelics naturalistically, and the degree to which they are trusted in a large, anonymous, online survey (N = 1221). The most common source of participants’ information on psychedelics was their own experimentation and experiences (79.52%). Most also sought information from Internet websites (61.67%), friends (61.02%), Internet discussion forums (57.08%), books (57.00%), and articles in peer-reviewed scientific journals (54.55%). Few sought information from their primary health care provider (4.83%). Articles published in scientific journals, psychedelic non-profits, and researchers based in colleges or universities were the most trusted sources of psychedelic information. Government agencies and pharmaceutical companies were the least trusted. Few participants thought that the popular media accurately stated the benefits and risks of psychedelics and most thought that the popular media failed to distinguish between different types of psychedelics. Our results indicate a high level of information seeking among psychedelic users, with a diverse array of information sources typically outside of mainstream health and medical care systems.
Identifying gaps and strengths in psychedelic-related knowledge is key to developing effective, evidence-based education to inform appropriate use of and harm reduction practices for psychedelics in the naturalistic use landscape. The current study piloted an assessment instrument with questions on legal status, therapeutic potential, and side effects of psychedelics among people reporting current psychedelic use. We recruited participants (N = 1435) at a psychedelic advocacy event and through psychedelic interest groups on social media. Respondents completed a brief survey of psychedelic use and psychedelic knowledge. Items assessed basic knowledge of various topics surrounding psychedelics, such as legal status, active compounds, and known therapeutic efficacy based on the clinical trial literature. Respondents who had used greater numbers of different psychedelics, with higher levels of education, lower age, greater frequency of psychedelic use, identifying as male, used high doses (vs. microdosing only), identifying as Caucasian/White, and with greater annual household income answered more questions correctly. Most respondents exhibited high knowledge of psychedelics, though there is also a demonstrated need for education and outreach, especially in under-represented communities.
Interest in and availability of psychedelics for therapeutic purposes has increased in recent decades. In a large, anonymous, online survey, we investigated patterns of communication with healthcare providers and awareness and utilization of substance testing kits or services among people using psychedelics naturalistically. The sample population included attendees of a psychedelic activism event and users of psychedelic social media forums.. Among 1,435 participants, 72.5% never discussed psychedelic use with their primary care provider (PCP). Only 4.4% reported using psychedelics with a therapist and 3% in clinical settings, although 77.8% were very or extremely likely to take psychedelics with a therapist if one were legally available. While 62.6% of participants were aware of substance testing services, 42.6% of these indicated never using them. Regression analyses identified several variables associated with disclosure to PCP and utilization of substance testing services including age, gender, frequency and number of psychedelics used, and likelihood of consuming psychedelics under the guidance of a therapist if one were legally available. Further research is necessary to investigate these findings among other groups. Our findings suggest that relevant training and education for healthcare providers is needed, along with more visible options for substance identity testing.