Exploring Psychedelics for Addiction: A Clinical Conversation on Integration and Recovery

Introduction: When Traditional Recovery Meets Plant Medicine

The intersection of psychedelics for addiction treatment represents one of the most compelling—and contentious—frontiers in mental health care. Recently, a panel of pioneering clinicians, researchers, and recovery advocates gathered to explore this complex territory, sharing clinical insights and navigating the tensions between traditional 12-Step recovery and psychedelic-assisted therapy. The event took place in West Los Angeles on October 23, 2025.

Dr. David Wiss, mental health scientist and functional medicine practitioner, opened the conversation with remarkable vulnerability: “In 2018, I took a public position against plant medicine for people with substance use disorder histories. I remember digging my heels in pretty strongly.” His journey from skeptic to integrator mirrors the field’s broader evolution—one characterized by careful observation, humility, and a willingness to challenge long-held assumptions.

Understanding the Landscape: Medical, Ceremonial, and Recreational Use

Before diving into clinical applications, the panel established crucial distinctions in how psychedelics for addiction are being used:

Medical Use

Administered under physician guidance with healthcare professionals. Ketamine, for example, is legal in California for therapeutic use, while psilocybin is legal in Colorado and Oregon, and decriminalized in California cities like Oakland and Santa Cruz. Ibogaine is used clinically in other countries, like Mexico. 

Ceremonial Use

Ancient indigenous practices with medicines like ayahuasca and iboga, typically conducted in traditional settings with experienced facilitators. Psilocybin is often used ceremonially as well. 

Recreational Use

Self-administration outside therapeutic or ceremonial contexts—an area requiring nuanced discussion regarding harm reduction and intention.

The Medicines: A Clinical Overview

Ketamine: The Dissociative Anesthetic Turned Mental Health Tool

Dr. Dana Lerman, founder of Skylight Psychedelics, described ketamine’s evolution: “Originally used as a battlefield anesthetic, over the last decade plus, we’ve realized it has tremendous mental health benefits for various conditions. My favorite indication is suicidality.”

Ketamine’s rapid action on suicidal ideation represents a breakthrough. As Dr. Lerman emphasized, “It saved my best friend’s life. After the fourth dose of ketamine, he no longer had any suicidality. That was 5 years ago.”

Routes of administration include intravenous, intramuscular, sublingual, intranasal, and rectal—offering flexibility for different clinical scenarios.

Psilocybin: The Fungal Teacher

Yeshaia offered a poetic yet scientifically grounded perspective: “Scientists describe psilocybin as a serotonin agonist, which reduces activity in the default mode network. In plain English, that means it temporarily switches off the part of your brain that keeps insisting that you are so terribly important.”

Beyond mechanism, Yeshaia emphasized psilocybin’s deeper action: “The real epidemic is not depression or addiction. Those are symptoms. The disease is disconnection. Psilocybin, approached wisely, doesn’t obliterate the ego—it teaches it manners.”

MDMA: The Bridge Between Science and Psychedelics

Dr. Joyce Braverman from Mexico City explained MDMA’s unique position: “It’s not a psychedelic drug. It’s an amphetamine. For me, it’s the substance that brings a bridge—sometimes we become judgmental about synthetic things, but I’ve never seen something working so well for trauma.”

MDMA works on the amygdala, increases oxytocin secretion, and allows trauma reprocessing without reliving traumatic experiences. Notably, “70% of challenging trips with psilocybin or LSD are reduced when you combine it with MDMA.”

Ayahuasca: The Amazonian Medicine

Dr. Kalen Flynn, holistic psychiatrist, described ayahuasca as a traditional plant medicine combining the chakruna leaf (containing DMT) with the ayahuasca vine (containing MAO inhibitors), extending the DMT experience to 4-6 hours.

Dr. Flynn’s perspective, shaped by sitting with ayahuasca since 2012 and studying with Shipibo teachers, carries important nuance: “If you asked me 10 years ago, I would have said everybody should do psychedelics. Now I’ve found that psychedelics haven’t just been helpful in a clear way—they’ve made things more complicated and opened up more questions.”

Ibogaine: The Addiction Interrupter

Marcos, treatment center founder and long-term recovery advocate, explained ibogaine’s unique properties: “It’s very predictable and effective in the treatment of substance use disorder, traumatic brain injury, and PTSD—particularly treatment-resistant cases.”

Ibogaine occupies an opioid receptor affected explicitly by substances such as fentanyl and kratom, making it particularly valuable for addressing opioid withdrawal symptoms.

Clinical Case Studies: Real-World Applications

The panel examined four complex cases, revealing how expert clinicians think about psychedelics for addiction within comprehensive treatment frameworks.

Case 1: Susie — Complex Trauma and Polysubstance Use

A 32-year-old woman with childhood sexual abuse, intimate partner violence, methamphetamine use, and current dependence on kratom and fat-burning supplements. She had abandoned 12-step recovery after a harmful fifth-step experience.

Clinical Consensus:

• Foundation First: All panelists emphasized nervous system regulation before introducing psychedelics
• Functional Medicine Approach: Address cortisol, HPA axis, mitochondrial function, nutrition
• Rebuild Safety: Intensive psychotherapy, somatic work, and establishing a therapeutic alliance
• Medicine Selection: Dr. Braverman suggested MDMA for PTSD once stabilized; Marcos recommended ibogaine HCL for kratom dependence and nervous system regulation
• Integration: Body-based practices, infrared sauna, structured exercise, community support

Dr. Flynn’s caution reflected clinical wisdom: “I wouldn’t bring up psychedelics for her because she’s frazzled and overwhelmed. I’m careful about who to introduce this to. If she came to me saying she’s thinking about mushrooms, that gives me an opening for harm reduction.”

Case 2: Daniel — The Lost Young Man

A 23-year-old with gambling addiction, pornography use, poly-substance abuse (MDMA, ketamine, benzodiazepines), and a near-fatal fentanyl overdose. Despite stopping drugs, he continued struggling with behavioral addictions and depression.

Clinical Approach:

• Meaning and Purpose: Marcos emphasized rights of passage work—sweat lodges, difficult hikes, cold plunge
• Rewiring Dopamine: “Teach him that there are pleasures and joys in this life that aren’t bad for you, unhealthy, expensive, or illegal”
• Masculine Initiation: If medicine was indicated, San Pedro (huachuma) was suggested as a “masculine compound—a good, hard medicine”
• Family Systems: Yeshaia highlighted missing relational information and suggested family work alongside potential MDMA with low-dose psilocybin
• Integration: Community-based, long-term container, potential 12-Step for gambling

The panel demonstrated restraint, recognizing that psychedelics aren’t always the first intervention—sometimes traditional therapeutic modalities and lifestyle changes build a necessary foundation.

Case 3: Abraham — Grief, Loss, and Suicidal Ideation

A 52-year-old with 20 years of AA sobriety, facing partner infidelity, father’s death, depression, and suicidal thoughts. Previous SSRI trials had failed.

Immediate Intervention: Dr. Lerman’s response was unequivocal: “Ketamine is a miracle medicine for suicidality. I think it’s negligent for people not to use it.”

Additional Considerations:

• TMS + Ketamine: Combined transcranial magnetic stimulation with ketamine therapy
• Psilocybin Trials: Dr. Flynn suggested enrollment in depression trials given failed conventional treatments
• Psychoanalytic Work: Parts-informed therapy to address relational trauma, betrayal, grief
• Men’s Work: Community healing with other men

Critical Safety Discussion: The panel addressed ketamine’s addiction potential honestly. Yeshaia noted the container matters: “Doing ketamine at a rave is very different than doing it in a healing center with intention, an eye mask, music, and introspective work. When addressing the potential use of MDMA for someone who abused it previously, Yeshaia stated: “I’ve treated maybe two people where MDMA was their drug of choice—it’s not typically addictive in therapeutic contexts.”

Dr. Flynn added: “I’m cautious about ketamine but love it for suicidality.

Case 4: Grace — Severe Opioid Addiction and Multiple Treatment Failures

A 27-year-old woman of mixed white and Thai descent is struggling with cultural identity, multiple trauma exposures, and a devastating fentanyl addiction. Her history included a DUI with injuries, prescription opioid abuse escalating to fentanyl (smoking to injecting), seven different treatment programs over three years, and witnessing her roommate’s fatal overdose in sober living. She was currently on Suboxone and buspirone, but continued relapsing.

Clinical Consensus — Clear and Immediate:

Marcos responded without hesitation: “This is an easy case. Without question, as soon as we felt comfortable with each other and she wanted to work together, I would want to administer high-dose ibogaine HCL. It immediately ameliorates 80 to 100% of withdrawal symptoms.”

He explained the unique power of ibogaine for opioid addiction: “She’s probably had many experiences of failing and getting better. To come into this space feeling so sick from withdrawal, meet someone with a story of hope, and then this medicine you never heard of takes all your dope sickness away—that would be a really curative experience.”

The Protocol:

• Two treatments over a 6-month period
• Highly structured program between treatments
• Leveraging ibogaine’s 3-month half-life for sustained neuroplasticity
• Full cardiac evaluation and medical team support

Dr. Braverman enthusiastically agreed: “100% ibogaine treatment. I wouldn’t waste even a second thinking of something else. I’m speaking on behalf of my friend who owns Beond Clinic in Cancun—she had the same story, recovering from addiction. It was like a miracle. Ibogaine, well done with a program that can detox the patient holistically, is 100% my option for opioid cases.”

The Recovery Community Question: Can Psychedelics Coexist with Abstinence-Based Programs?

Perhaps the most challenging territory explored was the intersection of psychedelics for addiction treatment and traditional 12-Step recovery.

The Vulnerability Problem

Yeshaia addressed the core tension: “People in 12-Step carry guilt and shame. They’re taught to be vulnerable—which is a great antidote to shame. But you can forget you also have a right to privacy. If you decide to keep something to yourself, you might think you’re keeping secrets, which you’ve learned is wrong.”

He emphasized the educational need: “You get to decide who you share with. You have the right to privacy about what you choose to share at a meeting with the whole community.”

The Identity Shift

Yeshaia shared his personal navigation: “I don’t identify myself as sober. I don’t identify myself as abstinent, even though there are reasons I could. I identify as in recovery.”

This linguistic precision matters—it allows for psychedelic medicine use while maintaining recovery identity without the internal conflict of “breaking sobriety.”

The Harm Pattern

Dr. Wiss observed: “I’ve seen harm with folks who have strong recovery identities with psychedelics—not from the medicines themselves, but from the internalization of ‘I did something wrong’ and the separation from their social network. The problem comes from internal panic and immediate loss of social support.”

Bill Wilson’s LSD Use

Dr. Braverman reminded the audience: “Bill Wilson, who created the 12 Steps, took LSD. It’s all about the relationship you have with the substance—how you relate to it. If you relate to it in a sacred way, in a medical way, it completely changes your framework.”

Safety, Risks, and Clinical Considerations

The Overlooked Risks

Dr. Flynn, who survived stage IV cancer and credits psychedelics with helping her cope with death anxiety, also spoke to complications: “I’ve worked with people who did ayahuasca for the first time and were disabled by it. It’s not spoken about enough—some people have lost their lives to psychedelic-induced psychosis. It’s not something with zero risk.”

Yeshaia added some mportant context about risk assessment: “We think about psychedelics and their risk, but we don’t think about the risk involved in not introducing them safely into the community. Not making a choice is also a choice. There’s silent suffering at 20 years sober—people who kill themselves or are miserable in meetings. That holds its own risk.”

Ibogaine’s Cardiac Considerations

Dr. Lerman addressed ibogaine directly: “You can’t talk about ibogaine without talking about cardiac risks. People can die in these ceremonies from arrhythmias—that’s why it must be done with full cardiac evaluation and medical team support.”

Marcos provided context: “I’ve facilitated for five years and never seen or heard of anyone dying. Yeshaia stated: “When I checked, there were about 300 recorded deaths ever—probably hundreds of thousands if not a million have done it. Still a risk, but not nearly as much as the fentanyl people are injecting.”

Dr. Braverman emphasized: “Never suggest an iboga ceremony—always do it with a full team of experts. The clinics I collaborate with have had cardiac events but always had enough support to keep people safe.”

Medication Interactions

The panel addressed deprescribing considerations:

• SSRIs/SNRIs: May need tapering before classic psychedelics; can continue with psilocybin in some research contexts
• Antipsychotics: Block psilocybin effects
• Benzodiazepines: Should be stopped several days before ibogaine
• Seroquel, Paxil, Prazosin: Require careful discontinuation planning

The Functional Medicine Foundation

Both Dr. Wiss and Dr. Braverman emphasized comprehensive assessment before introducing psychedelics for addiction treatment:

Key Evaluations:

• HPA axis function and cortisol patterns
• Mitochondrial function
• Nutritional status (B vitamins, omega-3s, trace minerals)
• Sleep and circadian rhythm
• Exercise capacity
• Inflammatory markers

Lifestyle Pillars:

• Whole food nutrition
• Infrared sauna
• Cold exposure
• Resistance training
• Community engagement
• Nervous system regulation practices

Dr. Braverman articulated the philosophy: “Functional medicine heals the soil of the body. Psychedelics are a tool doing a lot for the immune system, but it’s only sustainable if you change your lifestyle.”

Integration: Where the Real Work Happens

Dr. Lerman emphasized the often-overlooked truth: “People get addicted to non-ordinary states of consciousness and bypass the work. We always talk about the work being in the ceremony, but the work is after the ceremony. It’s every single day.”

Dr. Flynn noted the Western innovation: “Integration is something we made up in Western psychedelic work. Indigenous communities have community—they don’t need separate integration because people stay connected to their community.”

The panel advocated for:

• Intensive psychotherapy (psychoanalysis, IFS, somatic experiencing)
• Parts work and nervous system co-regulation
• Breathwork practices
• Body-based modalities
• Men’s/women’s circles
• Ongoing therapeutic support
• Community containers

Looking Forward: Access, Equity, and New Institutions

Yeshaia voiced concern about medicalization’s limitations: “I’m interested in how we build communities and practices that work, then get it out of the clinical space—into religious areas, areas that are more affordable. Anything in the clinical space, the numbers add up, the red tape adds up. How do we introduce this into communities that won’t have access because it costs too much for a therapist to sit for six hours?”

This question speaks to a broader tension: as psychedelics for addiction treatment move toward FDA approval and medical legitimacy, how do we prevent creating a two-tiered system where only the wealthy can access these medicines?

Dr. Lerman shared her response to problematic at-home ketamine services: “Companies send whopping doses of ketamine to people to use in their homes by themselves. That didn’t feel right. So I started Skylight—I prescribe ketamine and train people’s therapists to sit with them. They bring their ketamine to their therapist’s office and do it together.”

The Integration of Perspectives: Science, Spirituality, and Recovery

What emerged from this clinical conversation was not advocacy for psychedelics as a panacea, but rather a sophisticated framework for understanding when, how, and for whom these medicines might offer healing possibilities within the larger context of recovery.

Key principles crystallized:

1. Foundation Matters: Nervous system regulation, safety, nutrition, and therapeutic alliance precede any medicine work
2. Not for Everyone: Clinical judgment, careful screening, and individualized assessment remain paramount
3. Container Is Everything: Set, setting, intention, preparation, and integration determine outcomes as much as the medicine itself
4. Recovery Is Multifaceted: 12-Step programs, plant medicine, therapy, lifestyle change, and community all have roles
5. Honest Risk Assessment: Neither minimizing dangers nor catastrophizing—just clear-eyed evaluation
6. Integration Is Primary: The medicine opens doors; daily practice and lifestyle change walk through them

Conclusion: Bridging Worlds with Humility

The panel’s diversity—infectious disease doctor turned ketamine specialist, holistic psychiatrist trained in the Amazon, Mexican immunologist bridging indigenous and scientific knowledge, recovery advocates who’ve walked both paths—demonstrated that thoughtful integration of psychedelics for addiction treatment requires multiple perspectives.

Marcos’s closing words resonated with humility: “I’m sitting in a room full of people I recovered alongside. I never foresaw a day when we’d be talking about recovery and getting well together this way. I’m excited to see dogma broken down, to see healing have its space, and to know that the sacraments are being heard.”

Dr. Wiss’s transformation from skeptic to bridge-builder reflects the field’s maturation. His final thoughts captured the evening’s spirit: “As a longtime proponent of dogma, I am very excited to see some of the dogma breaking down, and to be a part of it.”

The path forward requires continued dialogue, rigorous research, clinical wisdom, and above all, a commitment to meeting people where they are with compassion, safety, and evidence-informed care.

Dr. Wiss wrote a reflection blog after the event called: “Risking Belonging: How Mental Health Recovery Principles Can Heal Our Fractured World.” You can also view the 2024 event: “Beyond Conventional Mental Healthcare: New Frontiers in Plant & Food Medicines.”

Resources

• Nuno Recovery: Revolutionary approach to integrated recovery in Costa Rica
• Wise Mind Nutrition: Mental health app integrating nutrition and lifestyle medicine
• Antedote Wholeness Center: Modern rite of passage programs for young men
• Skylight Psychedelics: Training and ketamine-assisted therapy programs
• MAPS: Multidisciplinary Association for Psychedelic Studies
• Clinical Trials: Search active psilocybin studies at clinicaltrials.gov

This article is for educational purposes only and does not constitute medical advice. Consult qualified healthcare providers before considering any treatment approach.