What does the ideal psychedelic continuum of care look like?

Welcome to Installment #2 of my series about pressing issues in the psychedelic field

The question I explore this week is, “What does the ideal psychedelic continuum of care look like?”

An Open Secret 

Here’s an open secret in the psychedelic field: Psychedelics won’t heal you. 

Sure, they may fling open the door to healing. But the real work begins after your journey, when you return to your daily life. 

As Christopher M. Bache writes in his exquisite book, LSD and the Mind of the Universe: 

It’s all too easy to think that because we have had a deep and profound experience, we have become a deep and profound person, but this is a fool’s delusion. Even when psychedelics allow us to experience the person we are in the process of becoming, we have to face the fact that we have not become this person yet, nor have we fully internalized the wonderful qualities we may have temporarily touched.

Yet many existing psychedelic healing models ignore this principle.

Most models—including those used by many ketamine clinics, retreats, clinical trials, and psilocybin centers in Oregon and Colorado—don’t include meaningful preparation or integration, and if those services are offered, they’re often served à la carte, meaning that a journeyer who wants to integrate needs to opt-in and pay extra.

This is like a surgeon asking a patient, “Would you also like me to sew you up?”

When integration services are bundled with the cost of treatment, the norm tends to be two or three sessions. This just isn’t enough. 

Deep healing and life change unfold slowly and often non-linearly. Setbacks and disappointments happen, often when you re-encounter the people, places, and temptations that precipitated the unhealthy patterns you’re trying to let go of. Without proper support, these setbacks are more likely to derail the healing process, and can even be harmful.

A primary reason for these deficient healing models is, of course, money.

Support from a skilled provider take time, and time costs money, especially if it’s the time of a therapist.

(This assumes that the journeyer can even find and pay for a qualified therapist, and that the journeyer is open to pursuing therapy. These are, of course, significant and often unwarranted assumptions. Therapy is expensive and is seldom covered by insurance. Plus, therapy can’t scale fast enough to meet the likely explosive demand if and when a psychedelic compound hits the market. And regardless, a therapist hasn’t necessarily had any psychedelic training or experience, and may hold inaccurate or biased views about psychedelics that can create a risk of harm to their clients.)

A Void in the Psychedelic Healing Landscape

Where does all of this leave us? It leaves us facing a void in the psychedelic healing landscape. Deep, lasting psychedelic healing requires far more support than current models contemplate. 

Staring into this void, we can either do what we’re currently doing, which is to continue skimping on or outright scrap preparation and integration. Or, we think creatively about how to fill that void. 

This invites consideration of my question of the week: 

What does the ideal psychedelic continuum of care look like?

There are the obvious, and indeed, vital segments of the continuum. Depending on the substance and the setting, doctor and/or nurses may be critical. So, too, are well-trained mental health professionals such as therapists, counselors, and social workers, who can provide both  one-on-one support as well as group therapy. Loved ones and community members can also play an invaluable role.

But this just isn’t enough support.

So what’s missing?

Fortunately, we can look to other care models, as well as to parts of the emergent psychedelic ecosystem, for some possible answers. These include, but aren’t limited to, peer support, coaching, and spiritual counseling. 

For this installment of my newsletter, I focus my discussion on peer support.

Peer Support Is Psychedelic

Peer support is a low-cost, scalable solution used in myriad other contexts such as for active duty service members, veterans, amputees, the elderly, and people facing mental and physical health challenges.

Plus, peer support works. Robust evidence demonstrates that peer support helps people lead happier, healthier lives. Peer support participants tend to have better mental and physical health, and feel more hopeful and empowered. Peer support participants are generally more engaged with their communities, more satisfied with their lives, and even have higher rates of employment. 

We don’t have to wonder whether peer support also works in a psychedelic context. We know it does. In recent years, organizations such as Fireside Project, Zendo Project, and VETS, Inc. have helped thousands of people reduce the risks and fulfill the potential of their psychedelic experiences.

Peer support in the psychedelic context can be especially meaningful. People navigating psychedelic experiences want to talk to others who they know have done the same, and who are therefore more likely to understand and less likely to judge or even pathologize the experience.

Fortunately, the psychedelic field is starting wake up to the value of peer support. As one example, Dr. Chris Stauffer and his team at Oregon Health Science University have begun to include peer support in psychedelic clinical trials with military veterans. This just makes sense. A peer supporter is cheaper than a therapist, and a veteran in a psychedelic journey may feel safer and more comfortable with another vet in the room.

What can be done to speed the adoption of peer support into existing psychedelic healing models?

First, more clinical trials should follow the example set by Dr. Stauffer in Oregon. This will continue to build the evidentiary foundation that peer support works even in the highly structured world of clinical trials.

Second, SAMHSA should offer pilot grants to psychedelic peer support organizations. This would be a common-sense extension of the funds they already spend on harm reduction in other contexts. Similarly, state and local governments, especially in jurisdictions that have changed psychedelics’ legal status, should explore similar grants. 

Third, ketamine clinics and other psychedelic businesses should start hiring peer supporters to provide preparation and integration services. Moreover, when some or all of the underlying ketamine treatment is covered by insurance, clinics should explore strategies for bundling peer support with covered services.

Fourth, psychedelic peer support should eventually be covered by Medicare. Non-psychedelic peer support already is in the context of mental health and substance use disorders. Some states have integrated peer support services into their Medicaid programs under the guidance of the Centers for Medicare & Medicaid Services (CMS), meaning that peer support may be reimbursable as part of a broader treatment plan. Medicare coverage of psychedelic peer support, especially when the psychedelic has been taken to address a mental health or substance use disorder, should be explored immediately.

Conclusion

I invite you to share your thoughts and questions in the comments. As always, thank you for reading!