What’s the difference between recreational and therapeutic psychedelic use? 5 Questions with experimental psychologist Harriet de Wit
De Wit discusses the difficulty of finding out what a drug does, outside of its context.
As several psychedelics inch towards Food and Drug Administration approval, some advocates are doubling down on only their support of medical legalization, not broader access. “I am still anti-drugs, recreationally,” former Republican Governor of Texas Rick Perry clarified in a recent New Yorker article, while emphasizing his support for psychedelic mental health treatments. During the development of Oregon’s psilocybin services program, committees debated over whether access should be limited to therapeutic uses, or a wider category of use, that might include spiritual and self-improvement goals, or maybe even… fun?
It’s always been difficult to draw a hard line between so-called recreational and therapeutic psychedelic experiences. Some people have joyous, positive moments during psychedelic-assisted therapy, and others find taking psychedelics at a rave to be therapeutic in its own way. People have difficult experiences in psychedelic-assisted therapy and bad trips on hikes with their friends.
Harriet de Wit is an experimental psychologist at The University of Chicago who has been studying psychedelic drugs for more than 40 years. Her work has tried to uncover in laboratory experiments what effects psychedelic drugs have on people when context and expectations are stripped away.
For example, people often say that being touched feels better when they take MDMA recreationally. Is this because of the drug, or from the recreational setting they’re used in? In 2019, De Wit and her colleagues gave people blinded doses of MDMA, methamphetamine (another stimulant), and a placebo. To control for expectations, the results from those who got MDMA were compared to those who believed they took MDMA, but actually got methamphetamine. The study was able to conclude that only MDMA increased the pleasantness of being touched. It also heightened the attention toward happy faces, whereas meth did not.
Is that specific effect of MDMA recreational or therapeutic, or is it both? The Microdose talked to de Wit about her attempts to isolate what exactly psychedelic drugs do, no matter the circumstances.
People use some drugs recreationally, which we might define as using them to have fun, to party, to experience happiness with friends. But those same drugs, say MDMA or psilocybin, are also used to relieve or confront distress and other pathologies. Do you find this to be a contradiction?
I think it raises broader questions about psychedelic research, and what psychedelic drugs do in general. My laboratory studies try to look at really basic units of behavioral change.
What are the psychological constructs that these drugs are working on? If you take away all the contextual factors and expectancy, what cognitive measures or emotional measures remain?
When we get to that level, we find that there are very fundamental behavioral effects that could apply to both recreational settings, and also to therapeutic settings. It’s almost as though the same drug effects can have benefits in both situations.
An example of a behavior is when a drug makes people less sensitive to negative expressions in other people’s faces. That might help you in a recreational setting if you feel less judged and more free to interact. It might help in a therapeutic situation if you feel like the therapist is not judging you, and you’re freer to talk about difficult topics.
So, it’s not as if MDMA has effects A, B, and C; the recreational users are taking advantage of A and B, and then the therapeutic users are leaning into C?
I’m not going to have a clear answer on this. It depends. Of course, people go into recreational experiences or therapeutic experiences with very different expectations. And we know those expectations can very much alter the response to the drug.
You could say the person in the recreational setting goes into it to have fun. They prepare to experience the stimulant-like effects, the affective effects that go along with being more social. The people going into therapy are looking for something very different, they’re looking for relief from some symptoms.
So, the drug effects are malleable and they’re changeable depending on the environment and the expectations. It’s both things. I’m saying that the same fundamental processes are probably involved in both settings, but the settings, context, and expectations can influence people’s responses. I wish I could have a more black and white answer.
In the lab, you’re using a very controlled setting to try to isolate effects. Can you give an example of how you do that?
Early on we wanted to know whether very low doses of LSD would change either mood or behavior. When people microdose in a natural setting, they take these low doses every three or four days, and then they report improvements in all kinds of cognitive and affective and social experiences. It’s hard to know whether their expectancies influence their response, or whether the drug is really doing something.
When we give the drug under blinded conditions, we don’t even tell people what class of drug that they’re going to get. We tell them you might get a stimulant, a sedative, a hallucinogen, a placebo, or antihistamine. Then we gave them a low dose of LSD or placebo on four occasions, separated by three or four days, and measured their mood, cognition and their feelings of well-being.
What we found was that on the first day that people got LSD, they felt a little bit stimulated, and they felt more of a positive mood and energetic. But when they got the dose on the second and the third and the fourth days, that effect declined. There was a sort of tolerance to the effect.
I think when people take it in the natural situation, they mistake that original stimulant-like effect as influence on their subsequent responses. They think, “This is the feeling of well-being, and it’s going to continue,” but it doesn’t. By looking at it under controlled circumstances, we can kind of measure exactly what the drug does or doesn’t do.
Are there any aspects of these drug effects that are not susceptible to any context?
I would start with the physiological effects, like an increase in heart rate or blood pressure that would be less influenced by context than the psychological processes and mood.
Next to that I suppose could be visual and perceptual distortions. But they’re still influenced by the context and your understanding. I would hesitate to say that there’s anything that’s completely not affected—maybe something like pupil diameter.
Could changing context switch a drug experience from recreational to therapeutic?
You could say, “well, we know the context influences people’s responses. So can you use the context then?” If people want enlightenment, they might create a certain context to use the drug in. If they want to get therapeutic benefits, they might create a different kind of context by having a trusted therapist and all the preparation and integration afterwards.
To be honest, I think the interaction between environment and drugs is something we haven’t studied very well. We all recognize it, but we haven’t studied, you know, creating a positive social environment or a negative social environment or a therapeutic environment.
But this distinction between medical and recreational—there is something in-between that too that a lot of people are looking for. It may not be recreational in the sense that they’re taking a drug to have fun. They’re taking the drug for curiosity or looking for meaning or looking for insight. They’re not using it for a medical reason, there’s not something clearly wrong with them. They’re looking for enlightenment.
This in-between category—our regulatory system doesn’t really have room for it. We either regard something as a medication and treating a particular disorder, or we regard it as sort of abuse in a sense—using it for fun. In the case of psychedelics, it’s somewhere in between.
This interview has been edited and condensed for clarity and length.
