First of all, I'd like to say I've been excited about this topic for some time and have been following each of you, and your (excellent) work individually, so it's a very pleasant surprise to have you all here!

Question: what is your thinking on how cost-effective, from a donor perspective, additional resources are if put towards psychedelics compared to other problems, e.g. the GiveWell-style health and development interventions? 

Follow up: How valuable do you think additional detailed research on this would be (to you)? 

This is primarily for Tim, seeing as he's really putting his money where his mouth is!

Background: I run the Happier Lives Institute and I want us to take look, in the near-future, into funding psychedelics.* Psychedelics seems very promising, but it's unclear exactly how promising.

One generic issue is that it's hard to sensibly model the cost-effectiveness of systemic interventions, e.g psychedelics, to 'atomic' ones, e.g. handing out cash transfers to one person at a time, because you have to make so many assumptions about how funding one thing might impact an entire society. The best analysis currently is from  Founders Pledge, who compared funding... (read more)

What is the best case against psychedelics being an important area? 

How could psychedelics-assisted therapy be scaled up? Isn't this super hard because you need at least two trained professionals on multiple lengthy occasions? Where will those people come from? 

For everyone: What are your thoughts on the effective altruism movement? What do you like about it, and what do you not like about it?

Really appreciate your taking the time to do this AMA — I badly want to see this cause area succeed, largely thanks to your writing (Michael), advocacy (Tim), and research (Matthew). Thanks for leading the way.

In a recent conversation with Tim, Hamilton Morris worries out loud about how the psychadelic pendulum has recently swung towards hype, with lots of trendy op-eds and new capital:

Well, what happens when that gets a little bit old, and what happens when, I don’t know, someone has a bad experience? Maybe a celebrity has a bad experience and they decide that mushrooms caused their psychosis. And then what?

How do you think about setting expectations here? Are you concerned about this resurgence in interest repeating some of the mistakes of the 60s? And, this time, what can we be doing to establish things for the much longer term?

Hi, very cool that you're doing this, thanks! Here goes my question:

How likely is it that taking psychedelics makes patients weird? Scott Alexander wrote up some anecdotes about many early psychedelicists getting weird as they experimented with these substances. He emphasizes it's all very speculative and of course subjective. And it probably involved pretty high doses / frequencies. But my very superficial understanding is, that it's hard to find good studies on this sort of thing, precisely because of the regulatory environment. Is that accurate or am I missing something? So should patients seriously consider the risk that their personality, motivations and view of the world would be significantly altered in a way their current self wouldn't necessarily endorse? Would that be a bad thing?

How much evidence is there for microdosing having an effect significantly larger than placebo? From this conversation with James Fadiman I got the impression that it is more underwhelming than I thought. 

MDMA-assisted couples therapy has been studied a bit. Could MDMA also be useful for interpersonal conflict resolution more generally, such as for enabling more constructive conversations between people with very different perspectives?

Thanks for doing this!

For all three – how would you like to see EA participate in the psychedelic renaissance? What do you think a good marriage of the two communities would look like?

For Tim: If for some reason you were unable to donate to scientific research and clinical treatments of "intractable" psychiatric conditions over the last few years (and in the future), what would you instead be donating that money on? I'd love to know about what other causes or projects you prioritize, whether they are mental health related or not.

What do you think of drug policy reform more broadly, and where do you see your work on psychedelics fitting into that?

(Disclaimer/hopefully-acceptable-self-promotion: Peter Singer and I argued, in the New Statesman, in favour of full legalisation a couple of weeks ago. We didn't mention psychedelics specifically, but full legalisation would, amongst other things, make research into and the therapeutic use of psychedelics easier).

How do you feel about people flying to e.g. Jamaica and going on psilocybin retreats? Is this a net positive or could it be a problem for changing the image of psychedelics towards a legal medicine? 

Imagine, two or three decades from now, that all your hopes about psychadelic-assisted therapy materialise — it works at scale, and it becomes about as neglected and unhelpfully politicised as hip surgery and antibiotics.

What do you picture? How did these remarkable early studies scale to a system which fully lives up to their promise and reaches milions of people? And just how ubiquitous (in your more imaginative moments) do you see these treatments becoming?

More personal question: what reactions have you gotten from other people, such as your friends and family, when/if you've told them about your use of psychedelics? Was anyone shocked and appalled?

I struggled with IV heroin addiction for a decade and got clean, with psychedelics playing a major role. I went back to school and got a computer science bachelor’s, but realized I want to dedicate my life to helping both the psychedelic movement and others with addiction and/or mental illness. I am considering applying to med school in my 30s in the hopes of becoming a psychiatrist. Is this foolish? If so, how else can I contribute to the cause?

Should psychedelic researchers have personal experience with the substances? It could be a source of bias, but also help one design studies. 

After enjoying an explosion of popularity in the 60s, psychedelic use declined with the emerging “War on Drugs,” and research was completely halted for 20 years starting in 1972. Fast forward to today, and we’re now seeing some form of psychedelic renaissance, with growing interest in their ability to “change minds” for the average person and to potentially help people with a variety of ailments. For those of us who are keen to minimize the risk of entering another psychedelic drought, and who have experience with launching nonprofit startups, what type of nonprofit psychedelic advocacy group do you think could do the most good? 

Many thanks for your important work, and for doing this AMA. 

What's the current state of research into 'bad trips' and hallucinogen-persisting perception disorder? 

There seems to be this weird disconnect between people saying "but what about bad trips?" and psychedelic researchers basically shrugging their shoulders and replying "we actually don't see these in clinical trials". Is one explanation that clinical trials screen out certain people, eg those susceptible to schizophrenia, who are most liable to react badly to psychedelics?

Within the field of psychedelics, where do you think additional action is most urgent, and why?

For Michael (or others): Do you think there might be a connection between (responsible) Psychedelic use and altruism? And if so, do you think this is a promising research avenue or future application for psychedelics?

In  How to Change Your Mind,  you reference the sense of 'oneness' and global community that often follows a psychedelic experience. I imagine these same feelings motivate many altruists, so psychedelics' ability to dial them up could potentially lead to some inspiring ethical change; the change that has motivated many players in the... (read more)

Thanks so much for doing this! I'm a massive fan of all of yours.

Michael, you've written that, as well as being used to treat mental health issues, psychedelics could be used for the 'betterment of well people'.

For anyone: currently, how much good evidence is there that psychedelic use can change healthy people in ways that are generally positive (by making them more open, empathetic, rational, etc.)? I'm never sure what to make of claims in this area.

 One of the other comments here says there might be some evidence of microdosing not doing much. One of my friends swears that a 'hero's journey' is orders of magnitude more impactful or effective than simply doing a normal dose. 1. Is there research being done on heavy one time usage? 2. If it turned out the most effective way to use psychedelics was to use a large amount at once, would this be politically feasible?

What are your thoughts on chronic anxiety and DP/DR induced by psychedelics? Do you have an idea of how common this kind of condition is and how best to treat or manage it?

What do you think of the research chemicals scene (e.g. r/researchchemicals)?

Hi! Thanks for doing this. I read How To Change Your Mind a few years ago and quite enjoyed it, which lead me to following this space since then. A few questions come to mind right now but I'll post them separately. Feel free to answer what is interesting and ignore what seems less important. 

First off: How do you see the regulatory environment around psychedelics changing in the next decade? IIRC from this podcast with Rick Doblin, it looks like MDMA could be decriminalized in the US in the next years and psilocybin might follow a few years after that. Is this correct? 

How do you balance your efforts between helping others and taking care of yourself? 

I've recently been feeling burnt out in a way that is making me less effective in both areas, and I think this is a somewhat common feeling in the EA community because there really is no limit to the amount of good you could do and how hard you could work for it. 

Thanks to all of you for your work in this space, and for doing this AMA. 

Question for anyone. In the spirit of Effective Altruism — where are donations best placed in this space? Is it simply about giving to MAPS, USONA, JHU, Berkeley, Neuroscape, etc. and letting them use as they see fit? 

Or is there a taxonomy or framework of giving opportunities potential donors should consider such as monitoring and litigating potential abuse in the patent landscape; scaling training for facilitators; harm reduction; public education campaigns; funding specific research studies ? Does it depend on how big the donation is?

Hi all, thank you for everything you have done in this area. 

Do you think it will be difficult for North American/European cultures (bit vague, sorry) to integrate the experiential aspect of these drugs? The clinical results are amazing and will speak for themselves but the black box that is the mystical-religious type experience with it's unitive consciousness, self transcendence, union with "God", entity interactions etc etc

I fear this aspect of the drugs (IMO the most interesting/profound aspect!) will be hard to integrate with wider culture. Do you have this fear? How have you thought about how this can be integrated and taken seriously and not dismissed as a delusion/hallucination ?

Regards

I'm interested in your thoughts on the use of psychedelics for the treatment of Autism. I have an older brother (58), 1st child of my mother, who has worked most of his life as a service clerk at a grocery store.  I have felt if he could break free of the fearful loops of his default mode network, so much more could open up for him.  My mother was diagnosed as having toxemia during her pregnancy with my brother.  I feel my mother's fears may have also been conveyed to my brother during pregnancy.  Do you feel psilocybin or mdma could be useful to treat my brothers Autism, and are you aware of any trials looking for candidates?  Thank you, Patrick

Successful legalization of psychedelics simply cannot happen without commercialization - but advocacy for psychedelic-assisted therapy has gone from being driven largely by medical academics, philanthropists,  and various grassroots enthusiasts, to being dominated by entrepreneurs and investors.  Shareholders seem prone to accepting company press releases regarding ethical concerns rather than questioning the approaches being taken by the relevant pharma startups they are stakeholders in. What can supporters of psychedelic therapy effectively do to ensure that healing, safety and accessibility get prioritized over ROI and market control?

Do you think harmala alkaloids alone have any potential in this developing field of psychedelic medicines?

What do you see as the best path toward mainstream adoption of psychedelics? Do you think that parts of the “psychedelic culture” (think: ritual, emphasis on hallucinatory experience, etc.) will be adopted into the mainstream, and do you think they should be? What do you all think about the idea of “non-hallucinogenic” psychedelics?

Thanks for doing this to you three! Two questions:

• Do you see any social dangers from psychedelic use and the associated insights becoming more widespread? I am thinking of for example new forms of religious sectarianism through psychedelic induced spiritual insights, less caring about one's own and other people's suffering through a complete transcendence of the self and the identification with conscious states, etc.
• Do you see any potential medical use of DMT?

Hi Tim, Michael, and Matthew. Thank you for doing this.

My question: Has there been any research that looks at how a person's pre-existing belief structures might affect a psychedelic experience? I've heard some anecdotal evidence that an extremely rigid set of beliefs (religious fundamentalism, in particular) can be a substrate for a very bad trip, because of a refusal to accept a frightening encounter during the experience as anything but the presence of real evil. Of course a "bad trip" can be extremely useful regardless, and these experiences ("good" or... (read more)

What’s the best way to get in touch with a trustworthy guide? Is there a community of reliable people who we can begin to explore with?

I have a 57-year-old sister with treatment-resistant depression (since age 12). Esketamine provides limites relief. What is the best way to get her into a trial or program to try psilocybin? Or, the more generalized question, how does one go about finding practitioners of psychedelic-assisted treatment?

Long comment; TLDR at the bottom.

Thank you all for doing this AMA. You three have done incredible things for the world of psychedelics. Michael—I loved How to Change Your Mind  and I'm looking forward to getting my hands on This is Your Mind on Plants when it comes out. Tim—I love your podcast and have been listening to it almost daily for the past two months. Dr. Johnson—your podcast with Lex Fridman was incredible.  

The question:

What are your thoughts on someone with Bipolar 1 taking psychedelics for non-therapeutic purposes? ... (read more)

Most folks who receive psychadelic-assisted therapy do so now because of a known and often severe issue — like depression, PTSD, or a form of addiction. Can either of you speak to an experience (personal or otherwise) of first realising or appreciating some issue through the use of psychadelics, in a way which helped resolve that issue?

More generally, how do you think about using psychadelics for treating the 'well'?

If you reran U.S. history from (say) 1960 to the present day, how likely does it feel to you that drug laws shake out in the way they did? Is there something about the way psychadelics ended up getting regulated that feels inevitable, or could the story easily have turned out differently? What could that tell us about hopes for influencing sensible regulation that lasts for > a decade?

What is especially neglected but promising within psychedelic science? 

What new psychedelic drugs are being invented, or are in planning stages? What would be the characteristics of the "perfect" psychedelic drug (regarding duration, intensity, etc). How might new, as-yet unheard of substances change the potential for psychedelic therapy? 

Thanks for doing this, guys, and for all the great work you’re doing in this field. As someone who is in serious need of these therapies, I’d like to submit that there is a huge piece of the puzzle that seems to have been ignored to this point. When it comes to treating TRD with psilocybin, has there been research done on the most effective method for transitioning patients off of their existing antidepressants and the implications of doing so? I, like many others, have tried and failed numerous times to get off of SSRI’s/SNRI’s. It’s a serious problem (se... (read more)

Is the renewed interest in psychedelic research & psychedelic-assisted therapy happening only in Western countries? Are other countries more worried about these substances for some reason(s)?

What would you say to journalists who may (or may not) be:

1. willing to do accurate reporting on these topics
2. too time-pressured (or otherwise unable) to read the original research
3. strongly incentivized to sensationalize these topics? 

Which treatment type do you expect to see approved first? Do you think it will open doors for additional treatment types?

Question for anyone: What is the next big book about the future of psychedelics that you hope gets written? 

Thanks for all of your work in this area and for doing this AMA. 

In the spirit of "80,000 Hours" (the effective altruism approach to using one career to do the most good) — what kinds of qualifications, experiences, or credentials are needed to work in this field? I'm sure there is a range. I'm personally interested in the challenge of scaling the training of facilitators, and I have credentials in learning design, but nothing in clinical psychology or psychiatry. Must one have experience in research or clinical settings to make an impact here?  ... (read more)

Dr. Johnson - After reading about your cautions about how  practitioner beliefs and/or setting (e.g. use of religious/spiritual symbols, artwork, etc.), I was left wondering about your thoughts, or any evidence you've seen, about the use of nature imagery in psychedelic assisted therapy? Based on the work around nature relatedness and views on the biophilia hypothesis, my hypothesis is that nature imagery could serve as a more neutral setting (i.e. free of religious beliefs) but haven't seen this studied yet with psychedelics. Thoughts on nature imagery during psychedelic treatment?

Have you seen any evidence, or are you aware of research in design phase, that will look at the potential effects of 

a) mindfulness practices (meditation, breathwork, etc.) as preparation for using psychedelics as a way to "train" for ego dissolution?

b) journaling intentions many weeks prior to a psychedelic experience as a way to improve outcomes?

Thanks for all of your thoughtful work!

I can think of a few different inter-related lines of effort in advancing the psychedelic movement, that may be most easily divided into:

1. policy work
2. scientific research
3. grassroots work

Do you have a sense of whether the policy work and scientific research are money constrained, talent constrained or both? For someone looking to enter the field what would be

And as far as grassroots work goes, it seems important to keep the movement "respectable" but at the same time it seems important for more people to have personal experiences with psychedelics if they're go... (read more)