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Perhaps this is one of the things psychedelics do: relax the brain’s inhibition on visualizing our thoughts, thereby rendering them more authoritative, memorable, and sticky. The overview effect reported by the astronauts didn’t add anything to our intellectual understanding of this “pale blue dot” in the vast sea of space, but seeing it made it real in a way it had never been before. Perhaps the equally vivid overview effect on the scenes of their lives that psychedelics afford some people is what makes it possible for them to change their behavior.

Matt Johnson believes that psychedelics can be used to change all sorts of behaviors, not just addiction. The key, in his view, is their power to occasion a sufficiently dramatic experience to “dope-slap people out of their story. It’s literally a reboot of the system—a biological control-alt-delete. Psychedelics open a window of mental flexibility in which people can let go of the mental models we use to organize reality.”

In his view, the most important such model is the self, or ego, which a high-dose psychedelic experience temporarily dissolves. He speaks of “our addiction to a pattern of thinking with the self at the center of it.” This underlying addiction to a pattern of thinking, or cognitive style, links the addict to the depressive and to the cancer patient obsessed with death or recurrence.

“So much of human suffering stems from having this self that needs to be psychologically defended at all costs. We’re trapped in a story that sees ourselves as independent, isolated agents acting in the world. But that self is an illusion. It can be a useful illusion, when you’re swinging through the trees or escaping from a cheetah or trying to do your taxes. But at the systems level, there is no truth to it. You can take any number of more accurate perspectives: that we’re a swarm of genes, vehicles for passing on DNA; that we’re social creatures through and through, unable to survive alone; that we’re organisms in an ecosystem, linked together on this planet floating in the middle of nowhere. Wherever you look, you see that the level of interconnectedness is truly amazing, and yet we insist on thinking of ourselves as individual agents.” Albert Einstein called the modern human’s sense of separateness “a kind of optical delusion of his consciousness.”*

“Psychedelics knock the legs out from under that model. That can be dangerous in the wrong circumstances, leading to bad trips and worse.” Johnson brought up the case of Charles Manson, who reportedly used LSD to break down and brainwash his followers, a theory of the case he deems plausible. “But in the right setting, where your safety is assured, it may be a good intervention for dealing with some of the problems of the self”—of which addiction is only one. Dying, depression, obsession, eating disorders—all are exacerbated by the tyranny of an ego and the fixed narratives it constructs about our relationship to the world. By temporarily overturning that tyranny and throwing our minds into an unusually plastic state (Robin Carhart-Harris would call it a state of heightened entropy), psychedelics, with the help of a good therapist, give us an opportunity to propose some new, more constructive stories about the self and its relationship to the world, stories that just might stick.

This is a very different kind of therapy than we are accustomed to in the West, because it is neither purely chemical nor purely psychodynamic—neither mindless nor brainless. Whether Western medicine is ready to accommodate such a radically novel—and ancient—model for mental transformation is an open question. In taking people safely through the liminal state psychedelics occasion, with its radical suggestibility, Johnson acknowledges that the doctors and researchers “play the same role as shamans or elders.

“Whatever we’re delving into here, it’s in the same realm as the placebo. But a placebo on rocket boosters.”

• • • THE WHOLE IDEA of using a psychedelic drug to treat addiction is not new. Native Americans have long used peyote as both a sacrament and a treatment for alcoholism, a scourge of the indigenous community since the arrival of the white man. Speaking at a meeting of the American Psychiatric Association in 1971, the psychiatrist Karl Menninger said that “peyote is not harmful to these people . . . It is a better antidote to alcohol than anything the missionaries, the white man, the American Medical Association, and the public health services have come up with.”*

Thousands of alcoholics were treated with LSD and other psychedelics in the 1950s and 1960s, though until recently it’s been hard to say anything definitive about the results. For a time, the therapy was deemed effective enough to become a standard treatment for alcoholism in Saskatchewan. Clinical reports were enthusiastic, yet most of the formal studies conducted were poorly designed and badly controlled, if at all. Results were notably impressive when the studies were performed by sympathetic therapists (and especially by therapists who themselves had taken LSD) and notably dismal when conducted by inexperienced investigators who gave mammoth doses to patients with no attention to set or setting.

The record was a complete muddle until 2012, when a meta-analysis that combined data from the six best randomized controlled studies done in the 1960s and 1970s (involving more than five hundred patients in all) found that indeed there had been a statistically robust and clinically “significant beneficial effect on alcohol misuse” from a single dose of LSD, an effect that lasted up to six months. “Given the evidence for a beneficial effect of LSD on alcoholism,” the authors concluded, “it is puzzling why this treatment has been largely overlooked.”

Since then, psychedelic therapy for alcohol and other addictions has undergone a modest and so far encouraging revival, both in university studies and in various underground settings.* In a 2015 pilot study conducted at the University of New Mexico ten alcoholics received psilocybin, combined with “motivational enhancement therapy,” a type of cognitive behavioral therapy designed expressly to treat addiction. By itself, the psychotherapy had little effect on drinking behavior, but after the psilocybin session drinking decreased significantly, and these changes were sustained during the thirty-six weeks of follow-up. Michael Bogenschutz, the lead investigator, reported a strong correlation between the “strength of the experience and the effect” on drinking behavior. The New Mexico results were encouraging enough to warrant a much larger phase 2 trial, involving 180 volunteers, which Bogenschutz is now conducting at NYU in collaboration with Stephen Ross and Jeffrey Guss.

“Alcoholism can be understood as a spiritual disorder,” Ross told me the first time we met, in the treatment room at NYU. “Over time you lose your connection to everything but this compound. Life loses all meaning. At the end, nothing is more important than that bottle, not even your wife and your kids. Eventually, there is nothing you won’t sacrifice for it.”

It was Ross who first told me the story of Bill W., the founder of AA, how he got sober after a mystical experience on belladonna and in the 1950s sought to introduce LSD into the fellowship. To use a drug to promote sobriety might sound counterintuitive, even crazy, yet it makes a certain sense when you consider how reliably psychedelics can sponsor spiritual breakthroughs as well as the conviction, central to the AA philosophy, that before she can hope to recover, the alcoholic must first acknowledge her “powerlessness.” AA takes a dim view of the human ego and, like psychedelic therapy, attempts to shift the addict’s attention from the self to a “higher power” as well as to the consolations of fellowship—the sense of interconnectedness.