Abstract
Background and aims
Improved outcomes for substance use disorders have been described following non-clinical (“naturalistic”) psychedelic use. This exploratory study aimed to describe the naturalistic psychedelic experiences of people with substance use concerns and their reported needs and perceived utility of psychosocial support following naturalistic psychedelic use to integrate experiences and achieve positive change. We also explored preferred formats of delivery of integration support to inform future co-design processes necessary for developing new services.
Method
English-speaking participants aged ≥18 years, who were concerned about their substance use and had consumed a classical psychedelic (i.e. psilocybin, lysergic acid diethylamide (LSD), N,N-Dimethyltryptamine (DMT) or Ayahuasca, mescaline) at least once in the past year, were recruited online for a 10–20-minute survey. Questions explored experiences of psychedelic use and perceptions of the need for and models of integration support. Data were analysed descriptively.
Results
Of 108 participants, 94 (87.0%) thought that integration support following naturalistic psychedelic experiences would have been useful, with the majority of those interested (n = 61, 64.9%) endorsing a model of individual support, led by a psychologist (n = 63, 67.0%) or peer worker (n = 55, 58.5%) with lived experience of psychedelic use, and primarily focusing on how to apply the insights gained during the psychedelic experience into life (n = 68, 63.0%).
Discussion
In our sample of participants with substance use concerns, potential benefits of psychosocial support following naturalistic psychedelic experiences were identified. These findings could be complemented with a qualitative exploration of the desire for integration support following naturalistic psychedelic experiences.
Introduction
There is an urgent need for more effective treatments in addiction medicine due to the high burden of disease and paucity of existing treatments for substance use disorders (SUDs) (Degenhardt et al., 2019). The backbone of substance use disorder treatment are psychosocial interventions facilitated by clinicians, occurring in individual or group settings. While the Opioid Treatment Program offers methadone and buprenorphine for opioid use disorder, limited effective pharmacotherapy treatments exist for alcohol or stimulant use disorders (Kranzler & Soyka, 2018; Siefried, Acheson, Lintzeris, & Ezard, 2020). Available treatment options for SUDs are often limited by poor effect sizes and high relapse rates (Kassani, Niazi, Hassanzadeh, & Menati, 2015; Siefried et al., 2020; Soyka & Mutschler, 2016), substantial access, cost and scalability constraints, and poor consumer acceptability (Marchand et al., 2019). To reduce barriers to treatment and increase engagement, peer workers are increasingly becoming an integral part of service planning and delivery, using their lived experience to support clients in reaching their treatment goals (Emery, Matthews, & Duggan, 2024; O’Neill et al., 2024).
In recent years, there has been a renewed interest in the therapeutic potential of psychedelic compounds, such as lysergic acid diethylamide (LSD) and psilocybin when combined with psychotherapy, for the treatment of diverse mental health conditions (Aday, Mitzkovitz, Bloesch, Davoli, & Davis, 2020; Dos Santos, Bouso, Alcázar-Córcoles, & Hallak, 2018; Van Amsterdam & Van Den Brink, 2022) and SUDs (DiVito & Leger, 2020; Mendes et al., 2022). Positive, rapid, and sustained outcomes appear to be achieved by a limited number of psychedelic dosing and therapy sessions with minimal adverse events and dependence potential (Dos Santos et al., 2018).
The psychological state of the individual (the ‘set’) and the setting in which the psychedelic experience occurs are hypothesised to significantly influence the outcomes of Psychedelic Assisted Therapy (PAT) (Johnson, Richards, & Griffiths, 2008; Zentner, 1985). Accounting for this, PAT typically follows three stages: preparation therapy, supported dosing, and post-dosing follow-up (integration) therapy (Johnson et al., 2008). Integration therapy within PAT aims to maximise the therapeutic benefit through incorporating the insights gained during a psychedelic experience into one's life (Bathje, Majeski, & Kudowor, 2022) and minimise potential risks by resolving the sometimes-challenging experiences that may arise (Barrett, Bradstreet, Leoutsakos, Johnson, & Griffiths, 2016; Gorman, Nielson, Molinar, Cassidy, & Sabbagh, 2021).
Psychedelic use which is not facilitated, supervised, monitored, or otherwise supported by clinicians or researchers in a legal context (termed “naturalistic use”) remains relatively common internationally (Australian Institute of Health and Welfare, 2020, 2024; Krebs & Johansen, 2013; Winstock et al., 2021). Naturalistic use is often with therapeutic intent; in the 2020 Global Drug Survey, over half of those who reported LSD and/or psilocybin use intended to increase their wellbeing, and approximately one in seven sought relief from a psychiatric condition (Winstock et al., 2021). Using psychedelics is not without risk and may occasion challenging experiences (colloquially termed “bad trips”), including flashbacks to traumatic memories, extreme fear or paranoia, or ruminating negative thoughts. This can lead to adverse reactions following the psychedelic experience, often affecting mental well-being (Evans et al., 2023; Wood, McAlpine, & Kamboj, 2024). These challenging experiences are putatively more likely when combined with poorly controlled environments and adverse psychological states, which are more common with naturalistic psychedelic use compared to clinical trial settings (Evans et al., 2023; Johnson et al., 2008; Kopra et al., 2023). Regardless of whether people are using psychedelics with therapeutic intent or have had a challenging experience, those consuming psychedelics in naturalistic settings have inconsistent access to support following such experiences.
Although not directly comparable to tightly controlled clinical research, naturalistic psychedelic use may generate similar positive outcomes to those described in clinical research, such as perceived transformative experiences, improvements in social connectedness, and positive mood (Forstmann, Yudkin, Prosser, Heller, & Crockett, 2020; Glynos et al., 2022; Mason, Mischler, Uthaug, & Kuypers, 2019; Raison, Jain, Penn, Cole, & Jain, 2022; Sexton, Nichols, & Hendricks, 2020; Sweat, Bates, & Hendricks, 2016). These positive effects reported after naturalistic psychedelic use also appear to include outcomes related to SUDs, such as reduced substance use following the experience (Argento et al., 2022; Garcia-Romeu et al., 2019, 2020; Glynos et al., 2024; Kervadec et al., 2023). Further clinical research and large longitudinal studies are needed to validate causality, highlighting the promising yet nascent stage of current research into naturalistic psychedelic use.
Additionally, since integration therapy is a relatively new concept in modern clinical settings, only a limited number of psychotherapeutic principles have been established (e.g., therapeutic alliance) and the relative value of other therapeutic components and models of care (e.g., individual or group approach) is currently unclear (Luoma, Chwyl, Bathje, Davis, & Lancelotta, 2020; Meikle et al., 2019). It is unknown how many people who are concerned about their substance use and undertake naturalistic psychedelic experiences prioritise integration, or whether the context and setting influence this. It may be that there are individuals who do not want to participate in integration support, or those that do not understand it. This study sought to understand people's experiences and beliefs about how integration therapy may fit within this context. Determining the desire for publicly available integration therapy (hereafter referred to as “integration support”) following naturalistic psychedelic use and understanding the preferences of potential clients is essential for designing a feasible and acceptable intervention. This information is currently unavailable in the literature. This exploratory study therefore aims to describe the experiences of people who are concerned about their substance use and have used a classical psychedelic (psilocybin, LSD, N,N-Dimethyltryptamine (DMT) or Ayahuasca, mescaline) in a naturalistic setting. Specifically, the study aims to identify the desire for integration support following naturalistic psychedelic use and elicit crucial aspects of the first preferred model of care for this population.
Methods
Study design
This study was a cross-sectional international web-based survey. Survey data were collected using REDCap (v11.0.3, Vanderbilt University) electronic data capture tools hosted at UNSW (Harris et al., 2009, 2019). A participatory research design (Salsberg et al., 2015) was employed, with a person with lived experience of using psychedelics for therapeutic intent (author MS) involved in all aspects of the study. This study was approved by the University of New South Wales Human Research Ethics Committee (HC230073).
Participants
Eligible participants included adults (≥18 years) that were concerned about their substance use, who had consumed a classical psychedelic at least once during the past year and were able to consent and complete the survey in English. The survey was available for the period May 2023 to February 2024.
Participants were asked to complete the 10–20-minute survey on one occasion via a web-based survey link which in cluded electronic consent. The survey link was distributed in several online locations with the recruitment material including: peer and user networks via the NSW Users and AIDS Association (NUAA), the Australian Psychedelic Society newsletter, online forums (BlueLight, Shroomery, Corroboree Forum), and social media (Instagram, Facebook, Reddit). Additionally, to achieve snowballing and reach hidden populations, sharing of the link was encouraged. No incentives were provided to complete the survey.
Survey measures
The survey comprised three sections: participant demographic and drug use information; psychedelic experiences; and preferences relating to integration support. Feedback on the survey was sought from representatives with lived experience from the Statewide peak body for consumers with lived experience of drugs, NUAA. They provided input into the content, questions and design.
Demographic variables included age, sex at birth, gender, and location of residence. Substance use variables included psychedelic(s) taken within the past year, lifetime substance use, and principal substance of concern. Additionally, degree of substance-related risk for the principal substance of concern was evaluated using a modified version of the 8-item Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) (WHO ASSIST Working Group, 2002). Participants were then asked about lifetime mental health condition diagnoses.
Participants were asked to recall the most personally meaningful psychedelic experience within the past year as this experience is most likely relevant to integration support. Psychedelic experience variables included the psychedelic taken, the dosage, the location, company during the experience, and concomitant substance use. Appendix A displays the response sets available for dosage (from ‘low’ to ‘heroic’ [i.e., extremely high]), informed by Erowid, a leading online community for drug education and harm reduction (Erowid, 2009). Psychedelic experience outcome measures were assessed using 100-point visual analogue scales asking participants how meaningful the experience was, and how much the insights from the experience felt unresolved or forgotten. Participants were asked to rate changes in their principal substance of concern and then other substance use during the period following their psychedelic experience on a 7-point Likert scale, and their desire for integration support. Additionally, the strength of psychological insight during the experience was assessed using a modified version of the 28-item Psychological Insight Questionnaire (PIQ) (Davis et al., 2021).
Lastly, we asked participants about their preferences on how integration support should be provided following naturalistic experiences. This included perceived impacts of integration (defined as “making sense” of the experience) on their well-being on a 100-point visual analogue scale, their most preferred model including whether this was group and/or individual, the ideal number of group attendees, delivery modality (in-person, online, or mixed), session length, facilitation (psychologist or psychotherapist/psychologist or psychotherapist with psychedelic experience/a peer with psychedelic experience/a peer with past drug and alcohol concerns/other), frequency of support availability, frequency of attendance, main reasons for attendance, and focuses of support.
For quality assurance purposes, participants with inconsistent responses were excluded from analysis for failing at least one of three tests. First was an attention check (Abbey & Meloy, 2017), which asked participants to select the option ‘slightly reduced’ from a list of five options; this approach was inspired by a similar survey which asked participants if they had ever had ≥1 fatal heart attack (Forstmann et al., 2020). Other inconsistencies screened for included selecting a principal substance of concern not selected in lifetime substance use, and selecting a psychedelic that caused the personally meaningful experience which was not selected in psychedelic use within the past year. These sets of questions were flagged as they relate to essential inclusion criteria. We additionally sought to limit recall bias by excluding participants from analysis who selected “not clear at all” when asked how clearly they remembered their selected psychedelic experience.
Data analysis
This study was predominantly descriptive with an exploratory component; therefore, no power calculations were performed. We aimed to recruit approximately 400 participants, consistent with similar studies in the field (Garcia-Romeu et al., 2019, 2020). Analyses were conducted with SPSS (v29.0.2.0, Armonk, NY). Survey results were summarised: (i) categorical data as numbers and percentages, (ii) continuous data according to their distributions as means and standard deviations (SD).
Results
Study population
During the recruitment period (May 2023–Feb 2024), 151 participants clicked on the survey link (Fig. 1). Of these, 135 consented and confirmed meeting the study inclusion criteria, and 27 were excluded due to failing one of the quality or recall bias tests. The final sample (Tables 1 and 2) contained 108 responses. As this study aimed to determine which format of integration support was preferred, the corresponding table (Table 3) only included responses from those who were interested in discussing their experience after it occurred (n = 94).
Study population
aFailed attention check, “for this question please select ‘slightly reduced’”. bInconsistent responses were detected by investigating two sets of flagged questions seeking further clarification on inclusion criteria. Major discrepancies constituted: (i) selecting a principal substance of concern not selected in lifetime substance use, and/or (ii) selecting a psychedelic that caused the personally meaningful experience not selected in psychedelic use within the past year. cSelected ‘not clear at all’ when asked: How clearly do you remember this [most meaningful in the past year] experience? dSelected ‘no’ to: Would you have liked to talk to someone about your psychedelic experience after it happened?
Citation: Journal of Psychedelic Studies 2025; 10.1556/2054.2025.00422
Participant characteristics
The majority of the sample identified as male (n = 63, 58.3%), with a mean age of 30.9 years (SD = 9.6), and almost half were located in the US (n = 49, 45.4%). The most commonly used psychedelics in the past year were psilocybin (n = 87, 80.6%) and LSD (n = 50, 46.3%). Regarding lifetime substance use, cannabis (n = 107, 99.1%) and alcohol (n = 104, 96.3%) were the most widely reported substances. The most common principal substance of concern was alcohol, identified by 37 participants (34.3%), followed by cannabis for 25 participants (23.1%). Most participants scored 27+ on the ASSIST for their principal substance of concern and thus met the criteria for high substance-related risk (n = 69, 63.9%), and 66 participants (61.1%) self-reported at least one diagnosed mental health condition.
Participant demographic characteristics (n = 108). Percentages rounded to one decimal place. Ordinal categories presented in natural ascending order; non-ordinal categories presented in descending order by n (%)
| Characteristic | n (%) | Substance use | n (%) | Mental health conditions | n (%) |
| Age (years) | Psychedelic (past year)d | Lifetime diagnosis(es)d | |||
| Mean (SD) | 30.9 (9.6) | Psilocybin | 87 (80.6) | Depression | 54 (50.0) |
| Sex at birth | LSD | 50 (46.3) | Anxiety | 50 (46.3) | |
| Male | 69 (63.9) | DMT/Ayahuasca | 26 (24.1) | Never diagnosed | 34 (31.5) |
| Female | 39 (36.1) | Mescaline/Peyote | 10 (9.3) | Other | 26 (24.1) |
| Gender | All lifetimed | PTSD | 20 (18.5) | ||
| Male | 63 (58.3) | Cannabis | 107 (99.1) | ADHD | 11 (10.2) |
| Female | 35 (32.4) | Alcohol | 104 (96.3) | Bipolar disorder | 11 (10.2) |
| Non-binary | 8 (7.4) | ATS | 75 (69.4) | Missinga | 8 (7.4) |
| Transgender | 1 (0.9) | Cocaine | 67 (62.0) | Current diagnosis(es)d | |
| Genderfluid | 1 (0.9) | Sedatives | 58 (53.7) | Anxiety | 30 (27.8) |
| Sexual preference | Opioids | 47 (43.5) | Depression | 25 (23.1) | |
| Heterosexual | 71 (65.7) | Inhalants | 46 (42.6) | Other | 13 (12.0) |
| Other sexuality | 34 (31.5) | Other | 16 (14.8) | PTSD | 11 (10.2) |
| Missinga | 3 (2.8) | Principal substance of concern | In treatment for mental health condition(s) | ||
| Location of residence | Alcohol | 37 (34.3) | Yes | 35 (32.4) | |
| US | 49 (45.4) | Cannabis | 25 (23.1) | Never diagnosed | 34 (31.5) |
| Australia | 28 (25.9) | Other | 15 (13.9) | No | 30 (27.8) |
| Other (12 countries) | 20 (18.5) | ATS | 15 (13.9) | Missing | 9 (8.3) |
| UK | 11 (10.2) | Opioids | 14 (13.0) | ||
| Primary language spoken at home | Missing | 2 (1.9) | |||
| English | 89 (82.4) | ASSIST riskc | |||
| Other | 19 (17.6) | Low | 12 (11.1) | ||
| Highest educational status | Moderate | 18 (16.7) | |||
| ≤ High school | 16 (14.8) | High | 69 (63.9) | ||
| Vocational certificate | 18 (16.7) | Missing | 9 (8.3) | ||
| ≥ Tertiary degree | 66 (61.1) | In treatment for substance use | |||
| Missinga | 8 (7.4) | No | 90 (83.3) | ||
| Employment statusb | Yes | 18 (16.7) | |||
| Not employed | 30 (27.8) | ||||
| Part time | 29 (26.9) | ||||
| Full time | 48 (44.4) | ||||
| Missinga | 1 (0.9) | ||||
Abbreviations: post-traumatic stress disorder (PTSD), attention deficit hyperactivity disorder (ADHD), amphetamine-type-stimulants (ATS), United States (US), United Kingdom (UK), standard deviation (SD).
aMissing category comprises “prefer not to say” and “I don't know”. bNot employed’ includes unemployed, retired, unable to work, and full-time student. ‘Part time’ defined as <35 h/week. ‘Full time’ defined as >35 h/week. cASSIST risk-category scoring: lower risk = 0–10 alcohol, 0–3 all other substances; moderate risk = 11–26 alcohol, 4–26 all other substances; higher risk = 27+. dCould select multiple options.
Psychedelic and integration experience characteristics
In the selected psychedelic experience, participants used psilocybin (n = 64, 59.3%), LSD (n = 35, 32.4%), or a different classical psychedelic (n = 18, 16.7%) either in isolation or together. The majority of participants reported using up to a moderate (n = 35, 32.4%) or high (n = 27, 25.0%) dose according to our definitions. The experience most often occurred in their own home (n = 48, 44.4%); and in the company of a ‘trip sitter’ (someone who did not consume a psychedelic), friend, or sibling (n = 58, 53.7%). Approximately half of the sample reported no concomitant substance use (n = 49, 45.4%), while the most frequently used concomitant substance was cannabis (n = 46, 42.6%). Several post-psychedelic outcome measures were collected on interval scales: the first being psychological insight with a mean of 2.3 (SD = 1.0) total score on the PIQ (from 0 to 4). Secondly, participants' degree of personal meaningfulness had a mean of 69.4 (SD = 22.9, on a scale from 0 to 100); with 10 participants (9.3%) rating the experience as the most meaningful of their entire lives. Furthermore, participants felt their experience was moderately resolved and that the insights gained were not forgotten, as evidenced by a mean of 43.8 (SD = 27.5, from 0 to 100 from ‘not at all unresolved/forgotten’ to ‘very much unresolved/forgotten’). Regardless, it appeared that most individuals believed taking time to integrate (or ‘make sense of’) their experience would have positively impacted their well-being, with 86 participants (79.6%) indicating greater than a moderate impact (mean = 70.8 on a scale from 0 to 100, SD = 23.0). Most participants (n = 64, 59.3%) reported a reduction in the frequency of use of their principal substance of concern following their psychedelic experience, with smaller proportions indicating no change (n = 37, 34.3%), or increased use (n = 7, 6.5%). Similar results were observed for other drug and alcohol use. The majority of participants (n = 71, 65.1%) reported that they would have liked supported integration (or ‘to talk to someone’) after the experience occurred, and a further 23 participants (21.3%) indicating that they would have ‘maybe’ liked supported integration. These participants (n = 94, 87.0%) then answered the section about their preferred model of care.
Psychedelic and integration experience characteristics (n = 108). Percentages rounded to one decimal place. Ordinal categories presented in natural ascending order; non-ordinal categories presented in descending order by n (%)
| Experience characterisation | n (%) | Experience outcome measures | n (%) |
| Psychedelic(s) takeni | Psychological Insight (0–4)d | ||
| Psilocybin | 64 (59.3) | Mean (SD) | 2.3 (1.0) |
| LSD | 35 (32.4) | ≤Slight | 25 (23.1) |
| Othera | 18 (16.7) | Moderate | 60 (55.6) |
| Doseb | ≥Strong | 23 (21.3) | |
| Low | 12 (11.1) | Meaningful Experience (0–100)e | |
| Moderate | 35 (32.4) | Mean (SD) | 69.4 (22.9) |
| High | 27 (25.0) | ≤50 | 19 (17.6) |
| ≥Very high | 26 (24.1) | 51–99 | 78 (72.2) |
| Missing | 8 (7.4) | The most meaningful of my life (100) | 10 (9.3) |
| When | Missing | 1 (0.9) | |
| <1 month ago | 19 (17.6) | Insights unresolved/forgotten (0–100)f | |
| 1 to <3 months ago | 23 (21.3) | Mean (SD) | 43.8 (27.5) |
| 3 to <6 months ago | 33 (30.6) | Not at all–Moderately | 66 (61.1) |
| 6–12 months ago | 33 (30.6) | >Moderately–Very much | 40 (37.0) |
| Planning | Missing | 2 (1.9) | |
| No planning | 16 (14.8) | Potential impact of integration on well-being (0–100)g | |
| That day | 29 (26.9) | Mean (SD) | 70.8 (23.0) |
| That week | 34 (31.5) | ≤Moderate | 20 (18.5) |
| ≥1 week | 29 (26.9) | >Moderate | 86 (79.6) |
| Location of experience | Missing | 2 (1.9) | |
| Own home | 48 (44.4) | Use of principal substance of concernh | |
| Outside in nature/bush | 23 (21.3) | Reduced | 64 (59.3) |
| Someone else's home | 20 (18.5) | No change | 37 (34.3) |
| Pub/club/music festival | 10 (9.3) | Increased | 7 (6.5) |
| Other | 7 (6.5) | Other drug and alcohol use | |
| Companyc,i | Reduced | 61 (56.5) | |
| Friend/sibling/trip sitterc | 58 (53.7) | No change | 35 (32.4) |
| Alone | 34 (31.5) | Increased | 12 (11.1) |
| Partner | 27 (25.0) | Would have liked to discuss with someone | |
| Unknown people | 8 (7.4) | Yes | 71 (65.7) |
| Missing | 1 (0.9) | Maybe | 23 (21.3) |
| Concomitant substance usei | No | 13 (12.0) | |
| None | 49 (45.4) | Missing | 1 (0.9) |
| Cannabis | 46 (42.6) | ||
| Alcohol | 18 (16.7) | ||
| Other | 24 (22.2) | ||
| Concomitant psychiatric medication | |||
| Yes | 26 (24.1) | ||
| No | 82 (75.9) | ||
Abbreviations: lysergic acid diethylamide (LSD), standard deviation (SD).
aComprised of DMT or Ayahuasca; or Mescaline or Peyote. bIf more than one psychedelic (and dose) was specified, only the highest dose was reported. Dose brackets for each substance are defined in Appendix A. cTrip sitter defined as someone who did not consume the psychedelic substance. dAs measured on the PIQ, with a 4-point Likert scale (‘none; not at all’ to ‘extreme’). The final score is a mean of all items on the PIQ (0–4) converted to a 3-point interval scale (from ‘≤slight’ (i.e., ≤1) to ‘≥strong’ (i.e., ≥3). eVisual analogue scale from ‘Not all all’ (0) – ‘The most meaningful of my life’ (100). fVisual analogue scale including ‘Not at all’ (0), ‘Moderately’ (50) and ‘Very much’ (100). gPreviously specified in the demographics section (Table 1). hVisual analogue scale including ‘Not at all’ (0), ‘Moderate impact’ (50), “High impact” (100). iCould select multiple options.
Participants responses regarding integration support
The final sample for this analysis comprised 94 adults (Table 3); 13 participants were not interested in integration support, and 1 additional participant left the question blank, leading to their exclusion. Participants expressed a preference for individual support arrangements (n = 61, 64.9%), with a smaller proportion opting for group support (n = 19, 20.2%); 14 participants (14.9%) had no specific preference and selected both options. A further question regarding the number of attendees was directed at individuals interested in group support, either exclusively or in conjunction with individual support (n = 33, 35.1%). Of these, most participants indicated a preference for “2–5” attendees (n = 22, 23.4%); and none of the participants expressed a desire for sessions with “more than 10” attendees. The most prevalent response among participants regarding delivery modality was in-person (n = 63, 67.0%), followed by online (n = 17, 18.1%). The most frequent response for length of support was 60 minutes (n = 36, 38.3%). More than half of the sample expressed a willingness for a psychologist/psychotherapist with psychedelic experience (n = 63, 67.0%) and/or peer (n = 55, 58.5%) with psychedelic experience to facilitate the support, and 33 (35.1%) selected a peer with past substance use concerns. Most participants indicated an intent to attend regularly (n = 41, 43.6%), favouring the frequency of support to be either once a month (n = 34, 36.2%), or once a fortnight (n = 30, 31.9%).
Participants responses regarding integration support (n = 94). Percentages rounded to one decimal place. Ordinal categories presented in natural ascending order; non-ordinal categories presented in descending order by n (%)
| Component | n (%) |
| Arrangement | |
| Individual | 61 (64.9) |
| Group | 19 (20.2) |
| No preference | 14 (14.9) |
| Number of attendeesa | |
| 2–5 | 22 (23.4) |
| 6–10 | 11 (11.7) |
| >10 | 0 (0.0) |
| Delivery modality | |
| In-person | 63 (67.0) |
| Online | 17 (18.1) |
| Mixed (i.e., online call during the meeting)a | 14 (14.9) |
| Length (minutes) | |
| 30 | 15 (16.0) |
| 45 | 24 (25.5) |
| 60 | 36 (38.3) |
| ≥90 | 19 (20.2) |
| Facilitator(s)b | |
| Psychologist or psychotherapist with psychedelic experience | 63 (67.0) |
| A peer with psychedelic experience | 55 (58.5) |
| A peer with past substance use concerns | 33 (35.1) |
| Psychologist or psychotherapist | 22 (23.4) |
| Other | 9 (9.6) |
| Missing | 5 (5.3) |
| Frequency of support | |
| Twice a week | 5 (5.3) |
| Once a week | 25 (26.6) |
| Once a fortnight | 30 (31.9) |
| Once a month | 34 (36.2) |
| Frequency of attendance | |
| Regular attendance | 41 (43.6) |
| Once/after another experience | 25 (26.6) |
| Unsure | 15 (16.0) |
| Irregularly | 13 (13.8) |
aQuestion/category only presented to those who selected “group” or “no preference” to Arrangement (n = 33).
bCould select multiple options.
Figure 2 details motivations to attend integration support. The most common motivations to attend were ‘to learn to apply the insights gained into life’ (n = 68, 63.0%), followed by ‘to hear different perspectives or see the experience from another angle’ (n = 54, 50.0%), and ‘for closure and resolution to a recent psychedelic experience’ (n = 46, 42.6%). Regarding substance use, 43 participants (39.8%) cited a main reason to attend would be to help reduce their substance use. Appendix B provides additional details on participants' desired areas of focus for integration support.
Main reason(s) participants would like to attend integration support (n = 94)
Participants could select multiple reasons to attend. *Question only presented to those who selected “group” or “no preference” when asked which format of integration support they would prefer (n = 33)
Citation: Journal of Psychedelic Studies 2025; 10.1556/2054.2025.00422
Discussion
Our surveyed participants were mostly young males located in the US, who were in the high-risk category of substance use according to the ASSIST tool. Naturalistic psychedelic experiences described here most often occurred within people's own homes, accompanied by familiar individuals, and participants believed that these experiences led to a decrease in use of their principal substance of concern and other drugs and alcohol in the following weeks. The majority of participants were interested in integration support, preferring individual sessions led by a psychologist and/or peer facilitator with lived experience of psychedelic use.
Although our study was limited by the sample size, our cohort appeared to be relatively representative of people who use drugs and psychedelics as reported in existing literature (Argento et al., 2022; Garcia-Romeu et al., 2019, 2020; Glynos et al., 2024; Kervadec et al., 2023). In a small (n = 12) qualitative study on naturalistic use by Shaw, Rea, Lachowsky, and Roth (2022), most interviewees highlighted utilising peer supports to optimise their experience – whether that be a trusted person or “trip sitter” (someone who did not consume the substance). These findings are broadly consistent with the present study, as 78.7% of participants were found to consume psychedelics in the presence of familiar individuals. Notably, 10 participants (9.3%) in our study rated their psychedelic experience as the most meaningful event of their lives, consistent with findings from previous research (Griffiths, Richards, McCann, & Jesse, 2006; Griffiths et al., 2016). Furthermore, without formal integration support it has been suggested that the positive insights gained will be forgotten or not transformed into durable behaviour change (Bathje et al., 2022). Although 37.0% of participants in our study reported that the insights from their experience felt unresolved and/or forgotten, 79.6% indicated a belief that integration (or ‘taking time to make sense of your experience’) could still positively affect their well-being. These results suggest factors beyond fear of forgetting or not resolving experiences influence the desire for integration support, warranting further qualitative exploration.
Decreased substance use in the weeks following the meaningful psychedelic experience was described by 59.3% of our cohort, consistent with other similar studies (Argento et al., 2022; Garcia-Romeu et al., 2019, 2020; Glynos et al., 2024; Kervadec et al., 2023). For instance, in a retrospective global survey (n = 5,268) approximately 70% of respondents reported ceasing or decreasing their use of at least one non-psychedelic substance following naturalistic psychedelic use (Glynos et al., 2024). In our study, 39.8% of those interested in integration support cited helping to reduce their substance use as a main reason to attend, highlighting the potential for integration support as an opportunity to assist individuals with substance use concerns.
The overarching goal of integration is to maximise benefit from psychedelic experiences and minimise harm when challenging experiences occur. In a 2022 study evaluating a ‘psychedelic helpline’, Pleet, White, Zamaria, and Yehuda (2023) found that 66.4% of 259 post-call survey participants who spoke with a peer-support specialist reported de-escalation from psychological distress, and 23.2% indicated that their conversation may have prevented physical or emotional harm. Australian Poisons Information Centre calls related to classic psychedelics more than doubled between 2014–2022, with significant toxicity observed (Wilkes, Roberts, Liknaitzky, & Brett, 2024). The authors note that these figures contrast with the reported safety of these substances within clinical trials of PAT, most likely due to the uncontrolled environments associated with naturalistic psychedelic use (Wilkes et al., 2024). These findings suggest the importance of integration support for people with challenging experiences to prevent harm following naturalistic psychedelic use. In Australia, a national helpline for people who use drugs to receive information, support and counselling services is available 24/7 (Bascombe et al., 2023), and it is unknown how much of support they are already delivering specifically to reduce harms associated with psychedelics. A deeper understanding in this context would be valuable.
Of those who expressed an interest in integration support, most endorsed a model of individual support, delivered in-person, led by a psychologist or peer worker with lived experience of psychedelic use. There was a preference for sessions lasting around 45–60 minutes, occurring once a fortnight to a month, and primarily focusing on how to apply the insights gained into life. These findings provide a novel contribution, as far as the authors are aware this is the first assessment of participant preferences for integration therapy in any context, but particularly with respect to people with alcohol or drug concerns following naturalistic psychedelic experiences. The results highlight the importance of a facilitator who experientially understands the nature of psychedelic experiences (Harris, 2020); a concept that is currently being evaluated in psychedelic clinical trials. While regular attendance of integration support was preferred, 26.6% of participants indicated they would attend only once or as a drop-in after another psychedelic experience. This suggests that ad-hoc support may be sufficient for some, even though integration is typically defined as a continuous and ongoing process (Bathje et al., 2022). A small qualitative study analysing integration challenges experienced after a psychedelic retreat noted that participants (n = 9) experienced the most challenges in the hours after the psychedelic had worn off, and during the days and weeks following the retreat (Lutkajtis & Evans, 2023). The authors suggest that the period immediately following a psychedelic experience is a critical time when additional support, care and monitoring is essential (Lutkajtis & Evans, 2023). This may explain the desire in our cohort for one-time integration support to resolve any immediate concerns, however, further research with larger sample sizes is needed to confirm this hypothesis.
There is a paucity of research on using group work as part of psychedelic-assisted psychotherapy; one notable example is a study of psilocybin assisted psychotherapy as a treatment for demoralisation (a state of hopelessness and helplessness) in older long-term AIDS survivor men, which had positive outcomes and recommended testing the model for other demoralised populations, such as SUD (Anderson et al., 2020; Hendricks, 2020). The present study was, to our knowledge, the first to show that most people in this population would prefer individual integration support over group support. Among those who were interested in group support, there was a preference for smaller groups, with no participants preferring groups of more than 10 attendees. This finding should be tested more rigorously, as currently, most integration groups advertised online contain upwards of 10–20 attendees, and the impact of group size on integration has not been explored in clinical or naturalistic research. Lower interest in group integration support may stem from confidentiality concerns, social anxiety, or uncertainty about the group format. However, 35.1% of participants indicated an interest in group sessions, and so therapeutic (Barlow, Burlingame, & Fuhriman, 2000; Leszcz, 2020) and economic considerations (Trope et al., 2019) may mean this is preferable for some individuals. Overall, further exploration and validation of the feasibility of a group setting and specific preferences of potential clients is a fruitful area for future research.
Future studies should employ population surveys and qualitative methodologies for a more in-depth understanding of the need for integration within the naturalistic population and to create an evidence-based model of delivery. Frymann, Whitney, Yaden, and Lipson (2022) created the first validated scales to measure the level of integration an individual feels after engaging in integration practices, and Cheung, Propes, Jacobs, Earp, and Yaden (2024) recently developed a set of preliminary guidelines for the assessment of group-based integration. Both measures are yet to be used routinely in research or clinical practice but present an opportunity for future research to evaluate different integration models and group formats.
Limitations
Although our cohort appeared consistent with the literature, this exploratory study used a convenience sample within the community and may not be representative of the population of people with substance use concerns who are using psychedelics. This limits the generalisability of the results, as it is important to consider that minority populations are critically underrepresented in this area and are disproportionally affected by mental illness and other negative health outcomes (Michaels, Purdon, Collins, & Williams, 2018; Thrul & Garcia-Romeu, 2021). In seeking responses regarding a ‘personally meaningful’ psychedelic experience we attempted to limit recall bias, but given the self-reported nature of the study, recall bias may still be present. The small sample size was a limitation. No power calculations were performed; therefore, although the original aim of recruiting a larger number of participants (approximately 400) was not met, the key aims of the study were still achieved. Despite these limitations, study findings highlight valuable consumer insights that could help inform the design of effective and publicly accessible integration support. Overall, these limitations indicate that the results should be interpreted as exploratory, and further research with larger sample sizes is necessary to confirm these findings.
Conclusion
This study recorded substantial interest in integration support following naturalistic psychedelic experiences for people with substance use concerns. Additionally, a preferred model of integration support was evident. Although the individual format was preferred, there was interest in a group setting, with preference toward smaller groups. This merits further exploration considering current group models of treatment for substance use disorders and potential to accommodate a larger number of participants simultaneously.
Funding sources
JB is supported by the National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Medications Intelligence (ID: 1196900) and an NHMRC Investigator Grant (ID: 1196560).
Authors' contribution
Ms Sophie van der Helder wrote the manuscript, with significant editorial input from project supervisors A/Prof Jonathan Brett and Dr Krista Siefried. Dr Mary Ellen Harrod and Dr Liam Acheson offered critical insights that significantly influenced the manuscript's composition. Ms. Maureen Steele, a peer worker with lived experience of drug use and using psychedelics for therapeutic intent, provided essential feedback from the initial proposal onwards to ensure appropriateness for the surveyed population of people who use alcohol and drugs.
Conflict of interest
The authors declare no conflict of interest.
Acknowledgements
Firstly, we would like to acknowledge and extend a special thanks to every survey participant. We also wish to express our gratitude to Dr Kathryn Fletcher for proofreading the final version of this manuscript.
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Appendix
Appendix A: Response sets participants could choose from for each classical psychedelic dosage.
Dosage categories participants could choose from for each classical psychedelic
| Low | Moderate | High | Very high | Heroic | |
| Psilocybin (dried, g) | 0.1–1.5 | 1.5–2.5 | 2.5–3.5 | 3.5–5 | >5 |
| LSD (µg) | 10–75 | 75–150 | 150–300 | 300–500 | >500 |
| DMT (mg) | 1–10 | 10–30 | 30–60 | 60–100 | >100 |
| Mescaline (mg) | 10–100 | 100–200 | 200–400 | 400–600 | >600 |
| Peyote (dried, g) | 1–10 | 10–20 | 20–40 | 40–60 | >60 |
Abbreviations: lysergic acid diethylamide (LSD), N,N-dimethyltryptamine (DMT).
Adapted from Erowid (Erowid, 2009). Values expressed in grams (g), micrograms (µg) and milligrams (mg). Participants were given the defined dosage brackets for each classical psychedelic and were asked to choose from the subjective categories of ‘low’, ‘moderate’, ‘high’ etc… if they were unsure of the dose consumed. A ‘don't know/can't remember’ option was also provided.
Appendix B: Participants' desired areas of focus for (a) individual (n = 75) and (b) group (n = 33) integration support of those interested in integration support (n = 94).
