Dr. Ben Sessa on MDMA, Healing Trauma, and the Future of Psychiatry

Podcast Highlights

• Why MDMA is the antibiotic of psychiatry (and how its use will transform the industry)
• Personal insight into Dr. Ben’s early days in the UK psychedelic scene with David Nutt and Robin Carhart-Harris
• MDMA’s usefulness at healing core attachment-based trauma - and the research Ben has carried out to prove this

Show Links

1. Dr. Ben Sessa’s homepage
2. Can Psychedelics Have a Role in Psychiatry Again?
3. The Psychedelic Renaissance by Dr. Ben Sessa
4. Anatomy of an Epidemic by Robert Whitaker
5. MDMA Treatment for Alcoholism

Podcast Transcript

00:42 Paul Austin: Hey, listeners, and welcome back to The Third Wave Podcast. I'm your host, Paul Austin, here with another episode. This one with Dr. Ben Sessa from the UK. In October 2018, I did a brief trip to London, and eventually Bristol, where Ben lives, and had a chance to sit down with him and have a great conversation about MDMA, the state of MDMA therapy in the UK, the efficacy of MDMA for treating PTSD and addiction. Ben ran the first UK-based study on MDMA for addiction, which we talk about in the podcast as well, and generally just hear Ben's perspectives on a various number of topics. He's a well-spoken man, entertaining, engaging, thoughtful, diplomatic, pragmatic and just generally a pleasure to be around. So it was a real honor to be able to sit down with him and record this podcast. I really, really believe that you will find it insightful and enjoyable. So without further ado, I bring you Doctor Ben Sessa. So I'm sitting here with Dr. Ben Sessa in his apartment in Bristol. And Ben, I just wanna welcome you into the podcast. And thank you for being here.

01:49 Ben Sessa: Thank you very much and welcome to my flat. I hope you like this place.

01:53 PA: It's beautiful. I see a few breaking convention posters, a lot of old books. You have a beautiful record player that we were just playing before. And it's a nice... It's homey, what you got here.

02:07 BS: Yeah. Thank you. Well, you're very welcome.

02:08 PA: Thank you. Well, let's get going with talking about the psychedelic renaissance. So this is a book that you wrote in 2012?

02:19 BS: '12 was... The first edition came out in 2012 and then there's a second edition in 2017. So updated.

02:27 PA: Updated, okay. I need to get my hands on this updated edition then. And what I wanna start with is just, what's your take on the psychedelic renaissance because obviously this is a term that's sort of become the nomenclature, the default way of referring to this resurgence of interest in psychedelics. And you were the one who published this book about it in 2012. So I'd love just to hear your thoughts about the name, where the name came from, why you chose it as a book title and just a little bit of context about that?

02:53 BS: Yeah. I'm really pleased to have that book title. I have to confess, I didn't come up with the term. People were already talking about it. I think I'd heard it at lectures. I can't remember where I first heard it. People had said in various talks, "This is a psychedelic renaissance going on." So then when I came to write my book, I knew what my book was gonna be about. It was gonna be about the whole thing. But I looked around and the name hadn't been used in a book or anything. So it being used as a phrase but no one had actually published under that name, so I thought, "Yes, I'm having that." So that's where the name came about. I wish I could say I came up with the phrase, I didn't, but I did manage to get the first book with that name. So that's pretty cool.

03:30 PA: That's a big deal because now it's basically every major mainstream media outlet that writes about what's going on with the resurgence of interest in psychedelics refers to it as the psychedelic renaissance. Is there any... What does that mean to you, what is the psychedelic renaissance?

03:44 BS: Well, in terms of the book, when I wrote the book, what I noticed when I... 'Cause I got so many psychedelic books, hundreds of psychedelic books on all the different compounds. And there's lots of books on DMT or MDMA or psilocybin or cannabis or whatever, but there was no real general textbook that covered everything. And I've got lots of books on the history, all the stuff from the '50s and '60s, some books on the very latest research. But there was no book that covered the whole thing. So the whole point about The Psychedelic Renaissance book is it's got all the stuff about the history, going back to Hofmann and earlier. And then it's got all the stuff that went on in the '60s and then the break down, and then the '70s, and the dark ages in the 80s, and then the rise of MDMA and then... But what it's got above other books really certainly at the time was a real showcase of the contemporary research.

04:33 BS: And so I just listed all of the studies that were going on in the last five to ten years and wrote a little bit about each of them. And in the 2017 edition, it's got photographs as well. So there's this whole section in the back with photographs of all these different players. Of course, since then, in the last two years, there's a whole load of people who I've missed out 'cause it's just grown so fast. But the idea at the time of writing it was, it would be the kind of go to textbook for students or people. There were other books that go into individual things in much more detail. If you wanna know all about just DMT, you won't get it from my book. But if you wanna know about everything, there'll be little bits in there. So it's kind of a general textbook for the beginner in a way, to pick up the history and the story and where to start and very up-to-date contemporary research.

05:23 PA: Tell us a little bit about your history as a psychedelic researcher and clinician and psychiatrist. Where do your paths in psychedelics sort of intersect, professionally at least?

05:31 BS: I can go back before professionally. So as a teenager, I had psychedelic experiences. I grew up in a family that was very left-wing or liberal, as you might call it, and hippies, basically. I was the youngest of six. So I had all these older siblings who'd lived through the 60s, so I inherited all their Dylan and Hendricks records. So I grew up in that atmosphere. My dad was an English teacher, so I was really into literature. So as a teenager I read Kerouac and Ginsburg and Leary and knew about psychedelics. Then I had psychedelic experiences, got really into psychedelic music as a teenager. That was my cultural invitation into psychedelics. And then I went to medical school.

06:16 BS: Qualified as a doctor, then went on to specialize in psychiatry. And when I started doing psychiatry, I knew about Humphry Osmond and Timothy Leary and Stan Grof and all the work done in Canada and all the work done in the States and in the UK, Wynny Sanderson. I knew about all this and I would always go to my psychiatry tutors and say, "What can you tell me about the work done in the 50s and 60s?" This was gonna be a big thing in psychiatry and they all said, "What are you talking about? You're crazy? What you mean psychedelic therapy? Are you mad?" And they'd never heard of it. And I thought it's just so weird. So from my generation of psychiatrists, that whole part of that psychiatric history had just been wiped off the curriculum. So I thought I would write a brief editorial about this. It got published in the British Journal of Psychiatry. It was the first article on psychedelics since the 60s, published in British UK medical press. And, suddenly, I started getting calls from people all over the world like, "Oh wow this is really great that someone in the UK is interested in psychedelics." Then in 2006, went along to...

07:20 PA: When was this? When did you...

07:21 BS: This is 2004. I was a trainee.

07:23 PA: Okay, and what did you write it about?

07:26 BS: It was called something like, "Is there a role for psychedelics in psychiatry?" And it was just kind of a very brief editorial about the history and the contemporary work. And at the time, there wasn't a lot going on, there was Heffter and MAPS were beginning their work really. So then I went to a conference in 2006, the Albert Hoffman's 100th birthday party conference in Basel, in Switzerland, and met Michael Mahaffey and Vic Dublin and all the people that were there. It was a very small scene at that stage in terms of medically, there was really not that many medics, half a dozen doctors around the world that were doing some... There was obviously heaps of hippies, lots of the culture was there, all though much smaller. That's also grown enormously in the last 15 years. The medical part was really pretty small, and certainly no one else in the UK, no one.

08:10 BS: So I started just going to more conferences, started writing more editorials. I actually found... It was quite good actually, 'cause I found it was really easy to get publications because if you submitted an article on psychedelics to any journal, they'd be like, "Wow, this is interesting." So if I was writing about SSRIs or something, I would have been a very small fish in a very big pond, but with psychedelics, I very quickly became both the authority locally because no one else was doing it. And not though any kind of a skills of my own, but just kind of luck that I chose this completely out there, esoteric subject, but what's interesting... And you ask what's happened to be professionally.

08:45 BS: So, for quite a few years, it was really hard, I felt very much in the wilderness. I got a lot of criticism from colleagues, people saying, "This is crazy, this is career suicide. Why you doing this?" And then 2007 I met David Nutt, who was a professor psychopharmacology at Bristol at the time. I joined his department. At the time, he wasn't really that into psychedelics, but it was at the same time, there's a chap called Robin Carhart-Harris was there just finishing his PhD in psychedelics. I worked with him on his study with psilocybin, and that became the UK's first human psychedelic study since the 60s. And I became the lucky person to become the first person to be administered a psychedelic since the 60s, in a research setting. I was injected with intravenous psilocybin by David Nutt in the clinic with Robin. So that was quite an experience. I've got some great video of that actually.

09:32 PA: So, you three are like a trio?

09:34 BS: Yeah, so we all started out together because David wasn't really into psychedelics at that point. He asked me to the department 'cause he'd read my paper, so he asked me to come and present at the department. And I came and presented and he was really fascinated, so he asked me to come and join the department. And Robin had just joined at the same time. And Amanda Fielding was just setting up the Beckley relationship with David, and this was all in Bristol. And then, of course, the whole thing moved to Imperial, and it's sort of grown a lot, but it all started in Bristol with myself and David and Amanda and Robin. It all just kinda came together at the same time, and then there were more conferences. Then in 2010 at a conference, met up with these other people in the UK, and we formed this group called Breaking Convention and started this conference. And the first meeting was in 2011, and there's now been five. The most recent one, this summer.

10:24 BS: So, it's amazing how much it's grown, but what's the most interesting thing for me and the most validating thing is this sense of moving from in the wilderness and people being critical and saying, "This is crazy" into this position where suddenly it's my day job and I'm getting paid for it. So, I'm now paid to be a doctor that studies psychedelics. Whereas in the past, I was a doctor doing other stuff and a bit of psychedelics on the side, quite criticized for it. And now it's become my day job. So yeah, it's really great that it's moved in that direction.

10:54 PA: When did that shift happen for you? That shift from the doctor who is just doing psychedelics on the side to, "This is my full thing and this is what I'm committed to."

11:00 BS: Well, in terms of getting paid for it, that's only happened in the last five years when I started doing this MDMA study. The validation sort of has been growing over the last 10 years, as more and more people have got interested, but it wasn't really until I got this opportunity to do this research study that was funded, that I could actually take time out of my day job to work with MDMA, and be paid for that. Now, of course, it's moved right on. And now we're... Now my full-time work is psychedelics within medicine.

11:29 BS: And yeah, it's just great. It's also... Part of me can't help saying, "I told you so," to some people because some of the people who were critical and hostile, five, eight years ago, and now are like, "Oh yeah, I think maybe there's some... We got... Maybe psychedelics could be an important thing in the future." It's like, "Yeah, man, where were you like eight years ago when you told me I was mad?" And now it's great that... It's just great that it's just becoming mainstream. It's good.

11:54 PA: Tim Farris who sends out this five bullet Friday newsletter, in one of the recent ones, I think it was the same one where he had announced the Johns Hopkins 17 million dollar funding for the new research center they're opening up. He emphasized in that newsletter, basically, if you've been on the fence about whether or not to come out about psychedelics, more culturally than medically, but up until this point in time, we're like what? Mid 2019, late 2019. He's like, it probably wasn't worth it, but now all of a sudden, the shift has turned where if you're coming out and you're saying, "I am in support of psychedelics." And you were then certain circles still, I wouldn't say it's totally mainstream yet, but certain circles, a lot of people will be curious and be asking questions. And I feel like it's... Ever since Michael Pollan's book, it's really not this sort of... Like you were saying, "Fringy, esoteric practice," it's really like the future of psychiatry in many ways.

12:45 BS: Yeah, very much so. And that's how I feel. And I was driven into the subject just because of the outside esoteric interest of it, my personal interest. But as I've grown as a doctor in the last 15 years, the other thing that drives me now is increasingly recognizing just how poor and ineffective current psychiatric treatments are. And I think that's also what's driving the whole psychedelic movement. Patients have had enough of sitting on SSRIs. They've had enough of ineffective psychotherapies. They've had enough of long-term maintenance medications. And I've actually seen that over the last 15 years developing. And now I sit there in front of a patient and I can't be bothered to put them on an antidepressant. They don't wanna go on an antidepressant. They know it doesn't work, I know it doesn't work.

13:29 BS: And so that's also driven their progress towards the psychedelic renaissance, has been just the lack of efficacy of current treatments in psychiatry. And a good thing too, because psychiatry has been pretty stuck for a long time. It's been quite stuck. And this is the most exciting new pharmacology in the last 75 years. It really is. It's the most exciting thing to come out of psychopharmacology. And the other thing that is a really important part of my development here, is I've always been really interested in the dual interests of both psychopharmacology and psychotherapy. All the way through medical school and training as a psychiatrist, I was always really interested in drugs, but I was also really interested in Freud and Jung and psychotherapy with an equal amount.

14:14 BS: So, in a way, that's the perfect marriage comes together in psychedelic therapies. It's neither one or the other. You can't be a staunch psychotherapist and reject the biological model and accept psychedelics. Nor can you be a staunch biological psychiatrist and reject psychotherapy. It really is equally both. 50/50 equally both. The two just don't work without the other when it comes to the therapeutic effect. So, it really suits the way I see the best way to do medicine.

14:48 PA: And would you say then it's accurate to say that most of psychiatry's approach up to this point has been biological compared to psychotherapeutic? Has there been that balance necessarily?

14:58 BS: That's a really good question coming from an American because the impression I get from American visions of psychiatry is it's just biological. You go to your psychiatrist to get drugs. Now, that wasn't how I was trained as a psychiatrist. I think, I was trained in London and a strong psychotherapeutic element, strong social element. And as a good psychiatrist, I think a good psychiatrist is like a social worker and a psychotherapist. And certainly, the way I was trained, psychiatry is all about psychotherapy, what person, what someone eats, whether they exercise, where they live, what their kids do, what job they do, what their future aspirations are, as well as what medicines I give them and what psychotherapies I give them.

15:40 BS: So I think in America, you've got quite a distorted view that psychiatry in America really does just mean drugs, isn't it? We don't do psychiatry like that here, at least not good psychiatry. So, in a way, yeah, there is that distinction between US and UK psychiatry or the rest of the world. I think America's definitely got stuck on this biological model to the exclusion of other things.

16:00 PA: In 2016, I read Anatomy of an Epidemic by Robert Whitaker. This is just when I was starting to get involved in the psychedelic space. It was a few months after I started Third Wave and about the same time I read the Psychedelic Renaissance, was digging into all these books. And a close friend of mine, she was like, "Look, if you wanna have more context about why psychiatry has failed so much, particularly in the United States, read this." And it basically was like, at least when it comes to antidepressants and anti-psychotics and anti-anxiety medications that are over-prescribed ADHD medications as well in the United States, it basically said the models that those were built on were similar to the penicillin model, where it was like, "Okay, there's this thing in our gut, that if we target the right thing then we can eliminate it and we'll be healed." And so they took that same model and tried to apply it to serotonin and dopamine in the brain without realizing that the brain-gut connection is much more complex than just killing bacteria, so to say, in the gut.

16:52 BS: There are a lot of simplicities within the biological model, there's no doubt about that, and we need to be a lot more sophisticated than that. And you can't apply a antibiotic model to psychiatry. The brain is so complex. There are so many different connections. One cubic millimeter of cerebral cortex contains 300 million neurons. 300 million. And each neuron can have potentially 10,000 dendritic connections in one cubic millimeter. That is immensely complex. The brain is by far and away the most complex machine in the known universe. And so some of the simplistic biological models that apply to other parts of medicine couldn't possibly work in the brain because not only is the physical biological mechanism of the brain complex but it's so influenced by social and cultural and psychological issues and it's constantly changing.

17:46 BS: There is no single brain. The brain is a constantly dynamic organ, changing all the time. So you can't ever apply a static biological model. But the other thing, just going back to my interest in pharmacology, I'm not one of these psychiatrists within psychedelics who also says there's no place for medical models. I've always taken a very nuanced stance in terms of my understanding of the different disciplines. I believe that there are a certain number of psychopharmacology interventions that are very useful. I think antipsychotics certainly have their place in managing acute psychosis. You also need to manage acute manic states. ADHD is one of those interesting ones that, certainly in the States, the diagnosis is overused, the diagnosis is not used correctly, and far too many people are treated medically with ADHD medication.

18:34 BS: On the other hand, when the diagnosis is made accurately and correctly, I've seen ADHD medication transform lives, reduce prison sentences, reduce teenage pregnancies, reduce substance misuse, get kids back on track into functioning people and reducing many, many psychiatric problems further down the line. But it's... We're talking 1-2% of kids that have true ADHD. And I know that there are some schools in the States were like 40% of the kids are saying they're on ADHD meds. It's not feasible that they've all got ADHD. What this highlights for me is there's a lot of misunderstanding around the whole psychedelic field because this is difficult, this is high level neuroscience and pharmacology.

18:42 BS: And sometimes a little bit of information can be mistreated and misunderstood. I don't wanna sound like it's an exclusive thing, and everyone's open and able to study these things, but this is difficult. Brain science is tricky. And I think that's why we have to not just throw things out. And I think a lot of the psychedelic community are often, "Oh, the whole medical model is wrong and all drugs are terrible apart from psychedelics." That's just not true. And when you study medicine, you can see the subtleties of it. Now, I'm not saying for a minute that we don't need to vigorously challenge the medical model. There are a lot of abuses within psychiatry. Psychiatry has made a lot of mistakes over its kind of 7,500 years. But in my experience, psychiatrists and the psychiatric profession are some of the most... It's one of the most self-reflective professions there are. I don't know of that many other professions that's so quick and able to criticize itself and be so keen to develop. Maybe I'm coming across as hopelessly optimistic and naive here, and I'm sure people have many experiences of very rigid models in psychiatry that have been damaging and that are still so. I'd like to think that I represent a generation of psychiatrists that are looking beyond that. I'm not gonna rubbish psychiatry. It's my profession, I think it's great. I just wanna see some reformation. And I think psychedelics are a really good way of doing that.

20:40 PA: How do you think psychedelics will reform psychiatry?

20:43 BS: Well, in many ways. Firstly, it's kind of what patients want. Like I said, patients are pushing for this. Patients are sick of maintenance therapies. They've really shone the spotlight on the futility of maintenance therapies, taking an SSRI every single day, day in, day out, just to mask the symptoms of the illness but not cure the illness. That's an outrageous, outrageous way of doing medicine. The analogy I often give when I'm talking about MDMA in my lectures is if you have an infection due to a bug, a microorganism, one of the symptoms is a fever, a high temperature. You can take a drug like paracetamol or ibuprofen or aspirin to bring your fever down, and you'll feel a bit better, sure, but those drugs are not antibiotics. They're not gonna kill the bug. And that's what we do when we treat so many disorders with SSRIs. If you've got depression, or anxiety disorders, or addictions, or PTSD, and you take SSRIs every day in, day out, it's like just taking away the fever, the temperature, but never killing the bug. You would never treat an infection like that. You'd take the antibiotics to kill the bug. So people get stuck in this daily maintenance model with SSRIs or even mood stablers or antipsychotics and hypnotic drugs, we're never getting to the true core of the problem, which is the trauma. So psychedelics have really shone a spotlight on that, that that's not the way to do it.

22:03 BS: I think the other thing about psychedelics and the reformation of psychiatry, and I often say this when I'm doing talks, is psychiatry has become this really negative, desperate, almost palliative care-type profession. And we're almost taught that from the beginning at medical school, you can't cure mental health patients. You can be alongside them for life, and we'll look after you forever. And if you're there in your early 20s with this severe mental illness, you're probably gonna be still seeing your psychiatrist in your 70s with the same illness, that is not good enough. That's rubbish. We should be doing better than that. And I can't think of other branches of medicine that would fall for such poor outcomes and settle for those.

22:45 BS: So we've become this palliative care profession who just don't use the cure word. Why can't we use the cure word? Why can't we be like the surgeons? Why can't we mend the broken ankle and then discharge you and never see you again? I believe we can. And I believe that the whole model of maintenance therapies supports this palliative care chronicity of disorders. And the pharma industry seem to be facilitating that. I wanna be careful 'cause I don't wanna slip into the whole conspiracy theory thing and there's too much of that crap in psychedelics, but it does feel as if the pharma industry don't really want people cured. It's in their interest that their product is taken every single day for decades. I wanna develop psychiatric protocols that the patient comes in, they have a discrete, focused, effective, safe, clean, fast treatment with psychedelic therapies, and then they go, and we discharge them, and we never see them again because they are cured. Now I think some psychiatrists hearing that would just think that sounds mad, but why? Why is that so mad for a doctor to say he wants to see his patients cured and never come back? But it's just not the way that we're taught and the way we do psychiatry, but I think we can.

24:05 PA: Well, one of the things we were talking about before this podcast was the difficulty of, for example, alcohol use disorder, right? And alcoholism generally. And it feels a little bit like some of these mental health issues, so to say, addictions and PTSD and depression, that they're are a lot gummier than for example if you break an ankle, you go and get that fixed, right? So there also seems to be a level of complexity that's dealt with when it comes to these disorders, that it's not, oftentimes, even with MDMA treatment or psilocybin treatment, it's not just like you go and you do the drug and you're clean 12 weeks later. It's like there are people who relapse, there are people who might have conditions again, so I'd be curious to hear your thoughts on what are practices from a psychiatric perspective or a medical perspective or just a general self-care perspective, that you've seen work with the clients that you've dealt with, that you've healed, that you've treated? How does integration help with that process of keeping things unstuck so that they continue to kind of show up without the trauma and all the other things?

25:04 BS: Going back to the first part of your question there, I totally agree that most psychiatric disorders are more complex than a broken ankle, but in some ways not, not when it's trauma. I mean, okay, you got people who everything would have been fine if they hadn't been raped as a child. That is pretty simple in some ways. Their schooling would have been okay, their friendships would have been okay, they would have had a decent intimate relationship with their partner, they would have been able to bring up their kids okay, if they just hadn't been raped that night when they were eight years old. So even complex things like mental health problems do often come down to fairly simple things, and that's the bit we're failing to do. Now, it's that kind of severe childhood trauma that then results in a whole catalog of lifelong disasters. And then, of course, as teenagers, they get into all these things and they get into sexual exploitation and using the wrong kinds of drugs and exploitative relationships. And so it becomes really, really, really, really complex the longer they go through the system. But actually, there often is some pretty basic stuff. And I'm a child psychiatrist by training, and it so often does come down to that very early nurturing attachment relationship. If you get those early years right, you provide a sense of resilience and resourcefulness that will allow the teenager and the young adult or the older adult to overcome adversity.

26:29 BS: And if you mess up that very early relationship, then all of those other things become huge vulnerabilities that otherwise you would be able to manage. Whilst most mental disorders are indeed complex with multiple facets and multiple factors that create the end phenotype, there's often a very simple root. And forgive me, this is a very long-winded answer to your question. But the point being that that simple root so often is this core trauma-based attachment relationship. And this is where psychedelics really come in. They get to the root cause of that. This is where psychedelics are the antibiotic that kills the bug. And all of those other treatments in psychiatry, patching people up with CBT and SSRIs and all the rest of it. Admissions into hospital, sectioning, all of this stuff, all of that is just paving over the cracks. And it's the psychedelic therapies that can get to that root cause, the trauma. So if we can start targeting that, we can improve people's lifelong outcomes. And so moving on to the question about integration, that's where this work happens. The psychedelics are the springboard and the platform in which to start new lifestyle changes through new understandings of early attachment relationships and rebooting and rebranding how we look at ourselves.

27:46 PA: Great response. I wanna go a little bit deeper into that 'cause there's a lot to unpack there.

27:50 BS: Sure.

27:51 PA: Can you just walk us through what's going on in a neurobiological level when we take something like MDMA? Why is MDMA psychiatry's antibiotic? Why is it so useful and helpful at helping to heal those early childhood attachments?

28:04 BS: Okay. So from a biological point of view, the way the drug works, it acts across a number of different receptors. A number of different serotonin receptors; the 1A and 1B receptors, that it increases the sense of positive mood and euphoria and reduction in anxiety and depression. And that's the feel good effect. Now, that's a really important tool clinically when you're working with patients who've never felt positive. They've only felt fear and pain. It's very useful for them to experience a positive mood. It has a mild effect at the 2A receptors, which is where the classic psychedelic drugs like psilocybin and LSD and DMT act, but nothing nearly as intense as the classics. Just enough to make you think a little bit outside the box and see things in a new way. But not the sort of distortion of ego and perceptions. It acts at the noradrenaline and dopamine receptors to increase sense of stimulation, and that's good. That make... That engages you and motivates you to engage in therapy so you feel engaged with the therapist.

29:00 BS: Paradoxically, at the same time, it's acting at alpha one and two receptors, which relaxes you. So anyone who's taking MDMA would be familiar with that peculiar sensation of being speeded up and slowed down at the same time. It's not like amphetamine and cocaine, where you're just speeded up. And it's not like something like cannabis or alcohol where you're just slowed down. It's weirdly a mixture of both. And then it has this hormonal affect at oxytocin... At the hypothalamus, which secretes oxytocin, which is the hormone secreted from the brains of breastfeeding mothers, which engenders this sense of attachment and bonding. And when you add up all these things together... I think my favorite phrase at the moment that describes MDMA is, it selectively impairs the fear response whilst leaving the other faculties intact.

29:43 BS: Now, that's very, very important. That is... If you were gonna design a drug for trauma-focused psychotherapy, that's exactly what you want. You want the patient to be able to talk and remember and reflect and debate and bring back old memories and remember the next day, and, basically, do psychotherapy. But you wanna take away the fear. Because the reason so many of these long term disorders like addictions or PTSD become long term is 'cause the patient cannot go there, to the fear. If you've been raped as a child, by the time you're in your 20s, 30s, 40s, you've become an absolute expert at never going to that memory. You'll do anything. You'll drink alcohol, you'll take heroin, you'll self-harm. You'll do anything but think about that night. And on MDMA, you can. You can go there and work through in real time, in clear consciousness, your traumatic experiences, and put it to bed and resolve it.

30:37 BS: A really good anecdote I like to share here is when I was like 18, and I think I was taking ecstasy with my friends after a rave. This is 1990, and this is before I went to medical school, o I can say this. We were all lying there after this rave, everyone was really high, and someone went, "Oh man, it's so beautiful. Let's think of the worst thing in the world." And we all lay there and someone went, "Oh man, let's imagine our mums dying." And we went, "It's not that bad." And I didn't know anything about MDMA therapy or anything then, but that's a really good example of what's going on. You can go there to a forbidden avoidant memory and actually dwell on it, and it's not painful. But that is the holy grail of psychotherapy because the barrier in all psychotherapies is the avoidance stuff you don't wanna go to 'cause it's too painful.

31:22 BS: And indeed, it's that avoidance that triggers this whole life of destruction with drugs, and alcohol, and violence, and promiscuous sex, all of these anti-social and difficult and maladaptive behaviors, which are all defense mechanisms around going to that painful place. And MDMA quite miraculously allows you to go there whilst leaving the other faculties intact. And that's really important 'cause there's lots of drugs that remove fear. A bag of heroin removes fear. A bottle of vodka removes fear. But those are messy, dirty drugs. You can't do psychotherapy on those. You won't remember the next day. So MDMA is unique pharmacologically in this ability to inhibit the fear response, but everything else is intact. That is essentially how it works in a nutshell.

32:08 PA: Thank you for explaining that so well, because it's very clear. It's something that I know our listeners will hold on to and enjoy. And I wanna deepen that a little bit because one of the things and one of the misconceptions, I would say, of MDMA is the come down effect. And you had a great post a few weeks ago and research that you recently published, and I'd love for you to just talk a little bit about...

32:27 BS: Yeah.

32:27 PA: What is the MDMA may come down effect? Why does it occur, and what are we finding out from clinical trials about the MDMA come down effect?

32:27 BS: Yeah. So it's a very well-known narrative within the raver community that, A, you gotta come down towards the end of the night when the MDMA is wearing off. And, B, you get this kind of three-day later, post MDMA affect drop. And ravers call it things like Blue Monday and Black Tuesday and suicide Wednesday, and all this sort of stuff. Now, I've always thought... I've always thought this since my raving days, that is this the MDMA or is this other stuff? And look at the way people normally take ecstasy, they go to the pub, they'll drink three pints, they'll go to a club, they'll pop a pill at midnight, dance a lot, drink some more, do a line of cocaine, do another pill or two, go back to someone's house, do some more cocaine, do some amphetamine, smoke loads of spliffs, drink a bottle of wine, stay up all night, maybe Sunday night, if they're lucky, have a cup of soup and then get three hours sleep.

33:28 BS: Then they're going to work on Monday and Tuesday and they feel low. And they say, Oh man, it's my ecstasy serotonin depletion." It's a fucking hangover, yeah? It's a hangover. You've missed out on sleep, you've missed out on food, you've danced all night, you've done loads of other drugs. So, first thing this tells us is you cannot make influences about clinical MDMA based on ecstasy users, whatever they are. Most people take ecstasy... Now, not everyone. There are quite a lot of psychonauts, particularly, who will take ecstasy with no other drugs and no alcohol. And they'll take it during the day and they won't miss out on sleep, but that's not the majority. The majority of people taking ecstasy, it's a nighttime party thing, it's all very externalized behavior.

34:09 BS: It's loud, it's lasers, it's dancing, it's shouting, it's having sex, it's this big party thing. When we give MDMA clinically, and the patient comes in at 9 o'clock in the morning, they've had a good night's sleep, they drop the medicine at half-nine, they have their experience during the day, they're back down to baseline by five or six in evening. They sit around, they have a nice meal, they sleep beautifully, and then they have this afterglow that lasts for a week. We don't see any drop in affect at the end of the day. We just see a gentle tailing off as the experience fades. We don't see any drop in affect in the following week. We ring them every day and we talk things through and we do mood and suicide scales with them. And we just haven't seen it at all. I guess what I can't say is the whole hypothesis of serotonin depletion sort of makes sense, you're having this massive dumping of serotonin and it's sort of arguable that that might take some time to refuel in the neurons, and the hypothesis being that you've got this affect drop three days later, but that's never been tested prospectively.

35:14 BS: It's never actually been tested with clinical MDMA. It's something you hear from ravers, who are this very heterogeneous group with all kinds of confounding factors. So, certainly within our MDMA study, I think that... And there's quite a lot of work on this that's been done, a lot work in the London at UCL. The biggest factors seem to be missing out on sleep, concurrent drug use, particularly alcohol, and excessive exercise. In other words, all the things you do at a rave. And when you take MDMA in a facilitated environment, without the lack of sleep, it's fine. So, more work is done, more work needs to be done. But what it really says is, let's not talk about ecstasy when we're trying to work out what clinical MDMA does.

35:56 PA: I had my own few MDMA experiences over the past few years, and what I've noticed is very similar to what you said. I don't do the all rave thing. I usually have a small group of friends. We have a house, there's maybe 8 to 10 to 12 of us, but it's, typically, you know, we take it at 10 PM. We do a re-up at 12 to 12:30. There might be some psilocybin involved as well. And usually, I don't get to sleep to 4 or 5 AM. And the sleep isn't great, it's a little jittery. And then I kinda wake up at 10 AM the next day, my jaw is a little sore. I don't feel great. And one thing that I've been considering is if I do this again or when I do this again.

36:34 BS: You're gonna invite me.

36:36 PA: First of all obviously invite you.

36:38 BS: Sounds great.

36:39 PA: Second of all, I'll just start earlier and to basically get to a point where then I can get to bed at midnight, feel good and sleep because I've been sometimes up as late as 5 AM, 6 AM and it's just like it wrecks you.

36:52 BS: Yeah, I mean the other thing that's... This is quite interesting: If you look at the way people take MDMA recreationally, it's very different from how we use it clinically, but if you look at the way people take classic psychedelics recreationally, it's pretty similar. So I mean, I know it's different, and, as I said, there's this whole group of psychonauts who do things in a particular way. But typically when people take things like LSD or magic mushrooms, it's a small group, they kinda sit in the dark, around a candle listening to Pink Floyd, they lie around, it's all gentle. And it's a very internal pseudo-clinical-type experience, not far from how we use it clinically. But the way people take MDMA recreationally, certainly in this country, is totally different. It's this externalizing thing, and it's at night, and it's with all these other... It's a party drug. And just imagine a rave where you had 5,000 people lying on their backs in the dark with eyeshades on not moving.

37:45 PA: It wouldn't be a rave.

37:47 BS: It wouldn't be a rave, exactly... So it's interesting that the two drugs, LSD and psilocybin stuff, and then MDMA, the way they're used recreationally are very different from the way they're used clinically, when it comes to MDMA. Another interesting thing about that is if you look at the psychospiritual experience that we see so commonly, 80-90% of people on classic psychedelics, first time threshold dose LSD psilocybin, will report talking to God, spiritual experience, breakthrough, peak experience, oceanic boundlessness, all this kind of seeing the white light psychospiritual experience.

38:22 BS: Not so common on MDMA. About 5-10% of people will report that on their first time threshold dose experience with MDMA. But I think that's because of the way it's taken. I think if people took MDMA more like the way they take psilocybin and LSD, we would have higher levels of psychospiritual experience. And that's actually quite interesting from what we've seen in our study, the study that we're doing is the world's first addiction study with MDMA. It's never been done with MDMA. All of the addiction work so far has been LCD, psilocybin, and things like ketamine and ayahuasca and stuff. So, no one has ever done it with MDMA. All the work up to now has been pretty much PTSD. But the reason I chose alcoholism was because I know there's high levels of trauma in alcoholism and we know MDMA works for trauma, so I kinda put two and two together and came up with five and said maybe it will work for alcoholism.

39:12 BS: But we knew going into it, that MDMA lacked the psychospiritual effect. And if you look at all of the studies that have been done with addictions and classics, all of them, whether it's Blocker Jack's work with alcohol, whether it's Matt Johnson's work with nicotine, whether it's Krupitsky's work with ketamine or going right back to Grof and Leary and Osmond in the work in the 50s and the 60s, with LSD and alcoholism. What they all have in common is, the higher the psychospiritual experience, the greater the sobriety. You have to blow the mind with this peak experience and see God, and then you're more likely to not drink. And we knew going into this that MDMA doesn't tend to do that.

39:53 BS: So we thought, it might not work, but we did know it works in trauma. But what we found is a lot of the people on the MDMA in our study are reporting what sounds very like a classic psychedelic experience. It's interesting. A lot of people are saying, I'm seeing the light, I'm communing with spirits, I'm in a different state of reality, even a sense of ego loss in some of them. And that's not typical for MDMA. So, I think that... I guess what I'm saying is, MDMA does have a greater capacity for psychospiritual effects when it's used in that way. And I think the whole party thing doesn't really... It doesn't really do that. It does other interesting things. There's not much God involved in a rave.

40:35 PA: Do people have visual experiences at all with MDMA or is it just usually just... Like with LSD or ayahuasca, you hear about the visions, is that common at all on MDMA for people to see things, have transpersonal experiences, or is that more like a classic psychedelic effect?

40:50 BS: Certainly visual effects are minimal. You get a saccadic eye movement shaking that can cause a mild visual effect. But in terms of actual hallucinations or delusions or illusions, it's very, very young uncommon. It's not typical with MDMA. But in terms of... Like I'm saying, in terms of transpersonal experiences or psychospiritual experiences, we are seeing them to some extent, more than we expected. But no, it certainly wouldn't be accurate for me to suggest they were as strong and as similar and frequent as with the classic psychedelics. But I do think that they are possible with MDMA under the right circumstances.

41:25 PA: Is there any sort of research that is being geared up to understand that deeper or is that something that might be on the horizon but nothing's in place yet?

41:32 BS: Well, I think the the perceptual changes and the ego dissolution changes that come with the classic psychedelics, the work that Robin and colleagues at Imperial have been doing the last 10 years in neuroimaging, has really been very important in looking at the neurobiological mechanisms of classics. And it's all about the 5-HT2A receptor partial agonism in the cerebral cortex, and how that disengages the normal mechanisms that maintain consciousness, the how it shuts out the external world and it leaves you at the mercy of the internal world without this bottom-up experience of external perceptions.

42:06 BS: And that really accounts for the visual distortions and things you get with LSD, as well as the mental changes in terms of ego dissolution, which, of course, MDMA doesn't hit that receptor group nearly as much; mild effect of the 2A receptors, but most of the action is within these serotonin 1A and 1B, and the dopamine, noradrenaline, and the oxytocin effects. So, there's pretty well understood neurobiological mechanisms as to why MDMA differs from the others. But, another thing that comes up here is, sometimes people say, "Well, MDMA isn't a psychedelic then." And if you're a purist about it, by definition, it's not what we call a classic psychedelic...

42:47 PA: What are the classic psychedelics, technically?

42:49 BS: LSD, psilocybin, DMT, mescaline, 5-MeO-DMT and all those derivatives. If you define them as those that work on the 5-HT2A receptor primarily, are usually what we use is classic; what we define as classic psychedelics. MDMA is a entactogen, it's in that group with other drugs like MDA, the 2C-series: 2C-I, 2C-B, those kinds of things. Where the ego distortion psychedelic effects are less pronounced, it's more about the feelings. Now, obviously, as a purist you would say that, that it's not a classic psychedelic. As a therapist, I very much consider it a psychedelic.

43:25 BS: If we define a psychedelic in the clinical sense as a tool that creates an altered state of consciousness that you can work in with a patient clinically, then it's a psychedelic. It's a different sort of psychedelic; it's a heart opening psychedelic. Now, personally, clinically, I favor it over the others. I think it's... One thing that's so important about developing clinical protocols is that they're tolerated. There are a lot of patients who just cannot tolerate a classic psychedelic, can't even tolerate the idea of it. And this is reflected in the epidemiology of recreational use. We've got 750,000 kids every weekend taking MDMA in this country.

44:05 BS: Every weekend three quarters of a million doses of MDMA are consumed, and have been for the last 25 years. Nothing like that many people take LSD and psilocybin. There's a reason why it's more popular in that respect. So, when you look at that then in terms of clinical protocols, you want patients to be able to tolerate it. Now, of course, there's enormous power and clinical opportunities in classic psychedelic therapy, of course. But, it requires a different sort of training and a different sort of rigor, and I think MDMA is more tolerated by most people. So, I certainly consider it a psychedelic, though not a classic, and it's a very useful tool clinically.

44:48 PA: Like what you're working on right now with the alcohol use disorder and MDMA study, I'd love if you could just go into a few details about that.

44:54 BS: Well, we started planning it about five years ago. It took a long time to get the MDMA and it took a long time to start. We were over 18 months behind. But we've been dosing clinically for about 18 months, and we're gonna finish at Christmas. We've got 15 people in the study. All of them were daily dependent drinkers and they had to be detoxed of alcohol using a drug called Librium. And then they come into the study dry, and it's an eight-week course, eight weekly sessions.

45:21 BS: They take MDMA twice sandwiched between non-drug sessions, and that's very typical for most psychedelic studies. It's never just take the drug. It's always preparation sessions without the drug, then the drug, then integration sessions, then, in our case, a second dose, and then more integration sessions. So an eight-week course, and we follow them up for then three-six-nine months, and then we're looking at outcome data. Now, because this is the first time MDMA is being used in alcoholism, it's what we call an open label study. So there's no placebo, there's no control group. Now, that sounds a bit methodologically unsound, but actually, it's what you have to do when you use a drug for the first time in a new condition. So our main outcome data is around safety and tolerability. Is it safe, do they tolerate it? And it's passed with flying colors. Everyone's found their treatment fine, they've all found it preferable to other treatments they've tried for alcoholism, and there's not been any physiological problems, no adverse effects, everyone's tolerated it.

46:16 BS: So now we can look at outcomes in terms of drinking, we can't make any strong scientific influences because there's no control group, but so far, about three quarters of the people are completely dry and have stayed dry. And about 25% have drunk something, but not necessarily back to the full levels. But I think when we get to the end of it, I'm anticipating we'll be about 50-50, which is not as great and miraculous as I might have hoped, but if you look at the current treatments for alcoholism, they are so bad, so bad, which is why we chose this. 90% of people are drinking within three years after the very best that medical science can throw at you. Our treatment of alcoholism is so bad, we were better in the Victorian times at treating alcoholism than we are today. 90% relapse in three years, I can't think of other parts of medicine that would put up with that kind of outcome, it's outrageous. So even if we do find 50% are drinking, that's still actually really miraculous results, so we're pleased with that.

47:14 BS: So we're winding that up in the next few months, we've just got the last few patients to get through. We're dosing tomorrow actually, and every week for the next six weeks, to get that finished by Christmas. And then we're gonna end that and then we're gonna write up the data and get that published. And then we're also starting a psilocybin study. We're finishing our training next week, we got another session this week, so we're gonna be, for a few months, gonna be doing MDMA and psilocybin at the same time in the same department here in Bristol. And then the other thing I'm doing at the moment is making plans to start a psychedelic therapy clinic here in the UK after Christmas or in the next few months, that's still very much in development. We're gonna be starting with ketamine because that's the kind of the only legal psychedelic we have, so we're gonna start training and start using ketamine assisted psychotherapy. But what we're very keen to do is to not just make this a ketamine infusion clinic, 'cause they're all over the place now, they're all over the states and they're starting to spring up in the UK. You just come along every week, you get an infusion of ketamine, you go home and you have to just keep doing that.

48:14 BS: Now, to me, that feels like an SSRI. That's exactly what I don't wanna do with psychedelics. I wanna combine ketamine with psychotherapy to get better, overcome the trauma issues, and not have to keep coming back. So we're gonna start with the psychotherapy with ketamine, but we wanna stand apart from other ketamine clinics. And the idea being that when we launch this, in terms of the branding, it's gonna be a psychedelic therapy clinic, ketamine now, LSD and psilocybin coming soon. So it's not just a ketamine clinic, it's a psychedelic therapy clinic that currently is just gonna be ketamine. But obviously, we work closely with MAPS and we work closely with COMPASS and we keep them on board and we keep working with them because we wanna be able to deliver MDMA and psilocybin therapy nationwide when the time comes.

49:00 PA: And when will that time be in the UK specifically?

49:03 BS: Well, Rick Doblin is looking at '21, '22 for the FDA license for MDMA. Hopefully, the EMA license, which is the European version of that, will be at the same time and psilocybin is a few years behind that. MDMA is in the phase three of development now, so it will become a medicine within the next two or three years. It can't not really. And psilocybin is in the late phase two to go into phase three soon, so it's all gonna be there within the next three to five years. What's happening in the states, which is quite good, is you have this expanded access program whereby people can start providing MDMA therapy now even before it's licensed, just because it's shown to work and it's safe. I'm really pushing to find a way, find a mechanism to get that done in the UK, so we can start actually providing MDMA therapy before its approval and licensing, not having to wait another three years. So...

49:54 PA: This is part of the expanded access program that they have in the States?

49:57 BS: Yeah, they have it in the States, but we don't have it here yet. At the moment here, we're only gonna be able to use psilocybin and MDMA when they get licensed, but that's another five years down the line. How many more people need to die from suicide due to untreated PTSD? Need to die of alcoholism before then? So we gotta find a clever and creative mechanism to do this.

50:19 PA: Beautiful. Okay, one last question, and this is, I've started doing this on a few of the podcasts just as a way to humanize us. And the question is, for you right now, just on a personal level, what's most difficult or most challenging for you about this work and about being involved with the psychedelic stuff? Because obviously, there's tremendous upside, it is really exciting to be at the forefront of this. People are being healed that have never been healed through anything else, but there's also other things that come with it. And I'd just love to hear from your perspective, what's been most difficult or challenging in this process for you?

50:52 BS: I can't think of one thing, I can think of three big things. Can I say that?

50:55 PA: Oh yeah, absolutely.

50:55 BS: Number one is the Misuse of Drugs Act and the war on drugs. It's just a horrible, frustrating, irritating barrier, this ridiculous, unethical, unpoliceable, dangerous, unscientific piece of rubbish that has destroyed societies for the last 50 years, imprisoned perfectly fine people, made criminals out of people, increased access to dangerous drugs, reduced access to services, funded the mafia. It's an awful, awful piece of legislation worldwide. We will look back and hang our heads in shame when it's finally dismantled by the United Nations in the next 20 years or so. Individual countries are doing that thing already, and the States are way ahead of this. So that's the first thing, the Misuse of Drugs Act and the war on drugs. Terrible, terrible piece of legislation. Second thing is I get very frustrated by the pseudo-science of the psychedelic community. As I said, it's great that there's so much cultural interest, but we also have to hold on to our heads. I meet a lot of nutters in this field. And it doesn't help, it doesn't help. We've... It destroyed it in the '60s, it destroyed it when the idea of, "Oh man, let's all drop acid and we'll all live in chemical utopia."

51:19 BS: It just doesn't work like that, you know? You have to take a balanced and a medical view. And I know that makes me sound very boring, but we are not gonna get these drugs licensed if we don't work with authorities. And there's a lot of people, certainly in the last few years, who are a real backlash against MAPS, backlash against COMPASS. "You're taking away our sacred medicines." I don't believe that. These sacred medicines are too good to languish in Peruvian jungles for rich trustafarians who can afford to fly out there and enjoy them. My patients deserve these medicines, my patients do not need to buy into the hippy subculture and grow their hair and wear rainbow t-shirts in order to be treated. We need to meet the people who need these medicines on their terms. We do not need to make them inaccessible unless you but into this subculture. I know that makes me unpopular with people, but I don't care because I care about my patients more than that. So that's the other thing, it's trying to find a voice and a way to make this accessible to people, and that means moving beyond the old stereotypes. And that means, unfortunately, working with authorities 'cause that's the only way to get drugs licensed.

53:18 BS: Now, we could just not do this, we could not work with the man, and they'll just stay illegal forever and that 0.4% of rich hippies who enjoy them can enjoy them, or we can work with the authorities. And the third and final thing is money. Most pharmacology research is run by the pharmaceutical industry with millions to spend. If we had those kinds of millions in psychedelic research, we would be streaks ahead. This is all funded by charitable donations, philanthropy, and if we had that sort of money, the millions that they have in pharmacology research, we'd be moving on. So those are the three big things.

53:52 PA: Well, we hear the door buzz, right?

53:54 BS: Yeap.

53:55 PA: The girlfriend's here.

53:56 BS: She's here.

53:56 PA: So, I just wanna thank you, Ben, for all your work, for everything you've done. And we'll put more details about where people can find about your work in the shownotes, so...

54:03 BS: Nice.

54:03 PA: I appreciate it.

54:04 BS: Thanks man.

54:04 PA: Absolutely.

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