The Long-Term Effects of Psychedelics Are Sometimes Ambiguous

Whether in clinical trials, academic articles, newspapers, or magazines, the effects of psychedelics are often discussed as what follows a single or a few experiences. A typical clinical trial would measure parameters before and after ingestion of a specific substance to see whether there is improvement, and if the results are more significant than those of a placebo.

For example, in trials with psilocybin for major depressive disorder, the severity of patients’ depression symptoms is evaluated according to recognized assessment tools like the Montgomery-Asberg Depression Rating Scale (MADRS). Then, patients are given psilocybin and any further intervention like therapy, and their symptoms are reassessed, sometimes at several measuring points: immediately, a week, or a month later. In this young field, a two-month study period is considered a longitudinal study.

Trials use the before/after logic to demonstrate the efficacy (and risks) of a certain medicine in curing or alleviating symptoms. For psychonauts and other lifetime users, this sort of measuring and evaluating of the effects of psychedelics can seem irrelevant or arbitrary. As scholar Erik Davis explained in an interview, “there is more of an extended relationship of being a psychedelic person rather than ‘I do it and then I get the thing and I’m done’, because that’s not really how transformation works. We need regular encounters to keep the thing moving.” The effects of such long-term relationships, which are also common in indigenous communities and psychedelic churches, are much more complex to assess.

The Before-and-After logic of Measurement

The shortage of long-term data can be explained in practical terms. The field is quite young, clinical trials are expensive, and following up on patients for a long period of time often exceeds the budget. But what about the very idea of measuring human experiences? As a society, we have developed an obsession with measuring and quantitative reporting. In psychedelic science, we see an ever-growing number of questionnaires, designed to measure anything from psychological states to mystical experiences.

Until not long ago, complex calculations belonged to mathematicians, scientists, and businessmen, but those days are gone. For example, establishments providing public services, once considered unquantifiable, like government agencies, cultural and educational institutions, are required to write periodic reports proving their effectiveness in numbers. The UN plays a great role in this international trend through its Sustainable Development Goals (SDGs). The goals are for all countries to apply and concern 17 different issues, from eliminating poverty to supplying education and protecting nature. Looking at the site’s header proves my point: “The 17 Goals | 169 targets, 4075 events, 1371 publications, 8550 actions”. Conceptually and graphically, the measurements come before what is being measured.

Depending on the industry, psychedelics are presented as a new elixir that can solve your psychological issues, improve your performance, make your life longer, your chronic pain disappear, your addiction go away… and the list goes on. Yet the prevalence of stories about a single psychedelic experience is not only due to the before-and-after logic. It also reflects caution due to illegality and social stigma. Researchers, trial participants, journalists, and celebrities who are interviewed in countries where psychedelics are illegal often avoid discussing regular use. Instead, they talk about ‘that one time’ they took ayahuasca in South America or truffles in the Netherlands. But as Erik Davis notes, meaningful development happens over time, and the longevity of such processes is precisely what makes them so complicated to understand.

Cause-and-effect and measurement-based scientific methods are useful in explaining short and specific processes in a lab environment, but longer real-life processes are much more complex and unpredictable. Recently, it became clear that this is true even in the case of technology, as AI creators admitted that they do not understand how their own creations work. Indeed, Kumo CEO Vanja Josifovski argues that our expectation of simple explainability does not fit complex, intelligent systems like AI, where decisions “may be based on billions of micro-decisions encoded in massive matrices.” Now think about all the decisions, relationships, and systems entangled in human life and development.

First Times and Long Relationships

Like with many other first experiences, it definitely creates a wow effect, and in the case of psychedelics, possibly a life-changing one. However, no matter how great it is, it is still a preliminary experience, partly based on amazement from its novelty. There is a saying among skydivers that the second jump is always scarier than the first. During the first jump, there is a sensory overload, which makes you too overwhelmed to be aware of everything. So skydivers describe the move from the first to the second (and later) jumps as becoming more aware of what is happening. Knowing more or less what is going to happen makes you less overwhelmed, which means that you have more time and space to actually get scared, maybe even terrified, about what might go wrong.

Think about the naivety and fireworks of your first love versus going into a relationship after you’ve experienced loss. When we think about relationships, it seems natural that experience brings a certain maturity (hopefully), making a relationship more meaningful over time. The first month of dating is glorious, intense, and shining in a way that can never be repeated. But all that glitter is incomparable with the depth and meaning of a decades-long relationship. Some of the “features” of psychedelic experiences can be completely transformed over time. As a first-time user or a beginner, effects can feel weird, scary, uncomfortable, or overwhelming, and much attention is given to figuring out what is happening. With time, entering into psychedelic space or being in a prolonged altered state of consciousness can feel like coming home. If you are in a long-term relationship with a psychedelic, can you still pinpoint its effects? The longer the period is, the harder it becomes to establish causality.

Moving Variables

With psychedelics, even the measuring of short-term effects in a lab is challenging, but when we try to assess long-term effects, the picture becomes much more ambiguous as variables keep moving and interacting with other factors. The before/after logic is so prevalent that even initiatives like the Global Psychedelic Survey, which are designed to gain knowledge from longtime users in the “global psychedelic community,” cannot avoid it.

For example, one subject on the survey was whether psychedelics contribute to openness in relation to gender and sexuality. Let’s say you have been using psychedelics for a decade or two, and you are now significantly more open sexually. Can you assess how much of it is due to psychedelics? How about the effects of the various relationships you have had during this period: friendships, intimate, romantic, and sexual ones? Perhaps you participated in an event that affected your sexuality, like Burning Man or a Tantra workshop? Watched any related films? Maybe your best friend got a degree in gender studies? Are you living in another, more sexually open environment? How about the effects of broader cultural changes on general attitudes towards gender and sexuality? And of your own growing up, can you compare your views on sexuality from age 20 and 30? And from then until age 50?

To understand such complex systems, Nora Bateson developed the concept of Warm Data. “Warm Data is the relational information that describes the many parts of a system. For example, to understand a family, one must understand not only the family members but also the relationships between them, the context they reside in, the ecosystem that shapes them and that is, in turn, shaped by them”. This kind of information is qualitative, and it “offers another dimension of understanding to what is learned through quantitative data (cold data).” Hopefully, using combined methods and applying a long-term logic of moving variables will give us a better understanding of long-term psychedelic effects. Until then, we might have to accept that we actually don’t have the answers.

Annabelle is one of our community bloggers here at Psychedelics Community. If you’re interested in joining our blogging team and getting paid to write about subjects you’re passionate about, please reach out to Sam via email at [email protected]