
126. Psychedelics & Addiction: What the Research Shows
Addiction psychiatrist Dr. Nathan Sackett on psilocybin, ibogaine, MDMA, ketamine, and what psychedelic-assisted therapy can and cannot do for substance use disorder.
Episode Summary
The conversation about psychedelics as addiction treatment is moving faster than the research. Dr. Nathan Sackett is trying to close that gap. Founding director of the Center for Novel Therapeutics at the University of Washington, Sackett is an addiction psychiatrist who still sees patients — which matters, because every study his center runs is rooted in clinical reality, not advocacy optics. In this live recording from the Psychedelic Salon at Town Hall Seattle, we cover what the evidence actually supports, what compounds carry genuine risk, and why the most important variable in treatment outcomes may not be the drug at all. If you've been following psychedelic news and want a clearer picture of what's real, this is the conversation.
🔵 Key Takeaways
Psilocybin works as an accelerant, not a cure. It amplifies therapeutic work already in progress — which means the therapeutic work has to be there first.
Ibogaine's cardiac risk is real and cannot be fully predicted even in pre-screened patients. Clinical monitoring with a cardiologist present is not optional — it is the protocol.
Ketamine is habit-forming in a way classic psychedelics are not. Since the pandemic, Dr. Sackett has seen a meaningful rise in ketamine use disorder in his clinical practice.
The variation in long-term outcomes across psilocybin trials may have more to do with integration therapy than with the drug. The field does not yet have standardized integration protocols.
Kratom is available at corner stores and gas stations nationwide and contains a compound with opiate-like properties roughly ten times more potent than morphine. It is undersupported in the research literature and underrecognized as a dependence risk.
🔵 Guest
Dr. Nathan Sackett is an addiction psychiatrist and the founding director of the Center for Novel Therapeutics at the University of Washington, where he leads clinical research at the intersection of psychedelic-assisted therapy, trauma, and substance use disorder. He sees patients in both an addictions clinic and UW's Psychedelic Education and Harm Reduction Clinic.
Center for Novel Therapeutics, University of Washington
🔵 Resources
#46 Cultivating the Witness with Natasha Lannerd — on metacognition, integration, and the internal observer that makes psychedelic work stick
#117 Ibogaine Treatment at Beond — a conversation with the co-founders of the Mexico-based clinic whose cardiac data Dr. Sackett is currently studying
Ask April: Q: Does the president's executive order legalize psychedelics? — on the executive order, fast-tracked FDA review, and what access will actually cost patients
Original Substack post: https://aprilpride.substack.com/psychedelics-addiction-research-nathan-sackett
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