What is actually available for alcohol and other substance use

If you have read that psychedelics can treat addiction, the first thing to know is that almost none of it is available as a treatment yet. This guide sorts the options by evidence and by legality, because the two do not line up.

The evidence, briefly

Psilocybin for alcohol. The strongest single result in the field. A 2022 randomised trial at NYU gave 93 people with alcohol use disorder two psilocybin sessions inside a course of therapy, against an active placebo. Over the following eight months the psilocybin group had heavy-drinking days about 10 per cent of the time versus about 24 per cent for the comparison group. Larger trials, including several in Canada, are now running to confirm it.

Ketamine for alcohol. A 2022 UK trial (KARE) gave 96 people three ketamine infusions with or without a structured therapy course. Ketamine plus therapy produced the highest proportion of days abstinent over six months. Earlier small trials from Columbia University found similar signals. The effect is real but modest, and it depends on the therapy.

Ketamine for cocaine and other stimulants. Small trials, encouraging, not replicated at scale.

Anything for opioids. Very little controlled evidence for any psychedelic. Medications like buprenorphine and methadone have decades of evidence and remain the standard of care; nothing here replaces them.

Ibogaine. Widely discussed for opioid withdrawal and used at unregulated clinics abroad. It carries a documented risk of fatal heart rhythm disturbance and has never been through a controlled trial in humans. Some US states have funded research into it; that research has not reported yet. We do not list ibogaine providers.

What you can legally do today

• Ketamine, Canada and the US. Legal, prescribed off-label by a physician, usually in a clinic. A handful of clinics run dedicated alcohol programs modelled on the trials; most treat alcohol use as part of depression care if at all. See our programs.
• Psilocybin, Oregon and Colorado. Legal for adults 21+ at licensed centres, without a diagnosis, under a non-medical program. Some centres name addiction among the things they work with. It is a supervised experience, not an addiction treatment: no detox, no medical follow-up.
• Psilocybin, everywhere else. Illegal outside clinical trials, with narrow exceptions: Canada's Special Access Program lets a physician apply on a patient's behalf, case by case, and Australia allows authorised psychiatrists to prescribe. Trials are the realistic route, and they are free. See our trials.

Where that leaves you

If your problem is alcohol, there are more legal options than for any other substance, and the order is: get stable first, then bring ketamine or a psilocybin trial to your treatment team as an addition. If your problem is opioids, nothing on this site should come before medication treatment, and the psychedelic options are years away. If someone is offering you a psychedelic for addiction outside these routes, our questions guide is written for that conversation.

This is general information, not medical advice.