Substance Assisted Therapy 101

What’s it about, who is it for, and what do we actually know so far?

There’s a lot of talk these days about ketamine, mushrooms, MDMA, and other substances being used in therapy, and no, it’s not just hype. Substance assisted therapy is slowly making its way from recreational use and clinical trials into more mainstream conversations around healing. But what is it actually? And how is it different from recreational use or self-medicating?

Substance assisted therapy means using certain psychoactive or psychedelic substances in a structured, supervised, therapeutic setting to support healing from trauma, depression, addiction, and more. It’s not a quick fix, and it’s definitely not a DIY solution. These therapies require preparation, guidance, and follow up integration with trained professionals.

Let’s break down what’s out there, what’s legal, and what’s being explored across the U.S.:

🧠 Ketamine Therapy

• Legality: It’s already legal. Ketamine is FDA-approved as an anesthetic and now used “off-label” for mental health. A nasal spray version called Spravato (esketamine) is approved specifically for treatment-resistant depression.

• What it helps with: Suicidal thoughts, depression, PTSD, anxiety, chronic pain.

• What it feels like: Dissociative. Some describe it like observing their life from the outside or like their mind is floating. It can help break stuck patterns and create a sense of distance from intense emotions.

• Where it’s available: Clinics across the country offer it, but most don’t take insurance yet.

• Good to know: This isn’t a one-and-done fix. Ketamine can offer short-term relief or insight, but it works best with talk therapy before and after each session.

🍄 Psilocybin (Magic Mushrooms)

• Legality: Still federally illegal, but decriminalized in some cities (Denver, Oakland) and now legal for guided use in Oregon and Colorado under regulated programs.

• What it helps with: Depression, anxiety (especially around death or dying), PTSD, addiction, long-standing trauma.

• What it feels like: Deep introspection, sometimes spiritual or emotional breakthroughs. Visuals, memory floods, body sensations. Sessions last 4–6 hours.

• Where it’s used: Right now, mostly in clinical trials or state-licensed programs. You can’t just book a mushroom appointment anywhere yet.

• Cultural note: Psilocybin has been used in Indigenous healing practices for centuries. Respecting these roots matters.

💞 MDMA-Assisted Therapy

• Legality: Still illegal for general use, but in final stages of clinical trials. Approval for treating PTSD could come as early as 2025.

• What it helps with: Severe PTSD, especially linked to early abuse, war trauma, or relational trauma.

• What it feels like: Emotional openness, reduced fear, easier access to painful memories without overwhelm. People often feel more connected to themselves and others.

• Why it works: MDMA calms the amygdala (fear center) while boosting serotonin and oxytocin—making it easier to revisit trauma without panic or shame.

• Access: Limited to MAPS-sponsored trials or compassionate use for now.

🌿 Ayahuasca & DMT

• Legality: Illegal in general, but some religious groups can use it legally. Otherwise, it’s mostly happening in underground or ceremonial settings.

• What it helps with: Addiction, depression, grief, spiritual trauma.

• What it feels like: Intense. Visions, body purging, deep emotional processing. Not for the faint of heart, and not something to do without serious intention and support.

• Cautions: Not safe for everyone. Especially risky for folks with heart conditions or untreated psychosis.

• Cultural respect: This is sacred medicine in many South American traditions. Western interest doesn’t erase Indigenous stewardship.

🔬 LSD (Acid)

• Legality: Still very much illegal federally, but being studied in universities and research labs.

• What it helps with: Anxiety, end-of-life fear, alcoholism, creativity blocks, existential questions.

• What it feels like: Expansive. Time, sound, sight, and meaning all shift. LSD can offer insight but also requires strong mental grounding and support.

⚠️ Let’s Be Real: It’s Not for Everyone

Substance assisted therapy isn’t magic, and it’s not a replacement for long term healing work. It’s also not safe for folks with a history of schizophrenia, untreated bipolar disorder, or some cardiac issues. These therapies open the door, but you still have to walk through and unpack what’s behind it. And that takes preparation, care, and real therapeutic support.

Most importantly, these experiences should never be used to force or rush healing. Informed consent, trauma sensitivity, and cultural humility matter just as much as the science.