Mixing psilocybin and alcohol can be risky. Psilocybin can mask the subjective effects of alcohol, potentially leading one to consume more than normal, which can have health and safety repercussions. Side effects like nausea and cardiovascular changes may be worsened by combining these substances. However, under professional medical care, psilocybin has shown promise in treating alcohol use disorder where legal.
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What Is Psilocybin?
Psilocybin (a.k.a. magic mushrooms) is a psychedelic drug that has long been known to induce perceptual alterations that can be mind-expanding but also disorienting. As such, psilocybin therapy has recently garnered considerable attention for its potential as a therapeutic agent within medical and mental health contexts. However, it is also commonly used for recreational purposes, usually illicitly.
As a naturally occurring compound found in over 200 different species of mushrooms, psilocybin is usually dried and can be eaten (sometimes coated in chocolate to mask bitter flavors), steeped as a tea, or ground into a powder and put into capsule form. When ingested, psilocybin is converted in the digestive system to the psychoactive metabolite psilocin that induces perceptual distortions that, while some find euphoric, others find frightening.
Effects Of Mixing Psilocybin & Alcohol
Psilocybin tends to dampen the subjective effects of alcohol. One study found that psilocybin diminished the subjective effects of alcohol for 60% of participants. However, psychedelic experiences can be unpredictable: the authors noted that there were exceptions where psilocybin enhanced the effects of alcohol.3 The point here is that you just don’t know how this combination will play out for each individual.
Neurological Effects of Mixing Psilocybin & Alcohol
Psilocybin and alcohol both act on several of the same neurotransmitters in the brain in a rather complex way. Psilocybin primarily acts on serotonin receptors, and it is believed that the cascade of signals that follow hamper the subjective experience of feeling “buzzed,” “relaxed,” or “drunk” that alcohol induces.
In addition, psilocybin alters signaling in excitatory neurotransmitters – like glutamate in the prefrontal cortex – that are deficient in those with alcohol use disorder. Psilocybin may indirectly regulate dopamine pathways that are impaired in alcohol addiction, helping to reduce cravings that lead to more use.4
Risks Of Mixing Psilocybin & Alcohol
Mixing alcohol and psilocybin can pose serious risks. Acutely, large amounts of alcohol can lead to alcohol poisoning or overdose, but in the long term, it can lead to serious health conditions like liver issues and cardiovascular disease. Just because psilocybin masks the subjective effects of alcohol doesn’t mean that the alcohol isn’t doing damage to the body.
Side effects of both psilocybin and alcohol may also be exacerbated, like nausea or increased heart rate and blood pressure. For individuals with certain medical conditions – like cardiovascular disease – serious complications can occur.
Can Mixing Psilocybin & Alcohol Cause Addiction?
Psilocybin is not considered to be addictive. However, alcohol can be addictive, especially for people who are genetically and biologically predisposed. Theoretically, psilocybin shouldn’t increase the risk of alcohol addiction since, for most people, it masks the subjective effects of alcohol.
On the contrary, psilocybin is currently being explored as a therapeutic for treating alcohol use disorder. In clinical trials, when combined with psychotherapy (motivational enhancement therapy or cognitive behavioral therapy for addiction), two psilocybin treatment sessions resulted in reduced craving and alcohol consumption (27-41% fewer days), extending to at least 32 weeks.5,6
Guidelines for Harm Reduction When Mixing Psilocybin & Alcohol
It is strongly advised not to mix alcohol and psilocybin. However, if you are going to use both, it is better to use them sequentially, not concurrently, to avoid cardiovascular and gastrointestinal distress.
For the sake of harm reduction, if you do plan to mix psilocybin and alcohol, limit the amount of accessible alcohol to what is below your normal intoxication threshold so that you don’t keep drinking while under the effects of psilocybin. Have a sober friend or family member present to seek help in case of a problem.
Consider that no source of psilocybin, outside of licit, approved dispensaries, is truly safe. Taking psilocybin in powder form or capsules increases the likelihood that it has been laced with other dangerous substances, like fentanyl, which can be fatal, especially when combined with alcohol.
But again, it is strongly advised not to mix substances.
Psilocybin Therapy for Alcohol Use Disorder
Psilocybin and alcohol have an interesting relationship. On the one hand, psilocybin masks the effects of alcohol. In recreational settings, this can pose risks of injury or medical complications. On the other hand, psilocybin has shown considerable potential in recent studies to treat alcohol use disorder. In this context, psilocybin can reduce cravings and consumption of alcohol and increase abstinence with just a few treatments.
If you need help finding a professional provider that offers psychedelic therapy in a safe and secure environment, you can learn more from the Psilocybin Assisted Therapy Association. You may also want to consider ketamine therapy, which is legal for clinical use; to learn more and find a provider, visit the American Society of Ketamine Physicians, Psychotherapists, and Practitioners (ASKP3).
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Other Treatment Options for Alcohol Use Disorder
There are several therapeutic options for treating alcohol use disorder. Detoxification and alcohol withdrawal are best completed on an inpatient level, with medical supervision, to ensure a safe transition to sobriety and access to medications that can ease withdrawal symptoms, which can be severe (e.g., seizure, delirium tremens).
A treatment plan for alcohol use disorder usually integrates individual psychotherapy with group therapy and family therapy. When possible, a residential recovery program can provide a secure, sober environment in which to recover. Twelve-step programs, like Alcoholics Anonymous (AA), go beyond the acute treatment period and provide ongoing support throughout life.
Treatment options for alcohol use disorder include:
- Inpatient Detoxification and Rehab: Withdrawal from alcohol dependence sometimes requires medical support to ease symptoms that can be dangerous (e.g., seizure, delirium). At an inpatient facility, medications can be given that can help with withdrawal.
- Cognitive behavioral therapy (CBT): A CBT for addiction therapist helps the individual identify maladaptive thought patterns and behaviors associated with alcohol use disorder, develop healthy skills and coping strategies to challenge maladaptive thinking, and manage cravings. Over time, these new ways of thinking and behaving are reinforced, with the goal being long-term change and relapse prevention.
- Dialectical behavior therapy (DBT): DBT is similar to CBT but with more focus on emotional regulation, mindfulness, and interpersonal skills to manage emotional distress. A DBT therapist will help an individual struggling with alcohol use disorder to accept current circumstances while also actively working towards change.
- Motivational Interviewing: Motivational interviewing helps the individual to see change (in this case, recovery from alcohol misuse) as occurring in steps or stages. The therapist helps the individual discover their intrinsic desire for change and establish clear, realistic steps for change through guided but open-ended questioning and reflective listening.
- Family Therapy: Understanding and adjusting family dynamics can be a very powerful tool in treating alcohol use disorder. Alcohol use disorder often involves the whole family and not just the person struggling. Family therapy will help the family members improve communication, support each other, and find healthy ways to cope with challenges during withdrawal, recovery as well as instances of relapse.
- Support Groups: Support groups like Alcoholics Anonymous (AA) play a crucial role in the recovery process for many individuals and their families. AA or other group therapy interventions provide a safe, non-judgmental space where individuals can connect with others experiencing similar struggles with addiction and dependence.
- Ketamine Therapy: Ketamine therapy has been used to treat several mental health disorders (mostly off-label). It is a legal alternative to psilocybin therapy in some areas, but there are differences to consider. A certified ketamine provider can help you determine if this is an appropriate and safe treatment for you.
When to Seek Professional Support
If you or a loved one is struggling with alcohol dependence or addiction, it is crucial to consult with a healthcare professional sooner rather than later. While psilocybin is increasingly being used therapeutically to treat alcohol use disorder in areas where it is legal, using it outside of a clinical setting carries risk. One should not self-medicate with psilocybin as there are medical contraindications and other factors to consider before use.
If you’re noticing that alcohol is getting in the way of relationships, work, or other aspects of daily life but are not sure how to proceed, you may want to find a therapist or find a psychiatrist who can help determine the best approach to treatment. If you have trouble finding a local therapist, consider searching an online therapist directory or online therapy platform.
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In My Experience
There is currently an elephant in the room with regard to the use of psilocybin as a therapeutic agent. On the one hand, psilocybin is gaining considerable attention from professionals and laypersons for its potential to relieve mental health symptoms, such as depression, anxiety, and alcohol use disorder. However, in most municipalities, psilocybin is not legal for clinical use outside of research trials.
In my personal clinical experience, the therapeutic effects of psilocybin tend to be more consistent and sustainable than those of ketamine – another drug with psychedelic effects that is now being used therapeutically – and with a lower potential for a “bad trip” or negative side effects. However, sourcing of psilocybin is problematic in areas where psilocybin is not legal.
For those interested in trying psilocybin therapeutically, without worrying about contamination with fentanyl or other substances, legal retreats with certified healthcare professionals are an option for those willing to travel to locations where psilocybin is legal. You can also search the government’s clinical trials database for enrollment opportunities in research studies using psilocybin therapeutically or look into growing your psilocybin-containing mushrooms from spores.
Frequently Asked Questions
Is psilocybin legal?
Since 1970, psilocybin has been classified as a Schedule I drug, along with more dangerous drugs, like heroin, that are deemed to have a high potential for abuse and have no recognized medicinal uses. Legally, however, things began to change in 2018 when the FDA granted breakthrough therapy status to psilocybin for treatment-resistant depression.
Then, in 2020, the Entheogenic Plant and Fungus Policy Act was passed, which eased enforcement laws for psychedelic drugs, including psilocybin, lowering its priority for law enforcement attention and prosecution.1 In addition, since 2020, several states have decriminalized psilocybin, including Oregon, Washington, California, Colorado, Michigan and Massachusetts.
Most recently, on June 23, 2023, the FDA issued guidance for clinical research using psilocybin (and also LSD and MDMA), allowing for legal use of psilocybin nationally within healthcare treatment settings with observation by two trained monitors, where one must be licensed with graduate-level professional training and clinical experience in psychotherapy.2
Psilocybin & Alcohol Infographics
ChoosingTherapy.com strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy.
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Chapter 9C. Entheogenic plant and fungus policy. D.C. Law Library. (n.d.). https://code.dccouncil.gov/us/dc/council/code/titles/48/chapters/9C
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U.S. Food and Drug Administration.FDA issues First Draft Guidance on clinical trials with psychedelic drugs. (2023, June 23) https://www.fda.gov/news-events/press-announcements/fda-issues-first-draft-guidance-clinical-trials-psychedelic-drugs
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Barrett, S. P., Archambault, J., Engelberg, M. J., & Pihl, R. O. (2000). Hallucinogenic drugs attenuate the subjective response to alcohol in humans. Human Psychopharmacology: Clinical and Experimental, 15(7), 559-565.
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Ziff, S., Stern, B., Lewis, G., Majeed, M., & Gorantla, V. R. (2022). Analysis of Psilocybin-Assisted Therapy in Medicine: A Narrative Review. Cureus, 14(2).
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Bogenschutz, M. P., Forcehimes, A. A., Pommy, J. A., Wilcox, C. E., Barbosa, P. C., & Strassman, R. J. (2015). Psilocybin-assisted treatment for alcohol dependence: a proof-of-concept study. Journal of psychopharmacology, 29(3), 289-299.
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Bogenschutz, M. P., Ross, S., Bhatt, S., Baron, T., Forcehimes, A. A., Laska, E., … & Worth, L. (2022). Percentage of heavy drinking days following psilocybin-assisted psychotherapy vs placebo in the treatment of adult patients with alcohol use disorder: a randomized clinical trial. JAMA psychiatry, 79(10), 953-962.
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