6 minute read
NASW-NJ FOCUS Magazine - March 2023
Bullet Train to the Unconscious: Social Workers Left at the Station?
By Ralph Cuseglio, DSW, LCSW
-Stanislav Grof
By now, you likely have seen the news articles, social media posts, and tv segments. Psychedelic treatments for mental health conditions are here, and the evidence-base continues to grow. As psychedelic-assisted therapies (PATs) become a more common treatment choice, social workers will be consequential in the provision of these services. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), social workers are the nation’s largest group of mental health services providers. 1 Yet, I’m concerned that our profession will spend years playing a game of “catch-up” or be left behind all together. The field of PATs is growing quickly. There are ongoing clinical trials and recognized psychedelic training programs. Ketamine is an off-label treatment for refractory depression and the FDA is likely to approve MDMA (methylenedioxymethamphetamine)-assisted therapy for post-traumatic stress disorder (PTSD) in 2024.
The History
If you are not quite sure what all this means, let me back up and explain a bit about how we got here and why social workers, at all levels of practice, are vital to the future of PAT. Psychedelic, from the Greek “mind manifesting”, includes the medicines psilocybin, MDMA, LSD and ketamine, just to name a few. As far back as the 1940s, psychedelic medicines were being researched and used for the treatment of individuals suffering from an array of mental health issues. However, these medicines became stigmatized in the 1960s due to their widespread recreational use, their association with the counterculture and the antiVietnam War movements. This ultimately led to many psychedelic medicines being classified into the most restrictively regulated drug schedule (Schedule I) of the United States Controlled Substances Act in 1970 with substances like cocaine and heroin, despite most having low abuse risk potential. This classification and the ensuing “War on Drugs” led to the prohibition of research regarding the efficacy of psychedelic medicines and their use to treat mental health issues until the 1990s. In recent years, however, psilocybinassisted therapy for depression and MDMA-assisted therapy for PTSD have been designated by the FDA with breakthrough treatment status, which is intended to expedite a drug’s approval process. 2,3 An FDA Phase III clinical trial found that 67% of participants no longer met the clinical criteria for PTSD after receiving MDMA-assisted therapy. 4 Perhaps most consequential is that these medicines have been shown to outperform other first line psychopharmacological treatments. Currently, PATs have already shown great promise in treating depression, PTSD, obsessive compulsive disorder (OCD), substance use disorders, and anxiety disorders. 5
The resurgence of PATs has brought with it a new paradigm for mental health conditions that has far- reaching implications for the future of practice and policy in the United States. Thus far, the psychedelic research and training communities have struggled to include BIPOC and other members of historically marginalized populations. 6 As a profession committed to promoting social justice, social workers need to be informed and trained in new treatments for mental health conditions, especially those that disproportionately affect vulnerable and oppressed individuals and communities. By becoming active now, social workers at all levels of practice can help to ensure equitable access to, and treatment with PATs.
Take Action
So, what can New Jersey social workers do now to become better informed? Whether you have any intention of becoming a psychedelic therapist or not, the clients you serve are going to ask you about PATs and will seek out or may have already pursued such treatment. It is imperative that social workers take the time to research and become educated on the treatments. Increasingly, social workers are going to be asked to provide referrals and follow-up care to clients receiving PATs and will need to collaborate with other mental health providers providing PAT care. It’s important to have at least a foundational understanding of PATs to support clients in their mental health journeys. For clinical social workers interested in becoming a psychedelic practitioner, education and certification is available through reputable PAT training programs.
The entire social work profession has a role to play in the new frontier of mental health treatment. A more diverse, equitable, and multifaceted approach to psychedelic assisted treatment is crucial to address issues of accessibility, representation, and cultural sensitivity. To increase accessibility and affordability, social workers must advocate for policies that address structural barriers preventing members of marginalized communities from accessing PATs. This can include efforts to reform drug laws and policies, as well as working to provide services and support for people who have been impacted by the War on Drugs. We must ensure people from diverse backgrounds are represented in leadership roles within the psychedelic community, as therapists, researchers, and advocates by providing training and mentorship opportunities to underrepresented groups. Lastly, we need to make sure that PATs and research is conducted in a culturally sensitive manner. We must actively recognize the ways in which indigenous cultures are exploited for their medicines and practices and actively work to repair these harms and to reduce future harm.
The psychedelic-assisted therapy train has arrived. Social workers’ unique set of values, advocacy skills, and mental health expertise are needed in psychedelic spaces now, before the train leaves the station and the unique expertise brought by this profession is left out of the conversations. There are clients and communities that will depend on us for their safe and equitable journeys.
References:
1. https://www.socialworkers.org/News/Facts/SocialWorkers#:~:text=According%20to%20the%20Substance%20 Abuse,of%20mental%20health%20services%20providers
2. https://compasspathways.com/compass-pathways-receives-fdabreakthrough-therapy-designation-for-psilocybin-therapy-fortreatment-resistant-depression/
3. https://maps.org/news/media/press-release-fda-grants-breakthroughtherapy-designation-for-mdma-assisted-psychotherapy-for-ptsdagrees-on-special-protocol-assessment-for-phase-3-trials/
4. Mitchell, J.M., Bogenschutz, M., Lilienstein, A. et al. (2021). MDMA-assisted therapy for severe PTSD: a randomized, doubleblind, placebo-controlled phase 3 study. Nature Medicine 27, 1025–1033 https://doi.org/10.1038/s41591-021-01336-3
5. Mackey K.M., Anderson J.K., Williams B.E., et al. (2022). Evidence brief: Psychedelic medications for mental health and substance use disorders. Washington (DC): Department of Veterans Affairs (US). https://www.ncbi.nlm.nih.gov/books/NBK586533/
6. Hutchison, C., & Bressi, S. (2021). Social work and psychedelic‐assisted therapies: Practice considerations for breakthrough treatments. Clinical Social Work Journal 49(3), 356–367. https://doi.org/10.1007/ s10615-019-00743-x
About the Author:
Dr. Ralph Cuseglio, LCSW is an Associate Professor of Social Work at Monmouth University where he teaches clinical social work practice courses. Dr. Cuseglio will receive his Certification in PsychedelicAssisted Therapies & Research in April 2023 and has completed a 100-hour MDMA-Assisted Therapy Training offered by the Multidisciplinary Association for Psychedelic Studies. Dr. Cuseglio maintains a private psychotherapy practice where he collaborates with adolescent and adult clients by using a psychodynamic treatment approach combined with mindfulness-based practices. He is the former Secretary of the Executive Board for NASW-NJ.
