Balancing Psychedelic Therapy and Addiction Risks from Board Certified Addiction Specialist Dr. Joel Hanson MD

This article is not legal or medical advice

As psychedelics gain recognition for their therapeutic potential, it is crucial for therapists and practitioners to navigate their benefits and risks, particularly regarding addiction and mental health considerations. At the Psychedelic Society of Utah Conference, Dr. Joel Hanson—a board-certified psychiatrist and addiction medicine specialist—shared his insights on balancing the use of psychedelics in clinical and spiritual settings while mitigating addiction risks. With over 15 years of experience in addiction medicine, Dr. Hanson has worked across inpatient, outpatient, and detox settings and currently practices as medical director at Altium Health.

Dr. Joel Hanson Medical Director of Altium Health

Understanding the Spectrum of Psychedelics

Dr. Hanson began by emphasizing that not all psychedelics carry the same risks and that the term ‘psychedelics’ broadly encompasses several distinct classes of substances:

• Empathogens (e.g., MDMA) – Increase emotional openness and bonding.

• Classic hallucinogens (e.g., LSD, psilocybin, mescaline) – Alter perception and consciousness.

• Dissociatives (e.g., ketamine, PCP, dextromethorphan) – Disrupt sensory processing and create out-of-body experiences.

Each of these classes interacts differently with the brain, and therefore, their addiction potential varies. “These substances affect the brain in unique ways, which is why we don’t use the blanket term ‘psychedelics’ in addiction medicine,” Dr. Hanson explained.

Key Considerations for Psychedelic Safety

While psychedelics hold promise for mental health treatment, Dr. Hanson outlined potential psychological and physiological risks, particularly for individuals with:

• Psychotic disorders (e.g., schizophrenia, schizoaffective disorder, bipolar disorder type 1)

• Borderline personality disorder

• History of substance use disorders

“These are the people I work with every day,” Dr. Hanson noted. “There are real risks when it comes to psychedelics and vulnerable populations, including persistent psychosis and hallucinogen persisting perception disorder (HPPD).”

Addiction Risk and Psychedelics

A major theme of Dr. Hanson’s presentation was evaluating the addiction potential of psychedelics and ensuring responsible use. The DSM-5 criteria for addiction include:

• Impaired control – Using more than intended or struggling to cut back.

• Social impairment – Neglecting responsibilities due to substance use.

• Risky use – Engaging in dangerous behaviors while under the influence.

• Pharmacological effects – Developing tolerance or withdrawal symptoms.

“If someone increases their dose frequently, uses daily despite negative consequences, or prioritizes use over responsibilities, that’s a red flag,” Dr. Hanson warned.

Which Psychedelics Carry the Most Addiction Risk?

Some psychedelics have a higher potential for addiction based on their euphoria, rapid onset, and withdrawal effects.

• High addiction risk: Ketamine, MDMA, and synthetic dissociatives (due to pleasurable intoxication, tolerance buildup, and withdrawal).

• Low addiction risk: Psilocybin and LSD (less euphoria, no major withdrawal symptoms).

“Classic hallucinogens like LSD and psilocybin don’t create the same compulsive use patterns as substances like opioids or stimulants,” he explained. However, he cautioned that individual predisposition plays a significant role, noting that genetic factors account for roughly 50% of addiction vulnerability.

How Practitioners Can Promote Responsible Use

Dr. Hanson urged practitioners to approach psychedelic use with caution and responsibility, particularly as laws evolve.

1. Screen for pre-existing vulnerabilities: Patients with psychotic disorders or severe trauma histories may have an increased risk of adverse reactions.

2. Assess addiction risk individually: Some clients may be more prone to substance dependence based on genetics and psychological makeup.

3. Support integration and accountability: Clients should engage in therapy, journaling, or community discussions to integrate their experiences.

4. Ensure ethical sourcing and dosing protocols: Misuse of unregulated psychedelics increases the risk of adulterants and unsafe consumption.

5. Follow best practices to maintain credibility: “If we want regulators to work with us, we need to show we’re responsible,” he emphasized.

“Know what you know. Know what you don’t know.”

Psychedelics have the potential to transform mental health care, particularly in addiction recovery. However, practitioners must balance enthusiasm with caution, ensuring clients are screened appropriately and guided through safe, intentional use.

“Know what you know and know what you don’t know” was the repeated theme of Dr. Hanson’s presentation. These words were then quoted by presenters that followed him, emphasizing the profound importance of practitioners working within their scope of competence, informed consent, consultation, and a strong referral network. 

For more information, therapists and practitioners can connect with Dr. Joel Hanson for a consultation or refer clients to Altium Health for compassionate, balanced, holistic addiction assessment and treatment.

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