Psilocybin May Aid in the Treatment of Cocaine Addiction

New research finds psilocybin to be a potentially promising approach to treatment.

Posted May 30, 2026 | Reviewed by Margaret Foley

Cocaine use reached record worldwide highs in 2023, and an estimated 25 million people used cocaine in the past year.[1] In its various forms, including crack, cocaine is more likely to facilitate addiction than other substances, and cocaine-related fatal overdoses in the U.S. rose sharply after 2019 before declining in 2024.[2] [3]

Cocaine use disorder (CUD) is extremely difficult to treat. Currently, there are no FDA-approved medications for addiction to cocaine (and other stimulants, including meth), which means treatment options are more limited than for other forms of substance addiction. The search for medications that can assist in the treatment of stimulant use disorders has been ongoing for some time. Now, a recently published (May 2026) study in JAMA Network Open has found that psilocybin-assisted therapy has significant potential for the treatment of cocaine use disorder.[4]

Over the last decade, psilocybin has demonstrated efficacy in treating mental health and related conditions, such as treatment-resistant depression [5] and depression and anxiety due to life-threatening cancer[6], as well as chronic pain and the opioid use linked to it[7]. In recent research on the use of psilocybin for alcohol use disorder (AUD), the percentage of heavy drinking days was lower in the psilocybin group compared with the placebo group.[8]

This new randomized clinical trial, conducted at the University of Alabama at Birmingham, is the first study to evaluate psilocybin for the treatment of cocaine use disorder (CUD). Participants consisted of 40 adults with cocaine dependence (addiction) based on DSM-IV criteria. Participants received manualized psychotherapy and were randomly assigned to either one all-day psilocybin session or one all-day active placebo session.

All participants were 25 years of age or older (the median age was 50), reported cocaine use on at least four separate days during the previous month, were motivated to quit, and were without significant comorbidities. Of the 40 participants, 82.5 percent were men, 82.5 percent were Black, and 17.5 percent were White. Most participants had lower socioeconomic status, with 65 percent having an annual income of $20 000 or less.

Participants were randomly assigned to receive a single dose of psilocybin (25 mg per 70 kg of body weight) or an active placebo (100 mg diphenhydramine), and received manualized psychotherapy that incorporated cognitive-behavioral treatment approximately one month before and one month after an all-day drug treatment session. Researchers measured the percentage of cocaine abstinent days, rates of complete cocaine abstinence, and time to first lapse into cocaine use through 180 days post-treatment, as assessed by follow-up interviews and confirmed with urinalysis.

Compared with those in the placebo group with the same manualized psychotherapy, the psilocybin group demonstrated a higher percentage of cocaine-abstinent days, a greater likelihood of complete abstinence, and a reduced risk of lapse into cocaine use through 180 days after treatment.

How psilocybin and other psychedelics rewire the brain

Psychedelic substances are known to alter thought processes, expand perspectives, and potentially inspire spiritual experiences, including creating or deepening a sense of connection with that beyond self. This is entirely consistent with my lived experience as someone with dozens of decades-ago psychedelic episodes (and long before entering personal recovery in 2006).

Although the specific mechanisms of psychedelic-assisted treatments remain uncertain, the action of these substances seems to enhance neuroplasticity, altering neural pathways, cognition , affect, and behavior in ways that increase psychological flexibility. There is an accumulating body of evidence that psilocybin and other psychedelics with similar effects on brain functioning can be effective in treating different forms of addiction by reshaping the neural networks in the brain associated with addiction-related habits and help loosen the bonds of rigid thinking patterns—reducing substance-focused obsessive thoughts and diminishing the tunnel vision and gravitational pull of cravings.

Talk therapy is an essential part of the process

Professional supervision by trained therapists to help patients prepare for and deal with psychedelic experiences that can be extremely intense and challenging, in combination with psychotherapy, is fundamental to successful outcomes. Potential adverse effects are not to be taken lightly, and psilocybin and other psychedelics alone have not been shown to be an effective treatment for addiction. The current study utilized manualized psychotherapy to help the participants to manage and make therapeutic use of the psychoactive effects of the psilocybin administered.

In the randomized clinical trial cited here, psilocybin appeared to be safe and efficacious for treating cocaine use disorder among individuals from underrepresented and vulnerable populations. It’s clear that further research is needed to replicate and expand these findings. The bottom line is that additional tools for addiction treatment are necessary, especially for stimulant use disorders, where medication options have been essentially nonexistent. This study suggests that psilocybin, when paired with structured therapy in a clinical setting, may help people reduce and potentially discontinue cocaine use.

[1] United Nations Office on Drugs and Crime. World Drug Report 2025. United Nations publication, 2025. https://www.unodc.org/unodc/data-and-analysis/world-drug-report-2025.ht…

[2] Lopez-Quintero C, Pérez de los Cobos J, Hasin DS, et al. Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drug Alcohol Depend. 2011;115(1-2):120-130. doi:10.1016/j.drugalcdep.2010.11.004

[3] Garnett MF, Miniño AM. Drug overdose deaths in the United States, 2023-2024. NCHS Data Brief. 2026;(549). doi:10.15620/cdc/174639

[4] Hendricks, P.S., Lappan, S.N., Shelton, R.C., et al. (2026). Psilocybin in the treatment of cocaine use disorder. JAMA Network Open.

[5] Goodwin GM, Aaronson ST, Alvarez O, et al. Single-dose psilocybin for a treatment-resistant episode of major depression. N Engl J Med. 2022;387(18):1637-1648. doi:10.1056/NEJMoa2206443

[6] Griffiths RR, Johnson MW, Carducci MA, et al. Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: a randomized double-blind trial. J Psychopharmacol. 2016;30(12):1181-1197. doi:10.1177/0269881116675513

[7] https://www.psychologytoday.com/us/blog/some-assembly-required/202504/psychedelics-may-reduce-chronic-pain-and-related-opioid-use

[8] Bogenschutz MP, Ross S, Bhatt S, et al. 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. 2022;79(10):953-962. doi:10.1001/jamapsychiatry.2022.2096

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Dan Mager, MSW, LCSW, is the author of Some Assembly Required: A Balanced Approach to Recovery from Addiction and Chronic Pain and Roots and Wings: Mindful Parenting in Recovery .

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This article is part of the Bringwise Psychology Journal — daily insights on human behavior, mental health, and personal growth.