Mental health benefits and downsides of psychedelic use in ACX readers: survey results
Over the last few years, I’ve had a lot of conversations with people in the rationalist and adjacent communities about psychedelic use, mainly focused on potential benefits, potential risks, and good and bad outcomes they’ve seen in others from using psychedelics. I often wished I had more hard data about this, and that it came from groups that seemed more analogous to people in the rationalist and nearby communities than eg the average taker of existing surveys on psychedelics. So I decided to run a survey on this on the recent ACX reader survey, and am sharing the results here. (I’m posting this using an anonymous username, but I’ve been around the community for a long time.)
Many thanks to Scott and all the survey-takers for making this happen!
You can see a blank copy of the survey here. It might be worth making some advance predictions about answers to the questions in it before looking at the stats below.
824 people took the survey and seemed like they’d done one of the drugs I was asking about (LSD, psilocin/psilocybin/magic mushrooms, chemical DMT without an accompanying MAOI, mescaline/mescaline cacti, Ayahuasca or “pharmahuasca” (DMT + an MAOI), + a write in option) in doses larger than a microdose (also, someone noted that I incorrectly referred to these as psychedelic tryptamines). (There were originally 986 responses, but Scott directed psychedelic users to take the survey, so it isn’t surprising that most had done psychedelics). I discarded the responses from people who hadn’t done one of the relevant drugs, and did my best in ambiguous cases.
I’m not very experienced with large survey and data analysis, so even though the things I did seemed pretty straightforward and I tried to double-check and sanity check the most important parts, I think there’s still a reasonable chance I made some meaningful mistakes that undermine my results
Summary of high-level takeaways
More psychedelic trips are reported to be good than bad (depending on how you count it, there are about 5x-11x as many good as bad trips).
Psychedelics are very good for some people (according to those people), e.g. among the best experiences in their lives. Specifically, 74% said a psychedelic trip was in the top 20 most enjoyable experiences of their life, 61% said a trip was in the top 20 most meaningful experiences, but also very bad for a smaller number of people (41% said they had one of their top 20 most frightening experiences on psychedelics, and 32% reported the same thing for mentally painful experiences).
The majority of respondents say that their psychedelic use caused at least some enduring (>6mo) personality change in them (~32% said “yes, very minor ones”, ~25% said “yes, moderately strong ones”, and ~7% said “yes, very strong ones”), the vast majority of which they said were positive.
Around 4.5% of respondents said the psychedelics caused them to experience psychosis, and another 4.5% they might have had this effect. In another question, ~5% said psychedelics had caused them serious mental problems (but 36% said those psychedelics had had big mental health benefits). But only ~1% said that they regretted trying using those drugs, while 58% said they thought that most psychedelic non-users were making a big mistake.
People vary vastly in terms of how important psychedelic use is to them, and psychedelic use seems extremely important to some people, to the point where they wouldn’t trade their ability to use these drugs for many times their net worth.
Overall, it seems to me like both doing and not doing psychedelics is a high-stakes choice.
Of the drugs I asked about, ~83% of the respondents had done LSD, ~82% had done psilocin/psilocybin/magic mushrooms, ~20% had done chemical DMT without an accompanying MAOI, ~13% had done mescaline or a mescaline cactus, ~8% had done Ayahuasca or “pharmahuasca” (DMT + an MAOI), which were the options I provided (people could also write in other options). No other option got >1%, though it looks like 2-CB might have gotten 1-2% if I aggregated all the different ways people wrote out the word. So it looks like LSD and the mushroom psychedelics are by far the most popular, and most people that have used one have used the other, then there’s a steep dropoff.
The mean number of instances of use so far (hereafter, “trips”) was ~22, and the median was 10 (I had to make guesses for ~2% of the answers, e.g. when people said “20+”, but I don’t think that other reasonable interpretations would lead to different bottom lines). Overall, respondents collectively reported having 19,579 trips so far.
Here is a chart showing how frequently respondents had had different lifetime numbers of trips (non-microdose instances of use of the types of psychedelics I was talking about). I discarded ~5 datapoints that seemed internally contradictory or that I couldn’t interpret.
As you can see from this and the above data-points, what I would call moderately-high repeat use seems common (doing psychedelics more than enough to try them out, but less than e.g. monthly, and less than one likely “could” if one was doing them as frequently as possible).
Trip subjective experiences
I asked 4 questions about people’s subjective experiences of their trips, below.
Out of all the times you did psychedelic tryptamines, what % did you consider a *positive* subjective experience (a more enjoyable/pleasant experience than being unconscious or not existing), *during the experience*?
Out of all the times you did psychedelic tryptamines, what % did you consider a *negative* subjective experience (a less enjoyable/pleasant experience than being unconscious or not existing), *during the experience*?
Out of all the times you did psychedelic tryptamines, what %, looking back, are you overall *glad* that you did? (E.g. because the experience was enjoyable without commensurate downsides, you feel you learned something of value (even if it was unpleasant at the time), you experienced some improvement in mental/emotional health following the experience, etc.) This should your [sic] perspective after reflecting on the experience and all the effects it ended up having.
Out of all the times you did psychedelic tryptamines, what %, looking back, do you overall *regret* that you did? (E.g. because the experience was unpleasant without commensurate upside, you feel you came away with false insight or trauma, you experienced some decrease in mental/emotional health, etc.) This should be your perspective after reflecting on the experience and all the effects it ended up having.
I didn’t ask specifically about neutral experiences.
The answer options were all deciles (~0%, ~10%, ~20%, etc.). There was very slight dropoff in response count (819 for the first question, 813 for the last of those 4)
A chart of the answers is below, unweighted by trip count (so, each respondent just puts in one answer for each question, and this doesn’t take into account how many trips they’ve had).
|Median||90%||10%||90% (~48% said 100%)||0% (64% of respondents said 0)|
The ratio of positive to negative mean trips was 5.5:1
The ratio of mean trips people were glad they’d had to ones they regretted was 10.6:1
Now, here are the implied counts for different numbers of trips (taken by multiplying people’s answers by how many trips they said they’d had in an earlier question, not them answering this specific question directly. So if you said 20% of your trips were negative, and you’d earlier said you’d done 10 trips, that implies 2 negative trips.).
|Mean||18.6 per person||2.5 per person||18.6 per person||1.7 per person|
|Median||7.2 per person||0.9 per person||7.2 per person||0.0 per person|
The ratio of positive to negative mean trips was ~7.5:1
The ratio of mean trips people were glad they’d had to ones they regretted was ~10.8:1.
In other words, positive trips are substantially more common than negative ones, but negative trips aren’t rare. It seems to be slightly more common for people to be glad they did a trip and not regret it than for the trip to be positive and not negative at the time (in other words, it’s slightly more common for people to have a negative experience in the moment that they overall don’t regret on reflection than vice versa).
The average trip is slightly more positive/rewarding than the average respondent experience, probably because people who have better experiences with psychedelics tend to take them more than people who have worse experiences (or get unlucky during their first few trips).
I didn’t look into whether it was statistically significant or anything.
I asked “Has your experience with psychedelic tryptamines resulted in long-term (>6mo) changes to your personality?”.
There were 821 responses. ~36% of people said no, ~32% said “yes, very minor ones”, ~25% said “yes, moderately strong ones”, and ~7% said “yes, very strong ones”.
So, the majority of people report lasting personality changes!
Then I asked “If you have noticed long-term (>6mo) changes to your personality following psychedelic tryptamine use, do you think those changes have been positive overall, or negative?”, with answers on a scale of 1 to 5, where 1= “very positive” and 5= “very negative”. I got 542 responses. The responses are below.
So, most people thought the changes were positive rather than negative (482 positive vs. 42 neutral vs. 18 negative, or a ratio of ~27:2:1).
I asked people to describe the changes that resulted, but I didn’t have time to code them. On skimming, commonly stated themes seem to include increased openness and compassion and overcoming things like “rigidness” or “narrowness”, happiness of a tranquil kind (lots of phrases like “contentment” “at-ease” “serenity” “acceptance”), progress related to depression or social anxiety, and instances of becoming “aware” or “mindful” or “able to appreciate” new things. Negative themes were obviously less common, but I saw mentions of increased depression, and feelings of detachment/apathy. So, kind of what one would expect. However, there were a few scattered reports of experiences in the opposite direction (more paranoid, more concerned about what others thought of them, etc.). Also at least 3 (or maybe more) mentions of reducing or eliminating meat consumption.
I also asked people to check all that apply for any of a series of options that were true of them:
One of the top 20 most *enjoyable* experiences of my life occurred during a psychedelic tryptamine trip (“top 20 enjoy”)
One of the top 20 most *frightening* experiences of my life occurred during a psychedelic tryptamine trip (“top 20 frighten”)
One of the top 20 most *meaningful* experiences of my life occurred during a psychedelic tryptamine trip (“top 20 meaningful”)
One of the top 20 most *mentally painful* experiences of my life occurred during a psychedelic tryptamine trip (“top 20 mentally painful”)
Doing a psychedelic tryptamine caused me to become noticeably *less* spiritual/religious/*decreased* my credence in the existence of a god or gods or similar (“less religious”)
Doing a psychedelic tryptamine caused me to become noticeably *more* spiritual/religious/*increased* my credence in the existence of a god or gods or similar (“more religious”)
I think most people who *never* try psychedelic tryptamines are making an important mistake (“no psychedelics = mistake”)
I think most people who *do* try psychedelic tryptamines are making an important mistake (“psychedelics = mistake”)
I wish I had never tried any psychedelic tryptamines (“wish never tried”)
I experienced serious mental health problems I believe were a result of using psychedelic tryptamines (“serious mental problems”)
I experienced large personal, health, or professional benefits I believe were a result of using psychedelic tryptamines (“big benefits”)
There were 739 respondents who answered (often checking multiple answers)
It’s very common for people who have done these drugs to report that they were among the most intense experiences of their lives, more often in positive but also often in negative directions.
People report more benefits than harms, but a non-trivial number of harms
Very few people regret taking these psychedelics (and most people who experience serious harms still don’t regret it)
Per common wisdom, it seems like they more often made people more spiritual/religious, rather than the opposite.
Psychedelics and psychosis
I asked people a series of questions about psychosis resulting from psychedelic trips.
Have you ever, to your knowledge, experienced psychosis that you believe was largely or wholly attributable to psychedelic use?
Out of 815 respondents to this question, 721 (88%) said no, 37 said yes (4.5%), and 37 (4.5%) said maybe/I don’t know.
If you have experienced psychosis that you believe was largely or wholly attributable to psychedelic use, did the experience follow a trip that was a positive experience while it was ongoing, or a negative experience while it was ongoing?
89 people answered this question, and a chart of the results is below (I don’t know why this got more responses than the question above would indicate). It doesn’t include write-in answers.
So it looks like it’s more common for a negative trip to precede a psychotic episode than a positive one, even though (per the above) positive trips are ~10x more common in general, Another way of putting it: ~10/15000 (or, 0.067%) of positive trips led to psychosis, and ~21/2000 (1.05%), a factor of ~16x difference.
Though, it also seems very plausible to me that either people remember trips as being worse if the preceded psychotic episodes, and/or the onset of the psychosis is what makes the trip negative (rather than negative trips being more likely to cause psychosis).
If you have experienced psychosis that you believe was largely or wholly attributable to psychedelic use, what psychedelic tryptamine did you take right before the onset of the psychosis?
LSD is a bit disproportionately represented here; above, a similar number of respondents said they’d tried LSD vs. psilocybin/shrooms (~83% vs. 82%), but perhaps people use LSD more frequently if they try it, or in larger doses. Or perhaps there’s something more inherently dangerous about it or how people use it, or a slightly more at-risk group of people use it.
Net worth question
I asked the question “Imagine that an omnipotent entity is offering you a deal where It gives you money, but if you accept the money, no psychedelic tryptamine will ever have a psychoactive effect on you again (if you ingest them, nothing will happen), for either 100 years or until you die (whichever comes first). Think about the minimum amount of money that this entity would have to offer, such that you would take this deal. Now, what fraction of your total current net worth does that amount of money constitute, in %? (Please put % in your answer, so I know you read the question, e.g. “X% of my current net worth”).”
I ignored people when it seemed pretty likely they hadn’t interpreted the question correctly (though I’d guess they interpreted it incorrectly in many more cases than the ones in which it was pretty clear to me), and people who said their net worth was negative. I regret how I structured this question; as some respondents noted, fraction of expected lifetime earnings would have been better, and this is a pretty bad question for young people who are far from peak earning; the answers are really all over the map in a way that I think reflects this. Still, I think some of the results are interesting.
Here’s a chart of respondent count by what fraction of their net worth they said they’d need to be given to give up the ability to do the psychedelics I was referring to.
49 people also included a minimum monetary amount they would want in order to make this trade; the mean for those people was ~$3.35M (!) and the median was ~$129k. For context, in the 2020 SSC Reader Survey (not this survey), the average income was ~$140k and the median income was $70k (obviously, the average for these survey respondents might be different, though I’d be somewhat surprised if the differences were large).
I didn’t count how many, but there were also several people who said they wouldn’t give up the ability to do psychedelics for any amount of money. Also some people said they never intend to do psychedelics again, and would forfeit the ability to do so for trivial amount of money, but would pay a lot to preserve the memories and insights they think they gleaned from past experiences. Also, some people noted that their numbers would be substantially higher if the question was about all psychedelics (instead of just tryptamines) or all psychoactive drugs in general.
I wish I had asked some questions about what their friends and family thought of the long-term personality changes in people that had those, or what they think their younger selves would have thought of these changes
I wish I’d asked people how long their psychosis persisted
I wish I’d asked people if their psychosis followed their first trip, or a later trip
I wish I’d asked the people who had psychosis before if it was their first psychotic episode, or if they’d already had one or more before.
I wish I’d done the Net Worth question differently
It would be neat if someone explored these in the future.
It seems like someone on this survey both became psychotic following LSD use, and also says they wouldn’t give up the ability to do psychedelics for 10x their net worth, which I thought was interesting.
I’ve heard quite a lot about psychedelic-related values changes. This mildly worries me and makes suspicious about respondents being happy with their personality changes.
One example from the data of this survey. I doubt that people from rationality adjacent communities would endorse becoming more religious, than they are now and would like to take a pill that would make them so in 24% causes. Yet the majority of respondents tend to endorse their personality changes from psychedelics.
That depends to what extend the change is through by having new data. While some people have belief-in-belief of being atheists, many are just atheistic because they think it matches the available evidence best.
It seems reasonable to be extra sceptical towards evidence that is obtained when your evidence-evaluating-engine is distorted and extremely sceptical toward evidence which can only be obtained in such state.
Experiencing divine grace under lsd is as much evidence in favour of god actually existing as witnessing psychic with an earphone telling you the details of your life is an evidence in favour of telepathy. Both performances can be impressive, but the design of the experiments is completely flawed.
I expect rationality adjacent people to understand it. And if they nevertheless change their mind on the subject of religion, this seems mildly disturbing.
Of course it can be completely harmless things. For instance, some people couldn’t have imagined how anyone can be religious, then took some psychedelics and understood the idea of religious experience in principle, which technically made them more religious than they used to be. But I suspect it can be much more dramatic than that. I wish we had more information about such matters.
It also depends on how one defines “religious”. A commonly used definition, which seems to be same as the one you’re using, is something like “believes in the objective existence of supernatural entities”. But while that may be a reasonable description for many of the Abrahamic religions in particular, it’s not a universal part of all religions, nor does it even accurately describe the psychology of many followers of those religions (even if it does describe the psychology of some).
For instance, someone might get a feeling of all experience being sacred and beautiful in some sense, in a way that is not strictly incompatible with traditional atheism (as it implies no difference in factual beliefs, at least not beliefs with regard to what actually exists or not), but nonetheless feels so different to them than what they had previously associated with atheism that it feels more right to identify as being spiritual from that moment on.
Or psychedelics might unlock intuitive access to phenomena which have traditionally been associated with religion, e.g. experiences of energies or seeing auras, that can be non-supernaturally interpreted as a native way for the brain to represent subconscious judgments of the emotional states of self and others. Those kinds of things are currently mostly discussed in the context of religion/spiritual practices, in which case one might describe themselves as “becoming religious” if they then start practicing systems for making use of that information that have been developed in the context of specific religions—which again doesn’t require belief in anything supernatural.
Or if one starts more strongly intuitively picking up on other people’s emotional states, perceiving states and moods most strongly associated with people e.g. causing each other to get upset in certain predictable and repeatable patterns (e.g. the same arguments playing out over and over between the same people) can cause one to perceive those people as being “possessed by demons”, “demons” the being particular patterns of noise / maladaptive emotional schemas that drive such behavior. And so on.
It’s certainly true that simply having an experience while on psychedelics doesn’t prove anything; however if being on psychedelics gives you access to a recurring experience that you can afterwards try to empirically test and see whether its predictions are valid, that may be a different matter.
Completely agree! Such possible explanations are the reason why I’m only mildly worried about psychedelic values drift. Cautious curiosity still seems to be the reasonable response.
Huh. I agree. That never really hit me until now. Seems like something people should invest more time in thinking about and considering.
For people who are planning on taking psychedelics (I’m not suggesting they do, but if they will anyway) or who have already done so: perhaps consider writing a high-quality trip report. They are super rare, and rationalist-informed trip reports might be excellent sources for research leads to figure out how the brain works.
For inspiration, perhaps read: Guide to Writing Rigorous Reports of Exotic States of Consciousness.
Also, I recommend reading “The Grand Illusion” by Steven Lehar for some excellent pointers for how psychedelic experiences can legitimately inform our understanding of consciousness. Here is a writeup I made about his life’s work and how it was informed by his (very rare) rational psychonautics.
For another example of rational synthesis of psychedelic phenomenology see: The Hyperbolic Geometry of DMT Experiences (@Harvard Science of Psychedelics Club) or this talk about mapping high-energy states of consciousness delivered at a ACX online meetup.
Finally, consider submitting a datapoint for the Tracer Tool. More info here.
Does anyone have a good model of how do they reconcile
1) a pretty large psychosis rate in this survey, a bunch of people in https://www.lesswrong.com/posts/MnFqyPLqbiKL8nSR7/my-experience-at-and-around-miri-and-cfar-inspired-by-zoe saying that their friends got mental health issues after using psychedelics, anecdotal experiences and stories about psychedelic-induced psychosis in the general cultural field
2) Studies https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3747247/ https://journals.sagepub.com/doi/10.1177/0269881114568039 finding no correlation, or, in some cases, negative correlation between psychedelic consumption and mental health issues?
- Studies done wrong?
- Studies don’t have enough statistical power?
- Something with confounding and Simpson’s paradox? Maybe there’s a particular subgroup in the population where psychedelic use correlates negatively with likelihood of mental health issues within this subgroup, or a subgroup where there is more psychedelic use and simultaneously lower likelihood of mental health issues on average across the subgroup?
- Psychedelics impart mental well-being and resilience to some people to such a degree that it cancels out the negative mental health effects in other people, so that in expectation psychedelics wouldn’t affect your mental health negatively?
This study at least didn’t ask about the length of the psychotic episode, so it seems compatible with the users having had short-term psychotic episodes that didn’t cause long-term damage.
Speculatively, a short-term psychosis could even be part of what causes long-term mental health benefits, if e.g. psychedelics do it via a relaxing of priors and the psychotic episode is the moment when they are the most relaxed before stabilizing again, in line with the neural annealing analogy:
A relevant-seeming comparison is that there are meditation traditions that basically hold that you are expected to go through what are something like psychotic episodes before you get better, on the theory that reconfiguring your brain to more clearly see reality will break some existing setups and require time to find a new workable configuration.
Alternatively, the psychotic episodes themselves may be part of what helps convey useful information to your brain: they are a very visceral indication of the fact that your experience is internally constructed. If something totally crazy may seem like an absolute truth during the trip/meditation experience, then that helps highlight the fact that even things that feel like absolute truths to you can be false. “Getting a visceral understanding of how your mind creates your subjective reality” is sometimes understood to be one of the goals of enlightenment, and it can also make it easier to discard incorrect emotional schemas that some part of your mind has so far taken as absolute ttruths and which have caused what we would ordinarily call mental health problems.
At the same time this also risks some craziness if you don’t already have good epistemology. One with the right background may end up thinking “okay so that was a really visceral indication of my mind being generated by a piece of fallible software, I’ll be much less sure about all of my beliefs now and try extra hard to test them against reality”. But someone else could interpret exactly the same experiences to imply “well apparently everything I took to be certain is bunk, that includes all that previous stuff about science that I once thought to be true, now I know that my mind creates reality so this has to mean that there’s no objective reality and I can make anything true just by believing in it!”.
My mental model for the difference between the two results is based on the following:
1) the studies by Krebs and Johansen are analysis based on the “National Survey on Drug Use and Health (...), randomly selected to be representative of the adult population in the United States”.
2) ACX readers population is not representative of the US population, in fact, it might be skewed in some dimensions that are very relevant here.
3) there are significant differences in the fraction of each sample that report psychedelic use
3.1) in the case of Krebs and Johansen (2013, 2015), it is ~13% reporting lifetime psychedelic use, while in the subsample of ACX readers survey considered in this report it is ~100%.
One important aspect here tying this together is that I would assume ACX readers do not have the same distribution of genes associated with intelligence as the general population, and there has been evidence that there is an overlap of those genes and the genes associated with bipolar disorder (https://www.med.uio.no/norment/english/research/news-and-events/news/2019/genetic-overlap-bipolar-disorder-intelligence.html). This genetic overlap can explain a higher susceptibility of psychotic-like experiences with higher intelligence, even if there is no particular diagnose. Furthermore, by considering the multiple types of psychotic disorder, https://pubmed.ncbi.nlm.nih.gov/17199051/ has found the prevalence in the general population to be ~3%, which does not fall too far from the 4.5% that responded a firm “yes” to the survey.
>in the case of Krebs and Johansen (2013, 2015), it is ~13% reporting lifetime psychedelic use, while in the ACS readers survey it is ~100%.
Just to be clear to casual readers, this wasn’t the whole ACX Readers Survey, I just only looked at the subset that filled out my psychedelic survey and seemed to have actually done psychedelics (i.e. the conclusion “all ACX readers do psychedelics” would be very incorrect). I don’t know what fraction of ACX readers have done psychedelics.
To avoid such misunderstanding I edited the original comment with “subsample of ACX readers survey considered in this report (...)”
Thanks for doing this survey! From what I can tell, you collected user IDs, so don’t you have all the data from the ACX demographic survey, too? That would allow you to consider correlations between use of psychedelics and age, gender, religious views, mental health issues, drug addiction (!), etc.
I have those for the people that put them in, but didn’t use them. If someone else was keen to do specifical analyses and explained why they’d be interesting, I’d definitely consider asking Scott for permission to share the data or trying to do the analysis myself.
The self-reported nature of surveys like this make them… well, “almost entirely useless” might perhaps be a slight overstatement, but not much of one. (Commentary.)
What I should like to see is evaluation, by others (family, close friends, etc.), of the effects of psychedelics on their users. We know that the gulf between self-perception and third-party evaluation of the effects of meditation, “enlightenment”, etc., can be vast. That this should also be true for psychedelics, seems to me to be quite likely. So I take self-reports—and conclusions drawn from surveys such as this one—with a grain of salt, to say the least…
Hm, I disagree! I think I share some of your skepticism, in that the fact that a very large fraction of survey users with long-term personality changes report that those changes were positive doesn’t cause me to be confident that I’d believe they were positive, or that a smarter, wiser version of me and others would believe that they’re positive, or that the average member of society would believe they’re positive, etc.
However, “almost useless” seems too strong to me; for me at least, it was still a meaningful update to know that people believed there were long-term changes and that they said those changes were positive and not negative. I’d have been much more concerned if people said the changes were negative (I think false positives of good changes are ore common than false negatives on bad changes) and psychedelics would have seemed lower stakes if there’d been fewer reports of long-term changes.
Also I think a bunch of the other questions have fewer issues related to self-evaluation, since a bunch of the questions are either more objective (“how many times did you trip?”) or explicitly subjective (“did you experience the trip as a positive one?”).
But yeah, I agree that evaluation by others would be really valuable.
For those looking to learn more, erowid.org is an excellent starting point.
I’m not sure if people understand term “psychosis”. Many people, especially those with partial psychiatric knowledge, will mistake anxiety for psychosis. You should ask for specific symptoms.