Can Psychedelic Therapy Cure Smoking Addiction?
Written summary of my discussion with psychiatry professor Dr. Matt Johnson on his study testing psilocybin therapy for smoking addiction.
In this new episode, I ask Johns Hopkins psychiatry professor Dr. Matt Johnson about his new study examining psilocybin for smoking addiction — and the results are remarkable.
(Link to study published in JAMA)
The study compared one psilocybin session against a standard course of nicotine patch, with both groups also receiving the same cognitive behavioral therapy protocol for quitting smoking. At the six-month mark, 52% of people in the psilocybin group were no longer smoking, compared to 25% in the nicotine patch group. And this wasn’t just based on people saying they quit — the outcomes were biologically confirmed.
What makes this especially fascinating is that psilocybin doesn’t work like a nicotine replacement. It’s not acting directly on nicotine receptors. Instead, Matt explains that it appears to work on the psychology of addiction itself: the habits, emotional patterns, identity structures, and deeply ingrained loops that keep people stuck.
Some participants had direct insights into their smoking. Others barely thought about cigarettes during the session. Instead, they had vast, mind-expanding experiences about childhood, relationships, suffering, mortality, the nature of reality, or what it means to be human — and somehow, when they came back, smoking felt smaller.
Matt describes this as a powerful perspective-shifting effect. People zoom out from the narrow tunnel of craving and see their addiction from a radically different vantage point. One participant realized he could quit smoking as easily as “flicking away a bug” — a stunning moment of agency where he saw that he could actually change something about himself.
We also get into why addiction is rarely just about the substance. Smoking can become a way to regulate emotions, cope with stress, bond socially, manage trauma, or feel a sense of control. As Matt puts it, substances often “work” in the short term — they give people a predictable way to alter their state. The problem is that over time, this can crowd out healthier ways of dealing with pain, stress, and emotional dysregulation.
That’s where psilocybin may be uniquely powerful. It can temporarily loosen rigid patterns, open people to new insights, and help them relate to themselves and their addiction differently. Combined with therapy, that altered state may help people move from “I’m a smoker who can’t quit” to “I’m a non-smoker who has agency.”
Matt is careful not to oversell it. Nicotine replacement, CBT, and other addiction treatments already help many people. Psilocybin is not a magic cure, and some people in the study did not quit. But the findings are deeply promising — especially because this was only one psilocybin session.
This is a fascinating conversation about addiction, agency, identity change, mystical experience, and why psychedelics may become one of the most important frontiers in addiction treatment.
Watch the full episode here:
Time-stamps:
0:00 - Intro
2:30 - Marty Makary Resigning & Flavored Vapes
10:40 - Vaping Greatest Risks
14:15 - UK’s Controversial Tobacco and Vapes Bill
19:20 - Matt’s Psilocybin vs Nicotine Patches for Stopping Smoking
43:14 How do Psilocybin act on smokers?
58:15 What else gave people stronger outcomes?
1:00:39 The Roll of CBT
1:05:07 Psilocybin safety profile
1:09:55 - Psilocybin for treating Cocaine Use Disorder
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