In- Advances, ln neuropsychopharmacologv Proc. Symp. VII _C_!Z. !mtermat. N_ur_ Psyc_=p_ ..... _,,1o ............

i £d. by: O.V1nar, Z.Votava, P.B. Bredley.

_i _ Nortn-Holland Pub1., Amsterdam/London Avicanum, r._ _, Praoue_ 1971 ; p_--.361-_,x"o_.

for ANOVA!

!s. | LSD 2129 a

| LSD IN THE TREATMENT OF ALCOHOLICS

I_i _,mt differences Wird "erent prepara- A.A. KURLAND, C. SAVAGE, W. N. PAHNKE, S. GROF andeffects of the J.E. OLSSON

; may account Maryland State Psychiatric Researctz Center, Baitimore4

,.e rnemcament

ray have been INTRODUCTION

,x_ea,,y r,,ocarc,, ,_,-'¢ c_m_,,_a,__.___and Hoffer on I,SD in the treatment

ring the actual of alcoholism was based on their .idea that its psychotomimetic pro-orion. ' potties could produce a delirium tremens-like _tate. it was hc,pcd '-

nay have been that such a state might have a favorable effect on the patient's drink-

_,_, different _ ing in a similar way as has been known for naturally occuring D.T.'s.

Although their early hope was not substantiated, they found thatrough so that:eflected. i some of their patients who had pos'_tive experiences wkh LSD did we!! !

thereafter. In a paper read to the New York Academy of Science

aitable in that in 1956, entitled, "A Review of the Clinical Effects of Psychotomi-

tp l.hetapy and _ metic Agents", OSMOND (1957) proposed the hypothesis that a sh_ojle !

pic which had _ overwhelming transcendental experience with psychedelic drugs iions, and only _ might be beneficial to alcoholics Within a relatively short time, _":ussion. !

Osmond's suggestion led to clinical studies seekivg to verify this hy-

the emotional ; pothesis.*) Uncontrolled studies carried out by SMI3H (1958) a_d

CHWELOS (1959) yielded favorable impressions which subsequent!y

led to controlled trials on alcoholic p_tients._pecifi¢, effects In these studies, different treatment techniques were employed.

SMART et al. (1967), _OHNSON (1969), and HOLLISTER et al. (1969)

utilized a treatment method that is perhaps best described as psyched-!on AG., Basel,elie chemotherapy, in which the major emphasis was on the adminis-tration of the drug itself. The amount of psychotherapy in the pre-

paration for the session and in the post-treatment per'_ed was minimal.

* The single overwheln'6ng experience has sometimes been referred toas "transcendental" by I-IoF_zR (1967) and SAVAG_(1960), "psychedelic"by KIIRLANDet al. (1967), and "psychedelic peak experience" by PAttNK_.et al. (1970).

361

I

362 A.A. KURLAND ET AL.

In a modification of this approach, LUDWIG et al. (1969) added view andtheprethypnotic induction during the very limited preparation for the session structured in ordand in the session itself. These studies have yielded essentially similar of the therapistfindings, namely, that the results of LSD therapy in this treatment the experience ocontext were not significantly different from those obtained in the The basic cha:

control groups, described by PalIn the present study, psychedelic-peak therapy has been used; 1. Sense of m

a treatment technique distinctly different from those described above, usual senseOne of its basic characteristics and immediate goals in the drug session 2. Transcendtitself is the achievement of a peak or transcendental experience, but 3. Deeply feltjust as important is the intensive psychotherapy which occurs in 4. Sense of a

! the weeks prior to the psychedelic drug session and the follow-up 5. Meaningfui therapy in the weeks after to help with the work of integration. ' 6. Ineffability_, The method of facilitating this experience has been described in by verbal

detail elsewhere (see SCHLIENet al., !968; KURLANDet al., 1967 and

i PAHNKEet al., 1970). The preparation for the drug session involves i METHODOLOGYan average of about twenty hours of intensive psychotherapy. During _ In this doub!qthis period, the therapist aims at establishing close rapport with the mitted to the A

i patient and gaining intimate knowledge of the patient's developmental Hospital, were[ history, dynamics, defenses, and difficulties. In specific preparation group (450 mcgl

for the session itself, the patient is acquainted with the basic effects one basis (90 hJof the drug and encouraged to trust the therapist, himself; and the alike dining thsituation. This is a very important part of the preparation that which group tbenables the patient to utilize the session in the optimal way -- to Analysis shovlet go voluntarily of his usual ego controls and so be completely therapy (exclusiopen to whatever experiences he encounters, averaged 20.0 Ii

The experimental drug sessions themselves are carried out in last therapy apF7.3 weeks in tre

a special treatment suite, furnished hke a comfortable living room,

with sofa, easy chairs, rugs, drapes, pictures, flowers, and high- Despite ran&fidelity music equipment. The patient's therapist and a psychiatric ficantly differernurse are in constant attendance throughout the period of drug action : group, 47.7%(10_12 hours). For most of the session, the patient reclines on the separated or dsofa with eyeshades and stcrcoplionic earphones, alternately listening married, 4% si:to carefully selected classical music or interacting with the therapist, group also has

The experiences that tile patients have under these circumstances missions _ !8 °

cover a wide range from aesthetic visions and sensations, through percent of the I;reliving of traumatic life experiences with a powerful abreaction and pared to 36 %

achieved matchcatharsis to psychedelic peak reactions. The psychedelic peak ex-perience has been found most useful from a therapeutic point of antly, on the

LSD IN ALCOHOLICS 363 i

(1969) added view and the preparation, as well as the set and setting, is specificallyxfor the session structured in order to iacdRatc Its occurrence. One of the major goals

;entially similar of the therapist during the session is to help the patient to stabilizethis treatment the experience on this level.

_btained in the The basic characteristics of the psychedelic experience have been idescribed by Pahnke: !

xas been used; 1. Sense of unity or oneness: (positive ego transcendence, loss of [escribed above, usual sense of self without loss of consciousness). !

:he drug session 2. Transcendence of thne and space, i|3. Deeply felt positive mood (joy, peace, and love). ]experience, but

,hich occurs in 4. Sense of awesomeness, reverence and wonder. !

1 the follow-up 5. Meaningfulness of psychological and/or philosophical insight. ]of integration. 6. Ineffability (sense of difficulty in comrmmicating the experience

described in by verbal description). ]:n

et al._ 1967 and t_ession involves METHODOLOGY OF THE PRESENT STUDY |

:herapy. During In this double-blind controlled study, 135 alcoholic patients ad-apport with the mitted to the Alcoholic Rehabilitation Unit of Spring Grove State 1

s developmental Hospital, were randomly assigned either to a high-dose treatment |1:ific preparation group (450 meg) or a low-dose control group (50 meg), on a two-to- [Lhe basic effects one basis (90 high dose vs. 45 low dose). All patients were treated !dmself, and the alike during the preparation since the therapist did not know to,reparation that which group the patient belonged. !imal way -- to Analysis showed that the high-dose group averaged 21.6 hours of

, be completely therapy (exclusive of the LSD session itself), while the low-doseaveraged 20.0 hours. The length of time in treatment from first to

carried out in last therapy appointment was similar; the high-dose group averaged

_le hying room, 7.3 weeks in treatment and the low-dose group averaged 6.7 weeks•vers, and high- Despite randomization, the high- and low-dose groups were signi-ad a psychiatric fieantly different on several important variables. In the high-dosed ofdrugaction group, 47.7% were married, 20% single or widowed, and 33%rechnes on the separated or divorced, while in the low-dose group, 36% were

rnately listening married, 4% single, and 60% divorced or separated. The low-dose ith the therapist, group also has a large percentage of patients with five or more ad- l;e circumstances missions- 18% as opposed to 3% of the high-dose group. Fifty-two l

_ations,through percent of the high-dosegroup had completed high school as com- t1abreaction and pared to 36% of the low-dose group. Randomization, however, i_edelic peak ex- achieved matching on IQ, age, occupational status, and most import-

tpeutic point of antly, on the pre-treatment rating of abstinence. ItI

i t

!!

364 A. A. KURLAND ET AL. i

RESULTS ! treatment, the high-A comprehensive psychological test battery including performance provement over the

and inte_gence tests, projective techniques, and personality inven- week of the LSD s.tories was administered just prior to acceptance into the program the pre- and post-/_and one week after the LSD session. A more limited battery of tests dose groups respec_was given at the six, twelve, and eighteen month follow-up points, treatment profiles ot

While the great majority of these psychological test results indicated ment, particularlysignificant improvement in both treatment groups from pre- to post- scales, but the high-

' of improvement owOther personaliq

" - _ " t Eysenck Personalit_8O A 4 - 80

,, I,, -7, ./-,,,. 75 sures of intelligenc,

,, , 11 y_,.." /_, _:: '* - : -, " . 1 the Benton Visual 1t"-''* _ RavenProgressive

a,*, _'- /_ _ _---" _ _' • ficantimprovement

I ,, '_ but again no signif40 40_ i• , , ,, ,, ,,, ,,, , o, , 4.- 01 _ low-dosetreatment

L F Ir Hs DHyPdMfPa PIScMaSI .A R 0 I _ [ 1 I

MI_P'ISo.ales L F K Its O HI Pd1'4tPO PI ._=_ _ A _ showed decrementIdMPI $¢a1_

_" MALt damage pre- to pc---_ Pre

I_st

,** Theresultsfor!

Fig. 1. Composite pre- and post-treatment MMPI profiles for 38 low- Rotter Sentence (

dosepatients. _ whichcanbeconsi

Fig. 2. Composite pre- and post-treatment MMPI profiles for 81 high- _, no significant diff_dose patients. However, both- hi_

l reductioninmala'*- '* -7:- Completion Test.

, ._ __. Final analyses (j 75- t-" ' months follow-up

?0 .......... _l 7_

i ,,- ,_-I° , consistent with th_

-_ _- "_o period in that th_$5 - _'_

• . and low treatmem,,-- ,, , Follow-up inter',,- _-,o i th si tb• , , ,., ,, , , , , , , , , i at e x-mon ,

, ..o_..._.._s._ _ • for atotalof!2! (

psychedelicpsych.... taw Dose

._ o.,. for the patients to

Fig. 3. Composite post-treatment adjusted MMPI profiles for high- mad experimental andlow-dosepatients, onetreatmentwil

...... t,,,._ Z2": _:_",'__

I

I

iLSD IN ALCOHOLICS 365 !

treatment, the high-dose group showed no significantly greater ira- ing pertbrmance provementover the low-dosegroup on any test variableswithin one !rsonality inven- week of the LSD session. As an illustration, figures 1 and 2 show

to the program the pre- and post-MMPI compositeprofilesfor the low- and high- +battery of tests dose groups respectively, while figure 3 compares the adjusted post- i

)w-up points, treatment profilesof both groups. Both groupsshowmuch improve- I

:esults indicated ment, particularly in the Depression (D) and Psychasthenia (Pt)I

_mpre- to post- scales, but the high-dose group shows no clear superiority in degree !

of improvement over the low-dose group.Other personality inventories, such as the Personal Orientation

iV- _ Inventory (POI), the Psychiatric Evaluation Profile (PEP), and the_1_+ Eysenck Personality Inventory (EPI) showed similar findings. Mea-

.._ sures of intelligence and perceptual-motor performance (inciuding

_- " " k,_i \_ i the Benton Visual Retention Test, Wechsler Adult Intelligence Scale,:_/_ ,}-"!__ i Raven Progressive Matrices and Imbedded Figures) showed signi-...... |. _x_, ficant improvement on some variables within both treatment groups,

t-,s[ [-[ but again no significant differences were found between high- and_-'__ low-dose treatment groups. It is important to note that no patientsi i i i

_,P,_ k M._ A _ showed decrement in performance on IQ or evidence of organicdamage pre- to post-treatment.

The results for three other tests, Holtzman Inkblot Test (HIT),files for 38 low- Rotter Sentence Completion Test and Human Figure Drawings,

which can be considered primarily projective in nature also showediles for 81 high- no significant differences between the high- and low-dose groups.

However, both- high and low-dose groups showed a large, significantreduction in maladiustment as measured by the Rotter SentenceCompletion Test.

Final analyses of psychological test results at six and twelve-months follow-up and preliminary statistics at eighteen months areconsistent with the above findings from the immediate post-sessionperiod in that there were no significant differences between highand low treatment groups.

Follow-up interviews and ratings of adjustment are now completedat the six-month, twelve-month, and eighteen-month checkpointsfor a total of 121 of the 135 alcoholic patients who were treated withpsychedelic psychotherapy. While the study design made it possiblefor the patients to have up to three sessions, the vast majority in both

es for high- and experimental and control groups (total of 117 patients) received onlyone treatment with LSD. The 18 patients who had more than one

. _r_ -+¸............................. __ ...... ........ "..............................:7:

366 A.A. KURLAND ET AL.

LSD session were not found to be different from the other 117 in .3 I,_psychological and social measures based on pre-treatment testing, _

i but as a group they received more average hours of treatment. There- _ _fore, in the interests of uniformity concerning amount of treatment, _ _ !_results were analyzed separately for the 117 patients who had only .9 °_i_oneLSDsession(eithera highor a lowdose). _ =i

The percentageof patients found and interviewedat the six-month "i _ ifollow-up point was 89 % (104 out of 117 treated cases). Although _o _q i-the percentages dropped somewhat at the twelve and eighteen-month mla0

follow-up points to 80 % and 78 % respectively, this is considered =

a very good follow-up rate, realizing that many alcoholics are difficult I _ !to keeptrackofin thecommunity. _ ---;

The follow-up ratings of adjustment were made by an independent t _ "_team of social workers. Ratings were made on each patient on a t _=predetermined 0 to 10 behavior rating scale. The Global Adjustment _ _ ". _rating included occupational, interpersonal, and residential factors i _ _

as well as the patient's use of alcohol,with a score of zero indicating I _ _poorest adjustment and ten indicating superior adjustment. Zero i "_ _ _>

,-_o o _i_on the scale measuring Drinking Behavior indicated daily almhol _ _ _consumption, and ten indicated total abstinence. Mean ratings of

Global Adjustment and Drinking Behavior for the high and low-dose _groups at the pre-treatment and six, twelve, and eighteen-month _ ,

follow-uppointsare shownin Table1. _ _ _

As shown, the high-dose group shows consistently higher mean _ _ratings than the low-dose group at all follow-up periods. However, _ _mean change scores (post-minus pre-means) do not show as large o__ _differences between the two treatment groups. In fact, when the data _

were submitted to analysis of covariance which takes pre-level into _consideration, 6 months after LSD was the only time that DrinkingBehavior and Global Adjustment showed a significantdifferencebe- _ _3 '

tweenthe high and low-dosegroups (p<.025 and .05respectively_ _one-tailed test). The magnitude of difference in Drinking Behavior o !

mean scores between the groups at 6 months is 1.4 and the difference _ iin Global Adjustment is .50. At 12 and 18-months, this staticaladvantage of the high-dose group has disappeared and there is vir- _dtually no differencebetweenthe two groups in mean change scores. _

Apparently the significant,but small advantage of the high-dose "_treatmentholdsforonlysixmonths.

•The percentage of patients functioning in an "essentially rehabili-

LSD IN ALCOHOLICS:he other 117 in 367eatment testing,

reatment. There- _ _. _ _6unt of treatment, _ +_ _ __ts who had only ._ +

_latthesix-month g __ _ _ _ _ _ _cases). Although "_ q II _ _ _ e,iad eighteen-month _ _ _ _ + _'/_ ,5+

, this is considered _ _ _ _ _ _ ._ ______:oholics are difficult _ _ I_o o _o

i+

: by an independent _: each patient on a _ r__: Global Adjustment _ _ _ _ _d residential factors _ o_ + , "

_re of zero indicating _ / _ ° _

or adjustment. Zero ._,dicated daily alcohol _, ,._ .oo 2 _ _ _e_" _ _ace. Mean ratings of i _ _ .-. + _ _the high and low-dose _ 8 _"

, and eighteen-month _ _ Z _ _; _5+e4 e_6__ _

asistently higher mean _ _ +0

'-up periods. However, _ _ _ _) do not show as large i _ _ _ ¢5 _ _._.In fact, when the data ! _ + _ "_¢_rich takes pre-level into ! ._ _ + _'

only time that Drinking i _ _ _ _ _ ,_ _ ._significant difference be- I _ _ Z_ _ _ .4 _ _ __5and .05 respectively _ i _ _ + _i _ _

o _ ta0_ce in Drinking Behavior i _ _ _ _. _ _ _ __sis 1.4 and the difference _ _ _ ,_ ,_ _ _ _ _ _ _;18-months, this statistical _ _ + e__ _ _ ._

_ppeared and there is vir- _ + o_ps in mean change scores. _ "_

lvantage of the high-dose "_ _ _ o_ _ _ _,

in an "essentially rehabili- _ _ _ _ " o _

368 A.A. KURLAND ET AL.

tated" fashion is shown for the various groups in Table 2. A score of

8 or more on the 0 to 10 scale was considered a rigorous criterion, _indicatingfor Global Adjustment that a patient was making "good _attainment or adjustment" with regard to drinking, occupation, inter- _d

personal relations, etc. A score of 8 on the Drinking Behaviorscale _indicated some, but only minimal, departure from total abstinence. "3

Statistical analysis revealed that there were significant differencesbetween the high- and low-dose groups in percentage of patients _ mreaching this criterion, both in Global Adjustment and in Drinking _ _

Behavior, but again, only at the 6-month follow-up. _ _ "In regard to the most important target symptom, Drinking Be- _0_,=D

havior, Table 2 reveals that at six months after LSD, 53% of the i "_ _ !high-dose group are greatly improved as opposed to 33 % of the i "_ _ _ ilow-dose group. By chi square this is significant at the .05 level i _ _ _ i(one-tailed test). This significant advantage does not obtain at 12 and _,18 months after LSD. At 12 months, 47% of the high-dose patients _ o= ..

are greatly improved as opposed to 48% of the low-dose patients, _ _ _ iand at 18months, 54% of the high-dosepatients are so rated as op- _ ,_ r_posed to 47% of the low-dose patients. The change in percentage ¢_ _' _ ._'_ii

of patients "greatly improved" in the high and low-dose groups _ _-

from the six-month follow,up point to the 12 and 18-months points _ _ _ i ' Itis in part due to the decreasein the number of patients found at '* _ _ _ !these latter points. However, other calculations carried out taking _-d

the unfound casesinto consideration alsoindicated that the advantage _ _ "_ [

of the high-dose group occurs only at the six-month follow-up _ _ ._ [" ]point. _ o

In speaking to questions which might be raised concerning the ._ _ _ I.......iharmful effects of LSD administration, only one adverse reaction _ _ _ _, i

has been observedin our entireseriesof wellover 200alcoholics : ._ _treated with eitherhigh or lowdoseto date (June 1970).Further- _ _,

i more, even in this one case,the reactionwas reversedby conven- : ._,

tional therapy, These observations would tend to indicate that the

risk of therapy is not substantially increased by the addition of a

highdose. _ .!

DISCUSSION _The main findingof a differenceat six months follow-upof 53% _ _,

of the high-dose group essentiallyrehabilitatedin regard to drinking _behavioras opposedto 33% in the low-dosegroup is on the face :_

LSD IN ALCOHOLICS 369

_ble 2. A score of _" ,"

igorous criterion, _ _ _ _as making "good i_ _ _ "-" _ _ Zaccupation, inter- o _ __14 t_

ag Behavior scale _ _ _total abstinence.

ificant differences o tn

ntagc of patients _ _ _ _ _t and in Drinking _: _ _ _ _ _ o Z

om, Drinking Be- _

I.SD, 53',';,,of the -_ _ _"d to 33 % of the _ _ _ _ __t at the .05 level ,_ _ _ _o _ _ oq ¢_otobtainat12and " ¢_

high-dose patients _ _ _

low-dose patients, O _ _aresoratedasop- __ _ _ _ _rage in percentage _ _ ._ _ _ Zt low-dose groups _ _ b_ _ __

t 18-months points _ -_f patients found at '* ¢ _" ---

carried out taking _ _ _- _ _"_that the advantage _ _ _ _ _ "_ _ Zx-month follow-up _ ._ _ _,

_o0

.sed concerning the _ ._he. adverse reaction "_ '_ _ _"

over 200 alcoholics ._ ,_ b_ _ _ o,ane 1970). Further- _ _o _ _ _ oi c_

eversed by conven- -'°to indicate that the .__y the addition of a _ !_

hs follow-up of 53% _ _ _ °_ _o°_. _=-BU _6in regard to drinking _ _ _ _ ,_ _ o =group is on the face _ _ • _ _ t_

f

!,

f

370 A.A. KURLAND ET AL.

of it quite substantial. However, the significance of this difference is that may yield additicat the .05 level, and from a more rigorous point of view, we would the duration of the thhave to say that a higher level of confidence would be more convincing, be tried, including t]Also, we must face the fact that randomization failed to match the many different dosag

two groups on such variables as marital status and previous admis-sious, although they were matched on IQ, age, occupational status ACKNOWLEDGEMENTSand pre-treatment abstinence. This failure of randomization may have These investigatioconferred some advantage to the high-dose group. There is also the Public Health Servkpossibility that a therapist may have been more effective with the FR-05546, administehigh-dose group though the high improvement rate of the low-dose Baltimore, Marylandgroup suggests that this is not true. It is also possible that the Grateful acknowlepeople in the high-dose group were able to take more advantage of Unger, Ph. D., Leevocational rehabilitation, etc. _ Richards, S.T.M., ar

On the other hand, the fact that the low-dose group did as well i study.as it did probably reflects the intensive preparation therapy and LSD !session which they received. Many of our 50 mcg sessions involved iconsiderable abreaction and catharsis of psychodynamically charged 1material. The dramatic changes observed in some of our high-dose t ABR_ISON,H. A., ed.Macy, Jr. P1

sessions suggests that for some patients the high-dose procedure is _ _, ed., 1967. T]probably most beneficial, but for a considerable number of other _ Bobbs-Merri]patients the low-dose treatment was also quite helpful. In retrospect, CnwrLos N., D. BL_Studies on A

a control group receiving no LSD would have been helpful in differen- , COLBY,K. /vl., 1964.tiating the exact role of psychotherapy as opposed to LSD session. Hxcxs, R. E. and P. VIn actual practice, however, these two factors it must be pointed New York.out are ciosely interwoven and work together as a unified treatment HOFFER, A., 1960. Inapproach. _, 1967.InAb_HOLLISTER,L. E., J.

In the context employed, the psychedelic psychotherapy was suc- 125, 58.cessful in helping over half of the alcoholics treated in this program JOHNSON,G., 1969. B.as opposed to a 12 _,_,improvement rate at 18 months follow-up for KURLAND,A. A., S. I.

comparable alcoholics in this treatment facility at Spring Grove State 1. Psychiat.Hospital. This 12°,/ofactor is from a prior study and does not repre- LEUNER,H., 1967. In

' LUDWIG, A., J. LEVlNsent a concommitant comparison control group. It would also appear 126, 59.that there may be a correlation between the psychotherapist's sldll OsMorm, H., 1957. Atand its contribution to the meaningfulness of the drug experience i PAHNKE, W. N. andsession. However, this is an issue requiring further investigation. _ 5, 175.

Finally, it is our impression that the overall clinical achievements of '_ --, A. A. Ku_,Amer. Med.only one psychedelic peak experience and its maintenance for a period S_LZMaN,C., 1969. (of several months in these types of patients is an observation that In Hicks, 1ocannot be discomlted. This will require further study of those factors SAVAGE, C., 1960. In

i

!LSD IN ALCOHOLICS 371 !

fis differenceis that mayyield additionalenhancementsthat can intensifyand extend

,Jew, we would the duration of the therapeutic effect. A variety of approaches shouldore convincing, be tried, including the use of LSD as an aid to psychotherapy atd to match the many different dosage levels. t,revious admis- '_

Lpationalstatus ACKNOWLEDGEMENTS 1]

:ation may have These investigations were supported in part by United States ]here is also the Public Health Service research grants MH-13747, MH-15555 and !ective with the FR-05546, administered by Friends of Psychiatric Research, Inc., l_f the low-dose Baltimore, Maryland. [ssible that the Grateful acknowledgement is made te the effe_s of Sanford I

|

:e advantage of Unger, Ph.D., Lee McCabe, Ph.D., Sidney Wolf, Ph.D., William [Richards, S.T.M., and Harry Shock, LL.B who collaborated in this i

mp did as well study, l_.rapy and LSD

i

_sions involved REFERENCES

aically charged ABV,AMSON, H. A., ed. 1960. The Use of LSD in Psychotherapy. Josiahour high-dose Macy, Jr. Publication, New York.

e procedure is --, ed., 1967. The Use of LSD in Psychotherapy and Alcoholism.mber of other Bobbs-Merrill Co., New York.

• In retrospect, CnWELOS N., D. BLEWETT, C. SMITH and A. HOFFER, 1959. Quart. J. !_ful in differen- Studies on Alcohol. 20, 577.

COLBY, K. M., 1964. Annual Review of Psychology 15, 347. tLSD session. HICKS, R. E. and P. V. FINK, 1969. Psychedelic Drugs. Grune & Stratton,ast be pointed New York. _"Jfied treatment HOFFER, A., 1960. In Abramson, loc. cit.

--, 1967. In Abramson, loc. cit.

HOLLISTER, L. E., J. SHELTON and G. KRIEGER, 1969. Amer. J. Psychiat.erapy was suc- 125, 58.

n this program JOHNSON, G., 1969. Amer. J. Psychiat. 126, 481._:follow-up for KURLAND, A. A., S. UNGER, J. W. SHAFFER and C. SAVAGE, 1967. Amer.ag Grove State J. Psychiat. 123, 1202. :

ioes not repre- LEUNER, H., 1967. In Abramson, loc. cir.LUDWIG, A., J. LEVlNE, L. SPARK and R. LAZAR, 1969. Amer. J. Psychiat.

uld also appear 126, 59.:herapist's skill OSiOl, m, H., 1957. Annals N. Y. Acad. Sci. 66, 418.

rug experience PArtaKE, W. N. and W. A. RICHARDS, 1966. J. of Religion & Health,,estigation. 5, 175.chievements of --, A. A. KURLAND, S. UNGER, C. SAVAGE and S. GROF, 1970. J.

Amer. Med. Assoc. 212, 1856.

Ice for a period S_ZMAN, C., 1969. Controlled therapy research with psychedelic drugs.)servation that In Hicks, loc. cit.)f those factors SAVAGE, C., 1960. In Abramson, loc. cit.

!

t

i 1 t,l

372 A.A. KURLAND ET AL.

SCHLIEN,J. M., H. F. HUNT, J. P. MATARAZZOand C. SAVAGE(eds.) 1968.Research in Psychotherapy. American Psychological Association,

Washington,D. C.SMART,R. G., T. STROM,L. SOLURSHand E. F. W. BAKER,1967. Lysergic

Acid Diethylamide (LSD) in the Treatment of Alcoholism. To-ronto, University of Toronto Press.

SMITH,C. B., 1958. Quarterly J. of Studies on Alcohol 19, 406.

A. A. K., Maryland State Psychiatric Research Center,Box 2235, Baltimore, Maryland U.S.A.

SPECIAL QUESqSUBJ

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