Abstract
Background Alcohol use disorder (AUD) remains a major global health concern, with high morbidity and mortality and limited long-term treatment success. Psychedelic therapy has re-emerged as a potential novel intervention for AUD, yet little is known about how affected individuals perceive such treatments. Methods This mixed-method study explored attitudes and perceptions of psychedelic therapy among individuals with AUD participating in two non-psychedelic clinical trials ( n = 102) and from addiction outpatient services ( n = 10). Quantitatively, 112 participants completed a four-item questionnaire assessing knowledge of psychedelic research, expectations of research promise, and willingness to participate in a psychedelic therapy trial, and, if willing, preferred setting (group therapy, individual therapy, or no preference). Binary logistic regression examined predictors of willingness to participate. Qualitatively, semi-structured interviews with 10 patients from addiction outpatient services were thematically analyzed to identify factors shaping attitudes toward psychedelic therapy. Results Quantitatively, 62.5% of participants were aware of psychedelic research and 64.3% were willing to participate in a psychedelic therapy trial. Willingness was significantly associated with higher expectations of research success (OR = 3.30, p < .001), but not with age or knowledge alone. Qualitatively, participants expressed a spectrum of attitudes with positive, neutral, and negative salience shaped by perceptions of therapeutic potential, fears of addiction or loss of control, personal and societal experiences with substance use, and media exposure. Expectation of benefit emerged as a central factor influencing openness to psychedelic therapy. Conclusions Patients with AUD already participating in clinical trials generally demonstrate awareness and conditional openness toward psychedelic therapy, primarily determined by their expectations of research promise. Limitations of this study include participation bias in the clinical trial sample as well as the lack of measurement of bias through prior psychedelic use. Nonetheless, thorough informed consent addressing expectations and misconceptions about risk and addiction potential remains crucial for ethically and effectively conducting future psychedelic clinical trials in AUD populations.