What is it about?
This article distinguishes between two epistemic perspectives in contemporary psychedelic research: the drug-centered view of psychedelics (DCP) and the drug-assisted view of psychedelics (DAP). Using ketamine trials as an example of DCP and MDMA-assisted psychotherapy as a case study of DAP, the authors examine how each perspective conceptualizes therapeutic mechanisms and how these assumptions are operationalized within randomized controlled trials.
Why is it important?
Although DCP and DAP differ in how they understand what drives therapeutic change, both are typically evaluated using evidence-based medicine (EBM) and randomized controlled trial methodology. The article shows that this shared methodological framework may be well suited to drug-centered interventions but poorly aligned with the relational, experiential, and value-laden processes central to psychedelic-assisted psychotherapy. Clarifying this tension is crucial for interpreting existing evidence and for designing future research that better matches its epistemic targets.
What do the authors argue?
The authors argue that applying EBM and manualized psychotherapy protocols to DAP creates a mismatch between epistemic commitments and methodological design. While DAP claims that therapeutic effects arise from interactions between drug-induced experience and psychotherapeutic engagement, current trials often treat psychotherapy as a fixed background condition rather than a manipulable causal variable. To address this limitation, the authors propose value-based practice as a complementary methodology that can make relational and normative dimensions of psychedelic psychotherapy empirically visible, without rejecting EBM outright.
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You can find the paper here.