TL;DR

•A 2026 randomized clinical trial found that psilocybin with psychotherapy was linked to more cocaine-abstinent days than an active placebo with psychotherapy.

•The trial included 40 adults with cocaine use disorder and used a single oral psilocybin dose plus manualized psychotherapy.

•Participants who received psilocybin were more likely to achieve complete abstinence and had a lower risk of cocaine lapse.

•The study is promising, but it was small and should not be read as proof that psilocybin is a stand-alone cure for addiction.

•People struggling with cocaine use should seek qualified treatment support rather than trying to self-medicate with psychedelics. 

Can psilocybin help treat cocaine use disorder?

A 2026 randomized clinical trial found that psilocybin combined with psychotherapy may help some people with cocaine use disorder reduce or stop cocaine use. Participants who received psilocybin had a higher percentage of cocaine-abstinent days, a greater likelihood of complete abstinence, and a lower risk of cocaine lapse than those who received an active placebo (1).

That is encouraging because cocaine use disorder is difficult to treat. Many people cycle through periods of stopping, craving, returning to use, shame, and renewed attempts to quit. A treatment that can help interrupt that cycle would matter.

But the key phrase is psilocybin combined with psychotherapy. The trial did not test taking mushrooms alone. It tested a structured treatment model that included psychological support. 

What did the JAMA Network Open trial actually study?

The trial included 40 adults with cocaine use disorder. Participants were randomly assigned to receive either psilocybin at 25 mg per 70 kg of body weight or an active placebo, diphenhydramine 100 mg. Both groups also received manualized psychotherapy that included cognitive behavioral therapy elements (1).

This was a quadruple-blind, placebo-controlled trial, which means the researchers designed it to reduce bias as much as possible. The active placebo was used because participants can often tell whether they received a psychedelic, and that can influence expectations.

The study found no serious adverse events. A university summary of the trial reported that transient high blood pressure was the most common adverse effect in the psilocybin group (2). 

Why might psilocybin therapy affect addiction?

Psilocybin therapy may affect addiction by increasing psychological flexibility, interrupting rigid patterns, helping people face painful emotions, and strengthening motivation for change. These are possible explanations, not proven mechanisms.

Addiction is not just a habit. It often involves stress, trauma, depression, loneliness, impulsivity, cue reactivity, and learned ways of coping with pain. A powerful therapeutic experience may help some people see old patterns differently or reconnect with reasons to live differently.

Serenity has written about related questions in The Ripple Effect: How Psychedelic Therapy Can Transform Your Health and Habits. The idea is not that insight automatically changes behavior. It is that insight, when paired with support and practice, may open a window for new habits. 

How strong is the evidence for psilocybin in substance use disorders?

The evidence is promising but still early. A 2025 systematic review found that psilocybin may help some substance use disorders, but overall efficacy and safety remain uncertain. The review identified 16 published studies and 26 ongoing trials, with the strongest preliminary evidence in alcohol and tobacco use disorders (3).

That matters for cocaine use disorder because one positive trial does not settle the question. Researchers still need larger studies, more diverse samples, longer follow-up, and clearer comparisons between psilocybin, psychotherapy, expectancy effects, and other treatment approaches.

The UAB summary of the cocaine trial also named important limitations. The study was small, the lead author served as the primary therapist, and it remains difficult to fully separate the effects of psilocybin from the effects of psychotherapy and therapeutic relationship (2). 

Why is therapy part of the treatment model?

Therapy is part of the treatment model because stopping cocaine use is not only about removing a substance. It is about changing the emotional, relational, and behavioral patterns that keep the substance in place.

Cognitive behavioral therapy can help people identify triggers, plan for cravings, challenge thoughts that lead to use, and build alternative responses. Psychedelic-assisted therapy may add a different kind of experience, but the practical work still matters.

This is why preparation and integration are so important. Before a psychedelic session, a person may need to name intentions, safety needs, fears, and patterns of use. Afterward, they need to turn insights into specific actions. Serenity has discussed this in The Crucial Role of Preparation and Integration in Psilocybin Therapy. 

Should someone with cocaine use disorder try psilocybin on their own?

No. Someone with cocaine use disorder should not try to treat themselves with psilocybin on their own. Self-treatment can be risky, especially if a person has medical problems, psychiatric risk, polysubstance use, unstable housing, trauma, or severe cravings.

A psychedelic experience can bring up shame, grief, fear, or memories that feel overwhelming. Cocaine use can also be connected with heart and blood pressure risks, and psilocybin can affect blood pressure and perception. These issues require professional screening and support.

If you are actively struggling with cocaine use, the safest step is to speak with a qualified addiction treatment provider, physician, or mental health professional. If a psychedelic experience has already happened and stirred up motivation, fear, or relapse concerns, psychedelic integration may help you process the experience while also staying realistic about treatment needs. 

What should people in Texas take away from this study?

People in Texas should take away cautious hope. Psilocybin-assisted psychotherapy for cocaine use disorder has early evidence from a small randomized trial, but it is not a widely approved treatment and should not replace established addiction care.

If you or someone you love is caught in a cocaine cycle, you may feel desperate for something different. That desperation is understandable. It can also make online claims sound more certain than the science really is.

Jeff Jones, LPC, offers psychedelic integration and therapy for adults in Texas who want grounded support around substance use, trauma, anxiety, and major life change. If you want to discuss what this research means, or process a psychedelic experience connected to recovery, schedule a free consultation with Jeff Jones, LPC

About the Author

This article was written by Jeff Jones, a Licensed Professional Counselor (LPC) in Texas in practice since 1999. He is a 2024 graduate of the CIIS Center for Psychedelic Therapies and Research program. With a compassionate and evidence-based approach, he helps clients navigate life's challenges and find a path toward healing.

Disclaimer

The information in this article, including discussions of psychedelic-assisted psychotherapy, is for informational purposes only. Psychedelic-assisted psychotherapy has not been approved by all regulatory agencies in the United States, and its safety and efficacy are still being established. This content is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

References

1.Hendricks, P. S., Lappan, S. N., Shelton, R. C., et al. (2026). Psilocybin in the treatment of cocaine use disorder: A randomized clinical trial. JAMA Network Open, 9(5), e2611029. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2848757

2.University of Alabama at Birmingham. (2026 ). Psilocybin proves promising treatment for cocaine use disorder, according to UAB study. https://www.uab.edu/news/research-innovation/psilocybin-proves-promising-treatment-for-cocaine-use-disorder-according-to-uab-study

3.Meshkat, S., Malik, G., Zeifman, R. J., Swainson, J., Balachandra, K., Reichelt, A. C., Zhang, Y., Burback, L., Winkler, O., Greenshaw, A., Vermetten, E., Mayo, L. M., Tanguay, R., Jetly, R., & Bhat, V. (2025 ). Efficacy and safety of psilocybin for the treatment of substance use disorders: A systematic review. Neuroscience & Biobehavioral Reviews. https://www.sciencedirect.com/science/article/pii/S0149763425001630