Difficulties following naturalistic psychedelic use and associations with adverse childhood experiences.

Naturalistic psychedelic use can result in a range of difficulties that impair social, occupational, and other important areas of functioning. Yet, the prevalence, phenomenology, and etiology of these outcomes remain poorly understood. Recent qualitative research has shown that individuals with long-term difficulties after psychedelic use sometimes attribute their challenges to childhood trauma. Further studies are needed to investigate these relationships. In this cross-sectional mixed-methods study of U.S. adults with lifetime psychedelic use (n = 3168), we examined the prevalence, duration, and nature of psychedelic-related difficulties, as well as associations with adverse childhood experiences (ACEs). Of all participants (n = 3168), most (n = 2785, 87.9 %) reported no difficulties; 6.4 % (n = 203) reported post-acute difficulties that lasted for more than one day, and 1.3 % (n = 40) for more than one year. Among those who reported difficulties (n = 383), 47 % (n = 180) reported that their difficulties resolved in one day or less. The most frequently reported post-acute difficulties were general anxiety (33.9 %), negative changes in self-concept (25.9 %), and social disconnection (23.0 %). In covariate-adjusted regression models, 2 ACEs (aOR: 2.24, p = 0.007), 3 ACEs (aOR: 2.27, p = 0.006), and ≥4 ACEs (aOR: 2.84, p < 0.001) were associated with higher odds of psychedelic-related difficulties compared to 0 ACEs. ≥4 ACEs were also associated with higher odds of difficulties that lasted more than one day (aOR: 2.37, p = 0.015) and more than one week (aOR: 2.89, p = 0.042). There are a range of difficulties that can follow psychedelic use and childhood adversity may represent a risk factor for persistent adverse effects.