Title : Beyond relapse prevention: Neuroplasticity and psychedelic-assisted therapies in addiction medicine

Addiction is increasingly understood not simply as a disorder of reward or willpower, but as a condition of maladaptive neuroplasticity in which chronic stress, trauma, and repetitive reinforcement shape rigid patterns of behavior, cognition, and emotional response. Despite advances in pharmacologic and behavioral treatment approaches, relapse rates remain high across substance use disorders, highlighting the need for therapies capable of promoting deeper neurologic and behavioral change rather than symptom stabilization alone.

Recent research has renewed scientific interest in psychedelic-assisted therapies as neuroplasticity-enhancing interventions for addiction and mental health disorders. Compounds such as psilocybin appear to promote increased neural connectivity, enhanced cognitive flexibility, and disruption of maladaptive default mode network activity through 5-HT2A receptor agonism. These effects may create temporary therapeutic windows in which entrenched emotional and behavioral patterns become more modifiable within structured therapeutic environments.

Emerging clinical trials from institutions including Johns Hopkins University, NYU, and Imperial College London have demonstrated promising outcomes in alcohol use disorder, tobacco addiction, depression, and trauma-related conditions. In alcohol use disorder, psilocybin-assisted therapy has shown significant reductions in heavy drinking days and increased abstinence rates compared with conventional approaches. Similar findings in nicotine dependence suggest potential utility in interrupting compulsive reinforcement pathways associated with relapse vulnerability.

This presentation explores addiction through the lens of stress physiology, trauma, neuroplasticity, and behavioral flexibility. It examines the proposed mechanisms by which psychedelic-assisted therapies may facilitate emotional processing, adaptive learning, and sustained recovery when integrated within evidence-based therapeutic frameworks.

The session will also address safety considerations, ethical concerns, evolving regulatory models, and the critical role of preparation and integration in translating acute neuroplastic states into long-term behavioral change.

As addiction medicine evolves, neuroplasticity-oriented interventions may represent an important shift from maintenance-focused care toward therapies capable of addressing the underlying drivers of chronic relapse and psychological suffering.

Stephanie Leopold, CRNA, APRN, is a Certified Registered Nurse Anesthetist with more than 20 years of clinical experience in critical care, anesthesia, and perioperative medicine. She has held leadership roles including Chief CRNA and has served on professional nurse anesthesiology boards. She is the founder of KNEW Integrative Health, which focuses on integrative approaches to addiction and trauma recovery. A graduate of the Changa Institute’s legal psilocybin facilitator training program, she lectures internationally on addiction relapse prevention, neurobiology of trauma, and emerging therapeutic approaches including psychedelic-assisted therapy.