Direct answer first. If you are dealing with addiction, your own or someone else's, the treatments with real evidence behind them are mostly not the ones making headlines. There is no approved psychedelic treatment for any substance use disorder anywhere in the world. What exists is a two-part picture: an unglamorous, well-evidenced core of psychosocial treatment, substitution therapy and approved medicines that European health systems actually provide; and a research frontier of real interest (ketamine and psilocybin for alcohol use disorder above all), that is further along than most clinical fields but still years from a bookable treatment. This guide maps both parts, so you know what you can get now, what is worth watching, and what is being sold ahead of the evidence. It covers mainly alcohol and opioid dependence, where the treatment evidence is deepest; tobacco, cannabis, stimulant and other substance use disorders have their own established care that this page only touches, and the psychedelic studies appear in their research context.
One reassurance before the list. Relapse is part of the clinical picture of addiction, not proof that treatment failed or that you did: the reference guidelines this page leans on, including the UK's NICE guideline CG115 on alcohol dependence, treat returning to treatment after relapse as the expected course of a chronic condition. Nothing on this page is a recommendation of one option over another; which step fits you is a decision for you and a clinician who knows your history.
TL;DR The evidence-based core of addiction treatment in Europe: structured psychosocial therapy for every substance; opioid agonist treatment (methadone or buprenorphine) as the standard of care for opioid dependence; and, for alcohol dependence, approved medicines, naltrexone, acamprosate, nalmefene (EU-authorised) and disulfiram, alongside therapy. On the research frontier, ketamine-assisted therapy for alcohol use disorder is in a UK phase 3 trial (MORE-KARE, 280 participants, eight NHS Trusts) after a positive phase 2; psilocybin for alcohol use disorder has a strong US phase 2 result and several European trials, including a French phase 3. Ibogaine is the outlier: no approval anywhere and documented cardiac toxicity, with QTc prolongation in half of one monitored cohort. None of these approaches is an established routine addiction treatment; in Europe the supervised route is a clinical trial, and whether any other access route lawfully exists is a question of the applicable national framework, not a blanket yes or no.
Safety first, whatever else you read here
Four points outrank everything below. Stopping alcohol suddenly after significant dependence can be dangerous: assessment for medically supervised withdrawal comes before any plan. Anyone using opioids, in treatment or not, should have take-home naloxone (and people around them should know how to use it); it reverses an opioid overdose within minutes and is available through substitution services and drug services. Tolerance falls fast after detoxification or abstinence, which is why the weeks after a detox carry the highest overdose risk of all. And detoxification is not addiction treatment: it is the start of one, and support should not be conditional on complete abstinence.
What the options actually are
The fact box above compresses hard; here are both parts again, with the detail.
Psychosocial treatment: core for every substance, but not a gate in front of medication. Structured psychological and social treatment belongs in every addiction care plan: cognitive behavioural approaches, motivational interviewing, contingency management, community reinforcement, behavioural couples therapy, and structured mutual-aid facilitation (NICE CG115). What treatment leads with is substance-specific: for opioid dependence, medication IS the first-line treatment, with psychosocial support offered alongside it, and nobody should have to prove themselves in a counselling-only or abstinence-only programme first. This is also the part of the system most often under-delivered: a brief advice session is not a structured programme, and a detox without follow-on treatment is the setup for relapse, not a treatment. If a previous attempt "didn't work", the useful question is what was actually delivered and what surrounded it: housing, work, relationships, co-occurring depression or anxiety. Addiction treatment that ignores the rest of the picture rarely holds.
Opioid dependence: substitution treatment is the standard of care. For opioid dependence the evidence is unusually settled: opioid agonist treatment with methadone or buprenorphine (both on the WHO list of essential medicines) reduces mortality, illicit use, infection risk and crime, and retaining people in treatment beats short detox on every hard outcome (NICE TA114). It is available through public addiction-care systems across Europe, though access and waiting times vary by country. If you are told the goal must be immediate abstinence from everything, that advice is out of step with the evidence base; stabilisation first is the guideline position.
Alcohol dependence: real medicines most people are never offered. Alcohol has approved, guideline-backed medicines that are strikingly under-prescribed across Europe. After withdrawal (medically supervised where dependence is significant: stopping suddenly can be dangerous), the options differ by goal and by patient, and choosing between them is an individual clinical assessment, not a menu. Acamprosate supports abstinence after withdrawal. Naltrexone, an opioid-receptor blocker that blunts alcohol's reward, is unsuitable alongside opioid use and complicates pain management, which the prescriber checks first. Nalmefene (Selincro) has a deliberately narrow EU indication: reducing consumption in selected high-risk drinkers without physical withdrawal symptoms and without a need for immediate detoxification, together with psychosocial support (EMA EPAR): a different goal from the abstinence medicines. Disulfiram, the old deterrent, suits selected motivated patients with supervision. NICE recommends acamprosate or oral naltrexone alongside psychological treatment after successful withdrawal (NICE CG115). All of them are strikingly under-prescribed across Europe: if you have an alcohol problem and nobody has ever mentioned these medicines, that conversation (with a GP or addiction service) is a reasonable next appointment to ask for.
Ketamine for alcohol use disorder: the furthest-along research route in Europe. Here the story is encouraging, with a hard caveat. The UK's phase 2 KARE trial randomised 96 people with severe alcohol use disorder across four arms (ketamine or low-dose comparison, each with or without relapse-prevention psychological therapy). The treatment was well tolerated, and the pooled ketamine groups had roughly 10 percentage points more abstinent days at six months than the pooled comparison groups, while relapse rates did not differ significantly; the design also cannot isolate how much the psychotherapy contributed (Grabski et al. 2022, American Journal of Psychiatry). That is an encouraging signal, not an established relapse-prevention treatment. On its strength, the phase 3 MORE-KARE trial tests repeated ketamine with a structured support programme against a low-dose comparison with alcohol education, around 280 participants across NHS sites, run by the University of Exeter (NIHR award NIHR150193; MORE-KARE trial site, where current recruitment and timetable should be checked directly). It may clarify benefit and durability; no trial can be promised to deliver a particular result. The standing caveats: ketamine is not approved anywhere for alcohol use disorder; private "ketamine for drinking" offers sit ahead of the evidence; ketamine itself carries dependence potential, which trials manage with screening and low, supervised dosing; and lower-dose ketamine still requires medical assessment, physiological monitoring, recovery supervision and emergency capability, with particular review of addiction history, sedatives, alcohol and other medicines. Psychological preparation and follow-up are valuable components of care, and they do not replace those safeguards or establish that a commercial package reproduces trial outcomes. Ketamine's general evidence and risks are in our ketamine evidence review.
Psilocybin for alcohol use disorder, one strong phase 2, and a real European pipeline. The best evidence for any classic psychedelic in addiction is Bogenschutz and colleagues' double-blind trial: 95 adults with alcohol dependence randomised, 93 receiving study medication and analysed. Heavy-drinking days over 32 weeks averaged 9.7% with psilocybin versus 23.6% with the active placebo (diphenhydramine), with 12 psychotherapy sessions in both arms (Bogenschutz et al. 2022, JAMA Psychiatry). Two caveats the authors themselves report: the sample was small, and blinding largely failed (most participants and therapists guessed the assignment), which weakens the comparison; and a result from this controlled psychotherapy-embedded programme does not generalise to a stand-alone psychedelic session. It is a promising phase 2 result needing replication at scale, and the replication is actually happening, partly in Europe: the trials section below lists a French phase 3 trial and studies in Belgium, Denmark and Switzerland recruiting now. For smoking, the evidence has moved past open-label work: a published pilot randomised trial compared psilocybin with nicotine patch, with CBT in both groups (82 participants), and found a cessation signal (Johnson et al.); it remains a small pilot, establishing neither routine use nor superiority to standard cessation treatment. For cocaine and other addictions the evidence is thinner still. No regulator anywhere has approved psilocybin for any addiction; in Europe the supervised route is a clinical trial, and any other lawful access is a question of the applicable national framework (a few countries, such as Switzerland, run restricted individual-authorisation pathways), not something to infer from approval status alone. The full picture of what psilocybin has and has not shown is in our psilocybin evidence review.
Ibogaine: the outlier. Ibogaine, a psychoactive alkaloid from the iboga shrub, has a persistent reputation as an opioid-detox treatment, built on observational reports and animal data rather than controlled trials. It has no marketing authorisation anywhere in the world, and it differs from the researched psychedelics in a way that matters medically: documented cardiac toxicity. The clinical data are stark: in a 14-person study under full monitoring, half of the participants developed QTc prolongation above 500 ms, a level at which dangerous arrhythmia is a recognised risk, and the authors' conclusion was that screening alone cannot make ibogaine administration safe (Knuijver et al. 2021; background: Koenig & Hilber 2015). It is not an established treatment in any country; whether a particular foreign provider operates lawfully is a question of that country's rules and worth checking case by case, but the cardiac risk applies everywhere, and providers routinely lack the cardiac screening and continuous monitoring that even ibogaine's research advocates consider mandatory. Whatever ibogaine's scientific future, taking a cardiotoxic substance during opioid withdrawal in a setting without arrhythmia management is a serious risk to take with a treatable condition, and opioid dependence already has a well-evidenced, widely available medical treatment.
How to work out where you are
First: what have you actually tried? Write it down, in one document: every treatment episode, detox attempts (supervised or not), residential or outpatient programmes, structured therapy, medications with doses and durations, mutual-aid groups and for how long; what helped, what didn't, and what surrounded each relapse. Include the co-occurring picture: depression, anxiety, trauma, pain. This is not busywork: addiction services triage on treatment history, trial screeners check it item by item, and patterns ("relapse three weeks after every detox, when the follow-up ended") are themselves clinically useful information.
Second: check the depression track separately. Depression and alcohol dependence feed each other, and treating only one is a common reason both persist. Depression needs its own assessment and its own treatment plan, and improvement in mood is not evidence that the substance use disorder is being treated. If your low mood has independently failed adequate antidepressant treatment, a treatment-resistant depression pathway may exist on that side: esketamine's EU label is indication-specific (treatment-resistant depression with an oral antidepressant, plus a separate short-term psychiatric-emergency indication), and whether it fits is a prescriber's decision against that label, not a universal two-failed-antidepressants rule. Our depression options guide maps the pathway, and our eligibility check runs validated screeners privately in your browser; it is an orientation tool and cannot establish a diagnosis or prescribing suitability. Note one complication in the other direction: active substance dependence is an exclusion criterion in most psychedelic depression trials, so the addiction usually needs addressing first, not instead. (If you are reading this for someone else, our guide for family members covers how to help without pushing.)
Trials as an option
For psychedelics in addiction, trials are the only lawful supervised route in Europe, and unusually for this site's subject matter, the addiction pipeline is busy. As of September 2026, the European registries show, among others: a French phase 3 trial of psilocybin for alcohol use disorder with depressive symptoms (ERPPAD, CHU Nîmes, CTIS 2025-525069-65-00, recruiting); psilocybin-assisted therapy for severe alcohol use disorder at CHU Brugmann, Brussels (CTIS 2024-518061-10-00, recruiting); a Danish study of single-dose psilocybin in alcohol use disorder (Region Hovedstaden, CTIS 2024-517497-17-01, recruiting); ketamine for combined depression and alcohol use disorder in Norway (University Hospital of North Norway, CTIS 2023-506052-24-00, recruiting); an authorised Irish pilot of psilocybin for cocaine use disorder (Trinity College Dublin, CTIS 2024-515147-32-02); and an authorised French pilot of psilocybin for gambling disorder (CHU Nantes, CTIS 2025-522743-18-00). In Switzerland, an LSD trial for alcohol use disorder is sponsored by University Hospital Basel with Basel and Bern locations (NCT05474989); the record lists recruitment, and current site availability should be confirmed directly. The UK's MORE-KARE phase 3 recruits through NHS sites (details). Registries change: check CTIS and ClinicalTrials.gov directly, and read our trials guide for how phases, placebo and consent work. Two practical notes: an authorised registry record is not proof that a particular site is enrolling this month, so the listed site contact is the source of truth, and participation is free though travel and time costs may still fall on you, with reimbursement varying by sponsor. The ground rules do not change: trials are voluntary and ethics-supervised; screening is strict (active medical instability, certain psychiatric histories and some medications exclude), eligibility and current capacity are decided by the study team, and being screened out is a protocol outcome, not a judgment on you.
Frequently asked questions
Is there a psychedelic treatment for addiction I can get now?
No. No psychedelic (psilocybin, ketamine-assisted therapy for addiction, LSD, ibogaine) is an approved treatment for any substance use disorder anywhere in the world. These are not established routine addiction treatments anywhere; the supervised route in Europe is a clinical trial, and that pipeline is active. A clinic selling psychedelic addiction treatment outside a trial is selling ahead of the evidence whatever its legal footing, which varies by national framework; retreats abroad typically operate without the screening and monitoring the research itself considers essential.
Does ketamine therapy work for alcoholism?
The short answer: promising, unproven, being tested properly right now. The four-arm phase 2 KARE trial found about 10 percentage points more abstinent days at six months for pooled ketamine groups versus pooled comparison groups, with relapse rates not significantly different, and without isolating the psychotherapy's contribution; the phase 3 trial (MORE-KARE, ~280 participants across NHS sites) may clarify benefit and durability, though no trial guarantees a particular answer. Until then it is a research treatment (not approved anywhere for alcohol use disorder), and ketamine's own dependence potential is one reason self-arranged use is a bad idea.
What about psilocybin for alcohol: didn't a trial show it works?
One promising phase 2 trial (JAMA Psychiatry 2022; 95 randomised, 93 analysed) found heavy-drinking days averaging 9.7% versus 23.6% with active placebo over 32 weeks, with psychotherapy in both arms, a small sample and largely failed blinding. That is encouraging and insufficient for approval, which is why phase 3 replication is underway, including a French trial recruiting now. Psilocybin remains unapproved for any indication; trials are the only lawful route.
Is ibogaine legal in Europe?
It has no marketing authorisation anywhere, it is explicitly controlled in several member states, and there is no established treatment route in the EU; the legal position of providers elsewhere varies by country and is worth checking case by case rather than assumed. More important than legality: ibogaine has documented cardiac toxicity, with QTc prolongation above 500 ms in half of one fully monitored 14-person cohort, and opioid dependence, its main claimed indication, already has well-evidenced, widely available treatment (methadone or buprenorphine with psychosocial support). That combination of unproven benefit, proven risk and an existing alternative is why no serious guideline lists it.
What actually works, then?
For opioids: agonist treatment (methadone, buprenorphine) plus psychosocial support, the best-evidenced intervention in all of addiction medicine. For alcohol: medically supervised withdrawal where needed, then acamprosate or naltrexone alongside structured psychological treatment, with nalmefene and disulfiram in defined niches. For every substance: structured psychosocial treatment, attention to housing, work and mental health, and treating relapse as a reason to adjust treatment rather than abandon it. None of it is glamorous; all of it is available in Europe now.
Sources
- NICE CG115 — Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence
- EMA — Selincro (nalmefene) European Public Assessment Report
- Grabski M et al. Adjunctive ketamine with relapse prevention-based psychological therapy in the treatment of alcohol use disorder (KARE). American Journal of Psychiatry 2022
- NIHR — MORE-KARE: a multi-centre investigation of increasing alcohol abstinence with ketamine-assisted psychological therapy in severe alcohol use disorder (NIHR150193)
- Bogenschutz MP et al. Percentage of heavy drinking days following psilocybin-assisted psychotherapy vs placebo in the treatment of adult patients with alcohol use disorder. JAMA Psychiatry 2022
- Koenig X, Hilber K. The anti-addiction drug ibogaine and the heart: a delicate relation. Molecules 2015
- Knuijver T et al. Safety of ibogaine administration in detoxification of opioid-dependent individuals: QTc findings. Addiction 2021
- NICE TA114 — methadone and buprenorphine for the management of opioid dependence
- Johnson MW et al. Psilocybin versus nicotine patch for smoking cessation: pilot randomised trial. JAMA Network Open
- EUDA — drug-induced deaths, European Drug Report 2026 (overdose prevention context)
- EMA — Spravato product information (licensed indications)
- MHRA — off-label or unlicensed use of medicines: prescribers' responsibilities
- ClinicalTrials.gov — NCT05474989, LSD for alcohol use disorder (sponsor: University Hospital Basel; Basel and Bern sites)
- CTIS — the EU Clinical Trials Information System
This guide is for general information only and is not medical advice, a diagnosis, or a recommendation of any treatment. It does not describe doses, preparation or session experiences, and it is not a guide to obtaining any substance. Stopping alcohol, opioids or benzodiazepines suddenly can be dangerous: seek medical supervision for withdrawal. Discuss your options with a licensed clinician who knows your history. If you are in crisis, contact your local emergency number (112 in the EU) or a crisis line immediately.