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 to you illegally.
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, documented cardiac deaths in unregulated settings, no lawful route in the EU. Nothing psychedelic is bookable as addiction treatment in Europe outside a clinical trial.
What the options actually are
The fact box above compresses hard; here are both parts again, with the detail.
Psychosocial treatment — the first line for every substance. Whatever the substance, structured psychological and social treatment is where the guidelines start: cognitive behavioural approaches, motivational interviewing, contingency management, community reinforcement, behavioural couples therapy, and structured mutual-aid facilitation (NICE CG115). 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. 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 are: acamprosate to support abstinence; naltrexone, an opioid-receptor blocker that blunts alcohol's reward; nalmefene (Selincro), EU-authorised specifically for reducing consumption in high-risk drinkers who do not require immediate detox (EMA EPAR); and disulfiram, the old deterrent, for selected motivated patients with supervision. NICE recommends acamprosate or oral naltrexone alongside psychological treatment after successful withdrawal (NICE CG115). 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 — 96 people with severe alcohol use disorder — found that three ketamine infusions combined with relapse-prevention psychological therapy were well tolerated, with greater abstinence at six months than placebo (Grabski et al. 2022, American Journal of Psychiatry). On the strength of that result, a full phase 3 trial — MORE-KARE, around 280 participants across eight NHS Trusts, run by the University of Exeter and co-funded by the MRC, NIHR and the treatment's commercial sponsor — began in 2024 and runs through 2026-27 (NIHR award NIHR150193; MORE-KARE trial site). The caveat: this is still a research treatment. Ketamine is not approved anywhere for alcohol use disorder, private "ketamine for drinking" offers sit ahead of the evidence, and ketamine itself carries dependence potential — a non-trivial consideration in addiction medicine that the trials manage with screening and low, supervised dosing. 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 in 93 adults with alcohol dependence: two psilocybin sessions embedded in psychotherapy roughly halved the percentage of heavy drinking days over 32 weeks compared with an active placebo (Bogenschutz et al. 2022, JAMA Psychiatry). That is a phase 2 result — promising, single trial, needs 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, cocaine and other addictions the psilocybin evidence is thinner still — small pilots and open-label studies. No regulator anywhere has approved psilocybin for any addiction; outside a trial there is no lawful route. 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 — QT-interval prolongation, arrhythmias, and a series of deaths in and around unregulated retreat settings (Koenig & Hilber 2015). There is no lawful ibogaine treatment route in the EU; providers operate either illegally or from jurisdictions with no meaningful oversight, usually without the cardiac screening and monitoring that even ibogaine's research advocates consider mandatory. Whatever ibogaine's scientific future, paying an unregulated retreat to administer a cardiotoxic substance during opioid withdrawal is a serious risk to take with a treatable condition — and opioid dependence, uniquely among the conditions on this page, 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. If your low mood has independently failed to respond to two adequate courses of antidepressants, the treatment-resistant depression pathway — including EU-approved esketamine — may be open on that side; our depression options guide maps it, and our eligibility check runs validated screeners privately in your browser. 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, the University Hospital of Psychiatry in Bern is recruiting for LSD treatment in alcohol use disorder (NCT05474989), with related work in Basel. 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. The ground rules do not change: trials are free, voluntary and ethics-supervised; screening is strict — active medical instability, certain psychiatric histories and some medications exclude — and most applicants are screened out, which is the norm rather than 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. The lawful supervised route in Europe is a clinical trial, and that pipeline is active. Anyone selling psychedelic addiction treatment in the EU outside a trial is operating illegally; retreats abroad 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. A UK phase 2 trial (KARE) found more abstinent days at six months with ketamine plus relapse-prevention therapy than placebo; the phase 3 trial (MORE-KARE, ~280 participants, eight NHS Trusts) runs through 2026-27 and will give the real 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 good phase 2 trial (JAMA Psychiatry 2022, 93 participants) showed roughly a halving of heavy drinking days versus active placebo over 32 weeks. That is genuinely encouraging and genuinely 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?
There is no lawful ibogaine treatment route in the EU: it has no marketing authorisation anywhere, and it is explicitly controlled in several member states. More important than legality: ibogaine has documented cardiac toxicity, including deaths in unregulated settings, 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
- ClinicalTrials.gov — NCT05474989, LSD treatment for persons with alcohol use disorder (University of Bern)
- 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.