# Mental health benefits and downsides of psychedelic use in ACX readers: survey results

Over the last few years, I’ve had a lot of conversations with people in the rationalist and adjacent communities about psychedelic use, mainly focused on potential benefits, potential risks, and good and bad outcomes they’ve seen in others from using psychedelics. I often wished I had more hard data about this, and that it came from groups that seemed more analogous to people in the rationalist and nearby communities than eg the average taker of existing surveys on psychedelics. So I decided to run a survey on this on the recent [ACX reader survey](https://astralcodexten.substack.com/p/please-take-the-reader-survey), and am sharing the results here. (I’m posting this using an anonymous username, but I’ve been around the community for a long time.)

Many thanks to Scott and all the survey-takers for making this happen! 

### Meta

*   You can see a blank copy of the survey [here](https://docs.google.com/forms/d/e/1FAIpQLSfm8_ou3WRUIvuJ0r7ljMD12nW1PgaZTF69k9kYDK4cqJBTtA/viewform). It might be worth making some advance predictions about answers to the questions in it before looking at the stats below.
*   824 people took the survey and seemed like they’d done one of the drugs I was asking about (LSD, psilocin/psilocybin/magic mushrooms, chemical DMT without an accompanying MAOI, mescaline/mescaline cacti, Ayahuasca or “pharmahuasca” (DMT + an MAOI), + a write in option) in doses larger than a microdose (also, someone noted that I incorrectly referred to these as psychedelic tryptamines). (There were originally 986 responses, but Scott directed psychedelic users to take the survey, so it isn’t surprising that most had done psychedelics). I discarded the responses from people who hadn’t done one of the relevant drugs, and did my best in ambiguous cases.
*   I’m not very experienced with large survey and data analysis, so even though the things I did seemed pretty straightforward and I tried to double-check and sanity check the most important parts, I think there’s still a reasonable chance I made some meaningful mistakes that undermine my results

### Summary of high-level takeaways

*   More psychedelic trips are reported to be good than bad (depending on how you count it, there are about 5x-11x as many good as bad trips).
*   Psychedelics are very good for some people (according to those people), e.g. among the best experiences in their lives. Specifically, 74% said a psychedelic trip was in the top 20 most enjoyable experiences of their life, 61% said a trip was in the top 20 most meaningful experiences, but also very bad for a smaller number of people (41% said they had one of their top 20 most frightening experiences on psychedelics, and 32% reported the same thing for mentally painful experiences).
*   The majority of respondents say that their psychedelic use caused at least some enduring (>6mo) personality change in them (~32% said “yes, very minor ones”, ~25% said “yes, moderately strong ones”, and ~7% said “yes, very strong ones”), the vast majority of which they said were positive.
*   Around 4.5% of respondents said the psychedelics caused them to experience psychosis, and another 4.5% they might have had this effect. In another question, ~5% said psychedelics had caused them serious mental problems (but 36% said those psychedelics had had big mental health benefits). But only ~1% said that they regretted trying using those drugs, while 58% said they thought that most psychedelic non-users were making a big mistake.
*   People vary vastly in terms of how important psychedelic use is to them, and psychedelic use seems extremely important to some people, to the point where they wouldn’t trade their ability to use these drugs for many times their net worth.
*   Overall, it seems to me like both doing and not doing psychedelics is a high-stakes choice.

### Use frequency

*   Of the drugs I asked about, ~83% of the respondents had done LSD, ~82% had done psilocin/psilocybin/magic mushrooms, ~20% had done chemical DMT without an accompanying MAOI, ~13% had done mescaline or a mescaline cactus, ~8% had done Ayahuasca or “pharmahuasca” (DMT + an MAOI), which were the options I provided (people could also write in other options). No other option got >1%, though it looks like 2-CB might have gotten 1-2% if I aggregated all the different ways people wrote out the word.  So it looks like LSD and the mushroom psychedelics are by far the most popular, and most people that have used one have used the other, then there’s a steep dropoff.
*   The mean number of instances of use so far (hereafter, “trips”) was ~22, and the median was 10 (I had to make guesses for ~2% of the answers, e.g. when people said “20+”, but I don’t think that other reasonable interpretations would lead to different bottom lines). Overall, respondents collectively reported having 19,579 trips so far.
*   Here is a chart showing how frequently respondents had had different lifetime numbers of trips (non-microdose instances of use of the types of psychedelics I was talking about). I discarded ~5 datapoints that seemed internally contradictory or that I couldn’t interpret.
*   As you can see from this and the above data-points, what I would call moderately-high repeat use seems common (doing psychedelics more than enough to try them out, but less than e.g. monthly, and less than one likely “could” if one was doing them as frequently as possible).   
     

![](https://lh5.googleusercontent.com/HHoupeNsOAkMRr76VofkSw09sM7vXXy_5vtcuunt8kXCgYi_NzUU-2uuedG_Mfpw_PJ5BIHkQ8Y-ujX8JacEmeraZOghnHxhUjKUbW1XJlH8H-EKXV7DeqXEMAzpL6aKO1Ww8Hj6=s1600)

### Trip subjective experiences

I asked 4 questions about people’s subjective experiences of their trips, below. 

*   Out of all the times you did psychedelic tryptamines, what % did you consider a \*positive\* subjective experience (a more enjoyable/pleasant experience than being unconscious or not existing), \*during the experience\*?
*   Out of all the times you did psychedelic tryptamines, what % did you consider a \*negative\* subjective experience (a less enjoyable/pleasant experience than being unconscious or not existing), \*during the experience\*?
*   Out of all the times you did psychedelic tryptamines, what %, looking back, are you overall \*glad\* that you did? (E.g. because the experience was enjoyable without commensurate downsides, you feel you learned something of value (even if it was unpleasant at the time), you experienced some improvement in mental/emotional health following the experience, etc.)  This should your \[sic\] perspective after reflecting on the experience and all the effects it ended up having.
*   Out of all the times you did psychedelic tryptamines, what %, looking back, do you overall \*regret\* that you did? (E.g. because the experience was unpleasant without commensurate upside, you feel you came away with false insight or trauma, you experienced some decrease in mental/emotional health, etc.) This should be your perspective after reflecting on the experience and all the effects it ended up having.

  
I didn’t ask specifically about neutral experiences.

The answer options were all deciles (~0%, ~10%, ~20%, etc.). There was very slight dropoff in response count (819 for the first question, 813 for the last of those 4)

A chart of the answers is below, unweighted by trip count (so, each respondent just puts in one answer for each question, and this doesn’t take into account how many trips they’ve had). 

|     | positive | negative | glad | regret |
| --- | --- | --- | --- | --- |
| Mean | 82% | 15% | 85% | 8%  |
| Median | 90% | 10% | 90% (~48% said 100%) | 0% (64% of respondents said 0) |

The ratio of positive to negative mean trips was 5.5:1

The ratio of mean trips people were glad they’d had to ones they regretted was 10.6:1 

Now, here are the implied counts for different numbers of trips (taken by multiplying people’s answers by how many trips they said they’d had in an earlier question, not them answering this specific question directly. So if you said 20% of your trips were negative, and you’d earlier said you’d done 10 trips, that implies 2 negative trips.). 

|     | positive | negative | glad | regret |
| --- | --- | --- | --- | --- |
| Mean | 18.6 per person | 2.5 per person | 18.6 per person | 1.7 per person |
| Median | 7.2 per person | 0.9 per person | 7.2 per person | 0.0 per person |
| Total trips | 15,177 | 2,035 | 15,151 | 1,407 |

  
The ratio of positive to negative mean trips was ~7.5:1 

The ratio of mean trips people were glad they’d had to ones they regretted was ~10.8:1.

In other words, positive trips are substantially more common than negative ones, but negative trips aren’t rare. It seems to be slightly more common for people to be glad they did a trip and not regret it than for the trip to be positive and not negative at the time (in other words, it’s slightly more common for people to have a negative experience in the moment that they overall don’t regret on reflection than vice versa). 

The average trip is slightly more positive/rewarding than the average respondent experience, probably because people who have better experiences with psychedelics tend to take them more than people who have worse experiences (or get unlucky during their first few trips). 

I didn’t look into whether it was statistically significant or anything. 

### Personality changes

I asked “Has your experience with psychedelic tryptamines resulted in long-term (>6mo) changes to your personality?”.

There were 821 responses. ~36% of people said no, ~32% said “yes, very minor ones”, ~25% said “yes, moderately strong ones”, and ~7% said “yes, very strong ones”. 

So, the majority of people report lasting personality changes! 

Then I asked “If you have noticed long-term (>6mo) changes to your personality following psychedelic tryptamine use, do you think those changes have been positive overall, or negative?”, with answers on a scale of 1 to 5, where 1= “very positive” and 5= “very negative”.  I got 542 responses. The responses are below. 

![Forms response chart. Question title: If you have noticed long-term (>6mo) changes to your personality following psychedelic tryptamine use, do you think those changes have been positive overall, or negative?. Number of responses: 542 responses.](https://lh4.googleusercontent.com/13U66JmhFe9qjzpoz18FKVjs8sIv_Pub3ndp4jl8xMC4pMd9azX6bLs0o6SsfSlgS4SIwhqRdErMzmTjwrTPVij1hhmVkMDTA_0xAT7wb1Fs1ADXMNzmWo-GF_lCW9l4qDQZW-Hs=s1600)

So, most people thought the changes were positive rather than negative (482 positive vs. 42 neutral vs. 18 negative, or a ratio of ~27:2:1).

I asked people to describe the changes that resulted, but I didn’t have time to code them. On skimming, commonly stated themes seem to include increased openness and compassion and overcoming things like “rigidness” or “narrowness”, happiness of a tranquil kind (lots of phrases like “contentment” “at-ease” “serenity” “acceptance”), progress related to depression or social anxiety, and instances of becoming “aware” or “mindful” or “able to appreciate” new things. Negative themes were obviously less common, but I saw mentions of increased depression, and feelings of detachment/apathy. So, kind of what one would expect. However, there were a few scattered reports of experiences in the opposite direction (more paranoid, more concerned about what others thought of them, etc.). Also at least 3 (or maybe more) mentions of reducing or eliminating meat consumption. 

I also asked people to check all that apply for any of a series of options that were true of them:

*   One of the top 20 most \*enjoyable\* experiences of my life occurred during a psychedelic tryptamine trip (“top 20 enjoy”)
*   One of the top 20 most \*frightening\* experiences of my life occurred during a psychedelic tryptamine trip (“top 20 frighten”)
*   One of the top 20 most \*meaningful\* experiences of my life occurred during a psychedelic tryptamine trip (“top 20 meaningful”)
*   One of the top 20 most \*mentally painful\* experiences of my life occurred during a psychedelic tryptamine trip (“top 20 mentally painful”)
*   Doing a psychedelic tryptamine caused me to become noticeably \*less\* spiritual/religious/\*decreased\* my credence in the existence of a god or gods or similar (“less religious”)
*   Doing a psychedelic tryptamine caused me to become noticeably \*more\* spiritual/religious/\*increased\* my credence in the existence of a god or gods or similar (“more religious”)
*   I think most people who \*never\* try psychedelic tryptamines are making an important mistake (“no psychedelics = mistake”)
*   I think most people who \*do\* try psychedelic tryptamines are making an important mistake (“psychedelics = mistake”)
*   I wish I had never tried any psychedelic tryptamines (“wish never tried”)
*   I experienced serious mental health problems I believe were a result of using psychedelic tryptamines (“serious mental problems”)
*   I experienced large personal, health, or professional benefits I believe were a result of using psychedelic tryptamines (“big benefits”)

There were 739 respondents who answered (often checking multiple answers)

![](https://lh5.googleusercontent.com/rZyss8KNYWEfzdz8zND9M3Es9Iyl2u0F-t-Lus1kJf6hKLRp8-w9f3J2nfqIL6sgtzdgg4IGCLpTe__ncJGUCTmJAQQF6PKNLWBH5rQzTRb___wN1tBLrkoHdmD88jQ_20BPFf9U=s1600)

So 

*   It’s very common for people who have done these drugs to report that they were among the most intense experiences of their lives, more often in positive but also often in negative directions.
*   People report more benefits than harms, but a non-trivial number of harms
*   Very few people regret taking these psychedelics (and most people who experience serious harms still don’t regret it)
*   Per common wisdom, it seems like they more often made people more spiritual/religious, rather than the opposite.

### Psychedelics and psychosis

I asked people a series of questions about psychosis resulting from psychedelic trips. 

*   Have you ever, to your knowledge, experienced psychosis that you believe was largely or wholly attributable to psychedelic use?
    *   Out of 815 respondents to this question, 721 (88%) said no, 37 said yes (4.5%), and 37 (4.5%) said maybe/I don’t know.
*   If you have experienced psychosis that you believe was largely or wholly attributable to psychedelic use, did the experience follow a trip that was a positive experience while it was ongoing, or a negative experience while it was ongoing?
    *   89 people answered this question, and a chart of the results is below (I don’t know why this got more responses than the question above would indicate). It doesn’t include write-in answers.

![](https://lh6.googleusercontent.com/yRHguQefpd9DPkQX6Z3D67iMtj5YvSXLXL0tmqCHvTB_eLRG0L1mz9Fv6zrmuXirUa4OvESJ3l5hqnyX3OpUS1IogaTZJDL7upSN5qKBN6lzwBEHYcq_B6wNegDilX-LVXc0SAWO=s1600)

*   So it looks like it’s more common for a negative trip to precede a psychotic episode than a positive one, even though (per the above) positive trips are ~10x more common in general, Another way of putting it: ~10/15000 (or, 0.067%) of positive trips led to psychosis, and ~21/2000 (1.05%), a factor of ~16x difference.
*   Though, it also seems very plausible to me that either people remember trips as being worse if the preceded psychotic episodes, and/or the onset of the psychosis is what makes the trip negative (rather than negative trips being more likely to cause psychosis).
*   If you have experienced psychosis that you believe was largely or wholly attributable to psychedelic use, what psychedelic tryptamine did you take right before the onset of the psychosis?

![](https://lh5.googleusercontent.com/phgrFWaIia6VWc5QbpxVxTaTDm-aJbw1yni3rdv7AiLvolB43BqWxzbBePESGLSrgOOHeRxaYwXjXWGobrTeiNHrpUNqmfvkixjr-vwP1SGQ6K1zcotUpZnqw9kcXzRlmklhTCWQ=s1600)

LSD is a bit disproportionately represented here; above, a similar number of respondents said they’d tried LSD vs. psilocybin/shrooms (~83% vs. 82%), but perhaps people use LSD more frequently if they try it, or in larger doses. Or perhaps there’s something more inherently dangerous about it or how people use it, or a slightly more at-risk group of people use it.    
 

### Net worth question

I asked the question “Imagine that an omnipotent entity is offering you a deal where It gives you money, but if you accept the money, no psychedelic tryptamine will ever have a psychoactive effect on you again (if you ingest them, nothing will happen), for either 100 years or until you die (whichever comes first). Think about the minimum amount of money that this entity would have to offer, such that you would take this deal. Now, what fraction of your total current net worth does that amount of money constitute, in %? (Please put % in your answer, so I know you read the question, e.g. "X% of my current net worth").”

I ignored people when it seemed pretty likely they hadn’t interpreted the question correctly (though I’d guess they interpreted it incorrectly in many more cases than the ones in which it was pretty clear to me), and people who said their net worth was negative. I regret how I structured this question; as some respondents noted, fraction of expected lifetime earnings would have been better, and this is a pretty bad question for young people who are far from peak earning; the answers are really all over the map in a way that I think reflects this. Still, I think some of the results are interesting. 

Here’s a chart of respondent count by what fraction of their net worth they said they’d need to be given to give up the ability to do the psychedelics I was referring to. 

![](https://lh6.googleusercontent.com/Y2-j9ZU-MU8oWc8wAuj-XSXw_znnyBx-AeLiUZYLTeJem6Y0fYHqz3N2bTI25AXKST40fSz1SL15zGNffU-iNQfuFM4W6qtJFdwBLNEfR4k_h6xTpnSPWHfl3CZazdV9JHXWiN8M=s1600)

49 people also included a minimum monetary amount they would want in order to make this trade; the mean for those people was ~$3.35M (!) and the median was ~$129k. For context, in the [2020 SSC Reader Survey](https://slatestarcodex.com/2020/01/20/ssc-survey-results-2020/) (not this survey), the average income was ~$140k and the median income was $70k (obviously, the average for these survey respondents might be different, though I’d be somewhat surprised if the differences were large). 

I didn’t count how many, but there were also several people who said they wouldn’t give up the ability to do psychedelics for any amount of money. Also some people said they never intend to do psychedelics again, and would forfeit the ability to do so for trivial amount of money, but would pay a lot to preserve the memories and insights they think they gleaned from past experiences. Also, some people noted that their numbers would be substantially higher if the question was about all psychedelics (instead of just tryptamines) or all psychoactive drugs in general.

### Regrets

*   I wish I had asked some questions about what their friends and family thought of the long-term personality changes in people that had those, or what they think their younger selves would have thought of these changes
*   I wish I’d asked people how long their psychosis persisted
*   I wish I’d asked people if their psychosis followed their first trip, or a later trip
*   I wish I’d asked the people who had psychosis before if it was their first psychotic episode, or if they’d already had one or more before.
*   I wish I’d done the Net Worth question differently

It would be neat if someone explored these in the future.

### Misc

*   It seems like someone on this survey both became psychotic following LSD use, and also says they wouldn't give up the ability to do psychedelics for 10x their net worth, which I thought was interesting.