An Overview of Psychedelics and Behavioral Health: It’s Complex
Makeba Royall, LCSW, Senior Practice Associate for Behavioral Health
August 17, 2026
Psychedelics are substances that can alter mood, thought, and perception, and their use in mental health treatment and integration into the behavioral health workforce is complex. However, in recent years, interest has grown in psychedelic-assisted therapy (PAT) because of its potential impact on treatment-resistant conditions, such as post-traumatic stress disorder (PTSD), anxiety, and depression.
There has been debate around classifying psychedelics and dissociative drugs that have similar properties and grouping them together because of the way in which they work in the brain. According to the National Institute of Drug Abuse (NIDA), “some people use the term “hallucinogens” to refer to all or some psychedelic and dissociative drugs” (National Institute on Drug Abuse (NIDA), 2023b).
For this reason, we often see non-classic psychedelics included in the conversations related to psychedelic assisted therapy. Ketamine, methylenedioxymethamphetamine (MDMA) also known as ecstasy and ibogaine are included in the conversations due to their ability to alter states of consciousness and make people feel disconnected from their body and environment, but they are not classic psychedelics. This document examines the origins of classic psychedelics, the current state of this re-emerging trend, and the ethical considerations related to this treatment approach for the behavioral health workforce.
Classic Psychedelics
Psychedelics can be traced back to 1897, when German pharmacologist Arthur Heffter identified mescaline, the psychedelic compound found in peyote (Madison et al., 2025, p. 15). Peyote is a small cactus with psychoactive properties due to mescaline. More than forty years later, in the 1940s, Swiss chemist Albert Hofmann accidentally synthesized lysergic acid diethylamide (LSD), sparking renewed interest in psychedelics. He later discovered psilocybin, commonly known as magic mushrooms, in the 1950s, and research expanded into the therapeutic use of these substances through clinical studies in North America and Europe. These studies focused on depression, anxiety, and alcoholism. However, by the 1960s, research began to slow as LSD and psilocybin became associated with recreational use and with youth culture, music, and political ideology. These associations fueled cultural concern, stigma, and broader social and political dissent tied to anti-war and anti-government movements, contributing to the criminalization of LSD and psilocybin. This led Congress to pass the Controlled Substances Act in the early 1970s, classifying psychedelics as Schedule I drugs—controlled substances considered to have a high potential for abuse and no currently accepted medical use (Drug Scheduling, n.d.)—and disrupting clinical trials.
Where Are Psychedelics Legal in the U.S.
With the federal governments scheduling regulations, psychedelic research had been halted for many years. Interest persisted, and researchers wanted to continue to explore whether psychedelics could help treat mental health conditions, particularly PTSD, anxiety, and depression and “despite their prohibited status, both classic and non-classic psychedelics continued to be used for therapeutic, exploratory, and recreational purposes in the "underground," a term referring to established communities, norms, and practices that were secretive in nature to protect individuals from potential legal consequences or stigma.” (Pilecki et al., 2021).
As a result, some states and jurisdictions have initiated their own legislative action for the purpose of legalization or decriminalization, which are different. Legalization usually means under regulations the substance can be produced and sold with no risk to criminal or civil charges. Decriminalization, by contrast, means the substance remains illegal, but possession or use may result in reduced or no criminal penalties. However, possession or sale could result in criminal charges.
In 2019, Denver Colorado became the first city to decriminalize psilocybin mushrooms and legalization followed in 2022. Oakland California also voted to decriminalize psilocybin along with peyote in 2019. In 2020 Oregon was the first state to legalize the supervised use of psilocybin and decriminalized personal possession in 2023, however in 2024 the decriminalization provision was repealed. The new law charged the Oregon Health Authority (OHA) with implementing clinical psilocybin regulation and licensure for treatment (Smith & Appelbaum, 2021).
Since the initiation of legislation several states began discussing psychedelic reform and introduced their own state legislation. In 2025, New Mexico established psilocybin therapeutic programs that would provide access to psilocybin under the guidance of a licensed healthcare provider.
In April 2026, President Trump signed an executive order directing the FDA and DEA to accelerate research, speed up clinical trials and develop pathways for access to psychedelic treatment, with the help of $50 million dollars in federal funds. It is important to note possession, or use remains illegal under both the state and federal law, except for Oregan and Colorado due to their state level psylocibin programs. The executive order does not legalize or decriminalize psychedelics, however; it opens the door to access for research and clinical trials.
While states are making attempts to create pathways for research and prove efficacy for improving mental health symptoms, some argue the approach needs to be considerate of how this emerging treatment would integrate into the behavioral health workforce. Increased interest in legalizing psychedelics has raised concerns around the medicalization of psychedelics. Nutt (2019) mentions we must be cautious in making claims about the value of psychedelic therapy in psychiatry and much more needs to be done due to its complexity, therapists’ time and involvement. Smith & Appelbaum (2021) suggest it would be wise to slow the rush to legalization of psychedelics to clarify the evidence, giving policy makers and the public better information to develop careful regulatory policy.
Other psychedelics such as peyote and dimethyltryptamine (DMT), an active ingredient in ayahuasca, are also considered illegal except for religious use because they are considered traditional medicines that require respectful cultural considerations related to religious ceremonial techniques and healing rituals. According to Caporuscio et.al (2025), “inclusivity and respect for indigenous traditions are key concepts when considering the use of psychedelics for mental health treatment. The increasing medicalization of psychedelics raises questions about the tension between therapeutic use and the broader cultural, spiritual, and traditional practices in which these substances have historically been embedded.”
The resurge in psychedelics for treatment has sparked conversations around the efficacy of psychedelics and their ability to help lessen the mental health crisis and provide symptom relief for treatment resistant conditions and establish a credible evidence-based treatment modality.
Psychedelic Use for Mental Health Treatment
While there are continued efforts to determine need for legalization, research continues to evolve. Researchers have been attempting to ascertain whether psychedelics can be used to help decrease or diminish symptoms related to depression, anxiety, post-traumatic stress disorder (PTSD) and even assist with substance use. According to NIDA, ways in which psychedelics have been researched include but are not limited to the following:
Psilocybin for treating alcohol use disorder, smoking, depression and anxiety and to ease chronic pain related to headaches, lower back pain, cancer-related pain and phantom limb pain.
Ketamine for the treatment of cocaine, methamphetamine and opioid use, along with treatment for depression. To date, only esketamine, a nasal spray made from ketamine, is FDA approved for therapeutic use. (National Institute on Drug Abuse (NIDA), 2024).
MDMA for severe PTSD.
Another important aspect of clinical research has been the use of psychotherapy in conjunction with the administration of psychedelics to help with symptoms. Nutt (2019) points out that not having both medical and therapist cover this would be unethical. However, on the other hand, Pilecki et al. (2021) points out that “incorporating psychedelics into traditional psychotherapy poses some risk given their prohibited status and many therapists are unsure of how they might practice in this area” because of the complex nature of treatment that includes both the administration of a controlled substance, and the therapeutic supports of psychotherapy by trained clinicians. Social workers are encouraged to educate themselves about this growing approach to mental health treatment.
What Does This Mean for Social Workers
Education related to the risks and benefits of the general use of psychedelics and use in therapeutic settings is essential with the rise in media coverage and conversations around legalization. According to Pilecki et al. (2021) there has been an upsurge of psychedelic integration training programs, workshops, and referral networks, which social workers are eager to learn more about. However, the complexity of a drug being illegal at the federal level, yet legal at the state level can cause an unclear understanding of the regulations for social workers wanting to assist with PAT.
The NASW Code of Ethics encourages social workers to, “keep current with emerging knowledge relevant to social work” as our ethical responsibilities as professionals; it also cautions social workers, “when generally recognized standards do not exist with respect to an emerging area of practice, social workers should exercise careful judgment and take responsible steps to ensure the competence of their work and to protect clients from harm.” (Code of Ethics: English. (n.d.) Social workers have an ethical duty to consider all factors when deciding to provide services even after receiving certifications that increase their knowledge and education around emerging treatment approaches and modalities. It is important to stress that providing unauthorized treatment that has not been verified by your state licensing boards, regulatory bodies and social workers liability insurance poses a liability risk and could affect licensure.
Pilecki et al. (2021) provides a detailed overview worth reviewing on the risks associated with conducting psychedelic harm reduction and integration therapy, that points out the risks related to licensing boards, criminal prosecution, potential litigation or malpractice, and professional reputation amongst peers and communities. Additionally, Pilecki et al. (2021) points out steps to mitigate risk and increase protective factors that include but are not limited to, avoid facilitating access to psychedelics or prohibited substances, refrain from coordinating work with underground guides, avoid certain terms such as “preparation” or “guide” to increase clarity and reduce the probability that someone may misperceive harm reduction and integration therapy (HRIT) as involving the administration of psychedelic substances, expand the boundaries and consider supervision and consultation with other professionals that are more experienced. To determine whether this is a practice of interest, social workers are advised to learn more about their state licensing board and state laws pertaining to controlled substances. The following appendix, Appendix: Personal inquiry for clinicians considering psychedelic Harm Reduction and Integration Therapy (HRIT), provides valuable questions for social workers to think about as it pertains to the future of psychedelics and its integration with the behavioral health workforce.
Conclusion
There are currently no federally regulated certifications, recognized qualifications or license specifically for offering psychedelic-assisted therapy. Additionally, there are no established standardized clinical competencies. Training programs are often operating for future readiness and preparation. Social workers should always consult with their licensing boards, regulatory bodies and social workers liability insurance before providing services for emerging practice areas.
NASW is actively engaged in this issue, has developed resources on it, and will continue to monitor and provide updated resources and information related to psychedelic assisted therapy and what it means for mental health treatment and social workers.
NASW Resources
Code of Ethics: English. (n.d.). https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English
NASW Social Work Talks Podcast: EP116: Psychedelic Assisted Therapy
NASW Social Work Advocates: The Intersection of Psychedelics and Mental Health Treatment
Social Work Online CE Institute: Social Work, Psychedelics, and the Future of Mental Health
Ethics Table Talk: Ethical Considerations for the Use of Psychedelics in Mental Health Treatment
NASW Ethics: 8 Ethical Tips for Social Workers When Considering or Using Emerging Practices - (member only resource)
Resources
Caporuscio, C., Poppe, C., Gieselmann, A., & Repantis, D. (2025). Ethical issues with psychedelic-assisted treatments in psychiatry: A systematic scoping review. Psychological medicine, 55, e284. https://doi.org/10.1017/S0033291725101761
Carlino, M., & Lawrence, G. (2025). A Brief History of Psychedelics. In Psychedelic Treatment for Neurodegenerative Disorders: A Review of the Research (pp. 15–18). Reason Foundation. http://www.jstor.org/stable/resrep66900.6
Drug scheduling. (n.d.). United States Drug Enforcement Administration. Retrieved February 9, 2026, from https://www.dea.gov/drug-information/drug-scheduling
Ferenstein, G. (2026, March 6). State psychedelics legalization and policy roundup — March 2026. Reason Foundation. https://reason.org/commentary/state-psychedelics-legalization-and-policy-roundup-march-2026/
Max Wolff, Hans Rutrecht, Gerhard Gründer, Andrea Jungaberle, Henrik Jungaberle, Key competencies for psychedelic treatment in real-world mental health care settings, General Hospital Psychiatry, Volume 97, 2025, Pages 11-24, https://doi.org/10.1016/j.genhosppsych.2025.09.003.
mikesmithdesign. (2026, March 23). 2025’s Psychedelic Policy Surge: A State-by-State, Bill-by-Bill Analysis - Psychedelic Alpha. Psychedelic Alpha. https://psychedelicalpha.com/news/2025s-psychedelic-policy-surge-a-state-by-state-bill-by-bill-analysis/
National Institute on Drug Abuse (NIDA). (2023b, April 4). Psychedelic and dissociative drugs. National Institute on Drug Abuse. https://nida.nih.gov/research-topics/psychedelic-dissociative-drugs
National Institute on Drug Abuse (NIDA). (2024, January 24). Psychedelic and Dissociative Drugs as Medicines. National Institute on Drug Abuse. https://nida.nih.gov/research-topics/psychedelic-dissociative-drugs-medicines#psychedelics-studied-as-medical-treatment
Nutt D. (2019). Psychedelic drugs-a new era in psychiatry?. Dialogues in clinical neuroscience, 21(2), 139–147. https://doi.org/10.31887/DCNS.2019.21.2/dnutt
Pilecki, B., Luoma, J. B., Bathje, G. J., Rhea, J., & Narloch, V. F. (2021). Ethical and legal issues in psychedelic harm reduction and integration therapy. Harm Reduction Journal, 18 (1), 40. https://doi.org/10.1186/s12954-021-00489-1
Psychedelics. (2025, January 21). United States Psychedelics Legality & Decriminalization. Psychedelics.com. https://www.psychedelics.com/guides/psychedelics-legality-and-decriminalization/
Smith, W. R., & Appelbaum, P. S. (2021). Two Models of Legalization of Psychedelic Substances: Reasons for Concern. JAMA, 326(8), 697–698. https://doi.org/10.1001/jama.2021.12481