The Emerging Use of Psilocybin in Adult Populations with Alcohol Use Disorder: A Scoping Review

Background: Alcohol Use Disorder (AUD) is a chronic pathological condition with significant burdens throughout the world. Despite the effectiveness of the current pharmacological treatments, the ongoing issues with AUD and the high relapse rates necessitate the exploration of innovative therapies, including the use of psychedelic drugs, which have shown promising initial results. The purpose of the current study is to map the evidence on potential uses of psilocybin and its neurobiological pathways, highlighting gaps in knowledge and suggesting research opportunities. Methods: A scoping review of the literature was performed according to the population, concept, and context (PCC) framework. Data were synthesized in tabular form to summarize key study characteristics. Results and discussion: After screening 757 records, we included 12 studies published between 1968 and 2025: 7 RCTs, 4 open-label studies, and 1 case report. Early Polish studies suggested long-term remission of alcohol cravings, while recent U.S.-based RCTs showed that psilocybin, when paired with psychotherapy, reduced heavy drinking days and alcohol-related and mental problems. Limitations have been identified in small sample sizes and short follow-up periods in patient safety data, particularly in those with comorbidities. Most of the studies have been carried out in a hospital and university psychiatry department setting involving physicians and psychologists. Conclusion: Psilocybin has emerged as a promising and innovative compound for the treatment of AUD in an experimental phase. Future research should be conducted to assess pharmacological effects, efficacy, and patient safety through rigorous RCTs across diverse populations. To achieve better outcomes, it is essential to address drug development and pharmaceutical legislation regarding safe therapeutic algorithms.