Drug-centered or drug-assisted? Epistemic perspectives and methodological tensions in psychedelic psychotherapy

Abstract This paper distinguishes the drug-centered view of psychedelics (DCP) and the drug-assisted view of psychedelics (DAP). While these approaches differ conceptually, both rely on the methodology of evidence-based medicine, using randomized controlled trials to validate therapeutic efficacy. Using MDMA-assisted psychotherapy as a case study of DAP, we reconstruct the causal reasoning underlying its proposed therapeutic effects, identify two key causal assumptions, and critically examine them. Our analysis shows that the DAP community’s reliance on evidence-based medicine is not merely methodological, but also reflects questionable epistemological assumptions inherited from the empirically supported therapy tradition. We conclude by proposing value-based practice as a complementary methodology better suited to the relational and value-laden dimensions of DAP.