High hopes? Precision psychedelic addiction medicine

Advancing addiction treatment through psychedelic therapies and biomarker-guided precision psychiatry

Authors: Rayyan Raja Zafar, Patrick Kleine, Danielle Kurtin, Matthew Wall, David Erritzoe

Addiction remains one of the most treatment-resistant areas of psychiatry, with fewer than 2% of individuals receiving effective care despite decades of neuroscience and neuroimaging research. In this comprehensive review, Zafar and colleagues propose a fundamental shift from traditional diagnostic approaches toward a theragnostic, precision-medicine framework—where biomarkers actively guide patient stratification, treatment selection, and outcome prediction.

The authors outline how multimodal neuroimaging biomarkers (fMRI, EEG, PET) integrated with emerging psychedelic therapies such as psilocybin could transform addiction drug development. By embedding brain-based measures into early- and late-phase clinical trials, researchers can assess target engagement, monitor pharmacodynamic effects, and identify biotype-specific responders. Drawing on translational work from the Centre for Psychedelic Research at Imperial College London, the paper provides a practical roadmap for co-developing therapeutics and biomarkers to enable truly personalized addiction care.

Why read this article

• Introduces a theragnostic framework for addiction medicine, moving beyond diagnosis toward biomarker-guided treatment decisions
• Details how fMRI, EEG, and PET biomarkers can accelerate psychedelic drug development and improve clinical trial success
• Connects neuroimaging to real-world translation , including early-phase and late-phase trial design and regulatory considerations
• Provides a clear roadmap for precision psychiatry , showing how psychedelics may enable personalized, mechanism-based addiction therapies

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