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[Ayahuasca and the Treament of Drug Addiction:]
[A Review of the Evidence and Proposals for the Future]
[Jose Carlos Bouso, Ph.D. April 20, 2013]
The public health impact of addiction, with its high relapse rates
and the limited efficacy of available treatments, has prompted
the search for alternative therapeutic approaches.
In recent times, there has been renewed interest in the
anti-addictive potential of psychedelics.
The ritual use of ayahuasca in shamanistic and religious contexts
is now popular in Europe and North America.
The studies in the long-term ayahuasca church members
have recorded discontinuation of drug use after starting ayahuasca use.
Several centers that offer therapies based on ayahuasca as a means
to treat addictive behavior claim higher success rates than
more traditional approaches. In this presentation I will review
the data available concerning the efficacy of ayahuasca in the
treatment of drug addiction. Also, ayahuasca has become
popular among the psychedelic community as a kind of medicine
to treat drug abuse and addiction. There are nearly 1,050 entrants
in Google; type in the words "ayahuasca drug addiction."
Evidence is weak, fragmentary and dispersed. Its fame as
a potential anti-addiction treatment is supported mainly by claims
from former drug users who recovered after joining an ayahuasca religion,
and also by reports from several clinics treating drug addicts
with ayahuasca, such as Takiwasi. Other centers in Peru and
in other parts of the world also offer patients treatment with
ayahuasca, but few have produced any assessment of their interventions.
Here we reveal all the fragmentary evidence obtained from the medical,
anthropological literature, and the reports of various treatment centers
regarding the effectiveness of ayahuasca in the treatment of
drug addiction. It is important to note that, as no peer-reviewed
studies had been published on this topic, the information discussed
can only be considered as anecdotal. How ayahuasca works therapeutically:
I think that there are three different approaches:
the shamanistic one, where ayahuasca is the tool that allows to entry
into the spiritual world, the real world, where the entities that rule
the forces of the world and nature live. There are, then,
the religious rules, where the syncretist doctrines direct the beliefs
of the community; and then the "psych:" I was afraid to put a suffix
to this word, because it can be said as "psychedelic," "psychonaut,"
"psychological," well, all the approaches with the prefix "psych,"
that provides a "peak experience" to induce personality changes.
All of them share neurobiological and phenomenological
commonalities, as the increase of the relative power of the EEG beta band,
enhancing CNS activity. The ayahuasca experience activation
is observed in cortical and paralimbic areas of the brain involved in
cognitive control, emotion, and memory. This may be translated as
"ayahuasca helps to bring to consciousness memories from the past,"
"to re-experience associated emotions and to reprocess them"
"in order to make plans for future."
In the last paper of Draulio that was presented yesterday,
they concluded that ayahuasca seeings stem from the activation of
an extensive network, generally involved with vision, memory,
and intention. By boosting the intensity of recalled images to the
same level of natural image, ayahuasca lends a status of reality
to inner experience. In sum, patients feel that the visions and emotions
that emerge under the effects of ayahuasca are real, and if they
are real, then one can work therapeutically towards real new behaviors
in the future. There are some evidence, the first one came from studies
with ayahuasca, members of ayahuasca churches. The first one was the
study from Grob et al, where 15 subjects from the UDV were compared
with 15 non-ayahuasca users, and also none of the UDV members
had a current psychotic diagnosis. Five had previously met criteria
for alcohol abuse, according to the DSM-III-R and ICD-10.
Eleven subjects had a history of moderate to severe alcohol use
prior to joining the UDV, with five of them reporting episodes of
binging, associated with violent behavior, who had been jailed
because of their violence. Four subjects also related prior involvement
with other drugs of abuse, including *** and amphetamine.
Eight of the 11 subjects with prior histories of alcohol and other
drugs' use and misuse were addicted to nicotine at the time of
their first encounter with the UDV and ritual ayahuasca use. The authors
conclude for showing these changes of quitting from drug use and abuse,
that a common theme was the perceived belief, while they induced altered
states of consciousness, that they were on a self-destructive path
that would inevitably lead to their ruin and even [inaudible] radically
change their personal conduct and orientation. During another study
from Halpern, were 32 regular users, all members of the
Santo Daime church of Oregon, again, the studies found that 24 subjects
met criteria for alcohol and drug abuse and dependence in the past,
but only, in the present time, one met criteria for marijuana
dependence, but was in remission at the moment of the assessment.
Of the 24 who had alcohol problems in the past, 6 described
church participation as the key turning point in their recovery.
There are also different evidences from the study of Doering/Silveira,
wherein comparing 40 adolescents, users of ayahuasca, members of the UDV,
with 40 controls found a tendency to less controlled use in the
ayahuasca group. In one of our one-year longitudinal studies
with a large group of members of Brazilian ayahuasca churches,
ayahuasca users showed significantly lower scores than controls
on the alcohol use subscales in the Addiction Severity Index,
a semi-structured interview designed to assess the impact of
drug use in a multidimensional fashion. So we concluded that
the ritual use of ayahuasca, as assessed with the ASI in currently
active users, does not seem to be associated with the psychosocial
problems that drugs of abuse typically cause. Even more, according to
our longitudinal study, ayahuasca users take fewer drugs than controls,
but have a longer history of drug use before their involvement
in the ritual use of ayahuasca. Only one study has published
quantitative data on the rates of prior and present drug dependence
problems related to the moment subjects joined an ayahuasca church.
A total of 83 individuals participated in this research, that is
published in the book that [Biala] et al and me will present in a while.
Again, 36 participants have been members of the church with at least
3 years. The first part was a list of drugs and the second part
was a series of 7 items based on the ideas and four criteria.
In the list of drugs, the subjects had to mark which drugs they had
used in the past and which ones they were currently using. They next
had to score the 7 items, first from the point of view of their past
situation, and then from the present situation at the moment of
the survey. If subjects scored 5 items positively, they were considered
drug-dependent according to these 4 criteria, and the criterion
for remission was not to be using the drug in the present.
The result showed that 38 subjects did not meet criteria
for a history of drug dependence. Of 41 subjects that met criteria
for dependence in the past, 37 had stopped taking drugs,
while only 4 remained dependent. Nineteen percent of the 41 had
recovered from tobacco dependence, 27% from alcohol dependence,
24% from *** dependence, 8% from crack dependence, and
5% from other substance dependence, as MDMA, solvents, LSD and ***.
So, anthropological situation regarding ayahuasca, useful in real use context,
it seems clear that involvement with an ayahuasca religion may
provide a useful alternative for many people wishing to overcome
drug dependence. Through research by Racciardi and Labigalini,
interviewing informants from the UDV who were recovering from
drug addiction after their involvement in the UDV, found that
an existential vacuum was a common primary reasons for subjects to
use drugs compulsively. Ayahuasca served to put them in contact
with the sacred and have an experience of transcendence,
allowed them to re-orientate their behavior in order to give up drugs.
The doctrine also played a major role in the abstinence process
as did support from the group, which serves as a factor of
social cohesion and increases confidence in their recovery.
Informants may be filled by a combination of the doctrine and
the ayahuasca experience.
In another study that was published in [Ploj] one in 2012,
we found that people that used to take ayahuasca in the long term,
compared with the controls, showed lower harm avoidance,
higher reward dependence, no differences in novelty seeking,
no differences in cooperation, lower self-directedness,
higher self-transcendence. The correlations that maybe exist with the
recovery of an addiction in the context of an ayahuasca church
may be that this lower harm avoidance, maybe, allows people
to expose to ayahuasca continuously without experiencing
the fear that maybe, average people could avoid in order to continue
the use and [inaudible] every shortened time to such an impressive
experience. But in my opinion, here there are no differences in
novelty seeking, and this maybe is expressing that people who is
involved in ayahuasca churches don't look at the ayahuasca experience
as the other people that used to look for drug experience, that they
look more to experience the pharmacological effects. Maybe here
in this sample, the subjects are looking for different things,
different from the experiencing of the pharmacological effects.
Another result that for me is very interesting, that may explain why
people that is involved in ayahuasca church may recover from addictions,
is the low self-directedness. Maybe the rules and the doctrine of the
community and the religion guides the behavior of the individual
to feel part of a community, may be the reason why people
used to have less drugs. But let's see, then, what is the difference
with another approaches. There is one evidence from ayahuasca use
in shamanistic context. It's one classical report, which also explains
the therapeutic method developed in Takiwasi, that offers some
data regarding the patients treated in the center between 1992 and 1998.
They only scored the benefits of the patients as having classified
as good: does mean favorable development, problems apparently resolved,
thanks to a true structural change manifested upon several life levels;
better: has shown improvement with evident structural changes,
but vestiges of the original problem still present; and same or bad:
that there's a relapse of consumption of substances, although
often, more discrete, no conventional structural changes,
frequent abandonment of substance for alcohol. This seems not a very
solid outcome measure, but is the result that we have.
Out of a total, 31% were classified as good and 23% as better,
while 23% were classified as same or bad, and 23% unknown.
In conclusion, according to Mabit, with hindsight, we can affirm that
about 35% of those who have lost contact with the center are again
good or better, that 8% of the total, which means that about 62%
of the patients have in the end positively benefited of the model
proposed after the Takiwasi Center. When only one takes into account
the subgroup of patients receiving a medical discharge, those who
have completed the entire program, the positive results rise to 77%.
The last evidence of some kind of benefit of ayahuasca in the
treatment of drug addiction came from our group that was supervising
a program of psychotherapy with ayahuasca in Brazil, using personality,
psychopathological, and neuropsychological assessments,
instruments, our team assessed the therapeutic effects
of an ayahuasca ritual treatment.
It was in the Brazilian Amazon basin, in the
Instituto de Psicología Amazonica Aplicada. The psychological
assessments were obtained both before and after treatment, which
lasted at least three months and included biweekly ayahuasca
consumption, and the main results for me, there is a very small sample,
is the scores in personality traits, above all, in the subscale of
self-directedness. There was also positive changes assessed with the
checklist [inaudible] revised in obsessive-compulsive positive
symptoms and anxiety, and also with a tool to assess frontal behavior,
we found a good recovery in the patients.
Despite important limitations in sample size, the present sample
of the study provides preliminary evidence suggesting psychotherapeutic
effects of ritual ayahuasca treatment in drug-related disorders.
For me, the most interesting part of this long and boring talk
is that there is a difference in people who are involved
in ayahuasca religions compared with people that might be
involved in psychotherapeutic process. The main difference
is the difference in self-directedness. Self-directedness is
a personality trait that is explaining a lot of things, [since]
possible personality disorders until recovery from some kind of
psychological problems. The explanation or the reason that
in ayahuasca religions self-directedness is lower than in the control group,
but that people can be recovered,
is the explanation that maybe the group is holding the individuals,
something that was similar to the ancient times where we used to live
in little groups and in tribes, and each one used to take care of
another one. Today, in our technological, isolated world, where we
have to go to pay to somebody strange, and in exchange of money
we receive psychotherapy, maybe the main result of the psychotherapy
is improve the self-directedness, and that the individual
can take care of his life and improve.
Well, as conclusions, therapeutic potential of ayahuasca
based on the evidence examined and the information, the lack of
systematic studies preclude firm conclusions. Initially,
research methodology should be improved with future studies
implementing well-planned clinical protocols, with adequate controls
and points and followups. That is the next thing that we'll do
in Spain in our research group from the ICEERS Foundation. We will
try to assess people that goes to take ayahuasca for the first time,
and we'll try to make follow-ups in order to see if there is some
more solid reason to think that ayahuasca may be a good tool to quit
from drug addiction or even for some other psychological problems.
Thank you very much, and for your patience. [applause]
Thank you, Jose. So if anybody has any questions, there's
a microphone there.
I have one question. Just in reference to the journal article that
you mentioned, which journal is it going to be published in?
Fernandez 2014? In one of your slides, you said Fernandez 2014?
Yes, Fernandez was a colleague, was a member of the team.
And which journal?
It will appear in this [Bialata's] book.
Oh I get it, it's going to be a book chapter.
Yeah, in a book chapter.
You have a question?
Jose Carlos, I have a question. Thank you for your presentation.
I didn't understand very well what you mean by the psychological
versus religious context when you say self-directness. Can you
explain that better? The other thing, I just, it's not so important,
but a suggestion, that you don't name, I consider there is a
big difference between psychological and psychonautic.
For me, psychonautic would give more the idea of like an underground
experiment and do-it-yourself basement shaman, and psychological
would more give the idea of a group and a mediator or something
more collective. I don't think that psychonaut is bad and psychological
is good, but Fábregas before presented idea, as some kind of
psychotherapeutic context, and appears as psychonautic in yours,
so just a suggestion.
Well, I don't know which word to use, because all words can be
used against you. [laughter] So I prefer to use just "psych," and then
the imagination of everyone can finish the word as they want.
It's like if we engage in this conversation about entheogen, hallucinogen,
it's very complicated for my simple mind to get involved in this kind of
debates. But for answering your other question, well, I'm in love
with this questionnaire, with the Temperament and Character Inventory,
and I think that the questionnaire explains a lot of things if you
make some dive into it. There are a lot of studies with different
clinical populations and with different kind of treatments that
conclude that this scale...I will talk tomorrow a little more deep
of this aspect, and I try also presentation more enjoyable,
in order to not get bored to the public, but these personality traits
of directness explain a lot of things in the combination with other
dimensions of the questionnaire. One of the things it may explain is
the therapeutical change. If you see that people get better in
that trait, maybe it is because there have been more profound change
in the personality because this is a trait that depends of the culture,
and depends of the relationships with other people
and the relationship with environment.
So to see changes in...low self-directedness, by example,
explain more than 70 or 80% of the addiction problems. When you
administer this questionnaire to people with addiction problems,
they consistently have lower scores in self-directedness.
This is in contradiction with the benefits that it seems that
ayahuasca induces when it is used in the context of ayahuasca religion.
But I think that have some... the explanation is that maybe people
is not so care of himself, and feels like a part of the community.
So this may be a reason to find low scores in this dimensional,
in this personality trait. The problem will be if we obtain lower scores
in this personality trait in people that is not engaged in some kind of
community, because that is the explanation why becomes the problems.
To have a low self-directedness, a low capacity to be autonomous
in life, because they have now the support of the group. I don't know
if I have answered to your question, but I try to do the best.
Okay, we're almost out of time anyhow, so maybe what, unless
there's any final questions... okay, thank you, Jose.
[applause]
[Presented by The Beckley Foundation]
[Council on Spiritual Practices]
[Heffter Research Institute]
[Multidisciplinary Association for Psychedelic Studies (MAPS)]
[More videos available at psychedelicscience.org]