Ayahuasca and the Treatment of Drug Addiction: Evidence and Proposals – José Carlos Bouso

[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
cocaine 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 cocaine dependence,
8% from crack dependence, and 5% from other substance dependence,
as MDMA, solvents, LSD and heroin. 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]