Tag Archives: ayahuasca

10/18/22

Back to the Future with Psychedelics

© Zhuxi1984 | Dreamstime.com - Back To The Future Photo

© Zhuxi1984 | Dreamstime.com – Back To The Future Photo

“I am 100 percent in favor of the intelligent use of drugs, and 1,000 percent against the thoughtless use of them, whether caffeine or LSD.” (Timothy Leary, in Chaos and Cyber Culture)

We’re going “back to the future” with recent research into the therapeutic benefits of hallucinogens for treating alcoholism and mood disorders. (See additional stories here and here; and a previous blog, “As Harmless as Aspirin?”) Classical hallucinogens such as LSD, mescaline or psilocybin, and dissociative anesthetics such as ketamine and PCP might be “useful” in the treatment of major depression, anxiety disorders and OCD. A recent study concluded: “There was evidence for a beneficial effect of LSD on alcohol misuse.” A single dose of LSD was found to be associated with a decrease in alcohol misuse. Another longitudinal study suggested that: “hallucinogens may promote alcohol and drug abstinence and prosocial behavior in a population with high rates of recidivism [with individuals on probation or parole].”

An issue of Current Drug Abuse Reviews (volume 6, number 1, 2013) was devoted to the investigation of psychedelics and their potential as therapeutic agents in the treatment of addiction. Several different articles suggested the therapeutic benefits of a variety of psychoactive substances—some classics and some newer ones.

Rick Doblin, in “Psychedelic-Assisted Psychotherapy for the Treatment of Addiction,” said: “There are multiple frameworks for understanding how psychedelic therapy can alleviate substance abuse.” He noted that the idea that psychedelics can be helpful in combating drug abuse conflicts with “the notion that psychedelic drug use is inherently wrong.”

Michael Bogenschutz of the University of New Mexico Health Sciences Center suggested that sacramental use of classic hallucinogens, like the Native American Church’s use of peyote, “is strongly associated with decreased alcohol and drug use.”

Lisa Jerome and others lobbied for studies that tested MDMA-assisted psychotherapy in people with an active substance use disorder. “It appears that MDMA, like classic psychedelics, may have a place in addressing substance abuse or dependence, which could be linked to its pharmacology or its psychological effects.”

Ayahuasca, a psychotropic brew prepared from an Amazonian vine and bush, may be associated with reduced substance use and “improvements in several cognitive and behavioral states.”

Thomas Kingsley Brown reported that ibogaine, a psychoactive alkaloid found in a rainforest shrub of West Central Africa, helps with withdrawal symptoms and reduces drug cravings.

A study of ayahuasca-assisted treatment for substance use problems by Gerald Thomas and others suggested that it was associated with significant improvements in several factors related to problematic substance use. While this particular study occurred in Canada, ayahuasca has been used as a remedy to help overcome drug addictions in Peru and Brazil. “Although these programs claim improved health outcomes for patients who complete them, neither has been evaluated with sufficient scientific rigor to provide definitive evidence of the success of their approaches.”

Ibogaine is not used in the US to treat addiction because of its severe side effects, which include hallucinations, bradycardia (slow heart rate), whole-body tremors and ataxia (lack of muscle control during voluntary movements). It also had cerebellar toxicity with high doses in rats. Nevertheless, it is a growing form of treatment outside the US. A subculture of ibogaine clinics has sprung up in Mexico. Read about a trip to one here.

A synthetic derivative of ibogaine, 18-MC, has been developed and is said to show promise. It resulted in “a long-lasting decrease in ethanol, morphine, cocaine, methamphetamine and nicotine self-administration [in rats], and attenuation [decrease] of opioid withdrawal symptoms.” Significantly, it is not expected to have hallucinogenic effects and does not have the negative side effects noted above with ibogaine.

In 2012 Savant HWP, a privately-owned pharmaceutical company in California, received a three-year grant from the National Institute on Drug Abuse (NIDA) for the pre-clinical development of 18-MC. Stanley Glick, the scientific founder of Savant and a long time researcher with ibogaine, said: “18-MC is likely to be the first of a new generation of agents effective against a broad spectrum of addictions—from hard drugs such as heroin and cocaine, to alcohol, nicotine and even sugary, high-fat foods, possibly reducing obesity rates.” On September 23rd of 2014 Savant announced they had begun human safety clinical trials on 18-MC. “Savant HWP plans to develop 18-MC as a treatment for many forms of addiction and compulsive behavior, with an initial focus on cocaine and opiate dependencies.”

The so-called “psychedelic treatment” approach, based on the original work of Humpry Osmond, uses pre and post therapeutic sessions and one large dose of your hallucinogen-of-choice (LSD, ayahuasca, psilocybin, mescaline). The spiritual, therapeutic goal is captured here by Aldous Huxley’s description of his experience with mescaline in The Doors of Perception:

The man who comes back through the Door in the Wall will never be quite the same as the man who went out. He will be wiser but less cocksure, happier but less self-satisfied, humbler in acknowledging his ignorance yet better equipped to understand the relationship of words to things, of systematic reasoning to the unfathomable Mystery which it tries, forever vainly, to comprehend.

But we should also remember the warnings of Albert Hofmann, the inventor of LSD, who cautioned not to underestimate the potential negative consequences of a deliberate provocation of mystical experiences with hallucinogens like LSD. “Wrong and inappropriate use has caused LSD to become my problem child.” In the “LSD state” the boundaries between the self and the outer world effectively disappear. “A portion of the self overflows into the outer world. . . . This can be perceived as a bless[ing], or as a demonic transformation imbued with terror.”

 

Originally posted on December 22, 2014.

05/17/22

Shamanistic Healing with Ayahuasca

Shaman in Ecuadorian Amazonia during a real ayahuasca ceremony, as seen in April 2015; © ammit | 123rf.com

Ayahuasca had (has?) a Hollywood connection. Celebrities like Jim Carrey, Lindsay Lohan, Chelsea Handler and others took the ayahuasca train for reasons as varied as personal enlightenment and telepathic experience. Celebrity interest in ayahuasca dates back to William Burroughs, who said the effects of yage (ayahuasca) were indescribable. “It is the most powerful drug I have ever experienced. That is, it produces the most complete derangement of the senses.”

The above quote is found in “The Yagé Aesthetic of William Burroughs,” the PhD Thesis of Joanna Harrop. She noted how The Yage Letters, published ten years after his own search for ayahuasca, did not include these comments. Perhaps Burroughs telepathically anticipated the actions that would later classify ayahuasca’s psychedelic ingredient, DMT (dimethyltryptamine), as a Schedule I controlled substance and intentionally left out those comments. Harrop noted that in his correspondence Burroughs seems to think of yage was a secret Cold War weapon. He said, “I know the Russians are working on it, and I think U.S. also. Russians are trying to produce ‘automatic obedience,’ have imported vast quantities of Yage for experiments on slave labor.”

While some follow Burroughs in his journey to the South American rainforests in search of their ayahuasca ritual, others simply fly a shaman in to L.A. from the Amazon River region to perform an ayahuasca ceremony. Because DMT is illegal in the U.S. these ceremonies are “invite-only.” You have to be vetted beforehand and show you’re serious about having the experience. In 2015, it was said: “On any given L.A. night, there are 50 to 100 circles being conducted.”

Scientific Studies of Ayahuasca for Healing

Yet there are also scientific studies being done to determine if ayahuasca can treat or heal depression, anxiety, PTSD and alcohol abuse. Scientists are also exploring how DMT alters the user’s waking brain-wave patterns, producing an experience that has been described as “dreaming while awake.” A study published in Scientific Reports by Timmermann et al found that immersion in the DMT state led to marked decreases in the user’s brain-wave patterns. Ars Technica said the subjects were fitted with EEG caps and electrodes to monitor their brain activity while being given an infusion of DMT. “The team found that the DMT caused a marked drop in alpha waves, a mark of wakefulness, along with a corresponding brief increase in theta brain wives, indicative of a dream state.”

These researchers also found there was more chaotic brain activity in subjects who were under the influence of DMT. They speculated this may explain why ayahuasca users report more vivid visual effects and a greater sense of immersion in the psychedelic experience. The lead author of the study, Christopher Timmermann, said: “From the altered brainwaves and participants’ reports, it’s clear these people are completely immersed in their experience—it’s like daydreaming only far more vivid and immersive, it’s like dreaming but with your eyes open.”

Co-author Robin Carhart-Harris said it was hard to capture and communicate what it is like for people experiencing DMT, comparing it to dreaming while awake or near-death experiences. “Our sense is that research with DMT may yield important insights into the relationship between brain activity and consciousness, and this small study is a first step along that road.”

A Brazilian study sought to assess the impact of ceremonial use of ayahuasca on alcohol and tobacco use disorder. Barbosa et al recruited 1,947 members of UDV—Uniã do Vegetal— from 10 states from all the major regions of Brazil. “Current use disorders for alcohol and tobacco were significantly lower in the UDV sample than the Brazilian norms.” This difference was even greater when UDV membership was more than 3 years.

We also found that ayahuasca use variables—ceremonial attendance during the previous 12 months and years of UDV membership—were much stronger predictors of reduced alcohol and tobacco use disorders and use during the previous 12 months than were the SES variables age, gender and level of education.

An another mostly Brazilian study by Palhano-Fontes et al of the therapeutic potential of ayahuasca on depression found evidence of rapid antidepressant effect after a single dose of ayahuasca when compared to placebo. The researchers noted that the severity of depression changed significantly, but differently for the ayahuasca and placebo groups. A review of the study in Mad in America by Hanna Emerson commented how the researchers noted a high placebo rate in their study—46% on day 1 and 26% on day 7. Their hypothesis was that the high placebo response was potentially associated with the ‘care effect,’ the comfortable and supportive environment experienced by participants in the study who were from low socioeconomic populations.

While all of the 29 participants reported feeling safe in the study, some participants reported it was not necessarily a pleasant experience. Some reported the experience was accompanied by a good bit of psychological stress. Most reported experiencing nausea and about 57% vomited. “Although vomiting is traditionally not considered a side effect of ayahuasca, but rather part of the purging process.” All participants were naïve to ayahuasca, with no previous experience with any other psychedelic substance.

The researchers touted their study as the first randomized placebo-controlled trial to investigate the antidepressant potential of a psychedelic with treatment-resistant depression. Because of the unique effects of psychedelics, a major challenge of the research was maintaining double blindness. They thought the additional measures taken in the study, including the use of an active placebo that increased anxiety and induced nausea, adequately preserved blindness in their study. But I wonder if that judgement was just wishful thinking on the part of the researchers. How do you truly double blind something with unique effects?

Uthaug et el concluded the drug was no better than a placebo. In order to understand the role of set and setting on psychological effects observed after participating in an ayahuasca ceremony, a naturalistic, placebo-controlled observational study was done. The researchers hypothesized that set and setting would impact both groups, but the pharmacological effects would only be seen in the ayahuasca group. Set referred to the intentions, mood state and expectations of the individual taking part in an ayahuasca ritual, and setting referred to the context in which the ceremony takes place.

A review of the study on Mad in America by Peter Simons observed that there was no difference between the ayahuasca group and the placebo group on outcome measures of anxiety, depression or stress. This suggested an important role for the set and setting of the ayahuasca ceremony itself. The researchers in Uthaug et al said:

Together, ratings of the psychedelic experience in the present study indicate that participants in both groups experienced altered states of consciousness during the ceremony and that the strength of the mean experience was low, with individual experiences ranging from absent to strong.

Participants in the study had extensive previous experiences with ayahuasca and may have developed personal sets of expectations and intentions. They speculated that repeated participation in ayahuasca ceremonies might stimulate learned associations with enhanced well-being, “which are memorized and experienced even when assigned to a placebo group.”

The present study primarily focused on the general impact of set and setting per se. In this context, it should also be noted that for many indigenous traditions, it is not necessary for the participants to consume ayahuasca. The belief held is that the shamans perform their work to aid those in the ceremony, even if they have not consumed the brew. [emphasis added]

The Shamanic Origins of Ayahuasca

Evidence of ayahuasca use can be dated back 1,000 years. In the 16th century, missionaries from Spain first encountered indigenous people using ayahuasca in the western Amazonian basin. Their earliest reports described it as “the work of the devil.” Its transition from an indigenous South American healing ritual, to fashionable Hollywood “circles” and a potential treatment for various mental health conditions was facilitated by William Burroughs, his book The Yage Letters, a Chilean psychiatrist and the Esalen Institute.

When he was travelling through South America, Burroughs read a paper by an American ethnobiologist, Richard Evan Schultes, who is known for his studies of the use of plants, especially hallucinogenic plants, found in Mexico and the Amazon. Burroughs then sought ayahuasca in hopes that it could cure or relieve his opiate addiction.  It did not cure his addiction to opiates, but it did lead to the publication of The Yage Letters.

A Chilean psychiatrist and self-proclaimed shaman named Claudio Naranjo convinced Schultes to permit him to travel up the Amazon with him in order to study ayahuasca with indigenous tribes. Naranjo brought back samples and eventually published the first scientific description of the effects of ayahuasca in 1967. In the U.S., he became a close friend of Carlos Castaneda (author of The Teachings of Don Juan), and worked with Fritz Perls, the originator of Gestalt therapy, as part of the early Esalen Institute community. He returned to Chile and began research into psychopharmacology. Afterwards he wrote The Healing Journey, originally published in 1973. Naranjo dedicated this book was to Franz Hoffman, “who sponsored my career as research psychiatrist in psychopharmacology and shamanism.”

Stanislav Grof, a well-known name in the psychedelic community, wrote the Foreword to The Healing Journey. In 1970 he presciently said that with the increasing knowledge of the nature and emotional dynamics of psychosomatic disorders, it became obvious there would be no overnight cure in the form of a new miraculous antidepressant agent. But he thought two independent streams seemed to have promise—the use of chemical agents with psychotherapy and the development of “new experimental psychotherapeutic techniques.”

Claudio Naranjo is an outstanding representative of both of these streams, and his synthesis of drug-assisted psychotherapy and the new experimental techniques seems to offer an interesting approach to the problem of brief therapy. . .  [His] experience with psychoactive substances is even more impressive than his work with new psychotherapeutic techniques. Over the years, he has experiments with more than thirty compounds—mostly psychedelics and amphetamine derivatives—as adjuncts to psychotherapy. He made a special canoe journey up the Amazon River to connect with South American Indians and study their use of ayahuasca or yage.

Naranjo is the embodiment of the shaman-psychiatrist, combining psychedelics with psychotherapy to promote his sense of healing. His last talk, given six weeks before his death in 2019 was titled “The relevance of ayahuasca in the problems of the world.” After an extended discussion of civilized culture, original sin, and the patriarchal order, he turned to ayahuasca. He then described some of his experiments in Chile.

There was group of people who were naïve to the culture of indigenous peoples, who didn’t know what they were taking. They would start seeing birds and snakes and other “typical indigenous images of ayahuasca, which are depicted in the ceramics of the South American peoples.” He convinced himself this was something like what Carl Jung called the archetypical world. He thought the most striking phenomenon in ayahuasca was not the appearance of the animal aspect, the personification of the primitive. “What’s striking about ayahuasca is a change of attitude toward the animal.”

We have transformed some animals into terrible animals, but clearly the terrible is a part within ourselves. But there is the potential of recognizing another type of animality that is sometimes called a power animal or a sacred animal. I don’t think that this is a strange phenomenon of ayahuasca, because one of the pillars of psychotherapy was the Freudian ambition of decriminalized instincts. It’s not usually achieved. Other things are much more easily achieved. The depth of the original sin leaves a really deep imprint in us. So we feel bad because we carry a life of instincts. So it’s quite rare to have this phenomenon, which we sometimes easily see in ayahuasca. One of my first voluntary subjects, a woman, came across a Siberian tiger, a white tiger, and the tiger then became her guide. She’s now older, she’s my age, and she still feels that the tiger is her spiritual guide.

We are at a time when mental health professionals are being challenged to seriously investigate the supposed scientific potential of various psychedelics like ayahuasca, MDMA and psilocybin for conjoint use with psychotherapy. We should also become aware of the long association of psychedelics with shamanistic healing rituals and the clearly unscientific explanations of their power. Is the discussion of dramatic healings with ayahuasca and other psychedelics just a description of a shamanistic healing ritual couched in scientific rhetoric? While further study is needed, it seems to me that the placebo effect of the ceremony, not the psychedelic compound itself, is the significant factor in reported therapeutic changes with ayahuasca.

For more information on Claudio Naranjo, see “Is the Enneagram Spiritually Neutral? Part 2 and Part 3.

06/11/19

Vine of the Spirits

© martinak | 123rf.com; Ayahusaca tea & ingredients

The Hollywood Reporter described a trend emerging over the past few years in Hollywood—ayahuasca ceremonies. It appeared as part of the plot in the 2014 movie, While We Were Young, with Jennifer Aniston, Naomi Watts and Ben Stiller. The website Ranker, in “Celebrities Who have Tried Ayahuasca,” said stars like Paul Simon, Chelsea Handler, Jim Carrey, Tori Amos, Lindsay Lohan, Sting and others have taken the “yage” plunge. Described as a muddy tea, the active ingredient in ayahuasca is one of the world’s most potent psychedelics. Derived from a vine harvested in Peru and Brazil, it has been used for spiritual ceremonies for centuries and apparently  it wants to be more widely used. A Hollywood psychiatrist that hosted a yage ceremony said: “The plants told them [shamans leading the ceremonies] Hollywood’s a good place to get the word out.”

Despite its faddish use today, it was originally described by 16th century Christian missionaries from Spain and Portugal who encountered South Americans using ayahuasca. The missionaries described it as “the work of the devil.” It was also sought out by William Burroughs in the early 1950s. Burroughs had hoped ayahuasca would relieve or cure his opiate addiction. His experience became the basis of a 1963 novel he co-wrote with Allen Ginsburg called The Yage Letters. Traditional use by shamans led to native religions forming around ayahuasca rituals in the 1930s. In Brazil ayahuasca has had a legal status for ritual use since 1987.

Ayahuasca is a combination of chacruna leaves and the bark of the Banisteriopsis caapi vine, or caapi. “Aya” contains DMT (dimethyltrytamine), a powerful psychedelic. It is illegal in the U.S. and classified as a Schedule 1 drug. Its acute effects last about four hours and include intense perceptual, cognitive, emotional and affective experiences. After about forty minutes the visions begin, but they are not always “Go Ask Alice-White Rabbit” experiences. An Emmy-winning television producer said:

The first thing you see is often your worst fear come to life. . . . Mine was Holocaust horror. Another time I saw a 50-foot black widow spider — my fear of death manifesting. It illuminates the dark of your subconscious, and like a horror movie, once you see it, it no longer scares you.

Other visions were less intense. One person saw what looked like a Star Wars set: “dragonflies, sparks of light, plants, stars — everything moving. You go into it asking Mother Ayahuasca a question, then she shows you what you need to know.” Another person said: “I saw a spaceship the first time, then a machine with little gears and fobs. ‘This is how the universe works,’ a woman’s voice told me. The more you do it, the less anxiety you have. It lifts us out of the isolation everyone feels, particularly in Los Angeles.” But a Hollywood internist named Gary Cohen wasn’t convinced:

Ayahuasca contains chemicals found in SSRI antidepressants like Prozac and dangerous, older MAO-inhibitor antidepressants like Parnate. There are potential serious side effects, both with other drugs and food. Foods that contain tyramine — alcohol, cheese, meat, chocolate — can theoretically interact with ayahuasca to cause severely elevated blood pressure, resulting in strokes and extremely high body temperatures, which can cause death. I strongly advise my patients against using it recreationally or ‘spiritually.’

A handful of deaths have been reported, particularly those with heart ailments and high blood pressure. An 18-year old California teen seeking spiritual rebirth in 2012 was buried at the center in the Amazon jungle where he took the drug. “His shaman was convicted of homicide and sentenced to five years in prison.” The stories of transformation tend to hook interested individuals into trying it. “The rise of festival culture, Burning Man, plus technology — it’s all making everyone desire a deeper place.”

There has been some research into the effects of Ayahuasca. A paper was published in Psychological Medicine. The researchers conducted a double-blind randomized placebo-controlled trial of 29 (14 received ayahuasca; 15 received the placebo} patients with treatment-resistant depression. They found a rapid antidepressant effect after a single dosing session with ayahuasca when compared to placebo. The authors concluded: “This study brings new evidence supporting the safety and therapeutic value of ayahuasca, dosed within an appropriate setting, to help treat depression.” The study was registered at http://clinicaltrials.gov (NCT02914769).

We found evidence of rapid antidepressant effect after a single dosing session with ayahuasca when compared with placebo. Depression severity changed significantly but differently for the ayahuasca and placebo groups. Improvements in the psychiatric scales in the ayahuasca group were significantly higher than those of the placebo group at all time points after dosing, with increasing between-group effect sizes from D1 to D7. Response rates were high for both groups at D1 [day 1] and D2 and were significantly higher in the ayahuasca group at D7. Between-groups remission rate showed a trend toward significance at D7.

I would suggest there are several issues with the study. First is the washout period of 2 weeks, meaning any patients using antidepressants were rapidly tapered off them two weeks before the study. This was to ensure antidepressant medication was no longer present in the patient’s body. However, because of the rapidness of the taper the patients will likely have experienced antidepressant discontinuation syndrome (withdrawal) and a rebound of their negative mood, confounding the assessment of depression.

This short maximum time—seven days—for assessing the antidepressant effects is another limitation of the study. Ketamine, another medication with rapid antidepressant effects and psychedelic effects, has been shown to fade rapidly and require frequent, repeated treatments. The positive effects (or evidence of fading effects) ayahuasca may have on the patients beyond seven days is not known since antidepressant treatment is resumed at that point. Then there is the context of the ceremony itself.

Neuroskeptic reviewed the study on his blog, stating it revived some long-standing questions. He did think it was a promising, well-designed study, however. One of the qualities he pointed out was how the placebo brew looked, tasted and smelt like the real thing. He noted where Palhano-Fontes et al. concluded that while no serious side effects occurred, “the ayahuasca session was not necessarily a pleasant experience.” He thought the antidepressant effects were themselves a kind of placebo response—”the ayahuasca caused powerful psychedelic effects, such as ‘altered perception’ and ‘transcendence.’”

Such potent subjective experiences could lead patients to have confidence in the treatment and thus drive placebo effects, if combined with expectations that ayahuasca will be beneficial. A profound experience could trigger improvement in other ways, as well, such as by giving patients a new perspective on their own mental state.Now, in the case of ayahuasca, this ‘psychological’ interpretation of the antidepressant effect is not necessarily a problem. I think most people (including the traditional ayahuasca users) already assume that the psychedelic experience is part of the therapeutic process.

But it does raise the possibility the positive effects are not due to the ayahuasca itself. As the researchers themselves said, ayahuasca is not a panacea.

Three of the study’s authors described their study on The Conversation. They said it was the first randomized, placebo-controlled clinical trial of ayahuasca, which means “the vine of the spirits” in the Quechua language. They began by recruiting 218 patients with depression. The twenty-nine selected for the study had treatment-resistant depression and no history of psychiatric disorders like schizophrenia, “which ayahuasca may aggravate.” Although the sessions took place in a hospital, the space used was designed like a quiet and comfortable living room.

One day afterwards, 50% of all patients were significantly improved, including reduced anxiety and improved mood. After a week, 64% of the patients who just received ayahuasca felt their depression had eased. They also noted that because ayahuasca is illegal in many countries, its therapeutic value is difficult to test. Even in Brazil, using ayahuasca to treat depression remains a fringe, informal endeavor. They cautioned that ayahuasca was not a panacea or cure for depression.

Such experiences may prove too physically and emotionally challenging for some people to use it regularly as treatment. We have also observed regular ayahuasca users who still suffer from depression.

Another of the study’s authors pointed out the media interest given to ayahuasca as a potential “cure” for addiction and depression and said maybe it is, but “it’s too soon to tell.” He cautioned against such a conclusion. Acknowledging the power of the placebo effect, he said, “It is not currently possible to conclude that the observed effects were really caused by ayahuasca, or that ayahuasca can ‘cure’ depression.” He also seemed to agree with Neuroskeptic, that the powerful psychedelic effects were a kind of placebo effect: “By helping us find the sacred within us, its psychoactive power seems to hold therapeutic potential as an alternative way to address common disorders that modern medicine has thus far found difficult to treat.” He concluded by saying we’ll have to wait and see what the science says.

For more on ayahuasca, go to: “Ayahuasca Anonymous,” Part 1 and Part 2.

05/8/18

Ayahuasca Anonymous, Part 2

© martinak |123rf.com – ayahuasca, traditional shamanic plant medicine.

MDMA-assisted psychotherapy has been designated as a breakthrough drug treatment for PTSD by the FDA. Ketamine has been widely touted as a treatment for depression and its biochemical “mirror image,” esketamine, has been designated as a breakthrough treatment for depression. Johnson and Johnson hopes to file an FDA application for the approval of esketamine by the end of 2018. The tide of the alleged therapeutic benefits of hallucinogens is rising. As we saw in Part 1 of this article, another psychedelic known as ayahuasca is being put forth as a potential treatment for alcoholism and drug addiction. So let’s take a closer look at ayahuasca use and its effects.

In Part 1 of Ayahuasca Anonymous we looked at the findings of a study by Lawn et al. published in Scientific Reports on the potential ayahuasca has as a treatment for alcoholism and found its claims questionable. But psychedelics are the newest fad in psychiatric treatments and I suspect we haven’t heard the last of research into the potential benefits of ayahuasca for alcoholism and drug addiction. So what is it, and how does it work?

Ayhuasca is a psychoactive tea brewed from the Amazonian vine Banisteriopsis caapi and leaves of the bush Psychotria viridis. Taken together, the combination allows the hallucinogen in Psychotria viridis, dimethyltryptamine (DMT), to activate. This induces “several hours of a dream-like altered state of consciousness characterized by intense visual, auditory, ideational and emotional effects,” according to Thomas et al. in “Ayahuasca-Assisted Therapy for Addiction.” As a result of increased tourism to the Amazon, ayahausca drinking has become a transnational phenomenon. Itinerant ayahuasqueros (individuals trained to administer ayahuasca in the traditional Amazonian healing ritual) have been conducting rituals in Europe and North America.

According to Fábregas et al. in “Assessment of addiction severity among ritual users of ayahuasca,” Brazilian churches that use ayahuasca in their rituals have faced legal proceedings in recent years as they expanded into Europe and North America. This was due to DMT being classified as a controlled substance in several countries. The US DEA scheduled DMT as a Schedule I Controlled Substance in 2011. It is a Class A drug, along with heroin, LSD and MDMA in the UK and a Schedule III drug in Canada, making it illegal. In Canada you can face up to ten years in jail if you are found guilty of trafficking ayahuasca.

Both Thomas et al. and Fábregas et al. noted that ritual ayahuasca use does not seem to lead to addiction. Fábregas et al. speculated this was due to DMT acting on serotonergic neurotransmitters within the so-called “neural reward circuit” of the brain instead of the dopaminergic neurotransmitters activated by of drugs of abuse. Ethnographic research also challenged the classification of ayahuasca as an addictive substance. “Furthermore, the therapeutic use of ayahuasca in indigenous traditional medicine is socially sanctioned and politically tolerated in Bolivia, Ecuador, and Colombia.” In Peru, it has been declared part of the national cultural heritage.

Thomas et al. noted where ayahuasca is used within a therapeutic community setting in Tarapoto Peru to help overcome drug addiction. Similarly, a treatment program in Brazil combines the ritualistic use of ayahuasca with psycho-social rehabilitation methods. “Although these programs claim improved health outcomes for patients who complete them, neither has been evaluated with sufficient scientific rigor to provide definitive evidence of the success of their approaches.” The researchers sought to apply ayahuasca-assisted group therapy to a population of First Nations and Aboriginal peoples in Canada. “We posited that this novel form of therapy could enhance the ability of participants to make conscious healthy choices and resist unhealthy urges by eliciting improvements in several attributes related to problematic substance use.”

They found that the ayahuasca retreats correlated with improvements with several cognitive and behavioral states, which they hypothesized would be positively related to recovery from problematic substance use. Participation was also related to improvements in quality of life. The findings suggest this novel form of treatment may facilitate reduced cocaine use and other positive health changes.

The changes in substance use reported by participants by the end of the study period—that is, that cocaine, alcohol and tobacco use declined, whereas cannabis, sedative and opiate use did not—may reflect the fact that in some cases the latter substances were medically prescribed. Some participants reported being in a methadone maintenance program (which was not a criterion for exclusion from the study) and others reported using medical cannabis under the recommendation of a physician. Of note is the fact that cocaine and alcohol were identified as the substances of primary concern by the majority of participants.

The authors noted how the limited number of study participants (18) and the absence of any matched controls means it was “impossible to assign direct causality to the treatment or to determine whether the findings may be generalized to other populations.” The study was not designed to assess the relative effects of the various other aspects of the retreats besides the use of ayahuasca. Also, it was possible that the intercultural bridging occasioned by the ceremonies may have introduced a positive, confounding effect to the retreats.  The connection between the Amazonian and North American indigenous peoples within the context of sharing an important ceremonial healing practice “may have had positive therapeutic effects on its own, independent of the ayahuasca drinking.” So it is not possible to generalize the results of the study to other first Nation peoples in Canada or other aboriginal peoples elsewhere.

Fábregas et al. studied members of several Brazilian ayahusaca churches from individuals living a community within the Amazon rain forest and from those living in an urban setting. The Addiction Severity Index (ASI) was used to assess potential drug abuse-related problems. Follow up studies were conducted after one year. The ayahuasca-using groups scored significantly lower on the ASI Alcohol Use subscale. At the one-year follow up those differences were still significant for the Amazon rain forest community of ayahuasca users, but not the urban group.

As with the Thomas et al. study, the cultural context of these ayahuasca users, all who were members of ayahuasca churches, limits the generalization of the reported positive results beyond the population studied. Significantly, the failure of the urban group of ayahuasca users to have a significantly lower ASI score after the follow up year was hypothesized to have been due to the member’s involvement with the church. This can be understood as suggesting the more isolated community of the Amazon rain forest group facilitated behavior leading to lower ASI scores. If so, the ayahuasca use could have simply been incidental to the findings of lower ASI scores. It could be that the ability to foster a closer community of church members within the Amazon rain forest group was the significant factor in maintaining lower ASI scores over the year, not the use of ayahuasca.

An addendum to the Thomas et al. study indicated the Canadian physician who initiated the ayahuasca-assisted group therapy in Canada was reprimanded and threatened with legal action by Health Canada if he continued his work with ayahuasca as an addiction treatment. An article in The Globe and Mail said the doctor would reluctantly comply with the order, as he didn’t want to break the law. He hoped to get permission to use it in a therapeutic context, but he did not receive it. The Health Minister ruled the Amazonian brew was “an illicit preparation of controlled substances” and even approving it for ceremonial use within a religious context would not be in the public interest.

Ayahuasca is illegal in the US, the UK and Canada. It’s positive effects were reported in two studies done with populations where the context of the healing ritual in which the drug was given likely had a significant placebo effect on its results. An international survey reviewed in Part 1 of this article found that alcohol consumption was reported to be minimally lower than Psychedelic [drug] Users—less than one point on the AUDIT, the Alcohol Use Disorders Identification Test. Its perceived lower potential for addiction is at least partly based on the likelihood of a participant in the ayahuasca ritual becoming nauseous and vomiting. I don’t think we’ll be seeing its widespread use in addiction treatment any time soon.

04/27/18

Ayahuasca Anonymous, Part 1

© ammit | 123rf.com; shaman during a real ayahuasca ceremony.

Researchers at the University of Exeter and University College London investigated whether a psychedelic drug traditionally used in religious rituals in the South American Amazon could be a treatment for alcoholism and depression. Previous studies had suggested a potential therapeutic benefit from ayahuasca. However, this was “the largest survey of ayahuasca users completed to date,” according to Joe Mellor for The London Economic. His TLE article concluded, as did the researchers, that this “Amazonian shamanic psychedelic brew” was a safe psychiatric medicine to treat alcoholism. But ayahuasca is an illegal psychoactive substance in the UK, Canada and the US.

The British study by Lawn et al. was published in the journal Scientific Reports. The researchers used data from the Global Drug Survey and found that ayahuasca users reported lower problematic alcohol use than individuals who took psychedelics like LSD or psilocybin. But both groups reported higher rates of problematic drinking than other respondents to the survey; and both groups would be considered to be hazardous drinkers according to AUDIT—the Alcohol Use Disorders Identification Test. “Importantly, all three groups [Ayahuasca Users, Psychedelic Users and Other Respondents] would meet the hazardous drinking criterion.”

AUDIT is a ten-item screening tool developed by the World Health Organization to assess alcohol consumption. Scores above 8 are considered to be hazardous. The Ayahuasca Users in Lawn et al. had a mean score of 9.41. The Psychedelic Users had a mean score of 10.33; and the Other Respondents had a mean score of 8.45. While ayahuasca users reported less problematic drinking over the past year than Psychedelic Users, they were higher than the Other Respondents.

Problematic drinking, as measured by the AUDIT, was less prevalent in ayahuasca users than the group using classic psychedelics. This is an interesting finding, as classic psychedelic users were similar to ayahuasca users in many other respects, and is concordant with previous observations of a reduction in substance use with regular ayahuasca use. However, ayahuasca users did show greater problematic drinking than non-psychedelic using respondents in the sample. Moreover, although the groups were statistically different on this variable, the mean differences were relatively small.

There was also a general pattern for ayahuasca users to have used recreational drugs in their lifetime and in the last month more than the Other Respondents. See Table 2 in the Lawn et al. study for data on eleven drugs for all three groups in the study. Comparing Other Respondents to Ayahuasca Users in Table 2 indicated significantly higher percentages for lifetime or past month use for cannabis, ecstasy, cocaine, amphetamines and heroin. The study suggested there was a lower potential for abuse with ayahuasca, “which speaks to its safety as an emerging treatment for depression, anxiety and drug addiction.” However, ayahuasca use produced a low urge to use the drug again and to take more of the drug while using.

Ayahuasca was rated as having stronger negative effects while high than LSD or magic mushrooms, and these differences were the largest observed. This may well be related to the well-known vomit-inducing effects it has. Interestingly, ayahuasca was rated as being stronger, but also less pleasurable. One might speculate that the ayahuasca experience is cultivated to be less about ‘pleasure’ and more about meaning, spirituality and learning, than LSD and magic mushrooms, which are frequently taken in a recreational way.

In a press release on the Lawn et al. study Dr. Lawn of University College London said their study lent some support to the notion that ayahausca could be “an important and powerful tool” in treating alcohol use disorders. He noted recent research demonstrated ayahausca’s potential as a psychiatric medicine, “and our current study provides further evidence that it may be a safe and promising treatment.” Senior author Celia Morgan of the University of Exeter agreed. She pointed to observational studies that “suggest that ayahuasca use is associated with less problematic alcohol and drug use.” She went on to say: “If ayahuasca is to represent an important treatment, it is critical that its short and long-term effects are investigated, and safety established.”

I don’t think the Lawn et al. study lends even limited support to the notion that ayahuasca has the potential “to be an important and powerful adjunct for the treatment of … alcohol use disorders” as the authors stated in their conclusion. In my article I am concentrating on the application of the study’s findings to alcohol use disorders and not depression, which it also examined.

First, look at the reported mean difference in AUDIT scores between Ayahuasca users (9.41) and Psychedelic Users (10.33) and Other Respondents (8.45). Their results met their original hypothesis, namely that Ayahuasca Users would have less problematic drinking over the past year than the Psychedelic Users. Their findings were statistically significant, but the difference was less than one point on the AUDIT!  Looking at the AUDIT self-report version linked above. That one point difference could reflect individuals reporting they drank alcohol 2-3 times a week versus 4 or more times a week; or drinking 7 to 9 drinks on a typical day of drinking versus 10 or more. It could also reflect a mean difference of individuals reporting they never drank six or more drinks on one occasion versus less than monthly—the next lowest option. The data gathered with self-reported AUDIT scores does not support the authors’ conclusion that ayahuasca could be an important or powerful treatment for alcohol use disorders.

If ayahuasca is used more widely to treat alcohol use disorder, its safety profile does need to be established. But it seems I have a different understanding of how ayahuasca use produced a “low urge” to use it again than was discussed in the study. The authors said this finding suggested ayahuasca has “a very low-abuse potential,” thus speaking to its safety as an emergent treatment for drug addiction. However the reason for its low abuse potential was apparently because of its adverse effects. Lawn et al. stated: “Ayahuasca was rated as having stronger negative effects while high than LSD or magic mushrooms, and these differences were the largest observed.”

I don’t see adverse effects like its “well-known vomit-inducing effects” as speaking to the safety of ayahuasca as an emergent treatment for drug addiction. I see vomiting as the logical reason why Ayahuasca Users in the study said it was less pleasurable and why they had a lower desire to use the substance again. The authors seem to be grasping at interpretive straws with their findings when they say: “One might speculate that the ayahuasca experience is cultivated to be less about ‘pleasure’ and more about meaning, spirituality and learning, than LSD and magic mushrooms, which are frequently taken in a recreational way.” The context of ayahuasca use is typically more about “meaning, spirituality and learning,” than pleasure. But the same would be likely to occur with a guided, healing experience of other psychedelic drugs like LSD. The simple, reasonable explanation for Ayahuasca Users in Lawn et al. having less pleasure and a lower desire to use the substance again is the greater experience of negative, adverse effects with ayahuasca.

Ayahuasca as a therapeutic agent in healing rituals is a novel approach to treating alcoholism and drug addiction. But investigating the potential for psychedelics like LSD as a treatment for alcoholism began back in the 1950s and even involved a cofounder of Alcoholics Anonymous, Bill W. Although Bill was enthusiastic about the therapeutic potential of LSD, he eventually withdrew from the research over concern his participation would compromise the future of A.A. Look at “As Harmless As Aspirin?” for more on this topic.

Nevertheless, as this study by Lawn et al. illustrates, the use of psychedelics like ayahuasca, LSD and MDMA are being explored and lauded as potential treatments for alcoholism, drug addiction, PTSD and other psychiatric/mental health issues. In part 2 of this article we will look closer at ayahuasca use and its effects.