© 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.