Associations between ayahuasca consumption in naturalistic settings and current alcohol and drug use: Results of a large international cross-sectional survey

This cross-sectional survey study (n=8269) investigates associations between ayahuasca consumption in naturalistic settings and the use of alcohol and other drugs across 40 different countries. Ayahuasca use was both strongly and consistently associated with very low (or even abstinence from) drug or alcohol use, with and without prior substance use disorders.

Abstract

“Introduction: Emerging evidence suggests that psychedelic compounds, including the Amazonian botanical decoction ayahuasca, may provide clinical benefit in the treatment of alcohol or other drug use disorders. This study investigates associations between ayahuasca consumption in naturalistic settings and current alcohol and other drug use.

Methods: Online cross-sectional study of people who have consumed ayahuasca in religious, traditional and non-traditional settings in over 40 countries. A total of 8629 participants (53% male, average age 40 years) were included in the analysis. Logistic regressions were used to explore associations between ayahuasca drinking variables and the current use of alcohol and other drugs, as well as the influence of confounding factors, such as church or community membership.

Results: The number of times ayahuasca had been consumed was strongly associated with increased odds of never or rarely drinking alcohol, never or rarely engaging in ‘risky drinking’ and having not consumed a range of drugs in the past month, with these effects greater for those with a prior substance use disorder compared to those without. The strength of ayahuasca drinkers subjective spiritual experience, number of personal self-insights obtained and drinking ayahuasca with an ayahuasca church were also associated with lower substance use in some models.

Discussion and Conclusions: Consumption of ayahuasca in naturalistic settings is associated with lower self-reported current consumption of alcohol and other drugs for those with and without prior substance use disorders, with such effects present after adjusting for religious or social group effects.”

Authors: Daniel Perkins, Emerita S. Opaleye, Hana Simonova, José C. Bouso, Luís F. Tófoli, Nicole L. GalvÃo-Coelho, Violeta Schubert & Jerome Sarris

Summary

A large international cross-sectional study of people who have consumed ayahuasca in religious, traditional and non-traditional settings found that ayahuasca consumption was associated with lower self-reported current consumption of alcohol and other drugs for those with and without prior substance use disorders.

Introduction

After many decades of inattention, a resurgence of interest is now underway in the potential clinical application of various psychedelic substances for the treatment of mental health and substance use disorders.

There is strong interest in the use of psychedelic compounds in addiction treatment, with studies identifying significant improvements in tobacco and alcohol dependence, as well as improvements in dependence symptoms in human studies.

Ayahuasca is a traditional botanical decoction of two South American plants containing DMT and harmala alkaloids. It has been used as a medicine by indigenous groups in South America for centuries.

Ayahuasca churches are structured religious organisations that use ayahuasca on a regular ongoing basis in all usual services. Studies have reported no adverse impacts on neuropsychological functioning and apparent positive effects on mood and wellbeing, in addition to reduced problematic substance use.

The classic psychedelics, such as DMT and psilocybin, modulate the serotonergic, dopaminergic and glutamatergic systems, promote structural and functional plasticity in the pre-frontal cortex, and cause agonism at the 5-HT2C receptors. Ayahuasca may also have anti-addictive effects through its harmala alkaloids and its community context.

This study uses the largest dataset ever collected relating to ayahuasca drinking to explore associations between ayahuasca consumption and participants current use of alcohol and other drugs, and the extent to which this may be influenced by patterns of use, aspects of the acute subjective experience and potential confounding factors.

Study design

Data were collected from 10 836 ayahuasca drinkers in five countries via email, Facebook and websites. Only participants who provided responses to at least one of the alcohol and drug items in the survey were included in the analysis.

Demographic data were collected, including age, education and country of residence. Subjective spiritual experience was assessed using the Persisting Effects Questionnaire (PEQ-S) and an adapted version of the Short Index of Mystical Orientation (SIMO) scale.

Several customised questions were developed from the ayahuasca literature, including a question about the number of self-insights experienced during an ayahuasca session, and a question about the extent to which extreme fear or panic had been experienced during an ayahuasca session.

Respondents were asked to identify any mental health diagnoses, including alcohol dependence/ abuse and drug dependence/ abuse, as well as any emotional or psychological ‘integration difficulties’ in the weeks or months after drinking ayahuasca.

Statistical analyses

Pearson’s 2 test and independent samples t-test were used to assess differences between categorical and continuous variables. Multivariate models utilised binary logistic regressions and were performed using STATA 16.

Sample characteristics

Respondent characteristics are reported for both groups, with a greater proportion of males and high levels of university education in the latter group. There are several differences revealed between respondents who had last drunk with an ayahuasca church and those who had drunk in other contexts.

Current alcohol and drug use

Ayahuasca consumption was associated with lower odds of rarely/never drinking alcohol, rarely/never engaging in risky drinking and having no recent consumption of any drugs. This association was strongest for individuals without a prior alcohol or drug use disorder.

A higher rated subjective mystical experience was associated with a lower odds of recent drug use for people with and without a prior drug use disorder, respectively. However, a lower SIMO score was associated with a lower odds of recent drug use for people with a prior drug use disorder.

The most consistent association between ayahuasca drinking variables and current drug use was for the number of times ayahuasca had been consumed, with the strongest association present for cocaine. The PEQ-S and number of self-insights attained were also negatively associated with recent use of cannabis and cocaine.

There were significant negative associations between drinking with an ayahuasca church and recent use of five of 11 individual drugs, and experiencing extreme fear was associated with slightly reduced odds of recent cannabis and LSD use.

We found that people with a prior DUD had stronger negative associations between times consumed and current drug use than people without a prior DUD for all drugs except magic mushrooms.

Discussion

Ayahuasca consumption is strongly associated with the likelihood of never or rarely drinking alcohol, never or rarely engaging in risky drinking, and not having consumed a range of drugs in the past month.

Ayahuasca drinking with an ayahuasca church was strongly associated with lower current alcohol and drug use for those with a prior AUD or DUD, and modest associations were found between the number of self-insights attained and current drug and alcohol use.

Our findings suggest that ayahuasca use may have anti-substance use effects, and are consistent with those reported in several smaller studies. It is unclear to what extent these effects are related to ayahuasca consumption per se versus broader group membership and social connection benefits.

This study has several strengths, including a large sample, cross-cultural sampling frame, and self-reported data, but also several limitations, including no data relating to historical alcohol and drug use, and no data relating to prior diagnoses of alcohol and drug use disorders and other mental health conditions.

Conclusion

This study identified a strong negative association between the consumption of ayahuasca and low current use of alcohol and other drugs, even after adjusting for ayahuasca church and community membership.

Acknowledgements

JS and NLGC are supported by a Clinical Research Fellowship from the National Health and Medical Research Council and the Brazilian Ministry of Education.