Acute and enduring effects of naturalistic psychedelic use among Indigenous peoples in Canada and the United States

This survey study (n=66) explored the effects of naturalistic psychedelic use on recalled psychological distress and trauma symptoms among Indigenous peoples living in the United States and Canada who had experienced racial trauma. The most commonly used psychedelics were psilocybin, MDMA and LSD.  Participants recalled experiencing fewer symptoms of depression, anxiety, stress, trauma, symptoms of discrimination, and alcohol use in the 30 days after (vs. before) the psychedelic experience

Abstract

“Experiences of past and present oppression/discrimination towards Turtle Island’s Indigenous peoples are pervasive, contributing to symptoms of stress and trauma. Psychedelic substances have been shown to be effective for treating multiple disorders; however, there is a lack of research within Indigenous groups. This study examined the effects of naturalistic psychedelic use on recalled psychological distress and trauma symptoms among Indigenous peoples living in the United States and Canada who had experienced racial trauma. Participants were asked to recall a memorable psychedelic experience and report experiences of past racial trauma and retrospective changes in mental health symptoms within a cross-sectional internet-based survey focusing on people of colour in North America. Sixty-six participants (74.3% residents of Canada, 60.6% female, mean age of 35.9 years) self-identified as Indigenous. Participants mostly reported oral intake of psilocybin, 3,4-methylenedioxymethamphetamine, or lysergic acid diethylamide, and reported frequent experiences of ethnic discrimination and high levels of related stress. Participants recalled experiencing fewer symptoms of depression, anxiety, stress, trauma, symptoms of discrimination, and alcohol use in the 30 days after (vs. before) the psychedelic experience. Greater overall changes were recalled following psilocybin consumption, whereas differential effects were found based on Tribal land, reservation, or reserve residency and participant sex. Exploratory analyses suggested that measures of ethnic discrimination, residency, substance consumed, and sex were related to recalled changes in symptoms. As the healing powers of psychedelic medicines gain in mainstream popularity, one must consider the historical contexts, implications, and perspectives of Indigenous peoples. Several reflection questions are recommended to aid psychedelic stakeholders in conducting their work in an allied manner. (PsycInfo Database Record (c) 2022 APA, all rights reserved)”

Authors: Sara de la Salle, Sophia Gran-Ruaz, Dawn D. Davis, Alan K. Davis & Monnica T. Williams

Summary

CITATION

Psychedelic-assisted psychotherapy is an emerging field of Western research that has produced promising improvements in patients with anxiety, depression, obsessive compulsive disorder, substance use disorder, and a variety of other psychiatric disorders. As the psychedelic science movement grows, leaders have started to explore the possible benefits of psychedelic-assisted psychotherapy for people of colour who have been subject to mental or emotional traumatization due to racism. However, it is currently unknown whether psychedelic-assisted therapies will benefit patients with racial trauma.

Indigenous Peoples of Turtle Island

In 1492, North America was home to millions of Indigenous peoples, many of which had strong and complex societies, governance systems, laws, economies, technologies, traditions, religions, medicines, epistemologies, ontologies, and much more. In 2016, there were 1.67 million self-identified Indigenous peoples in Canada.

Within the United States, approximately 2.9 million people self-identify as American Indian or Alaska Native, and an additional 2.3 million people self-identify as American Indian or Alaska Native in combination with one or more other races. There are 574 federally recognized Native American and Alaska Native Tribes.

Surviving Historical and Modern-Day Structural Racism

Indigenous peoples were and continue to be a very diverse group of peoples. While they may have shared territory, great differences can still be seen between neighbouring Tribes.

Despite the heterogeneity in identity and history of Indigenous peoples, not a single nation remained unaffected by the arrival of European settlers. Examples include the Canadian pass system, forced relocation from territorial land, the missing and murdered Indigenous women and girls crisis, and the Indian Boarding era.

Indian Residential/Boarding Schools

The Indian Residential School system was created in the 1830s with the aim of eliminating Indigenous peoples as a distinct cultural group and assimilating them into Canadian society. Many children suffered sexual, physical, and psychological abuse at the hands of educators, clergy, or by other students. The children’s living conditions were far from sufficient, and the schools were underresourced and overcrowded, leading to high rates of malnourishment, influenza, tuberculosis, and other infectious diseases. Some children were deliberately underfed for involuntary nutritional experiments.

Hundreds of Indigenous children were discovered at the Kamloops Indian Residential School and elsewhere, with searches beginning in the U.S.

The U.S. government began overseeing Native American reservations in 1870 and opened the first Indian boarding school in 1879. Over 10,000 Native children were sent to these schools, where they endured physical, emotional, sexual, spiritual, and cultural abuse. The number of children who died, went missing, or never returned home following their time at boarding school is unknown in the United States.

The Sixties Scoop and Adoption Era/Indian Adoption Project

In the 1950s, policymakers in Canada began removing Indigenous children from their parents and communities by way of the child welfare system. This practice continued well into the 80s and remains disproportionately represented within the child welfare system today.

The Bureau of Indian Affairs funded organizations that placed Native American children in White families from 1958 to 1978, to further the agenda of assimilation, colonization, and integration of Native Americans into Western culture and society.

Coerced Sterilization of Indigenous Women

Colonial policy sought to remove Indigenous children from their parents and communities, and prevent Indigenous women from having children. In Alberta and British Columbia, more than 4,500 people were sterilized between 1929 and 1972, with Indigenous women being disproportionately targeted.

In 1927, the U.S. Supreme Court ruled that the state of Virginia could sterilize those deemed “feebleminded” or unfit to procreate. In 1970, the Family Planning Services & Population Research Act was passed, and sterilization rates skyrocketed among Indigenous women.

Although many today’s authorities condemn coerced sterilization in North America, recent reports suggest such horrific acts are still practiced, albeit on a lesser scale.

Everyday Discrimination

Many discriminatory experiences are less overt, and can be committed through everyday automatic responses. Indigenous peoples are particularly vulnerable to being targets of microaggressions due to inaccurate, yet stereotypical portrayals of Indigenous peoples in popular media, and cultural appropriation of Indigenous ceremonial practices and language use within Western psychedelic communities. Racial microaggressions against Indigenous peoples are pervasive, and include assumptions of intellectual inferiority, assumptions about criminality, invalidation and/or denial about an individual’s culture, identity, spirituality, ethnoracial reality, etc.

Psychological Distress and Trauma Among Indigenous Peoples

After hundreds of years of discrimination, oppression, and genocide, it is highly likely that these acts will have a negative impact on Indigenous peoples’ mental health. However, the Diagnostic and Statistical Manual of Mental Disorders (DSM) was created almost exclusively by non-Indigenous people with minimal input from Indigenous experts.

Indigenous populations in North America suffer from a range of mental health issues at substantially higher rates than their White non-Indigenous counterparts, including anxiety, depression, sleep disturbances, substance and alcohol misuse, and suicidal ideation.

Posttraumatic stress disorder (PTSD) may arise following personally experienced or witnessed traumatic events. It includes symptoms of intrusion, avoidance, negative changes in thoughts or mood, and changes in arousal and reactivity. While diagnoses of PTSD are commonly associated with members of the armed forces returning from combat zones, research suggests Indigenous peoples present with PTSD at disproportionately high rates.

Indigenous individuals do not need to have experienced or witnessed traumatic events themselves to feel some of the effects. Intergenerational trauma can be passed on to offspring through genetics or environmental factors such as loss of traditional languages, cultural practices, traditional ecological knowledge, and spirituality. Children of residential school survivors were more likely to have suicidal thoughts, attempt suicide, suffer from depression, and have learning difficulties.

Psychedelics as a Medicine

Indigenous peoples globally have been stewards of plant medicines with psychedelic properties since time immemorial. They refer to these plants as healers, with spirit and sentience.

Indigenous peoples of North America have been experiencing racism, oppression, and discrimination for hundreds of years, resulting in psychological distress and a suite of trauma responses. Recent work has shown that psychedelic substances may have therapeutic potential for alleviating symptoms of racial trauma.

Purpose of This Study

This study examined how psychedelic substance use, ethnic identity, discrimination, and sex affected self-reported mental health symptoms in Indigenous peoples who experienced ethnic discrimination.

Participants

A cross-sectional study was conducted on people of colour who had taken psychedelic substances and experienced relief from the challenging effects of ethnic discrimination.

Study Procedure

This study used Qualtrics survey research panels to recruit 550 participants. Of these participants, 66 identified as Native or Indigenous, and all participants provided their informed consent prior to completing the survey.

Measures

A demographic questionnaire was administered to collect information regarding prior psychedelic experiences, including type of substance used, type of dose, route of administration, length of time of psychedelic experience, and coadministration of other psychoactive substances.

Participants completed questionnaires about their current ethnic identity and experiences of ethnic discrimination, followed by assessments of change in psychological flexibility and various mental health and trauma-related variables.

A modified version of the General Ethnic Discrimination Scale was used to evaluate experiences of discrimination prior to the psychedelic experience that brought about relief from the negative effects of these experiences.

The Multigroup Ethnic Identity Measure – Six Item Version is a six-item measure that assesses affiliation with one’s ethnic group.

AAQ-II, a seven-item measure displaying good internal consistency, was used to assess change in psychological flexibility following the psychedelic experience.

The Depression Anxiety and Stress Scale (DASS21), composed of three subscales, was used to assess changes in symptoms 30 days before and 30 days following the recalled psychedelic experience.

The Trauma Symptoms of Discrimination Scale assessed discriminatory distress and anxiety-related trauma symptoms 30 days before and after the recalled psychedelic experience.

Statistical Analysis

Statistical analyses were performed using SPSS Version 25 International Business Machines Corporation (IBM Corp). One-way analyses of variance (ANOVA) were conducted to examine changes in trauma symptoms of discrimination (TSDS) and mental health symptoms (DASS21) with substance consumed, country, and sex as between-subjects factors.

Pearson r correlations and multiple linear regressions were used to examine whether participants with a greater association with their ethnic group, experienced more discrimination events, or experienced greater stress from these events, recalled exhibiting greater psychedelic experience-related changes in mental health symptoms/ cognitive flexibility.

Participant Characteristics

66 individuals were included in the study, 74.2% were residents of Canada and 25.8% of participants were residents of the United States. The majority of participants were First Nations.

Psychedelic Use

A major aim of this study was to characterize Indigenous users’ experiences with psychedelics. Participants described their most memorable psychedelic experience occurring at the mean age of 22.3 years.

Ethnic Identity and Frequencies of Experiences and Stress of Ethnic Discrimination

Participants in this subsample reported frequent experiences of ethnic discrimination and high levels of related stress, as well as moderate engagement in learning about their ethnic group.

Pre–Post Psychedelic Experience Alterations in Trauma and Mental Health Symptoms, Substance Use, and Psychological Flexibility

All prior findings related to decreased racial trauma symptoms, alcohol use, depression, anxiety, and stress were replicated in this subsample.

There were statistically significant differences in measures when comparing substance consumed, participant sex, residency on Tribal lands, reservation, or reserve, and country of residence. Females recalled greater improvements in their discrimination-related trauma and anxiety symptoms following the psychedelic experience.

Relationship Between Ethnic Identity, Ethnic Discrimination (Frequency and Stress), and Recalled Psychedelic Experience-Related Change in Mental Health Measures

When examining the relationship between ethnic identity, ethnic discrimination, and recalled psychedelic-related change in mental health measures, a negative correlation was found between TSDS and sum of stress from discrimination.

Stepwise multiple linear regression models were fitted to explore the relationship between the type of substance consumed, country of residence, residency on Tribal lands, strength of ethnic identity, frequency/severity of discriminatory distress, participant sex, and change within each mental health variable.

Discussion

This study examined factors related to improvements in mental health in Indigenous peoples from pre to postpsychedelic experience.

The 66 individuals self-identifying as Native or Indigenous reported decreasing trauma symptoms, alcohol use, depression, anxiety, and stress, as well as increasing psychological flexibility after using psychedelic medicines. This study’s Indigenous sample reported frequent experiences of ethnic discrimination and high levels of related stress, which are similar to the scores described in the measure’s development for people of colour. The overall mean of ethnic identity was 4.1 (SD 0.8). In a recent study, a stronger ethnic identity was found to be associated with decreases in recalled racial trauma symptoms. In the present study, a stronger ethnic identity was not found to be associated with any of the psychedelic experience change scores.

In a subsample of the sample, psilocybin was found to have a significantly larger recalled effect on reducing symptoms of racial trauma, depression, anxiety, and stress than MDMA or LSD. There have been no direct comparisons of substances, though each has been examined separately for their beneficial effects on mental health. Both biological and sociocultural determinants may contribute to responses to psychedelic-assisted psychotherapy, though current research is lacking. Additional inquiry is needed to parse apart the differential effects of all psychedelic substances in diverse populations, particularly since people of colour have been excluded from modern psychedelic research.

Participants who did not live on Tribal lands, reservations, or reserves reported greater decreases in substance use and anxiety symptoms following the psychedelic experience as compared to those who did, despite similar levels of reported racial trauma.

Participants who experienced higher levels of stress from discrimination, and not necessarily the highest number of discrimination events, recalled a greater decrease in discrimination-related trauma symptoms, and participant sex was predictive of greater decrease in anxiety symptoms from pre- to post-psychedelic experience.

The effects of sex and gender on mental health outcomes, particularly in ethnoracially diverse populations, are not well understood. However, it is important to consider the historical contexts, implications, perspectives, and experience of Turtle Island’s original peoples.

Recommendations

Native and Indigenous populations have remained the stewards and traditional knowledge keepers of many psychedelic medicines, but they are severely underrecognized, underconsulted, and underserved in modern psychedelic science. Psychedelic researchers must start by asking themselves the following questions.

When doing research on Indigenous peoples or using Indigenous traditional knowledge, it is important to consider the following: how much do I know about the past and present lived experiences of Indigenous peoples in Canada and the United States? How do I appropriately acknowledge and attribute Indigenous influence in my research?

To work with Indigenous peoples, therapists must understand the differences between PTSD, historical trauma, intergenerational trauma, and racial trauma, and have culturally competent assessment tools, be open to involving Indigenous healers, and have relationships with Indigenous peoples.

The author has considered the impact this policy has on Indigenous peoples relationship with psychedelic medicines, consulted Indigenous experts, obtained official consent from the Indigenous community, and ensured that the policy recommendation is not negatively extractive of plant communities.

Limitations and Future Directions

This study, which includes a subsample of Indigenous participants, was not developed specifically for the Indigenous population, and the questionnaire used to collect information on participant psychedelic experience was an abbreviated version of the MEIM (6 items).

Direct comparisons with previously published findings cannot be made because the current survey did not capture psychedelics used ceremonially or information on use with members of one’s community. This study’s sample size is the largest our team has encountered to date within the scientific literature for this population, but participants are quite diverse and this diversity was largely unexplored. The study also does not address experiences with psychedelic substances that were uneventful or negative/ harmful.

Conclusion

The use of psychedelic substances for healing among Indigenous communities is still largely unknown, but may be helpful for alleviating symptoms related to trauma, substance use, depression, anxiety, and stress, as well as increasing psychological flexibility.

Résumé

Sixty-six participants identified as being autochtone were asked to report on a memorable psychedelic experience, past racial trauma, and retrospective changes in mental health symptoms. Participants reported taking psilocybine, 3,4-methamphéthamphétamine or diéthylamide of lysergique by mouth. They reported less depressive, anxiety, stress, traumatism, discrimination and alcohol consumption symptoms after the psychedelic experience, but the effects were different depending on the land tribe, the reservation or the location of residence and the gender of the participant.