This observational study (n=12) investigated the impact of ayahuasca-assisted group therapy within the context of a retreat ceremony, on self-reported and qualitative measures of mental health and addiction. Participants exhibited improved mindfulness, personal empowerment, and hopefulness, and reported less frequent use of cocaine, alcohol, and tobacco up to 4 weeks after the ceremony. Their intake of cannabis, sedatives, and opiates (e.g. methadone) did not change, however, these were not identified as the substances of primary concern by the majority of participants.
Abstract
“Introduction: This paper reports results from a preliminary observational study of ayahuasca-assisted treatment for problematic substance use and stress delivered in a rural First Nations community in British Columbia, Canada.
Methods: The “Working with Addiction and Stress” retreats combined four days of group counselling with two expert-led ayahuasca ceremonies. This study collected pre-treatment and six months follow-up data from 12 participants on several psychological and behavioral factors related to problematic substance use, and qualitative data assessing the personal experiences of the participants six months after the retreat.
Results: Statistically significant (p < 0.05) improvements were demonstrated for scales assessing hopefulness, empowerment, mindfulness, and quality of life meaning and outlook subscales. Self-reported alcohol, tobacco and cocaine use declined, although cannabis and opiate use did not; reported reductions in problematic cocaine use were statistically significant. All study participants reported positive and lasting changes from participating in the retreats.
Conclusions: This form of ayahuasca-assisted therapy appears to be associated with statistically significant improvements in several factors related to problematic substance use among a rural aboriginal population. These findings suggest participants may have experienced positive psychological and behavioral changes in response to this therapeutic approach, and that more rigorous research of ayahuasca-assisted therapy for problematic substance use is warranted.”
Authors: Gerald Thomas, Philippe Lucas, N. Rielle Capler, Kenneth W. Tupper & Gina Martin
Summary
Background
Ayahuasca is a psychotropic brew prepared from the Amazonian vine Banisteriopsis caapi and leaves of the bush Psychotria viridis. It induces a dream-like altered state of consciousness characterized by intense visual, auditory, ideational and emotional effects.
Ayahuasca has been traditionally drunk in ritual contexts by Amazonian indigenous and mestizo peoples for a variety of divinatory, magical, spiritual, aesthetic and other cultural purposes. It has become a transnational phenomenon through increased tourism to the Amazon and ceremonies regularly conducted by itinerant ayahuasqueros.
Ayahuasca rituals do not typically produce health or psychosocial problems such as addiction. Instead, they are associated with less excitability and impulsivity, more confidence and optimism, and less past-month use of alcohol and no significant difference in lifetime illicit drug use.
In a study of 32 members of a U.S.-based chapter of the Santo Daime church, fewer reported substance use problems were found than in matched controls.
Takiwasi and IDEAA run treatment programs that incorporate the ritual use of ayahuasca with complementary 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 their success.
Dr. Gabor Maté, a Canadian physician specialized in addictions medicine and experienced in working with Aboriginal people, conducted ayahuasca retreats with mostly non-aboriginal Canadian participants in 2009 and 2010, reporting positive outcomes for participants with a variety of psychological health conditions and illness severities.
The retreat team’s work with ayahuasca was noticed by a rural aboriginal First Nations band, which invited the team to conduct retreats for community members with substance dependence or other habitual behavioral problems.
The band’s health office offered the research team an opportunity to conduct an observational study of the retreats, and the health office agreed to closely monitor participants for any adverse psychological or other reactions following the retreats.
Purpose
Ayahuasca-assisted group therapy may 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.
The ayahuasca ceremonies in the context of the “Working with Addiction and Stress” retreats were associated with improvements in mindfulness, emotional regulation, personal empowerment, hopefulness and quality of life.
Methods
Observational Study Procedures
The band’s health office recruited potential participants, who were informally screened for inclusion criteria and exclusion criteria (under age 18, have drunk ayahuasca in the past, taking selective serotonin reuptake inhibitor or monoamine oxidase inhibitor medications, currently experiencing psychosis or have experienced a psychotic break in the recent past).
Participants were invited to attend a group orientation session at the band’s health office several hours before the start of the retreat, and completed self-administered surveys to collect baseline data on a number of psychological and behavioral factors related to problematic substance use.
Participants completed the State of Consciousness Questionnaire (SOCQ) immediately following the end of the retreats, and were contacted again two weeks, four weeks, and monthly thereafter for five months to collect further data using the same six measures.
Seven post-retreat follow-up assessments were conducted, most in person at the band’s health office. Participants received $20 in gift certificates and meals were provided at in-person sessions.
Observational Study Instruments and Rationales for their Use
The Difficulty in Emotion Regulation Scale (DERS) is a validated 36-item questionnaire that is suitable for use in evaluations of substance dependence treatment.
Researchers have long recognized that the desire to regulate positive and negative emotional states is an important motivating factor for substance use. Recent studies have shown that poor emotion regulation is a risk factor for problematic substance use.
The Philadelphia Mindfulness Scale (PHLMS) is a validated 20-item instrument that assesses two components of mindfulness posited to have salutary effects on substance dependence (awareness of the present moment and acceptance of one’s emotions).
Mindfulness training has been shown to improve outcomes for substance dependent clients over control conditions by allowing them to accept unusual physical sensations, decentre from a strong urge and not act impulsively, and maintain perspective in response to strong emotional states and decrease dysfunctional avoidance.
The Empowerment Scale (ES) is a 28-item questionnaire that assesses psychological and social empowerment over five dimensions. It was constructed through a process involving consumers of mental health services and demonstrates acceptable internal consistency.
A First Nation observational study included empowerment as an independent factor in substance use prevention and addiction treatment programs, due to the documented relationship between trauma, powerlessness and problematic substance use.
Although there is some debate as to whether depression and substance dependence are directly causal to one another, their co-occurrence is widely acknowledged. Hopefulness, a key personality trait, is a protective factor against psychological problems such as depression and behavioral problems such as substance dependence.
Theoretical and empirical evidence suggests that quality of life and wellness can influence substance dependence patterns. In this study, quality of life was interpreted as both an independent factor potentially influencing patterns of substance use, and a dependent variable.
The ASSIST questionnaire is a valid and reliable screen for problematic substance use. The 4WSUS is the main behavioral outcome variable for this study, and it measures changes in substance use patterns over the past two weeks.
We collected data using several instruments, including the States of Consciousness Questionnaire, and will report on this data in future papers.
We selected the various psychological and behavioral instruments listed above based on a holistic interpretation of the bio-psycho-social-spiritual model of human behavior, trauma and substance dependence.
After hearing from several participants that the questionnaires and surveys were not capturing the totality of their experience, the study team added a short semi-structured interview to the seventh follow-up session to collect qualitative data about their experience of the retreat.
Statistical Analysis Procedures
Statistical analysis was performed on five scales: mindfulness, empowerment, emotional regulation, hopefulness and quality of life. Missing values were imputed using the mean of the valid responses.
The Four Week Substance Use Survey was used to assess problematic substance use. The survey asked about substance use in the past four weeks, two weeks, and four weeks, with higher values indicating more problematic use.
A one-group repeated-measures ANOVA was conducted on each of the scale measures to statistically assess any changes over time. A trend analysis was conducted if a measure showed significant differences between time points, and a second repeated-measures ANOVA was conducted if four participants received the intervention twice.
The Intervention: “Working with Addict-Ion and Stress” Retreats
The retreats incorporated two ayahuasca ceremonies, and group talk therapy sessions to elicit personal reflection and insights about traumatic life experiences and consequent emotional and psychological responses, including dependent substance use.
Day 1 of the Retreat
The retreat team arrived and welcomed the participants with songs of strength and courage. They explained the process that would take place over the next few days.
Day 2, Morning/Afternoon
The retreat team led a discussion to elicit reflection by participants about their addictions, and provided a safe space for exploration into the multi-generational trauma endured by retreat participants.
Day 2, Evening
After dinner and a sweat lodge ceremony, all participants gathered back in the longhouse to share their intentions for the ayahuasca ceremony. The ceremony lasted for 4-5 hours, and participants slept in the longhouse under the supervision of the observers from the band’s health office.
Day 3
Day 3 began with unstructured dialogue among participants and a formal debrief with the retreat team. The second ayahuasca ceremony took place on the third night.
Day 4
The first retreat ended with the participants presenting the retreat team leaders with gifts, and all participants left the site before noon.
Results – Psychosocial and Substance Use Measures
The results show that for the twelve participants who attended at least one retreat, mindfulness, empowerment, hopefulness, quality of life-meaning, and quality of life-outlook improved over time, while emotional regulation, quality of life-overall, and quality of life-psychological did not.
Quality of life-meaning, mindfulness, and hopefulness increased from baseline to the third data point, and continued to increase over the 6 month follow-up period. These increases could be interpreted as contributing to alleviation of problematic substance use following ayahuasca-assisted therapy for problematic substance use.
Fig. (2). Average mindfulness score.
Table 3 shows that fewer participants used alcohol, tobacco and cocaine in the four weeks preceding the seventh follow-up than in the four weeks preceding baseline. The past-month use of cannabis and opiates showed no change in use during the study.
Fig. 4 shows that the 4WSUS scores decreased for all substances except cannabis, with statistically significant reductions documented for problematic cocaine use.
Results – Semi-Structured Interviews
Eleven study participants completed semi-structured interviews to discuss the effects the retreats had on their lives. Eight participants ranked the experience as 8 or higher, and no one ranked it below 5.
Participants responded to questions about their experiences on the retreats and how they differed from other types of treatments.
Connection with Self
S1 (male, age 30): “With my last experience with the ayahuasca, I really faced myself. I think I overcame my fear, my anger, and my addictions.”
The retreat gave me a second chance at life, and I realized I deserve a better life. Ayahuasca opened my eyes, and I felt like a brick was lifted off of my shoulders.
Connection with Others
S3 (male, age 56): “It’s opened up where I felt I had a door closed to allow and to be around my close family members.”
Connection with Spirit and Nature
S6 (female, age 19): “After the ayahuasca retreat, I sat outside and stared at the trees and the wind for two hours, it was just beautiful.”
S7 (female, age 49): “I got my spirit back, for one. Nature is saying “wake up and smell the coffee”, and I go spirit bathing every morning.”
Substance Use
Substance Use S2 (female, age 41): “I went to this retreat to release the hurt and pain that I was carrying around and trying to bury with drugs and alcohol.”
Differed from Past Treatment or Therapies
S1 (male, age 30): “I had no sense of spirituality before really, coming clean and sober, but after the retreats I really opened up to spirituality big time.”
S8 (male, age 55): “This treatment got deep into myself, which I’ve never admitted to or confronted in other treatments. It was just a mind-bending experience, boy!”
The semi-structured interviews proved useful in understanding how the ayahuasca ceremonies affected participants, and highlighted the limitations of purely quantitative methods in studying the subjective impacts of this kind of therapy.
Discussion
We found that participating in the ayahuasca-assisted group therapy retreats was associated with improvements in several cognitive and behavioral states, including enhanced mindfulness, personal empowerment and hopefulness. The retreats were also associated with improvements in quality of life and subjective feelings of connection with self, others, spirit and nature.
These findings suggest that ayahuasca may have therapeutic effects on rural aboriginal populations, including reduced problematic cocaine use. Ayahuasca may also increase the personality trait of openness, which is correlated with mystical or spiritual experiences induced by psilocybin.
This study of ayahuasca-assisted group therapy has a number of limitations, including the small sample size and the absence of any matched controls. It also did not assess the relative effects of the group therapy work, other ancillary potentially therapeutic elements, or the psychodynamic context of the retreats.
Ayahuasca-assisted therapy may have positive therapeutic effects on its own, independent of the intercultural bridging occasioned by the ceremonies.
A limitation of this study is that there was no scientific chemical analysis of the ayahuasca drunk during the ceremonies at the retreats. Nevertheless, the effects of the brew were characteristic of ayahuasca phenomenology and therefore do not suggest any concerns about its composition or potency.
The study included 12 participants, one-third of whom participated in two retreats, and two-thirds in one. No conclusion can be drawn on the potential harms/benefits of repeat treatments.
Conclusion
Our results suggest that ayahuasca-assisted therapy for stress and addiction may have salutogenic effects and may contribute to statistically significant reductions in cocaine use. Further research is warranted on ayahuasca-assisted addictions treatment.
Health Canada had recommended in principle to exempt certain forms of ceremonial ayahuasca use from the Canadian Controlled Drugs and Substances Act, but in November 2011 they reprimanded Dr. Maté and threatened him with legal action if he continued to work with ayahuasca as an addictions treatment.
The authors would like to thank the retreat participants, the First Nations band, Dr. Gabor Maté and his team, Dr. Bronner’s Soaps, the Riverstx Foundation and TIDES Canada for their support.
APPENDIX Table 4 shows that cocaine ASSIST scores improved significantly between study follow-ups, while tobacco ASSIST scores improved marginally.
The results of the analysis showed that there was no significant interaction between the groups and trend indicating no significant difference between the changes over time between those who participated in two retreats and those who participated in one.