Ayahuasca’s entwined efficacy: an ethnographic study of ritual healing from ‘addiction’

This interview (ethnographic) study finds that the caregiving context of ritual ayahuasca use plays a key role in the treatment of addiction. This offers an contrasting narrative to the more ‘standard’ or ‘medical’ model in which addiction is often framed.

Abstract

Background: A range of studies has demonstrated the efficacy of the psychoactive Amazonian brew ayahuasca in addressing substance addiction. These have revealed that physiological and psychological mechanisms are deeply enmeshed. This article focuses on how interactive ritual contexts support the healing effort. The study of psychedelic-assisted treatments for addiction has much to gain from ethnographic analyses of healing experiences within the particular ecologies of use and care, where these interventions are rendered efficacious.

Methods: This is an ethnographically grounded, qualitative analysis of addiction-recovery experiences within ayahuasca rituals. It draws on long-term fieldwork and participant observation in ayahuasca communities, and in-depth, semi-structured interviews of participants with histories of substance misuse.

Results: Ayahuasca’s efficacy in the treatment of addiction blends somatic, symbolic, and collective dimensions. The layering of these effects, and the direction given to them through ritual, circumscribes the experience and provides tools to render it meaningful. Prevailing modes of evaluation are ill-suited to account for the particular material and semiotic efficacy of complex interventions such as ayahuasca healing for addiction. The article argues that practices of care characteristic of the ritual spaces in which ayahuasca is collectively consumed play a key therapeutic role.

Conclusion: The ritual use of ayahuasca stands in strong contrast to hegemonic understandings of addiction, paving new ground between the overstated difference between community and pharmacological interventions. The article concludes that fluid, adaptable forms of caregiving play a key role in the success of addiction recovery and that feeling part of a community has important therapeutic potential.”

Authors: Piera Talin & Emilia Sanabria

Summary

Introduction

Although no randomized controlled trial has ascertained efficacy against a placebo, a growing corpus of biomedical studies gives some credence to anthropological research that has long recorded its therapeutic uses in traditional settings.

Ayahuasca is an herbal brew, made from the Banisteriopsis caapi vine and the Psychotria viridis shrub. It was used in shamanic ritual and healing practices in the Western Amazon, and was later ‘globalized’ into new ceremonialized forms of ayahuasca use.

The existing literature on ayahuasca and addiction shows that physiological and psychological mechanisms are deeply enmeshed. A sustained and detailed ethnographic analysis of people’s experience of addiction healing in therapeutic and ritual contexts is needed. When assessing the use of ayahuasca treatments for addiction, the emphasis is placed mainly on the pharmacological efficacy of ayahuasca. However, the efficacy of such treatments cannot be reduced to either the pharmacological effect of ayahuasca or the ritual.

Addiction recovery involves more than abstinence and a rescripting of the past. It involves a radical transformation of people’s understanding and experience of substance use.

Methods: situating our study

We focus on people diagnosed as ‘addicted’ who find support within regular ayahuasca churches or spiritual groups. We draw on observations and interviews with ritual experts and participants who give or receive support within the context of ayahuasca ritual practice.

This article is based on ethnographic research conducted among Italian chapters of the Santo Daime church and among urban Brazilian spiritual communities that emerged from, but have broken with, the original ayahuasca religions.

In 2015, research was conducted on seven people who overcame substance dependence through the ritual use of Daime (the name given to ayahuasca in the Santo Daime church). In-depth interviews were also conducted with ritual experts, a physician and a psychologist working at a public centre for addiction treatment.

Based on the rituals we observed, ayahuasca ceremonies tend to be performed after dark, and participants are invited to wear white clothing. Ayahuasca doses are adapted to suit each person and carefully evaluated on a case-by-case basis.

We present here a loose assemblage of empirical, case-by-case assessments within structured networks of support that allows for an iterative and reflexive dimension to the healing of addiction.

Biomedical understandings of psychedelics’ efficacy

There is a growing body of literature on the therapeutic potential of psychedelic substances such as ayahuasca, but the randomized-controlled trial (RCT) was not designed to evaluate the efficacy of complex LSD-assisted psychotherapeutic interventions that were neither purely pharmaceutical nor solely psychotherapeutic. Psychedelic researchers are careful to differentiate their studies and claims to efficacy, and must adapt existing clinical trial protocols to account for the synergistic efficacy of pharmaceutically assisted therapeutic interventions.

Psychedelic-assisted therapeutic approaches to substance dependence use a limited number of controlled and supervised ‘dosing’ sessions, in contrast with substitution approaches, which are unsupervised and chronic.

Ayahuasca is thought to reduce addictive behaviour through its action on dopaminergic and serotonergic mesolimbic pathways, and increase neuroplasticity, facilitate adaptive neural architectural changes, and break down pathological associations, triggers and cues associated with addiction.

Ayahuasca states are thought to produce a state of heightened suggestibility, enabling repressed memories to resurface, and mitigate retraumatization by such emotional resurfacing. This provides a unique situation enabling access to a previously unavailable, corrective aspect of the emotional pattern.

Researchers use neuroimaging, psychometric evaluations and clinical investigations to examine the relations between biomarkers and subjective responses to psychedelic-assisted therapeutic interventions. However, such studies are only valid within their own terms of reference.

The material-semiotic efficacies of ayahuasca

Loizaga-Velder and Verres (2014) argue that ayahuasca must not be understood as a pharmacological intervention. Instead, it is a therapeutic catalyst whose value is dependent on the experience being appropriately managed and integrated through trained guidance.

Weinberg (2002, 2013) argues that existing studies of addiction tend to analyse it in neurobiological or cognitivist terms, but that the experience of drug use is always in interaction with emotions, music and space, and cannot be experientially disaggregated.

We adapt this argument, drawing on material-semiotic analyses of drugs, to consider how ayahuasca can catalyse cathartic transformations under certain conditions. This process challenges existing conceptual vocabularies for the effects of interventions, which tend to ascribe efficacy to either substance or context.

Ayahuasca improves the craving symptoms that you have when you stop the methadone, and this allows you to reduce the methadone dose in a few days. The stronger the trabalho, the easier it is to reduce the methadone dose.

I was asked to try not to take drugs for at least twelve hours before the ceremony. After taking the ‘medicine of the forest’ [Ayahuasca], I have only taken two painkillers for back pain since that day.

The Daime reset my body and capacity to feel, so much that it simply cancelled the craving. The body didn’t want heroin anymore, and I felt a sensation of nausea, a poisoning.

Mercante (2013) writes that ayahuasca cures addiction by blending the somatic, symbolic and collective dimensions of the experience. The process of purging in ayahuasca ceremonies is a deeply psychosomatic process, in which people are expelling attachments, behaviours or negative emotions through the catharsis of the body.

I used to take methadone in syrup, and was very intoxicated and very ill, physically. After taking Ayahuasca for two days, I felt relieved and as if a black cloak had been removed, and so many new things could receive light.

Ayahuasca can help with different types of cleansing, including the catharsis brought about by the flow of tears. Roberto, a long-term heroin user, reports having a vision of himself journeying at great speed inside a tunnel.

I felt like my fifteen-year old self again, I smelled all the scents, felt all the effects and tasted all the drugs I ever used, and I felt like a new person, just as if I had never used drugs in my soul, in my body, in the wholeness of myself.

A few days later, he had a relapse and took heroin again, but realized that he did not have the same attachment to heroin.

Wilson’s (2015) analysis of the somatic entanglement of affects reminds us that affects are heavily modulated by social, suggestive, spatial, placebo, material, cultural, symbolic and semiotic events. The gut is involved in ayahuasca experiences through the central practice of purging.

Much of the literature on ayahuasca treatment for addiction does not critically engage with the notion of addiction itself. In our ethnography, we encountered people who spoke instead of healing problems of dependência (being dependent) or of vicio (depravity), and we suggest that ayahuasca can reconfigure the very meaning and experience of addiction.

Francesco had previously used peyote, but had not recovered from his heroin addiction because he had used it without therapeutic intention. It takes more than drinking ayahuasca for durable changes to take place.

Methadone was part of the loop, and I have done fifteen or twenty of these loops, each lasting from two to four months, with more or less the same characteristics. Ayahuasca and the Daime showed me how these forces of addiction act.

A psychiatrist who had treated Roberto in a residential addiction treatment centre in Italy recognized that methadone was highly addictive and had not worked well for him. She was stunned by how effective ayahuasca had been in his recovery process.

I tried to decrease the methadone, but it was as much an enslavement as any heroin addiction. I could not abide by the rules of the residential program, and I thrived in the Santo Daime community, where the rules are self-imposed by the community members. I never once went to a big city with one of Italy’s largest drug markets.

People we encountered in our research often had come to ayahuasca rituals after unsuccessful attempts to recover through outpatient clinics or psychiatric residential centres. They felt stigmatized as socially dysfunctional ‘junkies’ and were told that ayahuasca was a ‘drug’ while being prescribed heavy doses of methadone or psychiatric medications.

Attending to specificity: dependência healing as care

People who use drugs and sometimes develop problems often feel part of a community, and ritual forms are often tailored to the specifics of people’s particular drug use predicaments.

During the ritual process itself, dedicated ‘helpers’ provide non-invasive supervision of the experience, and remain at hand to help should it be needed. There are different understandings of what constitutes good care during the ritual itself, with the Santo Daime tradition considering it best to intervene as little as possible. Neo-ayahuasca healing ceremonies often include specific therapeutic interventions.

Santo Daime rituals are iterative, and leaders adapt to what is happening in the congregation. Hymns have vibrational influences that connect people with their own powerful mechanism of self-healing.

In the Santo Daime doctrine, rituals are brought to a close with an informal, joyful gathering, where people share food and hot beverages and discuss their experiences. This creates a space of community and relationality that spills over into everyday sociality and interactions.

The treatment of addiction involves a persistent tinkering that blurs the boundaries of the objects configured through care. Ayahuasca rituals do exactly this by making the normative contours of what addiction is unstable, by caring differently.

Given the limited efficacy of existing addiction treatment modalities and the scale of the problem, allowing the guided use of psychedelic substances for the treatment of drug dependence may be an ethical responsibility.

We have sought to shed light on an existing practice of addressing substance dependence that demonstrates a different understanding of how substances act, and provides new frames through which people can experience recovery and reframe their understandings of addiction.

We want to show that the current framing of what can count as evidence precludes demonstrations of efficacy for interventions that cannot be measured in standardized ways, and that case reporting is often perceived to be at the bottom of the evidence pyramid.

Acknowledgements

We are very grateful to all those who accepted to participate in this research and shared their stories with us. The research was made possible thanks to generous funding from the European Research Council.

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