Traditional Amazonian medicine in addiction treatment: Qualitative results

This open-ended interview study was followed by thematic analysis to assess the perspective of patients (n=9) who underwent treatment with ayahuasca in the Takiwasi Center (rehabilitation centre). While the therapeutic effects are supported, the complexities are also discussed.

Abstract

“Traditional Amazonian medicine, and in particular the psychoactive substance ayahuasca, has generated significant research interest along with the recent revival of psychedelic medicine. Previously we published within-treatment quantitative results from a residential addiction treatment centre that predominately employs Peruvian traditional Amazonian medicine, and here we follow up that work with a qualitative study of within-treatment patient experiences. Open-ended interviews with 9 inpatients were conducted from 2014 to 2015, and later analysed using thematic analysis. Our findings support the possibility of therapeutic effects from Amazonian medicine, but also highlight the complexity of Amazonian medical practices, suggesting that the richness of such traditions should not be reduced to the use of ayahuasca only.”

Authors: David M. O’Shaughnessy, Zoltan Sarnyai, Frances quirk & Robin Rodd

Author Highlights

  • Long-term addiction patients at the Takiwasi Center reported therapeutic effects.
  • Patients found particular benefit in the traditional Amazonian techniques.
  • Salient techniques included plant purges, ayahuasca sessions, and dietary retreats.
  • Similar regimes may be effective for those with a history of failed treatment.
  • The scope of traditional Amazonian medicine is larger than ayahuasca/psychoactives.

Summary

A study of 9 inpatients at a residential addiction treatment centre that predominately employs Peruvian traditional Amazonian medicine found that the psychoactive substance ayahuasca may have therapeutic effects, but also highlighted the complexity of such practices.

Substance abuse and other addictive disorders are challenging to treat because of their origins and because they co-occur with other disorders at unusually high rates. Psychedelic therapies have shown promise in treating these disorders. Natural psychoactive substances have been recognized for thousands of years, and have shown promise in treating addictions, including the peyote cactus and the potent ayahuasca decoction. Although ayahuasca-based addiction treatment is a new concept from a Western clinical perspective, there are already active treatment centres making use of ayahuasca in Peru.

The center uses psychoactive and purgative plant preparations, individual and group psychotherapy, community living, daily occupational therapy, a variety of workshops, and intermittent biomedical evaluation to treat addiction. The treatment process is a lengthy process that aims to work initially at a physical level, but then develops to address psycho-emotional and spiritual elements. Preliminary quantitative results regarding the centre’s therapeutic process have been positive, although qualitative work is needed to reveal how patients understand their experiences of illness, treatment, and healing with psychoactive substances.

AMAZONIAN QUALITATIVE 6 Participants’ lived experiences are central to therapeutic outcomes in ayahuasca and psilocybin, even though there are likely also pharmacological actions which support the process irrespective of context and subjective effects. In this paper we present the qualitative results of interviews with Takiwasi inpatients, conducted while they were residents at the centre and undergoing treatment for addiction. The results support the inference of within-treatment therapeutic effects that we reported previously.

Design

The qualitative results presented in this paper were part of a larger biopsychosocial study of the treatment programs at the Takiwasi Centre, which combined quantitative and qualitative methods to better understand the treatment and its effects. The interviews with patients were open-ended and exploratory, and focused on their prior life situation and reasons for coming to Takiwasi. They were audio recorded and later transcribed, and a thematic analysis was conducted using a realist approach.

The extraction of themes was partially theoretical (i.e. coding based on reports with specific treatment techniques) and partially inductive (i.e. coding not related to specific treatment techniques).

The qualitative data sample consisted of 9 male inpatients with a mean age of 28 years, and the mean time spent in treatment was 275 days. The qualitative sample had an intake addiction severity that was comparable with the larger sample on most dimensions, although with fewer alcohol and employment problems. When you live with fifteen people, you can’t go out and you don’t even have cigarettes. You talk to your therapist.

Patients at the centre live in a dorm area separated from the main building, and work on baking bread, preparing food, cleaning, and caring for animals. They attend workshops, group and individual therapy sessions, sports, and an optional Catholic mass. While the daily communal living environment was often described by patients as difficult and frustrating to varying degrees, it was also valued as a useful part of the therapeutic structure.

P9: It’s hard living with the same people all the time, but it creates a strong bond, and people really tell what is in their guts.

Participants described many different experiences with Amazonian medicine, including ayahuasca experiences, plant purges, and diets. Ayahuasca experiences were the dominant treatment theme, but there was also significant participant discussion around other Amazonian techniques. New patients must first pass through a detoxification period (lasting a number of weeks) before they can drink ayahuasca. However, the first ayahuasca sessions can have a profound impact, as in the case of P9, who below discusses why he decided to abandon his plans to exit the treatment early.

Ayahuasca is not enjoyable, but it helps you see what’s inside you. The participant experienced pain for hours, but said he could see the change. Ayahuasca sessions can be highly unpredictable, as there are also sessions where very little takes place from the patient’s perspective. P1’s second session began with classic visions of colourful geometric patterns, followed soon after by a powerful form of self-reflection tied to his own family history. Ayahuasca can help one heal from developmental traumas by bringing them to the surface and allowing one to process them.

You can’t get cured until you know why you got hurt, so you have to grow up from that and let it go. Ayahuasca helped me clear out a deeply traumatic experience. Patients have mentioned the combination of ayahuasca sessions with therapy as a great help. The sessions can be really strong, but in the days after you realize how much progress you made. Even though patients often recounted deeply impactful experiences with ayahuasca, they tended to see it as a supportive element, rather than a panacea.

AMAZONIAN QUALITATIVE 13 also know that I’m getting better, and I’m going to give everything I have to do it. The ayahuasca won’t do the treatment for you, so you have to give all of who you are. Before drinking ayahuasca, Takiwasi patients engage in regular purges, where they consume a purgative plant preparation along with large amounts of water, which induces emesis.

The use of purgative plants as a medical practice has been described for a number of Peruvian Indigenous peoples, and in Takiwasi, decoctions of Banisteriopsis caapi are used in purging rituals. These rituals can take on an extreme nature, although the process can be subsequently valued by patients. The first yawar panga knocked me out. I puked quite a lot during the purge, and after that I could chill in bed a bit, but then the therapist came to give me cinnamon tea, and I puked for four hours and couldn’t stop.

Multiple patients referred to the concept of the body being “cleaned” through purging, and several extended this logic to the ayahuasca sessions. The purges are seen as essential preparation for future sessions with ayahuasca, and thus they work together in a complementary manner. Takiwasi has been like a laboratory for me, where I am obliged to study myself. It has given me a magnifying glass to look at my problems and search for tools to alleviate them.

Diets

Plant diets are a distinctly Peruvian Amazonian medical practice that involves behavioural, alimentary, and social restrictions along with the intake of specially prepared plant substances over a lengthy period of time. They function as milestones in treatment, where therapeutic material and prior treatment experiences can be integrated. In Takiwasi, patients are isolated to a small hut and visited by a traditional healer who brings very basic food and medicinal plant preparations. The combination of social isolation, reduced food intake, consumption of traditional plant preparations, and general lack of access to recreational activities tends to provoke introspection and emotional responses.

In general, patients spoke highly of the dietas for their capacity to recover forgotten aspects of the self and one’s personal history, and for the possibility to have that information integrated more thoroughly. Within-treatment changes were a theme that was salient in the data. The patients tended to describe personal and interpersonal changes that they attributed to the treatment, and in some cases this related specifically to drug use and an altered perspective on their life prior to treatment.

I used to drink and snort cocaine to escape from my reality. I lived my life as a kid, like Peter Pan, and didn’t ask myself what I was doing with my life. P1 described his past tendency to combine illicit drug use with pornography, and the negative impact on his family and social life. He wanted to get away from his life, of what he was feeling. When I first came to Takiwasi, I didn’t know what I wanted in life, why I was on earth, or if I liked red or blue or white or black. Now I do, and I’m friendly with everyone.

The Amazonian qualitative study found that ayahuasca use was associated with positive changes in behavioural self-regulation, emotional and interpersonal well-being, and fitness. Patients reported that they changed their relationship with food after the dieta, and realized the importance of caring for their bodies. P6: I’m learning to receive love, and I’m starting to learn to give love. I had problems with drugs, but I’m working on those problems without pills or antidepressants.

P8 and P9 both stated that they felt the same after the treatment, and that they didn’t see much of a difference. P8 felt more sensitive to sounds and smells, but didn’t feel a huge change. Although multiple quantitative studies have suggested within-treatment therapeutic effects, there has been a lack of published work providing context for the experiences of inpatients going through the Takiwasi addiction treatment programme.

Patients found ayahuasca sessions, plant purges, and dietary retreats to be helpful in their therapeutic process. However, not every long-term patient reported benefits or positive change from this integrated process, and thus the treatment modality may be more suitable for certain patient profiles. The results of the present study suggest that age, nationality, and student status are potential predictors of treatment dropout. Longitudinal research is needed on outcomes for patients, particularly in terms of primary outcomes and treatment effectiveness once they leave the centre.

The experience of patients at Takiwasi strengthens the case for Amazonian medicine as a viable treatment option for substance abuse, at least for certain patients. Yet, it is difficult to attribute therapeutic effects to ayahuasca alone. The patients’ scepticism of ayahuasca as panacea stands in contrast with the fact that ayahuasca has captured the most scientific and public attention. This attention has revolved around therapeutic potentials, yet obscures the traditionally ambiguous nature of South American shamanism. Ethnographic and qualitative work is necessary to better understand the implications of ayahuasca use across various therapeutic contexts.

Ayahuasca as an addiction treatment in Catalonia: Cognitive and cultural perspectives. In Ayahuasca healing and science, Apud, I., Argento, E., Capler, R., Thomas, G., Lucas, P., Tupper, K. W., rhem, K., & Martin-Soelch, C. (2019).

In this paper we review the literature on the use of psychedelic drugs in the treatment of psychiatric illnesses, and we discuss the therapeutic potential of psilocybin in the treatment of substance use disorders. A systematic review of clinical trials published in the last 25 years found that ayahuasca, psilocybin and lysergic acid diethylamide (LSD) have antidepressive, anxiolytic, and antiaddictive effects. This review also found that the globalization of ayahuasca shamanism and the erasure of indigenous shamanism are related. Gearin, A. K., Labate, B. C., Cavnar, C., Giovannetti, C., Arce, S. G., Rush, B., & Mendive, F. (2019). Ayahuasca: Psychological and physiologic effects, pharmacology and potential uses in addiction and mental illness.

Harner, M. J., Hartogsohn, I., Troppoli, T. A., Wulff, A. B., Cole, A. B., & Thompson, S. M. (2017) reviewed the literature on the use of psilocybin in drug addiction treatment and the prevalence of comorbid substance use in schizophrenia spectrum disorders.

The therapeutic use of ayahuasca in the treatment of substance dependence: Qualitative results. In: Grimes, U. Husken, & B. Stephenson (Series Eds.), Oxford Ritual Studies: Ayahuasca shamanism in the Amazon and beyond.

Lorains, Cowlishaw, Thomas, S. A., & Luna, L. E. (2011) reviewed the prevalence of comorbid disorders in problem and pathological gambling, and Luna, L. E. (1984a), described the healing practices of a Peruvian shaman, and Mabit, J. (2002) discussed blending traditions to treat drug addiction.

A randomized, double-blind, placebo-controlled phase 3 study of MDMA-assisted therapy for severe PTSD found that the treatment was effective in treating the symptoms of post-traumatic stress disorder.

A pilot study of alcoholics in the peyote ritual was conducted in 1976. A large international survey was conducted in 2021 to assess the influence of context and setting on the mental health and wellbeing outcomes of ayahuasca drinkers. Plant based assisted therapy for the treatment of substance use disorders: The case of Takiwasi Center and other similar experiences. Rehm, J., Friso, F., Saucedo, G., Torres, J., Robinson, D. W., Brown, K., McMenemy, M., Dennany, L., Baker, M. J., etc. A systematic review of preclinical and human studies on the effects of ayahuasca and its alkaloids on substance use disorders has been published. Ayahuasca-assisted addiction treatment at Takiwasi Center has also been evaluated. Plants are used in medicinal practices in Chazuta valley (Peruvian Amazonia), including strict diets. Shannon (2010) describes the phenomenology of the ayahuasca experience.

A systematic review and meta-analysis of the prevalence of gaming disorder, ayahuasca-assisted therapy for addiction, and a randomized study of different musical genres in supporting psychedelic therapy are available.

Study details

Compounds studied
Ayahuasca

Topics studied
Addiction

Study characteristics
Qualitative

Participants
9 Humans

PDF of Traditional Amazonian medicine in addiction treatment: Qualitative results