Treating drug dependence with the aid of ibogaine: a qualitative study

This open-label qualitative study (n=22) investigated the therapeutic efficacy of ibogaine (840/1050mg) in combination with cognitive behavior therapy (CBT) and relapse prevention to treat drug-dependent patients. Patients reported decreases in craving and improvements in personal relationships, quality of life, and self-efficacy.

Abstract

“Background: Substance use disorders are important contributors to the global burden of disease, but current treatments are not associated with high rates of recovery. The lack of approved and effective treatments is acutely problematic for psychostimulants like cocaine and crack cocaine. One promising alternative in the treatment of drug dependence in general and psychostimulants in particular is the use of the psychedelic alkaloid ibogaine combined with psychotherapy. This was recently shown to induce prolonged periods of abstinence in polydrug users, including psychostimulants. However, drug dependence treatments cannot be comprehensively evaluated with reductions in consumption alone, with current recommendations including secondary outcome measures like craving, family and social relationship, quality of life, and self-efficacy.

Methods: We therefore employed a directed approach to qualitative content analysis to evaluate the outcomes of a treatment combining ibogaine with cognitive-behavioral therapy based on data gathered from patient’s reports obtained in semi-structured interviews.

Results: The results revealed that patients benefited from the treatment in all the secondary outcomes, reporting decreases in craving and improvements in personal relationships, quality of life, and self-efficacy, thus supporting existing notions that treatments combining ibogaine and psychotherapy do have a therapeutic potential in the treatment of substance use disorders.”

Discussion: The data support the notion that ibogaine can be therapeutically useful in a treatment combining both pharmacotherapy and psychotherapy among polydrug users.

Authors: Eduardo E. Schenberg, Maria A. de Castro Comis, Joao F. M. Alexandre, Bruno D. R. Chaves, Luís Fernando Tofoli & Dartiu Xavier da Silveira

Summary

Introduction

Recent estimates suggest that 149 – 271 million people used illicit drugs worldwide in 2009, and that this illicit drug use causes considerable morbidity and mortality in many countries. Legal drug use is also a serious problem, contributing to more than 20 million disability adjusted life years.

The search for effective drug dependence treatments is paramount, but current available options include behavioral therapies, pharmacotherapies, and combinations of both approaches. Ibogaine, an alkaloid extracted from the root bark of Tabernanthe iboga, may be a new therapeutic approach for drug abuse and dependence.

Evidence of ibogaine efficacy in the treatment of drug addiction spans a wide variety of methods, including anecdotal evidences, small clinical trials, and improvements in some pre-clinical animal models of drug addiction.

Ibogaine is metabolized to noribogaine in the liver, and both compounds have different effects on the brain, including N-methyl-D-aspartate, opioid receptors, and sigma-2 receptor sites. Ibogaine may also have important cardiotoxic effects mediated by its action at hERG potassium channels.

In previous research, it was shown that ibogaine administration in a hospital with pre- and post-ibogaine cognitive therapy facilitated prolonged periods of abstinence in drug-dependent patients. In this study, a directed approach to qualitative content analysis was employed to test the hypothesis that this treatment is beneficial to patients with substance use disorders.

Materials and Methods

Sampling and recruitment

The study sample consisted of 22 drug-dependent patients, who participated voluntarily and signed an informed consent agreement before starting the interview.

Sample characteristics

There were 7 women and 15 men in the sample, ranging in age from 22 to 53 years. Twenty patients had previously failed in drug treatments, with sixteen (73%) having previously undergone treatments as inpatients at other clinics, some against their own will. Six participants were unemployed, nine resided with parents, ten with the spouse, one was living with the aunt, one with parents-in-law, and one had missing information. Ten participants had university degrees, ten were enrolled in university studies, and two had never started a university degree.

Therapeutic procedure

The therapeutic procedures were conducted as private practice before the research was conducted. Patients were psychologically and physically evaluated at the clinic by a multiprofessional team, and were given ibogaine in a hospital setting with psychotherapy sessions conducted both before and after administration of ibogaine. Patients were required to stay abstinent for 30 days before ibogaine administration, and to stay away from other people, duties, or social activity for 7 days after the ibogaine session.

Ibogaine hydrochloride was legally imported from a Canadian provider and was administered in a private hospital with an average dose of 15 mg/kg for men and 12 mg/kg for women.

Qualitative interviews

Semi-structured one-to-one interviews were conducted personally by a trained psychologist to obtain information about the patients’ drug use patterns, their reasons for starting to use drugs, and their perceptions of how ibogaine helped them recover from drug abuse.

Content analysis

We hypothesized that patients benefited from a treatment combining cognitive therapy with ibogaine sessions in a hospital, further supported with cognitive therapy sessions before and after ibogaine administration. We created a structured matrix of analysis based on six categories and studied the data choosing only the contents that fitted into the category.

Results

Patients were explicit about the importance of the ibogaine session in their recovery processes, but they were also keen to reinforce that without the accompanying cognitive therapy, the ibogaine session might not have been very useful.

Family support

Patients reported visualizations of childhood memories with eyes closed, especially of parents quarrelling and fighting. These memories gave insight into how the patient’s alcohol abuse habit was learned.

Many patients reported feeling regret toward not being close and caring for their children, while at the same time receiving more care and attention from the family.

Patients emphasized insights related to the emotional aspects of their familial relationships. These insights resulted in improvements in feelings toward and relation with parents.

Network/social support

Ibogaine helped participants to be aware of problematic issues in friendships and social interactions during their period of using drugs, and to compare these issues with social relationships outside of the drug use periods or outside of the circles of people they knew who used drugs.

Psychosocial functioning

Some patients achieved important insights through visualizations of memories and imagination of possible future scenarios in their life. They realized how their drug abuse behaviors were severely keeping them away from activities they considered more important and rewarding.

Leisure activities were mentioned as an area where improvements could be felt after the treatment, with an increased and intensified perception of the pleasure they can have while at leisure.

Quality of life

Patients reported overall improvements in quality of life following ibogaine sessions, including a solution of previous unfavorable mood and lack of will to engage in activities, and increased attention to the activities done at the present moment.

Patients realized how poor their nutrition was and how their mechanic habits toward food were taking away the pleasure of eating healthy foods.

Patients reported improved health through increased attention toward nutrition and a renewed willingness to practice sports and stay fit.

Participants reported profound gains in their basic desire to stay alive and enjoy life itself, as well as deep feelings of gratitude.

Craving

Patients reported reduced craving to different drugs after the ibogaine sessions, including strong nausea and disgust toward tobacco smell. Their feelings toward drug consumption changed from a compulsive style to a repulsive and disgusting feeling.

Participants whose primary drug of choice was alcohol reported reduced craving, and those whose primary drug of choice was cocaine reported reduced emotional attachment to their drug use memories.

Patients whose primary drug of abuse was crack cocaine mentioned an increased capacity to stay away from the drug and its users.

Changes in self-efficacy

Participants reported having insights and improvements about how they relate to their own strengths and weaknesses, and how they can cope with daily challenges, stress, and emotional discomfort.

Discussion

Ibogaine HCL can improve the psychological experiences of alcohol, tobacco, cocaine, and crack cocaine users, and can also help them to improve their family and social relationships, engage in study and professional activities, engage in healthy nutrition, practice sports and therefore generally improve their quality of life.

These results support the hypothesis that ibogaine can be helpful in the treatment of drug abuse and dependence. However, limitations must also be highlighted, such as selection bias. The treatment included extended sessions of cognitive therapy and other therapeutic practices, such as music therapy, yoga, and group meetings, and not all improvements can be uniquely and exclusively attributed to ibogaine sessions. However, most patients had previously failed other psychotherapeutic treatments, leading us to consider an important role ibogaine sessions may have played.

The first fatality after ibogaine ingestion for the treatment of cocaine and crack dependence was reported in Brazil in June 2016. This study used medical grade ibogaine HCL with dose precisely calculated for each patient, under constant medical supervision in a hospital, in a legal environment.

The data support the notion that ibogaine can be therapeutically useful in treating polydrug users, with caution to avoid adverse events.

The authors thank Centro de Tratamento Cleuza Canan for helping them reach patients and for their participation in this research.