Well-being, problematic alcohol consumption and acute subjective drug effects in past-year ayahuasca users: a large, international, self-selecting online survey

This analysis of a survey study (n=527 used ayahuasca) found that users reported lower drinking rates than other psychedelics users and better well-being scores.

Abstract

“Ayahuasca is a natural psychedelic brew, which contains dimethyltryptamine (DMT). Its potential as a psychiatric medicine has recently been demonstrated and its non-medical use around the world appears to be growing. We aimed to investigate well-being and problematic alcohol use in ayahuasca users, and ayahuasca’s subjective effects. An online, self-selecting, global survey examining patterns of drug use was conducted in 2015 and 2016 (n = 96,901). Questions were asked about: use of ayahuasca, lysergic acid diethylamide (LSD) and magic mushrooms; demographics, current well-being and past-year problematic alcohol use of past-year ayahuasca users and comparison drug users; and subjective effects of ayahuasca and comparison drugs. Ayahuasca users (n = 527) reported greater well-being than both classic psychedelic users (n = 18,138) and non-psychedelic drug-using respondents (n = 78,236). Ayahuasca users reported less problematic drinking than classic psychedelic users, although both groups reported greater problematic drinking than the other respondents. Ayahuasca’s acute subjective effects usually lasted for six hours and were most strongly felt one hour after consumption. Within our online, self-selecting survey, ayahuasca users reported better well-being than comparison groups and less problematic drinking than classic psychedelic users. Future longitudinal studies of international samples and randomised controlled trials are needed to dissect the effects of ayahuasca on these outcomes.”

Authors: Will Lawn, Jaime E. Hallak, Jose A. Crippa, Rafael Dos Santos, Lilla Porffy, Monica J. Barratt, Jason A. Ferris, Adam R. Winstock & Celia J. A. Morgan

Notes

This paper is included in our ‘Top 10 Articles Introducing Psychedelic-Assisted Therapy‘

Summary

Ayahuasca is a powerfully psychoactive brew that is prepared by boiling leaves of the Psychotria viridis bush and stems of the Banisteriopsis caapi vine. It contains DMT, a tryptamine hallucinogen, and -carboline alkaloids that are MAO-I inhibitors.

Ayahuasca is used by both indigenous tribes and modern syncretic religious groups in and around the Amazon, and has been suggested to have increased in use in Europe and the US amongst Western ‘neoShamans’.

If ayahuasca is to represent an important treatment, it must be investigated and its safety well established. Several observational studies suggest that long-term ayahuasca use is associated with better mental health and cognitive functioning.

A study was conducted on a large, self-selecting, international sample of people who had recently used ayahuasca to compare the positive and negative effects of ayahuasca on mental health, and to assess whether there were differences between countries with and without a history of ayahuasca use.

A global online cross-sectional drugs survey was conducted between November 2015 and February 2016 to explore the use of uncommon and new drugs. All participants were aged 16 years or over, provided informed consent, and were made aware that their responses were anonymous and confidential.

We collected demographic data and detailed information on drug use from participants in a survey. We formed three groups: Ayahuasca Users, Classic Psychedelic Users and Other Respondents based on past year ayahuasca use, current well-being, past year problematic drinking and lifetime mental illness.

We stratified participants into those from countries with historical ayahuasca use and those from countries without historical ayahuasca use. We investigated whether differences between user groups existed in both types of countries.

We asked respondents about their last new drug experience and analysed the subjective effects of ayahuasca, LSD and magic mushrooms. We also reported how the drug was sourced, how long the effects lasted and what the predominant effect of the drug was.

We used one-way ANOVAs and chi-square tests to compare the age, gender, country of residence, past year problematic alcohol use, current well-being and lifetime mental illness diagnosis of ayahuasca users, classic psychedelic users and other respondents.

Results

A total of 100,711 responses were recorded. A relatively small number of respondents reported lifetime ayahuasca use, compared to over a quarter of the sample reporting lifetime magic mushroom or LSD use.

We split the respondents into Ayahuasca Users, Classic Psychedelic Users and Other Respondents.

There was a main effect of user group on age, with Ayahuasca Users being older than Classic Psychedelic Users and having a similar age to Other Respondents. Fewer females than males reported ayahuasca use.

There was a main effect of user group on reported well-being, with Ayahuasca Users reporting greater well-being than Classic Psychedelic Users and Other Respondents.

There was a main effect of user group on total AUDIT score, with the Ayahuasca User group having a lower total AUDIT score than the Classic Psychedelic User group.

There were different proportions of people who reported having a diagnosed mental illness in their lifetime in the Ayahuasca User group, Classic Psychedelic User group and Other Respondents group.

Magic mushroom and LSD users were similar in age, wellbeing, problematic drinking, gender, and mental illness diagnosis to those who only used magic mushrooms in the last year.

There was an interaction between User Group and Country Type on psychological well-being. Ayahuasca Users had a higher well-being than Classic Psychedelic Users and Other Respondents.

In countries without a history of ayahuasca use, there was a significant difference in incidence of lifetime mental illness diagnoses between Ayahuasca Users, Classic Psychedelic Users and Other Respondents.

For those who said they had most recently tried ayahuasca, 166 people swallowed it, 20 people drank it, and 5 people smoked it. Only respondents who reported taking ayahuasca orally were included in these analyses.

Ayahuasca was sourced from a friend, 13 from a website, 5 from a family member, 3 from a dealer, 1 from a headshop and 114 from ‘other’. The median and modal reported duration of effect was 6 hours and the estimated time to peak effect was 1 hour.

Most people described ayahuasca as ‘mostly psychedelic’, three people described it as ‘mostly cannabis like’, two people described it as ‘mostly empathogen like’, and 48 people stated ‘other’.

Ayahuasca was described as ‘spiritual’, ‘medicine’, ‘healing’, ‘hallucinogenic’, ‘indescribable’, and ‘introspective’ by people whose last new drug they had tried was ayahuasca/LSD/magic mushrooms.

Ayahuasca was rated as having a smaller comedown, less urge to use more, less risk of harm, and no significant differences between ratings of value for money between Ayahuasca and the other drugs.

Discussion

This study investigated the characteristics of past-year ayahuasca users, their current well-being, their past year problematic alcohol use and their lifetime mental illness diagnoses, and the subjective effects of ayahuasca in new users. Ayahuasca users reported greater well-being and less past year problematic drinking than classic psychedelic users.

We examined the subjective effects of ayahuasca in people whose most recently taken new drug was ayahuasca. Ayahuasca was rated as stronger, less pleasurable, having more negative effects while high, having weaker ‘comedown’ effects after use, and creating less of an urge to use more.

Ayahuasca users had better self-rated psychological well-being than classic psychedelic users, perhaps due to the non-DMT compounds in ayahuasca, or a pre-existing difference in the kinds of people who use ayahuasca compared with LSD and magic mushrooms. The use of classic psychedelic drugs is not associated with greater well-being in the long-term, but this may be due to confounding factors such as additional drug use and pre-existing differences between classic psychedelic drug users and other respondents.

In this study, ayahuasca users and classic psychedelic users had a higher incidence of lifetime mental health problems compared to non-psychedelic other respondents. This could be due to a relationship between poly-drug use and mental illness, or to an unconventional treatment.

When we stratified by country of origin, people who used ayahuasca had no different lifetime mental health diagnoses than classic psychedelic users or other drug users. People who use ayahuasca in countries with historical ayahuasca use may be attracted to the experience for different reasons, and may have different lifetime mental health diagnoses. Previous work has examined the impact of cultural context on the response to drugs, and the expectation of their positive and negative effects. Ayahuasca use has recently emerged as a promising treatment for depression, and longitudinal studies have found lower incidence of mental health issues associated with use of the drug.

Problematic drinking was less prevalent in ayahuasca users than in classic psychedelic users, although ayahuasca users did show greater problematic drinking than non-psychedelic using respondents in the sample. People who take ayahuasca are more likely to use many different drugs than the other respondents, and may be using ayahuasca to treat their alcohol-related problems.

Ayahuasca produced a low urge to use the substance again, which is in agreement with previous findings. It was rated as having stronger negative effects while high than LSD or magic mushrooms, but also less pleasurable.

The study used an international sample of drug users, was self-selecting, and was unable to confirm the substance ingested was indeed ayahuasca. It also did not measure current from resolved mental health problems, so future studies should measure this variable.

Conclusions

In this international study, ayahuasca users reported greater well-being and less problematic alcohol use than classic psychedelic users, but also a higher incidence of lifetime mental illness diagnoses. There was a need for more research into the relationships between ayahuasca use, mental health, well-being and problematic alcohol and substance use.

Author Contributions

The Global Drug Survey was conducted by Will Lawn, Jaime Hallak, Jose Crippa, Rafael dos Santos, Lilla Porffy, Monica Barratt, Jason Ferris and Adam Winstock. Celia Morgan thought up the study and partially wrote the first version of the manuscript.

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