This open-label study (n=36) found that ayahuasca led to significant (and clinically relevant) changes in addiction scores (e.g. ASI) and cognitive function. There was significant drop-out (39%), and the open-label character makes it difficult to draw causative conclusion. Still, this research provides another data point for ayahuasca for substance use disorder (SUD) treatment.
Abstract
“Aims: The therapeutic use of psychedelics is regaining scientific momentum, but similarly psychoactive ethnobotanical substances have a long history of medical (and other) uses in indigenous contexts. Here we aimed to evaluate patient outcomes in a residential addiction treatment center that employs a novel combination of Western and traditional Amazonian methods.
Methods: The study was observational, with repeated measures applied throughout treatment. All tests were administered in the center, which is located in Tarapoto, Peru. Data were collected between 2014 and 2015, and the study sample consisted of 36 male inpatients who were motivated to seek treatment and who entered into treatment voluntarily. Around 58% of the sample was from South America, 28% from Europe, and the remaining 14% from North America. We primarily employed repeated measures on a psychological test battery administered throughout treatment, measuring perceived stress, craving frequency, mental illness symptoms, spiritual well-being, and physical and emotional health. Addiction severity was measured on intake, and neuropsychological performance was assessed in a subsample from intake to at least 2 months into treatment.
Results: Statistically significant and clinically positive changes were found across all repeated measures. These changes appeared early in the treatment and were maintained over time. Significant improvements were also found for neuropsychological functioning.
Conclusion: These results provide evidence for treatment safety in a highly novel addiction treatment setting, while also suggesting positive therapeutic effects.”
Authors: David M. O’Shaughnessy, Ilana Berlowitz, Robin Rodd, Zoltán Sarnyai & Frances Quirk
Summary
Addiction treatment was an exciting line of inquiry during the first wave of psychedelic research, but was marred by inadequate research methodology and growing controversies. A revitalized second wave of research is now well underway.
Therapeutic use of ayahuasca
Ayahuasca is an ethnobotanical substance made from Banisteriopsis caapi and Psychotria viridis leaves. It is powerfully psychoactive but appears to be safe when used appropriately, and has been shown to have therapeutic potential for the alleviation of substance abuse, depression, and anxiety-related disorders.
The Takiwasi Center
Ayahuasca-assisted treatment programs have been established in Peru since 1992, and combine traditional Amazonian medicine with Western psychotherapeutic and biomedical approaches. Patients cease taking psychiatric medications prior to entry, and undergo a variety of traditional and Western therapies.
Takiwasi is a treatment center for people with mental health problems that uses medicinal plants to help them recover. The treatment process lasts around 9 months and involves physical detoxification, psychotherapy, occupational therapy, community living, psychological and spiritual development, and biomedical evaluation.
Study rationale
Takiwasi offers the potential for generating unique insights into the use of traditional medicines in addiction treatment, including the use of ayahuasca. However, scientific evaluation of Takiwasi’s treatment has been lacking, and this study builds on these results by reporting on patient changes at multiple points within treatment.
Participants
All patients who entered Takiwasi’s admission protocol for addiction treatment were eligible to participate. No patients declined to participate, and no patients dropped out of the study while in treatment.
36 male inpatients were admitted to Takiwasi, with ages on treatment admission ranging from 20 to 50 years. 61% completed the treatment, 22% exited voluntarily, 14% were suspended from treatment, and one patient abandoned the treatment without advising staff.
Design
In accordance with World Health Organization recommendations, we obtained repeated measures on psychological variables to assess clinical change in a global sense.
Measures
The Brief Symptom Inventory (BSI) is a shorter 53-item version of the Symptom Checklist-90 Revised, and measures psychiatric symptoms across nine dimensions.
The SWBS85 assesses two dimensions of well-being: Religious Well-Being and Existential Well-Being. Higher scores indicate greater well-being.
The Short Form Health Survey 36 version 2 (SF-36v2) measures eight health domains, but only reports global measures of physical and mental/emotional health.
The Self-Evaluated Transition (SET) is a 5-choice item from the SF-36v2 that captures perceived change in general health over the past year.
Neuropsychological functioning was tested with the Repeated Battery for the Assessment of Neuropsychological Functioning Update (RBANS)87.
We measured the clinical battery at important treatment points, which were diets and exit from treatment. The diets were followed by a reflective phase where patient plant intake was negligible, which allowed us to minimize interference from the acute effects of psychoactive plants when taking repeated measures.
The RBANS was administered on treatment intake and at a follow-up point. Fluent Spanish speakers were only tested.
We compared the sample’s intake ASI scores with normative values from mainstream inpatient centers and compared the intake scores on the clinical battery against available normative samples.
Within-treatment changes were analyzed using mixed-effects models. Total treatment time was not warranted as a predictor based on Akaike information criterion values.
Results
Intake profile
The Takiwasi sample was characterized on intake, making comparisons against available normative values. Addiction severity was assessed using the ASI composite score.
Takiwasi patients had significantly higher scores on drug, family, and legal issues compared with the Canadian sample, but significantly lower scores on medical and work issues.
Takiwasi patients had significantly higher scores for drug, family, and psychiatric problems compared with the US sample.
Clinical battery scores were not significantly different from the US average, but MCS scores were significantly lower, PSS-10 scores were higher, and GSI scores were significantly higher than the US male average.
We found that RWB scores were possibly lower than US mental health patients, EWB scores were not significantly different from US mental health patients, and CEQ-F scores were significantly higher than an Australian sample of alcohol abuse outpatients.
Within-treatment changes
We present predictive mixed-effects models for patient change throughout treatment on the clinical battery, where higher scores indicate positive clinical outcomes.
Self-evaluated transition was similar on intake and repeated measures during treatment. Only two patients rated their health as “about the same”.
The group’s neuropsychological functioning improved from intake to treatment, but only the Total Scale and Delayed Memory indexes were significantly different from intake scores.
Dropout analysis
Early treatment dropouts were younger than the rest of the sample on average (M = 22 years, SD = 2), but not on nationality, religion, or ASI intake scores.
Takiwasi patients on admission
Takiwasi patients are likely to have a high severity of addiction on intake, and psychiatric co-morbidity is likely to be prevalent. The clinical battery indicated that mental and emotional health is likely to be especially low, although physical health is comparable to the US inpatient average.
Within-treatment changes
Over the course of treatment, Takiwasi patients are likely to make clinically significant improvements on a variety of measures relevant to addiction, including increased mental and emotional health, increased meaning and purpose in life, and reduced perceived stress, mental illness symptoms, and craving.
Our results suggest that clinical improvements occur relatively quickly, and that dropouts are unlikely to be caused by lack of clinical change. However, younger patients may be more likely to drop out of treatment early on.
We found some divergence in the modeling of spiritual well-being throughout treatment at Takiwasi, with strong predicted increases in existential well-being whereas spiritual well-being formulated in explicitly religious terms was more uncertain.
Limitations and significance
This observational study of patients in a residential center for drug addiction does not distinguish between specific treatment interventions and the unusual environment of the center.
Although the present results are limited, they provide evidence of treatment safety in a highly novel setting. However, further study is needed on the basic effects of Amazonian medicinal plants and practices.
Our results suggest that Takiwasi treatment may have a therapeutic effect, but it is difficult to determine if these patient changes translate into addiction treatment success. Moreover, it is difficult to assess how well these results would generalize to other patients seeking treatment.
We found that Takiwasi healers used ayahuasca ceremonies and dietary retreats as part of their treatment protocol, which is consistent with the contemporary literature on the use of indigenous psychoactive plant sacraments.
Conclusion
The resurgence of psychedelic research holds promise for the addiction treatment field, and Takiwasi’s treatment protocol is more deeply connected with traditional medical practices. Further clinical work is called for to investigate treatment effectiveness.