Blending Traditions - Using Indigenous Medicinal Knowledge to Treat Drug Addiction

Blending Traditions - Using Indigenous Medicinal Knowledge to Treat Drug Addiction

Jul 18th, 2009 •

By Jacques Mabit, M.D.

Abstract
Ancestral medical practices are based on a highly sophisticated practicalknowledge and view the controlled induction of non-ordinary states ofconsciousness as potentially beneficial, even in the treatment of themodern phenomena of drug addiction. These ancestral practices stand incontrast to the clumsiness with which Western peoples induce alteredstates of consciousness. Drawing from his clinical experience in the HighPeruvian Amazonian forest, the author describes the therapeutic benefitsof the wise use of medicinal plants, including non-addictive psychoactivepreparations, such as the well-known Ayahuasca tea. Within aninstitutional structure, a therapeutic system combining indigenouspractices with contemporary psychotherapy yields highly encouragingresults (positive in 2/3 of the patients). This invites us to reconsiderconventional approaches to drug addiction and the role of the individual’sspiritual journey in recovery.

The Backwards Approach

Moving beyond the strict position that the final objective of drugaddiction therapy is complete abstinence, the Western world has respondedto its failures and limitations by considering the possibility of merelyreducing risks. The notion of substitution, as in methadone therapy forheroin addiction, indicates a certain tolerance towards altered states ofconsciousness. In this model, which treats these states as “inevitable” insome sense, one would now be satisfied with limiting their negativesecondary effects. In the face of a Puritanism resigned to an almostconstant failure, this attitude opens new possibilities in treating drugaddiction. It now seems thinkable that drug addiction is an attempt,certainly clumsy and sometimes extremely dangerous, of self-medication.Users may be responding to a real need to escape the constricting mud of adry and devitalized lifestyle, one lacking exciting perspectives or roomto blossom.
Some take this new tolerance of drug use further, for example by proposingto ravers that they learn about the drugs they consume, the risks thatthey run, and the best way to avoid the negative consequences of theirconduct3. In this model, the drug user is considered a thinking andconsenting subject, who is invited to take responsibility for his actions.The “repressive machine” that tends to substitute itself for the subject,making his decisions, revoking his responsibility, and, in the end,reinforcing an internal pattern of dependence, gives way to an approachwhich appeals to the user’s intelligence. This model accepts theauthenticity of the user’s quest, even if it is often unconscious, for atrue liberty that can be confused with caprice.
While this attempt at finding meaning by exploring new realms ofconsciousness can be chaotic and confused outside of a controlled setting,it is reminiscent of more purposeful undertakings among traditionalpeoples. In fact, one finds the induction of altered states ofconsciousness for the purposes of initiation and therapy in alltraditions. Such experiences, always guided by a ritual frame, oftendepend upon a fine understanding of the animal and vegetable substancesthat serve as their catalysts. One may also affirm that, sometimes, thesame substances that serve as the “remedy” in indigenous cultures are the“poison” in Western society. Hence the coca leaf, which is well integratedinto daily life in the Andean world, becomes a highly addictivecocaine-based paste when taken out of context. Similarly, cannabis, poppy,and tobacco may generate either remedy or poison according to the mode ofconsumption and the context of ingestion.
It is noteworthy that biologists observe that all animal species consumenatural psychoactive substances with great eagerness when possible(Siegel, Ronald, 1990). In fact, Siegel considers this conduct a fourthinstinctual instance of animal biology, as if life tends spontaneouslytowards a broadening of perceptions and a concomitant amplification ofconsciousness. It becomes difficult, then, to extract man from this vastbiological movement that embraces all animal life.
Indigenous Knowledge

Our observations in the Peruvian Amazon yield a supplementary fact: notonly do the natural psychoactive substances used by indigenous peoples notgenerate dependence, they are utilized to treat the modern phenomenon ofdrug addiction. This changes the way we understand toxicity; the Westernobsession with “substances” (drugs) is replaced, or at least accompaniedby, the concepts of the set (the subject, including geneticpredispositions, life history, and preparation) and setting (ritualized ornot). Indeed, psychoactive substances may be a treatment for “drugaddicts,” a fact that still seems paradoxical or impossible even to thespecialists in question. And yet, the facts speak for themselves.
This phenomenon also works for ethnic groups strongly affected bysubstances such as alcohol, which represents for them, inversely, animported product removed from its context. Hence, the healers of thePeruvian coast treat their alcoholics through the ritual use of themescaline cactus with a high rate of success (around 60 per cent, afterfive years) (Chiappe, Mario, 1976). The Native North Americans reduce theincidence of alcoholism on their reservations considerably and quiterapidly by reviving their ancestral practices, including the ritual use ofpeyote and tobacco (Hodgson, Maggi, 1997).

The ritualization of induced modifications of consciousness, with orwithout substances, establishes a universal symbolic frame within whichthese experiences acquire significance by allowing the individual toinscribe himself within a model of cultural integration. In indigenousgroups, then, such experiences frequently accompany rites of passage,particularly at adolescence, permitting the youth’s appropriation of thediscourse, images, and myths generated by the community. It is evidentthat the fundamental lack of cultural consensus in our fragmentedpost-modern society, along with the desacralization of the lived interiorand exterior, and the disappearance of all authentic rites of passage,leaves us without the means to integrate experiences of altered states ofconsciousness into our daily lives. In other words, the drug user sets offrandomly with neither compass nor map, often finishing badly.
These considerations lead to the following conclusion: not only must we nolonger take a position of passive tolerance toward an inevitableconsumption of psychoactive substances, but, on the contrary, we mustactively explore the coherent therapeutic use of psychoactive substanceswithout the outcome of dependence. Even more broadly, we must be open toevery induction of altered states of consciousness through diverse methods(such as music, dance, fasting, isolation, breathwork, physical exercise,pain, etc.) This calls for the application of therapeutic techniques thatcreate both a space of temporary containment and an authentic symbolicframe which, as in the indigenous ritual space, integrates therapists andusers. Traditional peoples also teach us that substances consumed in theirnatural form, used with respect to the body’s digestive natural barriers(that is, orally), do not induce dependence, in spite of their powerfulpsychoactive effects. The risk of toxicity is also lower because theiractive principles are similar, if not identical, to the neuromediatorsnaturally secreted by our bodies. In case of overdose (which is generallydifficult to produce given the extremely disagreeable flavor of thebeverages), these substances are eliminated naturally by vomiting. Thisself-regulating phenomenon provides for safe prescription and is anintegral part of the expected effects of ingestion, as well as those ofpurgation-detoxification (hence their special role in the domain of drugaddictions). The context of ingestion requires rigorous dietary, postural,and sexual regulations. In the course of successive ingestions,sensitivity increases instead of creating a habit. As a result, the dosesgradually decrease: their use in addiction therapy is not, then, a simplesubstitution.

It is remarkable that no visionary natural substance is addictive. Visionsseem to be the proof of sufficient cortical integration, of ametabolization of the symbolic charge revealed during the experience ofaltered consciousness. Entheogenic substances (also misnamedhallucinogens) are hence among the best of those that may be used in atherapeutic setting. This has already been attempted in psychotherapy(LSD, MDMA, Harmaline, DMT, etc.), but generally without an integratingsymbolic framework (or ritual space), without engaging the therapist inthe method, with synthetic or semi-synthetic substances or extracts, andthrough processes of assimilation that violate physiological barriers(i.e., injections).

Ayahuasca

This highly psychoactive ancestral beverage is situated at the heart ofboth the empirical medicinal practices of Amazonian cultures and,recently, of explorations into the therapeutic potential of medicinalplants, in particular in the domain of psychopathology, including drugaddiction therapy. The pharmacological sophistication of this preparationreflects the high degree of understanding of the Amazonian peoples, whoare proven to have discovered Monoamine Oxidase Inhibitors (MAOIs) atleast three thousand years before Westerners. Tryptamines andbeta-Carbolines, the major active principles of Ayahuasca, are present inmany natural secretions as well as in the central nervous system (pinealgland) (Mabit, Campos, Arce, 1993).
The entheogenic or visionary effects of this beverage have been hastilycalled “hallucinogenic,” stigmatizing a compound which could be asignificant topic of research. Its potential as such risks being dismissedby the academic community due to a stance less indebted to scientificrationality than to society’s collective fears. We have argued that theimages stimulated by the use of Ayahuasca in a therapeutic contextsymbolically manifest the content of the unconscious. Moreover, theseimages are not without an object, whether it be psychological orotherwise, which differentiates them completely from the “illusionswithout object” that are by definition “hallucinations” (Mabit, 1988). Theexploration of the unconscious through Ayahuasca permits the rapidextraction of extremely rich and highly coherent psychological material,which can then be worked through with various psychotherapeutic methods.Visions, like dreams, indicate the beginning of an integration at thesuperior cortical level. The effects of Ayahuasca are not merely visual,but embrace the entire perceptual spectrum, as well as the non-rationalfunctions tied to the right brain and to the paleoencephal or so-calledreptilian brain. The patient’s clinical experience fosters the developmentof not only the projective but also the integrative functions ofsymbolization, enabling the progressive readjustment of personalitystructures. These explorations touch cross-cultural psychological depthsand, hence, may be applied in extremely broad and varied contexts of humanlife.

After the observation for fifteen years of more than eight thousandinstances of Ayahuasca ingestion under specific conditions of preparation,prescription, and therapeutic follow-up, we can affirm that the ingestionof these preparations has a wide range of indications, with a totalabsence of dependence. The expansion of the perceptual spectrum, whichsimultaneously engages body, sensations, and thoughts, permits thede-focalization of the ordinary perception of reality, thus allowing thesubject to confront his habitual problems on his own and from a new angle.The intense acceleration of cognitive processes which accompanies thisprocess may permit the subject to conceive of original solutions that fithis unique personality and situation.

The Center: A Pilot Project

Our ignorance in regard to the controlled induction of altered states ofconsciousness could greatly benefit from ancestral medical knowledge. Themaster healers of various traditions are ready to transmit their heritageto those willing to learn and to embark upon a path of initiation. Sixyears of teaching beside Amazonian healers has led us to develop atherapeutic method using the controlled modification of states ofconsciousness. Our system is based on ancestral techniques involvingmedicinal plants and natural methods of detoxification, sensorystimulation, and sensory deprivation. This pilot project attempts tocombine ancestral knowledge with contemporary psychotherapeutic practices,working under the guidelines of ethical considerations and therequirements of the Western mentality.
The program, in which no method of coercion is exercised, accepts groupsof no more than fifteen voluntary patients. The location is a five acrepark bordered by a river, just outside the city of Tarapoto, in thePeruvian High Amazon, in the piedmont of the Andes (Mabit, Giove, Vega,1996).
The therapy is based on a three-part method which includes the use of theplants, psychotherapy, and community life. The guided experiences ofaltered consciousness generate psychological material which issubsequently discussed and evaluated in the psychotherapy workshops andthen directed towards expression in community life. In reverse, everydayactivities supplement the therapeutic sessions (with or without plants).
The initial use of purifying, sedative, and purgative plants reduceswithdrawal syndromes, rendering any return to prescription medicationduring the stay unnecessary. Then, the psychoactive plants intervene,powerfully facilitating the psychotherapy. From the brief sessions to theeight day isolation in the forest with rigorous rules pertaining to food,sex, external contacts and daily activities, each ingestion ofpsychoactive plants is governed by specific conditions. Each session isalso facilitated by a trained therapist, and clearly inscribed into aprecise and rigorous symbolic frame, which improves the chance of successfor the session and its subsequent integration into the subject’s life.

These techniques permit the exploration of buried memories and there-emergence of censured situations or events. These “revelations” bothrelieve the addict’s conscience and motivate him to face his sickness. Atemporary reduction of critical functions and discriminations facilitatesthe cathartic expression of emotions. These experiences, with the help ofpsychotherapeutic work, may then correct the defective formation of thesubject’s emotional expressions and ideals. By plunging under the veils ofordinary consciousness and unblocking the paths of access to the deep Ego,this exploration of the subject’s interior universe brings out richmaterial, in contrast to these patients’ often insufficient symbolization.During the subsequent sessions, the subject will learn to translate and tointerpret this material in order to explore subsequent dreams on his own.Dream life is stimulated by these practices, also benefiting the patient.One also observes an acceleration of cognitive processes and anamplification of the attention-span and of the depth of mentalconcentration. The clearly defined context, supplemented by a carefullyregulated lifestyle, invites the resident to implement the knowledgeobtained by this work. Hence, the space constitutes a laboratory in whichthe residents are at once the observers and the subjects of theirobservation. The medicinal plants play the central psychotherapeutic role,while caretakers offer guidance and security. The users are guided intoliminal, or symbolically transitional, experiences in which they visittheir interior gods and demons. These experiences simultaneously involvethe subject’s psychological state, the whole range of emotionalsensations, and the spectrum of his psychological perceptions. In theseexperiences, existential questions may come to light and demand an engagedresponse. The guided and cathartic process can help the individual totranscend his or her ordinary mindset and access somatic memories. In thebest cases, the individual is able to transcend the Ego, which can allow ahealthy deflation of the Ego, a reconciliation with human nature, and anacceptance of our modest inscription in time and in matter, which isnevertheless exciting because of its perceived meaning. In other words,this is a process of initiation; it is a semantic experience which carriesmeaning that can respond to the chaotic and disorderly quest of the drugaddict, which may be seen as a path of counter-initiation or as a savageinitiation (Mabit, 1993). This therapeutic method does not, then, simplyfocus on abstinence, but also offers an adequate alternative. Thisalternative method, which respects altered states of consciousness, isable to respond to the drug addict’s quest by furnishing it with clearends and with non-dangerous means to reach them. This process supposes aninternal structural change which goes beyond the palliative of a simpleexternal behavioral change, which is never totally satisfying and mostoften ineffective.

The duration of the stay is, in general, nine months, and the follow-up isideally two years. The centre has received patients of all social andcultural origins. The techniques, which mainly demand self-explorationthrough the senses, do not require any analytic verbalization orintegration, which represents an enormous therapeutic advantage. One mayeven say that these experiences of altered consciousness give access toineffable, inexpressible trans-verbal spaces, which are as muchpre-logical or infra-verbal as they are ecstatic or supra-verbal. Here,the local alcoholic peasant meets the European college student dependenton pot, the urban bourgeois who functions on cocaine, the dealer addictedto a cocaine-based paste, or the delinquent pathological liar who smokescrack. To the contrary of what certain theorists say, the exploration ofthe interior universe by these methods does not require that either thetherapist or the subject belong to the native culture of these practices.Rather, these practices give access to personal intra-psychical symbolswhich remain coherent to the subject and which touch depths that could becalled transcultural by virtue of reaching universal psychologicalcomplexes (love, hate, rejection, abandon, fear, peace, etc.). At the sametime, the accompanying psychotherapy allows the patient to betterunderstand the experience of the session, to integrate it, generate newquestions, and enrich the following session. We have now mastered thesetechniques ourselves, and we make use of them with patients from culturesother than our own. They are accessible to any Western therapist willingto fulfill the requirements of their long apprenticeship.
Results

Since its founding in 1992, the center has received more than 380patients. One study has just been made (Glove, not yet published) of thefirst seven years of activity (1992-1998), examining drug addicts oralcoholics having completed at least one month of treatment and with atleast two years of time out of the clinic - a sample of 211 courses oftreatment (175 first-time patients and 36 returning patients). Note thatthe results of this study do not include data on the 32% of patients wholeave during the first month before the first ayahuasca session, when thetreatment is not yet considered to have started. 28% reached the sixthmonth of treatment, and 23.4% finished the entire treatment.
Two-thirds of the patients consumed mainly a highly addictive anddebilitating cocaine-based paste. 80% consumed alcohol alone or inaddition to other drugs. More than half of the patients (53.5%) hadalready tried treatment, one-third of which had tried psychiatricservices. For 49%, the gateway drug was alcohol, and for 42%, cannabis.The average age was thirty years and the average duration of consumptionof psychoactive substances at the time of entrance was 12.5 years. At31.3%, with a tendency to augmentation, the index of retention (percentageof prescribed exits out of total exits) gives proof of the relativeacceptance of this therapeutic method. The voluntary exits make up themajority (52%) compared to prescribed exits (23%), runaways (23%), and therare expulsions (3%).

The evaluation of the results integrates qualitative givens, as well asthe incidence of abstinence or relapse due to poor prognostic criteria.One should note that the patients leave free of any post-residentialmedication. In addition to evaluating the relation to addictivesubstances, especially those that the subject consumed before, we considerpersonal evolution (internal structural change), the indications of socialand professional reintegration, and the capacity for familialrestructuring. According to these criteria, we may distinguish threecategories:

* “good”: favorable development, problems apparently resolved thanksto a true structural change manifested upon several life levels.

* “better”: favorable development with evident structural changes, butvestiges of the original problem still present.

* “same or bad”: relapse of consumption of substances, although oftenmore discrete, no convincing structural change, frequent abandonmentof substances for alcohol.

Out of the total, then, 31% were “good” and 23% “better,” while 23% werethe “same or bad” and 23% unknown. With hindsight, we can affirm thatabout 35% of those who have lost contact with the Center are, in the end,“good” or “better” (that’s 8% of the total), which means that about 62% ofthe patients have, in the end, positively benefited from the follow-up ofthe model proposed at the center. When one only takes into account thesample of the patients with “prescribed exit,” (those who have completedthe entire program) the positive results are raised to 67%.

When the patients relapse or simply re-offend, 55.5% return to the centerand 26% find other local practitioners of traditional medicine, whichdemonstrates their high opinion of this approach. When this occurs,purgative plants are more solicited than psychoactive plants. This choicedemonstrates the absence of dependence on the psychoactive substances.
This method, officially recognized by the Peruvian authorities, hasexpanded into a number of programs including educational programs (forstudents), psychiatric and anthropological research, and outreach (writtenand audio-visual media, and seminars for personal development).

Conclusion

The mere repression of drug consumption represents a simplistic approachto the problem, with demonstrated ineffectiveness as a therapy. We maywell call it illogical and even immoral since it omits the substances thatare currently the most deadly (alcohol and tobacco). In addition, theaccelerated development of new substances on the market outstrips anyrepressive attempt at control and relegates the game of penalinterdictions to failure. We are hence condemned to approach the problemunder another angle, whether we want to or not. Similarly, if harmreduction and substitution only indicate proof of failure and a last-ditcheffort of pure social convenience, they are also, in our view,reprehensible and morally dubitable. This is because they consecrate atacit rejection of healing, and the officialization, in a manner ofspeaking, of a population of second class citizens tolerated for lack of atherapeutic alternative.
The high degree of diffusion of the drug phenomenon in the 50’s and 60’swas born of the contact between a few intellectuals with traditionalpeoples, and, in particular, of North Americans with Amazonian Indians(Ginsberg, Leary, Alpert, etc., — see Leary, Metzner, Alpert, 1964).These intellectuals believed that they could appropriate ancestralknowledge while only retaining the physical substance, reducing “theapproach of the gods” to the consumption of an active principle, playingneurochemists like apprentice sorcerers (see Leary’s delirious work,1979). This oversimplified view of substances and their potential hasgenerated a terrible drama. The phenomenon of substance addiction ischaracteristic of Westernized societies and continues to be practicallyunknown in indigenous populations or among peoples free from prolongedWestern influence.

By approaching this ancient knowledge with respect and careful study, itseems possible to reinstate an authentic relation with the Mystery of Lifeby returning to true paths of initiation. By validating the legitimatequest of the drug user and redirecting it into a structured, meaningfulexperience, perhaps we may avoid the lax defeatism of the “anything goes”attitude as well as the rigid and useless bellicosity of “everything isforbidden.”

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