Showing posts with label entheogens. Show all posts
Showing posts with label entheogens. Show all posts

Tuesday, 11 August 2009

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.”


Bibliography

Chappe, Mario. 1976. The use of hallucinogens in psychiatric folklore.Boletin de la Oficina Sanitaria Panamericana (Bulletin of the PanamericaSanitary Office), 81 (2): 176-186.

Giove, Rosa. 2002 (to be published). The liana of the dead to the rescueof the life. Contradrogas (Anti-drug) ed., Lima 200.

Hodgson, Maggi. 1997. From Alcoholism to a new life: the eagle has landed.In: Indian communities develop futuristic addictions treatment and healthapproach, Institute of Health Promotion, Research and Formation, Alberta,Canada, 139, 11-14.

Leary, T. 1979. Graine d’Astre, Cosmos Ed., Canada, 204.

Leary, T., R. Metzner, R. Alpert. 1964. The Psychedelic Experience, FirstCarol Publishing Group Ed.

Mabit J. 1993. Amazon shamanism and drug addiction: initiation andcounter-initiation. In: Revue AGORA, Éthique, Médecine et Société (AGORAReview, Ethics, Medicine, and Society), Paris, 27-28, 139-145.

Mabit J., J. Campos, J. Arce. 1993. Considerations surrounding theayahuasca concoction and therapeutic perspectives. Revista Peruana deNeuropsiquiatría, Lima, LV (2), 118-131.

Mabit J., R. Giove, J. Vega. 1996. Takiwasi : The Use of AmazonianShamanism to Rehabilitate Drug Addicts. In: Yearbook of cross-culturalmedicine and psychotherapy, Zeitschrift für Ethnomedizin (Journal ofEthnomedicine), Publishing House for Science and Education, VWB, Berlin,257-285.

Mabit J-M. unpublished. Ayahuasca hallucinations of the warriors of thePeruvian Amazon, Working Paper 1/1998, French Institute of Andean Studies,Lima, 15 p.

Siegel, Ronald. 1990. Intoxication, Pocket Books, New York, 1990, 390 p.

Sueur C., A. Benezech, D. Deniau, B. Lebeau, C. Zizkind. 1999.Hallucinogenic substances and their theraputic usages - Literature Review,Revue Documentaire Toxibase (Review of Drug Abuse Literature), 66 p.

Tuesday, 21 July 2009

The globalization of ayahuasca: Harm reduction or benefit maximization?


The globalization of ayahuasca: Harm reduction or benefit maximization?


Kenneth W. TupperCorresponding Author Contact Information, a, E-mail The Corresponding Author

aDepartment of Educational Studies, University of British Columbia, BC, Canada

Received 9 June 2006;

accepted 1 November 2006.

Available online 4 December 2006.

Abstract

Ayahuasca is a tea made from two plants native to the Amazon, Banisteriopsis caapi and Psychotria viridis, which, respectively, contain the psychoactive chemicals harmala alkaloids and dimethyltryptamine. The tea has been used by indigenous peoples in countries such as Brazil, Ecuador and Peru for medicinal, spiritual and cultural purposes since pre-Columbian times. In the 20th century, ayahuasca spread beyond its native habitat and has been incorporated into syncretistic practices that are being adopted by non-indigenous peoples in modern Western contexts. Ayahuasca's globalization in the past few decades has led to a number of legal cases which pit religious freedom against national drug control laws. This paper explores some of the philosophical and policy implications of contemporary ayahuasca use. It addresses the issue of the social construction of ayahuasca as a medicine, a sacrament and a “plant teacher.” Issues of harm reduction with respect to ayahuasca use are explored, but so too is the corollary notion of “benefit maximization.”

Keywords: Ayahuasca; Entheogen; Hallucinogen; Religious freedom; Benefit maximization

Article Outline
Introduction
Ayahuasca and its effects
Contemporary ayahuasca uses
Constructing ayahuasca—ontology
Ayahuasca, globalization and public policy
Conclusion
References

Introduction
In February 2006, the United States Supreme Court ruled that religious freedom may trump U.S. drug laws with respect to the ceremonial use of ayahuasca, a tea indigenous to the Amazon and long revered by its peoples (Hollman, 2006). The case of Gonzales v. O Centro Espirita Beneficente União do Vegetal (UDV) addressed the question of whether ‘hoasca,’ which contains the Schedule I substance dimethyltryptamine, could legally be consumed as a sacrament by the Brazilian-based UDV church according to the provisions of the Religious Freedom Restoration Act (RFRA). Passed by Congress in 1993 in response to the question of whether the Native American Church had the freedom to use ceremonially the scheduled drug peyote, the RFRA established that the limits of drug laws in the United States were at the boundaries of religious liberty.

The U.S. ayahuasca case is just one of several similar ones in countries such as Australia, Italy, the Netherlands and Spain. The issues raised by these court actions centre not only on religious freedom, but also on the substance in question: ayahuasca. Although somewhat obscure in pantheon of psychoactive substances, ayahuasca has begun to thrive beyond the Amazon. Practitioners, policy-makers and researchers face significant challenges in responding to psychoactive substance use that resists traditional conceptualizations and categorizations of illegal drug “abuse.” In this article, I briefly describe ayahuasca, its effects and its traditional and contemporary uses. I next explore some philosophical and policy issues raised by the “globalization” of ayahuasca, the burgeoning world-wide interest in and use of the tea. This discussion leads to a questioning of the deficit model of drug use implicit in the term “harm reduction” with respect to ayahuasca, which arguably warrants a re-framing such that policy discussions address the corollary concept of “benefit maximization.”

Ayahuasca and its effects

“Ayahuasca” is a word from the language of the Quechua people, a group indigenous to the Amazonian regions of Peru and Ecuador (Metzner, 1999). Translating as “vine of the soul,” ayahuasca refers both to Banisteriopsis caapi, a liana found in Western parts of the Amazon basin, and to a decoction prepared from B. caapi that typically contains other admixture plants. One of the most common admixtures to the ayahuasca tea is the leaf of Psychotria viridis, a plant from the coffee family. To avoid confusion, in this article the plant will be referred to by its botanical name, B. caapi, and the common tea preparation of the combination of B. caapi and P. viridis simply as ayahuasca.

The synergy between the respective psychoactive chemicals in B. caapi and in P. viridis is a remarkable pharmacokinetic interaction. The B. caapi vine contains harmala alkaloids, such as harmine and tetrahydroharmine, which are short-acting reversible monoamine oxidase (MAO) inhibitors. MAO inhibitors are a pharmacological class of antidepressant chemicals that function by preventing the breakdown of the monoamine neurotransmitters in the brain (Julien, 1998). P. viridis contains dimethyltryptamine, or DMT, a potent hallucinogen which is active when taken parenterally, but not orally (Shulgin, 1976). This is because the gastrointestinal tract also contains the enzyme monoamine oxidase, which metabolizes orally ingested DMT long before it can reach the brain. However, when DMT is ingested in conjunction with an MAO inhibitor – as is the case with the ayahuasca tea – its immediate metabolism is delayed, thus enabling it to reach the brain (McKenna & Towers, 1984; Ott, 1999). From a biomedical perspective, then, ayahuasca's unique effects are a function of the combination of DMT and the potentiating psychoactive harmala alkaloids ([Callaway et al., 1999] and [McKenna et al., 1984]). In contrast, the explanation of ayahuasca's effects by Amazonian indigenous peoples reflects a paradigm involving spiritual domains and supernatural forces, an account corroborated if not validated by the phenomenology of the ayahuasca experience.

The extensive range of ayahuasca preparations in the pharmacopoeias of different indigenous peoples throughout the Amazon region indicates that its use long predates first contact with Europeans. The variety of names given to B. caapi, such as yagé, caapi, natem, oni, nishi, also suggests widespread historic use (Luna, 1986). However, the legacy of colonialism in South America, as with so many other parts of the world, has irredeemably impacted indigenous peoples and their traditions, including cosmologies in which ayahuasca has played a central role (Whitten, 1981). Colonial and religious authorities tended to condemn ayahuasca shamanism as diabolical and discouraged its practice ([Taussig, 1986] and [Vickers, 1981]). Nevertheless, the ritual use of ayahuasca among indigenous peoples of the Amazon continues to the present day, albeit with varying degrees of Christian syncretism through past and present influence of missionaries in the region (Luna, 1986). Likewise, cross-cultural transfer of ayahuasca healing knowledge among indigenous peoples and to non-indigenous people continues to occur ([Gray, 1997], [Luna, 2003] and [Pollock, 2004]); this includes mestizo vegetalistas who offer alternative health treatments to urban dwellers in countries such as Peru (Dobkin de Rios, 1973).

The specifics of traditional Amazonian ayahuasca practices – as with the name for the tea itself – vary across different cultural groups, but there are some common elements, most notably a ceremonial context for its consumption. Rituals are conducted by an experienced healer, or ayahuascero, who has undergone many years of training to become adept in administering the brew. Preparation for this role includes long periods of isolation, sexual abstinence and adherence to strict dietary taboos involving certain foods or meats. Some of these behavioural directives apply also to participants in the ritual who will drink, as they risk invoking untoward spiritual forces if these are violated. Rituals invariably incorporate chanting or singing of icaros – special songs through which healing, divination or connecting with spirits may be effected – and often include an accompanying use of other sacred plants, such as tobacco ([Demange, 2002] and [Luna, 1986]). In many respects, ayahuasca is a paradigmatic entheogen, or psychoactive substance used for spiritual purposes (Ruck, Bigwood, Staples, Ott, & Wasson, 1979; Tupper, 2002).

Ayahuasca's psychoactive effects are qualitatively similar to those of other drugs from the same pharmacological class, such as LSD and psilocybin, yet they are also phenomenologically unique. The effects generally begin 30–40 min after ingestion, peak by about 2 h and have completely subsided by 6 h (Riba et al., 2003). Ayahuasca produces moderate cardiovascular stimulation, including moderate increases in heart rate and diastolic blood pressure (Riba et al., 2003). Users report sensations of visual or auditory stimulation, synaesthesia, psychological introspection and strong emotional feelings ranging from occasional sadness or fear to elation, illumination and gratitude (Shanon, 2002). The tea itself has a bitter taste and cannot be described as pleasant to drink. Emesis, or vomiting, is not uncommon during the ayahuasca experience, an effect which is generally regarded as a spiritual or physical cleanse.

The long-term effects of ayahuasca on regular drinkers have not yet been well studied by medical scientists, as the tea has remained relatively obscure until the last few decades of the 20th century. Preliminary small-scale investigation on members of Brazilian ayahuasca churches suggests that the tea is not physiologically or psychologically harmful when used in ceremonial contexts (Barbosa, Giglio, & Dalglarrondo, 2005; [Callaway et al., 1999] and [Grob et al., 1996]; Riba & Barbanoj, 2005). Shanon (2002) has analysed the phenomenology of the ayahuasca experience from the perspective of cognitive psychology, work that suggests many avenues of future psychological research. Evidence for ayahuasca dependence is lacking; indeed, some have suggested ceremonial ayahuasca use may have therapeutic applications as an adjunct to treatment for addictions ([Mabit, 2002], [McKenna, 2004] and [Winkelman, 2001]).

Contemporary ayahuasca uses

In addition to continued ayahuasca use among traditional indigenous and mestizo denizens of the Amazon, other types of ayahuasca practices have arisen in modern times. The inevitable mixing of indigenous and dominator cultures in South America over time has resulted in hybridities of ayahuasca use that continue to evolve through the forces of globalization. Brazil has been the source of several syncretistic religious movements that combine elements of indigenous ayahuasca use, African spiritualism and Christian liturgy. These include the Santo Daime, founded in the 1930s by Raimundo Irineu Serra; the União do Vegetal, founded in 1961 by José Gabriel da Costa; and the Barquinha, a group, which split from the Santo Daime in 1945 (MacRae, 2004). As with traditional indigenous ayahuasca practices, these modern groups incorporate a strong ritual context in their uses of ayahuasca. Towards the end of the 20th century, chapters of the Santo Daime and the União do Vegetal started to be established beyond Brazilian borders, in such countries as in Australia, Canada, France, Germany, Japan, the Netherlands, Spain and the United States.

The Santo Daime is both the oldest and the most internationally active of the syncretistic Brazilian ayahuasca churches. Its origins trace back to the 1920s, when its founder – a Brazilian rubber tapper named Raimundo Irineu Serra or Mestre Irineu – encountered the tea through contact with Amazonian indigenous peoples in remote forests of the Brazilian frontier state of Acre (Alverga, 1999). The Santo Daime remained obscure and geographically isolated in the rural Amazon for many decades. However, when Mestre Irineu died in 1971, the church split into several different factions, one of which – the Eclectic Center of the Universal Flowing Light, or CEFLURIS – has been central in the Santo Daime's subsequent expansion (MacRae, 2004). From the 1970s, CEFLURIS has attracted middle-class Brazilians and international visitors to its rituals and established chapters in urban Brazilian centres and more recently overseas (MacRae, 1998). After a period of legal vicissitudes, in which the status of ayahuasca was uncertain, the Brazilian government in 1991 determined that the benefits of its ritual use outweighed any potential risks and recognized the rights to sacramental use of the tea by groups such as the Santo Daime and the UDV.

As a result of expansion into countries unprepared for the policy conundrums posed by non-indigenous entheogenic substance use, the Santo Daime and its adherents have faced legal action in several different countries in the past decade, including the Netherlands, Spain and Italy. In the Netherlands, as with the UDV case in the United States discussed above, the courts ruled in favour of religious freedom and the Santo Daime was granted the right to use its sacrament legally in Holland (Adelaars, 2001). In Canada, a chapter of the Santo Daime in the province of Quebec has applied for an exemption to the Canadian Controlled Drugs and Substances Act in hope of obviating a costly legal battle; the Canadian government is still considering the application (J.W. Rochester, personal communication, February 7, 2006). These cases epitomize the struggle between groups seeking the legitimation of the sacramental use of ayahuasca and governments in liberal democratic states endeavouring to uphold both religious freedom and punitive drug laws.

The forces of information and communications technology have also provided avenues for the expansion of use of ayahuasca-like preparations. A quick Internet search results in scores hits for websites selling live cuttings or dried samples of B. caapi, P. viridis and numerous other plants, such as Mimosa hostilis and Peganum harmala, that are botanical sources for dimethyltryptamine and harmala alkaloids. The Internet also abounds with information (and misinformation) about how to prepare ayahuasca-like brews and “trip reports” of first-hand accounts of experiences individuals have had with these ([Bogenschutz, 2000] and [Halpern and Pope, 2001]). Predictably, some amateur psychonauts or self-styled kitchen shamans have harmed themselves through experimenting with ayahuasca analogues in recreational contexts (Brush, Bird, & Boyer, 2003; Sklerov, Levine, Moore, King, & Fowler, 2005). However, it should be noted that reported adverse outcomes are extremely rare and have been sequelae to uncontrolled use of non-traditional preparations (Callaway et al., 2006).

Ayahuasca tourism has also become a cultural phenomenon in the Amazon at the turn of the 21st century. With growing awareness of ayahuasca in developed Northern countries has come the concomitant desire among some to seek “authentic” ayahuasca experiences in countries such as Peru, Ecuador and Brazil ([Dobkin de Rios, 1994] and [Winkelman, 2005]). The effects of ayahuasca tourism on both the local people and the economies of these regions are open to interpretation, but are significant and continuing to grow. Some indigenous healers in the Amazon have expressed concern about the ill-trained or manipulative locals who may exploit naïve or undiscerning travellers and potentially cause inadvertent harm through careless administration of ayahuasca (Dobkin de Rios, 2005).

The expansion of ayahuasca use can be expected to continue as public awareness of the tea grows and as it becomes further available both through commercial sales and through spiritual communities. Accounts of ayahuasca experiences and the tea's purported spiritual and health benefits are beginning to appear in mainstream English news media stories ([Creedon, 2001], [Montgomery, 2001] and [Salak, 2006]). Some of the effects of ayahuasca – for example, its tendency to provoke vomiting and its sometimes heavy emotional and psychological effects – may discourage casual experimentation. However, its relative obscurity and lack of negative associations from the demonizing of such hallucinogens as LSD, psilocybin and peyote in the late 1960s and early 1970s, as well as growing interest in alternative medicines and therapeutic practices, may increase ayahuasca's uptake among the general public. Thus, ayahuasca presents unexpected challenges to judicial systems and policy-makers, who struggle to balance tensions between criminal justice, public health and human rights interests.

Constructing ayahuasca—ontology

One of the conundrums ayahuasca presents for contemporary drug policy is ontological. Ontology is a branch of metaphysics that involves the philosophical analysis of existence and the categorization of reality. Modern drug laws and policies are ontologically predicated on a mechanistic view of the universe, as they are socio-political extensions of the modernist project of scientific materialism. According to this view, drugs and their effects can be wholly explained by the sciences of biochemistry and psychopharmacology. Reinarman and Levine (1997) identify this as pharmacological determinism, the belief that a drug's effects are caused solely by its pharmacological properties, irrespective of psychological idiosyncrasies or social context. However, a constructivist perspective acknowledges that beyond this, drugs are powerful cultural constructs. The effects they produce on human consciousness and behaviour are functions not just of their biochemistry, but also of the rich symbolic and social meanings they are given.

From a constructivist perspective, drugs cannot be fully understood merely by analyzing their chemical structures and how these interact with neurophysiological systems. One needs to consider also the meanings underlying their growth, production, preparation, consumption and categorization, all of which can vary across cultures and over time. For example, the concept of “medicine” is a cultural construction that in contemporary Western societies is given meaning through the powerful institutions of medical practitioners and systems. Particular substances are deemed medicines not by any properties inherent in them, but by virtue of their being blessed as such by members of powerful professional classes (i.e. physicians and pharmacists). Lysergic acid diethylamide (LSD) had this blessing in the 1950s and early 1960s, when it was considered a promising psychiatric medication, but was quickly delegitimized when its non-medical use became headline news and the subject of moral panic ([Dyck, 2005], [Littlefield, 2002] and [Sessa, 2005]). Alcohol was also once deemed a medicine, whereas today in most societies it is a recreational (or sometimes ceremonial) substance, except in some Muslim states, where it is a dangerous prohibited drug ([Baashar, 1981] and [Heron, 2003]). Indeed, the common phrase “alcohol and drugs” betrays a lingering implicit ontological commitment to the notion that alcohol is something other than a drug.

Ayahuasca quintessentially defies the simplistic categorization of being merely a “drug”—or, in the terminology of the U.S. National Institute on Drug Abuse, a “drug of abuse.” Indeed, ayahuasca has been culturally constructed by its various users as a medicine, a sacrament and a “plant teacher.” In the Amazon, ayahuasca is considered a master plant, both a diagnostic tool and a force for healing ([Demange, 2002] and [Luna, 1984]). Along with tobacco, it is one of the most important substances in the pharmacopoeias of Amazonian folk healers (Bennett, 1992). Yet ayahuasca has also come to be culturally constructed as a sacrament by religions such as the Santo Daime and the UDV. For their adherents, the tea is considered a divine gift allowing contact with forces and energies from which humans are ordinarily cut off in our quotidian lives. And ayahuasca is quintessentially a “plant teacher,” a natural divinatory mechanism that can provide esoteric knowledge to adepts skilled in negotiating its remarkable effects. These conceptualizations pose a challenge to modern Western drug policies and laws, which are premised on a rationalist/positivist ontology that constructs psychoactive substances essentially as chemicals and their effects as simply mechanistic.

Ayahuasca, globalization and public policy

The policy implications of contemporary ayahuasca practices can be usefully explored by regarding them as a cultural manifestation of globalization. By the term globalization, I refer to the economic, political, technological and cultural transactions and integrations resulting from the increased ease of movement for people, goods and ideas at the turn of the 21st century. As Collier and Ong (2005) observe, “[g]lobal phenomena … have a distinctive capacity for decontextualization and recontextualization, abstractability and movement, across diverse social and cultural situation and spheres of life” (p. 11). Thomas (2005) cites the resurgence of religion – including the spread of new religious movements and cultural and religious pluralism – as one of the “megatrends” of the 21st century. In response, states and faith communities alike “are being forced more than ever before, to define, defend or redefine the social boundaries between the sacred and the profane in the face of modernization and globalization” (Thomas, 2005, p. 26). The evolving spiritual practices whose nexus is the ayahuasca tea exemplify well these trends and tensions of globalization.

Ayahuasca has begun its ascendancy into popular global consciousness at a time of unprecedented interpersonal and intercultural knowledge exchange. One issue this raises is that of cultural appropriation. I would be remiss not to acknowledge humbly that ayahuasca is an exemplar of indigenous knowledge, a shamanic technology or cognitive tool that has long been what may best be described as intellectual property of the native peoples of the Amazon. Accordingly, its commodification, commercialization and secularization are concerning trends. The issue of intellectual property came to public attention in the 1990s when representatives of Amazonian tribes formally protested against the U.S. patent office, which had naïvely granted a patent on ayahuasca to an American pharmaceutical entrepreneur—it was subsequently rescinded (Fecteau, 2001). However, dismissing the growth of interest in ayahuasca as merely appropriation is somewhat simplistic. The genesis of the Brazilian ayahuasca churches – which are in many respects primary drivers of ayahuasca's globalization – was arguably a by-product of cross-cultural fertilization (MacRae, 2004). There is also reason to believe that, in the age of wikis, file-sharing and the open source movement, the concept of intellectual property is rapidly becoming a quaint anachronism, a development that concerns corporations and academics as much as it does indigenous peoples.

Curiously, in the 1960s, ayahuasca largely stayed off the Western cultural radar despite increased popular interest in visionary plants such as peyote and psilocybin mushrooms. Unlike only a few decades ago, however, the collective mindscape of the early 21st century is being expanded and shaped by revolutionary information and communications technologies (Friedman, 2005). Thus, insofar as ayahuasca is being variously and simultaneously culturally constructed in the (post)modern world, novel forces are at play. For example, authorities whose interests might be served by the dissemination of inaccurate or deprecatory representations of ayahuasca – as they have been countless times in the past for other illegal drugs – are hard-pressed to challenge the size and scope of factual information easily available to the lay public. The use of the Internet by ayahuasca aficionados allows for a diversity of thought and expression about the tea and its effects that poses significant challenges to policy-makers.

It is my contention that the policy issues presented by contemporary ayahuasca practices are not easily dealt with from the traditional framing of modern drug policies. Schön (1993) proposes that the framing of policy solutions for social issues is constrained by underlying, often implicit, “generative” metaphors. With respect to non-medical psychoactive substance use, two dominant constructions of the problem are identified by Marlatt (1996): drug use as a moral issue and drug use as a disease. The first constructs some drugs as intrinsically malevolent, imbuing them with agency and the power to override human free will. Implicit in this “malevolent agents” metaphor is the notion that people who use drugs are wicked and need to be punished; it is this generative metaphor that underpins the global regime of prohibition of (some) drugs. The second dominant metaphor constructs psychoactive substances as pathogens. This metaphor has become the predominant one in the field of public health, where it is prevalent in the discourses of treatment and prevention. With the “pathogens” metaphor, drug use is constructed as a disease against which youth need to be inoculated and for which people who use need to be treated.

The two dominant metaphors underlying current drug policies – “malevolent agents” and “pathogens” – are particularly unhelpful in framing policies with respect to entheogenic substance use. Ayahuasca's long tradition of uses as a medicine, sacrament and plant teacher poses a challenge to such simplistic metaphorical categorizations. Rather, I submit that a shift to a generative metaphor of drugs as “tools” offers a much more nuanced way of conceiving of the risks and benefits posed by ayahuasca practices. Rather than essentializing psychoactive substances as inherently dangerous, to regard them as tools – ancient technologies for altering consciousness ([Eliade, 1964] and [Winkelman, 2000]) – allows for a realistic assessment of their potential benefits and harms according to who uses them, in what contexts and for what purposes. To be sure, as with the use of any tool, there are risks associated with ayahuasca use, especially for those who are not prepared for its effects or who treat it as a toy. However, both traditional and contemporary ceremonial ayahuasca practices suggest benefits that the tool metaphor better accounts for in terms of policy considerations.

The philosophy of harm reduction is also further illuminated by a shift to the generative metaphor of drugs as tools. To the extent that policy-makers or practitioners emphasize a behaviour's potential risks, the harm reduction policy approach is justified. However, the tool metaphor for psychoactive substances warrants a corollary notion of “benefit maximization,” the other side of the harm reduction coin. Instead of approaching drug policy from a deficit perspective – implied by the “malevolent agents” and “pathogens” metaphors – the tool metaphor opens discursive avenues for realistic policy considerations of benefits as well as harms. Although harm reduction has been a valuable concept in challenging abstinence-based approaches to non-medical drug use and shifting policy to a more humane public health perspective, its limitations become apparent with the “drugs as tools” generative metaphor. Along these lines, the Health Officers Council of British Columbia (2005) has incorporated the concept of beneficial substance use in a recent policy discussion paper arguing for government regulation of currently illegal drugs; the paper explicitly makes reference to ceremonial use of ayahuasca (p. 5).

A traditional harm reduction approach to ayahuasca would emphasize similar general types of cautions as those for LSD, psilocybin or other psychedelic drugs. These include knowing and trusting the source of the substance, controlling set and setting (e.g. psychological preparation and physical surroundings), having a “sitter” who can be mindful of safety, not driving or engaging in other risky activities while under the influence, and discouraging use by individuals with underlying psychiatric disorders. It would also include specific cautions regarding diet and combining medications. The MAO-inhibitor effects of harmala alkaloids in the ayahuasca tea warrant dietary restrictions for foods containing the monoamine compound tyramine. Tyramine eaten in combination with MAO inhibitor drugs may result in hypertensive crisis. Likewise, selective serotonin reuptake inhibitors can have potentially harmful interactions with MAO inhibitors, so people taking these kinds of medications are advised to avoid ayahuasca (Callaway & Grob, 1998). Interestingly, indigenous ayahuasca practices in the Amazon also universally incorporate strict dietary and behavioural protocols (Andritzky, 1989).

A benefit maximization approach to ayahuasca use, by contrast, would involve the creation of policies to provide legitimate access to ayahuasca in ceremonial settings. This process would include considering a variety of policy levers at the disposal of public health authorities to ensure the minimization of risk (Haden, 2004). Such an approach might begin with the formalization of the harm reduction protocols listed above. It might also include enacting provisions to ensure ayahuasceros or spiritual leaders are skilled and competent in leading rituals (either through self-regulation or certification), inspecting and licensing facilities or centres where ayahuasca ceremonies are conducted, and regulating production of the tea to ensure it conforms to specified purity or potency (as is currently done in some countries with other natural health products). A benefit maximization approach would certainly entail further research into both the short- and long-term effects of ayahuasca and the social practices in which it is used, which may in turn provide further policy direction.

Conclusion

The growing interest in and use of ayahuasca by modern non-indigenous peoples poses significant conceptual challenges regarding drugs and drug policies. Ayahuasca has a rich history of use as a medicine, sacrament and plant teacher, cultural constructions that do not readily fit contemporary drug policy frames. The globalization of ayahuasca in the latter part of the 20th and the early 21st centuries is a phenomenon that demands reconsideration of some of the metaphysical and sociological presuppositions of contemporary drug policies. Already several legal cases have opened the door to granting religious freedom to the ceremonial use of ayahuasca. Accordingly, policy-makers would be well advised to consider other policy tools than criminalization to balance the competing interests of criminal justice, public health and human rights. With respect to harm reduction theory, the contemporary uses of ayahuasca lend weight to the corollary notion of benefit maximization.

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