Within-treatment changes in a novel addiction treatment program using traditional Amazonian medicine

David M. O’Shaughnessy , Ilana Berlowitz, Robin Rodd, Zoltán Sarnyai and Frances Quirk

Therapeutic Advances in Psychopharmacology, 2021, Vol. 11,  1–18

DOI : 10.1177/2045125320986634

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.

Keywords : addiction, ayahuasca, safety, Takiwasi, traditional Amazonian medicine

 

Introduction

Addiction treatment was an exciting line of inquiry during the first wave of psychedelic research in the mid-20th century, but the field was marred by inadequate research methodology and growing controversies that led to a near total investigatory suspension.1–4 After a decades-long hiatus, a revitalized second wave is now well underway.5–7 Once again, addictions are a target of psychedelic research with some impressive early results,8–14 and there is hope for a breakthrough treatment similar to the recent success of MDMA-assisted psychotherapy for post-traumatic stress disorder.15 Yet while the psychiatric discovery and embrace of psychedelics is relatively recent, the use of similar substances in shamanic and ethnomedical contexts is much older and is likely to have ancient roots.16–18

Therapeutic use of ayahuasca

One such ethnobotanical substance is ayahuasca— the common name of the vine Banisteriopsis caapi, which contains monoamine oxidase-inhibiting β-carbolines and is traditionally used alone or with various admixtures19,20—but also the name of the decoction prepared from B. caapi and the leaves of
a plant containing the psychedelic N,N-DMT,21 such as Psychotria viridis or Diplopterys cabrerana.22
Ayahuasca (i.e. the DMT-containing decoction) is powerfully psychoactive but appears to be safe
when used appropriately.23–30 In recent times its therapeutic potential has been increasingly
documented, particularly for the alleviation of substance abuse, depression, and anxiety-related
disorders.31–37

Ayahuasca is not considered to carry a high intrinsic addiction potential,38,39 and indeed suggestions
of anti-addictive outcomes have been reported since the earliest biomedical study on the sacramental use of ayahuasca,40 with evidence slowly accumulating since then.41–47 Various potential mechanisms have been proposed,48–52 yet quantitative studies of ayahuasca for addiction have only rarely been conducted in explicitly therapeutic settings, 53,54 in part due to regulatory challenges.55

The Takiwasi Center

Running parallel to these developments is a wellestablished and nationally accredited therapeutic community in Peru, the Takiwasi Center, which has been employing ayahuasca in the treatment of
addictions since 199256—around the same time that human psychedelic research resumed.57,58
However, Takiwasi is rather poorly characterized as an “ayahuasca-assisted” treatment, since a
variety of other traditional techniques are used; for example, the traditional dieta (diet) is particularly
important, during which a patient enters social seclusion while receiving restricted alimentation,
along with the intake of prescribed medicinal plants.59,60 The ceremonial use of ayahuasca, diets, and other plant-based techniques proceed from traditional Amazonian medicine,61–63 which Takiwasi combine with Western psychotherapeutic and biomedical approaches.

Being founded by a French medical doctor, the combination of Amazonian and Western medicine
in Takiwasi is operated from within a biopsychosocial- spiritual framework.64 For example, clinical
staff at the center may be healers with training in traditional Amazonian medicine, but there are
also professional doctors, psychologists, and nurses. Due to potential interactions between pharmaceuticals and plant medicines,25 patients cease taking psychiatric medications prior to entry,
although this does not apply to those with a history of psychosis, as they would not be accepted
for treatment.56 Certain physical health conditions are also part of the center’s exclusion criteria, including diabetes, gastric ulcers, and epilepsy, but also renal, cardiac, respiratory or hepatic insufficiency.56,65 Once admitted, the ideal treatment process lasts around 9 months (although this
is flexible), and progresses through stages of: (a) initial isolation (around 8–10 days); (b) main treatment (around 7 months); and finally (c) a reinsertion phase (around 2 months) where patients continue with the main treatment, but are preparing for post-treatment life and thus are able to leave the center and engage in work in the community (see Figure 1). Across the phases, treatment primarily revolves around physical detoxification (focusing on the use of emetic and psychoactive plant preparations), psychotherapy (group and individual), occupational therapy, community living, psychological and spiritual development (through psychoactive plant sessions and diets), and also biomedical evaluation. The application of medicinal plants in Takiwasi has parallels to psychedelic-assisted psychotherapy, although the Takiwasi framework differs in that its roots are in traditional Amazonian medicine. More detailed descriptions of these treatment procedures have been provided by Berlowitz et al.,66 Mabit et al.,67 Bustos,68 and O’Shaughnessy.69

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