Dry Salad: Learning to Live the Questions: 2016

The Role of Spiritual, Religious, or Mystical Experience
in the Treatment of Addiction
Though the focus in this paper is not in comparing the effectiveness of Alcoholics Anonymous to various psychedelics in addiction treatment, the seminal principle of spirituality in AA does provoke my interest in how this principle has similar therapeutic uses in other cultural and treatment settings. Though I have not compared, for example, the belief system of the ayahuasca church to that of AA, and without necessarily considering AA methodology beyond the importance of the factor of spirituality, is there, as some psychedelic researchers suggest about the role of spiritual significance in addiction treatment, something to be gained from understanding the founding of AA, as well as for the generation of these principles? Without necessarily focusing on the other aspects of AA treatment such as group membership and the social support that involves—as researchers John Kelly, Robert Stout, Molly Magill et al. phrase it, “surprisingly little research has been conducted in the area of spirituality, despite its place as the central mechanism of recovery in the AA literature” (Kelly, Stout et al., 2011, p. 2). As a prominent figure who is the lodestar of wide following by the AA community, are the origin and generation of AA co-founder Bill Wilson’s ideas of equal importance to the later evolution and application of these ideas?
The intention here in not focusing specifically on a single psychedelic, but instead on a group of psychedelics (those that work on the serotogenic system), is in wondering if there is a shared reason for why serotogenic psychedelics impart the kinds of effects and meaning that they do. My exploration of serotogenic-based treatment for addiction, is based on the dopaminergic or reward-inducing theory of addiction. Though, that which will be of particular discussion here, is the psychedelic-induced spiritual significance gained during the “trip” experiences of subjects.
Ben Sessa (2005), in writing about whether “psychedelics have a role in psychiatry once again,” charts the considerable historical precedence for the use of psychedelic substances in an experimental setting in 20th century United States and Europe. In the late 1940s, after Swiss chemist Albert Hoffman accidentally discovered Lysergic acid diethylamide (LSD) in 1938, psychiatry began experimenting with LSD. Initial work considered the potential of psychedelics as “psychotomimetics,” or chemicals which could “mimic mental states of patients with schizophrenia” (Sessa, 2005, p.457). For others, it was used to supplement psychotherapy treatment. By the mid-1960s, extensive research was available for the effects of various psychedelics on patients, with few side effects to note. Yet despite the effectiveness of much 1960s research, it is now of little value to modern researchers because of the lack of control and follow up studies. By 1966, LSD had leaked into wider recreational use by the public. In 1968, opportunity for scientific research came to a halt by the US justice department, as LSD possession was made illegal. The last study to be conducted with LSD on patients in the US was in 1980. It was also banned by the 1970s Controlled Substance Act, and as a schedule I, is not recognized as having any established medical use in the US.
    Steven Finlay’s article The Influence of Carl Jung and William James on the Origin of Alcoholics Anonymous offers a less reported history of the founding of AA. In 1930, Swiss psychiatrist and psychotherapist Carl Jung tried various treatment methods on successful investment banker and former state senator of Rhode Island, Rowland Hazard, in treating his alcoholism. After a year of failed treatment methods, Jung’s final message to Hazard was that religious conversion was the only way to reform a struggling alcoholic such as himself. Hazard began associating with the Oxford group, a Christian evangelical movement that was gaining an ardent following in America at the time. Bill Wilson- later to become the founder of AA- was also a successful stockbroker following World War I, and a severe alcoholic precipitated by a job loss in the early 1930s. After undergoing a few unsuccessful hospitalizations for his condition, Wilson one day received friend, also an alcoholic, Edwin “Ebby” Thatcher into his home. Thatcher related his membership at the Oxford group to his recovery from alcoholism, speaking of submission to a “higher power”, and offering oneself to the service of others for mutual social support and recovery, encouraging Wilson to undergo a similar spiritual revival through church membership (Finlay, 2000, p. 4). Thatcher and another fellow member visited Wilson on an additional occasion. Taking up their recommendation, Wilson visited the Calvary Church they extolled, showing up very drunk, and returning home that night, admitting to his wife he had found a way to become sober. To calm his nerves the following morning, he began drinking; though after three days, arrested to his bed for unabated drinking, on December 11, 1934, he decided to admit himself to the Towns hospital to clear up his thinking. He was administered the Belladonna treatment: a concoction of morphine, other psychoactive substances, and belladonna—a substance which can induce hallucinogenic effects in large doses. At the second or third evening in treatment, Thatcher visited Wilson. Thatcher outlined the Oxford group principles, just as Wilson slipped into a state of depression. While Wilson had otherwise no other call to God, twenty years later he reported an experience that while being in the hospital, he realized God and the peace that he underwent as a consequence of this experience. Following his recovery from this profound spiritual experience, he was given recommended readings from the Oxford Group: William James’ Varieties of Religious Experience. Wilson read about the life-changing effects of religious experiences, and how they can come in many forms. More than anything, Wilson garnered that these experiences “came to people in dire circumstances, those experiencing severe anguish or calamity” (Finlay, 2000, p. 5). In 1957, detailing these experiences, Wilson narrated that “more than I could ever want anything else, I now knew that I wanted to work with other alcoholics”; Wilson felt he was given a sense of purpose (ibid). Wilson joined the Oxford group in NY, with the ultimate intention of sobering alcoholics worldwide. Though, in the early days of practicing his new creed, Wilson struggled to convert alcoholics by imparting his own religious experience, and in discussing this, Dr. Wilkworth of the Town Hospital remarks,
You’ve got to deflate these people first. So give them the medical business and give it to them hard. [Tell them] about the obsession that condemns them to drink.. [that they will] go mad or die if they keep on drinking. Coming from another alcoholic, one alcoholic talking to another, maybe that will crack those tough egos deep down. Only then can you begin to try out your other medicine, the ethical principles you have picked up from the Oxford Group (Finlay, 2000, p. 6).
Groups of alcoholics then began regularly meeting with the Oxford Group in New York, headed by Wilson and partner Dr. Bob Smith. In August of 1937, Wilson and Smith split off from the Oxford Group; the primary text of Alcoholics Anonymous, written primarily by Wilson, was published in April of 1939.
    In the 20th century, Jung’s early views on alcoholism were generally about a moral defect; although in other cases, there is something different, “not simply alcoholism” (ibid). Jung makes an interesting observation in his work Modern Man in Search of a Soul (1933), that of his patients above 35 years and searching for a psychological treatment, not a single one has maintained any kind of religious connection or perspective on life, suggesting that this explains their inability to heal (Finlay, 2000, p. 7). Jung considered both the Oxford Group and the Catholic Church equally admirable psychotherapeutic institutions. In A Psychological Approach to the Trinity (1948/1958), Jung writes about the conversion experience such as Wilson underwent:
Modern man has such hopelessly muddled ideas about anything “mystical”…. The numinous character of these experiences is proved by the fact that they are overwhelming, an admission that goes not only against our pride, but against our deep-rooted fear that consciousness may perhaps lose its ascendency (ibid).
Man’s fear of losing his ascendency is related to his predilection for ego-control. In a letter Wilson writes to Jung in appreciation for the conversion prescribed by Jung and which inspired himself, he states that the element of “hopelessness” which made Hazard beyond cure by any standard psychiatric treatment, became the founding principle of Alcoholics Anonymous (ibid). Jung replies that Hazard’s “craving for alcohol was a low level equivalent of the spiritual thirst of our being for wholeness, expressed in medieval language: the union with God”. Jung later goes onto explain that “alcohol in Latin is spiritus and you use the same word for the highest religious experience as well as for the most depraving poison” (Finlay, 2000, p. 8). Despite Jung’s undeniable influence, William James is the only author cited in the book Alcoholics Anonymous, in reference to the various ways one can subscribe to a higher power. By “religion”, James meant an individual’s basic outlook on life and that the example of drunkards, are those with “sick-minded religion” (Finlay, 2000, p. 10). James’ influential ideas on conversion were:
(a) conversion could occur either suddenly or more gradually over time, (b) dire circumstances almost always preceded the experiences, (c) the individuals who experienced the conversion had admitted defeat, and (d) they had all appealed to a higher power for help.
Along with the idea that dire circumstances were a necessary precondition for conversion, in the early days of AA, there was a practice to “send persons back out” if group members felt that someone had not “suffered enough” (Finlay, 2000, p. 10). Wilson was allegedly active in finding other forms of alcoholic rehabilitation, such as drug therapy studies using LSD and Niacin, up until his death in 1971.
John Kelly, Robert Stout, Molly Magill et al. tested to see if the mediational variable of spirituality and/ or religiousness (S/R) could account for positive treatment outcomes and behavior change in Alcoholics Anonymous members. The study recruits a clinical sample of individuals with alcohol use disorder. Their hypothesis is that AA attendance is associated with better adjustment with alcohol use and increased S/R. The subjects include 952 outpatients, of which 72% were male; and 774 aftercare, of which 80% were male. Participants in either group had a current DSM-III-R diagnosis of alcohol use or dependence, at 95% and 98% respectively, which included drinking over the last 3 months prior to study; and were omitted if had a current DSM-III-R diagnosis on other illicit or licit drugs. Subjects were randomly assigned to one of three psychosocial interventions: Cognitive Behavioral Therapy, Motivational Enhancement Therapy, or Twelve-Step Facilitation Therapy. Psychological measures included alcohol use and Alcoholics Anonymous attendance over the past 90 days; measure of spirituality and/ or religiousness which instead of testing for life-time religiosity, assessed only the past 90 days. While controlling for a number of variables, this lagged controlled mediational analysis found that S/R increased the most among those who were lowest on this variable. Additionally, there was a positive effect observed with AA attendance on drinking behaviors, in part due to AA’s enhancement of S/R. These outcomes were consistent for both outpatient and aftercare groups. An interesting possible explanation is that because these spiritual practices are
mobilized within the specific alcohol recovery context of AA, their prescribed regular use outside of AA meetings may serve to activate an associated global ‘recovery schema’ that in turn mobilizes additional motivation and behavioral coping (Kelly, Stout, Magill et al., 2011, p. 7).
Similarly, there is also the likelihood that the flexibility of one’s interpretation of a “Higher Power” enables one to test new practices and beliefs which promotes changes conducive to one’s recovery. For those with already high baseline levels of S/R, AA did not further increase this effect, as it did with those initially low on this variable. Limitations of this study include the subjects being predominantly white males, and Americans. Interesting to note, the study mentions that 85% of Americans are self-reported as being “religious,” with 70% claiming belief in “a personal God” (Kelly, Stout, Magill et al., 2011, p. 8). Kelly et al. further imply that the mediational role of religiosity in this sample group is influenced by the “religious socio-historical context” in which AA originates. In comparison, in other English-speaking countries where AA is similarly pervasive, members report comparatively lower measures of religiosity and spirituality. Though, per the history of the founding of AA told above, their next limitation seems pertinent in response: that studies testing for the role of spirituality is fundamentally confounded by how difficult it is to define spirituality.
    Katherine MacLean, Matthew Johnson and Roland Griffiths test for, to iterate the study’s title, Mystical experiences occasioned by the hallucinogen psilocybin, found to increase in the personality domain of openness. The researchers define “mystical experiences”, adapted from Stace (1960) and Hood (2003) as:
Feelings of unity and interconnectedness with all people and things, a sense of sacredness, feelings of peace and joy, a sense of transcending normal time and space, ineffability, and an intuitive belief that the experience is a source of objective truth about the nature of reality (MacLean et al., 2013, p. 2).
It is generally accepted that personality traits are “enduring styles of thinking, feeling and acting”, with the most widely endorsed model of personality structure being the five-factor one: assessing traits of neuroticism, extroversion, openness, agreeableness, and conscientiousness (ibid). Studies suggest that these are heritable, and consistent across cultures, composing a universal human personality structure that is biologically-based. However, and though without any casual link, dramatic life experiences can shift personality.
    Participants were locally recruited, having recognized a flyer, stating “a study of states of consciousness brought about by psilocybin, a naturally occurring psychoactive substance used sacramentally in some cultures” (MacLean et al., 2013, p. 3). 52 hallucinogen-naïve patients were selected, all well-educated (54% post-grad), spiritually active (90% regular practitioners of some religious service, discussion group, prayer, or meditation). The psilocybin sessions consisted of two to five eight-hour drug sessions, with consecutive sessions separated by at least three weeks. Participants were informed they would receive a moderate to high dose (30mg/70 kg) during a single session, but neither they nor the researchers knew when this would be. As for the study protocol, participants were asked to lie down on a couch, given an eye mask to block out visual stimuli and head phones through which a music program was played, and were instructed to attend to their internal sensations.
    Personality measures were assessed at screening, again one to two months after each drug session, and approximately fourteen months after the last drug session. NEO personality inventory assesses five factors of personality, with 6 facets that define each factor. In this case, the single personality trait of openness was broken into 6 facets, each judged on a five point scale: fantasy, aesthetics, feelings, ideas, values and actions. States of consciousness questionnaire (SOCQ) assessed the mystical type experiences of each session, or “phenomenological content during altered states of consciousness” (MacLean et al., 2013, p. 4). The mysticism scale was used to assess one’s degree of mysticism across the life span, and was additionally edited for felt mysticism isolated to the drug sessions. The APZ was a yes/no questionnaire measuring three scales of: “oceanic boundlessness… unity, bliss, and transcendence of time and space”; “visionary restructuralization… visual pseudo-hallucinations, illusions, synesthesia”; and “dread of ego dissolution… dysphoric feelings.. anxiety, fear and feeling trapped” (ibid). Finally, additional data from two double-blind psilocybin studies was aggregated to detect personality change at a larger level, as well as to differentiate among sub-groups of individuals to demonstrate varied mystical-type experiences. MacLean et al. hypothesized that of the three predictors of openness measured: openness at screening; mysticism scale for lifespan and psilocybin experience, respectively; and mystical score on the SOCQ, that the mystical score on the SOCQ would be the overall greatest indication of the variability of openness between participants than the other two measures.
    As for personality changes, no significant changes in openness after the first session was found for the subgroup who did not receive a high dose of psilocybin, as compared to those who did. In other factors measured during high-dose sessions, no changes from screening to post-test were found for neuroticism, extroversion, agreeableness or conscientiousness. In aggregate, these findings suggest that apart from openness which specifically increased following the high-dose sessions, the other personality traits are comparatively more stable (MacLean et al., 2013, p. 5). MacLean at al. claim that increases in openness after a single high-dose psilocybin session had a larger effect size than changes in personality typically observed in healthy adults over decades of life experience, suggesting that the nature of this intense mystical experience was enough to change a personality trait, in comparison to those who have not had a similarly profound experience. To explain further, “during normal aging, openness typically decreases linearly at a rate of approximately 1 T-score point per decade—T scores being one’s raw score from the NEO personality inventory, which for the present study, meant the five facets of openness (MacLean et al., 2013, p. 7). Whereas participants in this study who had a “complete mystical experience”—defined by scoring 60% or higher on each of 6 subscales of the SOCQ—during their psilocybin session had a more than 4-T score increase from screening to post-assessment (MacLean et al., 2013, p. 7). Though this study does not directly correlate benefits of increased openness, the subscales used in measuring the facets of openness do suggest improvements in aesthetic and cognitive domains.
With a similar design as the previous study, eighteen participants with no history of alcohol or drug dependence over the last 20 years, were randomly assigned to either a group of ascending psilocybin doses or a descending dose sequence, which both they and the researchers were obscured to, with a large dose thrown in. Participants reported disconcerting feelings during the session, wherein despite the social support offered at a rate of four occasions before each session (8 hours total), 39% of participants (7 of 17) reported extreme feelings of fear, fear of insanity or feeling trapped at some point during the session. In this study, “complete” mystical experience was defined as at least 60% of the maximum possible score of the self-rated seven domains of mystical experiences on the SOCQ: “internal unity.. with the ultimate reality”; unity of external things; sacredness; “noetic quality” of having encountered this ultimate reality; transcending time and space; positive mood; and ineffability of experience (MacLean et al., 2013, p. 5). Despite the reports of terrorizing feelings, the SOCQ data from five of those seven participants revealed that they also self-reported a complete mystical experience; while 4 of 8 participants who reported delusions or paranoid thinking also had data consistent with a complete mystical experience (MacLean et al., 2013, p. 10). However, while discomforting feelings did not prevent the subjective sense of a mystical experience, two volunteers who underwent the most sustained anxiety during the high dose, 30 mg/70 kg session, did not have a complete mystical experience. Of the 90 total sessions, none were rated as having decreased one’s life satisfaction or well being (MacLean et al., 2013, p. 11). At the fourteen month follow up, in comparison to the other amounts, the highest dose of 30 mg/70 kg was consistently judged on multiple measures as conferring the most personal meaning and spiritual significance; though, more of those assigned to the ascending dose sequence rated their high dose experience as more favorable than did the descending sequence group (MacLean et al., 2013, p. 12).
In the Native American Church (NAC), the peyote cactus is used for sacramental purposes among some 300,000 Native Americans during all-night prayer ceremonies. The healing tradition of the NAC utilizes peyote as a vehicle to explore the power relations between creator and individual, as mediated by the road man, who is “not unlike the Western psychotherapist” (Krystle Cole, 2009). One of the main tenets of the NAC is “abstinence from alcohol and drugs”, which means that when a person is admitted as a member of NAC, they become apart of a community that abstains from alcohol use: a process that is thought to facilitate “resocialization” (Krystle Cole, 2009).
John Halpern, Andrea Sherwood, James Hudson et al. wanted to get a population of people who have long term use of only a single hallucinogen, without any other drugs, to test for the psychological and cognitive effects of long-term peyote use among Native Americans.
Mescaline, the active ingredient in peyote, is supposedly partially homologous to the chemical structure of LSD, and is a partial agonist of the 5-HT2a receptors within the central nervous system. Though with the lowest potency of the “orally active naturally-derived hallucinogens (1:2500 to 1:4000 mescaline: LSD), a full dose (200 to 400 mg) has a long duration of action, with peak effects 2 to 4 hours after consumption” (Halpern et al, 2005, p. 624). In comparison to LSD, mescaline is described as more sensual and perceptual and less altering of thought and sense of self.
    Members of the Navajo Nation, which constitutes an independent governmental body which manages the Navajo Indian reservation in the United States, were asked to perform psychological and neuropsychological evaluations of NAC members, regular users of mescaline. There were three groups of Navajos, ages 18 to 45, composing three experimental groups: the peyote group who have ingested peyote on at least 100 occasions; the former alcoholics, who had at least five years of drinking more than 50 12-oz beers per week, yet were sober at least two months; and the comparison group, who reported minimal use of any substance. The peyote group was asked to perform a battery of neuropsychological tests at least seven days after their most recent peyote meeting; all others were tested within four weeks of the baseline evaluation. The final sample was 61 longstanding members of the NAC in the peyote group; 36 Navajos in the former alcoholic group, all who were very young, with a median of eight months of abstinence from alcohol and perhaps notably, admitted more cannabis consumption than the other two groups; and 79 in the comparison group, who reported minimal lifetime use of peyote or other substances. In comparison to the other two groups, the former dependent alcohol users showed very significant psychological deficits such as decreased visuospatial memory on the ROCF task—which exposes a subject to a complicated line drawing, asks that they imitate, and then draw it again but from memory—and “increased perseverations” on the Wisconsin Card Sorting Task—which tests for task-shifting capacities during a task which offers changing and conflicting reinforcements (Halpern et al., 2005, p. 5). These psychological deficits indicate that alcohol abuse has persisting effects on the frontal lobes even after cessation of use. The peyote group showed no significant differences from the comparison.
    Similar to the effects of high-dose psilocybin, peyote use for therapeutic means in the NAC has been associated with what is referred to as “peak experiences”: which, according to an article written for the website Neurosoup about the healing tradition of peyote use in NAC, is a form of emotional healing that can produce in a single session, what takes years of work in psychotherapy (Krystle Cole, 2009). The byproduct of this peak experience is the “afterglow” effect, wherein for a period of a few weeks to months, formerly problematic users stop craving their drug of choice. There is some speculation that effects similar to the afterglow might be consistent across psychedelics: the west African plant ibogaine used for treating opiate addiction, is found to store in the adipose liver tissue, which is thought to account for the anti-craving properties for former opiate dependents; and similar to LSD, this latent storage property of the substance also facilitates flashbacks occasioned from those peak experience. In another news article reporting on Peyote in the Brain, authors John Horgan and Jennifer Tzar mention the possible biochemical effects of the afterglow effect, consistent among LSD, mescaline and psilocybin, which is thought to be mediated by their effects on the serotogenic and dopaminergic systems (Horgan, Tzar, 2003).
In contrast to the psychedelics of LSD, mescaline and psilocybin, also in trial for their therapeutic potential, the psychoactive distillation of two amazonian plants, ayahuasca, seems to be unique among the others because of its alleged, complete lack of negative neurocognitive effects (though bad hallucinations and rises in blood pressure are reported occurrences). Additionally, and for unknown reasons, trace amounts of ayahuasca’s active agent, dimethyltryptamine, or DMT, are found in human blood and brain tissue (Horgan, Tzar, 2003) (Liester, Prickett, 2012, p. 202). Apart from these vague notions, there does seem to be more information, if not more thorough speculation, about the significance of ayahuasca on serotonin and dopamine systems, as opposed to brief mention of action of 5HT2a receptors, as is often mentioned of the other thus far known and relatively benign, serotogenic psychedelics.
Mitch Liester and James Prickett (2013) discuss four distinct, yet interrelated hypotheses in speculating on the mechanisms of ayahuasca which relates to the basic biochemistry of first, ayahuasca; and second, addiction. Ayahuasca contains beta-carboline alkaloids: harmine, harmaline, and tetrahydroharmanine which are potent oxidase inhibitors (MAOIs). The MAOIs in the Banisteriopsis caapi South American jungle vine function to inhibit the enzyme, monoamine oxidase, that breaks down monoamines, a group of neurotransmitters and neuromodulators. DMT, typically from the plant Psychotria viridis, is a psychoactive compound of the trypatamine family, a subtype of monoamines, which is actually naturally occurring in the human body, even found in the human cerebrospinal fluid. DMT, usually broken down by monoamine oxidase in the gastrointestinal tract, is biologically active when ingested in the presence of an MAOI.
    Liester and Pricket refer to how the ingestion of alcohol, nicotine, stimulants, opiates and marijuana increase dopamine release in the mesolimbic pathway (MDP). The mesolimbic pathway has three fundamental regions of activation: the ventral tegmental area (VTA), the nucleus acumbens, and the prefrontal cortex (PFC). The VTA releases dopamine to the nucleus acumbens in response to internal and external cues associated with addictive behaviors. The nucleus acumbens then relays this information to the PFC, which then returns this information back either directly to the VTA, or through the intermediary amygdala region-- involved with learning related to reward, fear, or other emotional responses to stimuli-- in order to complete what is referred to as the “reward circuit” (Liester, Prickett, 2013). Dopamine release within this mesolimbic circuit has been associated with synaptic plasticity, which develops and maintains the addictive behavior. Specifically, the release of dopamine into the VTA is hypothesized to reorganize neuronal circuits, reinforcing addictive behavior. Drugs of abuse are thought to induce enough dopamine release that such “diabolical” learning, or addictive behavior, occurs (Liester, Prickett, 2012, p. 205).
    States of withdrawal undergone following chronic use of a substance is associated with low dopamine levels; and the characteristic of impulsivity during withdrawal is associated with low 5-HT serotonin levels. Liester and Prickett (2012) reason that craving must be a subjective manifestation of the brain’s homeostatic drive to normalize dopamine, as expressed by the state of withdrawal. Whereas high dopamine in the MDP is associated with conditioning and reinforcement of addictive behavior and its related stimuli, low dopamine and 5HT are implicated in acute withdrawal symptoms and increased potential for relapse.
    The biochemical hypothesis proposed by Liester and Prickett is that ayahuasca’s MAOIs raise global serotonin as well as dopamine, which is another type of monoamine (of the catecholamine subtype), by blocking their metabolism. DMT then functions as an agonist at most serotonin receptors. 5HT1C agonist raises dopamine levels in the MDP; whereas 5HT2A, which is thought to induce the hallucinogenic component of drugs such as LSD and psilocybin, and 5HT2C lower dopamine. Liester and Prickett (2012) conjecture that ayahuasca curtails and resists the potential for addiction by increasing serotonin, while also crucially balancing dopamine between low levels of withdrawal, and the high levels of reinforcing behaviors.
Ayahuasca is thought to facilitate what is called “adaptive synaptic plasticity,” which is the learning of new behaviors and creating associations between behaviors and certain stimuli; except instead of “hijacking” the reward circuit, it regulates dopamine levels in the mesolimbic pathway (Liester, Prickett, 2013). It also is implicated in the unlearning of addictive associations and cues by experiencing them under visionary influences of ayahuasca, which “protects” the person from dopaminergic surges that reinforce the “diabolical learning” of addictive synaptic formations.
    On the topic of establishing dependence with psychoactive substances, Jacques Mabit, French physician and founder of the Takiwasi center, argues in Blending Traditions: using indigenous medicinal knowledge to treat drug addiction, that "traditional peoples also teach us that substances consumed in their natural form, used with respect to the body’s digestive natural barriers (that is, orally), do not induce dependence, in spite of their powerful psychoacive effects” (Mabit, 2002, p. 27). Mabit specifies that beta-carboline and tryptamines, the main active principles in ayahuasca, are present in the central nervous system and particularly in the pineal gland. Along with this idea of being respectful and mindful of the body’s barriers in ingestion, self-regulated modulation by vomiting if consumed too much of a substance, ensures against overdose. The purgation-detoxification is also often a necessary element of this process, and partially why it assists in treating drug addiction. He further explains that as opposed to tolerance or establishing habit with increased use, sensitivity increases over the course of successive ingestions of a traditional substance. Thus, unlike other substitution-approaches to some addiction therapies, which use replacement medication for the problem substance, one is sensitive to the appropriate and cultural use of the substance. Though this does seem a counterintuitive assertion given the dose-dependent effects of psilocybin in inducing profound mystical experiences, it does provoke additional consideration for the participant’s dose preferences in later use. However, as Mabit does seem to suggest in discusing the importance of cultural rites and traditional indigenous uses, is this sensitivity effect more contingent on the principles of “set and setting” of drug use which determines one’s appraisal and experience of the drug event, rather than of necessarily the drug itself? Mabit implies that “hallucinogens” is a misnomer, and that therapeutic use of these “entheogenic substances” cause visions which are explorations of unconscious and vivid psychological material which one feels motivated to work with. In his words, “visions, like dreams, indicate the beginning of an integration at the superior cortical level”; which implies that there is something real and convincing about the visualizations generated by a psychedelic like ayahuasca which are not mere hallucinations, or “illusions without objects” (Mabit, 2002, p. 28).
    The importance of the internal generation of imagery during ayahuasca ingestion is implicated in the neural basis of imagery during ayahuasca ingestion. To briefly explain the experiment, ten frequent ayahuasca participants performed two fmRI sessions. The first was a scanning before ayahuasca intake; the second fmRI scan occurred 40 minutes after intake of the ayahuasca brew. Each fmRI session included three conditions in a block design: 21 seconds per condition, 3 conditions per block, 7 blocks per session. The first condition was with natural images, where the subjects passively viewed images of people, animals or trees—with one different image per block. The second condition was the imagery task: instructed to close their eyes, subjects were to mentally generate the same image just physically seen in the first condition. In the last condition, subjects were to passively view a scrambled version of the first condition or natural image, considered the baseline image or condition. Before intake, the internal imagery condition had the lowest levels of BOLD responses. All participants showed a marked increase in their capacity to perform the imagery task following ayahuasca intake, reporting much more vivid and detailed images in the second session. Further, as Araujo et al. explain, “ayahuasca did not enhance occipital BOLD signal during the natural image condition in comparison with the scrambled image condition. Perhaps activity in the BA17”—the Brodman’s area, the primary visual area—“and other visual areas reaches a ceiling when subjects see with open eyes, irrespective of ayahuasca ingestion” (Araujo et al., 2011, p. 8). Araujo et al. further explain that,
The activity of cortical areas BA30 and BA37, known to be involved with episodic memory retrieval and the processing of contextual associations, was also potentiated by Ayahuasca intake during imagery. Within this framework, Ayahuasca engages cortical regions necessary for the integration of separate visual elements into a whole scene … engagement of mnemonic circuits, possibly feeding visual areas with the content of the ayahuasca settings (Araujo et al, 2011, p. 9)
As mentioned previously, Mabit is the founder of the Takiwasi center, which is a project that accepts no more than fifteen voluntary participants at a given time, and is set in a five acre park bordered by a river outside the city of Tarapoto, of the Peruvian High Amazon in the Andes. It is a three part model which integrates “plants, psychotherapy, and community life”, wherein participants learn to interpret their dreams and visions in subsequent psychotherapeutic sessions supplemented with purgative plants (Mabit, 2002, p. 29). Though there has not been any rigorous scientific attempts to measure the effectiveness of this, or a similar psychosocial rehabilitation intervention Instituto de Etnopsicologia Amazonica Aplicada (IDEAA), Gerald Thomas, Philippe Lucas, N. Rielle Capler et al. conducted an observational study in Canada for ayahuasca-assisted therapy for addiction based on these two models. Pioneered by Dr. Gabor Mate, a Canadian physician specializing in addiction medicine with experience working with Aboriginal people and the potential use of ayahuasca for assisting group therapy. Mate piloted a retreat program “Working with Addiction and Stress” which works in partnership with ayahuascqueros from Peru and British Columbia, collecting participants with psychological health conditions from the general Canadian population. The structure of these retreats became the framework for conducting the First Nations band retreat in the current study. Thomas, Lucas, Capler et al. sought to assess the following predictions:
That participation in the ayahuasca ceremonies in the context of the “Working with Addiction and Stress” retreats would be associated with improvements in mindfulness, emotional regulation, personal empowerment, hopefulness and quality of life in study participants; and, that participation in the retreats would be associated with reductions in problematic substance use (2013, p. 2).
Twelve participants were recruited, all members of the same first Nations band. The psychometric measures included the consciousness questionnaire (SOCQ), which assessed the intensity of the ayahuasca experiences following the retreat. As for measures of observation: difficulty in emotion regulation scale assessed goal-directed behavior and impulsivity, which determines one’s capacity to regulate both positive and negative emotional states which are motivating factors for substance use. The Philadelphia mindfulness scale assesses two components of mindfulness, “awareness of present moment and acceptance”. The empowerment scale assesses psychological and social empowerment, and capacity for personal control over one’s lifestyle. The Hope scale tests for hopefulness by presence of successful agency, which suggests a direct relationship, if not just common etiological roots, between depression and substance abuse. Finally, the McGill Quality of Life assesses quality of life, considered a protective factor against substance dependence. Quality of life was interpreted as an independent variable which is likely to increase along with dependent factors of emotional regulation, mindfulness, hopefulness and empowerment. The 4 week substance use scale (4WSUS) is an WHO alcohol, smoking and substance involvement screening test for problematic use of illegal and legal substances which is meant to show levels and patterns of use, as well as “frequency and intensity of cravings for use and also harms resulting from the subject’s substance use” (Thomas, Lucas, Capler et al., 2013, p. 5). This scale measured two factors of whether the subject reported using the substance from baseline to six months, and whether the 4WSUS scores significantly changed within this time frame. Interestingly, at the urging of a few participants, semi-structured interviews were additionally included in the seven follow-up sessions, intended as qualitative data of participant’s experience of the retreat in their own words. The questions were:
Did the stress and addiction retreat have any impact on your life (Y or N)? On a scale of one to ten… how would you rank the effects of the stress and addiction retreat on your life? Please describe how this experience a) impacted your connection to yourself, others, and nature or spirit; b) affected your substance use; c) differed from past drug treatments or therapies (ibid).
Four consecutive days and three nights were spent in the band’s longhouse, a traditional community ceremonial space. The retreat schedule went as follows: On day two, following dinner and a sweat lodge ceremony, participants gathered in the longhouse to share their intentions for the ayahuasca ceremony. At nine pm, members sat in front of the master ayahuasquero to drink (50-100mL) the brew. All lights were shut off; and after an hour of silence, the ayahuasquero began chanting icaros—a traditional chant assisting healing—for four to five hours. Some purged—“a common and not necessarily adverse effect of ayahuasca”—and each member was individually invited to sit in front of the ayahuasquero to receive soplada—a chant sung in Shipido, Quchua or Spanish—while also having perfume or mapacho smoke, an Amazonian tobacco, blown on them. At three am, the ceremony ended, and participants slept in the longhouse. On the following morning, day three, unstructured dialogue about the previous night’s experience was shared among participants at breakfast; a proceeding formal debrief was delivered by the retreat team. The second ayahuasca ceremony occurred this night; one participant chose not to engage in this session. On day four, participants received their final morning debrief, and concluded the program by presenting the retreat team with gifts.
    All twelve participants showed statistically significant improvements on factors of mindfulness, empowerment, hopefulness, quality of life-meaning and quality of life-outlook; whereas improved measures such as emotion regulation, quality of life-overall and quality of life-psychological were not of statistical significance. Of the 11 participants administered the semi-structured interviews at the seventh follow up session, all claimed the experience had an “impact on their lives”, and in being asked to rate their experience on a scale from one to ten, the mean was 7.95, with none rating below a 5. Further, alcohol, tobacco and cocaine were used by fewer participants in the four week follow-up preceding the seventh and last, showing improvements over baseline use of these substances before the study. While cannabis, sedative and opiate use did not decline by the end of the study, this might be partially explained by these substances being medically prescribed to some patients; whereas cocaine and alcohol did decline in use, and were identified by participants as the substances of primary concern.
In Steve Ross’s MAPS presentation, psilocybin, addiction, and end of life he mentions that the 1950s to 70s supplementary use of hallucinogens in a psychotherapeutic format has a continuing legacy by fellow contemporary psychedelic researchers who have utilized similar methods in their own treatment models. Specifically for his work, he employs 1950s and 70s model of using two therapists, one male, one female; and the buffering from external stimuli while administering music and encouraging introspection of the patient. Rhetorically asking why he uses similar methodology, he answers “I don’t know, because they [50s to 60s psychedelic researchers] said so” (Ross). Additionally, in relation to the psilocybin study which found persisting effects at the 14 month follow-up, those more open to mystical experience beliefs have the personality trait of openness; to paraphrase, Steve Ross asks, isn’t this precisely the kind of personality attribute that a patient is encouraged to adapt during psychotherapy? (Ross).
Though I was skeptical upon hearing this dubious assertion about the commensurability of modern psychotherapeutic methods with 1960s psychotherapeutic-combined-psychedelic treatments, this literature does suggest the cultural appropriateness of it. I think it could potentially be useful to conduct a more systematic comparison between western psychotherapeutic methods, as it is similar and different from psychotherapy supplemented with psychedelics in the 1960s versus today’s better controlled yet fundamentally similar protocol, and various indigenous or cultural conceptions of psychotherapy with traditional substances as mediated by a roadman or ayahuasquero. The protocol used in both psilocybin studies of having the patient shut out external distractions while bringing the focus inward, is worth considering in comparison to the NAC and Canada’s First Nation band’s approach to ceremonial practices in a therapeutic format, especially since psychedelic-induced internal imagery is much more active in the shutting out of external stimuli.
    The similarity among the NAC idea of peak experience; the western mediational analysis of spiritual and/ or religious significance of AA intervention; the western analysis of mystical experiences facilitating personality shifts; and ayahuasca’s theoretical facilitation of spiritual experience through visions of psychological material; as well as the more general role of community and associated religion in AA, NAC, and ayahuasca religious churches, warrants more research in terms of the potential significance of this common factor in facilitating therapy or treatment. How do components such as the perspective of mindfulness or nonjudgmental acceptance of one’s illness, and the spiritual component of communities such as AA, assist treatment; and if these factors do effectively contribute to addiction psychotherapy, is there an additional complementary need for membership within a community of recovery for treatment to be sustained?

Resources:

Bouso, J. C. (Performer) (2013). Ayahuasca and the treatment of drug addiction: a review of the
evidence and proposals for the future [Web]. Retrieved from http://www.maps.org/conference/ps13josebousoaddiction/

Bouso JC, Gonzalez D, Fondevila S, Cutchet M, Fernandez X, et al. (2012) Personality,
Psychopathology, Life Attitudes and Neuropsychological Performance among Ritual Users of Ayahuasca: A Longitudinal Study. PLoS ONE 7(8): e42421. doi:10.1371/journal.pone.0042421

Bouso, J. C., & Riba, J. (2011). 3. an overview of the literature on the pharmacology and neuropsychiatric long term effects of ayahuasca. The Ethnopharmacology of Ayahuasca, , 55-63.
de Araujo, Draulio B., et al. "Seeing with the Eyes Shut: Neural Basis of Enhanced Imagery Following Ayahuasca Ingestion." Human Brain Mapping (2011): 1-10

Finlay, S. W. (2000). Influence of carl Jung and William James on the origin of alcoholics anonymous. Review of General Psychology, 4(1), 3-12.

Garcias-Romeu, A. (2013). Psilocybin in the treatment of smoking addiction: psychological mechanisms and participant account [Web]. Retrieved from http://www.youtube.com/watch?v=RHc60goAxv8

Griffiths, R. R., Johnson, M. W., Richards, W. A., Richards, B. D., McCann, U., & Jesse, R. (2011). Psilocybin occasioned mystical-type experiences: Immediate and persisting dose-related effects. Psychopharmacology, 218(4), 1-15.

Halpern, John H., et al. "Psychological and Cognitive Effects of Long-Term Peyote use among Native Americans." Biological Psychiatry 58 (2005): 624-31.

Hoffmann, E., Keppel Hesselink, J. M., & Silveira Barbosa, Y. M. d. (2001). Effects of a psychedelic, tropical tea, ayahuasca, on the electroencephalographic (EEG) activity of the human brain during a shamanistic ritual. Maps, XI(1), 25-29.

Horgan, John, and Jennifer Tzar. "Peyote on the Brain: Is the Secret to Alcoholism and Other Addictions Locked Up in Hallucinogenic Drugs?" Discover Magazine February 2013 February 01, 2003. Web.

Kelly, John F., et al. "Spirituality in Recovery: A Lagged Mediational Analysis of Alcoholics Anonymous' Principle Theoretical Mechanism of Behavior Change." Alcohol Clinical Experimental Research 35.3 (2012): 454-63.

Krystle Cole. "Peyote Use in the Treatment of Alcoholism in the Native American Church." September 3, 2009.Web. <http://www.neurosoup.com/peyote-use-in-the-treatment-of-alcoholism-in-the-native-american-church-2/>.

Liester, M. (Performer), & Prickett, J. (2013). Four hypotheses regarding ayahuasca's mechanism of action in the treatment of addictions [Web]. Retrieved from http://www.maps.org/conference/ps13liesterprickett/

MacLean, Katherine A., Matthew W. Johnson, and Roland R. Griffiths. "Mystical Experiences Occasioned by the Hallucinogen Psilocybin Lead to Increases in the Personality Domain of Openness." Journal of Psychopharmacology 25.11 (2011): 1-10.

Ross, S. (Performer) (2013). Psilocybin, addiction, and end of life [Web]. Retrieved from http://www.youtube.com/watch?v=I8X4I-VxScI

Sessa, B. (2005). Can psychedelics have a role in psychiatry once again? The British Journal of
Psychiatry, , 457-458.

Thomas, Gerald, et al. "Ayahuasca-Assisted Therapy for Addiction: Results from a Preliminary
Observational Study in Canada." Current Drug Abuse Reviews 6 (2013): 1-11.

Thomas, G. (Performer), Lucas, P., Capler, N., & Tupper, K. (2013). Ayahuasca-assisted therapy in the treatment of addiction in a Canadian first nations band [Web]. Retrieved from http://www.maps.org/conference/ps13ayahuascacanada/

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