Addiction/Substance Abuse, Health
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Blending Traditions – Using Indigenous Medicinal Knowledge to Treat Drug Addiction

By Jacques Mabit, M.D.

Abstract

Ancestral medical practices are based on a highly sophisticated practical
knowledge and view the controlled induction of non-ordinary states of
consciousness as potentially beneficial, even in the treatment of the
modern phenomena of drug addiction. These ancestral practices stand in
contrast to the clumsiness with which Western peoples induce altered
states of consciousness. Drawing from his clinical experience in the High
Peruvian Amazonian forest, the author describes the therapeutic benefits
of the wise use of medicinal plants, including non-addictive psychoactive
preparations, such as the well-known Ayahuasca tea. Within an
institutional structure, a therapeutic system combining indigenous
practices with contemporary psychotherapy yields highly encouraging
results (positive in 2/3 of the patients). This invites us to reconsider
conventional approaches to drug addiction and the role of the individual’s
spiritual journey in recovery.

The Backwards Approach

Moving beyond the strict position that the final objective of drug
addiction therapy is complete abstinence, the Western world has responded
to its failures and limitations by considering the possibility of merely
reducing risks. The notion of substitution, as in methadone therapy for
heroin addiction, indicates a certain tolerance towards altered states of
consciousness. In this model, which treats these states as “inevitable” in
some sense, one would now be satisfied with limiting their negative
secondary effects. In the face of a Puritanism resigned to an almost
constant failure, this attitude opens new possibilities in treating drug
addiction. 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 a
dry and devitalized lifestyle, one lacking exciting perspectives or room
to blossom.

Some take this new tolerance of drug use further, for example by proposing
to ravers that they learn about the drugs they consume, the risks that
they run, and the best way to avoid the negative consequences of their
conduct3. In this model, the drug user is considered a thinking and
consenting 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 approach
which appeals to the user’s intelligence. This model accepts the
authenticity of the user’s quest, even if it is often unconscious, for a
true liberty that can be confused with caprice.

While this attempt at finding meaning by exploring new realms of
consciousness can be chaotic and confused outside of a controlled setting,
it is reminiscent of more purposeful undertakings among traditional
peoples. In fact, one finds the induction of altered states of
consciousness for the purposes of initiation and therapy in all
traditions. Such experiences, always guided by a ritual frame, often
depend upon a fine understanding of the animal and vegetable substances
that serve as their catalysts. One may also affirm that, sometimes, the
same substances that serve as the “remedy” in indigenous cultures are the
“poison” in Western society. Hence the coca leaf, which is well integrated
into daily life in the Andean world, becomes a highly addictive
cocaine-based paste when taken out of context. Similarly, cannabis, poppy,
and tobacco may generate either remedy or poison according to the mode of
consumption and the context of ingestion.

It is noteworthy that biologists observe that all animal species consume
natural psychoactive substances with great eagerness when possible
(Siegel, Ronald, 1990). In fact, Siegel considers this conduct a fourth
instinctual instance of animal biology, as if life tends spontaneously
towards a broadening of perceptions and a concomitant amplification of
consciousness. It becomes difficult, then, to extract man from this vast
biological movement that embraces all animal life.

Indigenous Knowledge

Our observations in the Peruvian Amazon yield a supplementary fact: not
only do the natural psychoactive substances used by indigenous peoples not
generate dependence, they are utilized to treat the modern phenomenon of
drug addiction. This changes the way we understand toxicity; the Western
obsession with “substances” (drugs) is replaced, or at least accompanied
by, the concepts of the set (the subject, including genetic
predispositions, life history, and preparation) and setting (ritualized or
not). Indeed, psychoactive substances may be a treatment for “drug
addicts,” a fact that still seems paradoxical or impossible even to the
specialists in question. And yet, the facts speak for themselves.

This phenomenon also works for ethnic groups strongly affected by
substances such as alcohol, which represents for them, inversely, an
imported product removed from its context. Hence, the healers of the
Peruvian coast treat their alcoholics through the ritual use of the
mescaline cactus with a high rate of success (around 60 per cent, after
five years) (Chiappe, Mario, 1976). The Native North Americans reduce the
incidence of alcoholism on their reservations considerably and quite
rapidly by reviving their ancestral practices, including the ritual use of
peyote and tobacco (Hodgson, Maggi, 1997).

The ritualization of induced modifications of consciousness, with or
without substances, establishes a universal symbolic frame within which
these experiences acquire significance by allowing the individual to
inscribe himself within a model of cultural integration. In indigenous
groups, then, such experiences frequently accompany rites of passage,
particularly at adolescence, permitting the youth’s appropriation of the
discourse, images, and myths generated by the community. It is evident
that the fundamental lack of cultural consensus in our fragmented
post-modern society, along with the desacralization of the lived interior
and exterior, and the disappearance of all authentic rites of passage,
leaves us without the means to integrate experiences of altered states of
consciousness into our daily lives. In other words, the drug user sets off
randomly with neither compass nor map, often finishing badly.

These considerations lead to the following conclusion: not only must we no
longer take a position of passive tolerance toward an inevitable
consumption of psychoactive substances, but, on the contrary, we must
actively explore the coherent therapeutic use of psychoactive substances
without the outcome of dependence. Even more broadly, we must be open to
every 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 that
create both a space of temporary containment and an authentic symbolic
frame which, as in the indigenous ritual space, integrates therapists and
users. 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
psychoactive effects. The risk of toxicity is also lower because their
active principles are similar, if not identical, to the neuromediators
naturally secreted by our bodies. In case of overdose (which is generally
difficult to produce given the extremely disagreeable flavor of the
beverages), these substances are eliminated naturally by vomiting. This
self-regulating phenomenon provides for safe prescription and is an
integral part of the expected effects of ingestion, as well as those of
purgation-detoxification (hence their special role in the domain of drug
addictions). 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 doses
gradually decrease: their use in addiction therapy is not, then, a simple
substitution.

It is remarkable that no visionary natural substance is addictive. Visions
seem to be the proof of sufficient cortical integration, of a
metabolization of the symbolic charge revealed during the experience of
altered consciousness. Entheogenic substances (also misnamed
hallucinogens) are hence among the best of those that may be used in a
therapeutic setting. This has already been attempted in psychotherapy
(LSD, MDMA, Harmaline, DMT, etc.), but generally without an integrating
symbolic framework (or ritual space), without engaging the therapist in
the method, with synthetic or semi-synthetic substances or extracts, and
through processes of assimilation that violate physiological barriers
(i.e., injections).

Ayahuasca

This highly psychoactive ancestral beverage is situated at the heart of
both the empirical medicinal practices of Amazonian cultures and,
recently, of explorations into the therapeutic potential of medicinal
plants, in particular in the domain of psychopathology, including drug
addiction therapy. The pharmacological sophistication of this preparation
reflects the high degree of understanding of the Amazonian peoples, who
are proven to have discovered Monoamine Oxidase Inhibitors (MAOIs) at
least three thousand years before Westerners. Tryptamines and
beta-Carbolines, the major active principles of Ayahuasca, are present in
many natural secretions as well as in the central nervous system (pineal
gland) (Mabit, Campos, Arce, 1993).

The entheogenic or visionary effects of this beverage have been hastily
called “hallucinogenic,” stigmatizing a compound which could be a
significant topic of research. Its potential as such risks being dismissed
by the academic community due to a stance less indebted to scientific
rationality than to society’s collective fears. We have argued that the
images stimulated by the use of Ayahuasca in a therapeutic context
symbolically manifest the content of the unconscious. Moreover, these
images are not without an object, whether it be psychological or
otherwise, which differentiates them completely from the “illusions
without object” that are by definition “hallucinations” (Mabit, 1988). The
exploration of the unconscious through Ayahuasca permits the rapid
extraction 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 the
superior cortical level. The effects of Ayahuasca are not merely visual,
but embrace the entire perceptual spectrum, as well as the non-rational
functions tied to the right brain and to the paleoencephal or so-called
reptilian brain. The patient’s clinical experience fosters the development
of not only the projective but also the integrative functions of
symbolization, enabling the progressive readjustment of personality
structures. These explorations touch cross-cultural psychological depths
and, hence, may be applied in extremely broad and varied contexts of human
life.

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

The Center: A Pilot Project

Our ignorance in regard to the controlled induction of altered states of
consciousness could greatly benefit from ancestral medical knowledge. The
master healers of various traditions are ready to transmit their heritage
to those willing to learn and to embark upon a path of initiation. Six
years of teaching beside Amazonian healers has led us to develop a
therapeutic method using the controlled modification of states of
consciousness. Our system is based on ancestral techniques involving
medicinal plants and natural methods of detoxification, sensory
stimulation, and sensory deprivation. This pilot project attempts to
combine ancestral knowledge with contemporary psychotherapeutic practices,
working under the guidelines of ethical considerations and the
requirements of the Western mentality.

The program, in which no method of coercion is exercised, accepts groups
of no more than fifteen voluntary patients. The location is a five acre
park bordered by a river, just outside the city of Tarapoto, in the
Peruvian 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 the
plants, psychotherapy, and community life. The guided experiences of
altered consciousness generate psychological material which is
subsequently discussed and evaluated in the psychotherapy workshops and
then directed towards expression in community life. In reverse, everyday
activities supplement the therapeutic sessions (with or without plants).

The initial use of purifying, sedative, and purgative plants reduces
withdrawal syndromes, rendering any return to prescription medication
during the stay unnecessary. Then, the psychoactive plants intervene,
powerfully facilitating the psychotherapy. From the brief sessions to the
eight day isolation in the forest with rigorous rules pertaining to food,
sex, external contacts and daily activities, each ingestion of
psychoactive plants is governed by specific conditions. Each session is
also facilitated by a trained therapist, and clearly inscribed into a
precise and rigorous symbolic frame, which improves the chance of success
for the session and its subsequent integration into the subject’s life.

These techniques permit the exploration of buried memories and the
re-emergence of censured situations or events. These “revelations” both
relieve the addict’s conscience and motivate him to face his sickness. A
temporary reduction of critical functions and discriminations facilitates
the cathartic expression of emotions. These experiences, with the help of
psychotherapeutic work, may then correct the defective formation of the
subject’s emotional expressions and ideals. By plunging under the veils of
ordinary consciousness and unblocking the paths of access to the deep Ego,
this exploration of the subject’s interior universe brings out rich
material, in contrast to these patients’ often insufficient symbolization.
During the subsequent sessions, the subject will learn to translate and to
interpret 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 an
amplification of the attention-span and of the depth of mental
concentration. The clearly defined context, supplemented by a carefully
regulated lifestyle, invites the resident to implement the knowledge
obtained by this work. Hence, the space constitutes a laboratory in which
the residents are at once the observers and the subjects of their
observation. The medicinal plants play the central psychotherapeutic role,
while caretakers offer guidance and security. The users are guided into
liminal, or symbolically transitional, experiences in which they visit
their interior gods and demons. These experiences simultaneously involve
the subject’s psychological state, the whole range of emotional
sensations, and the spectrum of his psychological perceptions. In these
experiences, existential questions may come to light and demand an engaged
response. The guided and cathartic process can help the individual to
transcend his or her ordinary mindset and access somatic memories. In the
best cases, the individual is able to transcend the Ego, which can allow a
healthy deflation of the Ego, a reconciliation with human nature, and an
acceptance of our modest inscription in time and in matter, which is
nevertheless exciting because of its perceived meaning. In other words,
this is a process of initiation; it is a semantic experience which carries
meaning that can respond to the chaotic and disorderly quest of the drug
addict, which may be seen as a path of counter-initiation or as a savage
initiation (Mabit, 1993). This therapeutic method does not, then, simply
focus on abstinence, but also offers an adequate alternative. This
alternative method, which respects altered states of consciousness, is
able to respond to the drug addict’s quest by furnishing it with clear
ends and with non-dangerous means to reach them. This process supposes an
internal structural change which goes beyond the palliative of a simple
external behavioral change, which is never totally satisfying and most
often ineffective.

The duration of the stay is, in general, nine months, and the follow-up is
ideally two years. The centre has received patients of all social and
cultural origins. The techniques, which mainly demand self-exploration
through the senses, do not require any analytic verbalization or
integration, which represents an enormous therapeutic advantage. One may
even say that these experiences of altered consciousness give access to
ineffable, inexpressible trans-verbal spaces, which are as much
pre-logical or infra-verbal as they are ecstatic or supra-verbal. Here,
the local alcoholic peasant meets the European college student dependent
on pot, the urban bourgeois who functions on cocaine, the dealer addicted
to a cocaine-based paste, or the delinquent pathological liar who smokes
crack. To the contrary of what certain theorists say, the exploration of
the interior universe by these methods does not require that either the
therapist or the subject belong to the native culture of these practices.
Rather, these practices give access to personal intra-psychical symbols
which remain coherent to the subject and which touch depths that could be
called transcultural by virtue of reaching universal psychological
complexes (love, hate, rejection, abandon, fear, peace, etc.). At the same
time, the accompanying psychotherapy allows the patient to better
understand the experience of the session, to integrate it, generate new
questions, and enrich the following session. We have now mastered these
techniques ourselves, and we make use of them with patients from cultures
other than our own. They are accessible to any Western therapist willing
to fulfill the requirements of their long apprenticeship.

Results

Since its founding in 1992, the center has received more than 380
patients. One study has just been made (Glove, not yet published) of the
first seven years of activity (1992-1998), examining drug addicts or
alcoholics having completed at least one month of treatment and with at
least two years of time out of the clinic – a sample of 211 courses of
treatment (175 first-time patients and 36 returning patients). Note that
the results of this study do not include data on the 32% of patients who
leave during the first month before the first ayahuasca session, when the
treatment is not yet considered to have started. 28% reached the sixth
month of treatment, and 23.4% finished the entire treatment.

Two-thirds of the patients consumed mainly a highly addictive and
debilitating cocaine-based paste. 80% consumed alcohol alone or in
addition to other drugs. More than half of the patients (53.5%) had
already tried treatment, one-third of which had tried psychiatric
services. For 49%, the gateway drug was alcohol, and for 42%, cannabis.
The average age was thirty years and the average duration of consumption
of psychoactive substances at the time of entrance was 12.5 years. At
31.3%, with a tendency to augmentation, the index of retention (percentage
of prescribed exits out of total exits) gives proof of the relative
acceptance of this therapeutic method. The voluntary exits make up the
majority (52%) compared to prescribed exits (23%), runaways (23%), and the
rare expulsions (3%).

The evaluation of the results integrates qualitative givens, as well as
the incidence of abstinence or relapse due to poor prognostic criteria.
One should note that the patients leave free of any post-residential
medication. In addition to evaluating the relation to addictive
substances, especially those that the subject consumed before, we consider
personal evolution (internal structural change), the indications of social
and professional reintegration, and the capacity for familial
restructuring. According to these criteria, we may distinguish three
categories:

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

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

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

Out of the total, then, 31% were “good” and 23% “better,” while 23% were
the “same or bad” and 23% unknown. With hindsight, we can affirm that
about 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% of
the patients have, in the end, positively benefited from the follow-up of
the model proposed at the center. When one only takes into account the
sample of the patients with “prescribed exit,” (those who have completed
the entire program) the positive results are raised to 67%.

When the patients relapse or simply re-offend, 55.5% return to the center
and 26% find other local practitioners of traditional medicine, which
demonstrates their high opinion of this approach. When this occurs,
purgative plants are more solicited than psychoactive plants. This choice
demonstrates the absence of dependence on the psychoactive substances.

This method, officially recognized by the Peruvian authorities, has
expanded into a number of programs including educational programs (for
students), psychiatric and anthropological research, and outreach (written
and audio-visual media, and seminars for personal development).

Conclusion

The mere repression of drug consumption represents a simplistic approach
to the problem, with demonstrated ineffectiveness as a therapy. We may
well call it illogical and even immoral since it omits the substances that
are currently the most deadly (alcohol and tobacco). In addition, the
accelerated development of new substances on the market outstrips any
repressive attempt at control and relegates the game of penal
interdictions to failure. We are hence condemned to approach the problem
under another angle, whether we want to or not. Similarly, if harm
reduction and substitution only indicate proof of failure and a last-ditch
effort of pure social convenience, they are also, in our view,
reprehensible and morally dubitable. This is because they consecrate a
tacit rejection of healing, and the officialization, in a manner of
speaking, of a population of second class citizens tolerated for lack of a
therapeutic alternative.

The high degree of diffusion of the drug phenomenon in the 50’s and 60’s
was born of the contact between a few intellectuals with traditional
peoples, 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 ancestral
knowledge while only retaining the physical substance, reducing “the
approach of the gods” to the consumption of an active principle, playing
neurochemists like apprentice sorcerers (see Leary’s delirious work,
1979). This oversimplified view of substances and their potential has
generated a terrible drama. The phenomenon of substance addiction is
characteristic of Westernized societies and continues to be practically
unknown in indigenous populations or among peoples free from prolonged
Western influence.

By approaching this ancient knowledge with respect and careful study, it
seems possible to reinstate an authentic relation with the Mystery of Life
by returning to true paths of initiation. By validating the legitimate
quest of the drug user and redirecting it into a structured, meaningful
experience, perhaps we may avoid the lax defeatism of the “anything goes”
attitude as well as the rigid and useless bellicosity of “everything is
forbidden.”


Bibliography

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

Giove, Rosa. 2002 (to be published). The liana of the dead to the rescue
of 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 health
approach, 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, First
Carol Publishing Group Ed.

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

Mabit J., J. Campos, J. Arce. 1993. Considerations surrounding the
ayahuasca concoction and therapeutic perspectives. Revista Peruana de
Neuropsiquiatría, Lima, LV (2), 118-131.

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

Mabit J-M. unpublished. Ayahuasca hallucinations of the warriors of the
Peruvian 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,
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5 Comments

  1. Mike Palmer says

    I’m doing my senior thesis on traditional medicine being used to treat drug addiction. I was curious if anyone has any sources or persons I may be able to contact. My email is mikepalmer_05@hotmail.com

  2. Liam Cummings says

    Hi Jacques

    Thanks for the post. Would it be possible to have a copy of the questionnaire used in your research. I’m working on getting the Church of Santo Daime legal here in Ireland. My intention is to put together a questionnaire to gather information on the existing church members here which will be used in our submission to further our cause.
    Thanks in anticipation.

    Liam

  3. Can I just say what a relief to seek out someone who actually is aware of what theyre speaking about on the internet. You undoubtedly know easy methods to carry a difficulty to mild and make it important. More people have to learn this and understand this side of the story. I cant imagine youre no more standard since you positively have the gift.

  4. James says

    Great article! Everything you wrote about had that ‘OM’ ring of truth. Thanks.

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