Mina Paš, MD, integrative relational psychotherapist
The use of psychedelic experience in the treatment of addictions is far from new. In the late sixties the benefits of LSD psychotherapy for alcoholism was well known and thanks to Stanislav Grof, also very well documented. Stanislav Grof was a Czech psychiatrist who conducted and wrote about several thousand LSD psychotherapies on psychiatric patients, including LSD therapies as a treatment of alcoholism. His excellent book LSD psychotherapy (The healing potential of psychedelic medicine) offers a comprehensive and systematic review of the practical applications of LSD psychotherapy and Grof dedicated a whole chapter about the potential of LSD psychotherapy in the treatment of alcoholism (Grof, 2001).
Grof describes several way of using LSD in psychotherapy, but the approach that was found to be the most effective in the treatment of alcoholism was so called Psychedelic therapy. Basically psychedelic therapy in Grof’s terms refers to the use of large dose of LSD in one session. With large doses of LSD the goal was for the patient to experience ego death, followed by a peak mystic experience (Grof, 2001).
This type of therapy was developed from the findings of two English psychiatrists Abram Hoffer and Humphry Osmond, that came to an idea in the early 50’s, that LSD psychotherapy might help alcoholics to quit drinking. They compared psychedelic experience with delirium tremens or any experience in which the alcoholic “hits bottom”, with often contributed to the alcoholics to stop drinking. But considering the fact that hitting bottom is often fatal, they smartly considered to try controlled psychedelic therapy for recovery instead of risking the death of a patient. In the following years, they tested their hypothesis on over 700 persons with 50% success. They concluded that the psychedelic experience and not the chemical itself (in this case LSD), offered rest therapeutic benefits (Dyck, E., 2006).
The research materials, published before the prohibition of psychedelic compounds were lacking the current scientific criteria that account for a reliable scientific study, but that changed with renaissance of research for the benefits of psychedelic experience, showing again very promising results for the treatment of addictions.
There are several research papers focusing on benefits of ayahuasca use in the treatment of addictions. In the late 90s Grob and coauthors wrote about the benefits of ayahuasca for addiction. In the paper about a research among the members of Uniao do Vegetal or UDV (a Brasilian Ayahuasca church) they described the benefits of ayahuasca regarding the outcome on alcoholism or problematic drug use. The research subjects (15 of them, who were randomly selected among the members of the church) were all long time members of the church (at minimum 10 years) and they were using hoasca at minimum twice monthly, many of them several times per week. The use was limited solely to ritual context. All of them were abstaining from any other psychoactive substances, because that is a requirement of the UDV church. Five of the members included in the research had previous psychiatric diagnosis of alcohol abuse and eleven of them reported a history of moderate to severe alcohol use before entering the UDV. Four subjects reported a history of other drugs of abuse, including amphetamine and cocaine. Many of the members reported, that the first hoasca experience gave them a strong and profound insight about where they are heading with their life and enabled them to see and expedience very clearly where the self destructive path of drug abuse will lead them. Subject attributed the positive changes they made with their life to the involvement in the UDV church and ritual hoasca drinking (Grob at all, 1996).
Lately, the research, focusing on the benefits of combination of ayahuasca ceremony and group therapy noted significant and positive impact of this combined intervention for the treatment of addiction. 12 participants were included in the study. The intervention consisted of four days of group counselling with two expert-led ayahuasca ceremonies in the retreat. The study collected pre-treatment and six months follow-up data from participants. Statistically significant (p < 0.05) improvements were demonstrated for scales assessing hopefulness, empowerment, mindfulness, and quality of life. Self-reported alcohol, tobacco and cocaine use declined, although cannabis and opiate use did not. What is especially interesting is a significant reduction of problematic cocaine use (Thomas et. all, 2013).
Both of the studies show, that ayahuasca administration in a ritual or therapeutic setting shows significant beneficial results for addiction or problematic drug use if it is combined with other psychotherapeutic interventions and strong support of a broader social setting. It is legitimate to conclude that psychedelic experience offered the people a better and clearer insight, which mobilised them to make lasting positive changes regarding their drug use. But to be able to sustain this change, the support of additional psychotherapy or significant others was crucial.
If we try to look a bit deeper into the mechanism of mobilisation for change, we can not go past the research about the genetic behind the treatment of addiction and psychedelic medicine. By far best researched in this topic is Ibogain, withe the studies showing the induction of metabolic pathways in cells exposed to Ibogain. The increased energy supply of the cell might be the crucial factor for adaptation of the cell after the person stopped using the drug of abuse (Paškulin et all, 2010).
Ibogain does that by triggering the housekeeping metabolism of the cell, resulting in increased efficacy of physiological anti oxidative systems and lowering of basal metabolic needs, therefore providing support for the recovery of addiction (Paškulin et all, 2012).
What actually happens in the psychedelic experience?
According to Grof, psychedelic experience offers the person a journey into the deeper realms of the personality and enables him to come into contact with different layers of his soul. It also offers the person a so called “mystical experience” or connection to inner self, which is always severed when it comes to addiction. In his book LSD psychotherapy, Grof systematically explains how the person goes deeper and deeper with each subsequent psychedelic psychotherapy. The first experiences are usually psychodynamic, relating to the traumatic memories from early childhood to current time memories. The next stage are perinatal experiences, covering the birth trauma and the deepest level is consisted of transpersonal experiences (Grof, 2001). Therefore, psychedelic experience can offer a person to relieve traumatic memories, emotions and feelings and integrate them at the new level.
According to contemporary neuropsychological research it is becoming clear, that this is exactly the thing that makes psychotherapy successful.
Neuroimaging studies of different psychotherapeutic techniques, for example EMDR and brainspotting show, that the brain possesses excellent self healing properties if the person is put under right conditions that enable the self healing experience of the brain. What was shown in the studies is that when neocortex, which acts as a sort of guardian is temporarily silenced and other areas of the brain are lightened up, the brain is able to rewire the neuronal pathways, that encode traumatic experience which are often the main reason behind addiction.
As we know, “Neurons that fire together, wire together” and the strong emotional component of the experience strengthens the wiring even further. Rewiring of brain circuits can happen in a glitch of a second if the brain is put in the right condition, which accounts for the so called “magical experiences” or a “magical click”.
Relational model of the treatment of addictions
Psychotherapy of addictions is still mainly based on cognitive-behavioral modalities of psychotherapy, which can be very useful in the early stages of establishing abstinence and relapse prevention, but are not enough for providing the necessary healing. A great majority of people who become addicted or experience harmful drug abuse, have a history of severe traumatic experience at the very core of their being. That’s why the addiction can not be healed if we don’t focus to the healing of the origin trauma that subsequently led to drug abuse.
For many people with addiction, drug represents an attempt for self medication of the original pain, which was usually created in the early childhood of the clients. The drug of choice offers them a temporary relief from the pain and as absurd as it may sound, this concept works for some time.
I could not agree more with the theory of Gabor Mate, described in his book In the realm of hungry ghosts. Mate writes about how opiate drugs give the people a sense of pleasure and reward and a sense of genuine human connection. For the people who were raised by parents who abused or neglected them, the first experience with heroine can be the first “genuine” experience of human closeness and acceptance and they often report that they felt “normal for the first time”. So, that’s why it’s extremely difficult for people to give up the drug even though in time it provides them with a very short tempered relief and a lot of negative side effects (Mate, 2010).
In the concept of relational psychotherapeutic modalities, a good and trusting relationship with the therapist enables the client to get an experience of close and genuine relationship in reality. So, instead of getting the feeling of closeness and connection with the drug, the client experiences the relationship in vivo. If we consider a drug of abuse as a transitional object of attachment, the client is only able to let go of this object if he is provided with the alternative and so the relationship with the therapist becomes a transitional object of attachment for a period of time (Khantzian and Albanese, 2008).
But the problem is, that this process requires a pretty good impulse control of the client and strong motivation for change. Some clients are quite capable of that, but some have great difficulties establishing abstinence and preventing relapse. If we look at the neurological causes it is quite clear why that happens. The drugs of abuse influence orbitofrontal pathways in a way, that impulse control in drug addicts is severely compromised. In we take into account also the fact that in the majority of addicts impulse control was never established in the first place, because of inadequate parenting and/or abuse it is clear that establishing enough control over one’s behaviour in addicts is very hard. And to be able to do relational therapy work, abstinence is crucial.
In my experience, established relational psychotherapeutic techniques are often not enough for healing, necessary for life lasting changes that need to be made. And that’s where the psychedelic experience can be benefitial.
The psychedelic experience can offer an addict a different and clear view on their trauma and addiction, it can offer them a sense of deeper meaning and connection to the self. It can enable them to relieve and integrate the traumatic memories and enables them a mobilisation of energy in the cells, needed for the change to take place. Psychedelic experience can offer the client to come into contact with emotions and sensations that they cut off from awareness a long time ago, because they were far too painful for them, but with them they also cut off the connection to their sense of self.
Because this people are usually so traumatised it is very hard for them to come into contact with this unconscious material in the course of psychotherapy and if they do, it usually takes years of therapy. In the meantime relapses often happen, which slow down the psychotherapeutic process and usually bring additional retraumatisation, not to mention that many people can not financially afford long term psychotherapy. Regarding all this, and the fact that relapses are often fatal it is of great importance to consider psychedelic psychotherapy to become a legitimate form of treatment, as it is quite clear that psychedelic therapy, combined with psychotherapy and support in a broader social support can be a life saving factor.
Let me finish with a quote of Dr. Jacques Mabit, the founder of Takiwashi treatment center: “The treatment of addictions can never focus solely on sobriety or abstinence without offering another means of access to consciousness, the beyond, or the world of the spirits; however each one wishes to formulate it. More importantly, it seems to us to be an obligation to anticipate an alternate route of access to the “other world;” otherwise we take away from the patient their full human realization, which is to say, the transcendental dimension, and consequently take humanity out of one prison only to enclose it in another.” (Mabit, 2007)
Dyck, E. Hitting highs at rock bottom: LSD treatment for alcoholism, 1950-1970. Social history of medicine vol. 19, No. 2 pp. 313-329, aug 2006.
Grof, S. (2001). LSD Psychotherapy (The Healing Potential of Psychedelic Medicine). MAPS.
Grob, C. S., McKenna, D. J., Callaway, J. C., Brito, G. S., Neves, E. S., Oberlender, G., Saide, O. L., Labigalini, E., Tacla, C., Miranda, C. T., Strassman, R. J., & Boone, K. B. (1996). Human pharmacology of hoasca, a plant hallucinogen used in ritual context in Brazil. J Nerv Ment Dis 184, 86–94.
Mate, G. In the realm of hungry ghosts: Close encounters with addiction. North atlantic books, Berkeley, 2010.
Mabit, J. (2007). Ayahuasca in the treatment of addictions. Psychedelic Medicine (Vol. 2): New Evidence for Hallucinogic Substances as Treatments.
Paškulin, R., Jamnik, P., Obermajer, N., Slavič, M., Štrukelj, B. Induction of energy metabolism related enzymes in yeast Saccharomyces cerevisiae exposed to ibogaine is adaptation to acute decrease in ATP energy pool. European journal of pharmacology 627 (2010) 131-135.
Paškulin, R., Jamnik, P., Danevčič, T., Koželj, G., Krašovec, R., Krstić-Milošević, D, Blagojević, D, Štrukelj, B. Metabolic plasticity and the energy economizing effect of ibogaine, the principal alkaloid of Tabernanthe Iboga. Journal of Etnopharmacology 143 (2012) 319-324.
Thomas, G., Lucas, P., Rielle Capler, N., Tupper, K.,W. and Martin, G. Assisted Therapy for Addiction: Results from a Preliminary Observational Study in Canada. Current drug ague reviews, 2013, 6, 000-000.