Blending Traditions:
Using Indigenous Medicinal Knowledge to Treat Drug Addiction” [1]
- In : MAPS, Bulletin of the Multidisciplinary Association for Psychedelic Studies, vol XII, nª2, pp. 25-32, USA, summer 2002.
By Jacques
Mabit, Director of the Takiwasi Center
[2]
Translated by Kartina Amin
Abstract
– Ancestral medical practices are based on a highly sophisticated practical
knowledge and, in contrast to the clumsiness with which Western peoples induce
altered states of consciousness, view
the controlled induction of non-ordinary states of consciousness as potentially
beneficial, even in the treatment of the modern phenomena of drug addiction.
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 famous
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 convention 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 farther, 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 conduct
[3]
. 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
consciousness towards initiatic and therapeutic ends 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, often, 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 avidity 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, but 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 are
there.
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%, after five years) (Chiappe, Mario, 1976). The Native North Americans
reduce the incidence of alcoholism in 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 postmodern 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 consciousness.
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 effects 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, 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
frame (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 (injections).
Ayahuasca
This
highly psychoactive ancestral beverage is situated at the heart both of the
empirical medicinal practices of Amazonian cultures and, recently, of explorations
of 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 MAOIS at least 3,000 years before Westerners. Tryptaminics
and carbolinics, 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 product which could be a significant study
of research. Its potential as such risks being dismissed out of ignorance
by the academic community, due to a stance less indebted to scientific rationality
that to the collective fears of society. 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 object (be it psychological) 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 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, authorizing
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 15 years of more than 8,000 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 personality.
The Takiwasi Center: A Pilot Project
Our
ignorance in regards 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 on
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 15 voluntary patients. The location is a park of more than 2 hectares
(about five acres), bordered by a river, just outside of 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 reworked in the psychotherapy workshops and directed towards its
concretization in community life. Inversely,
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 psychotropic medication during the stay
unnecessary.
Then,
the psychoactive plants intervene, powerfully facilitating the psychotherapy. From the brief sessions to the 8-day isolation
in the forest with rigorous rules for 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 Takiwasi 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 it 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. Takiwasi 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 Takiwasi 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 6th 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
30 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 ¼ prescribed exits (23%), ¼ 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 the 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 (re)structuration. According to these criteria, we may distinguish
three categories:
- “good”: favorable development, problems apparently
resolved thanks to an 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 “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 Takiwasi 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 Takiwasi 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 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.”
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