The Therapeutic Use of Ayahuasca, Beatriz Caiuby LABATE & Clancy CAVNAR, 2014

The Therapeutic Use of Ayahuasca

Beatriz Caiuby LABATE, Clancy CAVNAR Editors, Springer-Verlag, Berlin, Heidelberg, 2014



Ancient Medicine and the Modern World

Ayahuasca, the ‘‘great medicine’’ of the Amazon rain forest, was, for millennia, entirely unknown to Western Euro-American civilization. While first scientifically identified, catalogued, and recorded in the mid-nineteenth century by the English botanist and explorer Richard Spruce, it had earlier been the object of brutal suppression by Spanish and Portuguese invaders of the New World who attempted to violently extinguish its ceremonial use by the indigenous people of the Amazon. Employing the harshest measures of the Inquisition, in 1616, the Catholic Church formally condemned the use of plant hallucinogens by the native people of the New World with punishment by extreme tortures and death. Use of powerful plants employed by native peoples for purposes of healing, divination, and cultural cohesion was virtually eliminated and forced deeply underground and, in the case of ayahuasca, into the remote regions of the forest, far from the reach of the marauding Europeans and their descendants. While occasional reports from traders and missionaries filtered out of indigenous use of ritual plants, it was not until Spruce obtained samples of the bark of Banisteriopsis caapi, a woody vine and one of the central plants used in the decoction ayahuasca, that the Western world took note.

In recent years, some controversy has arisen over the antiquity of ayahuasca. Given the climactic and soil conditions in the Amazon Basin, archeological finds have been limited, and suggestions have been made that the potent plant hallucinogen decoction may have existed only for a few hundred years. While definitive evidence does not exist, it seems highly unlikely that the indigenous people who traditionally made the region their home would have been ignorant of these powerful psychoactive plants that grew throughout the geographic region they knew so intimately. Rather, it is highly likely that traditional ayahuasca use, particularly in the Upper Amazon, dates long before the arrival of the first Europeans.

Lack of awareness of the existence of plant hallucinogens around the world by Euro-American culture has itself been endemic over time. In the classic Plants of the Gods by Richard Evans Schultes and Albert Hofmann, the very first sentence in the book states that ‘‘the use of hallucinogenic plants has been a part of human experience for many millennia, yet modern Western societies have only recently become aware of the significance that these plants have had in shaping the history of primitive and even of advanced cultures.’’ A telling example was the collective ignorance, until the mid-twentieth century, of the existence of hallucinogenic mushrooms. It was not until R. Gordon Wasson’s ‘‘discovery’’ in June 1955 of
indigenous Mazatec healers’ use of highly potent Psilocybe cubensis in a remote region of the state of Oaxaca in Mexico, that Western scientists accepted such powerful psychotropic fungi as something other than the products of myth. In the case of ayahuasca, the earliest known commentary on its existence came from Jesuit missionaries in the 1600s, who spoke of ‘‘diabolical potions’’ made from lianas growing in the Peruvian Amazon. Throughout the New World, and particularly South of the Equator, with its lush tropics and extraordinary plant diversity, the new European overlords, in the wake of their conquest of the native peoples, harshly condemned the use of sacred plants they observed as part of aboriginal religion and ritual. Hernando Ruiz de Alarcon, an early Spanish chronicler of native customs, described his observation of how the plants ‘‘when drunk deprive of the senses, because it is very powerful, and this means they communicate with the devil, because he talks with them when they are deprived of judgment with the said drink, and deceive them with different hallucinations, and they attribute it to a god they say is inside the seed.’’ With forced conversion to Christianity and the eradication of native cultures and traditions, the great secrets of the forest could not be tolerated openly, and, as was the case throughout Central and South America with the remarkable psychoactive plant pharmacopeia endemic to the region, the use and even knowledge of their existence faded from awareness. Not until the waning of the Inquisition and the end of forced imposition of Church decree, along with the advent of the Age of Enlightenment and the rise of Western scientific inquiry, did the very presence of these taboo plants begin to re-emerge.

In regard to ayahuasca, following isolated reports of native heresies from missionaries in remote forest outposts, the first notable subjective account of the effects of ayahuasca came from Manuel Villavicencio, an Ecuadoran geographer, who studied tribal groups in the Rio Napo area of Ecuador; he became intrigued by the use of yagé (another term for ayahuasca), and sought the opportunity to investigate first-hand the effects of this beverage. In a written account published in 1858, Villavicencio described how : “In a few moments, it begins to produce the most rare phenomena. Its action appears to excite the nervous system; all the senses liven up and all faculties awaken; they feel vertigo and spinning in the head, followed by a sensation of being lifted into the air and beginning an aerial journey; the possessed begins in the first moments to see the most delicious apparitions, in conformity with his ideas and knowledge; the savages [apparently the Zaparo of eastern Ecuador] say that they see gorgeous lakes, forests covered with fruit, the prettiest birds who communicate to them, the nicest and the most favorable things they want to hear, and other beautiful things relating to their savage life… As for myself I can say for a fact that when I’ve taken ayahuasca, I’ve experienced dizziness, then an aerial journey in which I recall perceiving the most gorgeous views, great cities, lofty towers, beautiful parks, and other extremely attractive objects; then I imagined myself to be alone in a forest and assaulted by a number of terrible beings from which I defended myself; thereafter I had the strong sensation of sleep.”

By the early twentieth century, increasingly sophisticated laboratory technology allowed scientists to isolate the principle biologically active alkaloids from psychotropic plants. Working from available samples of Banisteriopsis, Louis Lewin, later renowned as a principle founder of the field of modern psychopharmacology, identified a compound he called banisterine, later renamed harmine (and, for a
time, telepathine, after ayahuasca’s reputed capacity to induce telepathic phenomena, though this term did not gain traction in the West). For several years, harmine even entered the formal medical pharmacopeia, valued as a treatment for Parkinson’s disease. Only with the discovery of L-Dopa by the pharmaceutical industry, and its promotion as a ‘‘modern’’ treatment of Parkinson’s in the 1930s,
did harmine fade from medical use and interest.

Ayahuasca did not come to the attention of Western science again until the explorations of the renowned Harvard ethnobotanist, R. E. Schultes, who, during the Second World War, had been tasked by the United States government to survey the prevalence of wild rubber trees in the remote Amazon. These had become a matter of strategic concern following the Japanese Army occupation of Malaysia, the only previous substantive source of rubber, deemed essential for the Allied war effort. Schultes, who had previously studied the ritual use of peyote by the indigenous people of the Southwestern United States, learned of the use of ayahuasca by tribal groups he encountered during his solo and often hazardous trek
navigating and mapping the remote Amazon. Among other observations, Schultes identified the presence of a second critical plant necessary for ayahuasca’s extraordinary psychoactive potency: the leaves of the dimethyltryptamine (DMT)- rich Psychotria viridis. Decades later, a new generation of scientists, including ethnopharmacologist Dennis McKenna at the University of British Columbia,
established the biochemical mechanism for the central nervous system activation of DMT-containing Psychotria, a plant that, when taken orally and alone, is entirely inactivated in the gut by the monoamine oxidase (MAO) enzyme system, but, when brewed together with Banisteriopsis-containing monoamine oxidase inhibiting (MAOI) harmala alkaloids, induces a far-reaching range of profound psychoactive effects. The origins of this remarkably sophisticated plant pharmacology, seemingly discovered by indigenous people throughout the Amazon long before the arrival of the European invaders, remains a mystery. Whether through methodical, reductionist, trial-and-error sampling of the various plants in the geographical region or through some form of divine or spiritual intercession, as some have proposed, the actual process of the initial discovery of ayahuasca will likely never be known.

Since the early 1990s, ayahuasca has been subjected to rigorous clinical assessment utilizing state-of-the-art research methodologies. In 1993, along with my colleagues Dennis McKenna and Jace Callaway, I had the opportunity to travel to the capital of the Brazilian state of Amazonia, the city of Manaus, a large metropolis located at the confluence of the Rio Solimoes and Rio Negro, and the origins of the Rio Amazonas. Here, we conducted a study of a randomly selected group of volunteers who were members of the syncretic religion União do Vegetal (UDV), a church that had achieved formal government sanction to use ayahuasca as a ceremonial sacrament in their religious ceremonies in the late 1980s. Beyond
establishing vital safety standards and documenting that ayahuasca, when taken within the structure of the UDV, can be safely administered to well-prepared and carefully monitored subjects, we were also able to explore effects on neuropsychological function, personality characteristics, cardiovascular reactivity, and pharmacokinetic profiles of the four primary alkaloids involved in ayahuasca function (DMT, harmine, harmaline, and tetrahydroharmine), as well as apparent modulation of a primary central nervous system neurotransmitter, serotonin. Through our investigations, we were also able to discern that, when taken under optimal, culturally specific conditions, ingestion of ayahuasca had the capacity to facilitate impressive degrees of psychological healing, including mood stabilization
and recovery from chronic alcoholism and other addictive behaviors.

While almost entirely unknown to mainstream Western culture until 20 years ago, beyond a few exotic and often fanciful accounts, such as the experiences of iconoclast bohemian writers Allen Ginsberg and William Burroughs during the 1950s, in recent decades, a growing movement of Brazilian syncretic churches has spread the use of ayahuasca from the Amazon to the urban centers of southern Brazil. In addition to the UDV, the Santo Daime and Barquinha churches have also established religions sanctioned to utilize ayahuasca ceremonially, though with markedly different structures and belief systems than the UDV. Legal status in Brazil through much of the twentieth century remained at issue and, in 1985, ayahuasca was formally, albeit briefly, classified as a dangerous drug of abuse. Nevertheless, legal sanction was achieved shortly thereafter, following extensive investigations by government commissions which were favorably impressed with the sincerity, ethical integrity, and psychological health of the ayahuasca religion members they interviewed. Full approval to use ayahuasca within religious contexts in Brazil was granted in 1987. This in itself was an extraordinary historical
precedent. While some countries, including the United States, have allowed their indigenous populations the right to resume their tribal traditions (e.g., the use of peyote by Native Americans is protected by law), the removal of ayahuasca from legal strictures in Brazil was an important step. A further development over the last few decades has been the establishment of branches of the Brazilian ayahuasca
churches in the United States and Europe. In 2006, a landmark decision was issued (unanimously) by the US Supreme Court authorizing the legal use of ayahuasca when taken within the UDV religious structure. More recently, efforts to restrict the sacramental use of ayahuasca by the Santo Daime were dismissed on the state court level in Oregon. Nevertheless, while use of ayahuasca within the context of
established religion (e.g., UDV) may now be considered legal in the United States, other models and settings for its utilization remain in a legal gray area.

Traditionally, ayahuasca was used from coastal Panama and the Orinoco Basin and south of Bolivia; from coastal Brazil across the vast expanse of the Amazon Basin to the foothills of the Andes; as well as in Colombia and Ecuador. In the shamanic model, ayahuasca is seen as a magic intoxicant, which the indigenous people believe can free the soul from corporeal confinement. Above all, ayahuasca is considered a medicine: the great medicine. Practically, in today’s world, the shamanic model incorporates easily-transferable features, including group structure, attention to set and setting, import of intention, and proper preparation for and integration of the experience. For both safety and efficacy, any future clinical research with these compounds will need to seriously examine these aspects of the
traditional shamanic model.

Beyond Brazil, other modern forms of ayahuasca use have evolved elsewhere in the Amazon Basin. Primarily in Peru, but also in Ecuador, Bolivia, and Colombia, a tradition of mestizo healing has existed for the past century. Until recently, this was an entirely local phenomenon, known only to the generally low socio-economic status inhabitants of the region. A tradition of healing has been cultivated over time, with the avocation of ayahuasquero (facilitators of ayahuasca ceremonies) often passed down in families from generation to generation. Generally used to diagnose and treat medical, psychological, and psychosomatic disorders, this form of healing was often perceived as a culturally acceptable alternative to the ministrations of conventional physicians and surgeons. Over the past two decades, however, increasing interest in ayahuasca by North Americans and Europeans has led to an influx of westerners seeking their own healing and spiritual transformation. The emergence of positive accounts in the mainstream press has encouraged increasing numbers of such seekers, some of whom fall prey to poorly trained facilitators lacking requisite knowledge, background, and ethical orientation, unfortunately leading to cases of psychological decompensation and at least a handful of deaths, the circumstances of which have sometimes remained obscure. While highly reputable ayahuasqueros have facilitated positive and often transformative experiences for the vast majority of Euro-Americans coming to the Amazon, the risks of exploitation and injury to naïve and vulnerable seekers is starting to receive more attention. The late anthropologist Marlene Dobkin de Rios, in particular, has called attention to this dark side of ayahuasca use, both in the region of its origins in the Amazon and as it has spread to North America and

With interest growing in the potential psychospiritual healing capacity of ayahuasca, it is becoming increasingly clear that efforts need to be undertaken to further rigorously investigate its range of effects, safety parameters, and potential to be utilized to treat individuals suffering from the psychological malaise endemic to the modern world. Important foundational studies have already been established, particularly at the Autonomous University of Barcelona in Spain, where pharmacology researcher Jordi Riba and neuropsychologist José Carlos Bouso have, for the past 15 years, conducted carefully designed explorations of the neuropsychological and physiological effects of freeze dried ayahuasca (necessary
in the experimental context to ensure consistency of dose and concentration of alkaloids) with normal volunteers in a laboratory setting. More recently, in established and reputable medical institutions in Brazil, a series of exciting and potentially valuable research studies have been initiated by Draulio Araujo, Jaime Hallak, and others, exploring effects of ayahuasca on brain function.

One potentially promising approach now being actively pursued, particularly in Brazil, is the ayahuasca treatment model for individuals suffering from alcoholism and other addictive disorders. Consistent with valuable, albeit long neglected, studies in the United States, Canada, and Europe, of synthetic hallucinogens for the treatment of alcohol and drug abuse in the 1950s and 1960s, which were regrettably terminated by the early 1970s because of political pressure emanating from the cultural wars of that era, the ayahuasca treatment model presents a new opportunity. Interestingly, encouraging signs of change have been in increasing evidence in recent years, particularly the authorization of clinical research of the classical hallucinogen psilocybin in the US, including a Heffter Research Institute developed study treating alcoholics at the University of New Mexico, along with initial efforts by other investigators to conduct controlled addiction research with ayahuasca in South America. Further buttressing the growing interest and activity in this area has been a recently conducted study from northwest Canada using an ayahuasca treatment model (employing an imported traditional ayahuasquero from the Shipibo tradition of Peru) to treat long-term, refractory alcoholics of the First
Nation people of Canada (indigenous tribal people of Canada) with highly promising preliminary results.

The growing use of ayahuasca for purposes of healing represents a particular challenge to mainstream medical orthodoxy. Examining traditional use of such visionary plants, it is clear that a consistent element of the experience is the awareness of alternative and unusual dimensions of consciousness, including the realm of spirits. Indeed, the translation of ayahuasca from the native Quechua language is ‘‘vine of the spirits,’’ or ‘‘vine of the dead.’’ Incorporating such phenomena into our consensus model of reality will test the limits of conventional thought. Nevertheless, awareness and validation of these unusual realms is integral to cultures that have used ayahuasca throughout time, up to the current awakening of interest by modernity. Reconciling such divergent belief systems and constructs of reality will certainly test the inherent cognitive flexibility of modern culture and science as we attempt to comprehend the implications of the emergence of these ancient mysteries of the forest into the modern world.

While it is essential to utilize standard and state-of-the-art scientific and medical methodologies when investigating the range of effects of ayahuasca, including its safety, efficacy, and mechanism of action, appreciation needs to also be accorded to traditional models and the knowledge and lessons accrued over
time. In order to ensure safety and optimal outcome, careful attention needs to be given to structures employed by cultures remote in time and place from our own. Particular attention must be given to proper screening and preparation, whether it be for subjects in scientific and medical investigations or for those in less-structured settings seeking their own healing and personal transformation. Individual vulnerability, in regard to psychological stability and seriousness of purpose, needs to be taken into account and, when indicated, inappropriate candidates may have tobe turned away. As a mestre (master) of the UDV told me during our research investigations in Manaus many years ago, the vegetal (a UDV term for ayahuasca) is for everyone, but not everyone is for the vegetal. Particularly, given the challenges of integrating the use of ayahuasca into the modern world, care must be taken to minimize the likelihood that individuals will suffer from serious adverse consequences. Potentially dangerous drug and alcohol interactions with ayahuasca need to be avoided. Attentiveness to set and setting, including preparation and scrupulous examination of intention, must be emphasized. Particular elements of preparation emphasized among the earliest practitioners of ayahuasca use, including special diets (excluding salt, sugar, processed foods, etc.) and a period of sexual abstinence, may have a role in ensuring safety and determining outcome and need to be explored, in spite of the challenges such restrictions may pose within modern society. Careful attention to structures of ayahuasca use, including proper monitoring and opportunity for subsequent integration of the experience, should also be provided to increase the likelihood of optimal outcome.

We are faced with the challenge of how to incorporate these ancient technologies of consciousness exploration into our own modern healing paradigms. Although historically our culture was remarkably unaware of these plants and the profound effects they induce, this is no longer the case. The secret is out, and in this age of high-tech communication and ease of transport, the great mysteries of the remote forest are now being revealed. The implications for the modern age may indeed be profound. As we confront a world of widespread environmental destruction, and as we become increasingly aware of the growing menace of global climate change, it might be worthwhile to regard the traditional perspective of
ayahuasca as communicator plants, representing a conduit between nature and humanity. Years ago, in the remote Amazon, I had an experience of hearing this call from Nature: that it was no accident that, after millennia of quiescence, these remarkable visionary plants are now revealing themselves. What I saw, or heard, or instinctively realized, was that it was no happenstance we were there; rather, we
had been called to wake up, to pay attention, and to bring the message back to the modern world that our species is on the verge of destroying the earth, and with it the hopes and dreams of future generations.

The deep healing that the ayahuasca experience potentially offers, for both the individual and the collective, represents an extraordinary opportunity. Medical and psychiatric research into its myriad effects will provide an essential framework from which we may acquire a safe and practical structure to further explore these visionary plants and their potential to facilitate healing of our damaged planet as well as healing of the damaged people who inhabit the planet. There must be careful and scrupulous attention to safety parameters, with particular emphasis given to the knowledge and skills of those facilitating the experience. There is a great need to employ academic and ethical rigor in order to establish a strong and healthy foundation for the growing field of ayahuasca studies.

This volume of scientific explorations into the potential range of therapeutic effects of ayahuasca, ably edited by Beatriz Caiuby Labate and Clancy Cavnar, is a valuable contribution to this endeavor of establishing a rigorous field of ayahuasca studies. The range and mechanisms of ayahuasca and its putative capacity to facilitate states of both psychological and physical healing are explored. The potential of ayahuasca to be optimally employed as part of a treatment model for such difficult-to-treat clinical conditions as post-traumatic stress disorder, refractory mood, and anxiety disorders, and a variety of other psychiatric and even medical conditions, are methodically examined. The potential mechanisms of action, neurobiological as well as psychological, and their apparent facility to promote healing, are carefully scrutinized. Valuable input from a traditional indigenous healer, Taita Juan Bautista Agreda Chindoy from the Sibundoy Valley in Colombia, is included, providing lessons from an extant practitioner of the ancient art of ayahuasca healing. The area receiving the greatest attention is the treatment of drug and alcohol abuse, clinical conditions for which modern medicine and psychiatry lack effective treatment models, and which exert enormous costs to society: a natural area in which to apply the ayahuasca treatment model. Preliminary indications, from a variety of investigators in South America, North America, and Europe, are consistently positive. The implications of such findings,
as they are replicated and expanded upon in the future, are enormous. Ultimately, ayahuasca may represent an entirely new medical paradigm; a model created for us by the ancients and the elders of the native peoples, who provide the link to the traditions and heritage of the earth.

Los Angeles, July 2013

Charles S. Grob



1 Therapeutic Applications of Ayahuasca and Other Sacred Medicines  . . . . . . . . . . . . . . . . . . . . 1
Michael J. Winkelman
2 The Therapeutic Potentials of Ayahuasca in the Treatment of Depression . . . . . . . . . . . . .. . . 23
Fernanda Palhano-Fontes, Joao C. Alchieri, Joao Paulo M. Oliveira, Bruno Lobao Soares, Jaime E. C. Hallak, Nicole Galvao-Coelho and Draulio B. de Araujo
3 Ayahuasca as a Candidate Therapy for PTSD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Jessica L. Nielson and Julie D. Megler
4 Moments of Insight, Healing, and Transformation : A Cognitive Phenomenological Analysis. .. 59
Benny Shanon
5 Healing with Ayahuasca : Notes on Therapeutic Rituals and Effects in European Patients Treating Their Diseases . . . . . . 77
Janine Tatjana Schmid
6 Ayahuasca and the Treatment of Drug Addiction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
José Carlos Bouso and Jordi Riba
7 Hypotheses Regarding Ayahuasca’s Potential Mechanisms of Action in the Treatment of Addiction . 111
James I. Prickett and Mitchell B. Liester
8 Therapist and Patient Perspectives on Ayahuasca-Assisted Treatment for Substance Dependence ..133
Anja Loizaga-Velder and Armando Loizaga Pazzi
9 Effect of Santo Daime Membership on Substance Dependence . . . . . . . . . . . . . . . . . . . . . . . .. . 153
Beatriz Caiuby Labate, Rafael Guimarães dos Santos, Rick Strassman, Brian T. Anderson and Suely Mizumoto
10 Experience of Treatment with Ayahuasca for Drug Addiction in the Brazilian Amazon. . . .. . 161
Xavier Fernández and Josep María Fábregas
11 Assessment of the Psychotherapeutic Effects of Ritual Ayahuasca Use on Drug Dependency : A Pilot Study . . . . . . . . . . 183
Xavier Fernández, Rafael Guimarães dos Santos, Marta Cutchet, Sabela Fondevila, Débora González, Miguel Ángel Alcázar, Jordi Riba, José Carlos Bouso and Josep María Fábregas
12 Healing with Yagé: An Interview with Taita Juan Bautista Agreda Chindoy . . . . . . . . . . . . . . 197
Brian T. Anderson, Beatriz Caiuby Labate and Celina M. De Leon
13 Postscript—Psychedelics in Unlocking the Unconscious : From Cancer to Addiction . .. . . . .. 217
Gabor Maté
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225