Ayahuasca in adolescence: a preliminary psychiatric assessment

Ayahuasca is a plant-based hallucinogenic concoction used as a sacrament in syncretic Brazilian churches such as União do Vegetal (UDV) and Santo Daime, where its ritual consumption is legally protected when practised as part of religious ceremonies. Earlier work in adults, notably the Hoasca Project, found no evidence of long-term injurious effects among regular ritual users and even reported apparent remission of serious psychiatric problems following entry into the religion. Despite these adult data and the common belief within churches that ayahuasca is harmless for adolescents when consumed in a ritual context, controlled empirical studies focusing on adolescents have been lacking. Xavier and colleagues set out to address this gap by conducting a preliminary psychiatric assessment of adolescents who consume ayahuasca within a religious setting. The primary aim was to compare psychiatric symptomatology in a sample of ritual-using adolescents with matched non-using controls using standard screening instruments, thereby evaluating whether regular ritual use is associated with differences in measures such as depression, anxiety, attentional problems, substance misuse, and body dysmorphic concerns.

This cross-sectional, case–control study recruited 40 adolescents aged 15–19 who had consumed ayahuasca in a ritual context at least 24 times over the previous two years and compared them with 40 matched controls who had never drunk ayahuasca. Matching criteria were sex, age, and educational level; both groups lived in the same communities. Ayahuasca participants were randomly selected from three UDV churches, and controls were randomly selected according to the pairing criteria. A minimum 20-day washout period preceded assessment. Interviews and scale administration were conducted by a trained psychiatrist in 2001 in two Brazilian cities, and written informed consent was obtained from adolescents and their parents. Psychiatric screening instruments included the Self Report Questionnaire (SRQ) for overall psychiatric condition, the Center for Epidemiological Studies Depression Scale (CES-D) for depressive symptoms, the Beck Anxiety Inventory and the State–Trait Anxiety Inventory (STAI) for anxiety screening, and the Drug Use Screening Inventory (DUSI) for drug misuse. The team also screened for body dysmorphic concerns and attention-deficit symptoms, using screening thresholds and DSM IV criteria operationalised for inattentive-type attention deficit (three or more items met). Tests used are described as standard screening tools designed for first-stage case identification in population studies. Data analysis comprised descriptive statistics followed by between-group comparisons. Chi-square tests were used for categorical variables and t-tests for continuous measures. The extracted text does not elaborate further on corrections for multiple comparisons or multivariable adjustment.

Both groups comprised 40 adolescents each. In the ayahuasca group 55% were male and the mean age was 16.52 ± 1.34 years; 75% self-identified as White and 92.5% lived with their parents. The control group was similarly distributed (55% male; mean age 16.62 ± 1.0 years), with 82.5% White and 97.5% living with parents. Educational levels in the ayahuasca group ranged from first year of high school to first year of college; controls ranged from first to third year of high school. Regarding patterns of ritual use, 63% of ayahuasca users began systematic drinking before age 13 and 37% began after 13. The mean duration of systematic (at least monthly) use was 4.05 ± 2.28 years. At assessment participants had abstained for at least 20 days (mean abstinence 41.16 ± 15.55 days). Only one adolescent reported ever drinking ayahuasca outside a religious context, and 97.5% reported a profoundly positive influence on their lives. On screening instruments, 3 adolescents (7.5%) in the ayahuasca group had high overall psychiatric scores. Substance-related screening identified one adolescent (2.5%) with problem drinking and one (2.5%) with substance misuse. Although 24 adolescents (60.0%) in this group reported anxiety symptoms at the time of assessment, only 3 (7.5%) scored highly on the Beck Anxiety Inventory and 2 (5.0%) on the STAI-State scale. Twelve adolescents (30.0%) screened positive for depressive symptoms. Four (10.0%) screened positively for body dysmorphic concerns and one (2.5%) met DSM IV screening criteria for inattentive-type attention deficit. In the control group, 4 adolescents (10.0%) had high overall psychiatric scores. No controls screened positive for alcohol problems or substance misuse. Although 32 (80.0%) reported anxiety symptoms at assessment, only 1 (2.5%) scored highly on the Beck Anxiety Inventory and 7 (17.5%) on the STAI-State. Eleven controls (27.5%) screened as probably depressive. Body dysmorphic screening was positive in 11 controls (27.5%), and 7 controls (17.5%) met DSM IV screening criteria for inattentive-type attention deficit. Comparative analyses showed trends favouring the ayahuasca group for fewer anxiety symptoms (p = 0.087), fewer body image concerns (p = 0.083), and fewer inattentiveness cases (p = 0.057), but these differences did not reach conventional statistical significance. Gender-stratified results were more pronounced among females: for example, 11 girls in the ayahuasca group versus 17 in the comparison group scored high on STAI-Trait, while body shape concerns were concentrated among females (13 total: 3 ayahuasca, 10 controls). For attention problems the exception was that six boys in the control group versus one boy in the ayahuasca group fulfilled screening criteria for ADD.

Xavier and colleagues interpret their findings in the context of prior adult work such as the Hoasca Project, which reported remission of past psychiatric histories among long-term adult ayahuasca church members but left unresolved whether improvements were due to the pharmacological effects of ayahuasca, the affiliative religious process, or factors related to set and setting. In the present adolescent sample, overall psychiatric profiles were broadly comparable between ritual-using adolescents and matched non-users, although small favourable differences were observed for anxiety symptoms, body image concerns, and inattentiveness. The authors note that these differences were only trends and did not achieve statistical significance, and they caution that the modest sample size may have limited statistical power. Possible explanations offered include direct neurobiological effects of ayahuasca, improved attentional training that may occur through participation in ritual practices, and personality or social differences associated with religious affiliation. The Hoasca Project's prior finding of greater confidence, optimism, sociability and emotional maturity among adult ayahuasca users is invoked as a potential parallel: a strong sense of belonging to a structured religious community might itself reduce anxiety and body image concerns. Key limitations highlighted by the authors include the cross-sectional design, which precludes causal inference about whether less psychopathology predisposes adolescents to join the church or whether affiliation confers a protective effect, and the small sample size that limits detection of statistically significant differences. The authors therefore emphasise the preliminary nature of the findings and call for further studies to clarify the contribution of ayahuasca, the religious setting, and other variables to adolescent mental health outcomes.