Ceremonial ‘Plant Medicine’ use and its relationship to recreational drug use: an exploratory study

Psychoactive, plant-based hallucinogens such as ayahuasca and psilocybin have a long history of ceremonial use worldwide and are increasingly discussed in the United States both in mainstream media and academic research. Clinical interest has resurged over the past decade, with trials suggesting potential benefits for conditions such as depression, PTSD and addiction, alongside media reports of self-formed ceremonial groups led by facilitators. Despite this, little is known about who participates in ceremonial plant medicine use in Western contexts, what motivates them, what risks and benefits they perceive, and how ceremonial use relates to recreational drug use. This exploratory study aimed to describe a cohort of US-based plant medicine facilitators and to examine how they distinguish ceremonial plant medicine use from recreational drug use. Using qualitative methods, the investigators sought to identify core themes about purpose, ritual, community and perceived relationships with recreational substance use to inform a larger mixed-methods study.

The study employed a modified focused ethnographic approach based on in-depth, semi-structured interviews with people who currently facilitate and participate in plant medicine ceremonies in the United States. A convenience sample of 15 participants was recruited through key informants and snowball sampling after institutional review board approval. Inclusion criteria were being aged 18 or older, English-speaking, and actively overseeing and participating in ceremonies in the US; participants were selected for insider knowledge of plant medicine culture and protocol. Interviews were conducted between January and June 2016, lasted 60–120 minutes, and were mostly performed by telephone. Verbal informed consent was obtained to protect anonymity and demographic information was collected in broad categories (for example, decade of life rather than exact age). Audio recordings were professionally transcribed and stored securely without identifying information. The sample collectively had worked with many hundreds of plant medicine users and reported involvement ranging from a minimum of three years to over 30 years. Data analysis followed an iterative, inductive thematic process. The primary investigator coded transcripts using a codebook developed with an experienced ethnographer and used Dedoose software for data management. Codes were condensed into themes about the relationship between ceremonial plant medicine use and recreational drug use. To establish inter-coder reliability, a second investigator double-coded 25% of transcripts. Participant quotations were edited only for verbal hesitations and presented to illustrate themes.

Participants were predominantly white, middle-aged, not religious and professionally employed, with at least a Bachelor's degree (four reported Doctoral degrees). They lived and worked across major US regions. From analysis of the 15 interviews, three main themes emerged about how facilitators differentiate ceremonial plant medicine use from recreational drug use. Theme 1: Conceptual differentiation. Participants consistently described plant medicine as distinct from recreational drug use. They used a specialised vocabulary—referring to the practice as "the work" and the substances as "medicine", "sacraments" or "supplements"—and framed plant use as an intentional, sometimes difficult healing process rather than pursuit of pleasure. Ritual elements such as preparatory diets, music during ceremonies, the creation of a safe "container", presence of a facilitator, and post-ceremony integration were emphasised as central to this distinction. Trust in the substance's authenticity and the surrounding community were also noted as safety factors. At the same time, some facilitators acknowledged difficulty screening out participants whose motives might be recreational, suggesting a continuum rather than a complete separation: "I don't pretend I can always tell the difference, but I hope I can." Another participant highlighted the importance of spirituality: "The spiritual aspect of the work is where it becomes really, really important, because without that you're just chasing a high." Theme 2: Potential role in treating addiction and attendant concerns. Many participants believed plant medicine could aid recovery from tobacco, alcohol and illicit drug use, describing decreased cravings and healing of trauma that had fuelled addiction. Some offered personal accounts suggesting marked reductions in substance use after engaging in the work. Concurrently, concerns were raised that plant medicine might interfere with established recovery pathways for some individuals or that less experienced facilitators might be ill-equipped to work with people with addiction histories. A facilitator reflected on screening and qualification concerns, noting reluctance to work with certain clients despite recognising therapeutic potential. Theme 3: Influence on recreational drug use. Participants reported diverse prior histories of recreational substance use, which affected their entry into the plant medicine community. A minority had no prior exposure and described feeling that plant experiences demystified drugs for them; others feared stigma or had negative prior experiences that made them hesitant. Some facilitators observed that a subset of people "chase" journeys and may substitute ceremonies for other substance use, while most did not see substantial risk of substitution because of ritual demands (including purging) and community monitoring. One facilitator described an active role in moderating attendance: saying people must sometimes "sit this one out, and then come back."

Dorsen and colleagues interpret their findings as indicating that facilitators distinguish ceremonial plant medicine use from recreational drug use principally by purpose, ritual context, type of substances used and integration into daily life. Ceremonial use was framed as seeking a "higher purpose"—healing trauma or addressing ongoing mental health issues—rather than pursuing euphoria. These participant perspectives align with limited prior studies that characterise Western plant medicine users as predominantly middle-aged, white and highly educated, although the authors note that this contrasts with some national profiles of recreational drug users and that changing drug trends complicate such contrasts. Ritual and community were highlighted as safety-enhancing features, consistent with earlier literature on set and setting. The study also supports the idea that plant medicines may contribute to reductions in addictive behaviour via multiple pathways, including decreased cravings, trauma processing and increased community support, echoing early clinical and observational reports on substances such as psilocybin, MDMA, ibogaine and ayahuasca. Nonetheless, the investigators acknowledge unresolved questions about whether ceremonial exposure demystifies or encourages subsequent recreational drug use for some individuals, and whether use might in some cases substitute for other forms of treatment. The authors situate their results within theoretical frameworks of substance use and health behaviour, suggesting that conventional models emphasising pleasure-seeking or subcultural resistance do not fully capture plant medicine motivations. They propose that harm reduction theories, which focus on reducing risk rather than moralising use, may offer a more appropriate lens. Key limitations acknowledged include the small, non-representative convenience sample of facilitators, potential self-censorship due to legal concerns, and lack of detailed follow-up on which recreational drugs, if any, were initiated or increased after entering the community. The investigators recommend larger quantitative and theory-driven studies, as well as research on non-clinical use employing a harm reduction perspective.

The authors conclude that ceremonial plant medicine use in Western contexts is commonly defined by participants as a community- and ritual-based natural healing modality, clearly distinguished from recreational drug use by intent, practice and social supports. Their preliminary qualitative findings suggest that plant medicine communities hold strong shared beliefs about purpose and safety, and that ceremonial use may reduce some participants' use of other substances and aid recovery for some. Given the study's exploratory nature, Dorsen and colleagues call for extensive further research—larger quantitative studies, clinical trials, and investigations of non-clinical ceremonial use using a harm reduction framework—to better characterise who is using plant medicines, motivations for use, actual risks and benefits, and strategies for safer ingestion.