Therapeutic effects of ritual ayahuasca use in the treatment of substance dependence: qualitative results

Earlier research and anecdotal reports have suggested that psychedelic compounds, including ayahuasca, may have therapeutic potential for substance dependence, but legal restrictions and methodological shortcomings have limited systematic investigation. Ayahuasca is an Amazonian plant brew combining Banisteriopsis caapi (MAO-inhibiting beta-carbolines) and DMT-containing admixture plants, and it is used in indigenous, syncretic religious, neoshamanic, and psychotherapeutic contexts. While some observational work and religious-community studies report no long-term toxicity and possible reductions in other substance use among regular ritual participants, important questions remain about mechanisms of action, safety, contextual influences, and how traditional rituals translate across cultures and into structured treatment programmes. Loizaga-Velder and colleagues designed an exploratory qualitative study to broaden understanding of how ritual ayahuasca use may assist recovery from substance dependence. The paper aims to describe therapeutically relevant mechanisms from the perspectives of therapists and ritual participants, identify variables that influence outcomes, and examine risks and issues related to intercultural transfer and integration into psychotherapeutic settings. The study is presented as hypothesis-generating rather than as a clinical efficacy trial and is positioned to inform further empirical work, including the need for randomised controlled designs.

The investigators used a qualitative reconstructive approach grounded in symbolic interactionism to capture subjective perspectives and produce a multidimensional phenomenological account of ayahuasca-assisted addiction treatment. Data collection combined participative field observation, problem-centred interviews, and review of textual materials; analysis employed content analysis with conceptually structured displays and triangulation across data sources to enhance validity. The extracted text does not report specific coding procedures, software, inter-rater reliability, or an exact analytic framework beyond these general methods. Sampling was purposeful and criterion-based: the study reviewed seven therapeutic projects in South America and interviewed three stakeholder groups. Thirteen therapists who apply ayahuasca professionally were interviewed—four traditional indigenous healers from Peruvian Amazon regions and nine Western-trained mental health professionals from several countries. Two academic experts (one psychologist, one psychiatrist) were also interviewed. For the patient perspective, 14 individuals who had undergone ayahuasca-assisted therapy or ritual participation for substance dependence were interviewed; 10 had completed formal treatment and four reported recovery through ritual participation outside formal programmes. All interviewed patients had completed treatment at least two years prior or had maintained abstinence for at least two years. The authors note that unsuccessful cases were not included, largely due to limited field time. The methods emphasised triangulation of therapist statements, patient interviews, patient files, and written project material. Participant demographics and treatment contexts are described (most ritual participants were Latin American, ages 24–52, varied educational and occupational backgrounds, long histories of substance dependence averaging 14 years), but some procedural details relevant to analytic transparency (for example, saturation criteria or full interview guides) are not clearly reported in the extracted text.

Therapists and ritual participants converged in viewing ayahuasca as a valuable therapeutic tool when used in carefully structured contexts. Many interviewees reported that ayahuasca can catalyse therapeutic processes and make them shorter and more effective than conventional approaches alone. All ritual participants stated that ayahuasca involvement had been pivotal for achieving or sustaining abstinence or for shifting to less harmful patterns of use; notably, 10 of 14 participants reported abstinence at the time of interview, while three described controlled use and one described moderated use of less harmful substances. The extracted text notes that persons who did not respond positively were not included in the sample. Participants and therapists described several interrelated mechanisms. Over half of the ritual participants (9/14) reported reductions in craving after ceremonies, an effect therapists observed lasting from days to years. The study records two hypothesised explanations: psychological or spiritual processes induced by non-ordinary states of consciousness, and possible pharmacological anti-craving mechanisms (the latter flagged by some therapists and scholars as requiring further research). A minority of patients (3/14) and therapists (4/15) reported attenuation of withdrawal symptoms; one scholar suggested heavy vomiting might trigger endorphin release as a contributing mechanism. Spiritual experiences were repeatedly ascribed high therapeutic value, increasing meaning, purpose, and connection—factors aligned with spiritually oriented addiction treatments. One ritual participant summarised an effect as: "After the first ayahuasca session I was not drinking any alcohol for two weeks. It was not even on my mind." Therapists likewise emphasised ayahuasca's capacity to lower psychological defences and force confronting previously denied aspects of the self—summed in a quoted phrase, "ayahuasca is a truth medicine." Such processes were described as able to produce reframing, insights, emotional release, trauma processing, and enhanced interpersonal awareness. The study identified four key determinants of therapeutic outcome: the substance (ayahuasca composition, dose, frequency, and quality), the set (participant expectations, preparation, and readiness for non-ordinary states), the setting (quality of containment, guidance, and broader therapeutic framework), and the level of integration (the patient’s capacity and the availability of strategies to implement insights into lasting change). Additional general treatment factors noted by therapists included motivation, primary substance and severity, comorbidity, appropriateness and duration of treatment, therapist characteristics and therapeutic alliance, aftercare, and culturally sensitive interventions. Regarding safety, interviewed therapists generally regarded ayahuasca as reasonably safe in well-structured contexts but emphasised contraindications (e.g., predisposition to psychosis, gastrointestinal lesions, severe liver/kidney impairment, cardiovascular or cerebrovascular disease, uncontrolled hypertension) and adverse interactions with many pharmaceuticals and supplements. Most therapists reported no lasting undesired side-effects; however, three complications were described: two transient psychotic episodes that resolved within days (one via traditional healer, one with psychiatric medication) and a suicide occurring the day after a ceremony, which an interviewed therapist attributed to insufficient integration and outpatient support. Therapists did not consider ayahuasca to be prone to abuse or dependence in supervised settings, citing unpredictable effects and aversive emetic properties that deter recreational use. None of the ritual participants reported seeking ayahuasca for recreational purposes; experiences were characterised as difficult inner work rather than pleasurable recreation.

Loizaga-Velder and colleagues interpret their findings to indicate that, when used appropriately, ayahuasca can support recovery from substance dependence by facilitating interconnected body-oriented, psychological, and spiritual experiences that aid reframing, insight, and behavioural change. The observed reductions in craving are highlighted as therapeutically important and as a priority for future investigation. The authors also note the plausibility of pharmacological contributions—for example, preclinical data suggesting harmine may influence dopamine reuptake—while emphasising that ayahuasca should be viewed primarily as a catalyst whose therapeutic value depends on management of set, substance, setting, and integration rather than as a stand-alone pharmacological intervention. The discussion acknowledges significant risks when contraindications are ignored or when ceremonies occur in inadequate settings, including psychological complications, ritual transfer problems, ethical abuses, unsafe preparations, and economic exploitation by untrained practitioners. The authors advocate for professionalisation, regulation, and culturally sensitive adaptation when integrating indigenous and Western therapeutic approaches, suggesting mutual benefits if knowledge systems are respected and combined—for example, informing traditional practitioners about pharmacological contraindications and providing Western-style integration support to ritual participants. Key limitations are explicitly acknowledged: potential participant and researcher bias, retrospective self-report and social-expectancy effects, selective sampling that excluded treatment non-responders, limited time in the field, and the exploratory nature of the study which precludes causal or efficacy claims. The authors recommend that the question of effectiveness be addressed through randomised, controlled clinical trials combining qualitative and quantitative methods and employing larger, systematically collected samples and standardised outcome measures. They present the present study as a preliminary cartography of therapeutic effects and influencing factors from the perspectives of therapists and ritual participants, intended to inform further empirical work rather than to establish definitive clinical efficacy.

For some patients and when administered within appropriate, professionally structured settings, ayahuasca appears to be an effective therapeutic tool for treating substance dependence according to the interviewed therapists and ritual participants. These findings are preliminary; the authors state they must be verified with systematic studies involving larger samples, standardised outcome measures, and rigorous designs. They conclude that stigma should not prevent objective scientific evaluation of unconventional and psychedelic-assisted therapies as potential strategies to relieve the suffering of people with substance dependence.