Traditional Amazonian medicine in addiction treatment: Qualitative results

Substance use and addictive disorders remain difficult-to-treat contributors to global disease burden, in part because their aetiology is contested and they commonly co-occur with other disorders. Over the past decade psychedelic therapies have re-emerged as promising interventions for addictions, and parallel interest has grown around long-standing Indigenous plant-based practices such as peyote and ayahuasca. One established centre using Amazonian techniques in addiction care is the Takiwasi Centre in Peru, which integrates Peruvian vegetalismo (a shamanic healing tradition), Christian elements, psychotherapeutic work, community living, occupational therapy, and intermittent biomedical evaluation. Treatment at Takiwasi is prolonged (ideal duration around nine months) and staged, with purgative plant remedies used during early detoxification, followed later by ayahuasca sessions and dietary retreats (dietas) intended to address physical, psycho-emotional, and spiritual domains. O'Shaughnessy and colleagues set out to provide qualitative context for within-treatment patient experiences at Takiwasi, complementing previously published within-treatment quantitative findings from the same programme. Rather than offering a full ethnography, the study aimed to capture which elements of the integrated Amazonian treatment were most salient to inpatients and how they reported therapeutic change or difficulty while resident at the centre. The authors therefore focused on patients' accounts of ayahuasca sessions, purges and diets, and broader changes in behaviour, emotion and social functioning during their stay.

The study received ethical approval from the James Cook University Human Research Ethics Committee (H5267) and all participants provided written informed consent. The qualitative component formed part of a larger biopsychosocial investigation of Takiwasi, designed to triangulate biological, psychometric and qualitative data collected concurrently with the centre's within-treatment quantitative measures. Data were collected through open-ended, exploratory interviews conducted in private at Takiwasi between 2014–2015 by the first author, O'Shaughnessy. Interviews were audio-recorded, transcribed by the first author, and Spanish-language transcripts were translated into English by the same researcher. Participants were prompted to describe their life prior to admission and, importantly for this paper, to describe what had transpired since arrival; the present analysis focuses on responses to the latter. The sample comprised nine male inpatients (labelled P1–P9) with a mean age of 28 years (SD = 6). Five participants were South American, three European and one North American. On average participants spent 275 days in treatment (SD = 93). The authors compared intake Addiction Severity Index (ASI) scores for eight of the nine qualitative participants with the remaining Takiwasi sample (n = 27) and reported broadly comparable addiction severity across most domains, with the qualitative subsample having fewer alcohol and employment problems; the alcohol score difference was statistically significant (t(30.2) = -2.61, p = 0.014, Hedges' g = -0.66; the extracted text does not clearly report the full 95% CI). Analytically, the first author conducted a thematic analysis using a realist approach, treating participant reports as straightforward accounts of lived experience rather than pursuing latent sociocultural constructs. Coding combined partially theoretical (technique-specific) and inductive elements, and was managed with MAXQDA. The authors note that the analysis was not intended to be an exhaustive thematic account of the whole treatment, but a focused exploration of the aspects patients found most salient.

Several recurring themes emerged from the interviews, beginning with the daily communal living environment. Patients lived in dormitories separated from the centre's main building, participated in early-morning work tasks (baking, food preparation, animal care), and attended therapies, workshops and optional religious services. Although patients often described the environment as high-pressure, physically austere and sometimes stressful, many also valued the intense social exposure as therapeutic—contributing to mutual support, frank disclosure in group therapy, and the formation of strong bonds. Experiences with Amazonian medical techniques were prominent. Ayahuasca sessions were central but not immediate: new patients first underwent a detoxification phase involving purgative plants before being permitted ayahuasca. Several participants described ayahuasca sessions as powerful catalysts for insight and emotional change, sometimes prompting them to remain in treatment rather than exit early. One participant characterised taking ayahuasca as "to go through the storm," noting that sessions could be physically unpleasant (vomiting, hours of pain) yet produce deep, non‑rational insight. Session intensity varied by occasion, with some sessions described as uneventful and others highly visionary. Plant purges (purgas) were used regularly prior to ayahuasca and were described as physically demanding but therapeutically meaningful. Purgahuasca (a large-dose Banisteriopsis caapi decoction) and other purgative plants could induce prolonged vomiting and, in some cases, visionary effects despite lacking DMT. Multiple participants reported a felt sense of bodily cleansing after purges and described purging as reducing withdrawal/craving and preparing the body and psyche for ayahuasca work; one participant stated that purges were the most effective part of treatment for him. Dietary retreats (dietas) involved seclusion in small jungle huts with strict behavioural, alimentary and social restrictions alongside plant preparations. Diets were portrayed as crucial integration points, provoking vivid dreams, memory retrieval and introspection. Several participants credited dietas with surfacing childhood material and facilitating decision-making and consolidation of therapeutic gains. Across techniques, many patients reported within-treatment changes they associated with Takiwasi: reduced drug use or altered responses to depressive states, improved emotional regulation, enhanced interpersonal relationships (including with children), and healthier lifestyles such as better diet and exercise. These changes were attributed variably to ayahuasca, purges, diets, therapy, convivencia (communal living) or the integrated whole; some patients emphasised ayahuasca's capacity to reveal inner material, whereas others later considered convivencia and therapy to be the most important elements. Not all participants experienced noticeable benefit: at least one patient reported minimal personal change despite observing transformations in fellow residents. The extracted text does not provide quantitative follow-up outcomes post-discharge, so links to longer-term effectiveness remain unreported here.

The authors interpret the interviews as providing preliminary contextual evidence that Takiwasi patients experience meaningful therapeutic effects during residency, while emphasising the limits of causal inference in observational work. Patient accounts did not single out ayahuasca as a universal or sole agent of change; instead, ayahuasca sessions, purges and dietas were described as complementary components within an integrated treatment system. Purges were framed as preparatory cleanses facilitating deeper ayahuasca work, ayahuasca as a source of emotional and non‑rational insight, and diets as consolidation and integration periods that generated new therapeutic material. The study team highlights heterogeneity in patient responses: some reported substantial personal and interpersonal change, others only modest or no change. This variability suggests the modality may suit particular profiles better (the authors note tentative suggestions that those with greater addiction severity or prior failed treatments might benefit, but acknowledge this is unclear). Treatment dropout predictors such as age, nationality and student status are noted as preliminary and in need of investigation with larger samples. Key limitations are acknowledged: the qualitative sample was small (N = 9), all male, and biased toward long‑stay patients (mean 275 days), which likely over-represents those who perceived benefit. The authors therefore caution against generalising these within-treatment experiences to all attendees, particularly early dropouts. They call for longitudinal research that tracks primary outcomes after discharge, and for further ethnographic and qualitative work to understand how ayahuasca and other Amazonian practices operate across therapeutic contexts. Finally, O'Shaughnessy and colleagues warn against reducing Amazonian medicine to ayahuasca alone, arguing that doing so neglects the wider social, ritual and semiotic dimensions that likely influence outcomes and that the rich diversity of traditional practices merits study in its own right.