Ayahuasca’s entwined efficacy: an ethnographic study of ritual healing from ‘addiction’

Clinical, biomedical and ethnographic work has converged on the idea that the Amazonian brew ayahuasca may help with substance dependence and other mental-health problems, yet no randomised controlled trial has definitively established efficacy against placebo. Talin and colleagues note that biomedical approaches tend to prioritise pharmacology and neurobiological mechanisms, while anthropological studies emphasise ritual and social contexts; this creates a conceptual cleavage when trying to explain how ayahuasca-assisted interventions appear to work. This paper sets out to fill a gap by providing a sustained ethnographic, qualitative analysis of people’s experiences of recovering from problematic substance use within ritual ayahuasca settings. The authors aim to show how pharmacological effects, symbolic meanings and collective caregiving are interwoven in particular ecologies of use and care, and to question whether prevailing biomedical evaluation models are adequate to capture the efficacy of such complex interventions.

The study is a multisited ethnographic investigation combining long-term participant observation and in-depth, semi-structured narrative interviews. Fieldwork took place mainly in 2015 among Italian chapters of the Santo Daime church and among urban Brazilian neo-ayahuasca spiritual communities; these sites were chosen because ritual use of ayahuasca was not illegal there. The research formed part of a broader programme using medical-anthropological and science-and-technology-studies methods to examine lived effects and regimes of use. Data collection included participant observation of ceremonies and related communal activities, and narrative interviews with several groups of informants: seven Italian individuals who reported overcoming problematic use of substances (heroin, cocaine, crack, methadone, alcohol, tobacco and antidepressants) through ritual Daime; ritual experts and leaders; community members responsible for 'holding space' during ceremonies; and a physician and a psychologist from a public addiction centre. Interview recordings were transcribed and, as reported in the extracted text, systematically analysed alongside fieldnotes and relevant scientific and policy documents. The paper also documents the ritual context as observed: ceremonies typically occur after dark, participants wear white, newcomers are screened and asked to avoid drugs for days before participation, doses are adapted case-by-case, helpers provide non-intrusive supervision, and a trabalho (ritual work) lasts about four to six hours. The authors emphasise that their analytic orientation is ethnographic and interpretive rather than experimental, seeking to describe how care practices and ritual form shape healing processes rather than to quantify clinical effect sizes.

Talin and colleagues report that ayahuasca’s perceived efficacy in addressing problematic substance use emerges from an intimate entwinement of somatic, symbolic and collective dimensions. Across interviews and observations, participants and ritual leaders described how the brew’s bodily effects (including vomiting, nausea and other visceral sensations), evocative visions and shared ritual meanings coalesce into experiences that participants interpret as cleansing, resetting or reconfiguring their relationship to substances. Ritual structures and caregiving practices were central. The ceremonies observed combined careful screening and preparation (for example, requests to abstain from substances for days beforehand), individually adjusted dosing, and designated helpers whose role was to provide minimal but attentive support (water, a place to rest, a tissue, or a place to purge). Ritual leaders monitored the congregation and could adapt the ritual—activating specific hymns or directing people to a nearby healing room—so that the intervention was iterative and responsive rather than strictly standardised. Post-ritual communal gatherings (food, conversation) functioned as sites for integration and social support. Several interview excerpts illustrate how participants mixed biomedical and symbolic idioms when accounting for change. For example, one informant (Carlo) described an experience of reduced methadone craving after a ritual, saying the Daime made withdrawal symptoms more manageable and enabled a rapid taper. Francesco spoke of being “washed from the inside” and of cravings being cancelled, describing both bodily and spiritual transformations. Marco and Roberto narrated how ritual experiences allowed them to perceive the ‘loops’ or forces underlying their dependence and to re-evaluate attachments; Roberto subsequently relapsed but reported that the relapse felt qualitatively different and less binding than prior episodes. Purging (limpeza) was repeatedly framed as psychosomatic expulsion that collapses material and symbolic domains: vomiting and tears were interpreted as discharge of attachments, guilt or maladaptive patterns. These embodied events were often linked in participants’ accounts to neurobiological explanations (for example, references to serotonin or receptor ‘resetting’) but were given meaning through ritual scripts and communal interpretation. Finally, participants contrasted these ritual spaces with standard addiction services. Many interviewees had previously experienced outpatient clinics or residential programmes as coercive, stigmatising and focused on managing rather than transforming addiction. By contrast, belonging to a ritual community—described in kinship terms such as irmandade (brotherhood)—was reported to provide freedom, mutual labour and sustained social integration that participants considered therapeutically decisive.

The authors interpret their findings to mean that ayahuasca-assisted healing cannot be reduced to either the pharmacology of the brew or to ritual context alone; rather, efficacy is produced by their interfusion within specific ecologies of use and care. They argue that rituals circumscribe and direct the brew’s powerful somatic and symbolic effects, and that adaptive caregiving practices—screening, tailored dosing, attentive helpers, hymns and integration gatherings—play a therapeutic role that is difficult to capture with biomedical protocols that isolate substances from context. Talin and colleagues situate these ethnographic observations in relation to biomedical literature: while neuroimaging and psychometric studies point to plausible mechanisms (eg. serotonergic modulation, changes in Default Mode Network activity, increased neuroplasticity), such accounts risk overlooking how meaning-making, sociality and iterative care shape outcomes. The authors therefore call for a conceptual move beyond strict pharmacology–context dichotomies toward analyses that can account for material-semiotic efficacies. They acknowledge limits and uncertainties inherent in their study. The research is ethnographic, with a small purposive sample and multisited fieldwork focused on contexts where ritual ayahuasca use is legal or tolerated; it is not an RCT and does not attempt to measure effect sizes or causal attribution in biomedical terms. The authors warn against overgeneralising from these cases and do not claim that ayahuasca is appropriate or effective for all people with problematic substance use. In policy and research terms, they contend that current evidence hierarchies—which privilege standardised RCTs—may not readily capture the efficacy of complex, context-dependent interventions. The implication is a call to ask different questions: not simply whether psychedelic-assisted interventions work, but for whom, under which conditions, and how to render dynamic forms of care legible within evidentiary systems. They also note ethical considerations arising from the limited efficacy of existing addiction treatments and the possible responsibility to explore guided use of psychedelics within appropriate frameworks.

Talin and colleagues conclude that asking about 'ayahuasca' in isolation is misleading; instead, inquiry must focus on 'the use of ayahuasca'—how its potentials are oriented, guided and integrated by particular forms of practice. The ritual use of ayahuasca, as observed in their fieldwork, offers an alternative frame through which people can experience recovery and reconfigure the meaning of addiction. They argue that standardisation and a narrow evidentiary focus impede recognition of complex, ecologically situated interventions, and recommend shifting the debate toward identifying for whom and under what conditions psychedelic-assisted, ritualised care may be therapeutic. The authors emphasise they are not advocating universal application, but seeking to make visible an existing, practice-based modality of care that merits more nuanced forms of evaluation and policy consideration.