This open-ended interview study was followed by thematic analysis to assess the perspective of patients (n=9) who underwent treatment with ayahuasca in the Takiwasi Center (rehabilitation centre). While the therapeutic effects are supported, the complexities are also discussed.
Traditional Amazonian medicine, and in particular the psychoactive substance ayahuasca, has generated significant research interest along with the recent revival of psychedelic medicine. Previously we published within-treatment quantitative results from a residential addiction treatment centre that predominately employs Peruvian traditional Amazonian medicine, and here we follow up that work with a qualitative study of within-treatment patient experiences. Open-ended interviews with 9 inpatients were conducted from 2014 to 2015, and later analysed using thematic analysis. Our findings support the possibility of therapeutic effects from Amazonian medicine, but also highlight the complexity of Amazonian medical practices, suggesting that the richness of such traditions should not be reduced to the use of ayahuasca only.
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.
Papers cited by this study that are also in Blossom
Argento, E., Capler, R., Thomas, G. et al. · Drug and Alcohol Review (2019)
Bogenschutz, M. P., Forcehimes, A. A., Pommy, J. A. et al. · Journal of Psychopharmacology (2015)
Carhart-Harris, R. L., Giribaldi, B., Watts, R. et al. · New England Journal of Medicine (2021)
Chi, T., Gold, J. A. · Journal of the Neurological Sciences (2020)
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.
Substance abuse and other addictive disorders are ongoing social problems that account for a substantial portion of global disease burden. Addictive disorders are often challenging to treat, firstly because there is a lack of theoretical consensus over their origins (e.g., are they best understood as fundamentally biological or socio-cultural phenomena?; and secondly because they co-occur with other types of disorders at unusually high rates. For these reasons, highly effective and broad spectrum treatments are still sought after. In this regard psychedelic therapies have shown particular promise, and over the past decade impressive evidence has emerged for the utility of psychedelics in treating addictionsand other disorders. However, pharmacologically similar natural psychoactive substances have been recognized for thousands of years, and such plant-based preparations developed in Indigenous contexts have also shown promise in treating addictions; including for example the peyote cactus in North Americaand more recently, the potent South American ayahuasca decoction. Although addiction treatment using ayahuasca is a new concept from a Western clinical perspective, when considered internationally there are in fact already active treatment centres making use of ayahuasca. One such institution is the Takiwasi Centre (Centro Takiwasi), a therapeutic community in Peru where a variety of Amazonian and Western techniques are applied in treating addictions (for around 15 inpatients concurrently;. The centre applies Amazonian medicine largely based in Peruvian traditions, which includes the use of ayahuasca as a central element, but also other techniques such as dietary retreatsJ o u r n a l P r e -p r o o f 2017;and the use of purgative plants. In addition to the ritualized use of psychoactive and purgative plant preparations, individual and group psychotherapy is practised, as well as community living (known in Takiwasi as convivencia, or "coexistence"), daily occupational therapy, a variety of workshops, and intermittent biomedical evaluation. Treatment in the centre is a lengthy process, with the ideal treatment time being around 9 months (for a basic timeline, see. During this time, patients undergo a process that aims to work initially at a physical level (e.g., through the use of the various purgative plant remedies), but then develops to address psycho-emotional and spiritual elements. Addiction is viewed in the centre from a biopsychosocial-spiritual perspective, and the spiritual component is informed by both Amerindian (Viveiros deand Christian ontological and epistemological concepts (including notions of good and evil spiritual entities that can impact human health). Such elements are traditionally characteristic of Peruvian vegetalismo)-a shamanic healing modality which is predicated on the existence of a sentient plant and spiritual world which expert practitioners engage with, often incorporating Christian elements and symbolism in idiosyncratic ways. In recent decades, international interest has impacted Peruvian vegetalismo, altering traditions both in Amazonia and in adaptations overseas. Preliminary quantitative results regarding the centre's therapeutic process have been positive, although these results leave open questions regarding the patients' experience of treatment, particularly so in the case of Takiwasi where a variety of techniques beyond ayahuasca alone are employed. Qualitative work can be helpful in revealing how patients understand their experiences of illness, treatment, and healing with psychoactive substances, as it has been in other contexts of addiction treatment with J o u r n a l P r e -p r o o f both ayahuascaand psilocybin. Indeed, participants' lived experiences in these treatment modalities appear to be central to therapeutic outcomes (e.g., being modified via set and setting;, even though there are likely also pharmacological actions which support the process irrespective of context and subjective effects. In this paper we present a selection of qualitative results drawn from interviews with Takiwasi inpatients, conducted while they were residents at the centre and undergoing treatment for addiction. These qualitative results act as a companion to our recently published quantitative analyses, giving a more contextualized understanding of the Takiwasi treatment, while also allowing patients to describe the treatment in their own words. We do not aim here to provide a complete account of the treatment, but instead focus on the aspects that were most relevant for the patients, with the finding that the traditional Amazonian techniques (i.e., ayahuasca sessions, purges, and diets) were particularly salient. We describe instances of patient reported therapeutic change, but also the potentially stressful and difficult nature of the treatment, which supports the inference of within-treatment therapeutic effects that we reported previously.
The study was approved by the James Cook University Human Research Ethics Committee (H5267). All participants gave written informed consent prior to participation.
The qualitative results reported in this paper were part of a larger biopsychosocial study of the treatment programs at the Takiwasi Centre (O'Shaughnessy, 2017), and interviews were conducted at the same time as the collection of quantitative psychological data. The biopsychosocial design aimed to J o u r n a l P r e -p r o o f combine quantitative (biological and psychometric) and qualitativemethods in order to "triangulate", or converge on a better understanding of the treatment and its effects. Thus the qualitative findings presented here are set in the context of the observational within-treatment changes that we previously reported, with clinically positive changes being found across a range of measures including: health (physical and emotional), spiritual well-being, perceived stress, mental health, craving, and neuropsychological performance.
The interviews with patients were open-ended and exploratory, but guided by two broad requests: (a) to describe their prior life situation and reasons for coming toto describe what had transpired for them since arriving. Here we focus only on answers given in part (b) of the interview. Patients could answer in whatever detail they felt comfortable with, and the loosely structured format allowed them to focus on the aspects of the treatment most salient to them. The interviews were conducted by the first author in private at Takiwasi between 2014-2015, and were audio recorded and later transcribed (first author). Transcripts for those interviews that were conducted in Spanish were then translated to English, again by the first author.
The first author conducted a thematic analysis) using a realist approach where patient reports were taken as relatively straightforward reflections of their lived experiences (as opposed to a more constructivist approach that might seek instead to discover latent themes derived from the sociocultural context). The extraction of themes was partially theoretical (i.e., when coding based on reports with specific treatment techniques, such as the use of ayahuasca), and partially inductive (e.g., when analysing reports not related to specific treatment techniques), but ultimately fell closer to a positivist approach. Coding was applied using MAXQDA. The results reported here are not an J o u r n a l P r e -p r o o f attempt at an exhaustive thematic analysis or an entire treatment description, and for a fuller ethnographic account of the treatment, see.
The qualitative data sample consisted of 9 male inpatients (designated P1-P9) with a mean age of 28 years (SD = 6 years). Five of these patients were South American (56%), 3 were European (33%), 1 was North American (11%), and on average they spent 275 days in treatment (SD = 93 days). To compare the qualitative sample with the broader sample it was drawn from, we contrasted intake Addiction Severity Index (ASI;scores for the qualitative sample (N = 8) 1 versus the rest of the Takiwasi sample (n = 27). 2 Figureshows that the qualitative sample had an intake addiction severity that was comparable with the larger sample on most dimensions, although with fewer alcohol and employment problems. However, only the alcohol scores were significantly different by t test, t(30.2) = -2.61, p = 0.014, Hedges' g = -0.66, 95% CI for g.
An important issue regarding therapeutic communities is the extent to which characteristics of the living environment account for any within-treatment changes in a transient way. Thus one notable theme from the interviews was the potentially stressful nature of the treatment environment, which is situated within a large grounds in the tropical climate of Tarapoto, Peru: P1: In a place where you live with fifteen people, it's high pressure. You have nowhere else to go. You can't go out, and you don't even have cigarettes. The only thing you can do is talk to your therapist, and that forces you to go into yourself and see what's really going on. 1 ASI data were unavailable for one patient. 2 ASI data for one patient in the qualitative sample was not reported in O'.
Patients in the centre live in a dorm area separated from the centre's main building (where many of the therapeutic and administrative staff are based), and they rise early every morning to begin their day by completing work activities such as baking bread, preparing food (which is generally of a simple nature due to the dietary restrictions imposed for therapeutic plant work), cleaning, and caring for animals. Later on in the day there will be workshops, a variety of group and individual therapy sessions, sports, and an optional Catholic mass which some patients attend regularly. These events will sometimes be punctuated by plant purges, preparations for ayahuasca sessions in the evening, and so on. Given that the Amazonian treatment techniques are often physically and emotionally taxing, the reductions in perceived stress over time that were reported in O'Shaughnessy et al. () are unlikely to be due to an especially easy life for patients at the centre, and are more likely to be the result of adaptation to the treatment environment combined with any therapeutic effects: P6: Well, the bed is not the best bed, and it's not the best breakfast, and you have to wake up early, and you have to work a lot. You also can't choose the people you live with: When I first got here I saw people as crazy as me, or worse! I thought, "Wow, we're all like sick brothers here". Now it's become familiar to me and I feel a kind of friendship with everybody, or with most. While the daily communal living environment was often described by patients as difficult and frustrating to varying degrees, it was also valued as a useful part of the therapeutic structure: P9: It's like constantly living with a mirror, which is kind of hard. At the same time, living with those same people all the time creates a very strong bond. And that bond is there with the group therapy too. People really tell what is in their guts. Like, they talk about their suicide attempts, the abuse story they have, the shit they did when they were doing drugs. So you know J o u r n a l P r e -p r o o f them almost from the deepest part of the soul. You actually receive a lot of support from them also. They're a good influence, that's what I want to say.
There are many facets to the Takiwasi treatment, and one consequence of our interview style was to allow participants to focus on those experiences that were the most personally impactful or memorable. Despite the prior expectation that ayahuasca experiences would be the dominant treatment theme, there was also significant participant discussion around other Amazonian techniques, in particular the plant purges and diets. Below we discuss patient experiences with each of these techniques, noting that the selection of these particular methods also accords with practitioner views on the most important Amazonian techniques used in Takiwasi.
Ayahuasca sessions play a central role in the treatment. However, in Takiwasi new patients are not able to drink ayahuasca immediately upon admission, as they must first pass through a detoxification period (lasting a number of weeks) during which they will take other purgative plants. This difficult period probably leads to an early increase in voluntary treatment exits, although the initiation of ayahuasca sessions can have a profound impact, as in the case of P9 who below discusses why he decided to abandon his plans to exit the treatment early: P9: I just realized that the treatment was working. Like a lot more than I could have expected. It happened after my two first ayahuasca sessions; they had a really, really strong effect. I'm not talking about during the session, but after. It's like bread, you roll up the dough, but the bread rises alone. It was like that. The ayahuasca rolls you up during the session, and then you start to rise. Those plants make you realize stuff. I don't know if you can really cure yourself from an addiction, but you can understand why you did it, and why you don't want to do it anymore.
What was crazy though was I could see the change. Often you change but you don't notice it-here I could see it. So I was like, yes, it's worth it. The same participant though was careful to point out that these ayahuasca sessions were not enjoyable experiences: P9: They say here that to take ayahuasca is to go through the storm. I had two sessions where I felt pain for hours. I mean it's also a process where you have to vomit to cure yourself. So no, it's not something pleasant. I have to say that, because I think it's important. But ayahuasca helps-it's like a microscope-it focuses on what you have inside you. Ayahuasca sessions can be highly unpredictable however, as there are also sessions where very little takes place from the patient's perspective. P1's first session for instance was completely uneventful, yet it was in stark contrast to his second session which began with classic visions of colourful geometric patternsThis attitude is probably related to the long-term nature of the treatment, as evidenced in the case of P3, whose feelings about the most important part of the treatment changed over time. Initially considering ayahuasca to be the most useful component, he later decided that living together with the other patients in conjunction with therapy was most important: P3: Early on I might have said the ayahuasca [was the most helpful], but if I had to say now, it would be the convivencia. My core problem has been a social phobia, so the therapy and the convivencia has helped me a great deal.We all have to get up in the morning with a lot of strength and fight every day. It's not easy, and the healing is not magic. It's not a "session of ayahuasca and then you're cured". No, this doesn't exist.
Prior to being permitted to drink ayahuasca, Takiwasi patients engage in regular purges (purgas) where they consume a purgative plant preparation along with large amounts of water, which induces emesis: P1: When I arrived here, I was very sceptical. Lots of mosquitoes were biting me, and then they gave me the purge. The first one was saúco, and I'd never done that in my life-drink a plant, drink water, and then vomit. Drink water and vomit again. I was looking outside and seeing all this green [jungle plants], and I said, "Man, where have I ended up?". The use of purgative plants as a medical practice has been described for a number of Peruvian Indigenous peoples (see, and among the Matsigenka the ayahuasca vine
Banisteriopsis caapi is known as kamarampi-or "vomiting medicine". Indeed, from time to time in Takiwasi, decoctions of B. caapi are used in purging rituals. This material is known in the centre as "purgahuasca", and it is taken in much larger quantitiescompared to ayahuasca (which contains N,N -dimethyltryptamine; DMT). According to the centre's records, around half of the patients that take purgahuasca experience some form of visionary effect, despite the absence of DMT. As in other Peruvian contexts, purging in Takiwasi is seen to cleanse or purify the body, ridding one of accumulated burdens in a physiological but also spiritual sense. Practitioners in Takiwasi believe that such purgative preparations, while having general health benefits which vary by plant, are also useful for addressing issues arising from substance abuse (such as craving). With certain plants these purges can take on an extreme nature (especially with a plant known locally as yawar panga), although paradoxically the process can be subsequently valued by patients: P4: The first one [yawar panga] just knocked me out. I puked quite a lot during the purge, and after that I could chill in bed a bit. Then the therapist came to give me cinnamon tea. One sip completely destroyed me-I puked and went to the bathroom for four hours and I couldn't stop. I wanted to die, it was horrible, horrible. You get up and you puke bile. Yeah, it was really a tough one. But also, it's the most efficient one. And that's the good point. I can say that the second and third times I had yawar panga I was much, much mellower, much better. P1: But when I purged the yawar panga, I nearly died. After vomiting all the water in the session, I went to isolation and kept vomiting from six until two in the morning. And these eight hours, it was just bile. I couldn't speak the next day because my throat was burnt. But I'd never felt so good, I felt like my blood and my body were somehow cleaned. And then with the purges, I started to shake off all the abstinence feelings.
The concept of the body being "cleaned" through purging was referenced by multiple patients. P2, who actually found the purges to be the most effective part of the treatment, also extended this logic to the ayahuasca sessions: P2: [The purges] were very effective. I think the purge was actually the main part of the treatment for me. Int: More so than the ayahuasca sessions? P2: Yes, but I see the ayahuasca like a purge as well because it cleaned out my body-which was very, very dirty-and it just felt so good to throw that out. Purges are seen in Takiwasi as essential preparation for future sessions with ayahuasca, and thus they work together in a complementary manner. Indeed, the aspect of purging-effected through physical expulsions but often co-occurring with psychological "purging" (e.g., catharsis or abreaction)-runs as a theme across many of the Amazonian plant-based techniques employed in Takiwasi (e.g., see also. P3: For me Takiwasi has been like a laboratory, but one where I am obliged to study myself. And this aspect has permitted me to analyse my problems. It's given me a magnifying glass. To look at what's happening to me. To feel. To see what's happening physically, emotionally, energetically, and spiritually. These are the four areas that I've been able to analyse. To analyse my problems and then search for tools to alleviate them. Some activities help me to feel calmer; reading, meditating, going to church, these sorts of things. But they are not my cure. Where is the cure for me? It's in speaking it. In remembering it and retelling it. In vomiting it, in dieting it, in purging it.
Plant diets (dietas) are a distinctly Peruvian Amazonian medical practicein which the dieter combines J o u r n a l P r e -p r o o f behavioural, alimentary, and social restrictions along with the intake of specially prepared plant substances over a lengthy period of time (usually with the oversight of a traditional healer). In traditional use these diets are complex and multi-purposed (e.g., including the learning of medicine itself;, but for the patients in Takiwasi they function overall as milestones where therapeutic material and prior treatment experiences can be integrated. There are a variety of plants used for different purposes, depending on the patient: P1: Some of the dieta plants are psychoactive, others not, but somehow, they work. Physically and psychologically. You have the most vivid dreams ever on the dieta, you digest information there and you make decisions. You also see the therapist three times a week. The dieta is like a pillar where you consolidate that stage of your treatment. I see that as crucial. In Takiwasi, diets take place in a secluded area of jungle land away from the main centre (the chacra). Each patient is isolated to a small hut (tambo) and they are visited on a regular basis by a traditional healer who brings very basic food and medicinal plant preparations, and a psychotherapist with whom they discuss their experiences. Very little activity is actually carried out by the patient, and the combination of social isolation in the jungle, reduced food intake, consumption of traditional plant preparations, and general lack of access to recreational activities tends to provoke introspection and a range of emotional responses, and patients sometimes recounted vivid dreams which had deep personal and therapeutic significance: P6: For me the dietas are the best part of the treatment. Some of the plants are for fears, some for grounding your thoughts, with others you have dreams or memories about things that happened in the past which are at the root of your problem. That can be difficult because you might receive some information that is very distressing for you. But it's not a miracle plant. I think that you have to want to work and cure yourself with all your energy and passion.
In general, patients spoke highly about the diets, particularly for their capacity to recover forgotten aspects of the self and one's personal history, and the possibility to have that information integrated more thoroughly: P7: Ayahuasca, purgahuasca, even the purges, they help you in a more ethereal kind of way. But dietas help you ground yourself actually. I think the best thing that happened to me here was the dietas. They gave me a chance to explore myself. You know, the few things that I managed to open up from my childhood didn't come from the ayahuasca-they came from the dietas.
One broad theme that was salient in the data was within-treatment change. Although the changes discussed under this theme can generally be classed as therapeutically positive, there is still a lack of longitudinal outcome data for Takiwasi patients, making it difficult to link these results to post-treatment effectiveness. Regardless, the patients interviewed tended to describe personal and interpersonal changes that they attributed to the treatment. In some cases this related specifically to drug use and an altered perspective on their life prior to treatment: P6: I think I'm strong now. I've really had an intense experience with plants, and I'm prepared to do difficult things. For example, I finished the first ayahuasca session on the floor, like, "Please, kill me!". Now I'm prepared to pass through bad moments. I know that I will never fully lose the depression in my life, but I'm not going to start taking drugs or going to bed when I feel down. Int: Whereas before it overwhelmed you? P6: It's like a tendency in my family. But you have to draw a line. Before I came to Takiwasi, when I got down, I went straight down. Now that's more gradual.
Int: And you used to drink when that happened? P6: Yeah, drinking or snorting cocaine. I wanted to escape from my reality. I would say now that I was very immature. I lived my life as a kid, like Peter Pan. I didn't like my life, so I created an artificial reality. OK, I went to work, but when I got home I was taking drugs. I wanted to go to nightclubs and parties and take ecstasy all the time, 24 hours. And what was I doing with my life? I never asked myself that. Similarly, P1 described a new perspective on his pre-treatment life situation, referencing his past tendency to combine illicit drug use with pornography, and its negative impact on his family and social life: P1: I couldn't express myself, I was in a deep depression, and the drug was really a world that I was ashamed of. I was a husband at that time, I'm still a father, and it's hard for a father to be eight hours masturbating himself on the computer, and then not being able to go to work, and feeling jealous of the other guys that play with their kids because you're not able to. I really wanted get away from my life, of what I was feeling. That's how I was. When I first came to Takiwasi, I didn't know what I wanted in life, why I was on earth. I didn't know if I liked red or blue or white or black, I didn't know anything. I was just a piece of functioning brain and I couldn't think, actually. I was just existing. I didn't have any meaning, and now I do. I wasn't friendly at all before, I was just a guy that was like, fighting and arguing with everyone. And this consciousness and patience and understanding, it's just something that changed my life I think. One thing that's very special to me is my kids. When I was on drugs they were a problem, as everything in my life was. But I don't see now as I used to. While P6 did not attribute these changes only to the use of ayahuasca, he did feel that it was vital to his process, particularly focusing on its ability to induce change at a deeply emotional and non-rational level: J o u r n a l P r e -p r o o f P1: I think I wouldn't be able to do that without ayahuasca. Because it showed me things inside that I didn't know about. I think I could do therapy for ten years and not be aware of the things that one ayahuasca session showed me. You can see things as they are, the raw things as they are. It's difficult to explain because the experience is, intrinsic, it stays in you. It's not intellectual. Like, you couldn't explain it in a paper, because it comes with a feeling! So that is a whole feeling experienced, and you don't have a different attitude because your intellect says so-you feel that the attitude has changed inside. It's something that comes from the heart, not from the mind. It's different. There were also patient reports of changes that did not relate specifically to drug use, but concerned positive changes in behavioural self-regulation, or emotional and interpersonal well-being: P9: I used to eat a lot of fast food. Or like a bowl of rice with an egg-took me two minutes to do it. When I came back from the dieta, I changed my relationship with food. Before I was eating because my body was forcing me to. After the dieta, I eat because it's caring for my body and giving me energy. Caring for my body is caring for my life. It went little by little. Doing sport, eating better. I realized that kind of stuff here in Takiwasi. P6: Now here in Takiwasi I'm starting to learn how to do it, or to say, "You can be loved. You can receive love". Why not? Because all my life I thought that I didn't deserve love, from anybody, including myself. And that creates a lot of suffering. But I'm changing it. I recognize that I had problems with drugs, but I had problems that were there before that too, and here I'm working on those kinds of problems without pills or antidepressants. Despite these self-reported changes for patients, there was one patient who noticed significant change in others, but experienced minimal treatment effects for himself, even though he did stay in treatment for an extended amount of time: J o u r n a l P r e -p r o o f P8: You see [P9], he came here very skinny, always crying because people are not fair; he was very much a child. But he left the treatment like a man, with a good body. For me I don't see a difference. Physically, I'm the same. People who come here, like [P9], their face takes on maturity-but I have the same face. I look at my photo from the beginning, and I'm the same. Int: And you feel the same? P8: Yeah. I feel a little better, but not too much. For me the treatment is not some, "Wow, big thing". No, it's like, the same thing.The plants didn't have a big effect, like I say. I feel more sensitive with sounds, with smell, some stuff like that, the five senses. But I don't feel a lot of change. Echoing this statement was P9, who noted that some patients had not seemed to change or benefit from the treatment, asserting that they were "the same guys" from entry through to treatment exit.
Multiple quantitative studies of the Takiwasi addiction treatment programme have suggested within-treatment therapeutic effects, but there has been a lack of published work providing context for the experiences of inpatients going through the treatment. This seems especially important in the case of Takiwasi, as the treatment is lengthy and involves a complicated application of Amazonian (and other) techniques. The qualitative accounts that we provide here offer some preliminary contextual data for understanding how the treatment may unfold for inpatients. Although observational quantitative studies strictly rule out the attribution of causality, the qualitative data that we present here do describe a treatment context with therapeutic effects, at least as seen from the perspectives of patients. Similar to the views of the healers at the centre, there was no consensus among J o u r n a l P r e -p r o o f our participants regarding the most important or impactful part of the treatment-at different turns patients found ayahuasca sessions (in conjunction with therapy), plant purges, and dietary retreats to be helpful in their therapeutic process. Indeed, these are three major Amazonian components used in Takiwasi, and the variety of patient views regarding their value accords with practice in the centre, where components are understood as operating within an integrated whole. For example, purges are seen to clean and prepare the body in a way that is useful for those suffering from addictions, but they are also meant to allow for more profound work with ayahuasca, which in turn provides richer material for therapy-the outcomes of which likely impact on the content of subsequent ayahuasca sessions. Diets, the first of which do not occur for a number of months for new patients, act as integration points, but also function to generate new material which feeds back into the entire therapeutic process after the diet is completed. However, it is notable that not every long-term patient reported benefits or positive change from this integrated process, and thus the treatment modality may be more suitable for certain patient profiles. It is unclear how exactly these might be defined, but there is some suggestion that the treatment may be more applicable for those with greater addiction severity and a history of failed treatment attempts. In terms of treatment dropout, preliminary analyses have suggested age, nationality, and student statusas potential predictors, but analyses using larger samples as well as qualitative work would be helpful in that regard. Furthermore, longitudinal research is needed on outcomes for patients, particularly in terms of primary outcomes and treatment effectiveness once they leave the centre and return to independent living (for an example of such an approach, see. One limitation of the present study is the narrowness of the qualitative sample, which is small and moreover consists of patients who persevered with the treatment (on average staying 275 days). Our sample is thus largely biased towards those who felt they were gaining some benefit from the treatment, and who had consistently made the J o u r n a l P r e -p r o o f decision to stay. Thus it is important to note that the experiences of patients who leave earlier in the treatment may be quite different. When considered alongside the available quantitative observational data, the presentation of patient experiences at Takiwasi strengthens the case for Amazonian medicine as a viable treatment option for substance abuse, at least for certain patients. Yet despite the existence of a growing body of literature pointing to ayahuasca as a therapeutic tool applicable to substance abuse disorders and beyond, in Takiwasi it is difficult to attribute therapeutic effects to ayahuasca alone, given the complex and idiosyncratic nature of the treatment. Patients themselves often expressed scepticism that ayahuasca would act as a panacea for their problems, seeing it instead as a useful component of the treatment overall. Within the frame of Amazonian medicine more broadly, the patients' scepticism of ayahuasca as panacea stands in contrast with the fact that ayahuasca has by far captured the most scientific and public attention. Much of this attention has revolved around therapeutic potentials, yet in the realm of medicine, the translation of ayahuasca into a context-independent therapeutic object serves to not only reduce and simplify rich Amazonian traditions, but moreover obscures the traditionally ambiguous nature of South American shamanism, and the importance of the social and the semiotic in determining outcomes with psychedelic substances more generally. Ethnographic and qualitative work will be necessary for better understanding the implications of ayahuasca use across various therapeutic contexts, although the study of Takiwasi also suggests that focusing on ayahuasca alone would likely impede a fuller appreciation of the scope and possibilities inherent in Amazonian medicine and its diverse forms. J o u r n a l P r e -p r o o f Long-term addiction patients at the Takiwasi Center reported therapeutic effects. Patients found particular benefit in the traditional Amazonian techniques. Salient techniques included plant purges, ayahuasca sessions, and dietary retreats. Similar regimes may be effective for those with a history of failed treatment. The scope of traditional Amazonian medicine is larger than ayahuasca/psychoactives. J o u r n a l P r e -p r o o f
Create a free account to open full-text PDFs.
de Veen, B. T. H., Schellekens, A., Verheij, M. M. et al. · Expert Review of Neurotherapeutics (2016)
Dos Santos, R. G., Osório, F. L., Crippa, J. A. et al. · Therapeutic Advances in Psychopharmacology (2016)
Hartogsohn, I. · Drug Science Policy and Law (2017)
Hesselgrave, N., Troppoli, T. A., Wulff, A. B. et al. · PNAS (2021)
Johnson, M. W., Garcia-Romeu, A., Griffiths, R. R. · The American Journal of Drug and Alcohol Abuse (2016)
Earp, B. D., Repantis, D., Langlitz, N. et al. · Frontiers in Psychiatry (2021)
Liester, M. B., Prickett, J. I. · Journal of Psychoactive Drugs (2012)
Loizaga-Velder, A., Verres, R. · Journal of Psychoactive Drugs (2014)
Mitchell, J., Bogenschutz, M. P., Lilienstein, A. et al. · Nature Medicine (2021)
Noorani, T., Garcia-Romeu, A., Swift, T. C. et al. · Journal of Psychopharmacology (2018)
Olson, D. E. · ACS Pharmacology and Translational Science (2020)
Olson, J. A., Suissa-Rocheleau, L., Lifshitz, M. et al. · Psychopharmacology (2020)
O'shaughnessy, D. M., Berlowitz, I., Rodd, R. et al. · Therapeutic Advances in Psychopharmacology (2021)
Perkins, D., Schubert, V., Simonová, H. et al. · Frontiers in Pharmacology (2021)
Rodrigues, L. S., Rossi, G. N., Rocha, J. M. et al. · European Archives of Psychiatry and Clinical Neuroscience (2021)
Ross, S., Bossis, A. P., Guss, J. et al. · Journal of Psychopharmacology (2016)
Rush, B., Marcus, O., García, S. et al. · Frontiers in Pharmacology (2021)
Strickland, J. C., Garcia-Romeu, A., Johnson, M. W. · ACS Pharmacology and Translational Science (2020)
Talin, P., Sanabria, E. · International Journal of Drug Policy (2017)
Thomas, G., Lucas, P., Rielle Capler, N. et al. · Current Drug Abuse Reviews (2013)