Abstract

In South America, indigenous people have used ayahuasca, a hallucinogenic tea, for thousands of years. For indigenous users, the tea has significant religious and medicinal benefits that are heavily related to the ritual aspects of consuming the tea itself. Recently, the increase in non-indigenous ayahuasca use has raised the question of how important the traditional context  of ayahuasca use is to its ability to provide benefits to users. This review article seeks to analyze the benefits of a ritual context in the use of ayahuasca to treat psychological disorders and spiritual deficits. Overall, the ritual context provides a controlled, supportive, and safe environment for Western users to engage in reflective emotional work that is often difficult. 

Introduction

Ayahuasca is a hallucinogenic tea used by indigenous peoples in South America, particularly Amazonia, for religious and medicinal purposes. The psychoactive tea is made primarily by boiling a combination of two different plant sources: the woody vine, Banisteriopsis caapi, and the leaves of Psychotria viridis (Riba et al., 2004). The traditional use of substances like ayahuasca dates as far back as 900 B.C. in artwork and paraphernalia from the Chavin people of Peru, who frequently depicted shamans using psychoactive plants (Sayin, 2014). While the use of ayahuasca by shamans continues in many South American countries, such as Columbia, Ecuador, and Peru, non-traditional use, or the use of ayahuasca by non-indigenous groups, continues to increase in Western countries (Sayin, 2014). Non-traditional use of ayahuasca is also increasing in South American countries through entheogen tourism, in which tourists travel to foreign countries to use psychoactive substances in religious or spiritual contexts (Davidov, 2010). However, some tourists, who are primarily driven by curiosity or a desire for adventure, travel to South America to simply use ayahuasca with little interest in the religious or cultural aspects of the hallucinogenic tea (Kavenska and Simmonva, 2015; Winkelman, 2005). As the use of ayahuasca continues to increase among non-indigenous individuals, significant questions arise regarding the differences between traditional and non-traditional uses and regarding the importance of spiritual context in reaping the benefits of ayahuasca use. 

Often times, Western tourists’ motivations for using ayahuasca are rooted in unrealistic or idealized views on shamanism. Davidov (2010) compared “real” and “fake” shamans and found that many Western tourists are motivated by the desire to participate in an authentic ayahuasca experience, but most tourists have little to no knowledge about the aspects that comprise such an experience. As a result, these tourists have non-traditional ayahuasca experiences that are led by “fake” shamans who only seek to gain monetary benefit for providing tourists with the mystical and often unrealistic experiences they seek (Davidov, 2010). To facilitate these experiences, “fake” shamans emphasize the use of ayahuasca, while de-emphasizing the necessary cultural or religious contexts for its use (Davidov, 2010). This minimization of cultural context fits into the greater phenomenon that appears to characterize entheogen tourism, in which ayahuasca and the natural environment are presented as the center of life in the Amazon. For example, on the website for Blue Morpho, an ayahuasca tourism company founded by a Westerner, pictures and references to sunsets, plants, and animals appear far more often on the website than the local people who actually live among these elements in nature, reflecting the Western tourist’s desire for an “authentic” experience in an “exotic” jungle (Holman, 2011). The emphasis on the exotic elements of the ayahuasca experience only further minimizes the role and presence of the indigenous people who use ayahuasca traditionally. Moreover, since many tourists enter these experiences with little knowledge about the traditional uses of ayahuasca, the tourists’ understandings of the ayahuasca experience are heavily influenced by the shaman’s framing of that experience (Davidov, 2010; Fotiou, 2016). These elements demonstrate that many tourists seek romanticized ayahuasca experiences but are unable to definitively determine the authenticity of those experiences, leaving the themselves to the devices of the shamans. 

Western users’ unrealistic expectations can also be contrasted to indigenous beliefs regarding the ability of ayahuasca to induce reality. Fotiou (2016) concluded that Western ayahuasca tourists romanticize the use of ayahuasca and ignore the complexity of indigenous people’s cosmology and the effect that ayahuasca tourism has on indigenous cultures. Often, this romanticizing of ayahuasca and indigenous cultures leads to disappointment in the experiences that tourists have while on ayahuasca journeys because many tourists enter the journeys with unrealistic expectations (Fotiou, 2016). Rooted within many of the motivations for engaging in ayahuasca tourism are the Western expectations for using ayahuasca to transcend or escape reality (Winkelman, 2005). Western users recognize life without the hallucinogenic effects of ayahuasca as true reality and the ayahuasca experience as a movement away from that reality (Winkelman, 2005). However, Fotiou (2016) noted that ayahuasca and the psychoactive states that it induces are highly fundamental to many indigenous groups, such as the Shuar, who uphold that the ayahuasca experience is actually true reality, while regular life is the illusion. These differing perspectives illustrate the variance in the perception of ayahuasca experiences among indigenous and non-indigenous users.

Recently, an increasing amount of evidence has indicated the benefits of ayahuasca experiences for spiritual development, psychological treatment, and the treatment of drug use disorders in Western users. In some recent studies, ayahuasca is presented as a beneficial treatment option outside the influence of a cultural or religious context (Soler, 2015). However, other studies emphasize that the contextual features of the ayahuasca experience are invaluable and essential for users to gain the full benefits from the experience (Kordova & Ventegodt, 2016). Overall, it appears that the beneficial elements of ayahuasca are enhanced when the cultural and religious aspects of its use are emphasized. Although ayahuasca has been implicated as beneficial for spiritual development and the treatment of psychological and drug use disorders in both traditional and non-traditional contexts, the traditional aspects of the ayahuasca experience are a necessary feature that provide significant benefits for Western users who seek healing, development, and treatment.

Ayahuasca Mechanism of Action

The mechanism of action for the hallucinogenic experiences induced by ayahuasca depends upon two main features of the plants that are used to make it. The two features include the beta-carboline alkaloids, found in the Banisteriopsis caapi, and the N,N-Dimetiltryptamine (DMT), found in the Psychotria viridis (Sayin, 2014). Specifically, the beta-carboline alkaloids act as monoamine oxidase inhibitors (MAOIs), which are a group of substances that inhibit the ability of the monoamine oxidases to catalyze the oxidation, and eventual degradation, of monoamines (Sayin, 2014). These MAOIs are especially important because DMT is classified as a monoamine and cannot function properly or bind to any receptors in the central nervous system if monoamine oxidases are present within the system (Riba et al., 2004). Essentially, without the addition of Banisteriopsis caapi or other chemically similar plants, the DMT in ayahuasca would be quickly metabolized by the digestive system, resulting in the absence of any hallucinogenic experience. Hence, when the monoamine oxidases are inhibited by the beta-carboline alkaloids, DMT can diffuse through membranes in the digestive system and cross the blood-brain barrier (Sayin, 2014). Once in the brain, DMT acts as an agonist to the neurotransmitter, serotonin, by binding to serotonin receptors (Riba et al., 2004). During a hallucinogenic experience, DMT binds most significantly to the serotonin receptor, 5-HT2A, and activates it (Riba et al., 2004). The combination of MAOIs and DMT within the plants used to create ayahuasca allows for DMT to be orally active and to produce psychoactive effects once the tea is consumed. Additionally, the presence of MAOIs in ayahuasca allows for levels of other monoamines that are naturally-present in the brain to increase. Neurotransmitters, such as dopamine, serotonin, and norepinephrine, accumulate in the central nervous system as the MAOIs prevent the monoamine oxidases from breaking down these neurotransmitters (Liester & Prickett, 2012). The increase in levels of these neurotransmitters has a positive effect on the users of ayahuasca, resulting in increased feelings of euphoria while under the influence of the tea. 

The Spiritual and Psychological Benefits of Ayahuasca

Although there are a number of motivations for ayahuasca use among indigenous populations, there are identifiable similarities among different native groups. Many of these motivations include accessing greater knowledge, entering an enhanced state, and healing aspects of the self or others. In many cases, hallucinogenic experiences are related to the acquisition of new knowledge. Fotiou (2019) described the concept of dietas in which ayahuasca shamans, ayahuasqueros, ingest various plants and plant concoctions, including ayahuasca, in order to gain knowledge from each plant. The process of dietas is rather ascetic because it usually involves consuming various plants that have considerable effects on the body, while also following a strict diet, abstaining from physical and sexual activities, and isolating oneself from most people (Fotiou, 2019). According to Fotiou (2019) dietas usually last for eight, fifteen, or thirty days, but for Western visitors, the experiences are usually much shorter, and the ingestion of the plants occurs less frequently. A former Kichwa shaman also described a similar process that occurs with the consumption of ayahuasca, in which shamans-in-training consume ayahuasca everyday over the course of five years, maintain a diet of only mashed banana, and abstain from sexual relationships (Davidov, 2010). As the former shaman argues, this process allows for a shaman to gain the knowledge of the true art of shamanism, which involves healing and divination (Davidov, 2010). Christian Kichwa shamans view ayahuasca as a sacred being that teaches and disciplines (Madera, 2009). These Christian shamans emphasize the importance of physical and mental suffering within the ayahuasca experience as a mandatory occurrence before true learning from ayahuasca can occur (Madera, 2009). Overall, there are a variety of reasons for engaging in the use of psychoactive substances like ayahuasca, and the acquisition of new knowledge appears to be a major motivation among indigenous groups. As illustrated in these examples, this process is usually accompanied by a seemingly ascetic change in lifestyle through fasting, abstaining from pleasurable activities, and general suffering.

Since many Western tourists are unable or unwilling to fully immerse themselves in the traditional ayahuasca experience or participate in those experiences for long periods of time, the tourists engage in modified versions of the experience that may not provide the same spiritual and personal benefits. For instance, ayahuasca tourists at a retreat in Amazonia expressed a desire for spiritual and personal development from the use of ayahuasca (Winkelman, 2005). However, the participants engaged in a highly minimalistic ayahuasca ceremony that was devoid of ritual aspects (Winkelman, 2005). In explaining the benefits of that ayahuasca experience, participants did not evaluate their experiences as specifically beneficial to their spiritual and personal development (Winkelman, 2005). In contrast, participants who experienced a highly ritualistic ayahuasca ceremony emphasized the development of spiritual awareness, sense of personal meaning, and personal knowledge (Loizaga-Velder & Verres, 2014). The participants attributed the benefits of ayahuasca to their immersion in the traditional aspects of the ayahuasca experience, which were often intense or difficult to endure, echoing the ascetic experiences of the traditional users (Loizaga-Velder & Verres, 2014). These reports demonstrate that the highly decontextualized ayahuasca ceremony did not appear to benefit the users’ spirituality as much as the contextualized ayahuasca experience. 

Traditional ayahuasca experiences can also be beneficial in the treatment of a variety of psychological disorders. For some Western ayahuasca users with eating disorders, the ayahuasca experience facilitated recovery and a change in body perception (Lafrance et al., 2017; Renelli et al., 2018). Each of the participants engaged in a ceremonial ayahuasca experience that involved following a restricted diet and vomiting as a result of consuming the tea, two aspects that also mimic the symptoms of most eating disorders (Lafrance et al., 2017).  However, none of the participants reported feeling triggered by these aspects of the experience (Lafrance et al., 2017). In fact, the participants described the restricting and purging that occurred during the experience as cathartic due to the cultural context that emphasized healing through release. (Lafrance et al., 2017). Additionally, participants also described the benefits of the intense, emotionally painful process of confronting negative emotions and memories while under the influence of ayahuasca (Renelli et al., 2018). The participants emphasized that the ceremonial experience created a safe and supportive environment that allowed them to address these unresolved emotions (Renelli et al., 2018). The ayahuasca experience pushed the participants to engage in their own healing, a process which could not be avoided when situations became difficult, unlike with conventional forms of treatment. Like the indigenous users, the Western users understood the benefits of the ascetic aspects that characterized the ayahuasca experience.

Ayahuasca as a Treatment for Drug Use Disorders

Besides aiding in spiritual development, ayahuasca has been used to treat drug use disorders in traditional contexts. Liester and Prickett (2012) argued that in addition to the biochemical, physiologic, and psychological effects, one possible benefit of ayahuasca in the treatment of drug use disorders is the transcendent effects that it induces. These transcendent effects are often tied to religious and spiritual experiences. As one ayahuasca user explained, his consumption of ayahuasca enabled him to enter another realm of consciousness and see God, and this deeply religious and transcendent experience cured him of his previously untreatable alcoholism (Liester & Prickett, 2012). Similarly, Talin and Sanabria (2017) asserted that all drug experiences are never just biological phenomena devoid of any emotional, cultural, or social contexts. Therefore, the treatment of drug use disorders must take a similar approach by taking these different contexts into account (Talin & Sanabria, 2017). According to Talin and Sanabria (2017), the traditional use of ayahuasca, which emphasizes personal and spiritual development, the acquisition of knowledge, and the improvement of interpersonal relationships, accounts for these contexts. The treatment of drug use disorders with ayahuasca appears to be strongly associated with the traditional contexts of ayahuasca use. 

Many Western tourists with drug use disorders emphasize spirituality as a necessary component of reaping ayahuasca treatment’s benefits. Participants who were diagnosed with crack cocaine dependence, according to the DSM-IV criteria, reported having a decreased affinity for crack cocaine after ingesting ayahuasca (Cruz & Nappo, 2018). The participants emphasized the benefits of the religious and cultural aspects of the experience, stating that ayahuasca awakened their religious curiosity. Moreover, the participants explained that the religious community contributed to positive feelings such as feelings of support, belonging, and safety that all facilitated the participants’ major psychological transformations (Cruz & Nappo, 2018). In fact, eight of the 40 original participants reported relapsing after finishing treatment due to becoming detatched from the religious community and experiencing a reduction of religious faith (Cruz & Nappo, 2018). Talin and Sanabria (2017) argued that the effectiveness of ayahuasca to treat drug use disorders depends upon the ritual experience. Participants described the significance of the ritual experience, emphasizing that the intense ritual work, following the consumption of ayahuasca, reduced symptoms of methadone withdrawal (Talin & Sanabria, 2017). Other participants attributed the benefits of ayahuasca to specific aspects of the ritual, such as the music and singing. One participant explained that singing gave him a vision that allowed him to cleanse himself from his previous, meaningless heroin use (Talin & Sanabria, 2017). Unlike other drug-induced experiences, the ayahuasca-induced experience was rendered meaningful due to the ritual context that gave it meaning. 

In addition to treating crack cocaine and opioid dependence, religious ayahuasca use has been implicated in the treatment of alcohol dependence. One ayahuasca tourist explained that the ayahuasca ceremonies made him realize that he did not want to drink alcohol anymore (Loizaga-Velder & Verres, 2014). The tourist felt that the spiritual connection he gained from the experience gave his life meaning and value that was more significant than his desire to drink alcohol (Loizaga-Velder & Verres, 2014). Similarly, as mentioned above, one tourist’s transcendent encounter with God enabled him to overcome his addiction to alcohol (Liester & Prickett, 2012). The strong experiences induced by ayahuasca and the religious and cultural contextualization of those experiences help to facilitate an ayahuasca experience that has demonstrated benefits for the treatment of alcohol dependence in Western users. Interestingly, tourists who sought treatment of alcoholism through ayahuasca did not describe any beneficial changes to the severity of their alcohol dependence after participating in a non-traditional ayahuasca ceremony (Winkelman, 2005). While the participants described other benefits such as increased self-awareness and development, the participants made no reference to the benefits of the ayahuasca experience in treating their alcoholism (Winkelman, 2005). Given that this experience lacked a traditional context, this suggests that religious and cultural elements may be necessary features of effective ayahuasca treatment of alcoholism. 

Substance, Set, and Setting

Beyond facilitating a transformative, spiritual, and cultural experience, a traditional ayahuasca journey may be beneficial for Western users primarily because it accounts for important aspects of the journey such as substance, set, and setting. Loizaga-Velder and Verres (2014) argue that a traditional ayahuasca journey led by an experienced shaman would ensure the quality of the substance, the efficacy of the dose, and the frequency of consumption. Unlike the non-traditional use of ayahuasca, traditional use involves oral consumption, which often leads to vomiting and diarrhea and decreases the probability of an overdose; conversely, non-traditional, recreational use of inhaling DMT notably increases the bioavailability of the substance, amplifying the potential for overdose (Lanaro et al., 2015). Additionally, deeply traditional experiences help to account for the “set” of the ayahuasca journey. The set refers to the expectations and intentions of the ayahuasca user and may be influenced by the traditional context that emphasizes the spiritual, personal, and interpersonal development that often occurs following the ingestion of ayahuasca (Loizaga-Velder & Verres, 2014). As previously mentioned, expectations and experiences of ayahuasca are often influenced by the shamans’ shaping of those aspects (Davidov, 2010). Most significantly, traditional ayahuasca experiences account for the setting by controlling the interpersonal environment (Liester & Prickett, 2012). Many Western ayahuasca users described the benefits of engaging in traditional ayahuasca use while immersed in a religious community (Cruz & Nappo, 2018; Renelli et al., 2018). The positive feelings associated with feeling supported and protected during the ceremony helped to facilitate a positive experience. 

Conclusion

While researchers have demonstrated the benefits of ayahuasca as a treatment for drug use disorders, mental illnesses, and spiritual deficits in Western users, the traditional context associated with the use of ayahuasca is also an essential aspect of the experience. Like indigenous users who emphasize the ascetic aspects of the ayahuasca experiences in inducing learning and development (Fotiou, 2019; Davidov, 2010; Madera, 2009), the immersion in an intense, often challenging ayahuasca ceremony leads to benefits for Western users who understand the necessity of these difficult experiences in reaping ayahuasca’s benefits (Loizaga-Velder & Verres, 2014;  Lafrance et al., 2017; Renelli et al., 2018). Moreover, Western users with drug use disorders emphasized that the cultural, religious, and communal aspects of the ayahuasca ceremony helped to decrease withdrawal symptoms and, in many cases, cured users of their drug dependence (Cruz & Napp, 2018; Talin & Sanabria, 2017; Loizaga-Velder & Verres, 2014; Liester & Prickett, 2012). The environment facilitated by the traditional ayahuasca ceremony allowed for the patients to address difficult emotions and experiences while feeling the support and protection of the shamans and the rest of the ayahuasca community. Overall, the traditional ceremony accounts for important aspects of the ayahuasca experience such as the substance, set, and setting.

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