Ayahuasca has an extensive history with the indigenous people in the Amazon River Basin (9), and has been used for medical and religious/spiritual reasons under the guidance of a shaman or community healer. Ayahuasca, used in the traditional sense, has only become popularized out of the Amazon since 1850.

Historical origins of Ayahuasca use are unknown. A number of indigenous and mestizo groups across the Amazon today reserve a key role of Ayahuasca within articulated visions of the cosmos, of myth and healing. There is an abundance of plants containing the active ingredient DMT in the Amazon River Basin. This basin covers around 40% of South America (including countries such as Peru, Ecuador, Brazil, and Venezuela). Due to the diversity of communities in the Amazon, there are differences in the way ayahuasca recipes are made, how it is being consumed and the context of the mythologies associated with its use.

Ayahuasca use has spread globally and is used as a sacrament regularly by members of the Santo Daime, Uniao do Vegetal, and Barquihha churches, by Western tourists seeking spiritual experiences or healing in the form of a “traditional ayahuasca ceremony”(10), by recreational users, and by those exploring self-development.

In recent years, science is beginning to focus on the therapeutic use of ayahuasca, in the treatment of mental health conditions including depression, alcoholism, substance abuse, eating disorders, grief, and post-traumatic stress. Many personal stories support its role as a healing toolwhen taken intentionally in a safe and supported environment, and when the experience is integrated into daily life. Due to lack of funding, illegalities, and stigma there is not enough ayahuasca research, however, preliminary studies are promising, and warrant further investigation into the healing effects of ayahuasca.

Standard procedures of preparing the brew need to be devised in order to reduce variability and enhance its relevance in clinical research.

Preliminary research supports that ayahuasca, when used in a controlled and supportive setting, allows ceremony participants to identify negative thought patterns, traumas, and barriers related to their addiction. It reduced cravings and substance abuse, causing lasting positive changes.

Ayahuasca may help with addiction due to many factors including an increased connectedness with one’s self, others, and nature; an increased sense of community and social network support, and incorporating these positive experiences into daily life. The ceremonial and community context in which ayahuasca is used may play an important role in healing addiction.

• The results from a preliminary observational study show that after ayahuasca-assisted therapy for addiction, self-reported alcohol, tobacco and cocaine use declined, although cannabis and opiate use did not. All 12 study participants reported positive and lasting changes from participating in the retreats (11).
  
  
• A qualitative analysis of the Canadian study’s results found that all 11 interviewed participants reported reductions in substance use and cravings (12). Eight participants experienced complete cessation of at least one substance.
  
  
• A study of 40 crack cocaine users in Brazil analyzed how these users recover from drug addiction using ayahuasca tea in a religious context. The results were based on in-depth interviews. Researchers found that the ceremony helped to increase spirituality, improving the self-esteem of participants and strengthening them emotionally, which may provide therapeutic value for treating crack cocaine dependence (13).

Ayahuasca’s effectiveness for the treatment of addiction is complex, but it does seem to help with drug cessation in some cases. The way ayahuasca is used as well as the quality of care received may play an important role in its effectiveness to treat addiction (14).

The WHO estimates that more than 264 million people suffer from depression worldwide. It’s the world’s leading cause of disability (15).  Initial research suggests that Ayahuasca has a fast-acting and sustained antidepressant effect for treatment-resistant depression. Depression is very complicated and it is difficult to pinpoint exactly how ayahuasca may help sustain decreased depressive symptoms, though there is some evidence to suggest that it induces changes in activity of the Default Mode Network (DMN), an area of the brain involved in major depressive disorder (16).

• In one randomized controlled trial, 29 patients with clinical depression were given a session of ayahuasca or placebo and analyzed for changes in depression scores (17). After one day, the ayahuasca group scored significantly lower on depression scores compared to the placebo. After seven days, the placebo group returned to normal depression levels, while the ayahuasca group was still much lower on the depression score.Ayahuasca alleviated treatment-resistant depression in 64% of study participants compared to 27% of the placebo group.
  
  
• In a preliminary report on a single dose of ayahuasca on patients with recurring depression, 82% reductions in depressive scores were observed up to 21 days after ayahuasca administration, without inducing any manic episodes in patients who had mood disorders (18).
  
  
• In an ayahuasca ceremony, attendants’ depression ratings and stress significantly decreased after the ceremony with these changes persisting for four weeks (19).
  
  
• A single dose of ayahuasca has been shown to cause rapid antidepressant effects lasting for at least 21 days. Increased blood flow to brain regions regulating mood and emotions were observed. No adverse effects were recorded apart from vomiting, which occurred in 47% of participants (20).
  
  
• Ayahuasca caused a significant decrease in activity through most parts of the DMN. This finding supports the notion that the altered state of consciousness induced by Ayahuasca, like those induced by psilocybin (another serotonergic psychedelic), meditation and sleep, is linked to the modulation of the activity and the connectivity of the DMN(21).

Preliminary research suggests that ayahuasca may help people deal with and overcome grief through experiencing emotional release.

• In one study, a group of 30 people who were taking ayahuasca during their grief process after the loss of a first-degree relative was compared to a group of 30 people attending peer-support groups for grief. The group who used ayahuasca experienced lower levels of grief and described experiences such as emotional release and contact with the deceased, which are experiences that may help them overcome the negative emotions associated with grief (22).
  
  
• An examination of 50 bereaved participants who attended Shipibo ayahuascaceremonies responded to an online survey at 3, 6, and 12 months post-ceremony.   There was a significant decrease in the Texas Revised Inventory of Grief, Symptom Assessment at all time points. Additionally, there was a relationship between acceptance and decentering, and a reduction in the severity of grief (23).

These results suggest that the ceremonial use of ayahuasca has therapeutic value by reducing the severity of grief. Acceptance and decentering are both psychological processes that mediate the improvement of grief symptoms

Ayahuasca may provide short term improvements in individuals with BPD affected by emotion dysregulation.

• In one study examining the effects of ayahuasca on borderline personality disorder (BPD), patients showed significant improvements in their emotional regulation 24 hours after an ayahuasca session (24).

Ayahuasca may help people with eating disorders (EDs) heal the root psychological cause of their condition. Tackling these psychological foundations of ED may help improve their feelings of self-acceptance, which can help process painful memories, allowing them to create more positive associations with food. Ceremonial setting and after-care were reported as being important aspects of participants’ experiences.

• In one study, 16 people previously diagnosed with eating disorders were interviewed with regards to their ayahuasca ceremony experiences. Common themes included reduced symptoms of their eating disorders (ED), improved mental health, changes in their body perception, as well as a greater sense of self-love and acceptance (25).
  
  
• In one study 13 people previously diagnosed with ED were interviewed to contrast their experiences with conventional treatments versus ayahuasca. The results show that participants reported that ayahuasca leads to rapid reductions in thoughts about ED and symptoms (26).

It is critical to carefully consider your mindset, intentions, safety and comfort of the environment, and facilitator before engaging in any activity that will expand your awareness, as this will profoundly affect the experience.

Though ayahuasca can have deep therapeutic effects, it can come with serious risks.  If ayahuasca is used inappropriately it can cause adverse effects and worsen problems, or in some cases create new ones (27).   Ayahuasca should be administered under the supervision of a trained professional.

Although uncommon, ayahuasca can provoke the onset of prolonged psychosis in vulnerable individuals making it critically important to investigate the mental history of family members before taking any psychedelic (28). 

Another important consideration, is the integration of the experience into your daily life.  While taking ayahuasca, or other psychedelics, unconscious material may be brought to the surface during the session and if it is not worked through or integrated properly, may lead to negative emotions or experiences after the session has ended (29).

Keys to decreasing risks when taking ayahuasca are: having a rigorous pre-evaluation, psychological preparation, taking it in a controlled environment with responsible facilitators, and proper integration of the experience. For more information on preparation and integration, and sound safety practices for both facilitators and participants consult the ‘better practices guide’created by ICEERS.

Do NOT Take Ayahuasca If…

• You don’t understand what ayahuasca is and its potential effect
  
  
• You’re feeling pressured to take ayahuasca because of others. One of the main reasons why people have bad experiences with ayahuasca or any psychedelic for that matter is that they don’t have the desire to try it.
  
  
• You’re taking antidepressants such as SSRIs
  
  
• You’re pregnant
  
  
• You do not trust the person who is giving you ayahuasca
  
  
• You have a family history of mental health conditions such as schizophrenia, bipolar disorder or something similar, do not take ayahuasca (without your doctor’s permission) as it couldexacerbate symptoms of these disorders or prematurely trigger a condition.
  
  
• You’re in very poor physical health, ayahuasca should be avoided
  
  
• You have severe clinical depression, panic attack disorders, suicidal thoughts, attempts or instances of self-harm, in these circumstances it is imperative that the work with ayahuasca is accompanied by adequate psychological supervision

Physical Contraindications

• Cardiovascular issues
• Glaucoma
• Recent surgeries
• Infectious diseases
• Issues with your liver, gallbladder, kidney or pancreas
• If you have difficulty vomiting, ayahuasca should be avoided
• Fractures
• Severe hypertension
• Epilepsy
• Convulsions
• Pregnant or lactating women
• Cerebrovascular accidents
• Tuberculosis

Adverse Drug Interactions

Do not take the following drugs while under the influence of ayahuasca:

• Medications that affect the neurotransmitter serotonin such as SSRIs (antidepressants) can be potentially fatal due to serotonin syndrome
• Antipsychotic drugs
• Alcohol
• Vasodilators Antihypertensives (high blood pressure medicine)
• Central nervous system (CNS) depressants (e.g Xanax, valium, and Ativan)

For any change in medication or combination of medication with ayahuasca, consult your doctor or medical professional who knows your health status.   You can read more about potential adverse drug interactions with ayahuasca here. 

Incompatible Psychoactive Substances

• Cocaine
• Amphetamines or MDMA
• 5-MeO-DMT and/or bufotenin (which are present in other natural substances such as Bufo alvarius, Anadenanthera colubrina or yopo).

Addiction Potential

There is currently no evidence that ayahuasca (DMT) is addictive, and initial reports have confirmed that ayahuasca doesn’t induce addictive behavior (30,31). There is a risk of a psychological desire to re-experience the positively associated events from an ayahuasca experience. It is very important to fully integrate your experience, to understand and apply the insights of your session, before taking part in another one. 

Long-Term Effects

Most research available on ayahuasca has focused specifically on acute and short-term side effects on mental health rather than long-term effects. According to one review, the long-term effects of ayahuasca are presently unknown (32). The largest long-term follow up of ayahuasca’s effects concluded that eight patients followed up four to seven years after their ayahuasca experience reported it was one of the most important experiences of their lives. Potential long-term side effects may still be a possibility, especially for people who have a predisposition to developing mental health conditions that could be triggered by using psychedelics.

In one study, a year after taking ayahuasca,  ayahuasca-users performed better in neuropsychological tests, scored higher in assessments of spirituality, and showed better adaption skills compared to controls (33).  More research need to be done to  confirm these findings, as people who had negative experiences with ayahuasca and discontinued use were not be included in this study group.

There is data that suggests structural changes in the brain can occur from intense and prolonged ayahuasca use, that may affect the function of the default mode network (DMN) of the brain (34). The DMN is associated with being the ‘neurological basis of self”, thinking of others and remembering past and future events (35).  The default mode network has been hypothesized to be relevant to disorders including Alzheimer’s, autism, schizophrenia, depression, chronic pain, posttraumatic stress disorder, and others (36, 37).

Harm Reduction Measures

Ayahuasca is not a substitute for psychotherapy or medical care and should be administered under the supervision of a trained professional. It’s important to understand that everyone responds differently to powerful psychoactive substances.

• Know why you are taking ayahuasca
  
  
• If it’s your first time, start slow. You can always take more, but you can never take less. Keeping this philosophy in mind, with any substance you consume, will minimize unnecessary harm.
  
  
• Use ayahuasca in a safe and comfortable environment
  
  
• Only take ayahuasca with a facilitator you deeply  trust
  
  
• Know your family mental health history
  
  
• Attend a ceremony with a trusted friend
  
  
• Do not mix ayahuasca with alcohol or recreational drugs
  
  
• Know what’s in the brew.  Some ayahuasca recipes contain potentially deadly admixture plants (Brugmansia and Datura).
  
  
• Avoid guides that present themselves as “gurus”
  
  
• Sexual abuse, which can occur whenever there is a power imbalance, is known to happen in ayahuasca circles. Reading these guidelines can help increase awareness and minimize risk.

For more information on how to choose a center or guide, and recommendations on ceremony preparation and integration consult ICEERS’ Guide TOWARDS BETTER AYAHUASCA PRACTICES.

Visit The  Chacruna Institute for The AYAHUASCA COMMUNITY GUIDE FOR THE AWARENESS OF  SEXUAL ABUSE