Human Psychopharmacology of Hoasca,
A Plant Hallucinogen Used
in Ritual Context in Brazil
Charles S. Grob, M.D., Dennis J. Mckenna, Ph.D., James C. Callaway, Ph.D.,
Glacus S. Brito, M.D., Edison S. Neves, M.D., Guilherme Oberlaender, M.D.,
Oswaldo L. Saide, M.D., Elizeu Labigalini, M. D. , Cristiane Tacla, Ph.D.,
Claudio T. Miranda, M. D., Rick J. Strassman, M.D., And Kyle B. Boone, Ph.D.
©Journal of Nervous and Mental Disease 184:86-94, 1996
A multinational, collaborative, biomedical investigation of the
effects of hoasca (ayahuasca), a potent concoction of plant hallucinogens,
was conducted in the Brazilian Amazon during the summer of 1993.
This report describes the psychological assessment of 15 long-term
members of a syncretic church that utilizes hoasca as a legal,
psychoactive sacrament as well as 15 matched controls with no
prior history of hoasca ingestion. Measures administered to both
groups included structured psychiatric diagnostic interviews,
personality testing, and neuropsychological evaluation. Phenomenological
assessment of the altered state experience as well as semistructured
and open-ended life story interviews were conducted with the long-term
use hoasca group, but not the hoasca-naive control group. Salient
findings included the remission of psychopathology following the
initiation of hoasca use along with no evidence of personality
or cognitive deterioration. Overall assessment revealed high functional
status. Implications of this unusual phenomenon and need for further
investigation are discussed.
Hoasca is a hallucinogenic concoction of potent psychoactive plants
that are indigenous to the Amazon basin of South America It has
been known under a variety of names, including ayahuasca, caapi,
yagé, mihi, dapa, natema, pinde, daime, and vegetal. Hoasca
is the Portuguese transliteration for ayahuasca and is the accepted
term utilized throughout Brazil. Prior to the European conquest,
domination, and acculturation of South America, beginning in the
16th century, hoasca was widely used by the native peoples for
purposes of magic and religious ritual, divination, sorcery, and
the treatment of disease (Dobkin de Rios, 1972). In spite of prolonged
and savage attempts by the European conquerors to repress and
eradicate native culture and belief systems (Taussig, 1986), sacramental
and medicinal use of hoasca remained extant.
Scientific study of hoasca began with the renowned English botanist
Richard Spruce, who from 1849 to 1864 traveled extensively
throughout the Brazilian, Venezuelan, and Ecuadorian Amazon to
compile an inventory of the varieties of plant life found there
(Schultes and Raffauf, 1992). Spruce made a number of valuable
discoveries, including Hevea, the genus of the rubber tree,
and cinchona, from which quinine is derived. He also identified
one of the primary sources of a powerful hallucinogenic brew used
by the Mazan and Zaparo Indians, called ayahuasca (Quechua for
"vine of the souls" or "vine of the dead"),
and previously described by the Ecuadorian Manuel Villavicencio
(1858), as a large woody vine that would later be given the formal
botanical designation of Banisteriopsis caapi (Ott, 1994;
Spruce, 1908). Subsequent laboratory analysis would reveal the
presence of the psychoactive beta-carboline alkaloids harmine,
harmaline, and tetrahydroharmine, although when first isolated
during the early 20th century they would receive the rather exotic
appellation of telepathine. As identified by early field observers
of hoasca use, additional psychoactive admixtures were often added
to the cooking B. caapi preparations, most notably highly
potent and hallucinogenic tryptamine-containing plants, including
such vision-inducing plants as Psychotria viridis (McKenna
and Towers, 1984).
Throughout the Amazon basin, the use of hoasca remained so deeply
rooted in tribal mythology and philosophy that modern investigators
have been able to confidently conclude that its use extended back
to the earliest aboriginal inhabitants of the region (Schultes
and Hofmann, 1992). They have recorded the tradition of hoasca
use by the indigenous peoples of the region for the purpose of
freeing the soul from corporeal confinement and facilitating access
to realms of alternate reality, allowing for a variety of magical
experiences, including accessing communication with the spirits
of the ancestors. Anthropologists who have conducted ethnographic
studies of the native inhabitants of the Amazon Basin have described
such common hoasca-induced phenomena as visions of jaguars, snakes
and other predatory animals, visions of distant persons, "cities
and landscapes, the sensation of "seeing" the detailed
enactment of recent mysterious events, and the sense of contact
with the supernatural (Harner, 1973).
Hoasca, as is the case with other plant hallucinogens, has a prehistoric
tradition of use by native aboriginal peoples as shamanic sacraments
or catalysts (Bravo and Grob, 1989; Furst, 1976). It is considered
a "great medicine" and is used to both diagnose and
treat illness (Schultes and Hofmann, 1992). Its use is fully sanctioned
by societal customs and laws and, in fact, is the core experience
upon which tribal and collective consciousness rests. Utilization
of such potent plant hallucinogens as hoasca typically occurs
within a ritualized context, including the traditional rites of
initiation (Grob and Dobkin de Rios, 1992). The powerful hypersuggestible
effects induced by the hallucinogenic plant drug reinforce collective
belief systems, strengthen group cohesion, and facilitate culturally
conditioned and syntonic visions which provide revelation, blessing,
healing, and ontological security (Dobkin de Rios and Grob, 1994).
Use of hoasca for purposes of healing and religious sustenance
has, during the centuries of European acculturation of Amazonia,
emerged from the exclusive tribal domains of the rain forest and
been incorporated into the contemporary fabric of rural and urban
society, particularly among the indigenous Mestizo populations
of Peru, Colombia, and Ecuador. Identified as a valuable adjunct
to folk healing practices, hoasca is ritually administered by
"ayahuasqueros" to carefully selected groups of patients
(Dobkin de Rios, 1972). Scrupulously adhering to the shamanic
models practiced by the aboriginal peoples, these folk healers
similarly use the sacramental hoasca for purposes of medical diagnosis
and healing, divination, and as a path of access to the realms
of the supernatural.
During the 20th century, the use of hoasca within the context
of modern syncretic religious movements, particularly in Brazil,
has arisen. One such church, and the object of the current study,
is the Uniao do Vegetal (UDV), whose translation from the Portuguese
means "union of the plants." The UDV originated in the
early 1950s when its founder, Gabriel de Costa, a rubber tapper
who had first experienced the effects of hoasca with the native
Indians of Bolivia, returned to the rapidly expanding Brazilian
Amazon settlement of Rio Branco with his visions of spiritual
revelation and personal mission. Gathering a group of loyal followers,
Maestre Gabriel, as he came to be known, elaborated a mythology
and structure for his new religion. Spreading first through the
Brazilian Amazon and then to the more densely populated and urbanized
South, the UDV grew over the subsequent four decades to achieve
an eventual size of approximately 7000 members nationwide, drawing
adherents from across the socioeconomic and professional spectra.
Organized along the lines of an early Christian parish, local
"nucleos," or congregations, are centers where sacramental
hoasca is consumed in large bimonthly ritual ceremonies which
are presided over by local "maestres," leaders of the
religious sect. Although not the only Brazilian syncretic church
to use hoasca as a ritual sacrament, the Santo Daime sect being
the largest and most widely known, the UDV does have the strongest
organizational structure as well as the most highly disciplined
membership. Of all the hoasca churches in Brazil, the UDV was
also most pivotal in convincing the government narcotics commission
to remove hoasca from the list of banned drugs, which was accomplished
in 1987 for use within religious ceremonial contexts.
Although achieving some attention and even notoriety in North
American literature and the popular press, most notably the work
of William Burroughs and Allen Ginsberg (1963), the psychological
phenomenon induced by hoasca has been subjected to virtually no
rigorous study. Various travelers to the Amazon Basin have reported
their own first-hand accounts of experiences with hoasca (Weil,
1980) while both formal and informal anthropological narratives
have excited the public imagination (Lamb, 1971; Luna and Amaringo,
1991). Indeed, interest in the exotic Amazonian traditions and
effects of hoasca have sparked a steady stream of North American
tourists, often attracted by articles and advertisements in popular
and New Age magazines (Krajick, 1992; Ott, 1993). Concern over
possible adverse psychological health effects incurred by such
naive travelers has also been raised by a noted anthropological
authority of hoasca use in the Amazon (Dobkin de Rios, 1994).
Contrasted with testimonials of improved psychological and moral
functioning by adherents of the syncretic hoasca churches in Brazil,
a formal study exploring the effects of long-term use of this
unusual hallucinogenic beverage would appear to be indicated.
During the summer of 1993 a multinational group of biomedical
researchers from the United States, Finland, and Brazil met in
Manaus, the capital city of the Brazilian state of Amazonia, to
conduct an examination of the psychological and biochemical effects
of hoasca. Prior to the actual performance of the study, an invitation
had been extended by the Uniao do Vegetal to conduct an investigation
of the toxicity of their hoasca "tea." Given the long
history of repression of their religious movement and use of the
hoasca sacrament prior to government sanction in 1987, the leaders
of the UDV had surmised that the conclusions of a fair and objective
scientific study might be of some protective value in the future
if the political winds in Brazil were to shift. Consequently,
and upon consultation with the North American research group,
a decision was made to utilize the oldest nucleo outside of Rio
Branco, in Manaus, where a large percentage of the membership
had been ritually consuming hoasca on a regular basis for more
than 10 years. Given the complicated logistics and demands placed
upon subjects in this study, the tightly organized structure of
the UDV and its highly disciplined membership proved to be invaluable
in the successful completion of the project's goals. Part 1 of
this report will detail the results of our investigation of the
effects of the hoasca tea on psychological function and Part 2
will discuss our examination of the effects of hoasca on human
biochemistry.
Methods
Fifteen members of the syncretic church, Uniao do Vegetal, living
in the Brazilian Amazon city of Manaus, were randomly selected
from a larger group of volunteers. Criteria for inclusion into
the study included membership in the UDV for at least 10 years.
Members of the UDV participate in church rituals utilizing hoasca
as a psychoactive sacrament a minimum of twice monthly, but often
as frequently as several times per week, although always within
ritual context. In addition to regular participation in ceremonial
consumption of hoasca, the UDV requires of its membership complete
abstinence from all other psychoactive substances, including alcohol,
tobacco, marijuana, cocaine, and amphetamines.
Fifteen control subjects who had never consumed hoasca were also
recruited, with the objective of matching them on all demographic
parameters. Because of the relatively small sample size, and the
need to limit the number of variables, all experimental and control
subjects were men. Controls were compatibly matched to experimental
subjects along the parameters of age, ethnicity, marital status,
and level of education. Although attempts were made to control
for diet and current consumption of alcohol, complete compliance
was not possible to achieve. Because of difficult field conditions
as well as limitations of time, it was not feasible to completely
analyze all demographic data until after initiation of the actual
study. At that time it was also identified that control subjects
had significantly higher yearly incomes than experimental subjects.
In endeavoring to explain this discrepancy we noted that the method
of control subject recruitment had called for each of the experimental
subjects to provide for the study a close friend or associate
who had never participated in UDV ceremonies nor had consumed
hoasca under any other circumstances. It was noted in retrospect
that several experimental subjects had asked their supervisors
at their places of employment to volunteer for the study.
A variety of parameters were utilized to assess past and current
levels of psychological function. Both experimental and control
subject groups were administered structured psychiatric diagnostic
interviews (Composite International Diagnostic Interview [CIDI]),
personality testing (Tridimensional Personality Questionnaire
[TPQ]), and neuropsychological testing (WHO-UCLA Auditory Verbal
Learning Test). Experimental subjects, but not control subjects,
were asked to fill out an additional questionnaire (Hallucinogen
Rating Scale [HRS]) following a hoasca session: Each of the experimental
subjects was also interviewed in a semistructured format designed
to ascertain their life stories.
All subjects were monolingual speakers of Portuguese. Portuguese
versions of the CIDI and the TPQ were readily available for this
study, having been translated previously and validated in Portuguese
by the creators of these instruments. Portuguese versions of the
WHO-UCLA Auditory Verbal Learning Test and the HRS were developed
for this study by Brazilian collaborators, who translated the
instruments first into Portuguese, then back into English, and
finally back once again into Portuguese. The CIDI and the WHO-UCLA
Auditory Verbal Learning Test sessions were conducted by collaborating
Brazilian mental health professionals instructed in their administration.
The TPQ and HRS are self-report questionnaires. The semistructured
life story interviews were conducted by an English-speaking psychiatrist
assisted by an interpreter fluent in both English and Portuguese.
All life story interviews were audiotaped.
Composite International Diagnostic Interview
The CIDI is a comprehensive, fully standardized diagnostic interview
for the assessment of mental disorders according to the definitions
and criteria of ICD-10 and DSM-III-R (Robbins et al., 1988). The
CIDI was conceived for use in a variety of cultures and settings.
Although its primary application has been for epidemiological
studies of mental disorders. the CIDI has also been utilized for
clinical and research purposes. In the course of its development,
the CIDI was subjected to a variety of tests in different settings,
countries, and cultures for feasibility (diagnostic coverage,
test-retest reliability, and procedural reliability (Wittchen
et al., 1991).
Tridimensional Personality Questionnaire
The TPQ is a 100-item, self-administered, paper-and-pencil, true/false
instrument which takes approximately 15 minutes to complete (Cloninger,
1987a). The questionnaire measures the three higher order personality
dimensions of novelty seeking, harm avoidance, and reward dependence,
each of which measures four lower order dimensions (Cloninger,
1987b). The novelty seeking domain measures the spectrums of exploratory
excitability versus stoic rigidity (9 items), impulsiveness versus
reflection (8 items), extravagance versus reserve (7 items), and
disorderliness versus regimentation (10 items). The harm avoidance
domain measures the spectrums of anticipatory worry versus uninhibited
optimism (10 items), fear of uncertainty versus confidence (7
items), shyness with strangers versus gregariousness (7 items),
and fatigability and asthenia versus vigor (10 items). The reward
dependence domain measures the spectrums of sentimentality
versus insensitiveness (5 items), persistence versus irresoluteness
(9 items), attachment versus detachment (11 items), and dependence
versus independence (5 items). The TPQ is based on a unified biosocial
model of personality integrating concepts focused on the neuroanatomical
and neurophysiological basis of behavioral tendencies, styles
of learning, and the adaptive interaction of the three personality
dimensions (Cloninger et al., 1991).
WHO-UCLA Auditory Verbal Learning Test
The WHO-UCLA Auditory Verbal Learning Test is a simple list-learning
task similar to the Rey Auditory Verbal Learning Test (Rey, 1964),
but which also is suitable for use in cross-cultural contexts
and is sensitive to mild degrees of cognitive dysfunction. To
be familiar to a variety of cultures, the test comprises a list
of items carefully selected from categories such as parts of the
body, tools, household objects, and common transportation vehicles
(Maj et al., 1993). Subjects are read a list of 15 items at the
rate of approximately one word per second, following which they
are asked to recite as many words as they can recall. The same
list is read to subjects a total of five successive times, and
on each occasion subjects are asked to recite as many words as
they can remember. This is followed by an interference test where
subjects are read 15 words from a second list and asked to recite
as many as they can from the second list, following which they
are asked to again recall the words from the first list. For the
final trial, subjects are read from a list of :30 words, half
of which (in random order) are from the original list. Subjects
then are asked to indicate after each word whether they recognize
it as part of the original list of 15 words.
Hallucinogen Rating Scale
The HRS is a 126-item questionnaire originally developed to assess
the range of effects induced by intravenous administration of
synthetic dimethyltryptamine (Strassman et al., 1994). A 0 to
4 scale is utilized for most questions, with 0 = not at all, 1
= slightly, 2 = moderately, 3 = quite a bit, and 4 = extremely.
Responses to items are analyzed according to six conceptually
coherent "clusters": somesthesia (interoceptive, visceral,
and cutaneous/tactile effects), affect (emotional/affective responses),
perception (visual, auditory, gustatory, and olfactory experiences),
cognition (alterations in thought processes or content), volition
(a change in capacity to willfully interact with themselves, the
environment, or certain aspects of the experience), and intensity
(strength of the various aspects of the experience).
Life Story Interview
Each of the 15 experimental subjects agreed to submit to an approximate
hour-long interview conducted by a psychiatrist (C. S. G.). The
interview addressed various facets of their lives related to their
experience as members of the Uniao do Vegetal and their frequent
participation in rituals utilizing the psychoactive sacrament,
hoasca. The interviews were conducted, with the aid of a translator,
in a semistructured and open-ended manner. Each subject was asked
to "tell the story of your life from the time before you
first drank the hoasca tea... to how you first became acquainted
with the UDV and the effects of the hoasca... to how your life
has developed since the time you became a part of the UDV."
Results
Psychiatric Diagnoses
A structured psychiatric interview was conducted with each of
the 15 experimental subjects and each of the 15 normal control
subjects. Administration of the CIDI identified that whereas none
of the UDV experimental subjects had a current psychiatric diagnosis,
active diagnoses of alcohol abuse disorder and hypochondriasis
were present in two of the matched control subjects. However,
assessment of past (although no longer active) psychiatric diagnoses
indicated that, according to ICD-10 and DSM-III-R criteria, five
of the UDV experimental subjects had prior formal alcohol abuse
disorders, two had past major depressive disorders, and three
had past phobic anxiety disorders. On the other hand, among the
15 control subjects, only one subject had a past psychiatric disorder
that was no longer present—an alcohol abuse disorder that had
remitted 2 years before the study.
Personality Testing
The TPQ, measuring the three domains of novelty seeking, harm
avoidance, and reward dependence, was administered to the 15 experimental
long-term hoasca-drinking subjects and to the 15 hoasca-naive
control subjects. Means and standard deviations and results of
t-test comparisons are shown in
Table 1. Significant findings
on the novelty seeking domain included UDV subjects having greater
stoic rigidity versus exploratory excitability (p <.049) and
greater regimentation versus disorderliness (p <.016). A trend
toward group difference was found along the spectrum of greater
reflection versus impulsivity (p <.1). No group differences
were found along the spectrum of reserve versus extravagance (p
<.514). Summation of all four spectrums of the novelty seeking
domain identified a highly significant difference between the
two groups (p <.0054).
Analysis of the harm avoidance domain of the TPQ also identified
significant differences between the two groups. The UDV experimental
subjects were found to have significantly greater confidence versus
fear of uncertainty (p <.043) with a trend toward greater
gregariousness versus shyness with strangers (p <.067) and
greater uninhibited optimism versus anticipatory worry (p <
.098). Totaling the four spectrums of the harm avoidance dimension
yielded a significant difference between the two groups (p <
.011).
Analysis of the final TPQ domain of reward dependence did not
demonstrate any significant difference between the two groups
in total score and any of the-subdomain scores.
Neuropsychological Testing
All 15 experimental subjects and 15 control subjects were administered
the WHO-UCLA Auditory Learning Verbal Memory Test (Table 2). Experimental
subjects performed significantly better than control subjects
on their recall of words on the fifth learning trial (p <.038).
Experimental subjects also performed better than control subjects,
although to a non-statistically significant degree, on the following
tests number of words recalled (p <.253), delayed recall (p
<.248), and words recalled after interference (p <.158).
There was no difference between the two groups in their collective
capacities On the test involving the number of false-positive
errors on the recognition task (CP <.602).
Phenomenological Assessment
The Hallucinogen Rating Scale was completed by each of the 15
UDV subjects within 1 hour following the close of the experimental
hoasca session, where a variety of medical and biochemical parameters
had been assessed. Analysis of the 126-item HRS yielded findings
placing the hoasca experience in the mild end of the spectrum
when contrasted to the highly potent, short-acting intravenous
dimethyltryptamine (DMT) experience. Whereas the highly intense
DMT experience is over in less than 30 minutes, the full hoasca
experience lasts on average 4 hours. The analysis of data revealed
that the clinical clusters of the HRS for the hoasca subjects
scored in the relatively mild range when contrasted with prior
investigations of the effects of intravenous DMT (Strassman et
al., 1994). The clusters of intensity (1.633 +.533), affect
(.947 +.229), cognition (.908 +.494), and volition (1.309 +
.429) were compatible to an intravenous DMT experience between
a dosage level of.1 and.2 mg/kg, whereas the cluster of perception
(.484 +.501) was comparable to an intravenous DMT experience
of.1 mg/ kg and the cluster of somatesthesia (.367 +.256) was
less appreciable than the lowest intravenous DMT dose (.05 mg/kg)
used..
Life Story Interviews
All 15 experimental subjects provided detailed information about
their personal histories, with particular emphasis on how their
involvement with the UDV and experience with hoasca had impacted
the course of their lives. Their age range at the time of the
study was from 26 to 48 years, with a mean age of 37. Two had
been born into the UDV, whereas the other 13 had formally been
members for 10 to 18 years, with a mean duration of membership
of 14 years. Three were currently maestres (church healers), two
were sons of senior maestres, and one was the son-in-law of a
senior maestre.
Many of the subjects reported a variety of pervasive dysfunctional
behaviors prior to their entering into the UDV. Eleven subjects
reported having a history of moderate to severe alcohol use prior
to entering the UDV, with five of them reporting episodes of binging
associated with violent behavior. Two had been jailed because
of their violence. Four subjects also related prior involvement
with other drugs of abuse, including cocaine and amphetamine.
Eight of the 11 subjects with prior histories of alcohol and other
drug use and misuse were addicted to nicotine at the time of their
first encounter with the UDN and ritual hoasca use. Additional
self-descriptions prior to entry into their church included impulsive,
disrespectful, angry, aggressive, oppositional, rebellious, irresponsible,
alienated, and unsuccessful.
All 15 of the UDV subjects reported that their experience with
ritual use of hoasca as a psychoactive ritual sacrament had had
a profound impact on the course of their lives. For many of them,
the critical juncture was their first experience under the influence
of the hoasca. A common theme was the perceived belief while in
the induced altered state of consciousness that they were on a
self-destructive path that would inevitably lead to their ruin
and even demise unless they embarked on a radical change in their
personal conduct and orientation. Some examples included: "I
had a vision of myself in a car going to a party. There w as a
terrible accident and I could see myself die." "I was
at a carnival, on a carousel, going around and around and around
without ever stopping. l didn't know how t o get off. I was very
frightened." "I could see where I was going with the
life I was leading. I could see myself ending up in a hospital,
in a prison, in a cemetery." "I saw myself arrested
and taken to prison. They were going to execute me for a horrible
crime I had committed." Subjects also reported that while
in the throes of their nightmarish visionary experience, they
would encounter the founder of the UDV, Maestre Gabriel, who would
deliver them from their terrors: "I saw these horrible, ugly
animals. They attacked me. My body was disassembled, different
parts were lying all over the ground. Then I saw the Maestre.
He told me what I would need to do to put all my body parts back
together." "I ran through the forest terrified that
I was going to die. Then I saw the Maestre. He looked at me. I
was bathed in his light. I knew I would be okay." "I
was in a canoe, out of control, going down the river. I thought
I would die. But then I saw Maestre Gabriel in a canoe in front
of me. I knew that as long as I stayed with the Maestre I was
safe."
Subjects reported that since entering the UDV their lives had
gone through profound changes. In addition to entirely discontinuing
alcohol, cigarettes, and other drugs of abuse, subjects emphatically
stated that their daily conduct and orientation to the world around
them had undergone radical restructuring: "I used to not
care about anybody, but now I know about responsibility. Every
day I work on being a good father, a good husband, a good friend,
a good worker. I try to do what I can to help others.... I have
learned to be calmer, more self confident, more accepting of others....
I have gone through a transformation." Subjects emphasize
the importance of "practicing good deeds," watching
one's words, and having respect for nature. Finally, subjects
report experiencing improvement in their memory and concentration,
continual positive mood states, fulfillment in their day-to-day
interactions, and a sense of meaning and coherence to their lives.
Subjects unequivocally attributed the positive changes in their
lives to their involvement in the UDV and their participation
in the ceremonial ingestion of hoasca They saw the hoasca as a
catalyst in their psychological and moral evolution, but were
quick to point out, however, that it was not the hoasca alone
that was responsible, but rather taking the hoasca within the
context of the UDV ritual structure. Several of the subjects were
in fact quite critical of other Brazilian groups which utilize
hoasca in less controlled and less focused settings. Subjects
described the UDV as a "vessel" that enables them to
safely navigate the often turbulent states of consciousness induced
by hoasca ingestion. The UDV is their "mother... family
... house of friends," providing "guidance and orientation"
and allowing them to walk the "straight path." They
emphasized the importance of "uniao," or union, of the
plants and of the people. Without the structure of the UDV, the
subjects contended, hoasca experiences may be unpredictable and
lead to an inflated sense of self. Within the "house of the
UDV," however, the hoasca-induced state is controlled and
directed "down the path of simplicity and humility."
Discussion
As this investigation was a first attempt to study the phenomenon
of hoasca use from a biomedical perspective, and as the setting
for the study was relatively primitive (the Brazilian Amazon),
these results need to be viewed as preliminary and tentative.
Nevertheless, the findings presented are intriguing and to some
degree unexpected. Psychiatric diagnostic assessments revealed
that although an appreciable percentage of our long-term hoasca-using
subjects had had alcohol, depressive, or anxiety disorders prior
to their initiation into the hoasca church, all disorders had
remitted without recurrence after entry into the UDV. Such change
was particularly noticeable in the area of excessive alcohol consumption,
where in addition to the five subjects who had CIDI diagnoses
of prior alcohol abuse disorders, six additional subjects reported
moderate patterns of alcohol consumption that fell short of achieving
actual psychiatric diagnostic status on formal structured interview.
All 11 of these subjects with prior involvement with alcohol achieved
complete abstinence shortly after affiliating with the hoasca
church. In addition to their chronic substance use problems, subjects
were also quite emphatic that they had undergone radical transformations
of their behavior, attitudes toward others, and outlook on life.
They are convinced that they had been able to eliminate their
chronic anger, resentment, aggression, and alienation, as well
as acquire greater self-control, responsibility to family and
community, and personal fulfillment through their participation
in the hoasca ceremonies of the UDV. Although the salutary effects
of a strong group support system and religious affiliation cannot
be minimized, it is not inconceivable that the long-term use of
the hoasca itself may have had a direct positive and therapeutic
effect on our subjects' psychiatric and functional status. Prior
biochemical analyses of hoasca preparations have identified significant
monoamine oxidase inhibitor action (McKenna et al., 1984), and
may be relevant to these clinical findings.
Personality evaluation utilizing the Tridimensional Personality
Questionnaire revealed significant differences between the UDV
subjects and normal controls on both the novelty seeking and harm
avoidance domains, but not on the reward dependence domain. The
UDV subjects scored significantly lower on both the novelty seeking
and harm avoidance dimensions as compared with control subjects.
Individuals who had relatively low scores on novelty seeking have
been described in the psychiatric literature as reflective, rigid,
loyal, stoic, slow-tempered. frugal, orderly, and persistent (Cloninger,
1987b). Low novelty seeking scores are also associated with overall
behaviors consistent with high social desirability and emotional
maturity (Cloninger et al. 1991). Individuals with low harm avoidance
scores are described as confident, relaxed, optimistic. carefree,
uninhibited, outgoing, and energetic (Cloninger, 1987b). The association
of low novelty seeking with low harm avoidance has been identified
with the traits of hyperthymia, cheerfulness. stubbornness, and
overconfidence (Cloninger, 1987b) As the personality dimensions
measured on the TPQ are thought to be heritable tendencies; a
pertinent question arising from these results is whether the personality
attributes as measured here have been influenced by long-term
ceremonial consumption of hoasca or rather are they factors predictive
specifically for individuals becoming involved with such a process
as the UDV?
A similar problem arises with the interpretation of the neuropsychological
data. Although long-term UDV hoasca-imbibing subjects scored significantly
higher on neuropsychological testing compared with their hoasca-naive
controls, as measured on the WHO-UCLA Auditory Learning Verbal
Memory Test, the lack of retrospective data makes it impossible
to determine whether the hoasca "tea" has had a cognitive
enhancing effect or not. Although our UDV subjects spoke at length
of how the hoasca had improved their powers of memory and concentration,
the current methodology was not designed to definitively substantiate
this connection. Only with comparative evaluation to neuropsychological
performance prior to their very first experience with hoasca consumption
can a comprehensive understanding of the long-term effects of
hoasca on cognitive status be established. Also, only by administering
such measures on naive subjects, and then following them prospectively
over time with serial evaluations as they became involved with
the UDV and ritual use of hoasca, can we definitively ascertain
whether the hoasca does indeed improve cognitive status. The methodological
approach utilized for the present study was only intended to be
preliminary and exploratory, and did not possess the necessary
logistics which would have allowed for such a prospective study.
Indications are, however, that given the presented data analyses,
the long-term consumption of hoasca within the structured UDV
ceremonial setting does not appear to exert a deleterious effect
on neuropsychological function.
This study has been an initial attempt to rigorously apply contemporary
research models and tools to the little-studied phenomenon of
ceremonial use of the plant hallucinogen hoasca. Although with
a long tradition of use among the indigenous peoples of the Amazon
Basin, widespread medicinal application by the mixed race mestizo
populations, and 20th century development of the syncretic churches
of Brazil, medical and psychiatric researchers have up to now
failed to address the question of what are the effects of this
highly unusual psychoactive botanical. Testimonials of its putative
health-enhancing and restorative effects need to be explored,
as do allegations of its potential for deleterious outcome. The
establishment of legal sanctions within a religious context in
Brazil provides an important and necessary prerequisite for future
objective and comprehensive investigations. The ceremonial use
of hoasca, as studied within the framework of this research project,
is clearly a phenomenon quite distinct from the conventional notion
of "drug abuse." Indeed, its apparent impact upon the
subjects evaluated in the course of our inquiries appears to have
been positive and therapeutic, both in self-report and objective
testing. There is clearly a need to pursue rigorous and comprehensive
follow-up studies to the preliminary explorations reported here,
not only to further elucidate the unique phenomenon of hoasca
use within a highly structured ceremonial setting but also because
of growing interest and use of hoasca in North America and Europe.
It will be imperative to carefully delineate the potential for
adverse effects as well as to establish the optimal safety parameters
within which hoasca might be taken. In this light, careful study
of the ceremonial structure and safeguards of such groups could
facilitate future research development. It is our hope that subsequent
endeavors to investigate the hoasca phenomenon will explore these
matters, and determine whether our preliminary findings can be
replicated. Regardless of whether these results will ultimately
be corroborated, we believe we have demonstrated that this fascinating,
albeit neglected, phenomenon can be rigorously studied utilizing
state of the art tools of research investigation.
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TABLE 1
Personality Testing in 15 Long-Term Hoasca Users and 15 Matched Controls
(back to text)
|
| TPQ | Subjects | Controls | t | p |
|---|
|
| Novelty Seeking | | | | |
| NS1: exploratory excitability vs. stoic rigidity | 3.78 ± 1.12 | 5.00 ± 1.79 | -2.08 | .049** |
| NS2: impulsiseness vs. reflection | 1.57 ± 1.34 | 2.81 ± 2.27 | -1.71 | .100 |
| NS3: extraxagance vs. reserve | 3.00 ± 1.30 | 3.36 ± 1.43 | -.66 | .514 |
| NS4: disorderliness vs. regimentation | 2.00 ± 1.11 | 3.64 ± 2.01 | -2.59 | .016 |
| NS total: NS1 + NS) + NS3 + NS4 | 10.36 ± 2.27 | 14.82 ± 4.81 | -3.07 | .0054** |
| Harm avoidance | | | | |
| HA1: anticipatory worry vs. uninhibited optimism | 1.21 ± 1.37 | 2.36 ± 1.97 | -1.72 | .098* |
| HA2: fear of uncertainty vs. confidence | 2.93 ± .73 | 4.09 ± 1.87 | -2.14 | .043** |
| HA3: shyness with strangers vs. gregariousness | 1.93 ± 1.77 | 3.27 ± 1.68 | -1.92 | .067** |
| HA4: fatigability and asthenia vs. vigor | 1.93 ± .92 | 3.00 ± 2.45 | -1.51 | .144 |
| HA total: HA1 + HA2 + HA3 + HA4 | 8.00 ± 3.57 | 12.45 ± 4.55 | -2.75 | .011** |
| Reward dependence | | | | |
| RD1: sentimentality vs. insensitiveness | 4.21 ± .89 | 3.90 ± 1.58 | .61 | .547 |
| RD2: persistence vs. irresoluteness | 4.43 ± 1.74 | 4.45 ± 1.86 | -.04 | .972 |
| RD3: attachment vs. detachment | 4.71 ± 1.94 | 4.27 ± 2.41 | .51 | .616 |
| RD4: dependence vs. independence | 1.93 ± 1.21 | 1.73 ± 1.62 | .36 | .725 |
| RD total: RDI + RD2 + RD3 + RD4 | 15.29 ± 2.76 | 14.36 ± 3.91 | .69 | .496 |
(back)
TABLE 2
Neuropsychological Testing in 15 Long-Term Hoasca Users and 15 Matched Controls
(back to text)
|
| WHO-UCLA Auditory Verbal Learning Test | Subjects | Controls | t | p |
|---|
|
| Words recalled on 5th learning trial | 11.21 ± 1.93 | 9.50 ± 2.07 | 2.19 | .038** |
| Words recalled after interference | 9.53 ± 2.72 | 8.16 ± 1.99 | 1.45 | .158 |
| Delayed recall | 9.53 ± 2.64 | 8.41 ± 1.62 | 1.28 | .248 |
| No. of words recealled | 14.33 ± .72 | 13.75 ± 1.76 | 1.17 | .253 |
| No. of false positive errors on recognition task | 1.06 ± 1.10 | .83 ± 1.19 | .53 | .602 |