Ayahuasca-assisted addiction treatment in Peru: qualitative results from a multi-year, mixed-methods study

Ayahuasca is a traditional plant medicine from the Amazon that is gaining global recognition for its potential in recovery from alcohol and other substance use disorders. The Ayahuasca Treatment Outcome Project (ATOP) is a longitudinal multi-site mixed-methods study of treatment outcomes that includes a government-accredited all-male therapeutic community in the Peruvian Amazon. The treatment protocol involves Traditional Amazonian Medicine (TAM), individual and group psychotherapy processes, and a therapeutic community milieu. TAM treatment components include multiple ayahuasca ceremonies in addition to plant medicine retreats (dietas) and other locally-influenced rituals. The ATOP study protocol integrates several measures of addiction severity, mental health, quality of life, and spiritual beliefs with semi-structured qualitative interviews conducted at baseline and discharge, then 3, 6-, 12-, and 24-months follow-up. In this paper we discuss the qualitative data yielded from baseline, discharge, and 12-month follow-up interviews for 52 participants that reached the one-year milestone. We identify main themes in treatment motivation and expectations and previous treatment experiences at program intake, then describe participants’ subjective reports of changes in well-being, components of the program viewed as particularly important and perceptions of treatment efficacy. Interviews with staff and practitioners are also presented and compared to patient understandings of treatment components and perceptions of efficacy. ATOP is the first longitudinal mixed-methods study of the therapeutic use of a psychedelic for addiction treatment in a naturalistic setting that employs such a robust set of measures, a mixed-methods design, and with such successful structured follow-up of this duration (80% completion at 12 month follow-up). Lessons learned from this evaluation process lend insight into complex interventions for addiction recovery and their evaluation. In addition, we learn what aspects of this innovative and complex intervention can inform the design, implementation and evaluation of the rapidly emerging psychedelic-assisted therapies.