As Rick Doblin, founder and executive director of the Multidisciplinary Association for Psychedelic Studies (MAPS), Rick Doblin, mentioned in the second installment of his three-part interview with Points (Part I is here), the organization — part psychedelic research lab, part advocacy group, and part pharmaceutical company — has begun a slew of interesting and productive studies on the uses of psychedelic drugs like ayahuasca and ibogaine for the treatment of all manner of addictions. In this, the final piece of his talk with Points, Doblin discusses that work. He also expounds upon his and MAPS’ particular understanding of addiction and situates it within a historical context that even includes AA co-founder Bill W.
Points: I know you’re doing some really interesting work on addiction and addiction treatment. That’s an area on which Points frequently focuses, and I think our readers would be particularly interested in hearing about it.
Doblin: Well, if we go all the way back to Carl Jung and the early part of the previous century, he had the sense that there would be a spiritual component to the treatment to addiction. And Bill W. who started AA, tried LSD when he was sober in the 1950s, and he thought that it had tremendous potential for the treatment of addiction. And it’s actually written about in the book Pass it On, which was published by AA about Bill Wilson’s life. [Ed. Note: Speaking of Jung and Bill W., the AA founder’s letter to the philosopher can be read here. Jung’s reply is here.] So the sense is that there is a lot of denial going on in addiction. There are a lot of things that people are not seeing. In a supportive context, psychedelics affect the membrane that separates the conscious from the unconscious. And particularly with the more classic psychedelics like LSD or psilocybin, there is a flood of material that people have tried to suppress or tried to deny, the whole denial process. People make a fuller accounting of their lives and what they’re doing. And then there’s also the potential for a spiritual connection that people have under psychedelics that they can then draw strength from. And based on that connection they can move forward in their lives and feel connected. A lot of drug abusers don’t feel connected to themselves, to others. They are separated from love and they seek support in the drugs. And with a deep spiritual experience that can come from psychedelics, people can draw strength from it.
Now ibogaine has a particular, relatively unique property in that it helps people through the withdrawal process from opiates. There are ibogaine clinics all over the world, except the United States and a few other countries where ibogaine is illegal. It’s not a drug of abuse, but we just have a culture that criminalizes substances that produce non-ordinary states of consciousness. Now, ayahuasca is something that has been used also in the treatment of addiction. It doesn’t help so much with the withdrawal process, but it again helps people to acknowledge the things that they have been denying, and it can give people a spiritual connection.
So, what we see is that there are a lot of different approaches to the treatment of addiction. I think people are surprised that what other people call a drug of abuse, psychedelics, can also be helpful in the treatment of abuse. That’s not really surprising if you recognize that all drugs have risks, all drugs have benefits, and what really matters is the relationship between the person and the drug – how it’s being used, in what context – and that you can end up having productive experiences if you approach it that way. Other people might approach the same drug in a different way and have an experience that ends up making them feel worse off. So, what we’re trying to understand is what role these drugs can play in the treatment of addiction.
There was a series of studies that were done in Russia in the 1980s and 90s with ketamine, a psychedelic drug, in the treatment of alcoholism and opiate addiction. And there were really good results from those studies, but unfortunately ketamine started being used recreationally in Russia, and the Russian government has a very heavy handed approach, very similar to our US government’s approach to marijuana. So ketamine was criminalized in Russia – and not only that, it was taken out of research context as well.
Points: It sounds like your model of addiction differs from the traditional disease concept, but it also sounds like it differs a little from other sociological and neurological concepts. How would you explain your concept of drug addiction? In what way does it differ from the disease model and others?
Doblin: Well, the disease model has some advantages. Because what it does is try to destigmatize [addiction]. Somehow or another it’s a biological situation and we need to be compassionate toward people. And to the extent that the disease model helps to destigmatize addiction and addicts and helps to promote treatment instead of incarceration, it’s a good thing. But I think it’s fundamentally incomplete, because I think it minimizes to too great a degree the element of choice. You can get lazy about choices, you can get into bad habits, but I think there still is a degree of personal responsibility and personal opportunity for people to make a change. We see that in cigarette addiction – we see that all over the place. People can just for whatever reason say enough’s enough, and then they turn themselves around.
So I think the disease model, by underemphasizing the role of choice, also tends to underemphasize the role of therapy and the role of psychedelic psychotherapy. People are told, “Here, we’re going to give you a vaccine to take [to inoculate you] against drug addiction” – that’s the latest effort. Or they’ll say, “We’re going to particularly prescribe abstinence.” I think that’s another big area where the disease model is associated with the goal of treatment as complete and total abstinence. And not just from that drug, but usually from other drugs. But AA is notorious for people smoking cigarettes and drinking coffee! So the idea that some drugs are okay, I guess, and others aren’t…I think that because we are in a society that is moralistic and punitive, to a large extent the disease model is helpful.
But the other big difference between what we’re doing and the disease model is how we evaluate success. In our studies, we use the addiction severity index, which is the key measure for studies of addiction. But our definition of success is not total abstinence. There is a lot of talk about how people have used marijuana to help them reduce their consumption of alcohol. And marijuana is less problematic than alcohol. So we’re comfortable with this idea of gradual improvement. We’re not moralistic about how drug use is inherently immoral; we’re just trying to improve people’s lives on average. We recognize that there are relapses, but we place more emphasis on people coming to grips emotionally and psychologically with what they are doing and then making choices to act differently in the future.
Bill W. also said that people need to hit bottom before they’ll make the necessary changes in their lives. What that implies, though, is that there is a choice. You hit bottom, you can see clearly, you can no longer deny it, and then you can make a choice again to act differently. But, in a sense, the idea with psychedelics is that you can precipitate the psychological hitting bottom, and people can clearly see what they’re doing. [Addicts] can precipitate that with psychedelics: do it at a time before they have destroyed their families, destroyed their relationships, destroyed their work environment, destroyed their health, gotten involved with the criminal justice system. They can precipitate that kind of confrontation with what they are doing with their lives at a point where they still have some support system left. And it’s this psychological hitting bottom that is the key. You can recognize that you are wasting your life, or withering it away, or hurting other people without it having to go totally into destruction. So, that’s one of the main ideas here. We can precipitate a kind of psychological hitting bottom and then people can see clearly and then have enough will power to make a choice to try to improve their lives.
Points: I think I also hear in your concept of addiction a spiritual component that differs from, say, AA’s or those underlying Christian and other religious drug rehab programs. What would you say about that?
Doblin: I would say that you heard right. I think there is a sense, too, that for those people who do have that sense of spirituality, it’s a sense of connection, and people can draw strength from that. And so you can have a difficult life environment – you could have lost your job, you could have a lot of stressors – but then you have a certain resilience in how you respond because people have a sense that they are still connected to life itself and that there is something magical and beautiful about that connection. There is a strong spiritual element in the psychedelic therapy, but what we don’t say is that spirituality, this spiritual connection, is somehow more important than acknowledging our personal psychodynamics. It’s like a rainbow, and there are all these different colors that form the rainbow, but no one color is better than any other.
There is a spectrum of consciousness – some of it related to our personal biography, some of it related directly to our parents, and then others are more spiritual. And it’s not that the spiritual is the most important, but many of us have lost touch with the spiritual, and that’s where people are longing to feel reconnected. So there’s one part which is this sense of strength, as I said, and another big thing is the sense of how precious time is and how precious our lives are and how little time we have here on earth. And there’s sort of a tragic aspect of wasting it. To that extent, to where you see how beautiful, how rare and amazing it is that we are alive at all, [the spiritual aspect] can help people to appreciate the moment more and then give them courage to make the hard choices to build a more productive life for themselves.