Ibogaine in the Psychospiritual Treatment of Addiction

Feeding the Hungry Ghosts: Ibogaine and the Psychospiritual Treatment of Addiction originally appeared in the Spring 2010 bulletin for the Multidisciplinary Association for Psychedelic Studies (MAPS), and was later republished in the anthology Manifesting Minds: A Review of Psychedelics in Science, Medicine, Sex, and Spirituality.

One of the most precious experiences in my life has been the opportunity to work with Kaariina Saarineen, a Canadian medicine woman who blends teachings from the Tibetan Buddhist and Ojibwe traditions, among others.

Until our meeting I had never encountered a force so wild, persuasive and consistent. I am still amazed at the depth of love and presence it must have taken to commit to leading a group of the young and the lost, mostly without any compensation for her role, through years of at least weekly rituals, to meetings with strong native elders, out of the city, to fire, to sweat, to smoke, to sit, to watch the sunrise standing on dew covered hills wrapped in the quiet rhythm of a skin drum.

Through all of her teachings, which echoed the voices of grandmothers and teachers around the world, the common thread was to remember that suffering and disease can be traced to our feeling of not having enough. There is desire and hunger in us, at the genetic and cellular level. Whether we feel for life, for love, for the cosmos, reacting to this hungry with a fear that it will consume rather than deepen us has the power to drive us towards unconscious behavior and away from those very experiences.

In the context of my current work, I sometimes think back on this as my preventative addiction treatment. Since 2009, I’ve been working in the field of ibogaine for the treatment of substance dependence and personal growth. Ibogaine is the primary alkaloid in Tabernanthe iboga, a West African perennial shrub that is used in traditional ritual of healing and rites of passage. Over the past few decades, despite the practical dearth of peer-reviewed human research and funding for clinical trials, ibogaine has become recognized as an effective, however controversial and potentially risky, treatment for addiction.

Its most often referenced and utilitarian function is it’s incredible ability to ease or sever withdrawal symptoms and cravings from even long-time opiate dependencies. Used effectively, people can walk away from years of regular use without the prolonged discomfort of withdrawal, which is one of the largest barriers to treatment. But this pharmaceutical marvel comes intrinsically associated with African tribal religion, some of the world’s most marginalized populations, and a challenging visionary journey. And personally, I don’t know if it could come any other way.

The prohibitionist policies of the global war on drugs were born in the harbors of west coast North America, at the end of the geographical frontier. They were ratified in a measure to suppress the Chinese populations that were forcibly enlisted as labor for the western expansion.

The effect is illustrated clearly in Vancouver’s downtown eastside, which has one of the most dense demographics of drug users in the world, a small portrait of how intensely prohibitionist policies have successfully stressed and marginalized without reducing drug consumption. Meanwhile, the DTES has also become a globally recognized force in the fields of activism, research and cutting edge harm reduction initiatives.

There are two Vancouver thinkers that have offered particularity poignant insights into drug use and addiction. One is Dr. Bruce Alexander, the creator of the famous Rat Park experiment, which showed that standard breed laboratory rats decreased self-administration of morphine when free to roam in more ideal living conditions. His most recent book, The Globalization of Addiction, outlines a model for understanding drug abuse based on patterns of social dislocation. According to Alexander, addiction surfaces in civilization as a byproduct of free-market capitalism, in which stress and competition are maximized and we are dislocated from family, culture and traditional spirituality.

Wheel of Samsara

Another Vancouver keynote is Dr. Gabor Mate, whose best-selling book In the Realm of Hungry Ghosts, recounts stories from his work as a physician in the DTES. Mate, like many researchers, notices that every case of severe addiction he’s witnessed can be linked to childhood traumas. Yet, many of these are chronic and intergenerational. He looks through many bio-psycho-social mechanisms of addiction, all of which contribute insight, but suggests the best way to characterize the deep personal experience of addiction is as a spiritual experience.

To visualize this, he uses the lens of the Buddhist Wheel of Samsara, on which there are six realms of unconscious living. In each, Buddha appears to reveal the path to liberation. In the realm of hungry ghosts he arrives standing on a rainbow, feeding light that pours from his hands to the starving souls that inhabit the realm. What this artistically depicts is a far cry from contemporary tactics like criminalization and forced treatment, perhaps teaching that no matter on which side of the fence we find ourselves, the security we are looking for is something we draw forth and reveal from within.

Obviously, addiction is inherently dynamic—it is at once both a deeply personal battle and a global-scale issue. It is difficult to quickly describe exactly the ways in which covering up personal pain with drugs, and politically dealing with “the drug problem” by instituting jail time, forced treatment, or habitual displacement, feed off of each other, but it’s clear that they are parts of the same activity.

Mate’s work cites some of the astounding biochemical dynamics between a mother and child, and specifically how crucial dopamine production in a newborn is catalyzed by stimuli as subtle as wider dilation of a nursing mother’s pupils. Even under ideal conditions, in such a delicate response system there must be endless miscommunications and countless unmet needs, which will eventually encourage a child to become emotionally independent.

On a primal level, feelings of not having enough are what drive the animal mind to migrate. Any perceived lack will activate the survival response to seek out a more stable supply of resources—whether those resources are emotional or practical, essential or acculturated.

Neurochemical imbalances might begin during development, to be later affected by much more complex accumulation of social factors, including all the readily available stressors of cultural dislocation, malnutrition, sexual violence, etc. What we know as addiction surfaces when an unmet need is so acute, and the stimulus reward so powerful and temporary, that it overrides the evolutionary response and leads to a chronic behavior.

I can see now that Kaariina’s medicine was to reawaken practices that were primary to our isolation from nature and original culture, and to do it with such accuracy and intensity that many of our learned behaviors were overridden by a deeper, global, evolutionary urge. Even in the case of those behaviours that weren’t, we had the opportunity to see and confront what was underneath them.

Ibogaine can have a similar effect, on multiple levels. It physiologically renews the neurotransmitter system to the extent that accumulated drug tolerances are reset. It initiates fully conscious REM, allowing deep subconscious images to surface. During the experience, cellular energy metabolism slows, and then is improved greatly for up to months afterwards.

Through the lens of cultural dislocation theory, the particular magic of ibogaine is that it is the extract of a root medicine from an indigenous culture in equatorial Africa. Through the lens of the realm of hungry ghosts, this magic might be better understood in looking more closely at the mysterious energy of death surrounding ibogaine.

In Bwiti, the contemporary ritual culture in Gabon, ingesting iboga is directly associated with death. The nighttime rituals, or Nzogos, have three distinct stages: the Efun, the genesis or beginning; the Mvenge, the death; and the Meyaya, the beyond. During the night, the initiate, or banzi, is brought into the realm of the dead, where they meet their ancestors in order to receive teachings and support, not only for themselves but for the entire tribe.

This has been witnessed in the context of addiction treatment. Anwar Jeewa, Director of the Minds Alive clinic in South Africa, claims that of his clients who reported experiencing visions, up to 70% say that they saw a deceased person they have known appear to them.

The acute physical effects of large doses include an overall decrease in life force. This appears as reduced energy, a slowed heart rate, sometimes into bradycardia, and ataxia, a gradual loss of limb coordination.

There are those who have actually crossed the threshold. According to research by Dr. Kenneth Alper of the NYU School of Medicine, as of 2008 there were 19 deaths that occurred within 72 hours of the ingestion of ibogaine. None of these deaths are attributable directly to ibogaine, and there is currently no evidence of neurotoxicity. Alper attributes all of the reports to one or a combination of known risk factors1, all of which are identifiable.

Although ibogaine treatment is unregulated and practices still vary widely, almost all providers, even those who operate underground, screen clients for pre-existing heart conditions prior to treatment. In addition to that, many providers make a verbal life contract with each client prior to administration. No one is given medicine until they agree that if they are offered any opportunity to permanently leave their body, they will come back. At least several people have stories of being offered the choice—seeing themselves peacefully drifting out into the open ocean, or drifting farther away from their body below them—and then remembering their agreement to return.

These stories are not the norm, and the statistics are closely in line with mortality rates associated with other treatments such as methadone maintenance, but they clearly reflect the seriousness of the journey and its preparation.

One of the gifts of perspective that ibogaine offers is an opportunity to deepen our understanding of what addiction actually is. Brain-centric models, genetic models, and disease models, all fall short in certain respects. Even if we look at the analyses of social dislocation and psycho-spiritual models, while they provide great insight and might help to instill a deeper sense of compassion for the individuals we meet who are struggling with addiction, they don’t contain their own solutions, except to call for sweeping social changes.

Of course, a more thorough investigation would find many similar changes would also be necessary for ibogaine treatment to become more readily accepted and available.

In any case, the metaphorical path through death and rebirth emerges constantly, cycling back to the principles from the Buddhist cosmology. Perhaps under the stratification of the ancient world, liberation from the realms of unconscious living might have taken a lifetime or more of karmic clearing. But, with a medicine that can reliably potentiate a spiritual renewal of the same magnitude, rebirth onto a new path could happen as soon as we are able to retrieve it.

Images used courtesy of a Creative Commons license.