At a shamanic ceremony in Mexico, an initiate is deep in his psychedelic visions. Some sort of wreath is placed on his head and the incessant rattling of indigenous instruments strengthens the trance. Candlelight flickers over a puke bucket as the drugged vision-seeker loses muscular control and sinks to the mattress, feeling a profound connectedness to the universe.
It’s a familiar scene to those who have been following the ayahuasca craze, in which Americans have flocked to South America for traditional knowledge-flavored encounters with Amazonian hallucinogenic plants. But this particular ritual is appropriated from Gabon, and it is marketed to heroin addicts. Like many other hallucinogens, ibogaine—the psychoactive compound derived from the roots of the iboga tree—induces several hours of awe, insight, and self-reflection. Unlike the others, however, ibogaine also removes all trace of heroin withdrawal. Users come to with no craving for a hit.
Exploring the frontiers of medicine
Drug recovery begins, so the story goes, with a crucial insight when an addict hits “rock bottom” and finally becomes ready to change. Given the notorious savagery of heroin withdrawal—along with the perceived importance of insight —ibogaine sounds like a panacea. The trouble is, the problem with heroin addiction is not withdrawal.
“I would never relapse when I was actively sick with withdrawal. The horribleness is exaggerated—certainly not as bad as a serious illness,” says addictions expert Maia Szalavitz, who is also a former heroin and cocaine addict. “It’s more like giving up the love of your life. You feel you will never have safety and comfort again.”
Howard Lotsof, who first discovered and popularized ibogaine’s application to addictions in the 1960s, later found there was more to the problem. Having had an intense trip and kicking his own withdrawal, he gave it to a couple of friends. They marveled at how their withdrawal symptoms had disappeared, then decided to go and buy some more heroin.
Physical dependence is only part of addiction, and not even part of its definition. Above all, it is a psychiatric problem. Cocaine, for instance, is powerfully addictive without dependence. Drug addiction is defined as the compulsive use of drugs despite negative consequences. That’s why tough love approaches don’t work; resistance to punishment is an intrinsic part of the condition.
After an ibogaine trip, users tend to describe experiences with a powerful other who describes to them how the world works, including the steps they must take to align themselves to their true paths. Those profound insights may figure prominently in recovery stories, but as Szalavitz argues in Unbroken Brain: A Revolutionary New Way of Understanding Addiction, about 10 percent of addicts are basically ready to quit at any given time and will respond to whatever they try.
“In my experience, I had an insight and went into recovery the next day,” she says. “But those people relapse a lot.”
Szalavitz frames addiction as a developmental disorder. Fewer than 10 percent of addicts develop their habits after their early 20s, when the cortex finishes developing and introduces an adult aversion to risk. Additionally, addicts are usually dealing with some other mental health problem or trauma that makes them vulnerable, and contrary to popular belief, most opiate addictions are not lifelong. They are resolved within five years—a little longer for heroin. The real task is mostly a matter of keeping addicts alive and otherwise healthy (Hepatitis C- and HIV-negative) until they can age out of addiction, preferably without a criminal record.
The best way to do that is well established. Methadone and other long-term maintenance treatments cut mortality in half. They create physical dependence but not addiction, and they form a foundation for a stable life.
Ibogaine was briefly picked up for testing by the pharmaceutical industry, in the early 1990s, but dropped after some cardiac problems emerged. Available on a gray market in Canada and Mexico, it is a Schedule 1 controlled substance in the United States, a list that includes LSD, pot, and, yes, heroin. Perhaps this contributes to its appeal among drug users, who often gravitate to underground culture anyway.
A disease with prayer as an answer is a contradiction.
There are other reasons an addict might shy away from mainstream programs, though. Eighty percent of treatment programs, including court-ordered treatments, are based on the Alcoholics Anonymous 12-step process, which requires surrendering to a higher power. The only reason this blending of church and state has not reached the U.S. Supreme Court is that wherever such treatment orders have been appealed, the appeal courts have agreed that it violates the constitutional right to freedom of religion.
“The official policy is that [addiction]’s a ‘biopsychosocial-spiritual’ disorder,” says Szalavitz. “How are they going to convince people it’s a health problem when you throw ‘spiritual’ into it? They would never use the word ‘spiritual’ for something like depression.”
A disease with prayer as an answer is a contradiction that is somehow no longer seen as a paradox in the troubled-teen industry. Still, other problems arise when a college student with a mild drinking problem is told his first step is to admit that he’s a full-blown, life-long alcoholic. It’s no wonder addicts are turning to other sorts of unearthly experiences that are less infantilizing.
History shows that for the most part, adults don’t want to be addicted to things. At the turn of the century, heroin was an ingredient in many over-the-counter products. When FDA labeling came into effect, consumption of those products plummeted. The issue, then, is that small percentage of the population that is prone to developing a destructive habit.
If ibogaine is the only treatment someone will accept, it may be a useful option to keep on the table, says Szalavitz, but maintenance treatments are by far the better and safer course. For the rest of us, she suggests a revolutionary new approach to our fellow humans who are traumatized and struggling with addiction: “Be nice to them.”