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Sunday, September 25, 2022

Psychedelic 12-Step Program: How a New Approach Is Saving Lives

In 2002, Dimitri M. was ready to die. He’d been addicted to heroin for over 20 years, and his once-promising artistic life had collapsed into a series of banal pit stops: from the methadone clinic, to the valet parking gig, to the coke dealer, to the dope dealer, to the bed, and over and over again. Eventually, his longtime partner succumbed to intravenous drug use, and, though they were married by common law, he was barred from attending her funeral.

Dimitri was ready to finally let the drugs carry him away, like an undertow. He planned to take a trip to Greece as a last goodbye to his ancestral homeland, but while researching his farewell voyage, he was reminded of a conversation with an old friend about a hallucinogenic plant with the purported power to heal opioid addiction. He embarked on his trip as planned, but scheduled a brief detour in the Netherlands to be treated with this so-called miracle drug: Ibogaine. Though the alkaloid extract of the Tabernanthe iboga plant with psychoactive effects is illegal in the United States, Ibogaine has been used for decades by the Bwiti people of Gabon as a sacrament in a coming-of-age ritual, akin to a Bar Mitzvah.

According to some estimates, the success rate for opioid users who attempt to quit using conventional methods is as low as five to 10 percent. A large part of what makes the endeavor so difficult is the intense physical withdrawals that accompany detox. Within 12 hours of an individual’s last opioid use, intense nausea, vomiting, soreness and restlessness take hold, an experience often described as being excruciating and traumatic. Ibogaine induces a psychedelic experience that often causes users to take an unflinching and critical look at their lives. The plant is said to embody the spirit of a harsh and loving patriarch that confronts an individual during their hallucinations. Ibogaine can also limit and even eliminate the symptoms of withdrawal for reasons that still aren’t entirely understood. 

Dimitri found himself tossing and turning, sweating and vomiting while processing 40 years of trauma and guilt. He recalls plunging through these intense emotions while staring at posters of pop stars on the bedroom walls of the ibogaine provider’s teenage daughter. He maintains that while the experience was tense and difficult, he never felt like he was in opiate withdrawal. But when he came out of it, he was clean. He then continued to the Greek Island of Icaria, not to die, but to celebrate his renewed passion for life. Dimitri says he never used heroin or cocaine again.

In the decade following his treatment, Dimitri would illegally provide Ibogaine to desperate addicts in hotel rooms across New York City, people who couldn’t afford to leave the country for the treatment. He says he’s earned his 10,000 hours of providing this specialized treatment which, aside from proper dosing and monitoring a patient’s vitals, can vary widely depending on the person. “It depends on biology and biography,” he says. “You really need to be with someone for at least 72 hours. It’s comforting folks, cleaning, encouraging people, holding their hand if they get afraid, or singing them songs.”

In 2011, he was eventually lured out of state and busted by the DEA for administering a Schedule I drug. What followed was a nearly three-year-long ordeal that ended with him pleading to a single misdemeanor. As a result, he became perhaps the most visible proponent for Ibogaine treatment. “I don’t know that I had much business doing this, but I’m not sure I had any less business than anyone doing this at Johns Hopkins or NYU or any of the training programs around the country,” he says. “I would say as a dope fiend and as someone with holistic experience, maybe I could relate to folks in a way that they couldn’t.” Dimitri identifies as coming from a tradition of “wounded healers,” a term originally coined by Carl Jung, for someone who had overcome a malady, and in turn helped others overcome it as well.

Yet, Dimitri has never been entirely comfortable as the face of Iboga treatment. He knew that it wasn’t Iboga, but rather, something far more commonplace that helped him stay sober: the Alcoholics Anonymous and Narcotics Anonymous 12-step programs that he enrolled in shortly after returning home from Greece. Sure, Ibogaine had diminished his withdrawal symptoms, and provided a spiritual experience that helped him come to terms with his guilt, but the AA/NA program had taught him to live without drugs. And yet, the program’s abstinence-based approach meant he couldn’t openly discuss the role that psychedelics had played for him.

In many ways, the “wounded healer” archetype is the underlying ethos of the 12 step phenomenon: someone who has already begun working through their addiction, or a “sponsor,” helps others recognize and start to overcome their own. Curiously, Jung is also linked to the origin story of AA. In 1930, the Swiss psychiatrist famously told a patient with alcoholism that his only hope for recovery was “a vital spiritual experience.” That same patient subsequently joined a small evangelical Christian fellowship called The Oxford Group, steering the focus of his chapter towards helping fellow alcoholics. Bill Wilson later joined that same chapter to grapple with his own alcoholism, and used the principles of fellowship and a personal development to start his own group called Alcoholics Anonymous. The main difference between the two groups was Alcoholics Anonymous steered clear of Christian themes, yet they maintained “having a spiritual experience” as a key ingredient to the group’s 12 steps to recovery. But the culture of the group depends on the culture in which it exists: During the war on drugs, many people were introduced to AA through court mandates. And these fellowships, particularly in religious areas, became heavily imbued with Judea Christian rhetoric and prayer.

NA and AA revolve around 12 steps and traditions intended to help individuals recovering from addiction to achieve and maintain sobriety and to rebuild their lives. Mainly, the steps have either existential or communal implications: The first step requires one to acknowledge powerlessness over their substance of choice and admit that their use has made their life unmanageable. The eighth and ninth steps involve the recovering individual to make amends with people they hurt during their addiction. Many facets of the group are not unlike self-help tropes, only without gurus or hierarchy. One of the most important traditions of the 12 steps requires all members to remain anonymous. Discussions are to be kept within the group and members introduce themselves by their first names, and sometimes last initial.

Another important tenet of AA/NA is the emphasis on abstinence. The goal is to help people become sober from all substances and stay that way. The program also includes steps that require members to believe in god or “a higher power.” For many, this is a major hurdle. Young people arrested for possession are often required to attend meetings by the courts; for an 18-year-old still grappling with their identity, the idea of surrendering their will to God can be extremely daunting. (Dimitri is adamant that the use of 12-step meetings as a court-mandated punishment is antithetical to the spirit of these fellowships.)

Bill W., as he’s known, became renowned for his work as the co-founder of AA, but he was still haunted by crippling depression. By 1956, he’d developed a friendship with the author and philosopher Gerald Heard who had turned many influential people onto the then-legal hallucinogen LSD. In the summer of 1956, stone-sober Bill Wilson took LSD under the guidance of Heard and LSD researcher Dr. Sidney Cohen. In the months and years that followed, Wilson became convinced that the LSD had a positive impact on him, and believed it could help other alcoholics with the spiritual awakening aspect of the AA program, according to Bay Area religion journalist Don Lattin’s 2012 book Distilled Spirits. But other AA members weren’t thrilled about this experimentation, and his story was told in hushed tones in AA circles for decades; many AA members at the time, and still to this day, felt the story of their abstinence-based group’s co-founder taking psychedelics could hurt the fellowship’s reputation. 

For a few years, Wilson was enthusiastic about LSD’s potential to help alcoholics referring to it as “non-addictive” and “as harmless as Aspirin.” According to Lattin, Wilson likely considered his LSD experiences as more on par with taking a psychotherapist-prescribed pharmaceutical medication, than a potential breach of abstinence. During the 1950’s, LSD had yet to develop the stigma that it would eventually carry. “LSD was thought of as a very useful and powerful tool for therapists to use to help people suffering from things like depression, substance abuse,” says Lattin. “There was a whole first wave of psychotherapy and research that continued into the 1960’s and then it all kind of shut down with the war on drugs.” While researching the book, Lattin uncovered a new letter from Wilson to Carl Jung, in which Wilson alludes to giving LSD to fellow AA members to aid them in their sobriety. Wilson didn’t appear to believe that LSD would help alcoholics become sober, but he did believe that it could assist with the spirituality aspect of recovery, which for many, had become the biggest obstacle in the program.

By 2016, Dimitri was administering Iboga outside of the U.S. as will as psychedelics like MDMA for behavioral issues other than addiction. Psychedelic conferences began hiring him as a speaker. Soon enough, he found himself interacting with more and more people who were sober and active in 12-step programs, but who also regularly took psychedelics to engage with their spirituality. Much like Bill W., they didn’t view it as taking a drug or as a breach of abstinence, but rather as medicine. Along with a few like-minded people in recovery he formed Psychedelics in Recovery — or PIR — the first 12-step group to emphasize psychedelics as a tool for recovery from addiction.

Despite early issues with attendance, the original members soldiered on and began writing official literature for the group. The literature rarely diverged much from the original AA/NA literature, aside from the occasional mention of the use of psychedelics for spiritual growth. It began as a single weekly group with anywhere from three to six people, held in office buildings and living rooms in New York City. Soon, a second group formed in San Diego, but spreading the word proved difficult and by 2019 in-person meetings dwindled. In March of 2020, their meetings, like 12-step meetings worldwide, came to an abrupt halt due to Covid-19.

As the fellowship moved to Zoom, though, attendance skyrocketed. People from across the world began showing up, people in all stages of life and recovery, some even joining from treatment facilities. At the beginning of 2020, PIR consisted of a single weekly online meeting and occasional in-person meetings in New York or San Diego. By the summer of 2020 it had grown to 17 meetings per week with as many as 40 people in a single group.

An average meeting can veer into how a DMT trip might inspire a member to realize the existence of a higher power, or how a Peyote experience may remind a member of the people they hurt during active addiction. Dimitri believes that this is no accident, that psychedelic treatment and the 12 steps were meant to be used in tandem. He says the purpose of both is the pursuit of becoming “a mensch.”

According to Dimitri, the insight psychedelics provide into personal growth has been a saving grace for many who had otherwise plateaued in AA/NA. “There are so many people in 12-step groups whose lives have been saved by [AA],” he says. “But for those who come in 15 years later — deeply depressed, suicidal, or unable to make the next move — there’s an opportunity to find a deeper recovery. A richer recovery.”

Kevin F., a board member for the psychedelic recovery foundation Project New Day, and one of the earliest members of the group, was impressed by impact the pandemic had on PIR’s membership, and looks forward to the day they can return to having traditional meetings. “I think that once it’s safe to go back to in person it’s going to take off more, and I think it will end up being even more interesting,” he says. However, the newfound attention could also bring increased scrutiny. According to Kevin, starting a new fellowship means walking a very delicate line. Certain choices are difficult to make, like which substances are on the table for discussion. MDMA is a synthetic stimulant, but it also holds great therapeutic value for many. Similarly, Dimitri maintains that newcomers are welcome to the group, but he also recommends people in early recovery defer to a sponsor when it comes to using psychedelics. “We’re not promoting the use of psychedelics, we may even discourage some people. It’s a just a safe place to discuss the possibility of trying to incorporate psychedelic medicine into recovery,” says Kevin. The fellowship also recommends that members have another, more traditional 12-step group as their baseline “home group,” as well as a working knowledge of the steps. 

Dimitri is still uncertain of how best to continue the marriage of AA and the psychedelic therapy movement. He has a great distrust for what he calls “the diseasification” of addiction, and asserts that it’s a byproduct of a greed-driven system where the goal is to make a condition, “legible, to make it treatable, to make it billable.”

Dimitri has even found himself suspect of the newfound embrace of psychedelics in the west. Studies on the efficacy of Ibogaine boast a recovery rate for opioid addicts as high as 40 percent, but Dimitri says that this is much higher than his anecdotal evidence has shown. He also predicts that once psychedelic treatments are integrated into the western medical system, efficacy is bound to decline. He emphasizes that psychedelics alone don’t get people clean. It takes aftercare of a kind that’s not nearly so sexy to American clinicians.

“Psychedelics are being presented in this system, and put on a capitalist clock,” he says. “They’re saying [things like] you can come do MDMA for four sessions and your symptoms will go away and then you can go back to work and you can go back to buying things.’ “

The fervor over 18-Methoxycoronaridine, a relatively new chemical compound that attempts to remove Ibogaine’s psychedelic components, leaving only anti-addictive ones, speaks to Dimitri’s concern. 18-MC has garnered significant hype in recent years, and a major investment from a Silicon Valley start-up called MindMed. Yet, Dimitri believes, 18-MC may represent a larger problem: a system that aims to always heal the wealthiest people with the fastest possible solution. Whether it’s psychedelic healing, 12-step recovery or even psychopharmacology, he sees this as the profitability model continuing to trump actual healing. ”The greatest downfall of the harm reduction, 12 step and psychedelic movements was that they sought to be included within those systems,” he says. 

Dimitri’s goal is to offer specialized treatment, tailored to an individual’s needs. He’s on the brink of opening his own psychedelic healing center, a nonprofit called The Cardea Institute, with the author and psychotherapist Ross Ellenhorn. The facility will offer ketamine treatment in Manhattan and psilocybin treatment on the Bahamian island Eleuthera, beginning this summer. He also continues to host harm reduction seminars in Harlem — offering yoga and meditation in the same building as a needle exchange. He remains one of the biggest proponents for psychedelic medicine in the U.S., and one of the biggest critics of how it’s being implemented. 

It’s not uncommon for people in recovery to distance themselves from active drug users once they become sober. Dimitri grew closer to still struggling substance users when he stopped using, and not just as a function of his work. These are the people he visits, calls and works with day in and day out.  Perhaps part of being a wounded healer is not just healing the sick, but walking amongst them. After all, these are the folks that remain closest to Dimitri’s heart. Or, as he puts it, “Drug addicts, whores, and marginalized people are the best people on earth.”

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