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11 January 2023

Indigenous-Amazonian Traditional Medicine’s Usage of the Tobacco Plant: A Transdisciplinary Ethnopsychological Mixed-Methods Case Study

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1
Faculty of Medicine, University of Zurich, 8057 Zurich, Switzerland
2
Department of Biomedical Research, University Hospital Bern, 3010 Bern, Switzerland
3
Traditional Amazonian Healer, Loreto, Iquitos 1600, Peru
4
Institute of Complementary and Integrative Medicine, University of Bern, 3012 Bern, Switzerland
Plants2023, 12(2), 346;https://doi.org/10.3390/plants12020346
This article belongs to the Special Issue Medicinal Plants: Advances in Phytochemistry and Ethnobotany
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Abstract

Harmful usage of tobacco is a global public health problem associated with adverse health effects and addiction. Yet, in the Peruvian Amazon, the native region of Nicotiana rustica L., this plant is used in remarkably different manners: it is considered a potent medicinal plant, applied in liquid form for oral ingestion to treat mental health problems, a common and ancient healing practice in this region. Using a transdisciplinary field research approach with mixed ethnopsychological methods, this work aimed to report for the first time a case study in this context. The intervention took place in the Peruvian Amazon (Loreto) and involved ritual tobacco ingestion in a weeklong retreat-like frame, administered by a specialized traditional Amazonian healer. The patient was a 37-year-old woman with diagnosed mood, anxiety, and attention deficit disorders, as well as a chronic somatic condition. We applied qualitative experience-sampling during and quantitative symptom assessments pre- and post-treatment. Our findings offer a detailed description of the experiential therapeutic process during the treatment week and suggest clinically relevant improvements in patient well-being. This work is significant in view of the globally prevalent harmful uses of tobacco and the current scientific trend of revisiting herbal psychoactives (e.g., cannabis, psilocybin) for their therapeutic potentials.

1. Introduction

Harmful usage of tobacco is associated with addiction, risk for non-communicable diseases, and, with over a billion smokers worldwide, is a public health problem of global concern [,,,,]. Yet, in the Peruvian Amazon region, the hypothesized birthplace of Nicotiana rustica L. [,], this plant is associated with a remarkably different usage and repute: it is seen as an exceptional medicinal plant, described as a ‘Master Plant’ [,] and as the main curing tool of Amazonian healers []. The Huni Kuin consider tobacco the ‘quintessential healing substance’ [] and the Amazonian Keshwa call it the ‘father of all plants’ [,]. Ethnographic accounts of tobacco as a sacred and medicinal plant are found across the Americas, in conjunction with millennia-old traditions [,]. However, it is particularly in Amazonian traditional healing that tobacco is fundamental; so fundamental that in various Indigenous languages the generic term for ‘healer’ is etymologically linked to the word for ‘tobacco’, for instance in the Yuracaré language, where korrë-n-chata (‘healer’) literally translates as ‘he who eats tobacco’; or in the Asháninka and Matsigenga languages, where the term for healer (sheripiari and seripigari, respectively) translates as ‘the one intoxicated by tobacco’ [,,,,]. The oldest archeological evidence of human tobacco use dates to 12,300 years ago [,,]. The Iberian colonizers encountered the plant in the 15th century, as it was used in healing and cultural practices of the American Natives, and brought it to Europe, from where it quickly spread to the rest of the world [,]. In spite of an initial interest in its medicinal value [], the plant’s large-scale commodification, and its global marketing by an increasingly transnational tobacco industry [,,,,,], propagated hedonic uses; uses which, in direct contradistinction to the plant’s origins in Indigenous medicine, later turned out to be detrimental to health [,]. The loss of Indigenous medicine knowledge on how to prepare and apply the plant for therapeutic purposes may have been crucial in what transformed tobacco from local medicinal plant to global substance of abuse.
Traditional or complementary medicines play an increasingly important role in global healthcare [,,,], with the World Health Organization (WHO) regarding their inclusion critical for universal health coverage []. This is particularly relevant also in the mental health domain, where treatments are known to be underprovided globally (cf. worldwide treatment gap in mental health [,,,,,]). In parallel, in the context of what is often labeled a ‘psychedelic renaissance’, compounds acting on the nervous system, which have formerly been known only for their harmful uses (e.g., psilocybin, cannabis; but also non-botanical compounds such as 3,4-methylenedioxymethamphetamine [MDMA] or lysergic acid diethylamide [LSD]), are now investigated for their therapeutic benefits in rapidly growing numbers of clinical trials [,,,,,,,,,,,,,,,]. In this context Amazonian traditional medicine, due to ayahuasca, has recently become the object of much scientific attention. Made of Banisteriopsis caapi and admixture plants (such as N,N-Dimethyltryptamine [DMT]-containing Psychotria viridis) [,,,,], ayahuasca is a psychoactive brew invented by and used in Amazonian Indigenous medicine—the same medicine system as tobacco. Increasing clinical research points to benefits for depressed patients, anxiety, or addictive disorders [,,,,,,,,,,,,,,], while concomitantly, growing numbers of international health-seekers each year travel to the Amazon to look for healing with Amazonian medicine means [,,,,,,], which, given the plant’s central position in this medicine, often includes tobacco-based treatment. However, in contrast to the bourgeoning research on ayahuasca-based therapies, Amazonian treatments involving tobacco have so far been scientifically underexplored.
The current work aimed to report for the first time a case study in this context. In a previous paper [] we provided an overview of clinically relevant aspects of Amazonian tobacco uses, including indications, contraindications, effects, risks, and adverse effect, in conjunction with different forms (solid, liquid, smoke) and routes of administration (topical, oral, intranasal, etc.). Among these applications, for the mental health domain particularly orally administered liquid-form tobacco (subsequently: “drinking tobacco”) was emphasized. The present work thus focused on this application. We conducted a case study in transdisciplinary collaboration [,,] with a so-called Maestro Tabaquero, a traditional Amazonian healer whose medical specialization focuses on tobacco (a common name for N. rustica in this Amazonian region is mapacho; other names reported in the literature from various Indigenous American groups include for instance sacha tabaco, yé, ya, tsalagayun’li, semaa, asemaa, real tobacco, Native tobacco, wild tobacco, Aztec tobacco, Hopi tobacco [,,,,,,,,,,]. Using a mixed-methods field research approach, we aimed to describe the therapeutic process experience and symptom changes of a patient receiving a weeklong treatment with oral tobacco by a Peruvian-Amazonian Maestro Tabaquero.

2. Results

2.1. Treatment Description and Setting

The treatment took place at the facilities of the Maestro Tabaqueo in the rural Maynas region (Loreto Province) of the Peruvian Amazon. For the eight days of the retreat-like intervention, the patient was accommodated in a simple wooden hut where she remained in solitude, as required by the traditional therapeutic protocol locally known as dieta (Spanish for ‘diet’). As the name suggests, the Amazonian dieta entails a strict nutritional regime for the time of the treatment (only plain vegetable foods; no salt, sugar, spices, oil, etc.), as well as the maintenance of certain rules (e.g., prohibitions on certain foods, sexual abstinence) for some weeks after the treatment (for further detail on Amazonian dietary practices in conjunction with psychoactive plant medicines, see [,]).
During a typical day of treatment, the patient spent the day in solitude in her hut; she was brought food twice a day (early morning and late afternoon), and each day was visited by the Tabaquero around midday. Table 1 shows brief descriptions of the healer’s daily visits to the patient based on the notes of an external observer who assisted the visits with Spanish–English translations. The Tabaquero would first inquire about the patient’s well-being and offer the opportunity to ask questions. He would then proceed to serve the tobacco remedy, an extract of cured tobacco leaves he had prepared at the outset of the treatment week. The dosage per serving was determined by the Tabaquero in the moment of his visits, based on his clinical observations at that time. The latter may be unlike standard biomedical or psychological criteria, involving heuristics from traditional Amazonian medicine (e.g., examination of patient’s subtle energy), which could be essential to the therapeutic benefit and safety of the tobacco-based treatment. The procedure for serving the tobacco was performed via traditional ritual techniques (see Table 1). Thereafter, the Tabaquero would encourage the patient to drink water, which was usually followed by emesis (plant-induced emesis is a common practice in traditional Amazonian medicine associated with depuration [,]). On the eighth day of the treatment, the Tabaquero performed a brief ritual procedure that marked the end of the retreat (corte, ‘cutting’ the diet), after which the patient was served a normal meal (with salt).
Table 1. Daily visits of the healer (Tabaquero) to patient.

2.2. Participant

The participant (subsequently: T.P. or ‘the patient’) was a 37-year-old woman who, at the time of the study was single and living by herself. She was a licensed nurse with substantial work experience in a specialized field of nursing (not mentioned here to guarantee anonymity) but described herself as a ‘nurse in transition’, as she recently lost a job and at the time of the study was unemployed. Clinical history. In her youth, T.P. had received diagnoses of dysthymia, anxiety disorder (NOS), and attention deficit/hyperactivity disorder (ADHD). In terms of somatic health, she had been diagnosed with hypermobile Ehlers–Danlos syndrome (EDS, hEDS), a genetically based connective tissue disorder that is associated with a range of symptoms, including orthostatic intolerance, pain, spinal instability, dizziness, foggy head, and sleep disruption. Symptoms have been present since childhood but were recognized and diagnosed as EDS only a few years prior to the study. Her scores on diagnostic tests assessing current somatic and psychological symptomatology are reported in the following section. Relevant prior treatments. For EDS, there is no specific treatment available, but her doctor recommended T.P. take large amounts of water with electrolytes on a daily basis. T.P. considered this to help, explaining that she would otherwise often be bed-bound. For the mental health symptoms, T.P. had been prescribed antidepressants from age 18–35, the success of which she considered limited. She therefore had tried alternative treatments, including ketamine-assisted therapy in medical context as well as ceremonial ayahuasca in her home country, both of which she described as helpful but not entirely in terms of symptom remission. She had not been to the Amazon before and had never received any kind of tobacco-based treatment. She was not taking psychopharmaceuticals or other medications at the time of the study. Primary treatment motive. T.P.’s treatment motives were mainly psychological in nature. She mentioned depressed mood, ‘parts of myself that need healing’, dissatisfaction with familial and romantic relationships, as well as a lack of directionality about professional goals and sense of not knowing her place within her professional field.

2.3. Pre-Treatment Diagnostic Scales

The patient’s psychological and somatic symptoms prior to treatment (past month) are found in Table 2. Most noteworthy are elevated depression symptoms on the Symptom Assessment (SA-45 [,]) and elevated stress levels on the Perceived Stress Scale (PSS-10 []), as well as somewhat elevated interpersonal sensitivity (i.e., discomfort in relation to others), paranoid ideation, and obsessive/compulsive symptoms (SA-45). Self-reported somatic symptoms as per Patient Health Questionnaire (PHQ-15 []) were relatively low in severity (see Section 4 for description of all scales).
Table 2. Psychological and somatic symptoms at pre- and post-treatment assessment.

2.4. Comparison of Pre- and Post-Treatment Scores (Descriptivie)

Table 2 also shows psychological and somatic symptoms one day after treatment. The descriptive comparison points to substantial improvements at post- compared to pre-treatment, with the SA-45 Global Severity Index (an overall psychological symptom score) having diminished from 47 to 2. Figure 1a visualizes the changes on the nine symptom domains of the SA-45: Depressive symptoms, the highest domain at pre-treatment, showed a large amelioration after treatment, as did interpersonal sensitivity, paranoid ideation, obsessive/compulsive symptoms, anxiety, and hostility. Phobic anxiety did not change after the treatment, but was quite low to begin with, and similarly for somatization. The patient reported no psychotic symptoms. Psychological stress (PSS-10) and somatic symptom severity (PHQ-15) decreased to zero after treatment (see Figure 1b); the negative affect score of the Positive And Negative Affect Schedule (PANAS) [] showed a two-fold decrease at post-treatment and positive affect on the PANAS had increased.
Figure 1. Pre- and post-treatment scores on psychological symptoms, somatic symptoms, stress, and affective states. Note: Pre- and post-treatment scores on (a) the 9 psychological symptom domains of the SA-45 = Symptom Assessment-45, and (b) the PHQ-15 = Patient Health Questionnaire-15, the PSS-10 = Perceived Stress Scale, and the PANAS = Positive And Negative Affect Schedule. Higher scores indicate higher severity of symptoms, except for PANAS positive affect.

2.5. Experience during the Treatment: Ecological Momentary Assessment

Table 3 shows the content-analytic results of the ecological momentary assessment (EMA) [], also called experience-sampling [] (see Section 4). The main headings (first column) reflect the content segments of the EMA organized chronologically from morning to evening, namely ‘experiences of the previous night’, ‘the healer’s visit’, ‘immediate effects after drinking tobacco’, ‘experiences of the afternoon/evening’, and ‘changes in physiological functions across the day’. The subheadings (second column) reflect the EMA questions (abbreviated form). The table content itself (cells) then reflects the responses by the patient.
Table 3. Ecological momentary assessment (experience-sampling) during the treatment week.

2.6. Patient Perspective at Post-Treatment

T.P. described feeling “emotionally steady and present” after the diet, noting “a kind of sustained attention that is very unusual for me”. She explained that in the course of the week certain personal tendencies of which she had not been aware, have become discernible. She also described important inspirational ideas in conjunction with her professional life. In this context she emphasized a strong sequence of insight particularly on the last evening of the diet, which she understood as a culmination of themes she had been working on during prior days (“as if filling in a multi-dimensional puzzle, all pieces came together”). It brought clarity about her true professional goals, as well as concrete ways to implement them, with a sense of excitement about the new perspective. T.P. further noted that, even though this had not been the motive of her consultation with the Tabaquero, there was also notable improvement of her symptoms related to EDS: she noted that she could now perform certain body movements that previously had been restricted and painful. She explained that the improvement has been progressive over the course of the seven days, but that in this context a marked shift was notable after the ‘singada’ (tobacco ingestion via nostrils on day 5): she described that for the subsequent day large amounts of mucus was clearing from her sinuses and then she felt significantly lighter and clearer, the foggy head and dizziness characteristic of EDS diminished, and her balance and orientation improved. T.P. summarized the tobacco diet as “a very powerful treatment”.

3. Discussion

In spite of tobacco’s central role in traditional Amazonian medicine, and its importance in Indigenous American cultures in general [,,,], the plant’s therapeutic applications and associated patient reports have remained scientifically underexplored. Moreover, while the last decade has seen remarkable renewed interest in the clinical potentials of psychoactive herbal substances, such as ayahuasca, cannabis, or psilocybin, tobacco’s potentials in this context have so far been neglected. The current work reported for the first time a case study in this context. We employed a transdisciplinary fieldwork approach that combined qualitative and quantitative ethnopsychological methods to describe the therapeutic process of a patient treated with tobacco by a Maestro Tabaquero (local designation of traditional healer specialized in therapeutic uses of N. rustica []). The treatment took place in the Peruvian Amazon (Loreto, Maynas) and involved daily tobacco ingestion during a weeklong traditional dietary retreat (dieta [,]). We applied qualitative experience-sampling (EMA) to document the therapeutic process during the week, and a quantitative comparison of symptom ratings using validated psychological scales before and after treatment. The participant was a 37-year-old woman with diagnoses of mood, anxiety, and attention deficit disorder, as well as a chronic connective tissue syndrome.
Clinically relevant improvements in well-being were evident on the quantitative scales (including indicators of depression, interpersonal sensitivity, paranoid ideation, obsessive-compulsive tendencies, anxiety, hostility, and stress) and the patient’s qualitative descriptions in the post treatment interview. Daily experience-sampling (EMA) during the week pointed to a gradually increasing sense of calm, mental clarity, and general fortification (e.g., “I am stronger daily; I do not feel sick”, “calm, clear-headed”, “my patience and self-compassion are growing”). The patient described the treatment as an embodied experience [] (“full body presence”, “the healing felt very grounded and physical”) with affective (e.g., “relief, gratitude, grief, joy came zipping out of me”) and cognitive (e.g., “my thoughts were remarkably clear and complete”) aspects (altered states). Spontaneously arising insights were commonly reported (e.g., “I have written 10 pages of deeply emotional insights”, “insight coming one after another after dark”), with themes relating to self-understanding (e.g., “I acknowledged my tendency to run, to seek novelty, to fluctuate […] the first time I have had real insight about this”, “my eagerness to please and be validated by others”), shifts of perception (“about my abundance: switch the perspective from having not enough to more than enough”), existential or spiritual themes (e.g., “things that caused me great distress are perfectly ordained”), or impetus for action (“what to do in my life to course-correct”). The development of insight is key in many forms of psychotherapy (e.g., psychodynamic, cognitive-behavioral, mindfulness-based) and discussed also in emerging therapies based psychoactive plants []. Amazonian medicine’s concepts of ‘plants that teach’ (Teacher Plants, Master Plants) is relevant in this context [,]: in this (emic) view, the tobacco plant is understood as a conscious, agentic, and wise ‘other-than-human being’ (see Amazonian ontologies in this context [,] who, if ingested under the appropriate guidance, ritual, and dietary conditions, may offer humans teaching, often via dreams or visions [,]). Indeed, the patient reported instructive dreams (“I saw myself as a student […] hastily climbing stairs of knowledge, then was instructed to slow down and wait, since I am just a student, not a master […] I better understand my tendency to rush big things”), and described these dreams as unusual (e.g., “I find these dreams to be of a higher source”, “the dreams feel ordered, logical, clear”). Visions, on the other hand, were infrequent for the patient. Nonetheless, given the visionary states described in some Indigenous applications, several authors discussed tobacco as a hallucinogen, hypothesizing that MAO-inhibiting harmala (β-carboline) alkaloids present in the plant may be linked to such effects [,,,]. Indeed, while investigations of tobacco usually focus on nicotine, the role of other alkaloids of the plant for psychoactive effects has not yet been established []. β-carboline alkaloids are known to be important in the psychopharmacology of ayahuasca, via their interaction with DMT and independently (neuro-enhancing and antidepressant effects in pre-clinical studies) [,,,,,]. Nicotine is known to impact attentional processes [,], which could be linked to the reported clarity of mind and improvement of ADHD symptoms post treatment. However, other aspects (e.g., altered affective states, psychological insights, lifting of depressed mood) will require a more multifaceted explanatory model, possibly including other tobacco alkaloids, as well as extra-pharmacological factors inherent in this treatment. Indeed, the traditional interventions of the Tabaquero during the treatment and the dieta frame may co-determine outcomes and processes [,]. From the Amazonian emic view, aside from the plant’s direct biochemical effects, the tobacco plant as the Tabaquero’s principal Teacher Plant also participates in the healing process via its imparting of knowledge to the healer. The healer’s work (diagnosing, selecting/preparing medicines, treating patients) is thereby constantly informed by the Teacher Plant, via a carefully cultivated relationship involving different forms of interspecies communication [,,,]. Another extra-pharmacological aspect of the treatment may involve the relationship between healer and patient; the importance of the therapeutic alliance between therapist and patient is well-established in psychotherapy research (see Common Factors Theory) [] and may well extend to traditional healing. The concepts of set and setting [] may also have merit in this context, but, as we have argued elsewhere [,], are insufficient to account for the complexity of Indigenous applications of psychoactives. As an example, emesis in conjunction with tobacco, ayahuasca, and other plants is considered a key therapeutic mechanism in Amazonian medicine, associated with multiple kinds of depuration, depending on the specific plant at hand [,,]. Related views around emesis and emetic plants and applications to treat nervous system conditions can also be found in other traditional medicines (e.g., Ayurveda, Thai, Zulu, or Xhosa [,,]).
A limitation of this study was that we could not provide sample analyses of alkaloid content and dosage of the remedy. A dose-dependent effect can be inferred from the patient’s descriptions, with the small doses on days 5 and 6 followed by less intense psychological and somatic effects than on the other days. Furthermore, while a case report offers an important descriptive account for exploring a scientifically unknown treatment, its results may not be generalized, hence an additional limitation of the current work. Studies based on patient cohorts treated with this Amazonian therapy will be needed to assess effectiveness and basic pharmacokinetic/-dynamic parameters. Moreover, although the current study’s data was mainly based on patient self-reports (self-reported EMA and quantitative self-report scales), the qualitative interviews at pre- and post-treatment were conducted by a health professional who was part of the research team, which may be a potential source of bias. Finally, the current work assessed only short-term outcomes due to logistic limitations (the study coincided with the COVID-19 pandemic and was on hold for an extended period of time, which made further follow-up points impossible within the project period) forthcoming cohort studies should include mid- and long-term follow-up assessments to determine whether beneficial outcomes persist over time.
Nonetheless, the current work presents an important first step for the study of tobacco’s therapeutic possibilities and could serve as template for a larger study into therapeutic mechanism involved. It illustrates the traditional use of tobacco in healing ritual and offers for the first time a detailed descriptive account of how an Amazonian treatment involving drinking tobacco is experienced by a patient. This is significant in view of the globally prevalent harmful uses of tobacco [,,], as it highlights a constructive usage of this plant as per Indigenous knowledge. It could in the long term open new accessible avenues in mental health (see worldwide gap in mental health services [,,,,,]), as well as economic opportunities for Indigenous populations with expertise in this context. Indeed, the transdisciplinary collaboration embedded in our research design is a strength of the current work, as it promotes inclusive research via knowledge co-production and benefit sharing [,]. Finally, this work is significant in the context of the aforementioned ‘psychedelic renaissance’. It suggests that tobacco, like psilocybin, MDMA, or LSD—all currently studied as promising clinical tools but previously seen as inevitably toxic [,,,,,,]—should be further investigated for therapeutic potentials. Indeed, unlike MDMA or LSD, tobacco possesses a millennia-old history of therapeutic use in Indigenous American cultures [,,,,,]; a fresh look at the tobacco plant in close collaboration with traditional healers knowledgeable in its medical application is thus warranted.

4. Methods

The study was approved by the responsible ethics committees in Peru (PRISMA Comité Institucional de Ética en Investigación, CE0724.20) and Switzerland (University of Fribourg, 88-A1).

4.1. Design and Procedure

This work used a transdisciplinary case study design with a multi-method approach. We used validated psychological scales to assess symptoms before and after the tobacco-based treatment (quantitative), as well as ecological momentary assessment (EMA) [] (also: experience-sampling, ambulatory assessment []) to document the patient’s process during the treatment (qualitative). EMA, which involves the repeated assessment of the variables of interest in the natural environment in which they occur, is increasingly used in psychology research due to the method’s capacity to capture experience in real- or near-real-time; contrary to the standard retrospective ratings (e.g., ‘How anxious did you feel over the last week?’), which are often biased by memory and heuristics [,,]. More specifically, we here report an EMA using qualitative items (open questions), also labeled descriptive experience-sampling [] or diary method [,,], since we were particularly interested in the nature of experience (phenomenology) during the Amazonian tobacco-based treatment, in the experiencer’s own words and in relation to contextual factors [,]. The sampling schedule we used was interval-based with four measurement points per full treatment day. The qualitative items were administered twice per day; we concomitantly used quantitative EMA (single items rated from 0 to 6 to assess the momentary intensity of affective, cognitive, and somatic states) four times per day, but which will be reported in a separate paper.
The patient was thoroughly informed about the study and wrote an informed consent before the treatment was initiated. T.P. was then interviewed by a health professional (first author) and filled in the diagnostic self-report scales (see Section 4.2). She was handed a paper-and-pencil questionnaire folder for each treatment day, which she was instructed to fill in over the course of the day, according to the following schedule: 1st set of questions in the early morning upon getting up and up to 30 min later, 2nd set of questions in the late morning at 10:30/11 a.m. (before drinking the tobacco), 3rd set of questions in the afternoon at 3/4 p.m. (after drinking the tobacco, once intensity of effects has lessened), and 4th set of questions in the evening at 7/8 p.m. (before going to bed). One day after treatment completion, the patient was again interviewed by the health professional and again filled in the diagnostic self-report scales.

4.2. Measures

Standard, psychometrically validated psychological self-report scales were used for assessing pre- and post-treatment symptomatology: The Symptom Assessment-45 (SA-45) [,] assesses mental health symptoms in nine domains, namely depression, anxiety, obsessive–compulsive, psychoticism, phobic anxiety, interpersonal sensitivity, paranoid ideation, somatization, and hostility; items are rated from 0 (not at all) to 4 (extremely). The Perceived Stress Scale-10 (PSS-10) [,] assesses general psychological stress, with items rated from 0 (never) to 4 (very often). The Patient Health Questionnaire-15 (PHQ-15) [] assesses somatic symptoms, with items rated from 0 (not bothered) to 2 (bothered a lot). Finally, we used the Positive and Negative Affect Schedule (PANAS) [] to asses affective states on two scales (positive and negative affect, 10 items each) rated from 1 (very slightly or not at all) to 5 (extremely). The EMA schedule was constructed from qualitative items of relevance based on general medical/psychological considerations, our previous research, and ethnographic literature on Amazonian tobacco [,]. It included questions in the mornings (quality and quantity of sleep, dreams in the preceding night), evenings (appetite, digestion, micturition, breathing, body temperature; how the visit of the healer was experienced; immediate effects after drinking the tobacco), as well as questions that were repeated in the mornings and evenings (experiences of healing, insights, instruction, transcendence experience).

4.3. Data Analysis

Data were analyzed using standard software (Microsoft Office and SPSS Statistics for Windows, Version 27.0, IBM Corp). For the quantitative questionnaires, scores were calculated by summing the respective items: nine domain scores (range 0–20 per domain) and one global severity index of the SA-45 [,], an overall psychological stress score (range 0–40) of the PSS-10 []; overall somatic severity (range 0–30) of the PHQ-15 []; positive affect and negative affect scores (range 10–50 each) of the PANAS []. Descriptive statistics and visual analysis were then used to explore differences in symptomatology before vs. after the treatment. For the qualitative items, we used the summarizing qualitative content analytic approach []: the main EMA content segments were defined as the main themes and used as main headings for a chronologically organized table. The items themselves served as subheadings (subthemes). The patient’s responses per item and day were then allocated to the corresponding subheading per day. If necessary, responses were slightly shortened, but the original wording was usually preserved in order to keep the meaning unaltered. If a description was repeated or spread out under several headings within the same assessment time point, the corresponding text was grouped together in order to improve the readability of the table.

Author Contributions

I.B.—conceptualization, funding acquisition, project administration, investigation, formal analysis, methodology, writing (original draft); C.M.-S.—conceptualization, methodology, formal analysis, writing (review and editing); E.G.T.—conceptualization, writing (review and editing); U.W.—methodology, formal analysis, writing (review and editing); C.M.—methodology, formal analysis, writing (review and editing). All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by the Swiss National Science Foundation grant number 190428.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committees of PRISMA Comité Institucional de Ética en Investigación (CE0724.20) and University of Fribourg (88-A1, 2019).

Data Availability Statement

The data are not publicly available to protect the privacy of the patient.

Conflicts of Interest

The authors declare no conflict of interest. E.G.T. is the Indigenous-Amazonian healer that administered the treatment; data collection and analysis were carried out by I.B. and C.M.-S., U.W., and C.M. independently.

References

  1. Reitsma, M.B.; Kendrick, P.J.; Ababneh, E.; Abbafati, C.; Abbasi-Kangevari, M.; Abdoli, A.; Abedi, A.; Abhilash, E.S.; Abila, D.B.; Aboyans, V.; et al. Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: A systematic analysis from the Global Burden of Disease Study 2019. Lancet 2021, 397, 2337–2360. [Google Scholar] [CrossRef]
  2. Martin-Soelch, C. Neuroadaptive changes associated with smoking: Structural and functional neural changes in nicotine dependence. Brain Sci. 2013, 3, 159. [Google Scholar] [CrossRef]
  3. Gowing, L.R.; Ali, R.L.; Allsop, S.; Marsden, J.; Turf, E.E.; West, R.; Witton, J. Global statistics on addictive behaviours: 2014 status report. Addiction 2015, 110, 904–919. [Google Scholar] [CrossRef] [PubMed]
  4. World Health Organization. WHO Report on the Global Tobacco Epidemic, 2017: Monitoring Tobacco Use and Prevention Policies; WHO: Geneva, Switzerland, 2017.
  5. Forouzanfar, M.H.; Alexander, L.; Anderson, H.R.; Bachman, V.F.; Biryukov, S.; Brauer, M.; Burnett, R.; Casey, D.; Coates, M.M.; Cohen, A.; et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015, 386, 2287–2323. [Google Scholar] [CrossRef] [PubMed]
  6. Oyuela-Caycedo, A.; Kawa, N.C. The Master Plant: Tobacco in Lowland South America; Chapter 1; Russell, A., Rahman, E., Eds.; Bloomsbury: London, UK; New York, NY, USA, 2015; pp. 27–44. [Google Scholar]
  7. Wilbert, J. Tobacco and Shamanism in South America; Yale University Press: New Haven, CT, USA, 1993. [Google Scholar]
  8. Russell, A.; Rahman, E. The Master Plant: Tobacco in Lowland South America; Bloomsbury: London, UK; New York, NY, USA, 2015. [Google Scholar]
  9. Jauregui, X.; Clavo, Z.M.; Jovel, E.M.; Pardo-de-Santayana, M. “Plantas con madre”: Plants that teach and guide in the shamanic initiation process in the East-Central Peruvian Amazon. J. Ethnopharmacol. 2011, 134, 739–752. [Google Scholar] [CrossRef] [PubMed]
  10. Barbira-Freedman, F. Tobacco and shamanic agency in the Upper Amazon: Historical and contemporary perspectives. In The Master Plant: Tobacco in Lowland South America; Russell, A., Rahman, E., Eds.; Bloomsbury: London, UK; New York, NY, USA, 2015; pp. 63–86. [Google Scholar]
  11. Lagrou, E. Sorcery and Shamanism in Cashinahua Discourse and Praxis, Purus River, Brazil. In Darkness and Secrecy: The Anthropology of Assault Sorcery and Witchcraft in Amazonia; Neil, L.W., Robin, W., Eds.; Duke University Press: Durham, NC, USA, 2004; pp. 244–271. [Google Scholar]
  12. Barbira-Freedman, F. Shamanic plants and gender in the healing forest. In Plants, Health and Healing: On the Interface of Ethnobotany and Medical Anthropology; Hsu, E., Harris, S., Eds.; Berghahn Books: Oxford, NY, USA, 2010. [Google Scholar]
  13. Janiger, O.; de Rios, M.D. Suggestive Hallucinogenic Properties of Tobacco. Med. Anthropol. Newsl. 1973, 4, 6–11. [Google Scholar] [CrossRef]
  14. Shepard, G.H. Psychoactive plants and ethnopsychiatric medicines of the Matsigenka. J. Psychoact. Drugs 1998, 30, 321–332. [Google Scholar] [CrossRef] [PubMed]
  15. Luziatelli, G.; Sørensen, M.; Theilade, I.; Mølgaard, P. Asháninka medicinal plants: A case study from the native community of Bajo Quimiriki, Junín, Peru. J. Ethnobiol. Ethnomed. 2010, 6, 21. [Google Scholar] [CrossRef]
  16. Thomas, E.; Semo, L.; Morales, M.; Noza, Z.; Nuñez, H.; Cayuba, A.; Noza, M.; Humaday, N.; Vaya, J.; Van Damme, P. Ethnomedicinal practices and medicinal plant knowledge of the Yuracarés and Trinitarios from Indigenous Territory and National Park Isiboro-Sécure, Bolivian Amazon. J. Ethnopharmacol. 2011, 133, 153–163. [Google Scholar] [CrossRef]
  17. Baer, G. The one intoxicated by tobacco: Matsigenka shamanism. In Portals of Power: Shamanism in South America; Langdon, E.J.M., Baer, G., Eds.; University of New Mexico Press: Albuquerque, NM, USA, 1992. [Google Scholar]
  18. Duke, D.; Wohlgemuth, E.; Adams, K.R.; Armstrong-Ingram, A.; Rice, S.K.; Young, D.C. Earliest evidence for human use of tobacco in the Pleistocene Americas. Nat. Hum. Behav. 2021, 6, 183–192. [Google Scholar] [CrossRef]
  19. Zimmermann, M.; Brownstein, K.J.; Pantoja Díaz, L.; Ancona Aragón, I.; Hutson, S.; Kidder, B.; Tushingham, S.; Gang, D.R. Metabolomics-based analysis of miniature flask contents identifies tobacco mixture use among the ancient Maya. Sci. Rep. 2021, 11, 1590. [Google Scholar] [CrossRef]
  20. Echeverría, J.; Niemeyer, H.M. Nicotine in the hair of mummies from San Pedro de Atacama (Northern Chile). J. Archaeol. Sci. 2013, 40, 3561–3568. [Google Scholar] [CrossRef]
  21. Nater, L. Colonial Tobacco. Key Commodity of the Spanish Empire, 1500–1800. In From Silver to Cocaine; Topik, S., Marichal, C., Frank, Z., Eds.; Latin American Commodity Chains and the Building of the World Economy, 1500–2000; Duke University Press: Durham, NC, USA, 2006; pp. 93–117. [Google Scholar]
  22. Charlton, A. Medicinal uses of tobacco in history. J. R. Soc. Med. 2004, 97, 292–296. [Google Scholar] [CrossRef]
  23. O’Keefe, A.M.; Pollay, R.W. Deadly targeting of women in promoting cigarettes. J. Am. Med. Women’s Assoc. 1972 1996, 51, 67–69. [Google Scholar]
  24. Henriksen, L. Comprehensive tobacco marketing restrictions: Promotion, packaging, price and place. Tob. Control. 2012, 21, 147–153. [Google Scholar] [CrossRef] [PubMed]
  25. Lovato, C.; Watts, A.; Stead, L.F. Impact of tobacco advertising and promotion on increasing adolescent smoking behaviours. Cochrane Database Syst. Rev. 2011, 10, Cd003439. [Google Scholar] [CrossRef]
  26. Russell, A.; Wainwright, M.; Mamudu, H. A chilling example? Uruguay, Philip Morris international, and WHO’s framework convention on tobacco control. Med. Anthropol. Q. 2015, 29, 256–277. [Google Scholar] [CrossRef]
  27. Singh, T.; Agaku, I.T.; Arrazola, R.A.; Marynak, K.L.; Neff, L.J.; Rolle, I.T.; King, B.A. Exposure to advertisements and electronic cigarette use among US middle and high school students. Pediatrics 2016, 137, e20154155. [Google Scholar] [CrossRef]
  28. Salgado, M.V.; Mejia, R.; Kaplan, C.P.; Perez-Stable, E.J. Smoking behavior and use of tobacco industry sponsored websites among medical students and young physicians in Argentina. J. Med. Internet Res. 2014, 16, e35. [Google Scholar] [CrossRef]
  29. World Health Organization. WHO Traditional Medicine Strategy 2014–2023; WHO: Geneva, Switzerland, 2013.
  30. Falci, L.; Shi, Z.; Greenlee, H. Multiple chronic conditions and use of complementary and alternative medicine among US adults: Results from the 2012 National Health Interview Survey. Prev. Chronic Dis. 2016, 13, E61. [Google Scholar] [CrossRef] [PubMed]
  31. Molassiotis, A.; Fernadez-Ortega, P.; Pud, D.; Ozden, G.; Scott, J.A.; Panteli, V.; Margulies, A.; Browall, M.; Magri, M.; Selvekerova, S.; et al. Use of complementary and alternative medicine in cancer patients: A European survey. Ann. Oncol. 2005, 16, 655–663. [Google Scholar] [CrossRef] [PubMed]
  32. Charlier, P.; Coppens, Y.; Malaurie, J.; Brun, L.; Kepanga, M.; Hoang-Opermann, V.; Correa Calfin, J.A.; Nuku, G.; Ushiga, M.; Schor, X.E.; et al. A new definition of health? An open letter of autochthonous peoples and medical anthropologists to the WHO. Eur. J. Intern. Med. 2017, 37, 33–37. [Google Scholar] [CrossRef] [PubMed]
  33. World Health Organization. WHO Global Report on Traditional and Complementary Medicine 2019; WHO: Geneva, Switzerland, 2019.
  34. Kohn, R.; Saxena, S.; Levav, I.; Saraceno, B. The treatment gap in mental health care. Bull. World Health Organ. 2004, 82, 858–866. [Google Scholar]
  35. Alonso, J.; Liu, Z.; Evans-Lacko, S.; Sadikova, E.; Sampson, N.; Chatterji, S.; Abdulmalik, J.; Aguilar-Gaxiola, S.; Al-Hamzawi, A.; Andrade, L.H.; et al. Treatment gap for anxiety disorders is global: Results of the World Mental Health Surveys in 21 countries. Depress. Anxiety 2018, 35, 195–208. [Google Scholar] [CrossRef]
  36. Kohn, R.; Ali, A.A.; Puac-Polanco, V.; Figueroa, C.; López-Soto, V.; Morgan, K.; Saldivia, S.; Vicente, B. Mental health in the Americas: An overview of the treatment gap. Rev. Panam. De Salud Publica Pan Am. J. Public Health 2018, 42, e165. [Google Scholar] [CrossRef] [PubMed]
  37. Patel, V.; Xiao, S.; Chen, H.; Hanna, F.; Jotheeswaran, A.T.; Luo, D.; Parikh, R.; Sharma, E.; Usmani, S.; Yu, Y.; et al. The magnitude of and health system responses to the mental health treatment gap in adults in India and China. Lancet 2016, 388, 3074–3084. [Google Scholar] [CrossRef] [PubMed]
  38. Evans-Lacko, S.; Aguilar-Gaxiola, S.; Al-Hamzawi, A.; Alonso, J.; Benjet, C.; Bruffaerts, R.; Chiu, W.T.; Florescu, S.; de Girolamo, G.; Gureje, O.; et al. Socio-economic variations in the mental health treatment gap for people with anxiety, mood, and substance use disorders: Results from the WHO World Mental Health (WMH) surveys. Psychol. Med. 2017, 48, 1560–1571. [Google Scholar] [CrossRef]
  39. Gureje, O.; Nortje, G.; Makanjuola, V.; Oladeji, B.; Seedat, S.; Jenkins, R. The role of global traditional and complementary systems of medicine in treating mental health problems. Lancet Psychiatry 2015, 2, 168–177. [Google Scholar] [CrossRef] [PubMed]
  40. Schenberg, E.E.; de Castro Comis, M.A.; Chaves, B.R.; da Silveira, D.X. Treating drug dependence with the aid of ibogaine: A retrospective study. J. Psychopharmacol. 2014, 28, 993–1000. [Google Scholar] [CrossRef]
  41. Lu, L.; Liu, Y.; Zhu, W.; Shi, J.; Liu, Y.; Ling, W.; Kosten, T.R. Traditional medicine in the treatment of drug addiction. Am. J. Drug Alcohol Abus. 2009, 35, 1–11. [Google Scholar] [CrossRef]
  42. McGuire, P.; Robson, P.; Jerzy Cubala, W.; Vasile, D.; Dugald Morrison, P.; Barron, R.; Taylor, A.; Wright, S. Cannabidiol (CBD) as an Adjunctive Therapy in Schizophrenia: A Multicenter Randomized Controlled Trial. Am. J. Psychiatry 2018, 175, 225–231. [Google Scholar] [CrossRef]
  43. Feeney, K.; Labate, B.C.; Hudson, J.H. Bubbling with controversy: Legal challenges for ceremonial ayahuasca circles in the United States. In Plant Medicines, Healing and Psychedelic Science: Cultural Perspectives; Labate, B.C., Cavnar, C., Eds.; Springer International Publishing: Cham, Switzerland, 2018; pp. 87–111. [Google Scholar]
  44. Hamill, J.; Hallak, J.; Dursun, S.M.; Baker, G. Ayahuasca: Psychological and physiologic effects, pharmacology and potential uses in addiction and mental illness. Curr. Neuropharmacol. 2018, 16, 108–128. [Google Scholar] [CrossRef] [PubMed]
  45. Kyzar, E.J.; Nichols, C.D.; Gainetdinov, R.R.; Nichols, D.E.; Kalueff, A.V. Psychedelic Drugs in Biomedicine. Trends Pharmacol. Sci. 2017, 38, 992–1005. [Google Scholar] [CrossRef] [PubMed]
  46. Nichols, D.; Johnson, M.; Nichols, C. Psychedelics as Medicines: An Emerging New Paradigm. Clin. Pharmacol. Ther. 2017, 101, 209–219. [Google Scholar] [CrossRef]
  47. Siegel, A.N.; Meshkat, S.; Benitah, K.; Lipsitz, O.; Gill, H.; Lui, L.M.W.; Teopiz, K.M.; McIntyre, R.S.; Rosenblat, J.D. Registered clinical studies investigating psychedelic drugs for psychiatric disorders. J. Psychiatr. Res. 2021, 139, 71–81. [Google Scholar] [CrossRef]
  48. Fisher, E.; Moore, R.A.; Fogarty, A.E.; Finn, D.P.; Finnerup, N.B.; Gilron, I.; Haroutounian, S.; Krane, E.; Rice, A.S.C.; Rowbotham, M.; et al. Cannabinoids, cannabis, and cannabis-based medicine for pain management: A systematic review of randomised controlled trials. Pain Rep. 2021, 162, S45–S66. [Google Scholar] [CrossRef] [PubMed]
  49. Carhart-Harris, R.; Giribaldi, B.; Watts, R.; Baker-Jones, M.; Murphy-Beiner, A.; Murphy, R.; Martell, J.; Blemings, A.; Erritzoe, D.; Nutt, D.J. Trial of Psilocybin versus Escitalopram for Depression. N. Engl. J. Med. 2021, 384, 1402–1411. [Google Scholar] [CrossRef] [PubMed]
  50. Palhano-Fontes, F.; Barreto, D.; Onias, H.; Andrade, K.C.; Novaes, M.M.; Pessoa, J.A.; Mota-Rolim, S.A.; Osório, F.L.; Sanches, R.; dos Santos, R.G.; et al. Rapid antidepressant effects of the psychedelic ayahuasca in treatment-resistant depression: A randomized placebo-controlled trial. Psychol. Med. 2018, 49, 655–663. [Google Scholar] [CrossRef]
  51. Osorio Fde, L.; Sanches, R.F.; Macedo, L.R.; Santos, R.G.; Maia-de-Oliveira, J.P.; Wichert-Ana, L.; Araujo, D.B.; Riba, J.; Crippa, J.A.; Hallak, J.E. Antidepressant effects of a single dose of ayahuasca in patients with recurrent depression: A preliminary report. Rev. Bras. De Psiquiatr. 2015, 37, 13–20. [Google Scholar] [CrossRef]
  52. Coe, M.A.; McKenna, D.J. The therapeutic potential of ayahuasca. In Evidence-Based Herbal and Nutritional Treatments for Anxiety in Psychiatric Disorders; Camfield, D., McIntyre, E., Sarris, J., Eds.; Springer International Publishing: Cham, Switzerland, 2017; pp. 123–137. [Google Scholar]
  53. dos Santos, R.G.; Osório, F.L.; Crippa, J.A.S.; Hallak, J.E.C. Antidepressive and anxiolytic effects of ayahuasca: A systematic literature review of animal and human studies. Braz. J. Psychiatry 2016, 38, 65–72. [Google Scholar] [CrossRef]
  54. Barbosa, P.C.R.; Tófoli, L.F.; Bogenschutz, M.P.; Hoy, R.; Berro, L.F.; Marinho, E.A.V.; Areco, K.N.; Winkelman, M.J. Assessment of alcohol and tobacco use disorders among religious users of ayahuasca. Front. Psychiatry 2018, 9, 136. [Google Scholar] [CrossRef]
  55. Nunes, A.A.; dos Santos, R.G.; Osório, F.L.; Sanches, R.F.; Crippa, J.A.S.; Hallak, J.E.C. Effects of ayahuasca and its alkaloids on drug dependence: A systematic literature review of quantitative studies in animals and humans. J. Psychoact. Drugs 2016, 48, 195–205. [Google Scholar] [CrossRef] [PubMed]
  56. Jovel, E.M.; Cabanillas, J.; Towers, G.H. An ethnobotanical study of the traditional medicine of the Mestizo people of Suni Mirano, Loreto, Peru. J. Ethnopharmacol. 1996, 53, 149–156. [Google Scholar] [CrossRef] [PubMed]
  57. Sanz-Biset, J.; Campos-de-la-Cruz, J.; Epiquien-Rivera, M.A.; Cañigueral, S. A first survey on the medicinal plants of the Chazuta valley (Peruvian Amazon). J. Ethnopharmacol. 2009, 122, 333–362. [Google Scholar] [CrossRef] [PubMed]
  58. Luna, L.E. Vegetalismo Shamanism among the Mestizo Population of the Peruvian Amazon; Almqvist & Wiksell International: Stockholm, Sweden, 1986. [Google Scholar]
  59. Beyer, S.V. Singing to the Plants: A Guide to Mestizo Shamanism in the Upper Amazon; University of New Mexico Press: Albuquerque, NM, USA, 2009. [Google Scholar]
  60. Berlowitz, I. Traditional Amazonian Medicine Adapted to Treat Substance Use Disorder. Ph.D. Thesis, University of Fribourg, Fribourg, Switzerland, 2017. [Google Scholar]
  61. Thomas, G.; Lucas, P.; Capler, N.R.; Tupper, K.W.; Martin, G. Ayahuasca-assisted therapy for addiction: Results from a preliminary observational study in Canada. Curr. Drug Abus. Rev. 2013, 6, 30–42. [Google Scholar] [CrossRef]
  62. Renelli, M.; Fletcher, J.; Tupper, K.W.; Files, N.; Loizaga-Velder, A.; Lafrance, A. An exploratory study of experiences with conventional eating disorder treatment and ceremonial ayahuasca for the healing of eating disorders. Eat. Weight. Disord. Stud. Anorex. Bulim. Obes. 2018, 25, 437–444. [Google Scholar] [CrossRef]
  63. Labate, B.C.; Cavnar, C. The Therapeutic Use of Ayahuasca; Springer: Berlin/Heidelberg, Germany, 2014. [Google Scholar]
  64. Rodrigues, L.S.; Rossi, G.N.; Rocha, J.M.; Osório, F.L.; Bouso, J.C.; Hallak, J.E.C.; dos Santos, R.G. Effects of ayahuasca and its alkaloids on substance use disorders: An updated (2016–2020) systematic review of preclinical and human studies. Eur. Arch. Psychiatry Clin. Neurosci. 2021, 272, 541–556. [Google Scholar] [CrossRef]
  65. Zeifman, R.J.; Singhal, N.; Dos Santos, R.G.; Sanches, R.F.; de Lima Osório, F.; Hallak, J.E.C.; Weissman, C.R. Rapid and sustained decreases in suicidality following a single dose of ayahuasca among individuals with recurrent major depressive disorder: Results from an open-label trial. Psychopharmacology 2021, 238, 453–459. [Google Scholar] [CrossRef]
  66. Ruffell, S.G.D.; Netzband, N.; Tsang, W.; Davies, M.; Butler, M.; Rucker, J.J.H.; Tófoli, L.F.; Dempster, E.L.; Young, A.H.; Morgan, C.J.A. Ceremonial Ayahuasca in Amazonian Retreats—Mental Health and Epigenetic Outcomes From a Six-Month Naturalistic Study. Front. Psychiatry 2021, 12, 898. [Google Scholar] [CrossRef]
  67. Gonzalez, D.; Cantillo, J.; Perez, I.; Carvalho, M.; Aronovich, A.; Farre, M.; Feilding, A.; Obiols, J.E.; Bouso, J.C. The Shipibo Ceremonial Use of Ayahuasca to Promote Well-Being: An Observational Study. Front. Pharmacol. 2021, 12, 623923. [Google Scholar] [CrossRef]
  68. Rossi, G.N.; Dias, I.C.d.S.; Baker, G.; Bouso Saiz, J.C.; Dursun, S.M.; Hallak, J.E.C.; Dos Santos, R.G. Ayahuasca, a potentially rapid acting antidepressant: Focus on safety and tolerability. Expert Opin. Drug Saf. 2022, 21, 789–801. [Google Scholar] [CrossRef] [PubMed]
  69. McKenna, D.J. Clinical investigations of the therapeutic potential of ayahuasca: Rationale and regulatory challenges. Pharmacol. Ther. 2004, 102, 111–129. [Google Scholar] [CrossRef]
  70. Fotiou, E. Shamanic Tourism in the Peruvian Lowlands: Critical and Ethical Considerations. J. Lat. Am. Caribb. Anthropol. 2020, 25, 374–396. [Google Scholar] [CrossRef]
  71. Fotiou, E. The globalization of ayahuasca shamanism and the erasure of indigenous shamanism. Anthropol. Conscious. 2016, 27, 151–179. [Google Scholar] [CrossRef]
  72. Berlowitz, I.; Walt, H.; Ghasarian, C.; O’Shaughnessy, D.M.; Mabit, J.; Rush, B.; Martin-Soelch, C. Who Turns to Amazonian Medicine for Treatment of Substance Use Disorder? Patient Characteristics at the Takiwasi Addiction Treatment Center. J. Stud. Alcohol Drugs 2020, 81, 416–425. [Google Scholar] [CrossRef] [PubMed]
  73. Berlowitz, I.; Walt, H.; Ghasarian, C.; Mendive, F.; Martin-Soelch, C. Short-Term Treatment Effects of a Substance Use Disorder Therapy Involving Traditional Amazonian Medicine. J. Psychoact. Drugs 2019, 51, 323–334. [Google Scholar] [CrossRef] [PubMed]
  74. Labate, B.C.; Jungaberle, H. The Internationalization of Ayahuasca; Lit Verlag: Zurich, Switzerland, 2011. [Google Scholar]
  75. Labate, B.C.; Cavnar, C. The Expanding World Ayahuasca Diaspora: Appropriation, Integration and Legislation; Routledge: New York, NY, USA, 2018. [Google Scholar]
  76. Berlowitz, I.; García Torres, E.G.; Walt, H.; Wolf, U.; Maake, C.; Martin-Soelch, C. “Tobacco Is the Chief Medicinal Plant in My Work”: Therapeutic Uses of Tobacco in Peruvian Amazonian Medicine Exemplified by the Work of a Maestro Tabaquero. Front. Pharmacol. 2020, 11, 594591. [Google Scholar] [CrossRef]
  77. Manuel-Navarrete, D.; Buzinde, C.N.; Swanson, T. Fostering horizontal knowledge co-production with Indigenous people by leveraging researchers’ transdisciplinary intentions. Ecol. Soc. 2021, 26, 22. [Google Scholar] [CrossRef]
  78. Bernstein, J.H. Transdisciplinarity: A Review of Its Origins, Development, and Current Issues. J. Res. Pract. 2015, 11, R1. [Google Scholar]
  79. Jahn, T.; Bergmann, M.; Keil, F. Transdisciplinarity: Between mainstreaming and marginalization. Ecol. Econ. 2012, 79, 1–10. [Google Scholar] [CrossRef]
  80. Sharrock, D. Smoky Boundaries, Permeable Selves: Exploring the Self in Relationship with the Amazonian Jungle Tobacco, Mapacho. Anthropol. Forum 2018, 28, 146–157. [Google Scholar] [CrossRef]
  81. Mehmood, F.; Abdullah; Ubaid, Z.; Shahzadi, I.; Ahmed, I.; Waheed, M.T.; Poczai, P.; Mirza, B. Plastid genomics of Nicotiana (Solanaceae): Insights into molecular evolution, positive selection and the origin of the maternal genome of Aztec tobacco (Nicotiana rustica). PeerJ 2020, 8, e9552. [Google Scholar] [CrossRef]
  82. Siegel, R.K.; Collings, P.R.; Diaz, J.L. On the Use of Tagetes lucida and Nicotiana rustica as a Huichol Smoking Mixture: The Aztec “Yahutli” with Suggestive Hallucinogenic Effects. Econ. Bot. 1977, 31, 16–23. [Google Scholar]
  83. Loughmiller-Cardinal, J.; Eppich, K. Breath and Smoke: Tobacco Use Among the Maya; University of New Mexico Press: Albuquerque, NM, USA, 2019. [Google Scholar]
  84. Gibson, S.D.; Halvorson, K.S.; Myers, L.; Colla, S.R. Insect visitation and pollination of a culturally significant plant, Hopi tobacco (Nicotiana rustica). iScience 2022, 25, 105613. [Google Scholar] [CrossRef]
  85. Armijos, C.; Cota, I.; González, S. Traditional medicine applied by the Saraguro yachakkuna: A preliminary approach to the use of sacred and psychoactive plant species in the southern region of Ecuador. J. Ethnobiol. Ethnomed. 2014, 10, 26. [Google Scholar] [CrossRef] [PubMed]
  86. French, L.A. Psychoactive agents and Native American spirituality: Past and present. Contemp. Justice Rev. 2008, 11, 155–163. [Google Scholar] [CrossRef]
  87. Valadeau, C.; Castillo, J.A.; Sauvain, M.; Lores, A.F.; Bourdy, G. The rainbow hurts my skin: Medicinal concepts and plants uses among the Yanesha (Amuesha), an Amazonian Peruvian ethnic group. J. Ethnopharmacol. 2010, 127, 175–192. [Google Scholar] [CrossRef]
  88. Berlowitz, I.; O’Shaughnessy, D.M.; Heinrich, M.; Wolf, U.; Maake, C.; Martin-Soelch, C. Teacher plants—Indigenous Peruvian-Amazonian dietary practices as a method for using psychoactives. J. Ethnopharmacol. 2021, 286, 114910. [Google Scholar] [CrossRef] [PubMed]
  89. Sanz-Biset, J.; Cañigueral, S. Plant use in the medicinal practices known as “strict diets” in Chazuta valley (Peruvian Amazon). J. Ethnopharmacol. 2011, 137, 271–288. [Google Scholar] [CrossRef]
  90. Sanz-Biset, J.; Cañigueral, S. Plants as medicinal stressors, the case of depurative practices in Chazuta valley (Peruvian Amazonia). J. Ethnopharmacol. 2013, 145, 67–76. [Google Scholar] [CrossRef]
  91. Fotiou, E.; Gearin, A.K. Purging and the body in the therapeutic use of ayahuasca. Soc. Sci. Med. 2019, 239, 112532. [Google Scholar] [CrossRef] [PubMed]
  92. Bustos, S. The Healing Power of the Icaros: A Phenomenological Study of Ayahuasca Experiences; California Institute of Integral Studies: San Francisco, CA, USA, 2008. [Google Scholar]
  93. Luna, L.E. The healing practices of a peruvian shaman. J. Ethnopharmacol. 1984, 11, 123–133. [Google Scholar] [CrossRef]
  94. Callicott, C. Interspecies communication in the Western Amazon: Music as a form of conversation between plants and people. Eur. J. Ecopsychology 2013, 4, 32–43. [Google Scholar]
  95. De Feo, V. The ritual use of Brugmansia species in traditional Andean medicine in Northern Peru. Econ. Bot. 2004, 58, 221–229. [Google Scholar] [CrossRef]
  96. Reyna Pinedo, V.; Carbajal, M.F.; Carbajal, J.R. Estudio etnomedicinal de las Mesas con San Pedro. Verificación de casos de curación. Cult. Drog. 2009, 14, 79–88. [Google Scholar]
  97. Davison, M.L.; Bershadsky, B.; Bieber, J.; Silversmith, D.; Maruish, M.E.; Kane, R.L. Development of a Brief, Multidimensional, Self-Report Instrument for Treatment Outcomes Assessment in Psychiatric Settings: Preliminary Findings. Assessment 1997, 4, 259–276. [Google Scholar] [CrossRef]
  98. Maruish, M.E.; Bershadsky, B.; Goldstein, L. Reliability and Validity of the SA-45: Further Evidence from a Primary Care Setting. Assessment 1998, 5, 407–419. [Google Scholar] [CrossRef] [PubMed]
  99. Cohen, S.; Janicki-Deverts, D. Who’s Stressed? Distributions of Psychological Stress in the United States in Probability Samples from 1983, 2006, and 2009. J. Appl. Soc. Psychol. 2012, 42, 1320–1334. [Google Scholar] [CrossRef]
  100. Kroenke, K.; Spitzer, R.L.; Williams, J.B.W. The PHQ-15: Validity of a New Measure for Evaluating the Severity of Somatic Symptoms. Psychosom. Med. 2002, 64, 258–266. [Google Scholar] [CrossRef]
  101. Watson, D.; Clark, L.A.; Tellegen, A. Development and validation of brief measures of positive and negative affect: The PANAS scales. J. Personal. Soc. Psychol. 1988, 54, 1063. [Google Scholar] [CrossRef]
  102. Shiffman, S.; Stone, A.A.; Hufford, M.R. Ecological Momentary Assessment. Annu. Rev. Clin. Psychol. 2008, 4, 1–32. [Google Scholar] [CrossRef] [PubMed]
  103. Trull, T.J.; Ebner-Priemer, U. Ambulatory assessment. Annu. Rev. Clin. Psychol. 2013, 9, 151–176. [Google Scholar] [CrossRef]
  104. Michael, G.A.; Guyot, D.; Tarroux, E.; Comte, M.; Salgues, S. Feeling Oneself Requires Embodiment: Insights From the Relationship Between Own-Body Transformations, Schizotypal Personality Traits, and Spontaneous Bodily Sensations. Front. Psychol. 2020, 11, 578237. [Google Scholar] [CrossRef] [PubMed]
  105. Peill, J.M.; Trinci, K.E.; Kettner, H.; Mertens, L.J.; Roseman, L.; Timmermann, C.; Rosas, F.E.; Lyons, T.; Carhart-Harris, R.L. Validation of the Psychological Insight Scale: A new scale to assess psychological insight following a psychedelic experience. J. Psychopharmacol. 2022, 36, 31–45. [Google Scholar] [CrossRef] [PubMed]
  106. Luna, L.E. The concept of plants as teachers among four mestizo shamans of Iquitos, northeastern Peru. J. Ethnopharmacol. 1984, 11, 135–156. [Google Scholar] [CrossRef] [PubMed]
  107. Shepard, G.H.; Daly, L. Sensory ecologies, plant-persons, and multinatural landscapes in Amazonia. Botany 2022, 100, 83–96. [Google Scholar] [CrossRef]
  108. Viveiros de Castro, E. Cosmological Deixis and Amerindian Perspectivism. J. R. Anthropol. Inst. 1998, 4, 469–488. [Google Scholar] [CrossRef]
  109. Peluso, D.M. That which I dream is true: Dream narratives in an Amazonian community. Dreaming 2004, 14, 107–119. [Google Scholar] [CrossRef]
  110. Janiger, O.; de Rios, M.D. Nicotiana an Hallucinogen? Econ. Bot. 1976, 30, 295–297. [Google Scholar] [CrossRef]
  111. Plotkin, M.J.; Mittermeier, R.A.; Constable, I. Psychotomimetic use of tobacco in Surinam and French Guiana. J. Ethnopharmacol. 1980, 2, 295–297. [Google Scholar] [CrossRef]
  112. Berlowitz, I.; Egger, K.; Cumming, P. Monoamine Oxidase Inhibition by Plant-Derived β-Carbolines; Implications for the Psychopharmacology of Tobacco and Ayahuasca. Front. Pharmacol. 2022, 13, 886408. [Google Scholar] [CrossRef] [PubMed]
  113. McKenna, D.J.; Towers, G.H.; Abbott, F. Monoamine oxidase inhibitors in South American hallucinogenic plants: Tryptamine and beta-carboline constituents of ayahuasca. J. Ethnopharmacol. 1984, 10, 195–223. [Google Scholar] [CrossRef] [PubMed]
  114. Morales-García, J.A.; de la Fuente Revenga, M.; Alonso-Gil, S.; Rodríguez-Franco, M.I.; Feilding, A.; Perez-Castillo, A.; Riba, J. The alkaloids of Banisteriopsis caapi, the plant source of the Amazonian hallucinogen Ayahuasca, stimulate adult neurogenesis in vitro. Sci. Rep. 2017, 7, 5309. [Google Scholar] [CrossRef]
  115. Riba, J.; Valle, M.; Urbano, G.; Yritia, M.; Morte, A.; Barbanoj, M.J. Human pharmacology of ayahuasca: Subjective and cardiovascular effects, monoamine metabolite excretion, and pharmacokinetics. J. Pharmacol. Exp. Ther. 2003, 306, 73–83. [Google Scholar] [CrossRef] [PubMed]
  116. Ferraz, C.A.A.; de Oliveira Júnior, R.G.; Picot, L.; da Silva Almeida, J.R.G.; Nunes, X.P. Pre-clinical investigations of β-carboline alkaloids as antidepressant agents: A systematic review. Fitoterapia 2019, 137, 104196. [Google Scholar] [CrossRef]
  117. Farzin, D.; Mansouri, N. Antidepressant-like effect of harmane and other β-carbolines in the mouse forced swim test. Eur. Neuropsychopharmacol. 2006, 16, 324–328. [Google Scholar] [CrossRef] [PubMed]
  118. dos Santos, R.G.; Hallak, J.E.C. Effects of the Natural β-Carboline Alkaloid Harmine, a Main Constituent of Ayahuasca, in Memory and in the Hippocampus: A Systematic Literature Review of Preclinical Studies. J. Psychoact. Drugs 2017, 49, 1–10. [Google Scholar] [CrossRef]
  119. Levin, E.D.; Conners, C.K.; Silva, D.; Hinton, S.C.; Meck, W.H.; March, J.; Rose, J.E. Transdermal nicotine effects on attention. Psychopharmacology 1998, 140, 135–141. [Google Scholar] [CrossRef]
  120. Valentine, G.; Sofuoglu, M. Cognitive Effects of Nicotine: Recent Progress. Curr. Neuropharmacol. 2018, 16, 403–414. [Google Scholar] [CrossRef]
  121. Dev, L. Plant knowledges: Indigenous approaches and interspecies listening toward decolonizing ayahuasca research. In Plant Medicines, Healing and Psychedelic Science: Cultural Perspectives; Labate, B.C., Cavnar, C., Eds.; Springer International Publishing: Cham, Switzerland, 2018; pp. 185–204. [Google Scholar]
  122. Daly, L.; Shepard, G., Jr. Magic darts and messenger molecules: Toward a phytoethnography of indigenous Amazonia. Anthropol. Today 2019, 35, 13–17. [Google Scholar] [CrossRef]
  123. Cuijpers, P.; Reijnders, M.; Huibers, M.J.H. The role of common factors in psychotherapy outcomes. Annu. Rev. Clin. Psychol 2019, 15, 207–231. [Google Scholar] [CrossRef] [PubMed]
  124. Hartogsohn, I. Constructing drug effects: A history of set and setting. Drug Sci. Policy Law 2017, 3, 2050324516683325. [Google Scholar] [CrossRef]
  125. O’Shaughnessy, D.M.; Berlowitz, I. Amazonian Medicine and the Psychedelic Revival: Considering the “Dieta”. Front. Pharmacol. 2021, 12, 639124. [Google Scholar] [CrossRef] [PubMed]
  126. Vinjamury, S.P.; Vinjamury, M.; Sucharitakul, S.; Ziegler, I. Panchakarma: Ayurvedic Detoxification and Allied Therapies—Is There Any Evidence? In Evidence-Based Practice in Complementary and Alternative Medicine: Perspectives, Protocols, Problems and Potential in Ayurveda; Rastogi, S., Ed.; Springer: Berlin/Heidelberg, Germany, 2012; pp. 113–137. [Google Scholar]
  127. Barrett, M.E. Prevention Programs:Wat Thamkrabok: A Buddhist Drug Rehabilitation Program in Thailand. Subst. Use Misuse 1997, 32, 435–459. [Google Scholar] [CrossRef]
  128. Hutchings, A. A survey and analysis of traditional medicinal plants as used by the Zulu; Xhosa and Sotho. Bothalia 1989, 19, 112–123. [Google Scholar] [CrossRef]
  129. Brandon, T.H.; Vidrine, J.I.; Litvin, E.B. Relapse and relapse prevention. Annu. Rev. Clin. Psychol. 2007, 3, 257–284. [Google Scholar] [CrossRef]
  130. West, R. Tobacco smoking: Health impact, prevalence, correlates and interventions. Psychol. Health 2017, 32, 1018–1036. [Google Scholar] [CrossRef] [PubMed]
  131. Berger-Gonzalez, M.; Stauffacher, M.; Zinsstag, J.; Edwards, P.; Krutli, P. Transdisciplinary research on cancer-healing systems between biomedicine and the Maya of Guatemala: A tool for reciprocal reflexivity in a multi-epistemological setting. Qual. Health Res. 2016, 26, 77–91. [Google Scholar] [CrossRef]
  132. Davies, C.; Bhattacharyya, S. Cannabidiol as a potential treatment for psychosis. Ther. Adv. Psychopharmacol. 2019, 9, 2045125319881916. [Google Scholar] [CrossRef]
  133. Crippa, J.A.; Guimarães, F.S.; Campos, A.C.; Zuardi, A.W. Translational Investigation of the Therapeutic Potential of Cannabidiol (CBD): Toward a New Age. Front. Immunol. 2018, 9, 2009. [Google Scholar] [CrossRef]
  134. Chi, T.; Gold, J.A. A review of emerging therapeutic potential of psychedelic drugs in the treatment of psychiatric illnesses. J. Neurol. Sci. 2020, 411, 116715. [Google Scholar] [CrossRef]
  135. Reiff, C.M.; Richman, E.E.; Nemeroff, C.B.; Carpenter, L.L.; Widge, A.S.; Rodriguez, C.I.; Kalin, N.H.; McDonald, W.M. Psychedelics and Psychedelic-Assisted Psychotherapy. Am. J. Psychiatry 2020, 177, 391–410. [Google Scholar] [CrossRef] [PubMed]
  136. Vargas, A.S.; Luís, Â.; Barroso, M.; Gallardo, E.; Pereira, L. Psilocybin as a New Approach to Treat Depression and Anxiety in the Context of Life-Threatening Diseases—A Systematic Review and Meta-Analysis of Clinical Trials. Biomedicines 2020, 8, 331. [Google Scholar] [CrossRef] [PubMed]
  137. Redvers, N.; Blondin, B.s. Traditional Indigenous medicine in North America: A scoping review. PLoS ONE 2020, 15, e0237531. [Google Scholar] [CrossRef] [PubMed]
  138. Sulkin, C.D.L. People of Substance: An Ethnography of Morality in the Colombian Amazon; University of Toronto Press: Toronto, ON, Canada, 2012; Volume 40. [Google Scholar]
  139. Londoño Sulkin, C.D.J.E. Paths of Speech: Symbols, Sociality and Subjectivity among the Muinane of the Colombian Amazon. Ethnologies 2003, 25, 173–194. [Google Scholar] [CrossRef]
  140. Bos, F.M.; Schoevers, R.A.; aan het Rot, M. Experience sampling and ecological momentary assessment studies in psychopharmacology: A systematic review. Eur. Neuropsychopharmacol. 2015, 25, 1853–1864. [Google Scholar] [CrossRef]
  141. Tomko, R.L.; Gray, K.M.; Oppenheimer, S.R.; Wahlquist, A.E.; McClure, E.A. Using REDCap for ambulatory assessment: Implementation in a clinical trial for smoking cessation to augment in-person data collection. Am. J. Drug Alcohol Abus. 2019, 45, 26–41. [Google Scholar] [CrossRef]
  142. Burgess-Hull, A.; Epstein, D.H. Ambulatory Assessment Methods to Examine Momentary State-Based Predictors of Opioid Use Behaviors. Curr. Addict. Rep. 2021, 8, 122–135. [Google Scholar] [CrossRef]
  143. Heavey, C.L.; Hurlburt, R.T.; Lefforge, N.L. Descriptive Experience Sampling: A Method for Exploring Momentary Inner Experience. Qual. Res. Psychol. 2010, 7, 345–368. [Google Scholar] [CrossRef]
  144. Mackrill, T. Solicited diary studies of psychotherapy in qualitative research–pros and cons. Eur. J. Psychother. Couns. 2008, 10, 5–18. [Google Scholar] [CrossRef]
  145. Bolger, N.; Davis, A.; Rafaeli, E. Diary methods: Capturing life as it is lived. Annu. Rev. Psychol. 2003, 54, 579–616. [Google Scholar] [CrossRef] [PubMed]
  146. Thiele, C.; Laireiter, A.-R.; Baumann, U. Diaries in clinical psychology and psychotherapy: A selective review. Clin. Psychol. Psychother. 2002, 9, 1–37. [Google Scholar] [CrossRef]
  147. Trull, T.J.; Ebner-Priemer, U.W. Ambulatory assessment in psychopathology research: A review of recommended reporting guidelines and current practices. J. Abnorm. Psychol. 2020, 129, 56–63. [Google Scholar] [CrossRef] [PubMed]
  148. Cohen, S.; Kamarck, T.; Mermelstein, R. A global measure of perceived stress. J. Health Soc. Behav. 1983, 24, 385–396. [Google Scholar] [CrossRef] [PubMed]
  149. Cohen, S. Perceived stress in a probability sample of the United States. In The Social Psychology of Health The Claremont Symposium on Applied Social Psychology; Sage Publications Inc.: Thousand Oaks, CA, USA, 1988; pp. 31–67. [Google Scholar]
  150. Mayring, P. Qualitative Inhaltsanalyse; Beltz Verlag: Weinheim, Germany; Basel, Switzerland, 2008. [Google Scholar]
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