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Article

Psychedelics and Mental Health Treatment Seeking Among Asians and Hawaiians

by
Sean Matthew Viña
Department of Sociology, The University of the Incarnate Word, 4301 Broadway, San Antonio, TX 78209, USA
Psychoactives 2025, 4(3), 32; https://doi.org/10.3390/psychoactives4030032
Submission received: 27 July 2025 / Revised: 20 August 2025 / Accepted: 2 September 2025 / Published: 4 September 2025
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Abstract

States like Hawai‘i are decriminalizing psychedelics based on emerging evidence linking their use to improved psychological well-being. Yet, in many cultural contexts, stigma surrounding mental illness may lead individuals to pursue non-traditional forms of healing, including psychedelics, in place of formal care. This study examines how psychedelic use relates to mental health treatment-seeking behaviors among Asians and Native Hawaiians and Other Pacific Islanders (NHOPIs). Using the National Survey of Drug Use and Health (NSDUH) data from 2008 to 2019 (n = 458,372), the analysis compares Non-Hispanic Whites with Asian and NHOPI respondents to assess associations between MDMA and lifetime classic psychedelic use, psychological distress (K6 scale), and formal mental health service utilization. Nested logistic regression models conducted in Stata 18 indicate that psychedelic use among White individuals is associated with a lower likelihood of seeking formal treatment. In contrast, among NHOPI individuals, psychedelic use is associated with increased odds of accessing mental health care. These findings suggest that psychedelic use may serve culturally distinct roles in coping with distress, shaped by structural stigma and the perceived trustworthiness of formal treatment systems.

1. Introduction

Despite extensive evidence finding positive health outcomes associated with psychedelic use in both clinical trials and population studies [1,2,3,4,5,6,7,8,9,10,11,12,13], recent research raises concerns about potential negative harm related to self-medicating behaviors and unequal outcomes associated with psychedelic use [14,15,16,17,18,19,20,21,22,23,24,25,26,27,28]. These concerns are not trivial, considering both growing evidence of negative outcomes associated with psychedelic use [29,30,31,32,33,34], and the growing popularity of psychedelics outside clinical settings. This means that many individuals may be engaging with these substances in contexts that are less structured and without adequate safeguards leading to many unintended consequences. Evidence suggests that those who had used psychedelics were far less likely to use formal mental health services as they perceived more stigma attached to mental illness [14]. Building on this, compared to those who have never used psychedelics, those who have used psychedelics become more distressed, stigma drives them away from formal treatment seeking, creating a cycle in which individuals may increasingly rely on drugs rather than professional support. Given overwhelming evidence that the stigma attached to mental illness acts as a barrier to seeking help, driving people to unhealthy coping strategies, including drug use [35,36], this becomes a particularly important issue. It is likely that because of the potential positive impacts of psychedelics on mental well-being, those who have used psychedelics in the past are more likely to avoid formal treatment because of a false sense of control, believing that the benefits of psychedelic experiences can substitute for professional care. Such a pattern may obscure underlying mental health needs and reduce engagement with evidence-based interventions, amplifying risks for already vulnerable populations.
The findings are concerning considering that although classic psychedelics are considered low toxic with a relatively low probability of overdosing [37], there is some evidence that psychedelic use could increase the odds of experiencing psychotic episodes among those with a predisposition for illnesses like bipolar disease and schizophrenia [38,39]. These vulnerabilities are often invisible until after exposure, which makes unsupervised use particularly troubling. This is problematic as the high stigma of major mental illnesses often leads to harmful behaviors and homelessness, compounding the risks faced by people already struggling with untreated psychiatric conditions. A meta-analysis found that among the homeless, the prevalence rates were: psychosis (21.21%), schizophrenia (10.29%), schizophreniform disorder (2.48%), schizoaffective disorder (3.53%), and other psychotic disorders (9%) [40]. These figures suggest that serious mental illness is not only common but also severely under-treated within marginalized groups, raising questions about how psychedelic availability might intersect with these vulnerabilities. Moreover, MDMA can lead to significant cardiovascular injury and illness which was a major reason why a recent FDA panel rejected authorizing MDMA for psychedelic use despite positive clinical trials. This demonstrates that even when there is strong enthusiasm for potential therapeutic effects, regulators remain concerned about safety profiles under real-world conditions. If people are using these drugs to cope with mental illness outside of a carefully controlled clinical environment, there is a real risk of harm [41]. Taken together, these risks highlight that if people are using these drugs outside of carefully controlled clinical environments, there remains a real possibility of harm, particularly when compounded by social stigma, lack of treatment access, and unrecognized health vulnerabilities.
Despite the risk described, because of the overwhelming evidence on the saltatory health benefits of psychedelic use, the FDA and many states have taken steps to expand psychedelics access to research and recreational use, including Oregon, Colorado, and even conservative Texas [42,43]. These initiatives reflect the growing momentum behind policy change, as states seek to balance enthusiasm for therapeutic breakthroughs with public health safeguards. Most recently, Hawai‘i took steps to expand access to MDMA and psilocybin through the Breakthrough Therapies Task Force, established by the Office of Wellness and Resilience [44]. This policy expansion underscores the urgency of examining how stigma and cultural context may shape the relationship between psychedelic use and treatment-seeking, since decisions made at this early stage will likely set precedents for how other states implement similar reforms. It is important to note that Hawai‘i has not decriminalized psychedelics; rather, the state has focused on studying their potential use and fast-tracking clinical applications, making this study directly relevant to those policy debates. By situating Hawai‘i’s actions within the broader national context, it becomes clear that understanding population-specific dynamics—particularly among Asians and NHOPI, who make up large portions of the state’s population—is not only an academic exercise but also a matter of practical policy relevance.
Given the evidence on the negative impact of the stigma attached to mental illness that both independently creates psychological distress, and drives people into harmful coping practices [35,36,45,46,47,48,49,50], as well as the rapidly increasing naturalistic use among the general population as these drugs become more available [51,52], this paper explores the effects of psychedelics on health behaviors among Asians and Native Hawaiians and Other Pacific Islanders (NHOPI) for several reasons. Firstly, these two groups are the largest non-White populations in Hawai‘i, accounting for 37% and 10%, respectively, compared to 25% for non-Hispanic Whites [53]. Their demographic weight makes them particularly important to examine, since any policy shifts in Hawai‘i regarding psychedelics will directly affect large proportions of the state’s population. Secondly, stigma is not experienced uniformly across groups, and this variation in cultural response to both illness and drug use is central to understanding behavioral outcomes. Although stigma likely drives people to negative coping strategies, whether that affects all populations equally is unlikely because of different cultural conceptions around both mental health and drug use. For instance, compared to all other ethnic groups, including non-Hispanic Whites, Asians have the lowest rates of treatment seeking due to higher rates of stigma attached to mental illness [54]. This pattern reflects a longstanding cultural tendency to manage such problems within families or communities rather than through outside institutions. Asians also have high rates of stigma attached to illicit drug use, whereby drug use is internalized as particularly shameful for the family unit [55]. Such cultural expectations can amplify secrecy and silence, further limiting engagement with formal services. Thus, while stigma can push Asians toward alternative coping behaviors, the heightened stigma around drug use may reduce the likelihood of psychedelics self-medication [56]. This suggests that Asian populations may simultaneously avoid formal treatment and avoid psychedelics as a coping tool, leaving them in a distinct position compared to Whites or NHOPI.
On the other hand, while most non-Hispanic Whites tend to view mental illness as an individual problem that is highly stigmatized [57], NHOPI have a more communal view of mental health that emphasizes interconnectedness and collective well-being [58]. Moreover, the extended family plays a critical role in providing mental health support for members in need [59]. Importantly, there is growing evidence that positive social relationships are key to producing the best outcomes associated with psychedelic use [18,19,60,61,62], so much so that some scholars ask if psychotherapy is always needed for psychedelic therapeutic purposes [63]. Rather, they argue that the focus should be on building supported companionship for the psychedelic experiences. Thus, while stigma can push Asians toward alternative coping behaviors, the heightened stigma around drug use may reduce the likelihood of psychedelics self-medication [58,64,65].
There is a growing demand for mental health services within both Asian and NHOPI populations, with higher rates of suicide attempts, mental health issues, and substance use [59,64,66,67,68]. Unfortunately, we do not know whether increased psychedelic access could help mitigate these issues, or if their use is associated with other unintended, harmful behaviors, as indicated by the literature on stigma and mental health. Accordingly. the goal of this analysis is to understand the relationship between distress, psychedelic use, and treatment seeking behaviors among Whites, Asians, and NHOPI.

2. Data and Methods

This study draws on pooled cross-sectional data from the National Survey of Drug Use and Health (NSDUH), covering the years 2008 to 2019 (n = 458,372). The NSDUH is conducted annually across the United States to monitor patterns of substance use and mental health, making it one of the most widely used national datasets for examining population-level trends in these areas. To ensure representativeness, the survey data are weighted to reflect the civilian, non-institutionalized population, which allows the results to generalize to the broader U.S. adult population rather than just the survey sample. Descriptive statistics for the dependent, independent, and control variables are presented in Table 1, providing an overview of the characteristics of the sample and ensuring transparency in how the analysis was conducted. All variables were derived from publicly available data files, which can be accessed on the NSDUH website (https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health/datafiles/2002-2019 (accessed on 15 January 2025)). The original survey protocols were approved by the Substance Abuse and Mental Health Services Administration’s Institutional Review Board (IRB), and informed consent was obtained from participants in accordance with IRB requirements. Importantly, because this study relies exclusively on secondary, de-identified public-use data, all identifying information was removed prior to public release. As a result, the project is exempt from further ethical review and did not require additional consent procedures, a standard approach when working with large-scale secondary datasets of this kind.
This study mirrors previous research methodology that has analyzed the association between psychedelic use and health outcomes, using data from the National Survey on Drug Use and Health (NSDUH) [17,27,60,69,70,71]. Although the key description of the analysis follow, please see [14,60] for further details. Table 1 provides descriptive statistics for the variables.

2.1. Dependent Variables

The analysis uses 4 measures for mental health treatment in the past year: prescription medication, outpatient services, inpatient treatment, and any formal treatment. These variables are dichotomized as yes or no.

2.2. Independent Variables

The analysis includes 1 categorical variable with 7 categories: Non-Hispanic African Americans, Hispanics, non-Hispanic Asians, non-Hispanic NHOPI, non-Hispanic Native American/Alaskan Native, Multi-racial/others, and non-Hispanic Whites. The study focuses on non-Hispanic NHOPI, non-Hispanic Asians, and non-Hispanic Whites. Psychological distress is measured using the Kessler Psychological Distress Scale (K6), which consists of 6 feelings or experiences rated on a 5-point Likert scale [72]. Higher scores indicate more distress and are associated with other mental health issues, including generalized anxiety disorder, bipolar disorder, and schizophrenia [73,74,75].
This analysis measures drug use of 7 substances: MDMA, DMT, ayahuasca, psilocybin, LSD, mescaline, and peyote [76,77]. Six of these substances are classic psychedelics with low toxicity that promote neurogenesis [37]. These include DMT, ayahuasca, psilocybin, LSD, mescaline, and peyote. MDMA produces psychedelic effects by increasing serotonin levels in the brain [77]. The analysis includes MDMA as a separate measure. Additionally, the analysis follows previous research and combines the 6 classic psychedelics into a single variable indicating any lifetime classic psychedelic use (LCPU) [14]. Table 1 shows the descriptive statistics for key dependent and independent variables among the total population.

2.3. Control Variables

In addition, the analysis follows previous research and includes multiple socioeconomic and behavioral control variables; annual household income, educational attainment, gender, age, marital status, religious attendance, religious salience, age of first alcohol use, risky behavior, year of survey, and lifetime drug use including cocaine; marijuana use; phencyclidine (PCP); inhalants; other stimulants; sedatives; pain relievers; and tobacco use (i.e., smokeless tobacco; pipe tobacco; cigar; and daily cigarette use) [5,27,60,70,78,79,80]. (See Supplemental Table S1 for full details on control variable coding).

2.4. Analytic Strategy

The analysis first calculated the mean of each variable for non-Hispanic Whites, Asians, and NHOPI. It then used LINCOM (non-linear combination) commands to calculate the statistical mean difference between subpopulation means [81,82]. Mean differences were calculated for White People minus all non-White people, Asians minus all non-Asians, and NHOPI minus all non-NHOPI (Supplemental Table S2).
Logistic regression models were used to examine the relationship between race/ethnicity, psychedelics, psychological distress, and treatment use, controlling for other variables (Supplemental Tables S3–S5)—The analysis followed recommendation to run a sensitivity analysis of alternative models (i.e., probit, multinomial, and ordinary least square regression), but results proved substantially identical [77]. Using an intersectional approach and following the recommendation by Long and Freese, the analysis compares different racial/ethnic groups by running individual models by race/ethnicity [82]. The analysis then compared race/ethnicity differences using a statistical method called post-estimation Seemingly Unrelated Estimation, which combines different regression models to compare differences in coefficients across the different models [83]. Models 1–3 predict prescription medication, Models 4–6 predict outpatient treatment, Models 7–9 predict inpatient treatment, and Models 10–12 predict any formal care. For each outcome, separate models include two-way interactions between MDMA and distress, and LCPU and distress, respectively.

3. Results

3.1. Descriptive Statistics

Supplemental Table S2 summarizes racial differences in health care utilization and mental health outcomes. White individuals have higher rates of prescription medication use, outpatient services, and any formal mental health care compared to non-Whites (p < 0.001). They also have lower rates of inpatient treatment and psychological distress (p < 0.001) and are more likely to use MDMA or LCPU (p < 0.001). Asians are less likely to use medication, outpatient, and any formal care (p < 0.001), as well as inpatient services (p < 0.05). They have lower distress levels and are less likely to use any psychedelics (p < 0.001). NHOPI individuals are less likely to use medication, outpatient services, and any formal care (p < 0.001), but there are no differences in inpatient care, distress levels, and MDMA use between NHOPI and non-NHOPI people (p < 0.001 for LCPU).

3.2. Mainline Results by Race and Ethnicity

Regression analysis by race reveals associations between MDMA and health care utilization. Among Whites (Supplemental Table S3), MDMA is negatively associated with using medication (Model 1, b = −0.227, p < 0.001), outpatient services (Model 4, b = −0.193, p < 0.001), and any formal care (Model 10, b = −0.229, p < 0.001). Similarly, among Whites, LCPU is negatively associated with using medication (Model 1, b = −0.0932, p < 0.05). Among Asians (Supplemental Table S4), MDMA is negatively associated with using medication (Model 1, b = −0.973, p < 0.01) and any formal care (Model 10, b = −0.560, p < 0.05). Lastly, for NHOPI (Supplemental Table S5), MDMA is only negatively associated with using medication (Model 1, b = −1.568, p < 0.05). However, LCPU is positively associated with using medication (Model 1, b = 2.302, p < 0.001) and any formal care (Model 10, b = 1.259, p < 0.05) among NHOPI.

3.3. Two-Way Interactions

Two-way interactions demonstrate that among Whites (Supplemental Table S3), MDMA lowers medication use (p < 0.001), outpatient services (p < 0.01), inpatient services (p < 0.05), and any formal care (p < 0.001). Similarly, for LCPU, it lowers medication use (p < 0.01), outpatient services (p < 0.05), and any formal care (p < 0.01) among Whites. Among NHOPI (Supplemental Table S5), MDMA and LCPU both amplify the positive association between distress and Outpatient Services (Model 5: MDMA b = 0.318, p < 0.05; Model 6: LCPU b = 0.398, p < 0.01), as well as any formal care (Model 11: MDMA b = 0.242, p < 0.05; Model 12: LCPU b = 0.279, p < 0.01). There was no significant interaction between psychedelics and distress among Asians. Figure 1 and Figure 2 present the interaction terms for regression models by Whites and NHOPI, respectively.

4. Discussion

This study examined the impact of psychedelic use on mental health treatment-seeking. The findings indicate that overall, whites who use psychedelics are less likely to seek formal mental health care, especially if they experience higher distress levels.
However, results did not find any significant interactions between psychedelics and distress among Asians, likely explained by multiple conflicting cultural perspectives. Unlike White people, who may be driven to psychedelic use as a consequence of stigma, Asians may not necessarily resort to negative behaviors because of the overall higher stigma attached to drug use. While this could be viewed as a positive outcome in terms of avoiding potentially harmful coping strategies, the results also suggest that Asians may be less likely to use psychedelics to manage mental health even as this legal treatment becomes available. These results may be attributed to several interconnected factors. Firstly, Asians face higher rates of stigma attached to mental illness than other racial and ethnic groups in the United States [55,84,85]. This stigma often extends beyond the individual to include family reputation, which can discourage both disclosure of distress and active treatment-seeking. Additionally, Asians also report significant cultural stigma associated with illicit drug use of any kind for any reason compared to other groups [54,55,85]. In many communities, drug use is not only seen as a personal failing but as a source of shame that undermines collective identity and family honor.
Qualitative research suggests that Asian Americans hold negative views toward drug use, as they perceive it as bringing shame to their family and conflicting with their traditional Asian identity [56]. For example, interviews have shown that concerns over “losing face” within one’s community or being viewed as dishonoring one’s parents can strongly shape reluctance to engage in both drug use and formal treatment. Therefore, while Asians may be less likely to utilize mental health services, they are also less likely to turn to psychedelics as a means of managing their mental health issues, even if these therapies become legally sanctioned. This dynamic reflects a form of dual stigma—against both mental illness and drug use—that may make psychedelic-assisted therapy uniquely inaccessible for many Asian populations.
Further research is needed to explore the implications of dual stigma in Asian culture, as these findings suggest that psychedelics may not necessarily be a panacea for Asian health and well-being in the future. Considering that Asians are less likely to receive mental health services due to limited access and cultural stigma [55,85,86,87], the availability of psychedelic-assisted therapy may not be a windfall that broadly improves Asian mental health. Instead, without targeted outreach and culturally adapted interventions, there is a real possibility that Asian populations will remain underrepresented in both clinical uptake and naturalistic use, limiting the potential reach of these emerging treatments.
On the other hand, NHOPI who have used psychedelics are more likely to seek mental health care as they become more distressed, which may be explained by specific positive cultural conceptions that view mental health differently than other communities. Growing evidence suggests that positive social relationships are key to producing the best outcomes associated with psychedelic use [18,19,60,61,62], leading some scholars to ask if psychotherapy is always needed for psychedelic therapeutic purposes [63]. They argue that instead, the focus should be on the preparation and safeguarding of vulnerable people with well-trained, supported companions [63]. This line of thinking fits particularly well with NHOPI traditions, where community relationships, shared responsibility, and extended family ties have long been central to processes of healing and resilience. The importance of social support for psychedelic use may align well with the NHOPI traditional conceptions of mental health, which emphasize interconnectedness and collective well-being [58,64].
Evidence suggests that Pacific Islander cultures, including Native Hawaiians, have a holistic view of mental health where the extended family and community play a central role in providing support and addressing challenges [59]. Within many of these traditions, wellness is not conceived solely as the absence of illness but as a balance of mind, body, spirit, and social connection. In practice, this means that when individuals experience psychological distress, the family network—rather than the individual alone—is mobilized to help provide care. This contrasts sharply with Eurocentric and Asian cultural models, where mental illness is often framed as an individual problem; those who are ill experience stigma that frequently leads to concealment or negative coping practices [36,57,88]. It is possible that, despite potential barriers like increased poverty among NHOPI which limits access to mental health care [65,67,89], the communal view of mental illness within NHOPI communities may actively facilitate a positive approach to seeking formal care. Psychedelics in these contexts may not only be tolerated but also integrated into shared coping strategies, making their effects more synergistic with cultural expectations of mutual support. Rather than isolating individuals or pushing them away from services, as stigma often does in other groups, psychedelics could be framed within NHOPI communities as complementary to collective healing practices. This suggests that for NHOPI populations, the presence of strong cultural traditions around interconnectedness and collective well-being may uniquely enhance the likelihood that psychedelic use is paired with formal care, creating outcomes that differ significantly from those observed among White or Asian populations.
Importantly, this study suggests that individuals who are not Asian or NHOPI and use psychedelics are less likely to seek formal mental health care, but it does not directly prove maladaptive coping or self-medication. The interpretation of this pattern is complex. While it is possible that these findings indicate self-medication with psychedelics, it is important to note that psychedelic use itself is associated with positive outcomes and may not be inherently harmful. Many clinical and population studies suggest that psychedelics can promote psychological openness, reduce distress, and foster meaning-making, which complicates assumptions that avoiding formal treatment automatically equates to maladaptive behavior. The results do not definitively suggest that psychedelic users engage in harmful behaviors like drinking or smoking. On the contrary, it is plausible that users employ positive coping strategies and seek support from their social networks for their mental health concerns, given that psychedelics can enhance positive psychological states. Such support may include turning to trusted peers, spiritual leaders, or community groups rather than formal health systems, which could represent a different—but not necessarily worse—form of care. Further research should explore this aspect by examining whether reliance on psychedelics outside of clinical frameworks supplements or substitutes for evidence-based treatment. Other studies have also found that psychedelic use is linked to improved well-being and stronger social relationships [90], reinforcing the possibility that these substances may in some cases function as tools for building resilience rather than simply risk factors for avoiding care.
These results present a unique opportunity for Hawai’i as it navigates new policies on psychedelics. While whites could be particularly harmed by stigma, driving them to negative coping, and Asians may not use psychedelics at all to manage mental health despite legal changes, there is some unknown cultural dynamic that may explain the association between psychedelic use among NHOPI and their mental health care. To develop effective policies that could counter the potentially negative outcomes found among Whites and Asians, further research is needed to understand the specific factors within NHOPI culture that contribute to this positive relationship. Policy makers should consider how to create culturally “centered” approaches to psychedelics [91]. One research points out that even though ayahuasca use is integral to rituals within the Santo Daime religion [91], leading to documented positive health outcomes, this religion was founded less than a century ago [92,93,94]. Therefore, rather than simply trying to fit ethnic and racial groups into a white, psychiatric model, a culturally centered approach would use proper health oversight to help local communities develop their own practices that meet their needs.

Limitations and Future Research

This study reveals significant connections between race, psychedelics, distress, and treatment seeking, but it has limitations. The main limitation is the data itself; as a cross-sectional data, it does not provide a comprehensive understanding of the long-term effects and behaviors of psychedelics on minorities and prevents drawing definitive causal inferences; longitudinal data with information on the timing of drug is needed. There may be other unmeasured factors contributing to the observed associations. Despite including various standard control variables, it is likely that additional factors were overlooked, such as personality traits, peak experiences, and dosage, which have been shown to impact outcomes in previous psychedelics trials. Additionally, the lack of information about the motivations behind psychedelic use limits our understanding. While some individuals may use psychedelics to address mental health issues, without specific measures, this cannot be confirmed. Future research should replicate these findings across various marginalized groups who may benefit from psychedelic use, such as women, immigrants, and LGBTQ+ individuals. It should also examine ethnic subpopulations and regional variations within the NHOPI community, such as Japanese vs. Chinese or Hawaiian vs. Samoan. Additionally, the data is unable to parse out regional differences, and future research should consider differences in the experience of, for instance, NHOPI and Asians in Hawai’i vs. East Coast or other regions. Qualitative methods, including ethnographic work and in-depth interviewing, will be very valuable to understand these unique cultural difference [95,96].
Another limitation is that the NSDUH data measure treatment utilization but do not capture respondents’ motivations for seeking or avoiding care. Without information on underlying reasons, interpretation of treatment-seeking behaviors is necessarily constrained. Future research should employ data that can measure the decision-making process directly, including stigma perceptions, cultural attitudes, and motivations for self-medication. It should also use more specific indicators of mental illness stigma, collect precise data on structural inequality and motivations for psychedelic use, examine the difference between classic psychedelics (e.g., psilocybin vs. DMT), and explore how psychedelics can influence perceptions of stigma. This will enhance our understanding of the differential effects of structural inequality and culture on psychedelic use and outcomes for NHOPI and other groups. Additionally, while NSDUH has released data for beyond 2019, these files have not yet been integrated into the pooled 2002–2019 dataset used here, and methodological differences make it ill-advised to merge them until SAMHSA provides an official harmonized release.
This study focused on MDMA and classic serotonergic psychedelics, consistent with the current clinical and policy debates surrounding psychedelic-assisted mental health treatment. Marijuana was excluded because it interacts with the endocannabinoid system rather than the serotonergic system that defines classic psychedelics. However, marijuana is often used to self-medicate for anxiety and other psychiatric symptoms and, in some cases, produces psychedelic-like perceptual phenomena. Although the policy landscape around marijuana is largely settled due to widespread decriminalization and legalization across the United States, future research would benefit from comparing how distress, stigma, and treatment-seeking behaviors differ when individuals self-medicate with marijuana versus psychedelics. Emerging evidence suggests that marijuana use is associated with both potential benefits for self-medication and risks of adverse outcomes depending on frequency, context, and population subgroup [97,98]. Such comparative work would help clarify how cultural influences and drug-specific mechanisms shape mental health outcomes.

5. Conclusions

Despite its limitations, this study provides valuable insights into the relationship between psychedelics, health, and race/ethnicity, which may be of particular interest to the State of Hawai‘i given their changing policies on psychedelics and their unique demographics. These findings highlight that patterns of use and treatment-seeking cannot be understood in isolation from cultural frameworks and historical experiences of stigma. They suggest that policy approaches should be culturally responsive rather than uniform as described by many ethical considerations for future psychedelics policy, including the role of indigenous knowledge as well as racial justice [99,100,101,102]. For example, efforts in Hawai‘i could incorporate NHOPI traditions of communal care while simultaneously addressing barriers among Asian populations where stigma toward both mental illness and drug use remains high. Tailoring policies in this way may help maximize potential benefits of psychedelic access while minimizing risks across diverse communities, ensuring that reforms do not simply reproduce existing health disparities.
As psychedelics become more accessible, their naturalistic use may surpass clinical treatment, potentially increasing the odds of harmful outcomes, especially in areas with limited mental health resources and higher stigma. A recent incident involving a pilot illustrates the negative potential of stigma, as he used psychedelics as self-medication out of fear of losing his pilot’s license if he sought care [103]. Such cases underscore how structural and cultural barriers can drive individuals toward risky behaviors, even when safer treatment options exist.
By using population-level data instead of relying solely on clinical trials, this study contributes a broader perspective on how psychedelics are already being integrated into health behaviors. These results not only position policymakers to make better informed decisions but also provide direction for future research. Longitudinal analyses could help determine whether these associations persist over time, while qualitative studies could capture the motivations, barriers, and lived experiences of Asian and NHOPI individuals navigating both stigma and psychedelic use. Beyond Hawai‘i, the lessons from this study are relevant to other jurisdictions considering psychedelic reforms, particularly those with diverse populations and uneven access to mental health care. Ultimately, recognizing the interplay of culture, stigma, and policy will be essential to designing equitable approaches that harness potential benefits while avoiding foreseeable harms. Policies that fail to account for cultural variation risk repeating past mistakes in drug reform, but policies that engage diversity directly may open new pathways for equitable care.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/psychoactives4030032/s1, Table S1: Descriptive Statistics for Dependent Variables, Independent Variables, and Controls (2005–2019) (weighted); Table S2. Mean or Proportion Differences of Dependent, Independent, and Control Variables by White, Asian, and Native Hawaiian and Other Pacific Islanders (NHOPI)le (Weighted); Table S3. Weighted Multivariate Logistic Regression Predicting Using Different Formal Mental Health Treatments the Last Year Among White People; Table S4. Weighted Multivariate Logistic Regression Predicting Using Different Formal Mental Health Treatments the Last Year Among Asian People; Table S5. Weighted Multivariate Logistic Regression Predicting Using Different Formal Mental Health Treatments the Last Year Among Hawaiians and Pacific Islanders.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Institutional Review Board Statement

This study was conducted in accordance with the ethical standards of the University of the Incarnate Word Institutional Review Board (IRB). The University of the Incarnate Word IRB reviewed the study and deemed it exempt from further ethical review as it involved the use of publicly available, anonymous, secondary data.

Informed Consent Statement

Informed consent was not required for this study, as it utilized publicly available, anonymous, secondary data, which does not involve any direct interaction with participants or the collection of personal identifiable information.

Data Availability Statement

The National Survey of Drug Use and Health (NSDUH) is public-use data and is available on their homepage: https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health/datafiles/2002-2019 (accessed on 15 January 2025); Code availability: STATA coding will be made available upon request by contacting the contributing author.

Conflicts of Interest

The author declares no conflicts of interest.

Abbreviations

The following abbreviations are used in this manuscript:
DMTN,N-Dimethyltryptamine
LCPULifetime Classic Psychedelic use
LINCOMnon-linear combination
LSDLysergic acid diethylamide
MDMA3,4-methylenedioxy methamphetamine
NHOPINative Hawaiian or Other Pacific Islander
H/PINHOPI (Used in Figures to Save Space)
NSDUHNational Survey of Drug Use and Health

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Figure 1. Predicted Margins of Lifetime Classic Psychedelic use (LCPU) or MDMA × Psychological Distress on Using Formal Mental Health Care (Prescription Medication, Outpatient Services, Inpatient Services and Any Care) Among White People with 95% Cis. Source: 2008–2019 National Survey of Drug Use and Health, n = 458,372; Note: Based on Supplemental Table S3 Models 2, 3, 5, 6, 8, 11, and 12.
Figure 1. Predicted Margins of Lifetime Classic Psychedelic use (LCPU) or MDMA × Psychological Distress on Using Formal Mental Health Care (Prescription Medication, Outpatient Services, Inpatient Services and Any Care) Among White People with 95% Cis. Source: 2008–2019 National Survey of Drug Use and Health, n = 458,372; Note: Based on Supplemental Table S3 Models 2, 3, 5, 6, 8, 11, and 12.
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Figure 2. Predicted Margins of Lifetime Classic Psychedelic use (LCPU) or MDMA × Psychological Distress on Using Formal Mental Health Care (Prescription Medication, Outpatient Services, and Any Care) Among Hawaiians/Pacific Islanders with 95% CIs. Source: 2008–2019 National Survey of Drug Use and Health, n = 458,372; Note: Based on Supplemental Table S5 Models 5, 6, 11, and 12.
Figure 2. Predicted Margins of Lifetime Classic Psychedelic use (LCPU) or MDMA × Psychological Distress on Using Formal Mental Health Care (Prescription Medication, Outpatient Services, and Any Care) Among Hawaiians/Pacific Islanders with 95% CIs. Source: 2008–2019 National Survey of Drug Use and Health, n = 458,372; Note: Based on Supplemental Table S5 Models 5, 6, 11, and 12.
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Table 1. Descriptive Statistics for Dependent Variables, Independent Variables, and Controls (2005–2019) (weighted).
Table 1. Descriptive Statistics for Dependent Variables, Independent Variables, and Controls (2005–2019) (weighted).
Mean aSDn%/Min–Max
Dependent Variables
Prescribed Mental Health Medication 55,4177.04
Outpatient Mental Health Treatment 32,1277.04
Inpatient Mental Health Treatment 39810.87
Any Formal Mental Health Treatment 66,10314.49
Key Independent Variables
Psychological Distress in Past 30 days (K6) b9.526.06151,6830–24
Psychedelic use
MDMA 32,4687.09
Lifetime Classic Psychedelic use c 63,89313.94
Race/Ethnicity 48,41310.56
White 301,98965.88
Native Hawaiian and Other Pacific Islanders (NHOPI) 16350.36
Asian 23,5635.14
Source: 2008–2019 National Survey of Drug Use and Health, n = 458,372. a All means were calculated in Stata using the summarize command. b K6 assesses the frequency of six emotional experiences in the past 30 days using a 5-point Likert scale (0–4). The experiences include feeling “nervous”, “hopeless”, “restless”, “deeply depressed”, “everything as an effort”, and “worthless”. Psychological distress is measured on a scale of 0–24, with higher scores indicating more distress. c LCPU indicates any lifetime classic psychedelics among the of six variables (DMT, ayahuasca, psilocybin, LSD, mescaline, and peyote). Note: Descriptive Statistics for the control variables are available in the supplemental file (Supplemental Table S1).
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Viña, S.M. Psychedelics and Mental Health Treatment Seeking Among Asians and Hawaiians. Psychoactives 2025, 4, 32. https://doi.org/10.3390/psychoactives4030032

AMA Style

Viña SM. Psychedelics and Mental Health Treatment Seeking Among Asians and Hawaiians. Psychoactives. 2025; 4(3):32. https://doi.org/10.3390/psychoactives4030032

Chicago/Turabian Style

Viña, Sean Matthew. 2025. "Psychedelics and Mental Health Treatment Seeking Among Asians and Hawaiians" Psychoactives 4, no. 3: 32. https://doi.org/10.3390/psychoactives4030032

APA Style

Viña, S. M. (2025). Psychedelics and Mental Health Treatment Seeking Among Asians and Hawaiians. Psychoactives, 4(3), 32. https://doi.org/10.3390/psychoactives4030032

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