The mainstream treatment approach to addiction in the U.S. is “alternative,” based in a fundamental reliance on Alcoholics Anonymous.  A paradoxical situation exists in the fundamental role of spirituality in Alcoholics Anonymous (AA) and the acceptance of the AA approach by biomedicine.  The only program that the American Medical Association and boards of medical examiners recognize as providing adequate therapy and support to meet its requirements for treatment of physicians suffering from addictions is the AA.   AA, an avowedly religious and spiritual approach to overcoming addictions, is the treatment of choice for what medicine tells us is a genetic and physiological disease.

The apparent contradiction between the biomedical definition of addiction as a biological process and the predominant treatment processes based upon a spiritual healing has a resolution in understanding spirituality in neurological terms.  “Neurotheology”  links spirituality with biologically based altered states of consciousness (ASC) and the dynamics of addiction.  Research on shamanic ASC illustrate that they too produce physiological changes in that brain (2017) that can address the dynamics of addiction and the search for transcendent consciousness, enabling ritual ASC and spirituality to address the dynamics of addiction (2001, 2003, 2004, 2009a) The incorporation of non-drug practices to deliberately induce altered states of consciousness is one of these areas in which cross-cultural perspectives can enhance addiction medicine.  

Psychobiological perspectives on shamanistic healing and other forms of natural ASC indicate that they are useful both as a prophylactic against drug abuse, as well as potential treatments for addiction and mechanisms of harm reduction (2009).  These ASC can provide an alternative source of transcendence to the drugs of addiction, facilitating a smoother transition to the path of recovery.  Many of the forms of ASC–drumming groups (2003), shamanic circles (2001, 2004), meditation centers, and others–also provide a social support group and activities to engage the person’s recuperative energies.  All of these aspects can facilitate recovery, easing the physical longing and mental anguish of abstinence, providing productive and supportive activities to occupy the addict’s time, and creating a social reference group to change affect and sense of self central to the self-transformations underlying recovery (2014, 2009). Shamanic practices provide a system of person and social reference that is biologically based in neurognostic structures, enabling the ritual participation to produce significant changes in physiological dynamics that abate the dynamics of addiction 2001, 2009).

Perhaps the most important and ironic finding in addictions studies in recent years is the robust effects of psychedelics in treating addictions (2018, 2014, 2009). Evidence from contemporary ayahuasca churches (2018) also show that it is a significant deterrent to alcohol and tobacco use. While psychedelics are classified as dangerous drugs considered to be without any medical applications, they are nonetheless highly effective in interrupting addictions to the truly addictive drugs. Findings reported in Psychedelic Medicine, Advances in Psychedelic Medicine and my 2014 article in Current Drug Abuse Reviews show the dramatic effects that psychedelics can have in curtailing addictive behaviors. Given the scope of the public health crises associated with numerous legal and illegal addictions, the immediate application of psychedelics to treat addictions out to be pursued, given that they have a very high safety profile.