As for other Americans who want to use psychedelics in a more secular setting, it’s easy to imagine spa-like retreat centers popping up across the country. Indeed, a prototype already exists: Field Trip Health has opened a half dozen lavishly appointed clinics (with more on the way) offering ketamine-assisted therapy for depression, which is already legal, in anticipation of Food and Drug Administration approval of MDMA and psilocybin. A psychiatrist on staff screens “patients” — i.e., customers — and then a doctor or nurse practitioner administers the drug; trained facilitators prepare the clients for what to expect and then sit with them during the experience, afterward helping to “integrate” — make sense of and apply — whatever they have learned.
Different as they sound, the medical, religious and, for lack of a better term, retreat-center uses of psychedelics are all highly formalized, which is important. When psychedelics first burst upon the West in the middle of the last century, they arrived without an instruction manual and so were sometimes used recklessly, without regard for set and setting. People thought nothing of dropping acid at festivals and protests or of spiking punch bowls with LSD, a practice that seems crazy, if not cruel. It’s no wonder the bad trip became such a powerful meme and the culture turned against psychedelics.
In fact, a user’s manual for the safe and constructive use of psychedelics did exist, even then; most of us just weren’t aware of it. I’m thinking of the use of psychedelics by Indigenous peoples, which suggests a model we would do well to keep in mind as we figure out how best to handle these substances. There are numerous examples of Indigenous peoples that have successfully incorporated psychedelic compounds into their cultures as a sacrament, medicine or medium of communication. Surveying these cultures, you find a few common denominators. People seldom, if ever, use a psychedelic alone and never casually: They are taken for a specific reason, with an intention. There is almost always an elder presiding, someone who knows the psychic terrain and can create a suitable container for the experience. And invariably the experience takes place within a structure of ritual.
Dr. Andrew Weil was one of the first to recognize the value of ritual in drug use. In his 1972 book, “The Natural Mind,” he writes:
Ritual seems to protect individuals and groups from the negative effects of drugs, possibly by establishing a framework of order around their use. At least, people who use drugs ritually tend not to get into trouble with them, whereas people who abandon ritual and use drugs wantonly seem to have problems.
Simply borrowing a ritual ceremony from any Indigenous group probably wouldn’t fly in 2021 America and, even if it did, would be an act of cultural appropriation. In my interviews with Native Americans, I encountered a deep reluctance to share with a white journalist exactly what happens during a peyote ceremony. “The great spirit gave us this plant a long time ago,” Steven Benally, a Diné leader of the Native American Church, explained when I asked him simply to describe a peyote ceremony. “I’m guessing you’re white, yes? All this information you want, what’s in it for me?” So much has been taken from Native Americans that they are determined to safeguard their peyote and the rituals that accompany it. We non-Natives will need to design our own culturally appropriate containers for the secular, nonmedical psychedelic experience. But that process should be informed by the principles guiding these Indigenous practices, since they are the product of deep experience with these molecules going back thousands of years.
The end of the drug war will confront us with cases more challenging than the psychedelics, several of which have been investigated by scientists as effective treatments for various forms of mental illness. They are also not habit-forming. But what about the so-called hard drugs, like heroin, cocaine and methamphetamine — drugs that people ostensibly take for pleasure? Is there a safe way to fold these more addictive molecules into our lives?
This is uncomfortable territory, partly because few Americans regard pleasure as a legitimate reason to take drugs and partly because the drug war (with its supporters in academia and the media) has produced such a dense fog of misinformation, especially about addiction. Many people (myself included) are surprised to learn that the overwhelming majority of people who take hard drugs do so without becoming addicted. We think of addictiveness as a property of certain chemicals and addiction as a disease that people, in effect, catch from those chemicals, but there is good reason to believe otherwise. Addiction may be less a disease than a symptom — of trauma, social disconnection, depression or economic distress. As the geography of the opioid and meth crises suggests, one’s environment and economic prospects play a large role in the likelihood of becoming addicted; just look at where these deaths of despair tend to cluster or the places where addiction to crack cocaine proliferated.
Two findings underscore this point, both described in Johann Hari’s 2015 book on drug addiction, “Chasing the Scream.” Much of what we know, or believe we know, about drug addiction is based on experiments with rats. Put a rat in a cage with two levers, one giving it heroin or cocaine, the other sugar water, and the rat will reliably opt for the drug until it is addicted or dead. These classic experiments seemed to prove that addiction is the inevitable result of exposure to addictive drugs, a simple matter of biology. But something very different happens when that experimental rat is sprung from solitary confinement and moved to a larger, more pleasant cage outfitted with toys, good food and companions to play and have sex with. This is the so-called rat park experiment, devised by a Canadian psychologist named Bruce Alexander in the 1970s. He and his colleagues found that in this enriched environment, rats will sample the morphine on offer but will consume a small fraction of the amount consumed by rats living in isolation, in some cases five milligrams a day instead of 25. Dr. Alexander came to see that drug abuse isn’t a disease; it’s an adaptation to one’s environment and circumstance — to the condition of one’s cage.