Alternative and traditional medicine approaches for substance abuse programs: a shamanic perspective
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International Journal of Drug Policy 12 (2001) 337– 351
www.elsevier.com/locate/drugpo
Alternative and traditional medicine approaches for
substance abuse programs: a shamanic perspective
Michael Winkelman *
Department of Anthropology, Arizona State Uni6ersity, PO Box 872402, Tempe, AZ 85287 -2402, USA
Received 1 February 2001; accepted 1 June 2001
Abstract
Analysis of the relationship of altered states of consciousness (ASC) to culture and human psychobiology provides
guidance for new approaches for addressing substance abuse and dependence. While Western cultures have a long
history of repressing ASC, cross-cultural research illustrates the ubiquitous human drive to alter consciousness and
the near universality of institutionalized healing practices based on ASC. These may reflect adaptive mechanisms that
do not operate in contemporary societies as they did in the human past. Effectiveness of ASC procedures in treating
substance dependence is found in ethnomedical treatments of addiction, the addiction literature, Alcoholics Anony-
mous, and the physiological effects of shamanistic practices. A review of shamanic therapeutic mechanisms illustrates
their applicability to addressing the psychodynamics of drug addiction. The utility of natural ASC practices to reduce
substance dependence problems is illustrated by clinical research on the treatment of drug dependence through the use
of meditative practice and models of their psychobiological dynamics. Shamanistic practices induce the relaxation
response, enhance theta-wave production, and stimulate endogenous opioid and serotonergic mechanisms and their
mood elevating effects. Directions of a shamanic based ASC therapy for drug dependence are suggested. © 2001
Elsevier Science B.V. All rights reserved.
Keywords: Traditional medicine; Substance abuse programs; Shamanic perspective; Altered states of consciousness
Introduction: culture, consciousness and tion are inadequate. Failure to effectively ad-
addiction dress the problems of the addicted
population produces major political and
Substance abuse and its consequences pro- financial consequences for the broader society
duce health and social problems, but the (Amaro, 1999). Treatment programs are in-
current practices for management of addic- adequate for many reasons —limited
availability and funding, a lack of knowledge
and awareness of alternatives, and the failure
to develop adequate public policy. This lack
* Tel.: +1-480-965-6215; fax: +1-480-965-7671.
E-mail address: michael.winkleman@asu.edu (M. Winkel- of treatment programs also reflects cultural
man). impediments to the practice of scientific
0955-3959/01/$ - see front matter © 2001 Elsevier Science B.V. All rights reserved.
PII: S 0 9 5 5 - 3 9 5 9 ( 0 1 ) 0 0 1 0 0 - 1338 M. Winkelman / International Journal of Drug Policy 12 (2001) 337–351 medicine and preventive health. These cul- and the increasing openness towards tradi- tural barriers derive from historical attitudes tional healing practices. This new openness is that have shaped societal views of conscious- exemplified in the World Health Organiza- ness altering substances and policy perspec- tion (1978) declaration at the International tives on management of drug problems Conference on Primary Health Care in Alma (McPeake et al., 1991; Jung, 2001, Fox, Ata, where the ‘‘Health for All by the Year 1999). This results in ineffective approaches 2000’’ program was initiated to incorporate focused upon drug supply interdiction and traditional healers into primary health care. persecution of users rather than provision of Acceptance of alternative approaches was in- adequate prevention and rehabilitation stitutionalized in the US Government’s Na- services. tional Institute of Health’s National Center Current practices of incarcerating drug of- for Complementary and Alternative fenders are ineffective as rehabilitation pro- Medicine. grams. Most people incarcerated for Consideration of alternative approaches to substance abuse related crimes are returned drug abuse rehabilitation has, until recently, to prison as a consequence of repeated drug been largely limited to suggestions or insights abuse (Bearman et al., 1997). Treatment is (e.g. Lex and Schor, 1977; Blum and Tilton, available to only about, one third of the 1981; McPeake et al., 1991; Rioux, 1996) estimated 5.3 million Americans who have rather than systematic approaches. Nonethe- severe needs for substance abuse treatment less, a growing body of evidence supports (Amaro, 1999). Most treatment programs consideration of these therapies as means for have limited annual and lifetime coverage, addressing substance abuse prevention and relapse penalties which make them ineffective rehabilitation. This includes: the relevance of and underutilized, and high levels of recidi- acupuncture for treatment of opiate based vism. Existing rehabilitation programs may addictions (e.g. Brumbrough, 1993; Riet et be no more successful than the spontaneous al., 1990; Avants et al., 2000) and the use of remission or natural self-recovery occurring Transcendental Meditation practices as suc- in the untreated population (Alexander et al., cessful means of treating addictions (see 1994; Miller, 1998b; Sobell et al., 2000; Cun- O’Connell and Alexander, 1994; Alexander et ningham et al., 2000). New policy and pro- al., 1994); and cross-cultural reviews of eth- gram directions for management of drug nomedical approaches to addiction treatment dependence and its consequences need to be (Jilek, 1994; Heggenhougen, 1997; Singer and developed. These can be derived from a Borrego, 1984). recognition of cultural biases impeding the The reputedly most successful substance use of scientific knowledge regarding sub- abuse rehabilitation program is Alcoholics stance abuse prevention and the development Anonymous (1976, 1987), a non-medical of cross-cultural perspectives about alterna- therapy that advocates meditation, a change tive healing resources for addressing these in consciousness, and spiritual awakening as problems. fundamental to achieving and maintaining Consideration of alternative and comple- sobriety. Shamanic practices, the most an- mentary healing approaches to substance cient of ASC spiritual healing approaches, abuse rehabilitation is supported by the lim- may also have potential effectiveness in elicit- ited effectiveness of contemporary substance ing psychobiological (opioid and serotoner- abuse prevention and treatment programs, gic) mechanisms (Winkelman, 2000), and
M. Winkelman / International Journal of Drug Policy 12 (2001) 337–351 339
addressing psychosocial and emotional dy- Siegel (1984, 1990) have proposed an innate
namics of drug addiction (Rioux, 1996). drive to seek ASC. This perspective is sub-
Shamanistic practices induce a relaxation re- stantiated by Mandel’s (1980) psychobiologi-
sponse, provoke integrative theta wave dis- cal model of ‘transcendent states’ that
charges, stimulate endogenous opioid considers diverse ASC to share common psy-
production, and enhance serotonergic mecha- chobiological mechanisms (c.f. Winkelman,
nisms and their mood elevating effects. The 1986, 1992, 1997, 2000). Nearly all societies
relationship of drug addiction to human psy- have institutionalized ritual group procedures
chobiological needs for experiencing alter- for altering consciousness (Bourguignon,
ations of consciousness also suggest the 1968, 1973; Winkelman, 1986, 1992). This
potential utility of ASC for addressing drug near-universal distribution of ASC for heal-
addiction. ing reflects a biologically based mode of inte-
This paper reviews evidence supporting the grative consciousness (Winkelman, 2000) and
use of alternative healing approaches based indicates that all cultures need to make some
in ASC as adjuncts to substance abuse pro- adaptation to these needs.
grams. It reviews the rationale for addressing Cultures differ, however, in how they relate
addiction in the context of ASC (McPeake et institutionally and personally to the experi-
al., 1991; Metzner, 1994; Miller, 1998a); pre- ences and potentials of ASC (Laughlin et al.,
sents principal aspects of the application of 1992). They represent the differences in cul-
ethnomedical healing practices to substance tural approaches to ASC as ranging from
abuse rehabilitation derived from cross-cul- ‘monophasic’ cultures which institutionally
tural reviews (Jilek, 1994; Heggenhougen, value only waking consciousness through
1997); assesses some studies and meta-analy- ‘polyphasic void’ cultures that value and ac-
ses that provided evidence of the effectiveness tively encourage exploration of different
of an ASC (transcendental meditation) in phases of consciousness. Widespread Western
substance abuse rehabilitation (Gelderloos et biases against ASCs, manifested in efforts to
al., 1991; Alexander et al., 1994; O’Connell marginalize, persecute or pathologize them
and Alexander, 1994; Walton and Levitsky, (Noll, 1983; Grinspoon and Bakalar, 1979;
1994); and summarizes material that illus- Harner, 1973), contrast with most cultures’
trates the potential of shamanic therapies for group rituals to enhance access to ASC.
addressing substance abuse (Lex and Schor, These cultural biases inhibit recognition of
1977; Miller, 1998a; Rioux, 1996; Smith, the factors that contribute to drug abuse and
1994, 2000; Winkelman, 2000). prevention (Amaro, 1999; Jung, 2001).
Even with cultural repression of ASCs,
they are still sought because they reflect sys-
Psychobiology, culture and the alteration of temic natural neurophysiological processes
consciousness involved with psychological integration or
holotrophic responses (Winkelman, 2000; c.f.,
Drug use and addiction are obviously asso- Grof, 1980, 1992). Although cultures differ in
ciated with the alteration of consciousness; their evaluation of and support of ASCs,
however, substance abuse problems have not people in all cultures seek ASC experiences
been widely analyzed from the perspectives of because they reflect biologically based struc-
consciousness theory or cross-cultural pat- tures of consciousness for producing holistic
terns of the use of ASC. Weil (1972) and growth and integrative consciousness. This340 M. Winkelman / International Journal of Drug Policy 12 (2001) 337–351
near-universality of institutionalization of ships among substance dependence, ASC, rit-
ASC induction practices reflects human psy- ual and spirituality (e.g. Lex and Schor, 1977;
chobiological needs. An evolutionary per- Blum and Tilton, 1981; McPeake et al., 1991;
spective on substance abuse (Smith, 1999; Metzner, 1994; Miller, 1998a; Smith, 1994;
Wilshire, 1998) suggests that humans have Rioux, 1996). McPeake et al. (1991) point out
evolved addictive potentials for adaptive rea- that substance abuse rehabilitation treatment
sons or as an evolutionary by-product. These programs have failed to incorporate the
evolutionary mechanisms may be explained knowledge provided by a vast body of litera-
by the dopamine hypothesis (Smith, 1999) ture indicating the important health benefits
that postulates their role in producing feel- of altered states of consciousness. They sug-
ings of well-being. In any case, the conditions gest a primary reason for relapse is failure of
that led to these adaptations are different treatment programs to address basic needs
that those faced in modern societies. for achieving ASC and providing alternative
Since contemporary Indo–European soci- methods for achieving those ASCs. Metzner
eties lack legitimate institutionalized proce- (1994) analyses addictive experiences in terms
dures for accessing ASCs, they tend to be of ASC, characterizing addictions as a con-
sought and utilized in deleterious and self-de- tracted state of consciousness, in contrast
structive patterns— alcoholism, tobacco with the expansive states of consciousness of
abuse and illicit substance dependence. Since the transcendent mystical states and ecstasy.
ASC reflect underlying psychobiological Addicts engage in a normal human motive to
structures and innate needs, when societies achieve altered states of consciousness, but in
fail to provide legitimate procedures for ac- self-destructive ways because they are not
cessing these conditions, they are sought provided the opportunity to learn ‘‘construc-
through other means. Incorporation of prac- tive alternative methods for experiencing
tices to induce ASC through non-drug means non-ordinary consciousness’’ (McPeake et al.,
could be useful as both a prophylactic against 1991, p. 76). The importance of an alteration
drug abuse, as well as a potential treatment of consciousness in substance abuse recovery
for addiction. This potential of shamanic is emphasized in the AA recovery process,
ASC as therapies for substance abuse rehabil- which calls for ‘‘a new state of consciousness
itation is illustrated in the following review and being’’ (Alcoholics Anonymous, 1987, p.,
of: material from the addiction field regard- 106) designed to replace the self-destructive
ing the applicability of ASC and shamanic pursuit of alcohol- induced altered states with
practices to substance dependence; cross-cul- a positive life enhancing approach.
tural literature on traditional healing ap- Standard approaches to addressing sub-
proaches to addiction; and the stance dependence have failed to consider the
psychodynamic and psychobiological effects role of ASC in human nature or drug depen-
of shamanic practices and ASCs. dence. ‘‘[I]t is rare to find substance depen-
dence explained by the desire to experience
more sought-after states…[the] ‘high’ so often
Addiction and ASC described by the drug-dependent person as
the state being sought’’ (McPeake et al.,
There have been no systematic assessments 1991, p. 76). Metzner compares Eastern and
of the relationship of ASC to addiction, but a Western approaches to addiction recovery,
number of writers have suggested relation- contrasting the western tradition exemplifiedM. Winkelman / International Journal of Drug Policy 12 (2001) 337–351 341 in Dante’s classic ‘‘Descent into Hell’’ with move beyond the developmentally fixated an Asian model focused on meditative prac- stage of drug dependence. Training in induc- tices that lead to transcendence and expanded ing ASCs can enhance the spiritual awaken- consciousness. This perspective is important ing considered essential to recovery in AA. since research indicates that central charac- An ASCT program should provide both teristics of those involved in drug use and patient and staff education, as well as a vari- abuse are sensation seekers in pursuit of new ety of opportunities for non-drug induced experiences and an expanded awareness. alterations of consciousness. These would in- The cultural perceptions of ASC activities clude: physical activities, including extensive as socially disapproved results in a means- exercise which could induce the opiate medi- end confusion and the rejection of the legiti- ated ‘‘runners high;’’ activities in nature mate and valuable aspects of the alteration of which can provide opportunities for ‘‘natural consciousness for substance abuse rehabilita- high’’ experiences; relaxation training based tion. ‘‘Despite the rich literature on ASCs in on progressive relaxation; yogic techniques psychology and spiritual writing, and despite and the use of vivid imagery; cognitive thera- the fact that AA clearly points its members pies in art and other forms of aesthetic expe- toward an ASC, reviewing the published lit- rience; and meditation and prayer, including erature on rehabilitation treatment or survey- Eastern meditative techniques, mantras, ing current rehabilitation treatment biofeedback, dance, music and other natural programming reveals a paucity of writing or methods of inducing ASC. treatment programming that clearly inte- McPeake et al. (1991) recognize the lack of grates ASCs with recovery’’ (McPeake et al., controlled outcome studies for evaluating the 1991, 78). They point to the lack of under- effectiveness of ASC therapies in substance standing of ASCs among treatment profes- abuse rehabilitation. They report anecdotal sionals, as a consequence of negative social information indicating the efficacy of this attitudes towards ASCs and the lack of pro- approach. Substance abuse clients strongly fessional training. endorse these ASCT principals; therapists al- McPeake et al. (1991) propose an altered ready utilize many of these modalities as states of consciousness therapy approach to supportive aspects of therapy; and the ASCT substance abuse as a natural complement to approach helps people recontextualize the re- the AA Twelve-Step recovery program (Alco- ligious aspect of the Twelve-Step program in holics Anonymous, 1976, 1987). ASCs can ways that are easier to understand the objec- enhance recovery by inducing ‘positive men- tives. The utility of an ASCT approach is tal attitudes, goal directedness, certain types also validated by cross-cultural reviews of the of cognition or self-talk, certain types of im- traditional ethnomedical approaches to agery, as well as consciousness of a power addictions. greater than self’ (McPeake et al., 1991, p. 78). This ASC Therapy (ASCT) approach meets human needs to alter consciousness Traditional ethnomedical treatments of and provides a path for personal growth and addiction development associated with transcendental needs. Such an approach can help address Heggenhougen (1997) and Jilek (1994) (c.f. substance abusers genetic or other predisposi- Singer and Borrego, 1984) review a range of tion to seek altered states and allow them to nonwestern traditional indigenous ap-
342 M. Winkelman / International Journal of Drug Policy 12 (2001) 337–351 proaches to substance abuse treatment in or- cally include: practices for detoxification, in- der to determine general patterns of these cluding the use of traditional plant remedies; healing processes and their advantages and a process of transformation and revitalization disadvantages. Their considerations of non- involving a ‘death and rebirth ritual’ produc- Western therapies for drug addiction are ing a positive self-image; coping mechanisms placed in the context of WHO programs of and social support that helps maintain absti- ‘Health for All’ through establishing the sci- nence; a means of achieving ‘highs’ without entific basis for traditional healing practices drugs; addressing psychosocial aspects of ad- and incorporating them into health care sys- diction (e.g., negative self-perception, alien- tems. Their reviews of the utilization of tradi- ation and a sense of anomie or tional medicinal practices in the treatment of meaninglessness that lead to addiction); and addiction reveals a lack of formal clinical supportive socio-cultural factors by creating evaluation, but widespread evidence that they a therapeutic focus at the level of community are likely effective. with support-groups and regular ritual inter- Traditional treatments of addicts in action (Heggenhougen, 1997). Malaysia with Chinese medicine and in Thai- In contrast to hostile Western attitudes land with Buddhist approaches typically in- toward most drug-induced ASC (alcohol and clude the use of plant medicines during the nicotine being exceptions), many cultures detoxification phase and when the craving for have a positive view of ASC induced by plant drugs returns; these often induce extensive medicines or ‘sacred plants’ (e.g. see Dobkin vomiting; analysis of samples suggest that de Rios, 1984; Schultes and Hofmann, 1979; they contain indole alkaloids (Heggenhou- Winkelman, 1996). The use of indole alka- gen, 1997). These healing processes also em- loids for treatment of substance dependence ploy various procedures for internal and is exemplified by the Native American external purification (e.g. purging), and a Church or Peyote Religion. The Peyote ritual public admission of errors and a commitment combines a variety of effective psychothera- to a new path. The induction of ASC through peutic modalities along with psychotropic culturally congenial processes helps intensify drugs (see Aberle, 1966; Wiedman, 1990). the effects of suggestion and facilitates affec- Other cultural traditions and addict groups tive release and psychodramatic abreaction. have utilized similar chemical substances (see Treatment includes rhythmic repetitive read- Heggenhougen, 1997; Jilek, 1994; Andritzky, ings, cleansing baths, and massages; and the 1989; Sanchez-Ramos and Mash, 1996; use of group ritual providing a support sys- Mabit et al., 1996). Although the psychother- tem for developing a positive identity and apeutic effectiveness of these substance have coping skills. These rituals use cultural im- undergone limited assessment (e.g. see Bliss, ages and symbols that address the affective 1988; Yensen, 1985, 1996; Passie, 1997), they level, facilitated by a collective therapy group have been largely banned from human re- in which participation helps foster a rela- search and psychotherapeutic practice for tional therapeutic approach that facilitates over 30 years. The political climate makes the client’s social reintegration. them unlikely candidates as therapeutic appli- Similar features found in other ethnomedi- cations for addictions, although they are cal approaches to the treatment of drug ad- likely effective for a range of conditions diction include addressing physical, social, (Winkelman, 2001). However, non-drug psychological and spiritual levels. They typi- means of achieving these ASC have equiva-
M. Winkelman / International Journal of Drug Policy 12 (2001) 337–351 343
lent neurological and psychodynamic proper- mechanisms underlying diverse ASCs (‘tran-
ties (Mandell, 1980, Winkelman, 1996, 1992, scendent states’) are based in serotonergic
1997, 2000; Grof, 1980, 1992) and may also mechanisms involving the temporal lobe.
be as effective in addressing addictions. ‘Most This results in increases in high voltage slow
alternative therapies engage addicts in a pro- wave EEG activity (alpha, theta, and delta,
cess of transformation and revitalization… especially 3– 6 cps) provoked by hypersyn-
through which the addicts realize that differ- chronous discharges across the hippocam-
ent and more profound ‘highs’ can be pal– septal –reticular – raphe circuit. These
achieved without reliance on drugs’ (Heggen- spread from the brain stem– limbic circuits to
hougen, 1997, p. 91). the frontal lobes, producing pleasurable sen-
sations and feelings of well-being.
Psychobiological aspects of shamanic healing Opioid mechanisms
Cross-cultural patterns of shamanic ritual Winkelman (1992, 2000) reviews the physi-
practices and beliefs reflect psychobiological ological aspects of many different shamanic
structures of the brain (Winkelman, 2000). ASC practices, illustrating their common ef-
This psychobiological perspective is proposed fects across many different procedures, and
by researchers in ‘biogenetic structuralism’ their inherent therapeutic effects related to
(e.g. Laughlin et al., 1992; d’Aquili and New- addiction involving stress reduction and opi-
berg, 1999) as reflecting innate representa- oid elicitation. Physical mechanisms for opi-
tional structures of self. The shamanic oid elicitation in shamanistic healing include
paradigm may be particularly appropriate for extensive drumming, dancing and clapping;
addressing addictive psychodynamics because repetitive physical activity; temperature ex-
of its basis in innate modules that represent tremes (e.g. sweat lodges); stressors such as
self, other and cognitive-emotional structures fasting, flagellation, and self-inflicted wounds;
and processes. and nighttime activities when endogenous
Shamanic practices also have potential util- opioids are naturally highest (see Bodnar,
ity as treatments for drug abuse because of 1990; Kiefel et al., 1989; Mougin et al., 1987;
their psychophysiological effects (Winkel- Rahkila et al., 1987; Sforzo, 1989; Thoren et
man, 2000). Shamanic ASC reflect the many al., 1990; c.f. Prince, 1982 and Ethos, 10,
different procedures that induce common c4, 1982). Shamanistic healing practices in-
physiological changes involving ‘transcen- volve rituals that enhance social integration,
dence’ (Mandell, 1980) or an integrative strengthen group identity, and promote inter-
mode of consciousness (Winkelman, 2000). personal and social bonding at physiological
Shamanistic ASC evoke the basic relaxation and psychosocial levels. A literature review
response characterized by a generalized acti- (Frecska and Kulcsar, 1989) indicates that
vation of the parasympathetic nervous sys- these shamanic community activities affect
tem, producing a regenerative and opioid-attachment interactions, utilizing the
recuperative state. Shamanic ASC induce the innate drive for affiliation to evoke opioid
parasympathetic response, low frequency release. Ceremonial opioid release is based in
brain waves, interhemispheric synchroniza- emotionally charged cultural symbols that
tion and limbic-frontal integration. Mandell are cross-conditioned with endocrine systems
(1980) proposes the common physiological during early socialization, linking somatic re-344 M. Winkelman / International Journal of Drug Policy 12 (2001) 337–351
sponses to symbol systems. This association Several researchers (Gelderloos et al., 1991;
provides a basis for ritual elicitation of the O’Connell, 1991; Alexander et al., 1994) have
opioid system through shamanic rituals. provided reviews and meta-analyses of the
Lex and Schor (1977) review cross-cultural benefits of transcendental meditation (TM) in
data on ritual and natural forms of ASC treating substance abuse. TM influences both
induction through manipulating the nervous psychological factors underlying addictive be-
system (e.g. repetitive stimuli, drumming and haviors and the disposing physiological pro-
other auditory driving, music and chanting, cesses involved in maintaining addiction
dancing, etc.) that suggests they induce alter- (Walton and Levitsky, 1994). TM addresses
ations in the brain similar to those produced psychological factors contributing to addic-
by drugs. Opiate receptor locations in the tion by promoting well-being, providing grat-
brain illuminate functions of ritual ASC. The ifying experiences and enhancing contact
opiate receptors are most highly concentrated with the deeper levels of mind and emotions.
in the limbic system and mid brain structures TM also addresses psychophysiological dis-
primarily responsible for motivational and positions associated with anxiety, tension and
affective behaviors, and directly connected to stress and imbalance in serotonergic mecha-
the corpus striatum. These brain structures nisms. TM holistically strengthens many lev-
mediate ‘species typical behaviors’ which are els of prevention of substance dependence
compulsive, ritualistic and repetitious and through the inherently pleasant affective ex-
emotionally charged reactions. Ritual and periences and the production of progressive
emotion have an intimate relationship. The relaxation, reductions in physiological
numerous ritual mechanisms for eliciting the arousal and psychological stress, and enhanc-
activity of the opiate system, and the parallels ing restful alertness. TM provides relief for
between ritual and opiate effects on behavior, substance abusers as ‘a natural way to
suggests ritual affects opiate receptors, and achieve the experiences substance users are
can therefore provide a means of addressing looking for’ (Gelderloos et al., 1991, p. 317).
addictions. TM has the ability to reduce negative emo-
tions associated with addiction (depression,
Transcendental meditation as treatment of anxiety, anger), promote positive moods and
addiction emotions, and increase feelings of happiness
and wellbeing. TM addresses the multiple
The potential for shamanic ASC to thera- levels of the addictive processes: the cogni-
peutically address addictions is supported by tive, emotional and psychodynamic aspects;
clinical research, meta-analyses, and applied the spiritual dimension associated with core
assessments on the utility of meditation prac- values and a dependence upon a ‘higher
tices as part of substance abuse rehabilitation power;’ and the social environment, particu-
programs (e.g. see O’Connell and Alexander, larly the proximal social relations directly
1994). The overall physiological dynamics of impacting substance abuse.
meditation ASC are the same as those associ- Alexander et al.’s (1994) meta-analysis of,
ated with other ASC (Mandell 1980; Winkel- 19 retrospective surveys, cross-sectional stud-
man, 1992, 2000) suggesting that the ies and longitudinal studies utilizing TM for
effectiveness of meditation in drug rehabilita- the treatment and prevention of substance
tion would also derive from other shamanic abuse found an effect size between the 0.5
ASC. medium treatment effects and 0.8 large treat-M. Winkelman / International Journal of Drug Policy 12 (2001) 337–351 345
ment effects. Some of the better designed tion effects of drug dependence and the resul-
studies using addict populations had treat- tant release of cortisol. ‘[B]ecause of
ment effect sizes exceeding, 1. They found serotonin’s roles at multiple sites involved in
TM to have substantially larger effect sizes successful interaction with the environment,
than other drug prevention programs, and its decreased availability may be one of the
concluded the TM treatment effect was not most important neurochemical components
due to nonspecific aspects (e.g. attention, ex- in the production of tendencies toward addic-
pectancy, social support, motivation). Their tion’ (Walton and Levitsky, 1994, p. 110).
meta analysis of TM studies also found a TM induced increases in serotonin availabil-
dose response relationship, with the more ity mirror Mandel’s (1980) model of sero-
regular TM practitioners having higher effect tonergic mechanisms for ASC (‘transcendent
size averages. states’) in general and suggests their
generic role in providing biological mecha-
A neuroendocrine model of meditation effects nisms for ASC to interrupt drug dependence
patterns.
Walton and Levitsky (1994) outline a neu-
roendocrine model for the mechanisms
through which TM produces reductions in Psychosocial dynamics of shamanic healing
drug use and addiction. The ability of TM to
reduce stress and enhance serotonin function- Utilization of ASC and shamanic practices
ing addresses the physiological level of addic- in the treatment of substance dependence
tive behavior and the cycle of addiction— the populations has been proposed by substance
depletion of serotonin by chronic substance abuse counselors (Rioux, 1996; McPeake et
abuse and the interference that it produces in al., 1991). Potential effectiveness of shamanic
homeostasis and stress responses. Neuro- practices in addressing addiction may derive
chemical and neuroendocrine factors con- from several factors, including providing a
tributing to substance dependence are holistic paradigm for integrating spiritual di-
physiological imbalances caused by chronic mensions within a biopsychosocial approach.
stress. TM can intervene in stress related Shamanistic ASC practices have a multivari-
aspects of addiction through inducing relaxed ate quality that enable them to address a
states, lowering levels of autonomic arousal, variety of aspects of the problems underlying
and enhancing EEG coherence. Walton and substance abuse and dependence through:
Levitsky propose TM intervenes to break the 1. the psychological and emotional effects of
cycle of drug dependence through actions on the shamanic ‘journey’ that meets psycho-
the locus coeruleus, increasing serotonin dynamic needs for emotional insight, self-
availability and producing an inhibitory ac- awareness and psychological integration
tion paralleling the effects of sedatives and (Rioux, 1996);
opiates. TM increases serotonin levels, lead- 2. the community based support group cre-
ing to reductions in cortisol levels, and indi- ated in shamanism that can meet social
rectly to reduction of stimulation of limbic needs for an intimate community for
anger and fear centers. The serotonin enhanc- affiliation and interpersonal support;
ing effects of TM affect the activity of the 3. spiritual needs for contact with a power
hypothalamic pituitary adrenal axis and beyond ourselves (Miller, 1998a; Smith,
chronic stress, reversing the serotonin deple- 1994); and346 M. Winkelman / International Journal of Drug Policy 12 (2001) 337–351
4. the physiological effects of the shamanic fested in visual symbols, animals and spirits.
ASC that: induce the relaxation response These derive from biologically-based self-rep-
and theta wave dominance (Winkelman, resentation structures (Laughlin et al., 1992;
2000; Mandell, 1980); stimulate the opioid Winkelman, 2000) that reflect individual and
system (Frecska and Kulcsar, 1989, group psychodynamics. Information acquired
Prince, 1982); and restore balance in the through the vision based ASC provide mate-
serotonergic neurotransmitter systems rial for individual and group processing.
(Walton and Levitsky, 1994). Shamanic ritual is directed towards empower-
Shamanic practices may take a number of ing one to know oneself through entering the
forms (Winkelman, 1990; Winkelman, 1992; spirit world, to acquire allies and powers, and
Townsend, 1997), but share core universal to heal through recovery of lost aspects of
aspects. These have been popularized by the one’s soul. Power animals and guardian spir-
anthropologist Michael Harner as ‘core its are conceptualized as ‘metaphoric healing
shamanism’ (Harner, 1980/1990). The classic energies’ (Rioux, 1996), providing an expan-
aspects of shamanic practice as characterized sion of the, Twleve-Step concept of Higher
by Eliade (1964) involved ecstatic states Power and its healing effects. Winkelman
(ASC) in interaction with the spirit world on (2000) has proposed that these animal powers
behalf of the community. These encompass reflect the innate brain processing modules
pillars of drug abuse rehabilitation— medita- operating through analogic processes. A
tion and transcendence, spirituality and modern perspective characterizes shamanism
higher power, and community relations as learning to enhance personal power
providing a support system. Basic aspects of through integrating dissociated or unen-
a shamanic practice involve a group that trained neural structures (Laughlin et al.,
engages in drumming and visionary experi- 1992) and entering into integrative brain
ences or a ‘journey’ in which one ‘travels’ to states that heal unconscious aspects of the
internal experiential worlds while in an ASC. self and emotions. Shamanism provides
Hunt (1995) has characterized these experi- mechanisms for developing awareness and
ences as based in a presentational symbolism. accessing unconscious powers shaping our
These experiences reflecting symbolic struc- lives, manifested in the concepts of spirits.
tures of the non-verbal mind provide connec- Shamanism elevates emotional and non-ver-
tions with self, emotions, and repressed bal dynamics, enabling us to change our
memories and the opportunity to formulate character and overcome personal shortcom-
future plans. These ASC offer a variety of ings by providing access to dissociated as-
opportunities to experience states of pro- pects of our soul and identity. ASC
found relaxation or excitation, insight, the contribute to reduced defensiveness, accep-
release of emotions, and healing through self- tance of others and development of a sense of
integration. community. The group setting of shamanic
practice also provides a social context for
problem solving and a social group that pro-
Psychodynamics of shamanic healing vides a therapeutic community that can play
a significant role in motivating sobriety and
Shamanism uses natural ASC that involve treatment adherence. Shamanic drumming
the brain’s primary processing capacities, a circles also provide a social support system
presentational symbolism (Hunt, 1995) mani- for spiritual awakening, leading participantsM. Winkelman / International Journal of Drug Policy 12 (2001) 337–351 347
to direct experience of spiritual powers, and main unknown, ‘[i]t is, in AA’s
naturally providing the major spiritual as- understanding, spirituality that finally and
pects emphasized in the AA, Twelve-Step reliably dries out the possessive spirit of ad-
program. diction’ (Miller, 1998a, p. 981). Spiritual
practices may have an important role in the
‘healing’ of addiction by providing a sense of
Soul loss and spirituality meaning to life often found lacking among
substance abusers. Spirituality has been a
A major paradigm of shamanic healing is significant feature of healing traditions
‘soul recovery,’ involving reintegration of dis- throughout history, and many contemporary
sociated aspects of the self. Shamanic treat- people find spirituality provides an important
ment of soul loss involves a conceptualization source of healing. Shamanism is the original
similar to TM and AA views of addiction as and natural form of prayer and meditation
resulting from a lack of spirituality. Spiritual- which provides a direct spiritual awakening,
ity can be seen as reflecting collective dimen- a means for transcendence of personal con-
sions of, and the individual connectedness sciousness, and consequently a mechanism
with, the social group. Soul loss reflects this for overcoming addiction.
lack of individual connection with broader Rioux (1996) illustrates how shamanic
units of social identity (c.f. Jilek, 1982). Since healing techniques can play a role in a holis-
fundamental aspects of shamanic practice are tic addiction counseling approach that inte-
concerned with establishing a connectedness grates spiritual perspectives into a
with animal spirits and personal souls and biopsychosocial approach by focusing on in-
allies, it can provide a means for addressing ner realities to produce harmony and self
the collective soul loss and lack of spirituality wholeness. Shamanic ASC can help clients
thought to be a major determinant of the achieve wholeness through transforming con-
addictive psychodynamic. Winkelman (2000) sciousness by providing a link between inner
has shown that these spiritual perceptions and outer realities, enabling inner world per-
have a psychobiological basis, reflecting an spectives to operate on the outer world to
analogic integration of innate brain modules produce harmony and wholeness. Important
that produce the basic structures of the brain aspects of the shamanic ASC include ‘focus-
and consciousness (Winkelman 2000). This ing’ of intention upon one’s purpose and
spiritual aspect of shamanism make it a po- spending time in relaxed conditions that
tentially important resource in addressing provide restful healing. ASC practices also
both psychobiological integration and incor- free one from ego-bound emotions and
poration of the spiritual aspects recognized as provide a balance of conflicting internal ener-
central to substance abuse rehabilitation gies. Work through dreaming and shamanic
(Miller, 1998a; Alcoholics Anonymous, 1976, journeying helps achieve the sense of ‘whole-
1987; Booth and Martin, 1998; Green et al., ness,’ countering the sense of self loss at the
1998). basis of addictive dynamics, and enhancing
The role of spirituality in recovery from self-esteem by providing connectedness be-
substance abuse may reflect a protective fac- yond the egoic self.
tor provided by religious involvement and Harner and Harner (2001) suggest that
spiritual engagement (Miller, 1998a). Al- there are basic forms of shamanic healing
though the actual protective mechanisms re- that have applicability in the treatment of348 M. Winkelman / International Journal of Drug Policy 12 (2001) 337–351
dependency on alcohol and other drugs. They rience, compounded by a lack of consider-
specifically mention shamanic healing con- ation of spiritual issues in their education,
cepts such as depossession, soul retrieval, leaves health professionals poorly prepared
guardian spirit retrieval. Winkelman (2000) to assess spiritual constructs. Professional
has characterized these healing dynamics in and scientific responsibility demands these
terms of the relationship between innate contributions to the addiction recovery pro-
brain processing modules and the dynamics cess be assessed. ‘Comprehensive addictions
of self and other, providing mechanisms for research should include not only biomedical,
individual integration into community life psychological and socio-cultural factors but
and identity. spiritual factors of the individual as well’
(Miller, 1998a, p. 979).
Shamanism reflects the primordial spiritual
Conclusions practices of humanity. The cross-cultural sim-
ilarities in shamanism, the widespread resur-
A cure for addiction has yet to be achieved gence of shamanistic practices, and their
by medicine or pharmacology. Social envi- formalization in nationwide and international
ronmental approaches focusing on drug pre- organizations (e.g. the core shamanism meth-
vention education have yet to curb epidemic ods through the Foundation for Shamanic
levels of substance abuse. The current social Studies) reflect their neurobiological basis.
crisis of substance abuse is coupled with the Shamanism provides readily available re-
lack of institutionalized procedures for ad- sources for developing new approaches to the
dressing innate needs for ASC and the evolu- management of drug addiction and rehabili-
tionary factors that produce drug tation of addicts. Shamanic practices provide
dependence. A view of ASC as a natural a natural means of evoking the relaxation
human need and a part of evolved disposition response, relieving the stress that is a princi-
suggests that addiction be addressed by pal trigger for relapse into drug use. A conse-
providing alternative means of achieving the quence of drug addiction is long-term
‘high’ addicts seek. Current rehabilitation changes in brain metabolism and neurotrans-
programs need to be complemented with tra- mitter levels; shamanic practices affect natu-
ditional ethnomedical approaches that meet ral opioid and serotonin levels depleted by
these physiological, psychological and social drug use and can provide a natural means of
needs. Amaro (1999) calls for the use of all stimulating the release of these natural plea-
scientifically established treatment programs sure-producing substances. Research on the
for demand reduction and addiction treat- preventive and treatment roles of TM in drug
ment. Spirituality and alternative medicine abuse establish the usefulness of ASC. The
practices have been increasingly recognized as meditative traditions have their origins in
a central means for effectively addressing shamanic ASC practices, and have psycho-
substance dependence, but little has been physiological effects that interrupt drug de-
done to effectively integrate these insights. pendence and meet natural psychobiological
A lack of a spiritual emphasis in the needs for ASC and transcendent experiences.
emerging biopsychosocial paradigm reflects Shamanic practices have been effectively
the general lack of religious beliefs and values incorporated in the healing systems of con-
among US health professionals (McPeake et temporary community mental health centers
al., 1991). This lack of involvement and expe- and appear able to meet the psychosocial andM. Winkelman / International Journal of Drug Policy 12 (2001) 337–351 349
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