BackgroundA range of studies has demonstrated the efficacy of the psychoactive Amazonian brew ayahuasca in addressing substance addiction. These have revealed that physiological and psychological mechanisms are deeply enmeshed. This article focuses on how interactive ritual contexts support the healing effort. The study of psychedelic-assisted treatments for addiction has much to gain from ethnographic analyses of healing experiences within the particular ecologies of use and care, where these interventions are rendered efficacious.MethodsThis is an ethnographically grounded, qualitative analysis of addiction-recovery experiences within ayahuasca rituals. It draws on long-term fieldwork and participant observation in ayahuasca communities, and in-depth, semi-structured interviews of participants with histories of substance misuse.ResultsAyahuasca’s efficacy in the treatment of addiction blends somatic, symbolic and collective dimensions. The layering of these effects, and the direction given to them through ritual, circumscribes the experience and provides tools to render it meaningful. Prevailing modes of evaluation are ill suited to account for the particular material and semiotic efficacy of complex interventions such as ayahuasca healing for addiction. The article argues that practices of care characteristic of the ritual spaces in which ayahuasca is collectively consumed, play a key therapeutic role.ConclusionThe ritual use of ayahuasca stands in strong contrast to hegemonic understandings of addiction, paving new ground between the overstated difference between community and pharmacological interventions. The article concludes that fluid, adaptable forms of caregiving play a key role in the success of addiction recovery and that feeling part of a community has an important therapeutic potential.

This chapter provides an ethnographically-grounded, qualitative analysis of the experiences of people recovering from substance dependence among Italian and Brazilian chapters of the Santo Daime church and among Brazilian spiritualist communities that make ceremonial use of ayahuasca. It suggests that substances such as ayahuasca are very peculiar pharmacological tools whose value needs to be made sense of within specific ecologies of use and care that are not yet easily comprehensible within the biomedical paradigm. The goal is to reveal how the pharmacology of ayahuasca, its rich semiotic worlds, and the thick relational fabric within which it is used, together, produce a uniquely potent and deeply caring, situated efficacy. The healing presented here emerges out of a loose assemblage of empirical, case-by-case assessments within structured networks of support. This gives the ritual space an iterative and reflexive dimension, thereby enabling a form of care that is attentive to the specificity of different situations and contexts. The chapter concludes with reflections on the conceptual challenges biomedical studies of ayahuasca face in making sense of the complex, dynamic, and amplified efficacy of psychedelic-assisted interventions within an epistemology that presumes a radical distinction between the "pharmaceutical" and the "social."Within such an epistemology, it becomes difficult to account for the specific, situated, and contextual efficacy that healers witness and patients experience. Supporting such a dynamic of care and making it legible within current evidentiary norms-that are standardized according to universal normspresents a considerable challenge.

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