Ayahuasca Users in Estonia: Ceremonial Practices, Subjective Long-

Term Effects, Mental Health and Quality of Life

Helle Kaasika* and Kairi Kreegipuub

aSchool of Theology and Religious Studies, University of Tartu, Tartu, Estonia;

bInstitute of Psychology, University of Tartu, Tartu, Estonia

* Ülikooli 18, 50090 Tartu, Estonia. Tel. +372 51921392 helle.kaasik@ut.ee

ORCID

Helle Kaasik 0000-0001-7807-6310

Kairi Kreegipuu 0000-0002-0953-7264

Acknowledgements

Authors are thankful for Signe Ainson and Maris Hinn for conducting the M.I.N.I. interviews.
H.K. thanks Helena Landes for her help in finding the participants for the control group, Jace
Callaway for information about chemical composition of ayahuasca, and the Santo Daime
community for sharing their experience and spiritual wisdom. Biggest thanks for all the
participants of the study who trusted the researchers with their unique experiences.
Ayahuasca Users in Estonia: Ceremonial Practices, Subjective Long-
Term Effects, Mental Health and Quality of Life

The study aims to describe ayahuasca users in Estonia and compare their mental
health and quality of life to those of non-users. Ceremonial practices, motivation
for ayahuasca use, use-related experiences and subjective consequences of use
are described. We conducted a cross-sectional case-controlled study of 30
ayahuasca users and 30 non-users matched by gender, age and education. The
participants completed questionnaires, standardized psychometric tests and
neuropsychiatric interviews. Ayahuasca use in Estonia occurred mainly in
(neo)shamanic group ceremonies. The main motives for ayahuasca use were
spiritual development, self-knowledge and spiritual experiences. The users
reported mostly positive subjective consequences of ayahuasca use for their
health and life. However, some difficult experiences and adverse effects were
reported. No abuse of ayahuasca or addiction to it was found. Screening test
indicators of depression and anxiety were lower in the ayahuasca-using group.
No deterioration of the mental health of ayahuasca users in comparison to non-
users was found. The users perceive their use of ayahuasca as a spiritual practice
with mostly favourable outcomes for their health and life. Ayahuasca use in
Estonia is a reasonably safe and self-limiting form of spiritual practice.

Keywords: ayahuasca, ceremony, mental health, quality of life, neoshamanism,

psychedelics

Introduction

Ayahuasca is a brew made from tropical liana Banisteriopsis caapi, which contains β-

carboline alkaloids harmine, harmaline and tetrahydroharmine. Admixture plants

containing N,N-dimethyltryptamine (DMT), usually Psychotria viridis or Diploterys

cabrerana, give ayahuasca psychedelic properties (Barbosa and Strassman et al. 2016).

Indigenous people of Amazonian rainforests use Ayahuasca for healing and

divination. Brazilian syncretistic religions founded during the first half of 20th century

(Santo Daime, União do Vegetal and Barquinha) use ayahuasca as a sacrament (Carlini
2003; MacRae 1992) Ayahuasca retreats have become a branch of tourism industry in

South America (Frood 2015; McKenna 2004). Group rituals with use of ayahuasca have

become a new form of psychospiritual practice and alternative medicine in many

countries, including Estonia (Tankler 2012).

Acute effects

Acute effects of ayahuasca begin usually 15-30 minutes after ingestion, reach the

maximum around 90 minutes and last 2-6 hours depending on dose. Among reported

effects are changes in perception, thinking and feeling. Psychedelic visions of diverse

phenomenology may appear (Shanon 2002, 2003). During the effect, ayahuasca

enhances creative divergent thinking while decreasing conventional convergent thinking

(Kuypers et al. 2016). Anxiety, nausea, vomiting or diarrhea may occur (Barceloux

2012; Gable 2007). Ritual users often consider vomiting and other forms of excretion as

necessary for healing and cleansing (Anderson et al. 2012; Metzner 2005).

Long-term effects on mental health and quality of life

Studies of Brazilian ayahuasca religions suggest that there are no long-term adverse

effects of ayahuasca on mental health or psychological functioning and that ritual use of

ayahuasca may be beneficial for psychological, spiritual, and physical wellbeing (Bouso

et al. 2012; Uthaug et al. 2018) assessed ayahuasca ceremony attendants in the

Netherlands and Colombia before and after the ritual. Ratings of depression and stress

significantly decreased after the ayahuasca ceremony and these changes persisted for 4

weeks. Convergent thinking improved until the 4-week follow-up, also satisfaction with

life increased the day after the ceremony (Uthaug et al. 2018). Mindfulness-related

capacities were found to be increased 24h after ayahuasca intake (Soler et al. 2016).

Ayahuasca use does not lead to abuse, addiction, withdrawal or psychosocial damage
(Fabregas et al. 2010; Gable 2007) and is pharmacologically quite safe (Riba et al.

2001; Riba et al. 2003).

Aims of the study

The study aims to describe ayahuasca users, their ceremonial practices, experiences and

subjective long-term effects of ayahuasca use in Estonia and to compare their mental

health and quality of life to those of comparable non-users. Generalizability of findings

from studies of long-term effects of ayahuasca use in Southern America to European

users with different genetic, cultural and spiritual background is not self-evident

because the ceremonial practices of ayahuasca use, the composition of the brew,

psychological predisposition of participants, the social environment and regulation of

ayahuasca use and even biochemical response to ayahuasca in European participants

may considerably differ from those in Southern America. Ceremonial use of ayahuasca

as a highly variable form of alternative medicine and new spirituality has been

increasing internationally for many years (Labate and Jungaberle 2011), bringing new

opportunities and challenges to the society as a whole. Both beneficial and adverse

effects of ayahuasca use need more detailed studies (Hamill et al. 2019). To understand

this phenomenon and properly respond to it, the society needs knowledge about who the

users are, what they do and experience during these practices and, most importantly,

which are the long-term effects of such practices to their mental health and quality of

life.

Method
Cross-sectional case-controlled study was based on questionnaires, psychometric tests

and neuropsychiatric interviews. We compared indicators of mental health of 30 Estonian

ayahuasca users to those of non-users matched with users by gender, age and education.

Data for the study were collected in Estonia during the years 2014-2016.

Sample

Participants - adults who had used ayahuasca at least once and matched controls - were

recruited by personal contacts, snowball method and announcements in social media.

Non-users were matched with users by gender, age (±10%) and educational level (±1

level according to Table 1).

Participants were 30 ayahuasca users (15 (50%) female, 15 (50%) male, age

range 25-62, average 38.7, SD=9.8) and 30 matched non-users (15 (50%) female, 15

(50%) male, age range 22-69, average 38.3, SD=10.9) from Estonia. Their demographic

profile is given in Table 1.

The number of ceremonies experienced was between 1-250 (median 10), with in

average 5 ceremonies (range 0-40) during the last 12 months. Two had participated only

once. Average age of first ayahuasca use was 33.4 years (21-58). Ten of the 30 users

considered themselves regular users of ayahuasca, 23 estimated that they will

“certainly“ or “probably“ use ayahuasca also in the future, 4 “probably not“.

The first language was all the participants was Estonian. Participants had varied

professions and diverse social and spiritual backgrounds. Two participants were

affiliated with an ayahuasca religion.

Lifestyle and ayahuasca use

Both groups completed questionnaires about basic demography and lifestyle. The

lifestyle questionnaire included questions “Are you satisfied with your life?” and “Are

you happy about your life?”, each with 4 possible answers: not at all / somewhat / quite

a lot / extremely. Ayahuasca users completed questionnaires about their motivation of

use, experiences and subjective consequences of use, safety of use (“Have you

experienced situations that are unsafe for yourself or others at ceremonies? If yes, what

happened there?”, “Can ayahuasca use be dangerous or harmful? If yes, please specify

the dangers.”) and attitudes towards regulation of ayahuasca in society (“To what extent

are you concerned with illegality of ayahuasca use in Estonia and possible problems

with the police?” “How should use of ayahuasca be regulated in the society?”)

The original questionnaires about lifestyle and ayahuasca use (in Estonian) are

available as supplementary data (10.5281/zenodo.3555591).

Ceremonial use

Reported first uses of ayahuasca in Estonia were in years 2002-2013, biggest numbers

of first-time uses in the sample occurred in 2008 (5) and 2010 (7).

Ayahuasca was used mostly during group ceremonies under guidance of experienced

facilitators. The ceremonies participants reported were mostly in shamanic or

neoshamanic style, with varying proportions of elements from different indigenous

traditions and from contemporary practices of new spirituality. Ceremonies were not

publicly announced, the information was shared by e-mails and personal

communication.

Some ceremonies were inspired by sacramental use of ayahuasca in Santo

Daime religion and included prayers, songs and elements of ritual from this tradition.

Majority of the studied participants reported that before participating in a

ceremony they undergo a period of preparation, including diet (avoidance of certain

foods and medications) and behavioral commitments (e.g. sexual abstinence). Similar

rules are observed for some days after the ceremony.

 (Neo)shamanistic ceremonies, the most common form of the ritual in Estonia,

are usually held indoors in countryside during weekend nights (often 2-3 consecutive

nights). The number of participants is usually 20-40. The ceremony begins with

introduction and a ritual opening, participants may tell their names and intentions for

the ceremony to the group. Then participants approach the leader of the ceremony and

drink their dose of ayahuasca. The dose is determined by the leader, sometimes

considering the preference of the participant. A participant estimated: “In my experience

they drink up to 120 ml (this is the biggest dose I have seen), but usually the doses are

limited to approximately 30-60 ml.” Concentrations of active constituents in ayahuasca

are very variable (Callaway 2005a; Callaway 2006), so the quantity of the liquid is not a

good indicator of the dose. Different people metabolize active constituents of ayahuasca

at different speeds and therefore their sensitivities to ayahuasca are different (Callaway

2005b). Often additional doses are offered later during the ceremony for those who

wish.

During the ceremonies of shamanic/neoshamanic style the ceremonial room is

almost dark. Participants sit or lie on their mattresses. The ceremony is supported by

singing of the leader or musicians, and/or recorded music. For possible vomiting

buckets are prepared. If somebody needs practical help or emotional support, organizers

or helpers assist them. After the ceremony participants have a light meal, rest overnight

and share their experiences in the circle.

In ceremonies inspired by Santo Daime participants sit in chairs around a central

table, men in one side of the room and women in the other. Participants wear white,

long dress or skirt for women, or a special uniform (church members). The ceremony is

opened and closed with Christian prayers. Most of the time of the ceremonial work is
spent singing spiritual hymns together while sitting, standing or dancing in simple

coordinated steps, or sitting and concentrating in silence.

Some experienced users reported using ayahuasca individually in less formal

ways for self-medication or -exploration. No recreational or public use of ayahuasca

was reported.

Rules of conducting the ceremony vary in details but they have a common core

of safety rules; e.g. not leaving the ceremony before its closure and not disturbing other

participants during the experience.

Experience and motivations

A list of 22 possible motivations for ayahuasca use with an open-ended option

was presented to participants with instruction to select all options that apply to them.

Most frequently selected answers were “for spiritual development” (26), “for knowing

myself better” (25), “for spiritual experience” (23) and “for psychological healing” (21).

One participant compared going to the ceremony without a specific intention to calling

a repairs team into one’s house without giving it a specific task.

Users experienced during the ceremonies a great variety of emotional states,

visions, changes of perception of their surroundings and self. Colorful descriptions of

subjective journeys were reported. Participants relived their memories and formed new

understandings about past events and their challenges in life. During the altered state the

user was usually lucid and aware of the fact that the changes of perception were caused

by influence of ayahuasca. When asked to estimate the percentage of the time during the

ceremony that was “pleasant and enjoyable”, the answers for both their first and last

experience spanned the whole scale from 0% to 100%. Some experiences were difficult,

unpleasant or scary, but most users (27) did not regret even their most difficult
experiences. Difficult experiences are usually interpreted as opportunities to cleanse,

heal and learn.

Mental health measures

The following mental health measures were used in this work:

(1) Emotional State Questionnaire EST-Q2 (Estonian: Emotsionaalse Enesetunde

Küsimustik, EEK-2), a screening test with 6 subscales for depression, anxiety,

agoraphobia, social phobia, asthenia and sleep disturbances (Aluoja et al. 1999;

Ööpik et al. 2006);

(2) M.I.N.I. international neuropsychiatric interview (Sheehan et al. 1998) Estonian

version 5.0.0 (Shlik, Aluoja, and Kihl 1999).

(3) Montreal Cognitive Assessment (MoCA) (Nasreddine et al. 2005) Estonian

version translated by Andrus Kaera (Nasreddine 2008);

(4) Raven Standard Progressive Matrices (Raven 1958; Raven 2000) 24-item

computer version with instruction in Estonian (Lynn et al. 2002).

Procedures

Participants received description of the study by e-mail. They had an appointment with

the researcher (HK) for informed consent and physical measurements (height, weight,

blood pressure, grip strength). A psychiatrist or a clinical psychologist conducted

MoCA, Brief Psychiatric Rating Scale (BPRS) (Overall and Gorham 1962) and M.I.N.I.

neuropsychiatric interviews with participants. Interviewers were blind to group status

(ayahuasca vs control) and were instructed not to ask participants about it. Participants

completed questionnaires about their ayahuasca-related practices, experiences

(including Hallucinogen Rating Scale (HRS), see (Strassman 1992)), lifestyle and
quality of life (questions about subjective wellbeing and WHOQOL-100). They

completed EST-Q2, Raven Standard Matrices and personality tests EE-PIP.NEO and

SNAP-2. Data from physical measurements, personality tests, HRS, BPRS and

WHOQOL-100 were not used in this article.

The study protocol was approved by Ethics Committee of Human Research of

University of Tartu (permit n. 248/M-16). Written informed consent was obtained from

all participants. An overview of the research results and an in-depth analysis of long-

term effects of ayahuasca practices to the users’ life will be published also in Estonian

(Kaasik, forthcoming).

Statistics and data processing

Numerical data were analyzed with the IBM Statistical Package for the Social Sciences

(SPSS) v. 20. Frequencies and descriptive statistics were calculated for numerical

outcome variables according to their scale type. Positive and negative subjective effects

for physical and mental health were compared by Wilcoxon signed rank test. Data for

life satisfaction and happiness were compared between groups by Mann-Whitney test.

Data from EST-Q2 subscales were analyzed by χ² -test. Data from MoCA and Raven

Standard Matrices were compared between groups by paired-samples t-test.

Relationships between life satisfaction, income and group (user vs control) were

analyzed using Spearman correlations, partial correlations and linear regression between

rank variables.

Free-text answers were grouped by topic and similarity and summarized.

Examples of textual answers were chosen based on typicality and expressiveness and

translated from Estonian. Complete sets of original free-text answers in Estonian are

available (in randomized order and edited for protection of confidentiality of the

participants) as supplementary data (10.5281/zenodo.3555591).

Results

Subjective long-term effects

Participants reported on 4-point scale (none to extreme) slight to extreme improvements

in physical health (16) and mental health (26) as results of their ayahuasca use. For both

physical and mental health, the estimates of improvements exceeded those of worsening

(Wilcoxon signed rank test for physical health Z=3,35; for mental health Z=4,78, for

both p<0.001). There were 2 participants who reported slight worsening in physical

health and 6 in mental health, for example increase in emotional sensitivity and

difficulties with understanding and interpreting the experiences of “different worlds”.

One participant mentioned reported having been “out of balance” for 2 weeks after the

ceremony. Another wrote:

I cannot live in innocent oblivion of other worlds or be certain about ordinary

reality, because I have experienced totally different worlds, and those experiences
are much more intense than everyday experiences. They have been even more real
than this reality here. I have not managed to completely understand and interpret
what I experienced, and this lack of knowledge generates some fear and suspicions.

After publishing preliminary results of this study as a masters’ thesis on her

website (Kaasik 2016), HK invited the readers of the webpage to report their negative

experiences with ayahuasca. One user (not from the study sample) who responded to

that invitation reported a serious physically and mentally traumatizing experience that

had happened several years ago and caused clinically diagnosed PTSD. She also

reported an opinion of another organizer of ayahuasca ceremonies that what she was

given in the ceremony “was not proper ayahuasca”.

Among positive influences, improvements in lifestyle, nutrition and exercise

were reported, also recovery from addictions (tobacco, alcohol, cannabis). Recurring
themes in answers were psychological healing, increase of awareness, diminished fears,

better understanding of self and others, increased endurance, better relationships and

new understandings. Participants wrote:

 I got rid of suicidal thoughts, self-injuring and bouts of heavy depression.

 Endurance of psychological and emotional stress has improved a lot.
 After the ceremony there was a big positive change in being and thinking.
 I guess that thanks to Aya I am still alive.
 It has increased my creative freedom a lot.
 Fully changed perception of the world, huge expansion of the worldview.
 Achieving better contact with my body and a strong religious experience.
 Many new understandings about topics that are essential for me, new view
of death and bereavement.
 This was like a rebirth and a gift, it was shown that life and consciousness
are much broader than we think.
 It has given me new experiences and opened a completely new world. If
you have never experienced this, you cannot imagine that something like
this could exist.

However, ayahuasca is not a panacea solving all problems at once – as evident

from the fact that many users return for repeated ceremonies.

Mental health and substance use

None of studied users fulfilled ICD-10 criteria for abuse of or addiction to ayahuasca.

Use of cannabis and classical psychedelics was more frequent in ayahuasca users than

in control group. There were no cases of alcohol addictions or abuse in ayahuasca group

vs 1 case of addiction and 1 case of abuse of alcohol in control group.

No significant differences from control group was found in cognitive abilities

(MoCA test, users’ average 28.08, control group average 27.70, t=0.83, df=55, p=0.410)

or fluid intelligence (Raven Standard Matrices, users’ average 20.33, control group

21.05, t=0.729, df=38, p=0.470). Those test scores were not significantly correlated
with lifetime or 12-month use in ayahuasca group. M.I.N.I. neuropsychiatric interview

did not show increased frequency of any mental health disorders. According to

screening test EST-Q2 indicators of depression (χ² =5,621, p=0,018), anxiety (χ²

=5,000, p=0,025) and asthenia (χ² =4,691, p=0,030) were lower in ayahuasca users.

Comparison of means for all subscales of EST-Q2 is in Table 2.

Quality of life

Questions “Are you satisfied with your life?” and “Are you happy about your life?”

were answered by 28 ayahuasca users and 25 non-users. Distribution of answers by the

group is shown in figures 1 and 2. Mann-Whitney test indicated a significant between-

group difference in both indicators: Z=3.19, p=0.001 for life satisfaction and Z=2.43,

p=0.015 for happiness.

Satisfaction with life was also positively related to income (Spearman rho =

0.337, p = 0.019). The income of the investigated users was higher than that of the

control group. We checked whether they show higher levels of satisfaction compared to

the control group regardless of the income gap. The partial correlation between the

group and life satisfaction rankings was 0.312 (p = 0.033), thus, there was a positive

correlation between use of ayahuasca and life satisfaction regardless of the income

difference. A linear regression model was developed for the life satisfaction rank, in

which the group (i.e. ayahuasca use) and income group were independent variables. The

coefficient of determination was small (R2 = 0.200), the model was statistically

significant (p = 0.007). The relationship between ayahuasca and satisfaction in this

model was positive and significant ( = 0.307, p = 0.033); the relation of income with

satisfaction was also positive but statistically insignificant ( = 0.249, p = 0.081).

Safety of ayahuasca use

Three users reported encountering unsafe situations during ceremonies. Their examples

included fainting and falling; strong physical discomfort, nausea and vomiting; being

emotionally very upset and misinterpreting psychedelic spiritual experiences.

Answering the question “Can ayahuasca use be dangerous or harmful?”, 18

users selected “yes”, 5 “don’t know” and 4 selected “no” (3 missing). Reported dangers

included scary visions, unpleasant physical feelings, loss of contact with reality,

becoming fixated with new beliefs and excessive influence of “spiritual teachers” with

selfish motivations. Users indicated several factors that can make using ayahuasca

unsafe: weak physical or mental health of the user, interactions with medical drugs,

physically unsafe environment, insufficient preparation of the user, wrong goals and

intentions, light-hearted attitude, and incompetent or irresponsible leaders of the ritual.

Attitudes towards regulation of ayahuasca use

From 28 of those who answered the question if they are concerned with illegality of

ayahuasca in Estonia, 19 were concerned, 7 were not concerned and 2 remained

indifferent. Legal safety of ceremony facilitators was a common reason of concern.

When asked their opinion about regulation of ayahuasca use by society, majority

of the participants (21) supported reasonable regulation of ayahuasca use. Some

examples from the answers:

First, it oppresses me that I have to do something illegal to survive and second,

illegality makes the ceremonies unnecessarily expensive.

For me, ayahuasca is a medicine and it makes me sad that its use is illegal.

The ban is unjustified and harmful because it restricts access to a highly effective
spiritual and psychotherapeutic tool.
 I think that for the public at large the use of Aya should be prohibited, but so that
the therapist / healer / shaman could still use it in their work. I think that Aya
rituals, their organization and intermediation has become a kind of business, and
this is also reprehensible.

As benefits of reasonable regulation were mentioned release of psychological

tension, better quality of the substance, safer use and potential therapeutic applications.

Participants supported legal use in scientific, therapeutic and spiritual or religious

contexts. Hopes for self-regulation were expressed:

The regulation should be done through self-regulation.

Because it is a substance that is not addictive and is rather unpalatable it will never
turn into so-called party drug.

Arbitrary dunces will not bother to drink it, it is not interesting for them.
Fortunately, in my opinion, this is not a means to enjoy.

Discussion

Ceremonies, motivations and experiences

Ayahuasca is used in Estonia mostly during ceremonies of (neo)shamanic style under

guidance of experienced facilitators. Answers about first-time use in Estonia support the

conclusion that ceremonial use of ayahuasca appeared in Estonia around the year 2002

or somewhat earlier and was more widely introduced during years 2008-2010.

Ceremonies are usually held indoors in countryside during weekend nights. Ceremonies

are formally opened and closed, there are rules agreed between facilitators and

participants to be observed during the ceremony. Most users observe a period of

restrictions (diet) before and after the ceremony. There is a continuous spectrum from

“shamanic” ceremonies conducted by visiting indigenous shamans from South America

to different practitioners of new spirituality of European origin.

Some ceremonies are influenced by Santo Daime religious practices of praying

and singing together. Some experienced users reported less formal individual use for

self-medication or -exploration. No recreational use of ayahuasca was reported.

Most frequently encountered motivations of use were spiritual development,

self-knowledge, spiritual experiences and psychological healing. This is in good

agreement with results of previous studies (Barbosa, Giglio, and Dalgalarrondo 2005;

Kjellgren, Eriksson, and Norlander 2009).

Experiences under influence of ayahuasca are very variable. They may be

pleasant or unpleasant, emotionally intense and sometimes very extraordinary compared

to everyday experience. This variability does not disappear with increasing experience

of use. Unpredictability of the experience together with unpleasant taste of the brew,

physical discomfort and high cost of participation in ayahuasca ceremonies discourages

recreational use of ayahuasca.

Subjective long-term effects

Most of the studied users did not regret even their most difficult ayahuasca experiences,

the focus is rather on the expectation of beneficial outcome. The outcome is often seen

as a result of purposeful application of the knowledge received in the altered state.

Traumatic experiences with no benefits are rare but possible, their causes and safety

measures to prevent them remain to be studied. Quality of the brew may be a factor in

difficult experiences.

Users see long-term effects of ayahuasca use as mostly beneficial. This

observation is in good agreement with earlier results (Kjellgren, Eriksson, and

Norlander 2009). Recurring themes in answers about long-term effects of ayahuasca

were healing, increase of awareness, diminished fears, better understanding of self and
others, increased endurance, better relationships and new understandings. Some users

also reported negative aftereffects, e.g. emotional lability, difficulties with

understanding the experience, fears and suspicions.

Studied users evaluated the effects of ayahuasca use on their physical and

mental health as mostly positive. This is in agreement with earlier findings of positive

subjective effects on health, relationships and wellbeing (Halpern et al. 2008; Kjellgren,

Eriksson, and Norlander 2009) and with decrease of stress and depression observed

after an ayahuasca session (Uthaug et al. 2018).

Mental health and quality of life

Studied ayahuasca users did not show any increase of mental health disorders in

comparison to the control group, they were mostly mentally healthy and cognitively

normal. Indicators of depression and anxiety in the ayahuasca group were lower than in

the control group. Absence of mental health damage in ayahuasca users is in good

agreement with studies done in regular users (Barbosa et al. 2012; Santos 2013; Bouso

et al. 2012). Lower indicators of depression and anxiety in ayahuasca users are in good

agreement with several previous studies (for review see (Santos et al. 2016)).

No abuse of ayahuasca or addiction to it was found and no examples of it were

found in available scientific literature. On the contrary, ayahuasca has been used in

treatment of addictions (Loizaga-Velder and Verres 2014; Nunes et al. 2016; Thomas et

al. 2013). Participants of this study reported that ayahuasca has helped them to

overcome addictions to tobacco, alcohol and cannabis.

Improved subjective mental health and perceived psychological healing are

likely to contribute to reported increase of subjective quality of life. Increased

subjective well-being in ayahuasca users has also been reported in a large survey (Lawn

et al. 2017). Increase of subjective quality of life can be mediated by increased self-
awareness and implementation of lifestyle changes that were inspired by participation in

ceremonies (Assis, Faria, and Lins 2014).

Biochemical action of monoamine-oxidase-inhibiting constituents of ayahuasca

is similar to some pharmaceutical MAOI antidepressants (e.g. moclobemide). This may

explain the antidepressant action of ayahuasca found in clinical research (Palhano-

Fontes et al. 2019), subjective relief from depression reported by participants and lower

EST-Q2 depression indicators in users. As MAO inhibitors are contained in

Banisteriopsis caapi that does not contain psychedelic DMT, it is possible that

ayahuasca made from only Banisteriopsis caapi has antidepressant action without the

psychedelic effect.

Limitations and applicability of the study

Main limitations of the study are smallness and self-selection of the sample. Self-

selected nature of the sample is likely to introduce a bias toward positive effects: people

who receive benefits from the ceremony will more likely repeat the experience, become

regular users and end up in a study of ayahuasca users. Predominantly positive effects

found among repeated ayahuasca users – even about their first experiences - cannot be

extrapolated to the general population and they should not be interpreted as

confirmation of safety of ayahuasca rituals for an average person. Analogously, some

people may relatively safely enjoy extreme sports, however, such adventures are

certainly not safe for everyone.

Another potential source for bias was affiliation of HK with Santo Daime, this

was taken into account in the study design.

We found no deterioration of mental health in studied users. The study showed

that ceremonial ayahuasca use, although a recently imported cultural phenomenon, has

established itself in Estonia as a self-regulating collective spiritual practice. Subjective

and objective outcomes of the practice are comparable to those of traditional ritual

ayahuasca use in Brazil (Bouso et al. 2012) despite cultural differences between the

populations.

Both desirable and undesirable effects of ayahuasca and other natural

psychedelic remedies can be researched and evaluated. Evidence-based evaluation of

risks and benefits gives an input for updating regulations of ayahuasca use and

clarifying needs for further research, also for informing the community to improve

safety of such practices. Guidelines for better ayahuasca practices recently published by

ICEERS (Londoño, Mazarrasa, and Aixalà 2019) offer evidence-based advice for

participants and organizers of the sessions. This is an encouraging example of ongoing

reasonable self-regulation of the European ayahuasca-using community.

Conclusions

No deterioration of mental health in studied ayahuasca users was found. Users reported

mostly positive subjective consequences of ayahuasca use for their health and life, and

good quality of life, but also unpleasant experiences and undesired outcomes were

reported. Findings of the present study are in good accordance with previous studies of

users in South America. Results of this study allow to describe ayahuasca use in Estonia

as a reasonably safe and self-limiting form of collective spiritual practice.

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Table 1. Demographic indicators of the sample of ayahuasca users and the control group
Group
control ayahuasca
N % N %
secondary 8 27% 6 20%
BSc 13 43% 16 53%
Education
masters 7 23% 5 17%
PhD 2 7% 3 10%
single 9 30% 13 43%
married or in
Relationship relationship 16 53% 15 50%
status
divorced 3 10% 2 7%
no answer 2 7% 0 0%
none 2 7% 1 3%
<250 3 10% 1 3%
250-500 7 23% 6 20%
Income 500-1000 6 20% 5 17%
(EUR/month) 1000-1500 4 13% 8 27%
1500-2000 1 3% 3 10%
>2000 0 0% 2 7%
no answer 7 23% 4 13%
employed 16 53% 13 43%
student 8 27% 5 17%
Employment
entrepreneur 6 20% 14 47%
status*
job seeker 1 3% 2 7%
stay at home 2 7% 3 10%
urban 19 63% 21 70%
Place of smaller town 4 13% 5 17%
residence rural 5 17% 4 13%
unspecified 2 7% 0 0%
*some participants belonged to several categories at once, e.g. “student” and “employed”.
Table 2. Comparison of means for all subscales of EST-Q2 screening test. SD=standard

deviation, SEM=standard error of the mean, t=t-statistic, df=degrees of freedom, p=2-

tailed significance.

Control Ayahuasca Comparison

Subscale Mean Max Min SD SEM Mean Max Min SD SEM t df p
Depression 9,27 25 0 7,28 1,55 5,60 14 1 3,91 0,78 2,11 31,2 0,043
Anxiety 8,14 16 0 4,69 1,00 4,56 13 1 3,22 0,64 3,01 36,5 0,005
Agoraphobia 0,41 6 0 1,33 0,28 0,32 4 0 0,99 0,20 0,26 45 0,794
Social phobia 1,23 3 0 1,15 0,25 0,48 4 0 1,00 0,20 2,38 45 0,022
Asthenia 6,68 16 1 3,80 0,81 4,72 11 1 2,89 0,58 2,01 45 0,051
Sleep 3,50 8 0 2,48 0,53 2,24 6 0 1,71 0,34 2,04 45 0,047
disturbances
Figure 1
Figure 2
Figure captions

Figure 1. Satisfaction with life in ayahuasca users vs. controls.

Figure 2. Happiness about life in ayahuasca users vs. controls.