Heink 2017 ibogaine by Nätverket för psykedelisk vetenskap

Journal of Psychoactive Drugs

ISSN: 0279-1072 (Print) 2159-9777 (Online) Journal homepage: http://www.tandfonline.com/loi/ujpd20

Examination of the Phenomenology of the Ibogaine Treatment Experience: Role of Altered States of Consciousness and Psychedelic Experiences Annamarie Heink M.A., Steve Katsikas Ph.D. & Tiffany Lange-Altman Psy.D. To cite this article: Annamarie Heink M.A., Steve Katsikas Ph.D. & Tiffany Lange-Altman Psy.D. (2017): Examination of the Phenomenology of the Ibogaine Treatment Experience: Role of Altered States of Consciousness and Psychedelic Experiences, Journal of Psychoactive Drugs, DOI: 10.1080/02791072.2017.1290855 To link to this article: http://dx.doi.org/10.1080/02791072.2017.1290855

Published online: 07 Mar 2017.

Submit your article to this journal

View related articles

View Crossmark data

Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ujpd20 Download by: [FU Berlin]

Date: 08 March 2017, At: 01:09

JOURNAL OF PSYCHOACTIVE DRUGS http://dx.doi.org/10.1080/02791072.2017.1290855

Examination of the Phenomenology of the Ibogaine Treatment Experience: Role of Altered States of Consciousness and Psychedelic Experiences Annamarie Heink, M.A.a, Steve Katsikas, Ph.D.b, and Tiffany Lange-Altman, Psy.D.c a

Doctoral Candidate, School of Professional Psychology, Spalding University, Louisville, KY, USA; bChair, School of Professional Psychology, Spalding University, Louisville, KY, USA; cPTSD/SUD Psychologist, Hampton Veteran Affairs, School of Professional Psychology, Spalding University, Louisville, KY, USA ABSTRACT

ARTICLE HISTORY

Psychedelic drugs have historically been used for ritualistic purposes and to help individuals gain insight. Ibogaine, a naturally occurring psychoactive substance, has been reported to have anti-addictive properties that aid in the treatment of substance use disorders. An online survey obtained retrospective data from individuals who used ibogaine in the past. Individuals who used ibogaine tended to describe thematically similar experiences post-treatment. This study adds to the literature by using the 5d-ASC, a psychometrically sound measure of altered states of consciousness (ASCs), to examine the ASCs induced by ibogaine and discusses the demographic characteristics of those who seek ibogaine treatment (N = 27). The study also examined several aspects of ibogaine treatment experience, including reasons for seeking treatment, course of treatment, and treatment outcome. Results indicated a positive correlation between the various dimensions of the ASCs and the outcome (ability to make changes in oneâ&#x20AC;&#x2122;s life, cravings, and how changed the person was as a result of ibogaine treatment). While this study is limited in generalizability due to high attrition and low sample size, it deepens the understanding of the phenomenological experience of ibogaine and explores the possible utility of ibogaine in the treatment of substance use disorders.

Received 3 July 2016 Revised 29 November 2016 Accepted 29 December 2016

Ibogaine is the active alkaloid of the root bark of the plant Tabernanthe iboga, which grows in western central Africa. The root bark of the plant has been used by the Bwiti tribe for religious rituals and induces a series of psychoactive effects, including vivid hallucinations. Animal studies, as well as several open human trials, suggest that ibogaine may have therapeutic value as a treatment for substance abuse, especially opiate addiction (Mash et al. 2000; Siegel et al. 1996). It is unclear whether the addiction interruption effects reported by some individuals are a product of the pharmacology of the substance itself or are also affected by the psychedelic effects of the substance. Given the prevalence of opiate addiction and a lack of pharmacological treatments other than substitution approaches (e.g., Methadone) and abstinence-based therapies, there remains a need for identifying additional approaches to treating substance use. Both popular press articles and scientific literature point to an increasing number of people with substance use disorders seeking out treatment using psychoactive substances (Kotler 2010; MAPS 2003). CONTACT Annamarie Heink ÂŠ 2017 Taylor & Francis Group, LLC

annamarie.heink@gmail.com

KEYWORDS

Addiction treatment; heroin; ibogaine; opiate; psychedelics

Ibogaine Anecdotal reports suggest that ibogaine may alleviate immediate symptoms of opiate withdrawal and cravings, as well as cravings over time (Alper, Beal, and Kaplan 2001). Yet, few studies have formally investigated these claims. A few studies have examined ibogaine and evaluated its medicinal qualities, focusing mainly on elucidating its chemical structure and studying its possible anti-addictive/anti-craving properties (Carnicella et al. 2010; Levi and Borne 2002; Mash et al. 1998). Alper, Beal, and Kaplan (2001) evaluated the reasons individuals provided for seeking ibogaine treatment, and the most common reasons were heroin use, unspecified addiction, and spiritual growth. Alper, Lotsof, and Kaplan (2008) estimated that 53% of those who took ibogaine for treatment of substance use disorders did so to treat or avoid opioid withdrawal. Currently, ibogaine is classified as a Schedule I substance in the United States. Resultantly, all formal treatment facilities are outside of the United States, although ibogaine is provided in the U.S. by an underground network of laypersons in nonmedical settings (Alper, Beal, and Kaplan 2001). The current

Spalding University, 901 South Fourth Street, Louisville, KY 40203, USA.

A. HEINK ET AL.

classification of ibogaine is a likely reason why few studies, and no randomized trials, have been conducted. Human trials Mash et al. (1998) studied the pharmacokinetics of ibogaine to assess for safety, dosage, and the efficacy of ibogaine used to treat opiate addiction. Researchers analyzed ibogaine in multiple administrative forms (bark and extract), as well as its metabolite, noribogaine. They reported the presence of some unpleasant side-effects (nausea and mild tremor), but no significant adverse reactions. However, the study was conducted under optimum conditions (single-dose administration after subjects had received a medical evaluation, physical examination, electrocardiogram, and blood work), and results may not generalize to the use of ibogaine outside of these conditions. However, the single-dose administration of ibogaine was well tolerated (Mash et al. 1998). Long-term effects of ibogaine treatment are still being investigated. Bastiaans (2004) used a retrospective self-report questionnaire to evaluate changes in behavior and attitudes over time. One quarter (24%) of participants ceased use of any substance (illicit drugs, pain medication, or alcohol) three and a half years post-treatment. Most (76%) quit using their primary and secondary drugs of choice for approximately one and a half years. Mash et al. (2000) evaluated mood and cravings at three points during a 14-day study and one month post-treatment. Results suggested lasting reductive effects of single-dose administration on the subjects’ mood and depressive symptoms. This study also showed significant decreased opiate and cocaine cravings at one month post-treatment. Phenomenology of the ibogaine experience Commonalities exist among ibogaine treatment experiences, including three general phases and physical and psychological effects. Alper (2001) described Phase I as a “waking dream” state where individuals commonly experience visions and have altered perceptions. Phase II is a period of evaluation of the inner experiences of Phase I and may involve review of the individual’s issues (e.g., past trauma, substance use, health problems) (Alper 2001; Lotsof and Wachtel 2003). Phase III occurs for days following treatment, and was described as an increased awareness of the external environment and a reduction in the psychoactive effects of ibogaine (Alper 2001). Physical and psychedelic effects Ibogaine induces physical effects, including feelings of warmth, paralysis or difficulty with movement, nausea,

and vomiting (Alper, Lotsof, and Kaplan 2008; KBF 2009; Naranjo 1974). Concerns regarding the potential cardiac effects of ibogaine are also well documented (Koenig et al. 2013; Maas and Strubelt 2016). There have been some reports of long-term sleep disturbance in the weeks or months after ibogaine administration (Lotsof and Wachtel 2003). The psychedelic effects of ibogaine include visual and auditory hallucinations and altered perceptions. Anecdotes recount visions of burning skulls, brightly colored patterns, goblin faces, and figures in black (Pinchbeck 2002). Lotsof (1994) reported rapid visualizations, with some individuals equating the experience to watching a movie in high speed or as a slideshow. The occurrence of visual altered states of consciousness (ASCs) seems to be vivid, personal, and meaningful to the individual. Personal anecdotes suggest that the visions themselves are a way to gather insight into current or past issues within the self (Pinchbeck 2002). Interest in alternative treatments for substance use disorder is growing out of the realization that treatments need to be multimodal and tailored to individual needs. This study set out to understand the phenomenology of the ibogaine experience and associated treatment outcomes. If the psychedelic experience itself contributes to outcomes for individuals treated with ibogaine, then understanding the subjective experience may increase the understanding of ibogaine’s mechanisms of action as an addiction-interruption treatment.

Methods Participants The researchers gathered data using an anonymous, online, retrospective survey. Criteria for participation included being at least 18 years old and previous use of ibogaine. Materials The materials consisted of a demographics questionnaire (DQ), assessment of ASCs, and additional items examining the phenomenology and self-reported treatment outcomes. The DQ examined age, race/ethnicity, country of origin, country in which they received treatment, education, and language. The researchers assessed the ASCs experienced with ibogaine by using the 5d-ASC, the second revision of the English translation of Abnormer Psychischer Zustand (APZ), the most widely used, standardized measure of psychedelic experiences. The 5d-ASC (Dittrich 1998) for use in this online study uses a sliding scale (Dittrich, personal

JOURNAL OF PSYCHOACTIVE DRUGS

communication, August 19, 2012). The sliding scale assessed deviation from normal waking consciousness and ranged from 0 to 100 where 0 indicated the experience was “No, not more than usual” and 100 was “Yes, much more than usual.” The 5d-ASC questions factor into six primary dimensions or scales: Oceanic Boundlessness (OBN), Dread of Ego-Dissolution (DED), Visual Restructuralization (VRS), Auditory Alterations (AUA), Vigilance Reduction (VIR), and a Global Altered State of Consciousness scale (G-ASC) (Dittrich 1998; Dittrich, von Arx, and Staub 1985). The 5d-ASC demonstrates good reliability, yielding internal consistency reliabilities between α = .88 and α = .95 for the various dimensions and a total scale score of α = .96 (Dittrich, Lamparter, and Maurer 2011). The 5d-ASC has been shown to distinguish between amount administered and type of psychedelic substance (Studerus et al. 2010). The questionnaire included additional items examining the psychedelic experience itself and self-reported treatment outcomes. Regarding phenomenology, participants responded to multiple-choice questions about the administration process, reasons for seeking treatment, and course of treatment, which included physical and psychedelic effects. Self-reported treatment outcome questions included symptoms of withdrawal and cravings over weeks and months, the importance of ASCs in the ability to make changes in life, how changed the person was as a result of ibogaine treatment, expectations, and perceived effectiveness (Table 1). Participants responded on a Likert scale.

Table 1. Self-reported treatment outcome questions. Factor

Question

Likert scale range

Withdrawal

What effect do you believe your ibogaine treatment had on your withdrawal symptoms?

1. Ibogaine dramatically reduced withdrawal symptoms 2. Ibogaine reduced withdrawal symptoms 3. No effect on withdrawal symptoms 4. Ibogaine increased withdrawal symptoms 5. Ibogaine dramatically increased withdrawal symptoms

Cravings (weeks)

What effect do you believe your ibogaine treatment had on your drug cravings in the first 4 weeks after your treatment?

1. Ibogaine dramatically reduced my drug cravings 2. Ibogaine reduced my drug cravings 3. Ibogaine had no effect on my drug cravings 4. Ibogaine increased my drug cravings 5. Ibogaine dramatically increased my drug cravings 6. I did not seek ibogaine as a treatment for drug use

Cravings (months)

What effect do you believe your ibogaine treatment had on your drug cravings in the months following your treatment?

Importance

How important were the visions/hallucinations to your ability to make changes in your life?

1. Not at all important 2. A little important 3. Very important 4. Extremely important 5. I did not experience visions/hallucinations

Changed

How changed are you as a result of your experience with ibogaine?

1. I am much worse because of the experience 2. I am worse because of the experience 3. I am the same 4. I am better because of the experience 5. I am much better because of the experience

Expectation

Compared to your expectations for your experience with ibogaine, how would you describe your actual experience?

1. My experience was completely different than what I was expecting 2. My experience was a little different from what I was expecting 3. My experience was close to what I was expecting 4. My experience was very similar to what I was expecting

Procedures Research procedures were approved by Spalding University’s Institutional Review Board approval of protocol and then prepared as an online survey tool. The researchers sent the link to the questionnaires to 14 ibogaine treatment centers, asking program directors to share the link with patients who had completed treatment at their facility within the past two years. Additionally, the survey description and link was posted on 12 relevant online forums and discussion boards, including Facebook and a threaded bulletin board devoted to Ibogaine discussion, obtaining permission from moderators as needed. After clicking on the study link, participants reviewed and signed an electronic informed consent form that described the study. A hyperlink led participants to the demographics questionnaire. If the participant met the criteria for the study, a subsequent link directed him or her to the rest of the survey. The length of the questionnaire required approximately

Effectiveness Overall, how effective was your ibogaine experience in helping with the MAIN issue you sought treatment for?

1. 2. 3. 4. 5.

Not at all helpful A little helpful Unsure Very helpful Extremely helpful

A. HEINK ET AL.

one hour to complete, and respondents received a gratitude statement.

Results The survey informed consent was viewed 392 times. The survey itself was started 100 times, and 27 individuals completed the survey.

Demographics The 27 participants were from 10 different countries, had a mean age of 35.11 (SD = 7.85), and most (96%) identified as White/Caucasian/European. About half (56%) identified as male. Regarding participant’s level of education, 7% had some high school, 35% had some college, 11% held a technical certification, 8% had an associate degree, 39% had a bachelor’s degree or higher. It is possible that individuals with a postsecondary education may be more likely to have the economic means to receive ibogaine treatment, as treatments can be costly (Ibogaine University 2013). Several participants (31%) reported multiple ibogaine treatments. Phenomenology of the experience Administration process. Participants reported various ibogaine treatment settings, including medical treatment facilities (22%), their own home (11%), someone else’s home (26%), motel rooms (22%), counseling centers (15%), and other places (4%). Ibogaine was administered by a medical professional 33% of the time, a non-medical professional with experience in using ibogaine 33% of the time, and a counseling professional 15% of the time, with the rest being described as either self-administered or “other.” Participants indicated that they were able to ask questions of the treatment providers, with 70% reporting that their questions were answered completely. Reasons for seeking treatment and expectations. When asked to indicate the most important reason for seeking ibogaine treatment, 78% indicated substance abuse (drugs or alcohol), 8% indicated spiritual growth, and 14% indicated alcohol abuse, chronic pain, anxiety, self-awareness, or “other.” Regarding expectations, participants indicated that the ibogaine treatment experience was “different” (4%) or “completely different” (59%) from what they had expected. Most individuals (92%) indicated experiencing the effects of ibogaine within the first hour after administration, including both physical and perceptual changes.

Physical effects. Participants indicated that they felt at least “some” of the following physical symptoms: lightheadedness/dizziness (56%), decreased control of movements in any body parts (70%), buzzing in ears (89%), nausea (52%), vomiting (30%), diarrhea (19%), feeling physically heavy (77%), difficulty trying to move (81%), emotional distress (46%), and feeling hesitant to take the next dose of ibogaine (35%). Psychedelic effects. Participants reported variations in perception as well as visual and auditory hallucinations. Eighty-eight percent (88%) of participants endorsed a heightened sense of perceptions. Participants reported change in perception of light (89%), change in perception of sound (85%), change in perception of their body (82%), change in perception of time (93%), and change in perception of space (78%). Most participants experienced hallucinations (97%), with 63% indicating “quite a bit” or “almost all” of the ibogaine experience included hallucinations or visions. Common themes and images included hallucinations of living people (77%) and deceased people (38%), visuals of animals (62%), visions of television screens (46%), hearing drums beating (54%), hearing a buzzing noise (96%), and communication with the deceased (27%). The majority of participants indicated that their visions told a story (70%) and contained symbolism (74%). Seventy-four percent also reported that the visions had an obvious personal meaning to them, and 77% had visions from their own childhood. Participants varied in their ability to control hallucinations. Most (78%) were able to exit the vision by opening their eyes, at least “a little” of the time. When participants shut their eyes again, most returned to the vision where they left off (78%). About half (52%) felt as though they were not able to control their visions “at all.” Participants also varied in their experiences of various internal and external events, such as the intensity of the altered state of consciousness and communication with treatment providers. Two-thirds (66%) found it at least “a little” difficult to communicate with counselors or staff members and 48% stated counselor/staff member “checking ins” interfered with their experience. All participants reported that the ibogaine experience yielded insight relating to their past, 92% had insights relating to the meaning of life, and 88% reported insights regarding creation. Others endorsed insights regarding the evolution of humanity (85%), evolution of the animal world (77%), evolution of the universe (89%), and death/ after-life (85%). After the ibogaine experience, 85% of participants indicated relief from guilt.

JOURNAL OF PSYCHOACTIVE DRUGS

Table 2. 5d-ASC scores by substance. Substance

OBN

DED

VRS

VIR

AUA

G-ASC

Ibogaine Psilocybin

62.45 41.72

41.96 22.53

66.23 44.27

48.18 41.59

54.87 11.53

168.19 108.52

Note. Psilocybin—high dose (315 μg/kg Psilocybin, n = 42). Data obtained from Studerus (2012).

Treatment outcomes Outcome questions concerned the impact of the ASCs, participants’ expectations of treatment, the perceived effect of ibogaine on withdrawal symptoms, and any insight gained through the experience. Withdrawal Nearly all participants (96%) found ibogaine to have a reductive effect on immediate post-treatment withdrawal symptoms. Many (68%) indicated that ibogaine “dramatically reduced” withdrawal symptoms. Altered states of consciousness (ASCs) Individual total scores for each of the 5d-ASC factors are shown in Table 2, together with similar data for psilocybin taken from Studerus (2012). These results suggest that ibogaine may result in a more intense psychedelic experience than psilocybin. Altered states of consciousness and outcome variables The authors ran a correlational analysis to evaluate the link between the ASCs and the following treatment outcome measures: importance of visions/hallucinations to the participant’s ability to make changes in life (importance variable), the level of change the participant attributed to the ibogaine experience (changed variable), the participant’s expectations, effect on cravings over the first four weeks, effect on cravings for months after treatment, how effective ibogaine was in helping with the main issues for which treatment was sought, and symptoms of withdrawal. There were no significant correlations between withdrawal symptoms and 5d-ASC variables. However, there were positive correlations between self-reported withdrawal and the effects on cravings in the first four weeks after treatment (rho = .720, p = .01) and the effects on cravings in the months following treatment (rho = .675, p = .01). A negative correlation was found between symptoms of withdrawal and how effective ibogaine was for the main issues for seeking treatment (rho = –.546, p = .01). Cravings Of those who sought ibogaine as a treatment for drug use, 92% reported that ibogaine “reduced” or “dramatically reduced” drug cravings in the first four weeks

after treatment. Craving reduction continued for months after treatment for 91% of participants and 49% indicated a “dramatic” reduction. There were no significant correlations between cravings reductions weeks or months after treatment and the 5d-ASC variables. However, the effects on cravings in the first four weeks after treatment factor was negatively correlated with how important the ASCs were to the participant’s ability to make changes in life (rho = –.391, p = .05). A negative correlation was found between the effects on cravings, in the months following treatment and the changed variable (rho = –.448, p = .05). There was a positive correlation between the effects on cravings in the first four weeks and the effects on cravings in the months following (rho = .972, p = .01). Changed Participants identified how changed they felt as a result of the ibogaine experience. Participants answered this question on a 5-point Likert scale that ranged from “I am much worse because of the experience” to “I am much better because of the experience.” Results yielded the “changed” variable. No participants indicated that they were either “much worse” or “worse” as a result of their experience with ibogaine. Instead, 30% of participants stated they were “better,” and 67% stated they were “much better” because of the ibogaine experience. There was significant positive correlation between how changed the participant felt as a result of the experience and the 5d-ASC factors VRS (rho = .679, p = .01) and GASC (rho = .419, p = .05). Importance The survey assessed the level of importance the participants placed on the ibogaine experience in their ability to make changes in life. Participants (41%) indicated that the visions or hallucinations were “extremely important” to their ability to make changes in their lives, and 82% stated they were at least “a little” important. There was significant positive correlation between this importance variable and the 5d-ASC factors AUA (rho = .433, p = .05). Effectiveness Participants indicated how effective ibogaine was in helping with the main issues for which treatment was sought, yielding the “effectiveness” variable. The majority of participants indicated that ibogaine was “very helpful” or “extremely helpful” (16% and 76%, respectively). There was no significant correlation between how effective ibogaine was in helping with the main issues for which treatment was sought and the 5d-ASC variables. Generally speaking, participants reported that ibogaine was effective and that they gained insight from the

A. HEINK ET AL.

experience. Most participants stated that ibogaine was “very” to “extremely” helpful (16% and 76%, respectively) for the main reason for which they sought treatment

Discussion This study revealed a number of variations in the ibogaine treatment setting that may be due to its lack of regulation or adoption of formal administration protocols. These variations included location of administration, protocols used, and use of informed consent. The rationale for administration of treatment by a nonprofessional provider, reported by a majority of participants, may be due to legality status (discouraging medical providers’ participation), or participants may gravitate towards a provider with personal experience with ibogaine (Lawson 1982). Addressing drug use was the primary reason for seeking ibogaine treatment. Most indicated that their experience was either “different” or “completely different” from what they expected. Many participants reported experiencing the physical and psychedelic effects of ibogaine treatment that were consistent with the literature (Alper, Lotsof, and Kaplan 2008; Lotsof 1994). A majority of participants endorsed a heightened sense of perception, including changes in perception of light, sound, time, space, and self. The ASCs seemed to be personal in nature and to contain symbols. Participants believed that ibogaine reduced withdrawal symptoms and cravings for up to months after treatment. Nearly all participants reported a significant reduction in withdrawal symptoms. Reductions in withdrawal symptoms were correlated with perceived effectiveness. These results suggest that ibogaine’s impact on withdrawal symptoms are closely related to future cravings and how participants rated its effectiveness, but also that ibogaine’s effect on withdrawal symptoms may be the result of factors that are independent of the ibogaine-induced ASCs. Participants reported that ibogaine reduced their cravings both in the weeks and months after treatment, independent of ASCs. Participants also reported that the visions/hallucinations were an important aspect of their experience in terms of their ability to make changes in their lives. ASCs appear important for individuals to be able to make changes in their life, specifically auditory hallucinations (AUA). However, there was no significant relationship between how important the ASCs were to the participant’s ability to make changes in life and the intensity of the overall experience (GASC). This finding suggests that participants get some benefit from the hallucinations induced by ibogaine, but that the benefit

is not contingent on the intensity of the ASCs. Participants did describe visual hallucinations (VRS) and the overall intensity of the psychedelic experience as being an important predictor of how “changed” they felt. The idea that the ASCs act as a catalyst for change has potential implications for treatment and research. It is well-established that a drug’s effect on the body is contingent on many factors, including the substance, the individual’s metabolic rate, and dose (Holford and Sheiner 1981). Clinical trials may be useful to identify the populations most likely to benefit from treatment, as well as the specific dosage necessary to induce therapeutic ASCs. The majority of participants stated that ibogaine was “very” helpful or “extremely” helpful for the main reason they sought treatment. There was no significant relationship between the perceived effectiveness and the ASCs, suggesting that ibogaine may be effective regardless of the intensity of the ASCs. However, the level of perceived effectiveness was positively correlated to withdrawal. These are encouraging results, as some research suggests one significant reason for relapse is withdrawal symptoms (Wikler 1948). The majority of participants seemed to benefit from their experience with ibogaine. While experiences varied greatly (in setting, reason for treatment, expectations), no participants indicated that ibogaine had a negative effect on their life, suggesting that ibogaine may have positive and generalizable treatment effects. Generally speaking, the ibogaine experience appears to be significantly different from normal waking consciousness across all aspects of a psychedelic experience, as defined by the 5d-ASC. Given the unpleasant physical side-effects and quick development of tolerance, ibogaine is unlikely to be used recreationally and does not likely represent a risk for abuse. This study has several limitations, including the use of a retrospective and self-report survey, a small sample size, and high non-completion rate. The 27 respondents who chose to complete the survey may be very different from other ibogaine users who consented or initiated, but did not complete, the survey. Expanding the knowledge base on ibogaine may involve the development of clinical trials with clear pre-post measures to assess changes in craving, withdrawal, and other psychological dimensions. The development of administration protocols, efficacy evaluations, and treatment outcomes can be addressed through the use of clinical trials. Finally, objective outcome measures, such as drug screens, could be conducted before and after treatment to reduce bias. This study evaluated the phenomenology of the ibogaine experience, including the physical and psychedelic

JOURNAL OF PSYCHOACTIVE DRUGS

effects of ibogaine and treatment outcome measures related to withdrawal, cravings, perceived effectiveness, importance of the visions or hallucinations, and the role of expectations. The hypothesis of a link between ASCs and the level of impact of the experience on the individual’s life was partially supported. ASCs were related to how important hallucinations or visions were to the individual’s ability to make changes in his or her life and how changed the participant felt as a result of the ibogaine experience. To date, little research has been done on what aspects of the ibogaine experience are linked to perceived treatment outcome. It is possible that the ASCs play a vital role in the treatment outcome; thus, should be considered an essential predictor of outcomes. Comparing ibogaine to a non-psychedelic derivative drug would be a useful study in further elucidating whether the psychedelic experience adds to treatment efficacy or is just an unpleasant (though striking) set of medication side-effects.

Acknowledgments The authors acknowledge Spalding University’s Ibogaine Research Interest Group: Edna Gyamfi, M.A.; Roshunna Lea, M.A.; Melissa Swartz, M.A.; and Carissa Timmerberg, M.A.

References Alper, K. R. 2001. Ibogaine: A review. The Alkaloids 56:1–38. Alper, K. R., D. Beal, and C. D. Kaplan. 2001. A contemporary history of ibogaine in the United States and Europe. The Alkaloids 56:249–81. Alper, K. R., H. S. Lotsof, and C. D. Kaplan. 2008. The ibogaine medical subculture. Journal of Ethnopharmacology 115:9–24. doi:10.1016/j.jep.2007.08.034. Bastiaans, E. 2004. Life after ibogaine: An exploratory study of the long-term effects of ibogaine treatment on drug addicts. Unpublished science internship report, Vrije University, Amsterdam, Netherlands. Carnicella, S., D. He, Q. Yowell, S. Glick, and D. Ron. 2010. Noribogaine, but not 18-MC, exhibits similar actions as ibogaine on GDNF expression and ethanol self-administration. Addiction Biology 15 (4):424–33. doi:10.1111/ adb.2010.15.issue-4. Dittrich, A. 1998. The standardized psychometric assessment of altered states of consciousness (ASCs) in humans. Pharmacopsychiatry 31 (2):80–84. doi:10.1055/s-2007979351. Dittrich, A., D. Lamparter, and M. Maurer. 2011. 5D-ASC: Questionnaire for the assessment of altered states of consciousness: A short introduction. Zurich, Switzerland: PSIN PLUS Publicationes. Dittrich, A., S. von Arx, and S. Staub. 1985. International study on altered states of consciousness (ISAAC): Summary of results. German Journal of Psychology 9:319–39.

Holford, N. H. G., and L. B. Sheiner. 1981. Understanding the dose-effect relationship: Clinical application of pharmacokinetic-pharmacodynamic models. Clinical Pharmacokinetics 6:429–53. doi:10.2165/00003088-198106060-00002. Ibogaine University. 2013. Ibogaine treatment cost. http:// www.ibogaineuniversity.com/ibogaine-treatment-cost/. KBF. 2009. A psycho-spiritual experience: Experience with ibogaine (ID 76892). erowid.org/exp/76892. Koenig, X., M. Kovar, L. Rubi, A. K. Mike, P. Lukacs, V. S. Gawali, H. Todt, K. Hilber, and W. Sandtner. 2013. Antiaddiction drug ibogaine inhibits voltage-gated ionic currents: A study to assess the drug’s cardiac ion channel profile. Toxicology and Applied Pharmacology 273 (2):259–68. doi:10.1016/j.taap.2013.05.012. Kotler, S. 2010. Fighting drugs with drugs: An obscure hallucinogen gains legitimacy as a solution for additions. Popular Science. http://www.popsci.com/science/article/ 2010-07/fighting-drugs-drugs (accessed July 21 2015). Lawson, G. 1982. Relation of counselor traits to evaluation of the counseling relationship by alcoholics. Journal of Studies on Alcohol 43 (7):834–39. doi:10.15288/jsa.1982.43.834. Levi, M. S., and R. F. Borne. 2002. A review of chemical agents in the pharmacotherapy of addiction. Current Medicinal Chemistry 9 (20):1807–18. doi:10.2174/0929867023368980. Lotsof, H., and B. Wachtel. 2003. Manual for ibogaine therapy: Screening, safety, monitoring, and aftercare (2nd revision). http://www.ibogaine.org/manual.html. Lotsof, H. S. 1994. Ibogaine in the treatment of chemical dependence disorders: Clinical perspectives. Maps (V) 3:16–27. http://www.ibogaine.org/clin-perspectives.html. Maas, U., and S. Strubelt. 2006. Fatalities after taking ibogaine in addiction treatment could be related to sudden cardiac death caused by autonomic dysfunction. Medical Hypotheses 67:960–64. doi:10.1016/j.mehy.2006.02.050. Mash, D. C., C. A. Kovera, B. E. Buck, M. D. Norenberg, P. Shapshak, W. L. Hearn, and J. Sanchez-Ramos. 1998. Medication development of ibogaine as a pharmacotherapy for drug dependence. Annals of the New York Academy of Sciences 844:274–92. Mash, D. C., C. A. Kovera, J. Pablo, R. F. Tyndale, F. D. Ervin, I. C. Williams, . . . M. Mayor. 2000. Ibogaine: Complex pharmacokinetics, concerns for safety, and preliminary efficacy measures. Annals of the New York Academy of Sciences 914:394–401. doi:10.1111/j.17496632.2000.tb05213.x. Multidisciplinary Association for Psychedelic Studies (MAPS). 2003. Ibogaine: Treatment outcomes and observations. Maps xiii(2):16–21. http://www.maps.org/news-let ters/v13n2/v13n2_16-21.pdf. Naranjo, C. C. 1974. Ibogaine: Fantasy and reality. The Healing Journey. http://www.ibogaine.desk.nl/naranjo. html. Pinchbeck, D. 2002. Breaking open the head: A psychedelic journey into the heart of contemporary shamanism. New York, NY: Broadway Books. Siegel, S., J. A. Kim, L. Weise-Kelly, and L. A. Parker. 1996. Effect of ibogaine on the development of tolerance to the analgesic effect of morphine. Experimental and Clinical Psychopharmacology 4 (3):258–63. doi:10.1037/10641297.4.3.258.

A. HEINK ET AL.

Studerus, E. 2012. Tolerability, assessment, and prediction of psilocybin-induced altered states of consciousness. Ph.D. thesis, University of Zurich, Zurich, Switzerland. Studerus, E., GammaA., Vollenweider, F. 2010. Psychometric evaluation of the Altered States of

Consciousness Rating Scale (OAV). PLoS ONE 5 (8):1â&#x20AC;&#x201C;19. Wikler, A. 1948. Recent progress in research on the neurophysiologic basis of morphine addiction. American Journal of Psychiatry 105:329â&#x20AC;&#x201C;38. doi:10.1176/ajp.105.5.329.