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Ibogaine, psychotherapy and the treatment of substance-related disorders
Barbara E. Judd, CSW
I have been working with chemically dependent patients, some having dual diagnoses, for twelve years in outpatient settings. My observations have been that the earliest phase of recovery, the first ninety days, is the most difficult for the therapist and the patient. I would like to compare and contrast certain issues seen as obstacles by patients, some of whom were treated with the Lotsof method and some treated in traditional outpatient settings.
My observations are based on a small sample of patients seen in the U.S. and overseas. These observations are inconclusive and my work is ongoing.
My involvement with Ibogaine began in June 1993, when I was approached by the International Coalition for Addict Self-Help (ICASH) and requested to provide after care for five patients who were treated with Ibogaine and were eager to share their experience and struggles. Four of the group were white males ranging in age from early thirties to mid forties. One was a female in her thirties. Their dependencies were to heroin, Methadone and/or cocaine. Additional substance use included marijuana, alcohol and psychedelics. This group met once a week for the duration of one year.
Concurrent treatment was provided to one member of this group on an individual basis. This patient, who we will refer to as "M" is still presently under my care. "M" is thirty-three years old and formerly heroin/methadone/cocaine dependent. He has been using drugs since the age of fourteen.
My most recent involvement with Ibogaine has been with NDA International, Inc. where I participated in the treatment of three patients using the Lotsof method in Panama. All three patients were white males in the thirty to forty age range. Two patients' major drug of choice was cocaine. The route of administration for one patient was nasal and smoking. The second patient also administered cocaine by IV route. The third patient was heroin/cocaine dependent and occasionally used methadone in attempts to curb his habit. All patients had used drugs from six to sixteen years.
One of the most difficult aspects of treatment is getting the patient to enter treatment. The three major obstacles are the fear of detoxification, lack of insight, and the inability of patients to control their urges to use drugs. These are the areas where I have observed the benefits of Ibogaine treatment versus traditional methods
Fear of Detoxification
Across the board, addicts who enter outpatient treatment programs report that their fear of detoxing from drugs has prevented them from attending treatment. Although withdrawal from cocaine is not as severe or obvious as that from opiate narcotics, there is a fear of the psychological pain of never being able to use again. There is also a dread that once drug free, feelings that have been blocked by self-medicating will surface and be too overwhelming for the patient to handle.
Most heroin addicts are petrified of withdrawal symptoms and are afraid of hospital detoxification. Outpatient clients have stated to me that they have delayed treatment to avoid this anticipated discomfort.
My observations with Ibogaine treated patients have been that patients are eager to be treated when they know that Ibogaine promises to eliminate painful withdrawal, takes one administration with up to seventy-two hours of supervised care, and promises to interrupt their urges to use drugs.
Patient '1' had used approximately $100 each per day of heroin and cocaine by IV administration for twenty of the thirty days prior to Ibogaine treatment.
Patient '2', prior to treatment was using $80 per day of cocaine and alcohol.
Patient '3' was using $50 of cocaine on a daily basis via IV injection and smoking. He had previously been heroin dependent.
I observed during treatment with the Lotsof method, all of the three patients treated appeared calm and comfortable and exhibited no signs of withdrawal. This is significant considering the extent of the level of their drug use prior to treatment with Ibogaine.
For these patients to have had little discomfort during withdrawal, speaks to the importance of the use of Ibogaine in the beginning of the recovery process. As patient 'M' had stated, 'Ibogaine is a much more humane and dignified approach to detox'.
Obstacles Within Traditional Treatment
Returning to the obstacles of treatment, the second being the patients' lack of insight. Insight is necessary for patients to be able to focus and develop goals while in recovery.
Patients in traditional outpatient groups who have less than ninety days clean, spend more time struggling with their urges to use and dealing with their defenses, specifically denial. They do develop insight into their problems, however, it takes at least one year of group treatment meetings one or two times a week on a regular basis.
In contrast, my involvement with providing after care for the Ibogaine treated group showed these patients as having tremendous insight into their own issues, their feelings, and what might have caused them to use in the first place.
After their Ibogaine treatment, patients began to see their drug use as destructive. This realization, coupled with psychotherapy, has allowed these patients to work on how to stay clean and to focus on what they must do to maintain a less destructive lifestyle.
The reason for this insight developed by these patients appears to be the release of repressed material during the visualization stage of Ibogaine treatment. This material includes both images and racing thoughts, which somehow get processed to allow patients to have a better understanding of their emotional histories.
The urge to use drugs again, is the highest cause for people to drop out of traditional treatment. Relapse, I think, is clearly inherent in the definition of substance-related disorders. In working with people treated with or without Ibogaine, my observations have been that relapse at some point is certain.
However, according to members in the Ibogaine group, Ibogaine had reduced their urges to use, anywhere from two months to more than one year. This advantage allowed these patients to get a head start in their recovery, whereas clients in traditional out patient treatment have a great deal of confusion around how to control their urges. Consequently, those patients have to learn very basic and concrete ways to stay clean as taught by self-help meetings, and emphasized in psychotherapy. The Ibogaine after care group did not appear to need self-help type assistance to reduce their urges, but seemed to benefit well from psychotherapy.
In conclusion, there is difficulty treating the drug addicted patient, particularly in the early stages of recovery, because of their fear of detox, their lack of insight, and their urges to relapse.
Thus far, there is no opportunity for Ibogaine treatment within the United States. It is my recommendation that there be future research done with Ibogaine, so that some of the above mentioned observations are supported by more conclusive data.
The prospects for a painless withdrawal method makes Ibogaine an attractive alternative to traditional treatment methods. Because Ibogaine interrupts substance related disorders, it gives patients a head start in their recovery. It also increases the patients' receptiveness to psychotherapy, which is a necessary component to the recovery process.
The Ibogaine Dossier