Abstract
Clinical trials combining psychedelic substances with psychotherapy or psychological support have shown early promise treating a number of psychological disorders. Yet the mechanisms behind this treatment are still not well understood. Meanwhile, some laypeople, spurred in part by reports of successful clinical outcomes, are self-administering these substances in uncontrolled settings with the intention of addressing health or wellbeing issues. Although this practice raises potential public health concerns, little is currently known regarding its occurrence in Aotearoa New Zealand. The aim of this thesis is twofold: to describe self-administration practices involving psychedelics in Aotearoa New Zealand, and to identify ways in which clinical models of psychedelic-assisted therapy might be enhanced or optimised.
To accomplish this aim, I have taken a qualitative exploratory approach. I have interviewed individuals in Aotearoa New Zealand (n = 34) who have self-administered psychedelics for health or wellbeing reasons, and I have used these data to perform three separate analyses. In the first analysis, I generate themes from the data that map this emerging public health phenomenon. I provide a description of this practice, identifying patterns and highlighting differences in the various and diverse ways individuals hoping to improve their health or wellbeing are self-administering psychedelics in Aotearoa New Zealand. I conclude that public health responses would benefit by shifting their focus from individual decision-making to the legislative, economic, and social forces that influence and shape individual motivations and behaviour.
In the second analysis, I present themes representing experiences and outcomes associated with self-administration practices that participants identified as being therapeutically salient. I argue that psychological mechanisms related to the subjective psychedelic experience may be in part responsible for positive therapeutic outcomes and that these experiences, shaped by contextual factors, are highly individualised. I identify a common characteristic underlying the majority of participants' reported experiences: their deeply personal nature, which gives the impression that the treatment is uniquely tailored to each individual. I argue that this personalisation may help explain why such diverse experiences can lead to positive therapeutic outcomes, contrasting sharply with the impersonal, standardised approaches of conventional treatments that many participants had previously rejected. I conclude that clinical models of psychedelic-assisted therapy could be optimised by leveraging relevant contextual factors to foster experiences that are closely aligned with patients’ personal understandings and experiences of illness.
These contextual factors are the focus of my third and final analysis. Here, I generate themes from the data representing common extra-pharmacological factors associated with psychedelic self-administration practices. I discuss how psychological, social, cultural, environmental, and spiritual factors may shape the subjective psychedelic experience. I suggest these factors may confer additional therapeutic benefits via separate mechanisms that are enhanced by the pharmacological properties of psychedelics. I argue that self-administered psychedelic therapy, rather than being a replication of clinical psychedelic treatment approaches, aligns more closely with traditional healing approaches, being a holistic practice where pharmacological and extra-pharmacological factors work synergistically to address subjective experiences of illness. I conclude this chapter by proposing a modular approach to psychedelic clinical treatment, where a standardised therapeutic model serves as a foundation, with additional components added collaboratively with the patient to create a personalised treatment that ensures safety while optimising efficacy.