Abstract
Background and aims
This qualitative ethnographic study of a psychedelic integration group in the Southeastern United States contributes to an understanding of the role of supportive communities in processing psychedelic experiences. This article proposes the concept of ‘social efficacy’ to capture the importance of social relationships to the efficacy of psychedelics. Social efficacy refers to a source of efficacy that includes not just the immediate social environment in which psychedelics are experienced and processed, but also the broad range of social relationships and political economic and historical contexts that frame their use.
Methods
This year-long ethnographic research project took place with a psychedelic integration group in an urban center in the Southeastern United States. It was based on observation, interviews, and a focus group.
Results
Overall, the participants in the integration group see the group as critical to their ability to effectively process their psychedelic experiences. The group is important as a supportive community of like-minded people that facilitates enduring cognitive and affective transformation.
Conclusions
Community-based non-therapeutic integration groups can play a vital role in the positive integration of psychedelic experiences, improving mental health and quality of life for users. The important role of community-based groups has significance for both the legalization and the medicalization of psychedelics. It highlights the need for safe and legal spaces in which people can talk about their psychedelic experiences and for medical models of efficacy that include social, relational elements.
Introduction
The use of psychedelics for self-actualization, spiritual growth, and mental health therapy, whether in lay or professional mental health contexts, has grown increasingly popular in the United States. Psychedelics are a class of drugs that are characterized by mind expansion, or, according to the psychiatrist Stanislav Grof, who worked extensively with LSD, “nonspecific amplifiers of unconscious processes” (quoted in Nichols, Nichols, & Hendricks, 2023, p. 1). Psychedelics were recently defined by the journal Psychedelic Medicine as serotonergic agonists that expand brain network connectivity by activating 5-HT2A receptors. They include classic psychedelics (psilocybin, mescaline, DMT, and LSD) as well as ketamine and MDMA, which are not serotonergic psychedelics but have similar pharmacological action (Nichols et al., 2023). Therapeutically, psychedelics hold promise for treating a range of mental health conditions (Ko, Knight, Rucker, & Cleare, 2022; Mosurinjohn, Roseman, & Girn, 2023), including depression (Carhart-Harris et al., 2018; Varley, 2019) and substance use (Nichols, Johnson, & Nichols, 2017). Psychedelics are also associated with enhancement of a sense of wellbeing in otherwise healthy people (Wiepking, de Bruin, & Ghiţă, 2023) and an increase in a sense of spiritual connectedness (Griffiths, Hurwitz, Davis, Johnson, & Robert, 2019). This ‘psychedelic renaissance’ has been supported by actual or anticipated legalization of psychedelics, by increasing numbers of clinical trials using psychedelics therapeutically, by growing business interests in marketing these substances and processes of taking them, as well as by robust social media promotion of them. The popularity of psychedelics is also represented in the plethora of academic writing about psychedelics. A quick Web of Science search of peer-reviewed publications revealed that in 2023, there were 436 publications with ‘psychedelic’ in the title, as compared with 96 in 2019, 48 in 2017, and under 20 every year before 2014.
This study contributes to an understanding of the role of supportive communities in preparing for psychedelic experiences and in processing them afterwards, focusing on people who take psychedelics with the goal of spiritual and personal growth in either naturalistic or structured therapeutic contexts. The general argument is that social relationships are critical factors in psychedelic efficacy, facilitating transformations in cognition, affect, and sense of mystical connection through human (and chemical) relational ties within integration groups. This research, located in an urban setting in the Southeast of the United States, focuses on a semi-public discussion group that provides a setting for sharing and making sense of psychedelic experiences and for exploring curiosity about these substances. Groups like this are often referred to as ‘integration groups,' or ‘integration circles,’ highlighting the final stage in a rite of passage: reintegration into society with a new phenomenological, affective, and cognitive subject positions (Turner, 1969). According to the Psychedelic Society, integration “describes how we can bring insights from a psychedelic experience into our lives at large” (The Psychedelic Society, n.d.). Integration is widely recognized as a process that takes place over time, facilitating cognitive and behavioral changes through meaning-making (Brennan & Belser, 2022; Earleywine, Low, Lau, & De Leo, 2022; Frymann, Whitney, Yaden, & Lipson, 2022; Katzman & Schwartz, 2024).
The need for integration is recognized in psychological scholarship, particularly in the context of ‘group therapy’ or in other therapeutic contexts (Bathje, Majeski, & Kudowor, 2022; Earleywine et al., 2022; Lewis et al., 2023; Trope et al., 2019). Considering psychotherapeutic models, Brennan and Belser (2022) contrast what they refer to as a basic support model, which includes minimal therapist intervention into integration processes, with models that include therapeutic approaches in addition to the immediate safe administration of substances. Frymann et al. (2022) advocate for the latter in their therapist-led EMBARK model, which combines attention to ethics, body awareness, mindfulness, relationships, affects, trauma-informed care, and cultural competence. They encourage multiple therapeutic integration sessions after taking psychedelic substances.
Other models of integration go beyond the psychotherapeutic context to consider the role of community-based groups, meditative practices, indigenous traditional knowledge, and other modalities in long-term integration processes (Urrutia et al., 2023). Urrutia et al. (2023) argue that combining psychedelic substances with “group psychosocial support” (2023, p. 530) has been a factor in improving mental health globally, pointing to Brazilian syncretic ayahuasca religions such as Santo Diame as an example. Because of the importance of local knowledge, they argue for policies and integration practices that recognize the role of indigenous and other communities in the effectiveness of psychedelics. The Psychedelic Society has also advocated and provided resources for community-based, peer support groups with the goal of creating “an inclusive, risk-reducing, and benefit-maximizing approach to advocacy, integration, and information” (Global Psychedelic Society, n.d.). Their website provides a handbook for creating community groups and a search tool for finding psychedelic community groups around the world.
This discussion of integration suggests that efficacy of psychedelic substances cannot be reduced either to the chemical itself (aligning with Zinberg's ‘drug’) or to the individual attitude and personality structure (Zinberg's ‘set’) in isolation from the ‘setting,’ or, “the influence of the physical and social setting in which the use occurs' (Zinberg, 1984, p. 5). “Setting” in Zinberg's triad is often conceived to include cultural frameworks in addition to the immediate social and physical settings in which people consume substances. My research into community integration groups cautions against an overly narrow conception of ‘setting,’ instead including a holistic context of peoples' everyday lives even well outside the immediate physical site of use. Furthermore, mindsets are not static ‘things’ people carry with them into psychedelic experiences. Rather, they are dynamic and fluid states in interaction with relational processes through which worldviews shift or become actively reinforced. I introduce the concept of ‘social efficacy’ to highlight the importance of these expanded constructs of set and setting in understanding relationships between psychedelics and their consumers. Social efficacy can be defined a source of efficacy that includes not just the immediate social environment in which psychedelics are experienced and processed, but also the broad range of social relationships and political economic and historical contexts that frame their use.
My more specific argument is that community-based peer-led integration groups can play a vital role in the positive integration of psychedelic experiences. The important role of community-based groups has significance for both the legalization and the medicalization of psychedelics in that for community-based groups to be effective, people need to have access to safe and legally protected environments. The importance of social relationships has implications for psychiatric models of efficacy, which often focus on the individual in isolation.
A description of the ethnographic method and context is provided in the next section, followed by key findings about the how psychedelic users processed their psychedelic experiences within the observed integration group. Following that is a discussion of social efficacy, considering the role of community in processes of psychedelic integration. Finally, the paper explores some of the implications these findings for medical and legal contexts.
Methods: ethnographic study of integration groups
The research conducted for this paper took place in an urban center in the Southeastern United States, where there are two integration groups with overlapping membership. The first integration group in the city was organized in 2019 through Meetup.com after the group's founder and facilitator, a Methodist pastor who is now also a practicing licensed professional counselor (LPC), had completed a clinical trial focusing on religious leaders at Johns Hopkins University.
The focus of this study is the second integration group in the city, which began in January 2023. I have been attending this group since its inception as an observer and conversational participant. The group was formed by a local therapist who started exploring psychedelic-assisted therapy with ketamine in his practice in 2022. In January 2023 he formed a weekly integration group that brought together a collection of his clients, friends, and associates. In his initial email about the group, he wrote that his intention was to form a community-based group that would be self-sustaining and not require the leadership of any one person. He wanted to create a space where people could meet with each other to engage in integration.
There were about 20 people at the first meeting, which was held in old stately Craftsman style home that was converted into an event center. The house is in a mixed residential and commercial pocket neighborhood in the city. It is a place that brings together people interested in various healing arts and political causes. The owner, who has remained active in the integration group, often tells people that he had always wanted to create a center of love and consciousness, and that he delights in holding events like yoga, ecstatic dance, political meetings, Sunday morning Love Circle, and now, since January 2023, the integration group. The attendees of the integration group were people who had been doing or were interested in psychedelics for personal growth and had been doing them in either therapeutic or naturalistic settings.
At our first meeting, the therapist presented his vision for it as a group that would be peer-led. He established his role as an equal member of the group and not as therapist-facilitator. Given that, he established guidelines encouraging people to seek emotional support outside of the group in case they are triggered by things that come up in the group sessions. He also asked people keep all that they hear confidential in order to protect everyone's safety and privacy. An additional request was that they address conflicts directly in the spirit of mature and open communication. The guidelines have been written out and continue to be read at the beginning of meetings when new people are present. He introduced a format that the group continues to maintain: It meets in person from 7–9 p.m. on Wednesdays, beginning with a short meditation, followed by numbering off and breaking into three different small groups throughout the evening, with 4–5 members in each group. At the beginning of the meeting, the group chooses three words or phrases to discuss as they relate to psychedelic experiences. Examples of words include suffering, compassion, expectation, resilience, validation, and realization. This format was based on the therapist's experience with group therapy at an eating disorder clinic. He explained to me that he chose the model because he noticed that smaller groups tended to facilitate deeper conversations as well as greater intimacy and connection between members. Breaking into multiple small groups throughout the evening allows people to make connections with more people.
At the end, the group comes back together in a circle to process the conversations with the full group. It often ends with a brief meditation. More recently, the group has decided to designate time in the beginning for people to share their ‘trip reports,’ or their personal accounts of recent psychedelic or mystical experiences they have had. They have also added an optional hour of breathwork and sound healing before the integration group begins.
The therapist continued to lead the group through early summer, when he decided to step down from that role for personal and professional reasons. There was a moment when no one was sure if the group would continue to meet, but some enthusiastic core members have kept it going based on a peer-led model. Various participants take turns setting it up and facilitating it. If the event center is booked on any given Wednesday night, participants have taken turns holding the meeting in their homes. Several factors contribute to the continuity of the group. For one, the group meets once per week, which is often enough to build bonds. Another reason is the stability and welcoming nature of this particular physical place, which is at once intimate and public.
Since the beginning, the integration group has been comprised of people with a variety of relationships with psychedelics. Some people have done or continue to do psychedelics in therapeutic contexts. Most people do or have done psychedelics in non-therapeutic, ‘naturalistic’ settings either by themselves or with other people that may or may not be involved in the integration group. Some attendees are learning about psychedelics and have not yet used them as an intentional tool for personal growth. People have used a variety of psychedelics, including LSD, 5-MeO-DMT, MDMA, and ketamine (both therapist-assisted and at ketamine infusion clinics), with psilocybin being the most common.
Since the integration group is not publicly advertised, it means that most new people show up by word of mouth – often from within the group, but sometimes from therapists in the community who practice ketamine-assisted therapy (which they do legally) and recognize their clients' needs for an integration community. Another source of new attendees is the Meetup group, which is publicly advertised (in contrast with the integration group, which is not), where people are invited to come to the Wednesday night group. Anywhere between 15 and 25 people continue to show up on any given Wednesday.
As for a population profile, while participants were never formally asked to report their demographic information, some information was revealed through interactions with participants. Most of the participants are of European descent, in addition to some who identify as ethnically African American, Latinx, and Asian. The majority are lower income to middle class in origin. The participants range in age from mid-20s to late 70s. In general, the majority identify as male (use he/him pronouns) or female (using she/her pronouns), with some identifying as gender non-conforming. Most were raised Christian, many in the Evangelical tradition. As a White woman who was raised Protestant (though not Evangelical), I was a cultural insider in the group.
At the beginning of every meeting, I shared my role as an anthropologist and passed out an IRB-approved information sheet, making it clear that their stories about the role of the integration group were confidential, and that I would not use their stories unless they had given their permission. My main source of information came by listening to people during the integration group meetings. In addition to this, I wanted to get people's direct responses as to what role the integration group played for them in processing their psychedelic experiences. In order to do this, I asked participants one evening if we could change the format so that I could hold a recorded focus group, asking them to reflect on the role of the group in their psychedelic integration.
In the focus group, I asked them to share a brief history of their use of psychedelics and to share positive and challenging experiences they had with the group. I asked them to specify stories about how the group had helped them process psychedelic experiences. My goal was to identify their perception of the value of the integration group in processing their psychedelic integration. That evening's circle, in which 18 people attended, was full of rich and heartfelt sharing that not only reinforced for me the importance of the group for psychedelic integration, but also strengthened and highlighted the group's bond. After that group session, one participant said that her partner shared with her that “this group may be the most impactful thing he will ever be part of in his life” (text October 19, 2023). The qualitative analysis in this paper is based primarily on the focus group research that was conducted, but it is enriched by information I have gathered both in interviews and ethnographically as a participant in the group. All participants gave oral consent, as specified in the Internal Review Board protocol. I clarified that I would change their names when sharing their stories with the public.
Results: stories of psychedelic integration
Processing psychedelic experiences
Many people reported that the group helped them process (and integrate) their psychedelic experiences. Several said that they learn new things about their journeys (psychedelic experiences are often referred to as ‘trips’ or, more commonly in this group, as ‘journeys’) by sharing it with others. Eric, a White man, veteran, and one of the de facto leaders of the group, talked about processing a particularly challenging journey with the group. He had taken a large dose of psilocybin with a friend. He said: “Through the group, I learned that it’s OK to be angry. And it's OK to walk away from that because I can choose to. I can choose to walk away from anger.” I have heard him emphasize since then that without the integration group, he would not have come to realize that as an important take-away from his otherwise challenging psychedelic journey.
Molly, a quiet woman with an infectious laugh and loyal presence, explained that, after having abstained from all psychoactive substances while growing up, she has taken psilocybin for therapeutic and spiritual reasons in the past year by herself or with trusted ‘sitters’ (a sitter is someone who remains present with someone during a psychedelic experience and may coach them through challenging experiences). As a result, she feels she has opened up and become “the captain of her life.” She now feels like she is in charge. She explained in the focus group: “Having experiences is amazing and profound; sharing it out loud with other people takes it to another level of acknowledging it to yourself.” I have heard her express in integration group meetings that doing psychedelics and sharing her experiences with the group made her feel more social overall, allowing her to come out of her shell and feel like she has a rich social life both within and outside of the group.
A particularly powerful story is that of Jamie, a single White mother of two elementary school age children who grew up in poverty in the post-coal Appalachian foothills in Alabama, surrounded by addiction, abuse, and neglect. She had done ketamine-assisted psychotherapy in late 2022, which is how she learned of the group. She had her first psilocybin journey in a group context in Spring 2023. I know from interviews as well as being with her in small groups on Wednesday nights how profoundly these experiences have shaped her life. What she shared with the focus group is that “the group has affected me and helped me continue that search and conquest” for self-growth and spirituality and acceptance. “To have a hope that those things don't always have to exist within myself because there are people and places where I'm accepted and I'm loved as well as I love and accept.” She explained: “This group has been a positive for me; it's helped me to love myself and to love other people again.” She also stated: “Within this group, it branches out into the world and I feel like that's the seeds that I want to always plant and they've kind of derived from continuing to come here and being fed each week.”
Another remarkable story is that of Kate, a White woman and a former megachurch pastor. She experienced major life transformations in the past three years, including the birth of two children, severe postpartum depression, moving to a new city, and the loss of her lifelong Evangelical faith. She shared in the focus group that she had had anxiety and depressive disorders “like real real bad, like panic attacks on the floor while my 2 year old is trying to dry my tears every day.” She started looking into psychedelics and did ketamine-assisted psychotherapy. Her therapist recommended our group to her. I still remember her first time to the group: She seemed withdrawn and sad. She looked down and seemed afraid to speak. She did share bits of her profound story, though, in a way that moved us all. I remember saying to her after our group that I imagined it took a lot of courage to come to our meeting, and she acknowledged that yes, it had. She said in the focus group that when she first came to our group she felt “so so low” and without purpose or hope. After her first meeting, she told her girlfriend that the group felt like “all the good stuff of what we love about the church without any of the yucky stuff.” She talked about the role of the group: She saw others in the group who had had transformations and said she had “just like the slimmest hope that that could be me. And it was enough to keep me coming back. I just needed people so bad.” By the time of the focus group, several months later, she had experienced a profound solo psilocybin experience in a naturalistic setting with a sitter, and her transformation was overwhelming and obvious to those who know her. Since then, she not only tells of the positive effects of the experience, but she also radiates joy through her warm smile and spirited interactions.
Richard, a White man in a 20-year marriage with three children explained that he had struggled with chronic pain and fatigue for most of his adult life. That, combined with a profound sense of disconnection in interpersonal relationships, including with his wife and children. At some point, he was diagnosed with autism, which was a relief to him, since it explained so much of the awkwardness he had felt all his life. He found no relief from any of his struggles – mental or physical – through mainstream medical (including psychiatric) modalities. He felt called by psychedelics and had had 5 or 6 profound psychedelic experiences over the past year at the time of the focus group. He explained that he felt much better and believed his neural pathways were being re-wired. As for the role of the group, he was emotional. He said in the focus group that he finally has felt socially connected. He said he had had a ‘profound revelation’ that very day, and the group helped him realize that his relationship needs get met in collective experiences, like in this group. He said: “My social interaction needs are met in the collective, and the reason I believe that I was depressed when I moved from [one city to another] is all of my collective connections disappeared for eight years until I came to this group.” At one point, Richard was driving 4 h each way just to attend the integration group. He currently drives 2 h each way.
The focus group affirmed the importance of the integration group in helping the participants articulate and share how psychedelics helped process both emotional and social challenges. The group helped Eric find meaning in a challenging psychedelic experience. For Molly, articulating her realizations to a group made them feel more powerful and impactful. Kate found group participants to be role models. Jamie and Richard found that the group made them feel accepted and connected, thereby intensifying the positive experiences they had had with psychedelics.
Value of community
In addition to the benefit of allowing for the integration and sharing of psychedelic experiences, the value of community itself was a major draw for many participants in the group. Jim, White man in his early 60s who also leads the breathwork sessions before integration group, explained that: “I was on a really solitary journey.” He originally came just to lead the breathwork. Then he decided to stay for a few minutes one time. “I really liked it, and I haven't missed. I don't know how long I've been doing this, but I haven't missed one since [I started coming].… I get a lot out of it.” He continues to lead the optional breathwork session before the integration group.
Jack, a retired man in his late 70s, said that psychedelics have helped him deepen relationships in his life. He appreciates being in a group of caring people where the exchanges are meaningful. These experiences have helped him open up in new friendships as well, as evidenced by a three-hour conversation he described having with a neighbor, who he invited to integration group. Jack said he doesn't think he would have gone that deep into conversation with anybody that he just met without psychedelics and the group conversations that opened him up to introspection. Throughout the months of integration group meetings, Jack has talked about the benefits of psychedelic experiences for deepening his commitment to his wife of about 30 years (who also attends the integration group) and healing some of the regret and distance he has felt with his adult children from a previous marriage. He states emphatically, however, that psychedelics are tools and the integration afterward is the real work of lasting effects.
“I entered the group at a pretty happy time in my life when things were going extremely well and seemed to be falling into place. It was extremely fortuitous that when things fell apart, I already had this network of people I could confide in, trust, commiserate, and have the depth of understanding that only groups of people who have been through trauma and profound adversity have…. it feels more like a family than a support group. And that’s really what community is…. It’s your chosen family… we’ve chosen to walk hand in hand with each other through life.”
The enjoyment of community is something regular attendees talk about increasingly with each other, as the group's bonds continue to solidify. Natasha first started coming to the integration group after she had had a frightening and challenging psychedelic experience. Finding an accepting place where she could share this challenge is what made her keep coming back to the group. Aside from this challenge, her broader life experiences (family, relationships, work) had been going generally well. At some point, she started feeling tension in her personal life, and, as she explained in the email, the integration group community was an important bond that helped her cope with that. The value of the group went far beyond simply integrating psychedelic experiences, and this was an observation shared by many in the group.
Discussion: social efficacy, world view & community
Social efficacy: embedded practices
Psychedelic efficacy is measured in different ways. Within a hegemonic biomedical framework, it lies primarily and most reliably within the context of evidence-based trials (Anderson et al., 2021; Muttoni, Ardissino, & John, 2019). In critically examining this medical model, Dumit and Sanabria (2022) challenge the ability of randomized controlled trials (RCT) to produce standardized, universal efficacy, considering its focus on decontextualized individuals as well as its exclusionary, colonial practices of knowledge production and financial gain. RCTs tend to reduce efficacy to the decontextualized molecule. A shortcoming of clinical trials is the difficulty of replicating the effects in non-clinical contexts, with different populations with different mindsets and settings. Langlitz (2023) called attention to “the peculiar cultural plasticity of the drugs' psychotropic effects” (3), as psychedelic experiences are context-dependent and easily affected by and setting (Noorani, 2021; Schleim, 2022). A concern of Noorani, Bedi, and Muthukumaraswamy (2023) is that “the proliferation of psychedelic [randomized control tests] that are currently underway is that they will achieve little for understanding the complex chemosocial properties of psychedelic interventions” (p. 8). Humanities perspectives are important in psychedelic research because of their ability to encourage dialog, to ask difficult questions and interrogate basic assumptions about phenomena such as efficacy (González Romero, 2023). Langlitz (2023) argued that philosophical consideration of epistemologies in the humanities can help “sharpen the sense of possibility and expand the imagination of the psychedelic renaissance” (p. 3).
As critics of the RCT model, Dumit and Sanabria (2022) call out the ‘magic bullet’ ideology that places the context-free pharmaceutical agent as a simple determining factor of efficacy, ignoring set, setting, and the potency of the placebo effect. Hendy (2022) traces discussions of chemical versus self-efficacy, the latter of which is not a simple biochemical process, but rather emanates from an interaction between the chemical and the psychological self, often mediated by therapeutic encounters, with the implication that the chemical will act differently on different individuals based on their psychological makeup. These competing definitions of efficacy have political implications for access to substances: if it is the chemical in isolation that is effective, that affects the development of pharmaceuticals, tying them to gate-keeping institutions regulating and setting policies for who is legally allowed to administer them. Debates about efficacy include whether or not subjective effects, such as self-reported mystical-type experiences, produce enduring beneficial effects (Brennan & Belser, 2022; Yaden & Griffiths, 2021) or whether the chemical effects are more important than subjective mystical experiences for treating neuropsychiatric diseases (Olson, 2021).
What cannot be ignored in these important conversations is that what is termed self-efficacy occurs with social relational spheres. The term ‘social efficacy’ captures this dynamic. Social efficacy refers on the one hand to the immediate social environment in which psychedelics are experienced and processed, which includes such factors as whether people are taking psychedelics alone or with other people, whether and how people engage with each other during the experience if others are present, whether there is a therapist or a designated ‘sitter’ present, etc. On the other hand, consideration of social efficacy also requires attention to social relationships outside of the immediate psychedelic event, including friends, family, mental health and other healthcare professionals, and co-workers, for example, who may or may not recognize taking psychedelics as legitimate. It also includes the political, economic, legal and historical contexts that frame their use. Hendy (2022) writes that “efficacy is a historically and socially embedded category and practice” (p. 322). In addition to the immediate social communities within which consumers internalize and process their experiences, social efficacy includes multiple facets, including political, economic, and historical contexts. Blevins (2023) has argued through a critical phenomenological lens that psychedelic experiences are intersubjectively mediated in reference to racial, colonial, gendered, and other embodied frameworks. Because of this, culturally-informed care is critical for creating and maintaining safe and inclusive spaces.
In this case, the Southeastern United States provides a distinctive context for psychedelic exploration, considering political hesitance to legalize psychoactive substances for recreational use and overall religious, political, and social conservativism. In my research, the Whiteness of the many of the participants has shaped their relationship with the substance, allowing them to feel safer. White people are more likely to take psychedelics in the United States (George, Michaels, Sevelius, & Williams, 2019), feel more comfortable talking about psychedelics in open conversations, and have statistically less risk of negative legal repercussions for discussing illegal substances because of histories of systemic racism and the punitive policies of the War on Drugs. These factors combined also make it easier for White-identifying people to participate in integration groups. Whatever their ethnicity, people in the integration group are processing psychedelic experiences in a conservative religious and political setting where group integration and the social affirmation it provides may be particularly important, given the broader context of suspicion of psychedelics.
“this group has been really, really beautiful because it answered a question from me that I've been asking for a long time, which is do people change. And they do, because I've seen it. I've seen it first-hand. Multiple people.” I’ve seen people who “went from having no journeys to having their first journey to coming back and telling us about it. And you can see the difference…[in the way] they talk the way they're open and it's like just the most powerful thing I've ever seen.”
Overall, the participants in the integration group see their participation in the group as critical to the efficacy of their psychedelic experiences. As discussed above, the social component of psychedelic use comprises the immediate context of consumption as well as the broader social and historical contexts of use. A consideration of only the chemical, or only the chemical plus an individualistic psychological process as mediated by a therapist, misses a critical component of psychedelics' efficacy. The concept of social efficacy was introduced here to underscore the necessity of considering extra/non-therapeutic social contexts when analyzing mechanisms for the effectiveness of psychedelics.
The next section develops a related aspect: a general consideration of the broader communities in which people live on a day-to-day basis and the role of the integration group for connecting their psychedelic experiences to their everyday life.
Community and integration
Even if users attend retreats far from home, and even if their therapeutic uses of psychedelics include integration sessions in therapeutic contexts, users still return to their daily life, where the people around them may not recognize psychedelic use as acceptable or comprehensible. Many participants say that the Wednesday night integration group is the only place they can process these profound experiences or just be present with people who find the psychedelic healing and growth journey an ordinary part of life.
Those who attend the integration group have been able to talk about their psychedelic experiences in a non-judgmental and non-transactional context with peers. This leads not only to processing psychedelic experiences, but also to the formation of deeply bonded communities that in turn contribute to and reinforce the processing. Joan, a retired therapist who exudes wisdom, stated that “what makes this group so special is that we … are really speaking from our heart. And it's all about just love and appreciation for each other's story and what we're going through. It's such an appreciation.” She continued: “I have never felt loved as deeply as I have with this group hearing everybody's journeys and struggles.” Similarly, Jamie shared: “This group feeds me” because of the meaningful connections. “It invites us to come here into our hearts. It recharges our batteries and it's just wonderful…. We don't have to be the same: we are like minded but not all the same.”
During the focus group, I found myself at first nudging people to talk about how the group helped them with specific psychedelic integration issues. While some people talked about that explicitly, others were just as if not more interested in articulating the value of their connection to the community within the integration group. Identifying the importance of community makes it hard to discern where effectiveness lies: in the psychedelics themselves or in the fact of having community. But it may not be an either-or answer: A sense of connectedness to others is a common factor in many forms of social wellbeing (Waldinger & Schulz, 2023), which helps explain why the benefits of psychedelics are enhanced by their integration into nontherapeutic everyday life. Not all people feel safe in all communities for a variety of reasons, including legal exclusions and other forms of social exclusiveness. This is especially important for people in marginalized communities, who may not feel socially and legally safe joining or creating integration groups.
To compartmentalize the process of integration as existing merely within interpersonal encounters immediately following the psychedelic experience (often transactional mental health therapy) is to ignore the way that integration processes spread in barely perceptible ways into domains of everyday encounters. The long-term nature of integration as a process is recognized in both scholarly literature and in the practices of many psychedelic integration groups across a broad geographic space. In their research with integration facilitators, for example, Earleywine et al. (2022) found that the majority of respondents described integration as “an ongoing process that never ends” (p. 7). Theoretical understandings of integrative experiences are strengthened by recognizing that integration extends deep into non-therapeutic contexts of everyday life.
Cognition and world view in localized contexts
Shared psychedelic integration experiences create a container for cognitive and affective transformation. Integration creates a space for expressing in language experiences that otherwise defy words. Gashi, Sandberg, and Pedersen (2021) wrote about the ways that acts of storytelling transformed challenging experiences into valuable ones for their Norwegian interlocutors. These stories performed social work of designating cultural insiders and outsiders, and they also helped people develop a framework for comprehending and working with challenging experiences while on psychedelics. They established competences (dosing, for example) and sets of rules to be followed to avoid ‘bad trips,’ such as attention to set and setting. Stories established a logic for describing and transformation of challenging experiences as positive.
Mechanisms for transformations in ways of knowing through psychedelics have been written about in compelling ways. David Dupuis (2022) wrote about processes of socialization into psychedelic ways of noticing, feeling, and being (cognition and affect) based on ethnography at a Peruvian ayahuasca retreat center. He called attention to the ways that already-initiated people talked to novices in ways that influenced ways that they categorized perceptions and shaped their emotions and expectations. Dupuis and Veissière (2022) point out that psychedelics enhanced suggestibility and openness to new ideas. In other words, “psychedelic drugs are both responsive to and enhancers of placebo effects” (Dupuis and Veissière, p. 573). Due in part to increased suggestibility, psychedelic rituals reinforce social group membership and shape transformed ways of understanding (Dupuis, 2022).
Tempone-Wiltshire and Matthews (2023) discussed the possibilities of psychedelics to challenge hegemonic worldviews by inviting perceptions that “challenge the paradigmatic assumptions of industrial society by provoking alternative epistemologies and metaphysics” (p. 238). Falcon (2021) similarly argued that psychedelic experiences can be a catalyst for ontological and decolonial reorientation toward a human and environmental interrelatedness that rejects oppressive power imbalances. Others caution against romanticizing the inevitability of inclusive, anti-authoritarian and pro-environmental thinking as a result of psychedelic use. They point out that shifts toward authoritarian and hierarchy-based thinking are just as possible (Pace & Devenot, 2021). The point here is that psychedelic experiences are often catalysts for transformed ontological and epistemological frames.
Psychedelic-related cognitive shifts in the Wednesday night integration group occur around a number of topics, with religion being a common theme. During their time with the integration group, many of the participants explored new ways of framing religious traditions and experiences they were raised with. In the focus group, for example, without having been asked to discuss religion or spirituality, Jamie talked about her experiences growing up within an Evangelical church: She recalled that church always focused on doing the right thing, but never connected to the trauma she experienced outside of church. “As I got older, I was going [to church] because it was a place of community and there was a goodness there. But I realized that it wasn't the pureness that I was seeking from the body of Christ and from the father of the Son and the Holy Spirit. Spirit didn't exist in that building or any of the buildings…. I didn't have it within my family. I didn't have it within my marriage.” In the group, she experienced some of what she termed the ‘pureness’ that she had always thought church should be. The integration group helped her both conceptualize and experience a different kind of spiritual connection.
One participant talked about wanting to deepen his spirituality by viscerally connecting with Christian principles of the ‘body of Christ’ and ‘communion.’ Another talked about always wanting to find spirituality within the Christian religion he was raised with and how psychedelics have helped him get there. Even Kate, who lost the Evangelical faith that had been the cornerstone of her life, hadn't rejected the idea of God but only expanded her idea of what and who God is. As they discuss past and present experiences with religion and spirituality, people in the integration group mutually enhance and reconstruct spiritual awareness. People often find a renewed interest in the religion they were raised with, and it is often blended with more universalistic, ecumenical, and New Age understandings and experiences. These opportunities for transformation occur both through dialogue with fellow participants and experientially during the short meditative sessions before and after the conversations, and, if they choose to participate, in the breathwork sessions that take place before the integration group.
Discussing and reframing religious and spiritual experiences is a common, unsolicited theme in the Wednesday evening integration group. The focus on religion and spirituality in conjunction with psychedelics is not unique for the Wednesday night integration group. Several studies point to mystical, spiritual experiences as an integral part of psychedelics (Griffiths et al., 2019; McCarthy, 2023; Mosurinjohn et al., 2023). The Journal of the American Medical Association for Psychiatry recently called for increased attention to spirituality and existential questions because of “mounting evidence supporting their mediating role in psychedelic-induced therapeutic change” (Palitsky et al., 2023: 743).
Significance and implications
Medicalization and social efficacy
Scholars and activists identify social support as critical after psychedelic experiences (Lutkajtis & Evans, 2023). This is often discussed in the context either of indigenous practices or as part of professional therapy, either group or individual, in a fee-for-service model. Much less is said about the role of localized social networks in non-indigenous contexts. In this context, local is either based in geographic proximity or in chosen communities of users brought together through communication technology, such as the internet.
The Wednesday night integration group provides a context for developing localized cultural understandings of how psychedelics work (which kinds of substances have what effects, etc.), shaping ideas about what happens during psychedelic journeys and ideal settings (including music choices), managing risk (the role of ‘sitters,’ for example), how to interpret both positive and challenging experiences, etc. Challenging experiences, those that might be framed as ‘bad trips’ by some, are reframed in the integration group as paths to learning what one needs to know to grow. This is in keeping with mainstream psychedelic constructions of negative experiences, as documented by Gashi et al. (2021), on practitioners' websites, in popular media by such figures as Joe Rogan and Hamilton Morris, and in popular websites such as Vice (for example, Santos, 2022). This is also in keeping with online survey research that found that while 39% of the nearly 2000 respondents found their worst trip to be among the top 5% of difficult experiences in their life, 84% of all respondents reported benefitting from challenging experiences (Carbonaro et al., 2016).
While tapping into broader global and national cultural concepts, psychedelic worldviews also take on local subcultural attunement (Hartogsohn, 2022), resulting in grassroots harm reduction. In an online survey of psychedelic users in naturalistic settings, Kruger, Enghoff, Herberholz, Barron, and Boehnke (2023) found that many people sought information but mistrusted information from government agencies and pharmaceutical companies. Over half got information from internet websites and online discussion forums, books and peer-reviewed articles, and friends. Studies have shown that effective harm reduction occurs at the grassroots level (Hardon et al., 2020), based at least in part on community- and peer-based and sometimes online (Barratt, Allen, & Lenton, 2014) groups who generate norms and practices supporting self-regulation, prevention, and intervention in case of harm. This is in contrast with top-down medical information, as well as prohibition-oriented regulatory frameworks that increase the risk of harmful use (Harder, Steinmetz, & Kohek, 2023).
“Any shift to the scale of plant causality—where the healing is caused by something larger in complexity and order than a chemical, and instead involves a subjectively palpable sentience—not only challenges our outdated prohibition laws, but also renders obsolete our past-due paradigms of materialist reductionism and mechanism” (482)
Social connections bind people within particular socioeconomic, political contexts. In my research, the work of the Wednesday night integration group was connected to the refuge people seek in each other in a cultural context where such experiences are not in the mainstream and may not be accepted. An important part of the efficacy of psychedelics in this context is socially grounded in people's relationships with each other through the group. Chemicals, cognition, individual biopsychological makeup, and relationships with people come together to form psychedelic subjects and communities. The recognition of social efficacy is critical to discussions of medicalization and questions of accessibility. It has implications for legalization and for safe protocols for dispensing these substances when and if they are legalized.
Need for safe, legal spaces
An implication of social efficacy is the need for safe, legal, and affordable spaces to talk about psychedelic experiences in therapeutic as well as in non-therapeutic spaces. Barriers to therapeutic spaces are partly financial and logistical (Williams & Labate, 2020). Therapy is cost-prohibitive, even for people with financial means, and integration groups may be hard to locate outside of dense urban areas. Another significant barrier is legal, borne out of histories of racist policing and uneven enforcement of drug policies that create a formidable barrier to intentional, community-based conversations for people of color. As George et al. (2019) point out, histories of exclusion, marginalization and appropriation surround access, legal risk, medical and financial inclusion, and stigma. Exclusions include both indigenous appropriations and racial injustices that result in unequal access (Hauskeller et al., 2023; Williams, Romero, Braunstein, & Brant, 2022). To change this, George et al. (2019) present practical recommendations, such as meaningful (not tokenized) collaborations between researchers and communities. They also propose a cultural shift in how we conceptualize the ways in which structures of power permeate psychedelic policies and studies.
There is also a need for safe and legal community-based spaces because people spend most of their time in relationships outside of therapeutic encounters, and that is where much of the integration occurs. In a global online survey of ayahuasca users, Cowley-Court et al. (2023, p. 217) found the role of community to be just as if not more important than psychotherapy. Furthermore, they found that, for members of ayahuasca churches, there was less to integrate and therefore less risk of crisis for those who were in communities where ayahuasca played a central role and was considered a normal experience. They wrote that “church members were also less likely to describe integration as challenging, which may be due, in part, to having an ongoing community of practice to share experiences with” (p. 217). In a similar way, the Wednesday night integration group serves as a community of practice that reduces risk of harm for users. Normalizing conversation around psychedelics—shifting the culture of stigma toward acceptance—is harm reduction and makes the community-based integration group akin to indigenous models of use where taking psychedelics is a normative activity.
To promote access to safe and legal spaces, there are many initiatives nationally and internationally to decriminalize and otherwise protect people from legal risk. A local therapist who has led the advocacy move to decriminalize psychedelics in our city told me that she is motivated by the recognition that people of color do not feel comfortable meeting in groups like the integration group at the heart of this study for fear of legal repercussions. She recognizes the need for safe spaces for people of color to meet in a similar way as the Wednesday night integration group, which is mostly White. She has spearheaded an advocacy campaign to both educate and create legal protections.
Conclusion
Psychedelic subjects are relational, not decontextualized individuals. Recognizing social efficacy is important theoretically, as it helps explain drug effects of psychedelics. It is also important practically, as it provides a pathway toward their ethical, equitable, and safe use. It illuminates immediate contexts of use as well as issues of social injustice that make access to safe use less obtainable for some. Recognizing social efficacy opens the door for decolonizing psychedelic science and including stakeholders in all aspects of research and implementation of programs (Fotiou, 2019; Earp & Yaden, 2021; Keel, 2022). Combining theory and practice, or what is sometimes called ‘praxis,’ “emanates from the interlocking imperatives of intellectual efficacy and social responsibility” (Harrison et al., 2016). Praxis includes intellectual grounding, sound ethics, and socially responsible work through dialogue and partnerships in the pursuit of doing some good (Kozaitis, 2000). This study of an integration group has supported assertions of the importance of peer-led, community-based opportunities for the efficacy of psychedelics. Making integration groups more socially accessible and more integrated into medical understandings of efficacy increases the potential of psychedelics for improving mental health and quality of life for users.
Funding sources
No funds were used for this research.
Conflict of interest
There are no conflicts of interest.
Acknowledgements
I would like to thank the participants in the integration group, who have graciously included me. I also thank the therapist who got the group started, all the local therapists who support this work, and the owner of the venue where we meet each week. Finally, I want to thank my academic community at UAB for welcoming this research.
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