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ORIGINAL ARTICLE
Use of tobacco purge in a therapeutic
community for the treatment of substance use
disorders
tereza rumlerov
a
Department of Psychology, Palacky University
tereza.rumlerova01@upol.cz
eric kube
Independent Researcher
eric.kube@coloradocollege.edu
nahuel simonet
Independent Researcher
simonetn@bluewin.ch
fabio friso
Center for Drug Addiction Treatment and
Research on Traditional Medicines –Takiwasi
comunicaciones@takiwasi.com
matteo politi
Center for Drug Addiction Treatment and
Research on Traditional Medicines –Takiwasi
Department of Pharmacy, University of
Chieti-Pescara
matteo.politi@takiwasi.com
Anthropology of Consciousness, Vol. 0, Issue 0, pp. 1–28, ISSN 1053-4202, Ó2022 American
Anthropological Association.
DOI: 10.1111/anoc.12169
1
abstract
In the Peruvian Amazon, tobacco (Nicotiana rustica) is considered a master
plant and is the main curing tool of local healers. Among its several medicinal
uses, we find drinking tobacco juice with the purpose of purging in order to
heal on a physical, mental, and spiritual level. This specific practice is part of
the addiction treatment protocol developed at Takiwasi Center. The goal of
this investigation was to focus on the effects of the tobacco purge as reported
by therapists at Takiwasi and to elaborate its relevance within the context of
addiction treatment. In order to obtain information on this topic, we performed
research fieldwork based on a participant-observation approach, and
retrospective data analysis on information from interviews conducted by
psychotherapists with patients. As alleged effects of the tobacco purge,
therapists reported that patients experienced feelings of mental clarity with the
greatest frequency (n =80), followed by noteworthy physical effects including
discomfort and intoxication (n =63). An effect on sleep and dreams was also
common (n =36) and many found the experience directly related to addiction
treatment and the desire to consume substances (n =20).
keywords: Tobacco, teacher plants, purge, substance use disorders, traditional
Amazonian medicine
Tobacco as master plant
The species of tobacco primarily used in the Peruvian Amazon for medicinal
purposes is Nicotiana rustica L. (Wilbert 1993); it may perhaps be considered
the most sacred plant of the Americas (Godlaski 2012) and it is well known
in the Amazon as a potent hallucinogen and medicine (Narby and Chan-
chari Pizuri 2021).
Tobacco is considered to be the first regularly cultivated plant in the Amer-
icas, having been cultivated for six to eight thousand years according to some
studies (Dickson 1954; Wilbert 1993; Kelner 2015). Over sixty species of Nico-
tiana have been documented (Charlton 2004), two of which are currently
cultivated: Nicotiana tabacum, also known as commercial tobacco and used
to produce cigarettes; and Nicotiana rustica, richer in narcotic properties
(Godlaski 2012) and a central plant in traditional Amerindian medicine (Wil-
bert 1993). The species of tobacco used in Amazonian shamanism is gener-
ally thought to be N. rustica, however this claim has not been precisely
verified, and some publications claim N. tabacum as the species primarily in
use (Fotiou 2017).
Tobacco occupies a central role in the shamanistic practices of Indigenous
people of lowland South America, who consider it to be a master plant and
their main curing tool (Goodman 1993; Russell and Rahman 2015; Barbira-
Freedman 2015). Amongst the Quechua-Lamista ethnic group, for example,
2 anthropology of consciousness 0.0
tobacco is considered to belong to the male cosmological domain and is cap-
able of enhancing the effects of all other shamanic plants (Barbira-
Freedman 2010). For this reason, it is also known as the “father of all plants”
(Barbira-Freedman 2010), “king of all plants”(Luna 1984a), and the “chief
medicinal plant”(Berlowitz et al. 2020a).
When Columbus arrived on the continent in 1492, he and his group
observed that Native Americans were growing and using tobacco for several
purposes, including for the treatment of various illnesses (Charlton 2004).
When the plant was brought to Europe and popularized as being able to
treat a wide range of conditions, it acquired a reputation as a panacea and
was thereafter called the “holy herb”and “God’s remedy”(Dickson 1954).
A wide range of methods of tobacco use in South America have been doc-
umented. These practices include drinking tobacco juice, chewing, licking,
enemas, cataplasms, baths, drops, snuffing, and smoking (Luna 1984a; Wil-
bert 1993). Other universal notions of tobacco use across the Amazon region
include the blowing of tobacco smoke (for protection and energetic cleans-
ing) and its use as food for the shaman (Wilbert 1993). Ingestion of tobacco
smoke symbolizes the assimilation of its strength or energy, which is often
described as spirit. This concept is present throughout the Americas in rela-
tion to the use or consumption of other psychoactive plants also considered
either master plants or sacred, such as the entheogenic mushroom teo-
nan
acatl,or“flesh of the gods”(Furst 1972), consumed by the Aztec (Schul-
tes and Hofmann 1979). Among the Ashaninka ethnic group, moreover,
healers specialized in the use of tobacco are given the title of sheripiari,
which literally means “the one intoxicated by tobacco,”and among the
Yuracar
e people, the word korr€
e-n-chata, used to refer to a healer, can be
translated as “he who eats tobacco”(Berlowitz et al. 2020a). This linguistic
architecture helps illustrate tobacco’s importance as nourishment for both
the body and the soul.
Another concept common among several Indigenous groups in different
regions of the Amazon is ingestion of tobacco to contact the spirit world and
to fight against evil spirits and sorcerers (Wilbert 1993). Indigenous peoples
believe tobacco can be offered to bad spirits to “appease”them, and addition-
ally that tobacco smoke “feeds the spirits”(Chaumeil 1998), attracts good
spirits, repels evil ones (Barcelos-Nieto 2006), and cleanses the body of nega-
tive energies (Jauregui et al. 2011).
Tobacco is a powerful ally of the traditional healer for its anti-pain, anti-
fatigue, and appetite suppressant characteristics, as well as for the strength
and protection it provides. Tobacco is considered to be at the same time the
most powerful plant medicine (Jauregui et al. 2011), as well as the most diffi-
cult to master. Within the realm of Peruvian Amazonian Vegetalistas (plant
experts) (Luna 1986), there are different specializations that correspond to the
tobacco purge in the treatment of addiction 3
level of mastery over each individual plant species. Tobacco specialists are
generally known as tabaqueros, whereas ayahuasqueros are specialists in the
use of ayahuasca and perfumeros are specialists in the use of perfumes and
aromatic plants (Luna 1984b; Beyer 2009; Jauregui et al. 2011). In mestizo
shamanism, it is possible to identify the caliber of a healer by his or her level
of mastery of certain healing practices: a curandero is usually considered to
be a fully initiated healer, a banco is "a healer of the greatest power and
repute" (Beyer 2009), and a curioso is only a partial expert in certain tradi-
tional therapeutic practices.
Tobacco: a poison or a remedy?
Within scientific literature, tobacco is mainly mentioned for its harmful
effects, most notably for containing addictive and carcinogenic agents (Jethwa
and Khariwala 2017; Prochaska and Benowitz 2019). Conversely, very little
space is dedicated to the fact that, first and foremost, tobacco is a medicinal
plant with a long history of use within the tradition of herbal medicine in
the Americas. The harmfulness of tobacco, accordingly, can be traced to the
incorrect use of this powerful plant. As mentioned elsewhere, “...the plant
itself is not toxic. Toxic (or intoxicated) are the people who use it wrongly and
put themselves at risk”(Politi et al. 2019); this applies not only to tobacco but
also to other similar medicinal plants that can turn from therapeutic tools
into harmful agents depending on the context of their use. This is a general
principle of medicine that was already well known in ancient Greece where,
for example, the very same word pharmakon means both remedy and poison
simultaneously. We could say, consequently, that the tobacco plant itself is
not harmful, but that knowing how to use it is crucial precisely because it is
so powerful.
Proper use of a medicinal plant is essential and starts with the acquisition
of the plant material and is followed by its processing. On one hand, the sci-
entific community is still in debate regarding the potential harmfulness inher-
ent in the methods of producing and processing industrial tobacco (Arcury
and Quandt 2006; Paumgartten et al. 2017); on the other hand, within cer-
tain traditional contexts, including those of the Peruvian Amazon (Tresca
et al. 2020), it is clear that the methods implemented for collecting, process-
ing, and transforming a plant into a benign (and not harmful) product are
fundamental steps in obtaining a remedy of good quality, safety, and efficacy.
The modern industrialized approach to producing and processing tobacco is
certainly not in line with the traditional methods used for preparing an her-
bal medicine, at least in the Peruvian Amazonian tradition (Tresca
et al. 2020), so the issue of elucidating the plant’s true biological character is
further complicated by these cultural differences in the production process.
4 anthropology of consciousness 0.0
This issue notwithstanding, certain therapeutic potential is indeed recog-
nized within the scientific literature, in which tobacco’s main alkaloid, nico-
tine, is known to possess anthelmintic, antibacterial, and antiviral properties,
and is also recognized as an anti-parkinsonian agent (Ma et al. 2017). Nico-
tine also exerts analgesic properties (Benowitz 2008; Ditre et al. 2016), which
might explain the shaman’s reported insensitivity to heat and pain (Wil-
bert 1993). The potential of nicotine in the treatment of Alzheimer’s disease
has also been reported (Newhouse et al. 2001; Quik et al. 2008). Further-
more, nicotine contained in tobacco improves concentration, memory and
cognitive performance, short-term memorization, reflexes, and the sense of
direction (Rusted 1994; Newhouse et al. 2012; Valentine and Sofuoglu 2018;
Jasinska et al. 2014). The broad range of effects of tobacco and nicotine cer-
tainly warrants further investigation.
Traditional herbal Amazonian medicine in the treatment of drug addiction
Located on the outskirts of the city of Tarapoto, in the Amazonian basin of
Peru, the therapeutic community Takiwasi Center combines the use of psy-
chotherapy and medicinal plants for the treatment of mental health and,
more specifically, addiction (Berlowitz et al. 2018). Takiwasi was founded in
1992 by French physician Jacques Mabit in collaboration with a group of
therapists, including Western-trained psychologists as well as Peruvian medi-
cal doctor Rosa Giove. Dr. Giove, wife of Jacques and physician responsible
for the biomedical follow-up of Takiwasi’s patients, attended to patients at the
center until her recent passing in 2022. Takiwasi emerged as a result of
research initiated in 1986 into the practices of traditional Amazonian medi-
cine, during which Dr. Mabit interacted with and was apprentice to several
master healers from the Peruvian Amazon, including Aquilino Chujandama
and Guillermo Ojanama of the Chazutino ethnic group.
Healers from the region of San Martin, where Takiwasi is located, are
mostly known for being paleros and purgueros. Paleros are experts in the use
of the bark and resin of palos, large hardwood trees with healing properties
(Beyer 2009), whereas purgueros are experts in the use of medicinal plants
with emetic effects. This knowledge has been incorporated into the therapeu-
tic practices of Takiwasi. During the first years after the center was founded,
numerous Amazonian healers shared their knowledge with Takiwasi staff,
most notably by participating in and leading ayahuasca ceremonies. Well-
known healers who have shared their healing expertise at Takiwasi include
Sol
on Tello, a mestizo from the city of Iquitos, Juan Flores of the Ash
aninka
ethnic group, Walter Cu~nachi of the Awajun ethnic group, Humberto Pia-
guaje, elder of the Siona ethnic group from the Colombian Putumayo, and
Adonıas Quintero of the Inga ethnic group in Colombia. Other practitioners
close to Takiwasi with different traditional medicine specializations include
tobacco purge in the treatment of addiction 5
Ignacio P
erez, a mestizo perfumero (i.e., healer expert in the use of per-
fumes) and native of Tarapoto, and Pastor Huam
an of the Quechua-Lamista
ethnic group, who was an expert healer in the extraction of virotes (magic
darts).
Takiwasi is a therapeutic community accredited by the Ministry of Health
of Peru.
1
The novel addiction treatment protocol implemented at Takiwasi
has been presented in several studies (Giove 2002; Berlowitz et al. 2018; Politi
et al. 2018; Giovannetti et al. 2020), as have the different medicinal plants
used in it (Hor
ak 2013; Politi et al. 2018; Cervi et al. 2019). Studies performed
on Takiwasi Substance Use Disorder (SUD) patients show that this popula-
tion is culturally heterogeneous (Berlowitz et al. 2020b): patients from Peru
(42%), other Latin American countries (34%), and North America/Europe
(24%) are welcomed into the 9-month in-patient program. Upon entry for
treatment, patients mainly suffer from dependence on cannabis (72%), alco-
hol (52%), and cocaine/cocaine paste (48%). The use of multiple substances
is a common characteristic (84% of the total) (Berlowitz et al. 2020b). By
comparing the scores of the Addiction Severity Index (ASI) of Takiwasi
patients with a sample of patients from the United States, it was observed
that, on average, Takiwasi patients present more serious problems in the psy-
chiatric and drug use domains (O’Shaughnessy 2017; Berlowitz et al. 2020b).
A recent study (Giovannetti et al. 2020) highlights the positive results of
Takiwasi’s therapeutic protocol in alleviating symptoms such as depression
and anxiety. The results are similar to those presented by other researchers
(O’Shaughnessy 2017; Berlowitz et al. 2019;O’Shaughnessy et al. 2021). Data
recorded by O’Shaughnessy (2017) showed a significant improvement in
scores of quality of life and spirituality, as measured by the Spiritual Well-
Being Scale (SWBS), and additionally that these scores were negatively corre-
lated with scores of depression and anxiety. In other words, patients with the
highest score increases in the dimensions of spirituality and quality of life
tended to show the strongest improvements in the measures of depression
and anxiety.
Further indications of the value of this protocol are offered by a naturalis-
tic study conducted by Berlowitz et al. (2019). This study investigated the
short-term therapeutic effects of the Takiwasi addiction treatment protocol
and found significant improvements after treatment completion in almost
every factor examined, including severity of addiction symptoms, emotional
stress, and quality of life. Baseline data from 53 dependence-diagnosed
patients admitted for treatment were analyzed by comparing their status at
treatment entry and at treatment completion. Upon completion, a significant
decrease was found for addiction severity outcomes such as drug use, alcohol
use, psychiatric status, and social/familial relationships. On top of this,
6 anthropology of consciousness 0.0
emotional distress and substance craving diminished significantly while qual-
ity of life increased significantly.
It is difficult to specify with certainty the reasons for patients’recovery.
One possibility is building resistance to stress during treatment (O’Shaugh-
nessy 2017). When asked about it, patients valued different aspects of the
treatment. The responses vary according to each individual, but, in general,
many patients spoke very positively of the traditional plant diets (Cholewka
et al. 2020; Politi et al. 2019; Rumlerov
a et al. 2022), which are considered
by Takiwasi’s therapists to be the key element for structural change in a per-
son (Berlowitz et al. 2018).
Sacred plants as purgas
Purification through purging is a widespread and ancient concept among the
Indigenous peoples of South America (Sanz-Biset and Ca~nigueral 2013;
Fotiou and Gearin 2019). Depurative practices based on the intake of emetic
plants such as tobacco, locally known by the name purgas, are a common
traditional medical approach in the Peruvian Amazon (Sanz-Biset and
Ca~nigueral 2013). The purpose of this practice can be to restore and main-
tain health, to tone and strengthen the body, and to treat different ailments.
One study conceptualized plants used in purgas as “medicinal stressors,”
which moderately activate neuroendocrine stress response pathways through
vomiting (Sanz-Biset and Ca~nigueral 2013) and in so doing protect against
stress-related diseases.
Plant remedies taken in purgas are aqueous extracts that, highly unpleasant
to drink due to their bitter taste, act chiefly as irritants of the gastric and
intestinal mucosa, which trigger nausea and emesis (Sanz-Biset and
Ca~nigueral 2013; Fotiou and Gearin 2019). The same ayahuasca brew that
has gained popularity among a global audience in the past three decades is
often referred to as the “purga”in the Peruvian Amazon because of its eme-
tic, cleansing, and depurative effects (Politi et al. 2021). Purging, itself, is an
important aspect of the ayahuasca experience and, in many cases, a variety
of other purgative plants, including tobacco, are used to prepare the body of
the individual who will later participate in an ayahuasca ceremony (Fotiou
and Gearin 2019). Purgas are considered to be useful in healing by working
to expel the cause of an imbalance located in the body; this concept occu-
pies a central role in the therapeutic practices of the region (Fotiou and
Gearin 2019). The use of purgatives and laxatives to “expel”evil spirits is
reported in ethnobotanical literature (Bussmann and Sharon 2006).
In the case of the Takiwasi Center, the purga is a ceremony that combines
the physical effects of a purgative plant along with the alleged effects on an
energetic or spiritual level, which become enhanced through the accompa-
nying ritual (Bourgogne 2012). The ritual gestures and the specific chants are
tobacco purge in the treatment of addiction 7
used to invoke the spirit of each plant in use and are important elements to
be taken into account within the ceremonial context (Bourgogne 2012). Eme-
tic plants promote not only physical, but also emotional and spiritual cleans-
ing, as each plant acts on a precise somatic zone that has its own symbolic
correspondence (Politi et al. 2018). Thus, we can observe that Rosa Sisa
(Tagetes erecta) is used in cleaning the mind from excessive rationalization;
Azucena (Lilium spp.) is considered useful for sexual cleansing and balance;
Verbena (Verbena litoralis) acts on the liver and the anger symbolically
linked with it; Sauco (Sambucus peruviana) is beneficial for cleansing the
respiratory system; and Yawar Panga (Aristolochia didyma) offers deep cleans-
ing and proves very useful in disabling the withdrawal syndrome in the first
phase of the treatment for drug addiction (Politi et al. 2018).
The ancestral uses of tobacco, described abundantly in the anthropological
literature, have been adapted to modernity for specific applications, such as
at the Takiwasi Center, which has been the subject of preliminary study
(Puig Domenech 2008). In this case, detoxification may be carried out
through the intake of an aqueous extract of tobacco, which has a powerful
emetic effect (Jauregui et al. 2011). Preliminary observation shows that this
use of tobacco as a purgative may be useful to treat tobacco addiction, as it is
aimed at physical purification, primarily of the respiratory tract, for those
who smoke industrial cigarettes in an addictive and compulsive manner (Puig
Domenech 2008). Clinical experience also points to its general applicability
in any dependence disorder (Bourgogne 2012).
Tobacco purges, as described by one of the founders of Takiwasi Center,
are considered essential in protecting against “bad energies,”primarily
through eliminating them from the body (Mabit 2021), but also through pro-
viding instruction in dreams and visions, and through bestowing mental clar-
ity and improved decision-making capabilities. The goal of this investigation
was therefore to detail more completely the relevance of the tobacco purge
within the center’s drug addiction rehabilitation program from the standpoint
of Takiwasi therapists and healers. These objectives were approached through
fieldwork based on participant observation and semi-structured interviews
with expert informants working at the Center. A similar ethnobotanical and
anthropological approach has recently been implemented by Berlowitz and
colleagues (Berlowitz et al. 2020a) to study an expert tabaquero from the
Peruvian region of Iquitos. As far as we know, the present study is the first in-
depth investigation of the therapeutic use of tobacco from the perspectives of
individuals who work with tobacco preparations in a therapeutic community
accredited by the Ministry of Health of Peru. This investigation is comple-
mented by a retrospective study of therapists’entries from Takiwasi’s clinical
database of the subjective effects of the tobacco purge as experienced by
patients enrolled in Takiwasi’s treatment protocol. The analysis of this clinical
8 anthropology of consciousness 0.0
data is intended to provide descriptive support to the interviews and observa-
tions of the tobacco experts and has no claim to be clinical research of any
sort.
&
materials and methods
Fieldwork and participant observation
In order to obtain direct information regarding the use of emetic plants at
Takiwasi, including the tobacco preparation here described, a research autho-
rization for ethnobotanical purposes was acquired from the Peruvian National
Forestry and Wildlife Service (SERFOR) through document of approval
AUT-IFL-2021-024. One of the authors (N.S.) performed field research
between April and July 2021 based on participant observation to describe the
preparation and administration of the tobacco purge. Moreover, semi-
structured interviews, lasting an average of 1.5 hours each, were conducted
with seven different therapists, healers, and an ethnobotanist of the center,
who are considered to be experts in this traditional Amazonian herbal prac-
tice. All interviews were conducted and recorded in Spanish and then tran-
scribed verbatim to be used for the analysis. The Institutional Review Board
for Research of the Takiwasi Center approved this part of the research
through document of approval CIRICT0022021, and all informants signed
written informed consent.
Some of the questions directed to the informants included: How is the
tobacco purge prepared? Why and when is it used? How is it administered?
What are the effects and benefits recognized by therapists and healers?
Retrospective study
Our research used information from interviews conducted by Takiwasi psy-
chotherapists with residential inpatients being treated for addiction. These
data are stored in the Takiwasi clinical data management system (Saucedo
et al. 2018). Formal approval by the Institutional Committee responsible for
the management of the clinical data was acquired for this research task. All
patients sign an authorization form for the use of their de-identified data for
research purposes at the beginning of treatment. As mentioned above, Taki-
wasi is an accredited therapeutic community recognized by the Ministry of
Health of Peru (resolution N°039-DG-DIRES/SM-96). In accordance with
article 15 of Law No. 29765 (Decreto Supremo N°006-2012-SA), which regu-
lates the establishment and exercise of therapeutic communities in Peru, all
care received by patients of therapeutic communities must be registered in a
clinical history, which includes, among other elements, a psychological
sheet. For the purpose of this article, the psychological sheet of the patients
tobacco purge in the treatment of addiction 9
of the Takiwasi Center has been consulted. The maintenance of the clinical
history is audited by the Ministry of Health periodically, and every three years
the authorization for the operation of the center is renewed. The last renewal
was approved by resolution 009–2021–GRSM/DIRESA–SM/DIREFISSA on
January 6, 2021, following a specific audit. As part of the audit process, the
recording and storage condition of patients’clinical data is assessed, includ-
ing the necessary measures for data protection and privacy requirements.
The data analyzed contained patients from 17 different countries. The
three most commonly represented countries were Peru (47), France (12), and
Spain (7). All participants were male (n =94), as Peruvian law for therapeu-
tic communities requires that all patients be of the same biological sex
(Decreto Supremo N°006-2012-SA). The average age was 31 years.
Each patient’s experience of the tobacco purge was recounted in a psy-
chotherapy session within a week following the purge. Sessions were con-
ducted with 19 psychotherapists over the course of the treatment period.
Questions regarding the purge were presented by psychotherapists in an
open-ended form, allowing informants to highlight any personally noteworthy
elements of their experience. These data were then transcribed by the thera-
pists and entered into the local online archive used to collect data from
patients undergoing treatment at Takiwasi. This system permits registration of
protocols that have been designed in accordance with the therapeutic model
of the center (Saucedo et al. 2018). Interviews were conducted and tran-
scribed in Spanish by the therapists and later translated into English by
authors E.K. and T.R.
A total of 254 testimonies were recorded between 2011 and 2021. Conven-
tional content analysis was chosen to analyze the data based upon recom-
mendation of Hsieh and Shannon (2005). This type of analysis is useful
when little is known about the phenomenon under investigation, as it per-
mits use of written texts without strong emphasis given to the source of the
material (Bengtsson 2016). The testimonies were subjected to a preliminary
reading and those that did not provide any substantive information were
eliminated. 173 testimonies remained after this first analysis. These testi-
monies were subsequently analyzed based on semantic similarities between
entries and then grouped into categories that emerged from their intercon-
nections. The goal of the analysis was to group and label the patient’s experi-
ences so as to identify interrelationships between the experiences. The
categories represent common effects and experiences perceived by patients
during and as a direct result of the tobacco purge. The reports given by the
psychotherapists varied in length and content, so it was usual for each testi-
mony to be assigned more than one representative category. The data were
analyzed using Microsoft Excel and Atlas.ti 8. Two authors of the present
research (T.R. and E.K.) analyzed the data separately and then discussed and
10 anthropology of consciousness 0.0
synthesized their analyses, as two different points of view help to increase
validity and prevent bias (Bengtsson 2016). The results include those cate-
gories that appeared more than 20 times.
The results have been compared with the extensive anthropological litera-
ture on tobacco, as well as with the empirical observations recorded for some
30 years by the same members of the Takiwasi therapeutic team and by exter-
nal researchers who have focused on the use of the tobacco purge in this
specific therapeutic context. Although most of this latter material is not peer-
reviewed, it turns out to be valuable for the discussion on the perceived
effects of the tobacco purge and its sacred character.
&
results and discussion
Preparation and administration of the tobacco purge: Healer’s and
ethnobotanist’s perspective
The following data are based on interviews with and observations of the Taki-
wasi staff who prepare and administer the tobacco purge. The data come pri-
marily from the observation of a native healer and from a semi-structured
interview with an empirical ethnobotanist. The healer is native to the
Quechua-Lamista Indigenous community of Santa Cruz, in the district of
San Jose de Sisa, and received his healer’s inheritance from his great-
grandfather. He has been administering the tobacco purge at Takiwasi for
over ten years. The empirical ethnobotanist is a mestizo from the San Martin
region. He has a degree as a nurse technician. He is in charge of assisting
the patients in their daily routine as well as making the plant preparations.
He learned how to properly handle the plants by working for over twenty
years in Takiwasi side by side with different healers.
The tobacco purge is prepared from a so-called mazo; a fermented solid,
but juicy, mass of tobacco leaves, tightly wrapped and bundled, that is pro-
duced in many parts of the Peruvian Amazon (Figure 1). Takiwasi acquires
the mazo as a ready-to-use product from an external provider, so it was not
possible to perform the botanical identification of the actual plant material
used for its preparation. A recent publication assumes the plant species to be
N. rustica, without the deposit of a voucher specimen (Berlowitz
et al. 2020a), however the exact species utilized remains unclear
(Fotiou 2017); further investigation should help to clarify this topic.
The tobacco purge is technically a decoction. The normal dose for one
person is one centimeter, or the width of a finger, of the mazo of tobacco.
This amount is cut from the mazo and boiled in 2-2.5 liters of water for ten
minutes. That decoction is then filtered and ready to drink. Important to
note, as stated by the interviewed ethnobotanist, is that the tobacco used in a
tobacco purge in the treatment of addiction 11
mazo can fluctuate in potency. So given that the mazo’s strength may vary,
the individual preparing the tobacco purge must know how to properly dose
the decoction. Tasting and feeling the concentration of the preparation is
part of the process, as is taking into account the sensibilities and history of
the person to whom it will be given.
The plant preparation is then administered in a ritualized context, during
the ceremonia de purga (purge ceremony). The context in which the plant is
administered is very important and includes the use of various tools of Tradi-
tional Amazonian Medicine (TAM), including the chanting of sacred melo-
dies (icaros), blowing tobacco smoke on specific points of the body such as
the hands, chest, and the top of the head (soplada), and/or sucking out the
agent that causes an illness (chupada). According to the healers, the plant
principally works on three levels: physical-biochemical, psychological-
emotional, and energetic-spiritual. At Takiwasi, this latter level, the energetic-
spiritual, is characterized by what cannot be seen or felt through the five
senses or the emotions. One informant, a Takiwasi therapist and healer,
explained this concept further through an analogy:
“There is something that we don’t see, [for example] there is wi-fi...but
our senses do not allow us to see it....When teacher plants are taken in
a ritualized context, we become sensitized. Our energetic body opens up
and we are like an antenna, like a wi-fi receptor. We are going to see, or
feel, and understand that spiritual energetic world that we do not nor-
mally access when we are in the ordinary state [of consciousness]. So we
figure 1. mazo of amazonian tobacco, possibly n. rustica (photo
by author e.k.).
12 anthropology of consciousness 0.0
modify our consciousness with the plants to be able to see those contents
that can be linked to our [health] problems.”
The use of the aforementioned tools within the ritualized context facilitates
access to each of these three levels. The tobacco preparation of 2.5 liters is
ingested and then followed by another 2.5 liters of lukewarm water to facilitate
vomiting. The tobacco purge is not pleasant to drink; it is bitter and it stings.
The ceremony lasts for about two hours. After the ceremony, the participants
take a shower without soap and rest until the next morning without eating.
During the interview, the ethnobotanist emphasized that it is important to
understand that the tobacco purge is a very strong plant preparation: one
must know how to prepare it and administer it properly because it has the
potential to kill. The curandero (healer) who administers the purge is in
charge of the entire ceremony and must know not only the techniques for
administering the plant and controlling the setting, but also how to handle
any potential difficulties that may arise within participants on the physical,
emotional, and energetic and spiritual levels. If a patient takes tobacco and it
makes him sick, the healer will know what to do to help. Both therapists and
healers reported that the tobacco purge is never to be administered to some-
body who suffers from heart disease, hypertension, diabetes, or gastritis.
Given these considerations, an in-depth understanding of how to prepare
and administer the tobacco purge is necessary. The rituality associated with
most of the TAM practices performed at Takiwasi, including the preparation
and administration of this purge, play a fundamental role in guaranteeing the
quality, safety, and efficacy of each therapeutic intervention, and should be a
focus of further investigation.
Takiwasi therapists’perspective on tobacco purge effects
The following information was gathered through interviews with Takiwasi
therapists trained in the TAM tradition. Some of these therapists have
learned TAM healing practices from various healers and are therefore also
considered healers. The interviewed therapeutic team consisted of a medical
doctor from France with specialization in tropical pathology and naturopathy
and four therapists from Peru, France, Czech Republic, and Venezuela with
degrees in psychology and psychotherapy and specializations in mental
health, drug dependency, and sexual abuse. As mentioned above, some thera-
pists are also healers and practice TAM with differing degrees of experience.
Their skills vary from those of a curioso,more precisely defined as a “...per-
son who has some limited knowledge of traditional therapeutical recipes”
(Luna 1986) to those of a proper curandero (healer).
TAM’s composition from a variety of Amazonian cultural backgrounds
forms, in part, the characterization of tobacco’s inherent qualities as
tobacco purge in the treatment of addiction 13
presented here. Tobacco is widely considered to be the main curing tool
within TAM (Berlowitz et al. 2020a), and it is an important plant for purging,
among its many other uses. Notably, tobacco is the purge par excellence in
the spiritual dimension, which is considered an important locus of informa-
tion within Takiwasi and within TAM more broadly. Access to the spiritual/
energetic world, which is described as a non-metaphorical plane of reality
populated by both good and evil spirits (O’Shaughnessy 2017), is facilitated
by tobacco, as consumption of tobacco is associated with the opening of the
energetic body and the modification of states of consciousness. At Takiwasi,
tobacco is noted to help balance the energetic system of the body when it is
in disequilibrium. It is commonly utilized to remove bad energies, bad spir-
its, and negative psychological and emotional charges, which are all com-
mon nosological categories within Takiwasi’s therapeutic environment
(O’Shaughnessy 2017). The concept of influence on energetic and spiritual
levels, ordinarily foreign to individuals in secularized societies, are key com-
ponents of treatment within TAM (Luna 1984b).
Therapists at Takiwasi classify tobacco as a planta de fuego y de aire (fire
and air plant) and as a masculine plant. In visions or dreams, tobacco often
appears as a very muscular and strong black man who has a density of energy
and who gives a feeling of power and potentiality. This representation of the
spirit of tobacco is consistent with previous ethnobotanical studies performed
in the Peruvian Amazon (Jauregui et al. 2011).
The impression of potentiality conveyed by tobacco helps one to under-
stand its classification as a planta maestra, a teaching plant (Luna 1984b;
Narby and Chanchari Pizuri 2021). Following the Takiwasi therapists’report,
tobacco teaches and provides mental clarity, verticality, righteousness, deci-
siveness, protection, and strength. So, when one undertakes a tobacco purge,
one may feel, for example, confusion, as one is clearing out confusion to
later find clarity; or one may feel weaknesses, because one must first take out
weakness to later find strength; one may confront vulnerability, as this is part
of the process for building protection and strength. So the tobacco purge
may sometimes be psychologically difficult, as one may be confronted with
negative feelings such as confusion, vulnerability, and dizziness, before feel-
ing the positive effect the following day. The next morning one can notice,
in addition to the physical cleansing, an easier ability to think, make deci-
sions, and discern things.
Tobacco, like each plant medicine, works differently for each individual.
Along with feelings of strength and clarity, some individuals describe height-
ened understanding into precise situations in life. One therapist, for example,
reports that one patient, upon purging with tobacco, had an insight into how
his father was treating him and how it was negatively affecting him and his
self-esteem. The patient then realized that he doesn’t have to conceptualize
14 anthropology of consciousness 0.0
his relationship with his father as he previously has: he had never looked at
what his father had told him in a critical way and could now understand
how this was bringing him down. More importantly, the patient saw that he
doesn’t like this part of his father and that he doesn’t have to be like him.
The therapist went on to state that patients often refer to tobacco as a severe
father who tells things as they are and with unquestionable clarity.
The clarity brought about through the purge can help individuals to make
decisions. One informant, a psychotherapist, had such an experience: during
the interview she described her own experience with tobacco purge, when
she found herself at a point in her life in which she needed to figure out
whether she wanted to remain at Takiwasi as a therapist or to leave. The
tobacco purge helped her to find an answer to her question. When she took
the purge she found herself asking, “What am I doing here?,”essentially
questioning the direction she wanted to take in her life. Examining her feel-
ings and experiences, she realized that she wanted to remain at Takiwasi.
The purge helped her to understand that she was happy where she was and
showed her that she was achieving what she wanted by reaffirming her love
of serving others. After that tobacco purge, she followed those feelings and
made the decision to stay. In order to figure out what she wanted, it was nec-
essary for her to ask herself this question and to put her attention toward it.
Tobacco helped to give her the requisite clarity and focus to confidently pro-
duce an answer to her question.
For some, this feeling of clarity may not manifest itself in waking life.
According to the therapists’interviews, and consistent in ethnobotanical liter-
ature (Wilbert 1993), tobacco is a dream-inducing plant and through dreams
it can transmit its teaching. The dreams can be very strong and clear. One
therapist recounted an example: a patient working on his struggle with sub-
stance abuse had multiple dreams about his addiction problem. In the first
dream the patient consumes the drug. In the next dream he hesitates and
withdraws a bit from consuming and is finally able to say to himself, “No, I
don’t want to take the drug.”In this same dream a person arrives and shows
him the drug. The patient says ‘No’to it, and the curandero from Takiwasi
who blows tobacco smoke on him (soplada) appears in the dream. So the
patient experiences in the dream his internal struggle of wanting to give up
the drug. In this dream, the building up of resistance within the patient to
consume the drug and him finding the strength to say no to it can be seen.
This patient had recently taken the tobacco purge and, following the thera-
pist’s reasoning, the tobacco manifested itself during the dream by appearing
to the patient as the curandero that blows tobacco smoke on him. So, in the
therapeutic context, one can observe the process of healing manifest through
the dreams of the patient, thus allowing him an experience where he feels
strong enough to be able to resist the drug and say ‘No’to it.
tobacco purge in the treatment of addiction 15
These experiences help to elucidate tobacco’s classification in the local
cosmology and folk wisdom as a distinctively masculine plant (Barbira-
Freedman 2010), associated with the qualities of fire and air. These elemental
attributes can be interpreted, among others, through the burns in the throat
that occur when drinking the purge and through the mareaci
on induced after
ingesting the plant, which is perceived mostly in the head and the mind.
Tobacco’s characterization as a purely masculine plant is illustrated in its
help in making decisions and conferring clarity, strength, verticality, righ-
teousness, decisiveness, and protection. The participant’s setting of an inten-
tion is also an important component of the tobacco purge at Takiwasi, given
that the goal is to have a deeper and more profound experience. This con-
cept in particular resonates with the widespread traditional Amazonian under-
standing of plants as living beings with agency, which have the ability to
interact with and teach those who properly connect with them (Attala 2017).
Retrospective study on tobacco purge: therapists’records of patients’experiences
The retrospective study based on the analysis of third-hand data obtained
through the Takiwasi clinical data management system produced seven prin-
cipal categories of subjective and physical effects in patients who took the
tobacco purge. The frequency of these effects is given in the numerical form
(n =...). Only those effects produced directly as a result of the tobacco purge
were included in the analysis. Results are presented according to their fre-
quency and the most common effects are discussed first. Each category will
be broken down and discussed in more detail in the upcoming sections of
the paper. As stated in the material and methods section, it should be noted
that the subjective effects of the tobacco purge experienced by Takiwasi
patients were recounted to therapists during a psychotherapy session, and the
data that we present below are based on the reports made by the therapists.
Participants reported feelings of mental clarity (e.g., mentally focused,
strong, and peaceful) with the greatest frequency (n =80). As the intention
of the therapy is inducing a physical purge, vomiting was a ubiquitous fea-
ture of the experience. So central is this effect during the experience that it
is taken as a given and was excluded as a category of analysis. Other notewor-
thy physical effects including discomfort, intoxication, etc. were reported fre-
quently (n =63). Emotions were a significant part of the experience for
many (n =47), as were thoughts (n =46). An effect on sleep and dreams
(n =36) was common, as were insights (n =28). Some participants, further-
more, found the experience directly related to their addiction treatment and
their desire to consume substances (n =20). These effects occurred with the
greatest frequency and were selected as categories based on their centrality to
the experience across participants. The categories that emerged from the
16 anthropology of consciousness 0.0
analysis are represented in Figure 2: mental clarity, physical effects, emotions,
thoughts, insights, sleep effects, and consumption effects.
Mental Clarity
Mental clarity was the most common effect experienced by participants as a
result of the tobacco purge (n =80). For these purposes, mental clarity is
defined as a clear, calm, strong, and focused feeling in the mind. One partic-
ipant states feeling “cleanliness in the head, disordered thoughts disappear
and settle.”Reports commonly mentioned themes related to feeling centered
and realigned in daily tasks. A feeling of focus, especially towards one’s goals
was common. One testimony stated, “The following day he awoke very
happy with no desire to leave, but rather a desire to work.”
Feelings of strength and general wellness were commonly reported. One
testimony states that the participant “feels the tobacco left him with strength
and well-being.”A state of peace and serenity also occurred frequently: “[He
feels] very good, he feels relieved, he felt strongly the effect of the tobacco;
bodily vibrations, tranquility, confidence.”These experiences mostly center
around the ability to focus one’s mind and to exist in the present moment
without preoccupation.
One patient recounted his experience and its effect on his behavior in con-
versation with a therapist:
[Patient]: It went well, in that moment I felt it ordering my thoughts, I
felt it, and not because I heard it, but because I felt it, I felt moved,
intoxicated...
figure 2. frequency of perceived effects of the tobacco purge
by takiwasi patients.
tobacco purge in the treatment of addiction 17
[Therapist]: Which thoughts did it order?[Patient]: Why I consumed, and
that I should be more mature and try to stop. The next day I tried it, I
tried to talk with my friends, to have a topic of conversation, we spoke
beautifully, friend to friend and without argument.
Physical Effects
Physical effects, defined as notable immediate or persistent physiological sen-
sations, were the second most common experience (n =63). In addition to
vomiting, participants experienced a variety of physical effects including
headache, chills, temperature change, and dizziness. Many experienced such
physical effects during the purge, whereas others found these effects to linger
after completion of the purge. It was common for these effects to persist
afterward.
Noteworthy effects other than vomiting are included in this category and
range from pleasant to difficult. “He vomited a lot, felt cleansed and slept
well,”one testimony describes. Physical discomfort was more common than
pleasant sensations during the purge: “It hit him hard, he wasn’t able to
drink the whole jar. It intoxicated him, burned him, and gave him strong
nausea and discomfort.”Another testimony describes persistent effects, “Very
strong, left him very tired and with chills and headache.”Most participants
have a strong physiological reaction to tobacco, however this reaction usually
passes within a short period after completion of the purge.
Interestingly, numerous participants found their physical sensations directly
connected with other states of mind. One testimony describes:
“He was fine and without effects until 8pm, but then stomach pain and
a strong, deep purge, from ‘something faraway,’‘as with the ayahuasca
session,’and only water came out. Afterward [he felt] a sensation of
gratitude (to the plants, Takiwasi, God; without knowing why), knowing
that something important had left.”
Emotions
Emotions are defined here as affective sensations that manifest without
rational thought (n =47). They were found to arise frequently both during,
and as a consequence of the tobacco purge. Emotions were generally found
to lie within two groups: some felt an amplification of affective perception,
whereas others experienced a strong emotional catharsis. The cathartic effect
seemed to manifest on its own, sometimes without the participant under-
standing its cause: “A lot of emotions were coming out, a lot of sadness. I
started to cry, and I didn’t know how, like a child and I didn’t know why.”
Another participant understood his vomiting specifically related to his emo-
tions: “For the first time, he saw the vomit related to personal contents, rage.”
18 anthropology of consciousness 0.0
Liberation of emotional pain occurred frequently. Another participant men-
tions: “The purge moved him a lot, he felt a lot of rage and a lot of sadness,
and he cried a lot. Something became unblocked at the emotional level.”
The increase in emotional perception was experienced mainly as a link
with one’s emotions: “Tobacco connected him with his emotions,”one testi-
mony states. Other participants reported feeling increased sensitivity or the
welling up of negative or positive emotions, sometimes hours after the purge
ended.
Thoughts
Thoughts, defined here as reflections that arise through rational contempla-
tion, were another notable category of experience (n =46). This category
was selected due to the number of testimonies containing participants reflect-
ing on their lives and their relationships with themselves and others.
Thoughts on interpersonal relationships were especially common: “[he had]
thoughts about his masculine relationships and thought a lot about his best
friend, who for him is like a brother.”It was common for these thoughts to
persist after completion of the purge: “He was left reviewing his life for six
hours after finishing [the purge], thinking about his childhood and his rela-
tionship with his mother and his lovers.”Another patient felt the need to
dive deeper into his thoughts after completion of the purge:
“After the purge he asked to be alone so that he could draw more
conclusions and distance himself from the noise. In isolation he had
many thoughts about his parents, his goals, his longings. He also
thought about himself, what he should do and improve, what he really
wants, what his gift is to do in this life, and what he was really born to
do.”
Many more patients experienced similar thoughts surrounding their life’s cir-
cumstances and their future during, or as a result of, the purge.
In general, the tobacco purge seemed to stimulate reflections on some
aspect of participants’lives, which is regarded as a necessary step in the treat-
ment process.
Sleep
The combined incidence of the effects on sleep totals n =36. Two distinct
effects on sleep were observed: a disturbance of sleep as well as an effect on
dreams. This section therefore has two subcategories. Tobacco was observed
to have a stimulating effect in many participants, and some found it difficult
to sleep after the purge (e.g., they could not sleep because they were preoc-
cupied, experienced an interruption of sleep, or their dreams disturbed their
tobacco purge in the treatment of addiction 19
sleep) (n =17). At the same time, given that the tobacco purge can be physi-
cally taxing for participants, others found it easy to sleep well. Various partici-
pants had significant dreams after the purge that they felt specifically related
to their experience with tobacco (n =26). There were certain patients who
had both a disruption in sleep as well as noteworthy dreams, so these patients
appear in both categories.
Many testimonies stated that the participant had a significant dream but
did not elaborate further, as there is another specific section of the Takiwasi
therapeutic protocol dedicated to recording dreams that has not been taken
into account for the purpose of the present work. A few testimonies, however,
detailed dream experiences directly. One entry recounts a significant dream
for one patient:
“[The purge] was good but the night was worse. He was dreaming, this
time not with demons but with concrete things in his life that he didn’t
like. He couldn’t remember the dream well, only the sensation that, in
relation to other people, he is afraid of losing control. In the dream he
saw himself passing by a canal filled with symbols that all had meaning.
We contrast this with his normal attitude in which he feels that nothing
has meaning.”
Personally significant dreams such as this can affect individuals deeply and
are considered particularly important in the context of the psychotherapeutic
work at Takiwasi, where they are interpreted within each patient’s particular
clinical history.
Insights
Insights (n =28) are defined here as novel realizations into certain aspects of
one’s life. These experiences build upon those in the thoughts category but
represent a deeper level of perception and understanding into the issues one
is currently facing. This category is especially important insofar as it shows
that the treatment evokes responses that the individual is able to incorporate
into his life and apply to the specific challenges he faces. One testimony
states, “The idea passed into his head, ‘and what would happen if I dared to
be good? What would occur if everything that happens to me has a reason
and that reason being that I learn?’” Participants found insights into their per-
sonal life as well as into their relationships with others. Another patient states
directly in his testimony, “I asked for clarification, I wanted to know the rea-
son for my fears and doubts with love. I discovered after the purge that my
weak point is in the mind, and not in my feelings or in my heart. I like the
tobacco plant, it does me well.”
20 anthropology of consciousness 0.0
Consumption
The consumption category includes those testimonies in which individuals
experienced a specific effect on their relationship with substances, addiction,
and treatment (n =20). This category is important because addiction treat-
ment is the primary objective of the Takiwasi Center. It is important to men-
tion that the purpose of the purge and the effects felt as a result of the purge
are all related to the therapeutic process and to the relationship with sub-
stance abuse, however this category includes those testimonies in which par-
ticipants felt a direct effect on their relationship with addiction or on their
desire to receive treatment. Many were reminded of their initial motivations
to receive treatment: “The desire to run away disappeared and a greater moti-
vation to complete treatment appeared.”Another testimony states, “It brought
him to his knees, saying, ‘I don’t want to consume anymore.’”
Some patients felt the contents of the purge relate directly to a certain sub-
stance: “It helped him hold more disgust toward cigarettes. He can’t smoke;
if he inhales, he feels he will break energetically.”Another patient relates a
change in perspective: “[The purge] helped him view Marijuana as a drug
too.”Other addiction issues unrelated to substances may also arise during the
course of treatment: “Thoughts of his main consumptions, many related to
sex and prostitution.”The consumption effects were both wide-ranging and
highly personal, as addictions manifest uniquely within each individual.
&
limitations
In keeping with the provisional nature of the present work, the retrospective
study on patients’data focused on the wealth of information already recorded
in the institutional repository of Takiwasi. Analysis of the effects of the purge
on the patients through the lens of the therapist situates the purge’s effects
within the overall therapeutic framework. Such a design allows for the identi-
fication of broad, observable effects, as would be warranted in a provisional
study, however lacks the precision and strength of a clinical investigation,
which in fact remains outside the scope of the present work. Consequently,
further research should focus on the specific clinical effects of the purge
from the viewpoint of the patients and might consider documenting changes
within individuals as the treatment progresses. Moreover, direct interviews
with patients at different points during the treatment process would be useful
to pinpoint specific changes induced over the course of treatment. Compar-
ison of the effects of the tobacco purge with non-treatment populations and
with individuals of both sexes would also be useful to broaden our under-
standing of the utility and scope of this therapy. Additionally, keeping in
mind the feedback loop between gut microbiota and brain function,
tobacco purge in the treatment of addiction 21
biochemical analysis of changes in the intestinal microbiome could prove
useful in identifying the influence of this therapy on molecular and physio-
logical biomarkers and their potential downstream effects on behavior. The
study’s scope as an ethnobotanical investigation provides one further limita-
tion, as it focuses solely on the Takiwasi therapeutic community. With the
present work, however, we hope to stimulate further investigation into the
tobacco purge in other similar centers in Peru.
&
conclusion
The author who performed the fieldwork in participant observation and con-
ducted the semi-structured interviews (N.S.) took part in a tobacco purge cer-
emony at Takiwasi; included here is a summary of his experience, which he
found consistent with the overall data acquired on the tobacco purge during
this research work:
“A lot of those qualities that the tobacco teaches, I had the chance to
experience myself. I took part in a ceremony where I took a tobacco
purge. It wasn’t easy for me to drink 2.5 liters of this tobacco preparation
since it burns in the throat. Also, the purging itself is a psychological
challenge for me, since I know that the more I drink, the more I vomit,
but the better I will feel afterwards. So that’s motivating. After the purge
I felt weak and disoriented, so I went to my room, took a shower without
soap, and went to sleep. During the night I had a vivid dream. I got
swallowed into tobacco leaves and then I could feel the mareaci
on
(dizziness). I could see the healer who was teaching me and other people
different things about plants. I could also see my dad and mom and tell
them that everything is okay and that I’m on the right track. Then I
woke up and could not sleep for several hours. The next day I felt strong
and had an incredible clearness in my thoughts.”
As reported in a recent work on traditional tobacco use in another region of
the Peruvian Amazon, so outside the context of Takiwasi (Berlowitz
et al. 2020a), the interviewed healer, an expert in the use of tobacco (taba-
quero), continually notes that the tobacco remedy “centers”or “strengthens”
the mind. Correspondingly, he points to “problems of the mind”or of the
“psychic-mental system”as primary indications for taking this medicine. He
points to psychological improvements related to attention, cognitive tenden-
cies, mood, self-image, and fearfulness. These descriptions echo the results
obtained in our work, in which, for example, mental clarity appears as the
22 anthropology of consciousness 0.0
most frequently mentioned effect experienced by patients. The elucidation of
tobacco’s effects in the subjective categories of mental clarity, emotions,
thoughts, and insights, helps to pinpoint some of the most beneficial psycho-
logical effects of the tobacco purge.
It is noteworthy to mention that within the Takiwasi treatment protocol,
other factors, including the ritual element of plant administration and the
concomitant psychotherapeutic integration of these medicinal plant experi-
ences, play fundamental roles in achieving positive outcomes (Rush
et al. 2021). The present work represents a first attempt to focus and docu-
ment the use and the overall effect of one particular tool, the tobacco
purge, utilized within the Takiwasi protocol for drug addiction. This tool
appears to be relevant not only from the psychotherapist’s and the tradi-
tional healers’perspective, but also from the very same voice of the drug-
addicted patients in their interviews with the psychotherapists in charge of
their rehabilitation process. More investigation on this subject is therefore
recommended.
&
disclosure statement
Authors T.R., E.K., N.S. are external to the institution studied. They have
carried out the fieldwork with participant observation, the interviews with the
healers and therapists, and the retrospective analysis of the data collected in
the institutional database. Authors F.F. and M.P. were employed by the Taki-
wasi Center at the time the research was conducted. They have accompa-
nied the realization of the study and contributed to the writing and editing
of the manuscript.
&
note
1
Definition of therapeutic community extracted from article 13 of Law No. 29765
(Decreto Supremo N°006-2012-SA), which regulates the establishment and exercise
of therapeutic communities in Peru: Therapeutic Community Type I. It is a Health
Care Center, where treatment and rehabilitation activities are carried out for people
with dependence on psychoactive substances without comorbidity or with mild clini-
cal and/or psychiatric comorbidity (author’s translation).
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