In what other contexts are psychedelics used, and how are these contexts different from psychedelic therapy?

Humans have been using naturally-occurring psychedelics like psilocybin, DMT, and mescaline for hundreds (if not thousands) of years as healing modalities, recreationally, and in religious/spiritual ceremonies. In some regions of the world, psychedelics hold significant cultural importance to this day.^[1][2] In recent years in North America, there has been a trend towards decriminalization, and in some cases, legalization which has led to increased access to some of these drugs. So, does it make a difference if psychedelics are consumed in the Amazonian jungle as part of a ceremony led by a shaman, in the setting of psychedelic therapy, or in your friend's backyard? The short answer: probably.

Psychedelics are unique compounds in that their short- and long-term effects can vary greatly depending on the context in which they’re consumed. This is where the concept of “set” and “setting” comes in. “Set” refers to someone’s mindset and overall mental state, while “setting” represents the surrounding environment, including the people in it — both of which can influence the overall experience of taking a psychedelic drug.^[3] In psychedelic therapy, both the set and setting are considered and controlled as much as possible. The individual receiving the treatment works with a mental health professional to mentally prepare. During the psychedelic session, the setting is usually warm with a comfortable place to lie, soothing music, and health professionals available to support the individual if they become anxious or fearful. This is a long way of saying that the benefits observed in psychedelic therapy research are not necessarily generalizable to psychedelic use in other contexts.

This is not to say that psychedelic use in other contexts holds no merit, there just isn’t a research base to draw any firm conclusions from. Observational trials have found associations between traditional ayahuasca ceremonies and improved mental well-being^[4] and reduced alcohol and drug use;^[5] however, these trials have a high risk of bias as they’re not placebo-controlled, prone to high drop-out rates, and based on survey results which can make the intervention look more effective than it is.