Right Relationship, Psychedelics, and Addiction Recovery

The following was written by Elizabeth Hoke and reprinted with permission from Voices: The Art and Science of Psychotherapy and the American Academy of Psychotherapists, from Vol 60, No 1-3, 2024. Copyright 2024 American Academy of Psychotherapists (AAP). All rights reserved.

It was 7:45 a.m. on a Tuesday morning, and I was getting ready for my 8:00 a.m. ketamine

assisted psychotherapy client. I was watering my plants in the office when Dr. Rosonke walked in. I greeted him with my typical large smile, and he said, “Are you happy all the time?” I told him that I used to live in hell and that every day I’m not living there feels like a gift. I am one of the lucky ones who managed to not die from her addiction, and plant medicines, fungi, psychedelics, and therapy are big reasons why I’m still alive today.

As far back as my memory goes, I always felt out of place and deeply insecure. I didn’t sleep at night and spent most of my days tracking everyone’s reactions to me so I could figure out how to feel more loved and connected to them. I’m not sure which came first—my lonely feelings of being constantly misunderstood and invisible to my parents, who were too busy either working or fulfilling their obligations with their new families after the divorce, or not trusting that my needs were valuable and that I deserved love even when I wasn’t doing anything to earn it. Either way, it was around the same time in early childhood that I also learned that if I was a good girl I would get more attention. So, I tried desperately to be helpful and make everyone around me happy. This worked half of the time, but with undiagnosed ADHD, school was incredibly challenging, and I constantly felt inadequate and unworthy. Because I deeply believed that I had no value unless I was doing something for others, I quickly became overly stressed and chronically uncomfortable in my body.

When I was 12, I spent a lot of time at a friend’s house whose single mom was never home. We spent most of our time there, after walking home from junior high school, eating macaroni and cheese, drinking Kool-Aid, and watching Jerry Springer. One day, we decided to drink a beer from the fridge, and the relief it brought me was so instant that my life was changed forever. My need for numbing quickly progressed to using any drug I could get my hands on by age 15. At 17, I was kicked out of my mom’s house for throwing a party that resulted in a childhood friend robbing us while I was passed out. By 20, I was a full-blown alcoholic. I didn’t drink every day or alone, but when I did drink, which was three or four times a week, I would black out. I desperately longed for connection and love but felt

further and further away from it.

Fast forward to 24, I was bartending in San Francisco, and my blackouts were getting worse. I was drinking and using drugs most days and started to wake up in places I didn’t know. I would wake up and promise to not do it again, then by 5:00 p.m. be drinking again, and the cycle repeated. I felt so out of control. I was ashamed of my behavior and terrified that I was going to die. My desperation to feel loved and valued paralleled my intense need to take care of everyone around me.

The extreme people-pleasing wouldn’t allow me to ask for help, and no one in my family knew the truth about my struggle. I was deeply depressed and had suicidal ideation. I also truly believed that I would be alone forever because if anyone knew the truth of who I really was and all the shameful mistakes I’d made, then they’d see that I was too disgusting of a human to ever deserve love.

I was lucky enough to have a friend who took me to a taqueria after work one night to confront me about my destructive behavior. He cried while he ate his tacos and told me that I was killing myself and that he wasn’t going to pretend otherwise any longer. He said he loved me and that I deserved better than the current life I was living. I didn’t change anything about my behavior that night, but I couldn’t get his words out of my head. I wanted to quit drinking, but 12-step programs didn’t work for me because I didn’t believe in a higher power and couldn’t surrender to it or believe that it would help me get past my addiction.

As a child, I was raised Jewish, but only by way of celebrating at Grandma’s. There was no connection to traditions, rituals, or ceremonies, only Grandma’s matzo ball soup on holidays. My father was Christian and married a woman who was Catholic, which meant that I had to start going to church when I visited them. When they got up for Holy Communion, I was told to stay in the pew because I was Jewish. I felt so much shame sitting there as the rows of people got up and walked to the front of the room, staring at me as they walked by. This experience solidified two beliefs: that religion was a crock and that if it wasn’t a crock, I was someone that didn’t deserve to be a part of it.

Many years after that night at the taqueria, a different friend offered me some mushroom tea in a country where it was legal. We drank the tea and ended up in the middle of a park around 11:30 p.m., alone with the tall trees and quiet rain. I lay on the wet grass and for the first time in my life felt what it was like to live inside my own body, and had so much gratitude for it. I felt, for the first time in my life, unconditional love for myself. It was also the first night in a long time that I was not blacked out and was not swimming in thoughts of being a disgusting worthless person. I saw myself as part of the earth, realizing that I and the rock in space I was living on were connected and I wasn’t separate from it. New thoughts were being formed in my head, saying I was valuable and deserving of love despite the mistakes I had made. I vowed that I would stop trying to destroy myself and would do everything I could to help others get out of the hell they felt stuck in from their addiction.

It didn’t happen right away, but over the next few years, I was able to get sober thanks to therapy and my new found belief that I had value and deserved a different life. I went back to school to earn a master’s in counseling psychology and found my dream job in 2011, at a community mental health clinic called The Liberation Institute. While my first 8 years of sobriety were focused on abstinence, I was able to find my way back to psychedelics, which helped me deepen my spiritual practice and recovery and became the focus of my career.

I am now working as a ketamine-assisted psychotherapist, specializing in addiction recovery. I also teach psychedelic-focused continuing education workshops and volunteer with psychedelic communities, running recovery groups for people who use psychedelics to aid their recovery. I have sat with hundreds of clients for ketamine-assisted psychotherapy and psychedelic integration, many of them coming to deal with issues of addiction. Some come in speaking directly about their struggle with alcohol, drugs, nicotine, sex, shopping, gambling, etc., while others come in suffering from problematic thinking and challenging behaviors that cause them to over use substances and other dissociative practices. While everyone has a different life story and reaction to addictive substances and pathological behavior, I do see a few common threads between their stories and mine.

The first common thread is the feeling of disconnection and loneliness. It seems that

the individual-focused capitalist structure we live in has caused people to forget what it means and feels like to be in right relationship with each other and with plants, animals, and our environment. I learned about this term of interdependence in the Multidisciplinary Association for Psychedelic Studies (MAPS) MDMA therapy training program. Kylea Talor (2017) discusses the importance of being in right relationship with ourselves in order to be in right relationship with clients in her book The Ethics of Caring. This concept is common in the Buddhist tradition, where Thich Nhat Hanh (2017) describes it as interbeing, and has also been shared through stories by Indigenous communities around the world.

So how do we get in right relationship? I had a client who wanted to quit smoking, but nothing seemed to work. She tried the gum, patches, 12-step programs, and even psychotherapy. One day, she met with an Indigenous healer who encouraged her to buy a nicotiana tabacum plant, which is used to produce smoking tobacco. She found one, planted it in her garden in the spring, and was instructed to love it and nurture it and heal the relationship she had to it so that it was no longer abstract and abusive. Instead of quitting through demonizing the tobacco and telling herself she was powerless over her addiction, she changed her relationship to it.

She and I spent months talking about her original relationship to smoking. We un packed the story of how she started as a teen, and she shared how smoking tobacco helped her feel calm and less activated when in painful and challenging situations. She started a journaling practice around her relationship to the plant, noting whether she was using and abusing it or enjoying and honoring it. The more time she spent in loving forgiveness of herself and seeing the tobacco as an ally not an enemy, the more she cherished it and didn’t want to have an abusive relationship with it any longer. She decided to do six ketamine sessions with me to help with the withdrawals, which were very challenging since she’d started smoking so young. While her desire to smoke was never completely relieved, she slowly quit by continuing her compassionate self-care inquiry and plant tending. She changed her relationship to her cravings, being with them patiently instead of rushing to appease them. This allowed her to gain control over her addiction, and a year later, she’s still abstaining from smoking.

The second common thread is people feeling utter hopelessness and a deep distrust in their ability to heal themselves. Most people with addiction issues show up so disconnected from their body that they can’t remember the last time they slowed down enough to feel their heartbeat in their chest or witness their breath move in and out of their lungs. Before doing any type of ketamine-assisted psychotherapy or psychedelic integration, I always start by reconnecting the person to their body.

Breathing exercises and guided meditations help clients gain awareness and internal grounding to support them through the psychedelic experience. Somatic exercises and psycho-education also help clients gain awareness of their body armoring and defensive character structure. The body storming in addicts typically shows up as pressure to be in an upright posture while the chest caves in to protect the heart and the neck and shoulders constantly feel sore from being held in a tense up right position. When helping clients feel into this, they start to relax the muscles instead and find themselves opening up more. When the body armoring is deactivated, the defensive character structure shifts to more vulnerable and open. The more a person utilizes their body to feel safe, the less they need to numb or disassociate. The more connected they feel to their body, the more they can use it as a tool for healing. Trust and deep connection with self bring remedies for loneliness, helping clients feel less urgency to numb and disassociate.

Our external living environment and institutions don’t always support everyone’s inner light and being. The individual-focused consumerism-driven society we’ve created doesn’t feel safe for people who are deeply sensitive, and when they seek professional help, they are often given labels and medication to help them change. This leads to feeling misunderstood and hopeless and creates a deep desire to constantly dissociate or numb these feelings.

From my experience as a ketamine-assisted therapist, I have witnessed and been told by clients that their addiction recovery feels different when the focus is on right relationship and the body. Using ketamine in conjunction with somatic techniques, talk therapy, and a relational framework with a biocentric focus can help people change the story they believe about themselves. Helping clients foster right relationship and develop a deep trust in their inner healing intelligence can strengthen their ability to heal from

their addictions.

Humans are like the flowers found growing through the cracks in the sidewalk. The environment is not conducive for thriving, but with the right amount of support, they can learn to grow and blossom and find strength in their wildness to break through concrete confines. To borrow words and inspiration from Robin Wall Kimmerer:

Action on behalf of life transforms. Because the relationship between self and the world is

reciprocal, it is not a question of first getting enlightened or saved and then acting. As we

work to heal the earth, the earth heals us. (Kimmerer, 2015, p. 328)

References

Hanh, T. N. (2017). The art of living. San Francisco: HarperOne.

Kimmerer, R. W. (2015). Braiding sweetgrass. Minneapolis, MN: Milkweed Editions.

Taylor, K. (2017). The ethics of caring: Finding right relationship with clients. Santa Cruz, CA: Hanford Mead Publishers.