Altered States of Autonomy: Entities, Agency, and Intentionality in Psychedelic-Assisted Therapy and Addiction Recovery

The use of psychedelic-assisted therapy in the treatment of addiction raises complex challenges regarding alterations of autonomy which require interdisciplinary collaboration to address. In clinical treatment, addiction is often described in terms of a loss of agency in which one’s autonomy is compromised by an external entity which directs their behavior, such as a substance. Intentionality is often attributed to this external entity, as it is described as an agent with its own desires, capable of interfering in one's autonomy (Brookfield et al. 2022; Törrönen 2022). A similar pattern appears in various psychedelic practices, where external entities are encountered and attributed intentionality. For example, this can be seen in the description of ayahuasca as an intentional entity which directs one’s agency after ingestion of the brew (Shanon 2002). It can also be observed in the identification of malicious external entities as demons, who are exorcised during the ayahuasca ceremony. These are described as having a parasitic relationship to one’s autonomy, paralleling the description of agents in addiction recovery (Dupuis 2022). Set, setting, and matrix play a crucial role in shaping the perception of these external entities, as people and their practices are inextricably influenced by the cultural frameworks in which they are embedded. Resources for understanding external entities are abundant in religious material, and are heavily utilized in the description of agents in both psychedelic experiences and addiction recovery. Collaboration with religious studies scholars will then be critical for understanding how addiction recovery frameworks which externalize substances as agents relate to psychedelic practices which also engage substances and external entities, and how their intersection may enhance practices of psychedelic-assisted therapy for addiction recovery.

The treatment of addiction through psychedelic-assisted therapy presents further questions regarding agency and autonomy. 12-Step programs are one of the most widely recognized discourses on addiction recovery. Step 3 frames the surrender of one’s sense of autonomy to a higher power as a necessary step in restoring it. A striking paradox emerges: while addiction is framed as an involuntary loss of autonomy to an external agent, the 12-Step program asserts that it is only through voluntarily surrendering one’s autonomy to a higher power that one can regain it fully (Brooks et al. 2013). In other words, it is claimed that in order to regain autonomy one must give it up totally to a totalizing entity. A comparable pattern can be observed in the treatment of addiction through psychedelic-assisted therapy. Various clinical studies have found a significant correlation between experiences of ego-dissolution and drastic improvements in addiction recovery rates (Kałużna et al. 2022). This phenomenon is described as a temporary collapse in the sense of self on which one’s sense of agency and autonomy rests. This experience is often framed in ways which mirror step 3, seen in descriptions of one’s sense of self being dissolved into and connected with some higher power, such as nature or God. Here we find the same paradox of autonomy: the dissolution of an agent's sense of autonomy enables the recovery of that very same autonomy. These parallels point toward the potential of using existing addiction recovery models in conjunction with psychedelic-assisted therapy. However, one’s conception of a higher power is shaped by their embeddedness in wider cultural frameworks. Therefore, the role of higher powers, being shaped by the set, setting, and matrix of wider religious discourse, further underscores the need for collaboration with religious studies scholars to adequately address these perplexing questions regarding lapses and restoration of autonomy.

Ego-dissolution might not adequately capture the subtlety of these questions. The concept itself and its measurement through questionnaires such as the MEQ or EDI (Barrett et al. 2015; Nour et al. 2016) has been rightfully questioned for their reliance on perennialist assumptions (Letheby et al 2024; Langlitz 2024). New approaches such as the Watts Connectedness Scale (WCS) (Watts et al. 2022) offers greater nuance. Rather than conceptualizing these experiences as a binary shift between ego-presence and its absorption into a higher power, Watts et al. view it through a multidimensional lens of connectedness. They identify three forms of connectedness: to self, to others, and to the world. This is significant, as it helps broaden the concerns of psychedelic-assisted therapy to include another key element found in addiction recovery: communitas (Turner 1969). In 12-Step programs, recovering addicts find support through a ritually structured community of others seeking the same goal of regaining autonomy. Through communal connectedness, one is better supported in the process of giving up their agency to a higher power and overcoming their addiction, thereby restoring their autonomy. By incorporating new paradigms such as the WCS or Communitas Scale (Kettner et al. 2021) researchers can better understand the relationship between connectedness to others and a higher power. From this improved understanding, psychedelic-assisted therapies may be developed which more effectively integrate connectedness–both social and spiritual–as a significant component of recovery. Religious studies scholars, with their wide expertise in ritualistic communities from AA to Santo Daime, will be crucial for developing effective treatment approaches that bridge addiction recovery and psychedelic frameworks in a way that is both scientifically and culturally attuned.     

This paper will examine the complexities regarding agency and autonomy which arise at the intersection of psychedelic-assisted therapy and addiction recovery, and will highlight the ways in which religious studies is uniquely positioned to contribute to a deeper understanding of their nuance. While the discussion is extensive, this paper does not seek to provide definitive answers. Rather, it attempts to identify key issues which warrant further interdisciplinary conversations. Ongoing collaboration between scientists, clinicians, and scholars in the humanities will be vital for unpacking these questions. Therefore, just as the boundaries between agents may be ambiguous in both addiction recovery and psychedelic-assisted therapy, so too must the boundaries between academic disciplines become more porous in order to explore the intricacies of these enigmatic altered states of autonomy.