Exploring Risky Substances Through Ayurveda
The concept of dinacharya - daily routine and preventive health, or put another way, foundational lifestyle medicine - is essential in the Ayurvedic medical system. There is a lot that falls under the umbrella of dinacharya, from circadian sleep schedules to meal timing and food choices to exercise and healthy movement to mindfulness and general behavioral health awareness, and more.
Lots of attention and written content are understandably dedicated to those elements of daily living. They are very impactful when it comes to health and well-being; in fact, from the Ayurvedic standpoint, when those aspects of daily life are not optimized, disease is basically guaranteed to develop at some point.
But there is another element that there tends to be less attention given to, and yet is no less important in our modern world. And that is the use of risky substances.
So, what is a risky substance?
In brief, a risky substance is any substance that alters brain chemistry, structure, and behavior both short- and long-term; that is capable of impairing key brain functions (such as inhibition and discernment) at modest doses; and whose use may become repeated in a compulsive way.
Risky substances, such as nicotine (e.g. in tobacco), alcohol, opioids, anabolic steroids, and amphetamines are very commonly used in a variety of ways. They can sometimes take the form of medications (for example, Adderall is a prescription medication type of amphetamine stimulant), and they can sometimes take on recreational and/or illicit forms (for example, methamphetamine, a common and inexpensive stimulant drug of abuse). Their effects are similar whether they are used medicinally or non-medicinally; the only real differences between medicinal and non-medicinal situations are the doses use, how frequently the substances are taken, and the intention. At any time, a risky substance used as a medicine can easily become a substance that does harm. That is a very fine line, and that line becomes blurrier the more a risky substance is used.
Because risky substances are so common in our modern world, this is a subject that warrants a lot of thoughtful attention and care.
Understanding Risky Substances through an Ayurvedic Lens
Let's return to the definition of a risky substance above for a moment. Risky substances alter brain chemistry in such a way that they impair key brain functions, and their use is likely to become repeated in a compulsive way. When the compulsion to use them reaches a certain threshold, we call that addiction.
If we were to break that down from an Ayurvedic perspective, we might say that generally, risky substances hijack and over-stimulate vata (the airy physiology of movement). They often also aggravate pitta (the fiery physiology of digestion and transformation). They may be rajasik (that is to say, activating), or tamasik (meaning slowing, or having a depressant effect on the central nervous system).
Astringency is a very common feature of these substances. Astringents have, among other qualities, a drying/dehydrating action to them. This is partly what accounts for their vata-deranging effects. They also often have an addictive quality to them.
A lot of risky substances have potential therapeutic use in very small doses (or as we often refer to them, microdoses), and a small number can be therapeutic at more moderate doses under supervised conditions - a good example being psilocybin and similar psychedelics. This is not true of all of risky substances (for example, there is no therapeutic use of inhalants like synthetic aerosols), but it is true of many of them. Beyond microdoses, though, most risky substances make brain activity and behavior erratic and sometimes outright dangerous.
How do we figure out which substances that can be used therapeutically versus those that cannot, and in what situations? Each risky substance has a different chemical profile, and therefore, a different profile of Ayurvedic qualities. For this reason, each substance needs to be evaluated individually and in detail to get the most complete picture. The fullness of that subject is beyond the scope of this post, though we will cover some of the larger categories of risky substances, as well as a couple of special cases below.
Categories of Risky Substances
Risky substances break down into a variety of pharmacologic categories. We'll cover some of the most common ones, and provide examples of each. Again, some of these can be healing in small, measured doses and used in the right situations - they just happen to be extra dangerous when used unhealthfully. Though most of these substances are in just one category, some do crossover between categories:
Psycho-stimulants: caffeine, nicotine, cocaine, amphetamines
Nervous system depressants: alcohol, opioids
Inhalants: aerosols
Anabolic steroids: exogenous testosterone
Cannabinoids: cannabis, extracts like THC and CBD
Psychedelics: psilocybin, MDMA, mescaline
High-reward dopamine triggers: salt, sugar, fat (when these are added to foods, usually in excess)
Mixed category: ketamine
Generally, the substances with the most healing potential will be those coming from natural sources. There are always exceptions, however. And again, every one of these has the potential to be exceptionally dangerous, and to cause significant harm.
Special Cases: Cannabis and Psychedelics
Let's cover, briefly, a couple of special cases with lots of known therapeutic uses, and that have been in the cultural zeitgeist over the last handful of years: cannabis and psychedelics.
Firstly: cannabis.
Each substance has a profile all its own in the Ayurvedic system. Cannabis is heating, drying, light, and sharp. The sharp quality lends to a penetrating action that brings on the high, though the other qualities also contribute. The effect on the doshas is therefore an upward-moving increase in both vata and pitta, but particularly vata, and especially toward the central nervous system.
This can be incredibly therapeutic in certain situations. For example, in nausea and vomiting caused by chemotherapy, cannabis takes the vata and pitta stew out of the peripheral and enteric parts of the nervous system and redirects it centrally. This brings on relief from the nausea and vomiting.
Similarly, in certain cases of insomnia, that upward moving action stimulates the pineal gland to function more effectively and help with sleep. And, in fact, we know that cannabinoids from cannabis can sometimes increase melatonin production in the pineal gland by a factor of 20.
Of course, vata and pitta in excess, especially together, can cause a ton of health issues as well, so in folks with high-vata and high-pitta constitutions and conditions, we must take special care if incorporating cannabis into a plan of care.
Next: psychedelics.
We'll focus specifically on the example of psilocybin and psychedelic mushrooms, because otherwise this could turn into a much longer diatribe.
A key bit of context here is that a whole host of medicinal substances have some psychedelic or psychedelic-like potential when used in large doses. For example, saffron and nutmeg, both commonly used in small, medicinal doses in Ayurveda for a variety of concerns and conditions, have known psychedelic action at higher doses. So there is, in a way, a very old precedent for microdosing in the Ayurvedic system!
In order for a substance to exert psychedelic effects, it must be innately heating and exceptionally subtle. And wouldn't you know it - psilocybin-containing mushrooms are indeed heating and subtle! These qualities can be therapeutic under the right circumstances. There is another feature of mushrooms, in particular, that is useful in certain therapeutic situations, though, and that is that they are tamasik. A tamasik substance is, by its nature, a substance that slows the roll of a highly active mind. Too much tamas can very quickly become a bad thing. But in cases of PTSD and treatment-resistant depression, for example, many of which are high in rajas (the trait of momentum and high activity), tamas can be profoundly therapeutic. From an Ayurvedic standpoint, this is the mechanism for how psilocybin and psychedelic mushrooms work when micro dosed, and also when utilized for therapeutic psychedelic experiences under a competent, trained guide.
The Importance of Non-Judgment in Ayurvedic Practice
As I hope this post highlights, there is a lot of gray area when it comes to risky substances. Many can be therapeutic when used in the right doses, at the right time, and for the right people.
Unfortunately, risky use of risky substances is probably much more common.
Simply because someone is using a risky substance in a risky way, though, does not mean that they deserve judgment or ire. To the contrary, when someone uses a risky substance in a risky way, they are doing one of the most human things imaginable: self-medicating. And we all self-medicate all day, through various means like food, sensory stimulation of different kinds (I'm looking at you, streaming services and social media), physical activity (or lack thereof), the relationships we choose and foster, and so on. Self-medication can be healthful or it can be unhealthful - and this holds true whether risky substances are used or not.
And it's important to point that out so that we collectively hold an attitude of non-judgment toward those who might be stuck in a loop with any risky substance(s) you can think of.
Non-judgment is at the foundation of our practice's approach to caring for folks with any relationship to a risky substance whatsoever. Maintaining non-judgment means maintaining space to hold open, honest conversations about substance use and health. Those conversations cannot happen without it.
Ayurvedic Assessment and Treatment of Substance Use
Once a non-judgmental groundwork is laid, the care for folks with a risky relationship to risky substances follows the same pattern to all others we care for: we identify their constitution (prakrti); we assess their present state and of health and their health conditions (vikrti) through the lens of the doshas and triguna; we share our findings; and we put together a plan of care based on our findings and the health goals, lifestyle needs, and care preferences of the person sitting in front of us.
That always involves identifying the root causes of the person's health conditions and concerns. The approach is no different when we are caring for someone with a pattern of risky use of risky substances. In fact, it becomes even more important. If someone is self-medicating for something, why would we fixate only on the substance? Why would we not find ways of tending to the thing they are self-medicating?
And then, we set about using tools for genuine healing, rather than for masking symptoms and conditions. Fully individualized nutrition plans without silly dogma; thoughtful prescriptions for safe, enjoyable physical activity; mind-body, emotionally-intelligent, and stress-relieving interventions; therapeutic breathwork; personalized herbal medicine treatments; and competent guidance on substance tapering and safe prescription medication use where appropriate. We address the underlying needs of the person without substances, and always with attentiveness to their constitution and condition.
We also don't shy away from collaborating with other healthcare professionals, particularly when it comes to specialty care like therapeutic microdosing.
The topic of risky substances is an important one with respect to our collective health in the present day. At The Buddha's Medicine, we don't shy away from discussing this with each and every person we have the privilege of caring for.
We encourage all of you reading to consider your own relationship with substances, and with daily routine and preventive health in general. This is the subject of our robust, self-paced course, The Essentials of Ayurvedic Daily Living: Dinacharya, which is a resource available to all, whether patients of our practice or not.
And if you're interested in more depth and direct care, I invite you to book a cost-free, 15 minute Consultation to see if we’re a good fit. Together, we can create a personalized plan that aligns with your health goals and addresses your health needs.
Dr. Matt Van Auken, MD, MPH
Dr. Matt is an Ayurveda-trained, triple board-certified physician.
