Meet UPRA: Oleg Orlov

Psychotherapy enhanced by the use of psychoactive substances is a very powerful transformational tool. It can potentially bring people a lot of benefits. But you need to know how to use this tool. For me, UPRA is an organization that should collect, improve, and disseminate the best practices of using this tool.

Evolution of views

UPRA began several years ago with the idea of holding a scientific conference on psychedelic assisted therapy in Ukraine.Then FDA granted MDMA psychotherapy the status of a breakthrough treatment. This was an extraordinary event, as the usefulness of psychedelics was recognized by the very institution that had actually blocked research in this area for the past 50 years. After that, interest in psychedelics in the Western world simply exploded.

Around the same time, an open discussion of the prospects for medical use of cannabis began in Ukraine. Personally, I am rather indifferent to medical cannabis. But I was positive that some scientists, doctors, and officials started discussing this topic publicly. Previously, public discussions either condemned any use of psychoactive substances (PAS) or avoided the topic altogether.

Anyway, my colleagues and I had the idea to get together and talk about the latest global trends in mental health care with a focus on the use of surfactants. It turned out that many people were interested in this topic. We planned to start a regular seminar, translate literature, and start unhurried negotiations with the authorities to create a research project in Ukraine. We thought that around 2024, the FDA would allow the widespread use of MDMA in the United States, and then in another 5-10 years, this topic could come to us.

Then the war started. Reality and priorities changed a bit.

Unreasonable fear or unreasonable optimism

I once gave an open popular science lecture on neurobiology and mental health. At the end of the lecture, after a question from one of the participants, we talked about psychedelic therapy. I was struck by several things in my communication with the audience. First of all, that people still believe in the stereotypes formed by American social advertising back in the 1970s, when it was believed that the best strategy to overcome the problems associated with substance abuse was to scare people as much as possible. Back then, the media spread information that LSD caused psychosis, genetic mutations, and encouraged people to commit suicide. This has long been proven to be untrue. It has also been proven that scare tactics do not work. I was also struck by how popular it is to think that simply taking LSD (or traveling to Peru and receiving real ayahuasca from a shaman) is enough to improve your mental health. People asked me "how to organize my psychedelic experience so that I don't have to go to a psychotherapist". Some of my colleagues have a similar attitude - groundless fear or groundless optimism.

I also had a prejudice against using PAS at first. My father had a problem with alcohol. Also, I, like everyone else, was influenced by the "educational work on drug prevention" that was carried out at least from kindergarten. Therefore, up to a certain point, I had a very negative attitude towards any substances, including alcohol. In my subconscious, two images were inextricably linked - any psychoactive substance and death from an overdose somewhere in a dark basement.

My attitude towards PAS began to change during my studies at university. At some point I wanted to learn about different psychological theories of personality. I found an excellent textbook by H. Ziegler, which briefly described almost all the theories of personality that exist today - from early behaviorism to humanistic psychology. I was so interested in this topic that I decided to read at least one book by each of the authors listed in Ziegler's book. And the topic of PAS came up quite often in my reading. W. James, Sigmund Freud, Carl Rogers, Ellis, F. Perls, Maslow, and many others are connected to it in one way or another. In the works of some psychologists of the 1950s and 1970s, it is difficult to distinguish between writing about psychology and writing about the culture and philosophy of the time, which was heavily influenced by the psychedelic experience. It is impossible to study modern psychology (as well as philosophy and culture) in depth enough without learning about psychedelics and their use in therapy. I also came across this topic when studying psychopharmacology and neuropsychology. The more I learned about the workings of the psyche, the less I generally divided mental phenomena and behavior into "good" and "bad", and the more I paid attention to biopsychosocial mechanisms, interrelationships, causes and effects. And their impact on the individual quality of life of people.

My interest would not be fully satisfied if I did not have my own experience with PAS. It allowed me to understand something important about myself. And it had nothing to do with the horrors I had once fantasized about. More than 10 years have passed since then, and it seems like I haven't gone crazy and haven't taken my mother's TV to the pawnshop.

Live and appropriate

I am against illegal psychedelic therapy. People who participate in it take risks and put others at risk. I also believe that self-administration of psychoactive substances, even to improve one's own psychological state, is not psychedelic therapy. But I cannot forbid people to make certain decisions, even if I do not approve of them. And I definitely won't refuse a person who wants to discuss any of their experiences, especially if they can benefit from my knowledge or personal opinion.

I remember several cases where psychedelic experiences helped people in therapy to move forward. These experiences are usually about understanding quite simple truths that may seem insignificant to other people. But it's the living of this experience that helps a person to really appropriate these truths for themselves.

One of the most striking examples of this was a girl I worked with many years ago. She went to therapy to improve her personal life. In my opinion, she had a lot to offer guys. She was kind, smart, quite attractive, and successful in her profession. But she was very concerned about one feature of her appearance, which she considered a "defect." Her parents also considered it a defect and constantly reminded her of it from an early age. In such circumstances, people often seem to grow up with their peculiarity and try very hard to compensate for it. This was the case with this girl. She considered herself to be "defective" and because of this, it was difficult for her to defend her own interests in relationships. One day she came to a therapy session and said, "You know, during the time we haven't seen each other, I suddenly realized that I am not my defect. It's just one of the many characteristics that I have."

No one but us

I am in favor of a gradual evolutionary approach. Psychedelic therapy should definitely develop as a method. It is already known that it can effectively help certain categories of people overcome some mental disorders with the use of certain auxiliary substances. Moreover, the effectiveness of psychedelic therapy is often higher than that of traditional methods. Therefore, it is definitely not worth ignoring as a phenomenon. But we shouldn't assume that taking psychoactive substances will rid humanity of all its problems. In my opinion, it is more useful to share information about psychedelic therapy, study it, engage in a scientifically based critical discussion, and gradually introduce this therapeutic modality into practice. All of this should be done in a civilized, transparent manner and with respect for the participants in the process. Of course, this is possible only within certain legal frameworks. Only then will it be possible to get the maximum possible benefit from psychedelic therapy and not be disappointed by unjustified expectations. The use of this tool should be regulated.

In Ukraine, there are problems with the regulation of mental health services in general. Only the activities of doctors are regulated. The vast majority of modern methods of psychotherapy do not exist for the state. A psychotherapist and an acupuncturist are in the same heading of the classifier of economic activity. It doesn't matter whether the psychotherapist uses scientifically based methods or those that he or she invented yesterday. This makes it difficult for people to find a quality specialist. And it is difficult for the specialists themselves to maintain the quality of the profession at the proper level.

UPRA should do everything possible to help psychotherapists in other fields build a professional culture in mental health care. But this will be in the more or less distant future. Currently, the use of psychoactive substances in therapy, with some exceptions, is prohibited in Ukraine. Therefore, the UPRA should focus on making psychotherapy services enhanced by the use of substances legally available, at least in early access programs. It is also necessary to train specialists, develop professional standards, and think about regulating professional ethics. There are many tasks. No one else will do it but us .

Watch and read

Michael Pollan, book “How to change your mind”. Very easy to read. The history of psychedelics, psychotherapy, neuropsychology, and the author's own experience.

How to change your mind - Netflix documentary series

Stanislav Grof, book“LSD Psychotherapy” (in Russian). For those interested in methodology. One of the most fundamental works on psychedelic therapy. Although I would not recommend Grof's later works, because I do not like the transpersonal approach.

Belouin, S. J. & Henningfield, J. E. (2018). Psychedelics: Where we are now, why we got here, what we must do. Neuropharmacology, 142, 7-19. Recommended for psychedelic pessimists and psychedelic optimists.

Blog DrugStore (in Ukrainian). Not exactly about psychotherapy. But there are a lot of scientific evidence-based information about both substance abuse and mental health.

The websites of projects and organizations are good sources of information. For example, The Boston Psychedelic Research Group, the Multidisciplinary Association of Psychedelic Studies. There are quite a few of them now, and new ones are appearing all the time. Unfortunately, they are mostly English-speaking.

UPRA is currently working on finding various high-quality materials on the topic. We translate some of them. We write something ourselves. I think that over time, we will become the main source of quality Ukrainian-language content on psychedelic therapy.