Psilocybin & Bufo (5-MeO-DMT): Evidence-Informed Paths for Trauma, Mental Health & Addiction—And How Aftercare Makes the Difference

By Christopher Shaw, LCSW-S CSAT-S RYT

Founder, Merkaba Temple & Merkaba Retreats

Co-Founder, ArcherShaw

Healing doesn’t have to be “Western or Earth medicine.” The most durable change often comes from integrating medical screening, evidence-based psychotherapy, and community support with carefully facilitated non-ordinary states.

Below is what current research says about psilocybin and bufo/5-MeO-DMT, how they’re used, where the evidence is strongest (depression, alcohol/tobacco use), what’s still emerging (drug and sexual compulsivity), and why aftercare is the bridge from peak experience to lasting remission.

Psilocybin: The Evidence Leader Among Classic Psychedelics

What it is & how it’s used. Psilocybin, the active compound in certain sacred mushrooms, is most effective when held in a structured, intentional process. This begins with thorough medical and psychological screening, followed by preparation that sets both mindset and intention. The experience itself may take place in a ceremonial retreat, shamanic session, or therapeutic container—often supported by music, prayer, and experienced facilitators who create a safe and sacred space. In the weeks that follow, integration practices help ground insights into lasting transformation. The depth of healing depends not only on the medicine, but also on the quality of the setting, the skill of the guides, and the strength of the therapeutic relationship.

Where evidence is strongest:

• Depression (including TRD): A randomized trial found psilocybin-assisted therapy achieved antidepressant effects comparable to escitalopram on the primary endpoint, with several secondary outcomes favoring psilocybin—demonstrating meaningful efficacy when paired with therapy (Carhart-Harris et al., 2021, New England Journal of Medicine).

• Alcohol Use Disorder (AUD): In a double-blind RCT (N=93), psilocybin + psychotherapy significantly reduced heavy-drinking days across 32 weeks versus active placebo + psychotherapy (Bogenschutz et al., 2022, JAMA Psychiatry).

• Tobacco Use Disorder: A Johns Hopkins pilot with long follow-up showed 67% biologically confirmed abstinence at 12 months and ~60% at ~30 months—remarkable for a small, early study that combined psilocybin with CBT-style support (Johnson et al., 2014, Journal of Psychopharmacology). Larger RCTs are underway.

• Trauma-related symptoms (early but promising): Small pilots and VA clinical summaries note reductions in PTSD-related symptoms when psilocybin is paired with trauma-informed psychotherapy; PTSD-specific psilocybin trials in Veterans are currently underway (Davis et al., 2020).

Bufo / 5-MeO-DMT: Ultra-Brief, Profound—Clinical Promise Still Emerging

What it is & how it’s used. Bufo (5-MeO-DMT), a powerful tryptamine found in the secretion of the Sonoran Desert Toad, is offered in ceremonial and therapeutic settings that emphasize both safety and sacredness. At Merkaba Retreats, Bufo is ethically and ceremonially collected by Sonoran Elders, with no harm to the toads, who are always released back into their natural habitat. The medicine is then administered in a guided ceremony—held with the highest reverence for the medicine, and the presence of skilled facilitators who ensure both protection and reverence. Although the journey itself is brief, often lasting only 20–40 minutes, its impact can be profound, offering ego-dissolution, trauma release, and deep states of unity. As with psilocybin, the true healing unfolds in the integration process, where insights are anchored into daily life with therapeutic support and community practices.

What research shows so far:

• Mood & anxiety (observational): Naturalistic and lab studies associate 5-MeO-DMT experiences with rapid reductions in depression, anxiety, and stress—signal of benefit, but without large diagnosis-specific RCTs yet (Uthaug et al., 2019; Davis et al., 2019).

• Short-term safety profile: A 2024 systematic PRISMA review of human studies reported favorable short-term safety and tolerability, with no serious adverse events in the included trials, and called for larger randomized studies with longer follow-up (Reckweg et al., 2024, Frontiers in Pharmacology).

Addiction & Compulsivity: Where These Fit

• Alcohol & Nicotine: Psilocybin shows the clearest benefits to date when combined with psychotherapy and integration (Bogenschutz et al., 2022; Johnson et al., 2014).

• Drug addiction: Trials are emerging across substances; early results are promising but not yet definitive.

• Sexual compulsivity (“sex addiction”/CSBD): Evidence is early. A recent clinical perspective highlighted plausible mechanisms (shame reduction, trauma processing, interrupting compulsive loops) and emphasized the need for controlled trials (Garcia-Romeu & Richards, 2022).

The Power of Having a Psychotherapist Who Is Also a Medicine Holder

One of the greatest assets in this work is a facilitator who is both a trained psychotherapist and an experienced medicine carrier. This dual role ensures the ceremony is not only held in sacred reverence but also grounded in evidence-based clinical wisdom. During the journey, the facilitator understands trauma responses, attachment dynamics, and the neurobiology of addiction, offering safety and containment when difficult material arises. After the ceremony, that same guide can translate insights into concrete therapeutic strategies, integration plans, and relational repair work. This bridge between the mystical and the clinical dramatically increases the likelihood that breakthroughs become lasting change.

How Earth Medicines Complement Western Care (and Sometimes Catalyze Remission)

• Potentiate psychotherapy. Psychedelics can amplify emotional openness and cognitive flexibility; therapy translates those states into behavior change.

• Biopsychosocial-spiritual synergy. Medical oversight ensures safety; psychotherapy targets mind and behavior; spiritual and community practices anchor meaning—together they support long-term remission.

• Aftercare = durability. Integration therapy, somatic practice, couples or group work, and consistent accountability are what transform peak states into new life patterns.

At Merkaba Retreats, we have witnessed outcomes that speak to the profound potential of earth medicines when combined with preparation, ceremony, and faithful aftercare. Some individuals who arrived on multiple psychiatric medications no longer needed those same prescriptions after their retreat—provided they stayed committed to their integration plan. Chronic relapsers have found long-lasting sobriety where conventional treatment had failed. People living with debilitating conditions have experienced significant healing and renewal. While research is still catching up, these lived experiences illustrate how psilocybin and bufo, when held in safe ceremonial containers and supported by rigorous aftercare, can complement Western treatment—and in some cases, catalyze breakthroughs that feel nothing short of miraculous.

Why Many Western Clinicians Hesitate — And Why Those Fears Miss the Point

Despite the growing body of evidence, many therapists, psychiatrists, and physicians remain hesitant to recommend or even acknowledge the potential of earth medicines. Some of this comes from valid concerns: the legal status of these substances, the lack of large-scale randomized clinical trials for every condition, and the potential risks when ceremonies are poorly facilitated. Caution is important.

But in many cases, resistance is also rooted in unfamiliarity or fear rather than evidence. Some clinicians are unaware of the extensive safety protocols, medical screenings, and integration practices that reputable retreat centers uphold. Others fear that if a client finds deep healing through psilocybin or bufo, they may no longer “need” ongoing therapy or psychiatric care in the same way—raising unspoken concerns about loss of professional control or income.

At Merkaba Retreats, we see the opposite. When someone finds relief from depression, addiction, or trauma through earth medicines, it does not end their healing journey—it transforms it. Many continue therapy or coaching with a renewed sense of purpose and effectiveness, now approaching the work from a place of wholeness instead of crisis. Far from making therapists obsolete, these medicines can make the therapeutic process more fruitful, efficient, and sustainable.

Rather than being at odds, earth medicines and Western medicine can work hand-in-hand. The future of healing is not about choosing one over the other—it’s about building bridges of trust and collaboration so people can access the full spectrum of tools available for human flourishing.

Bottom Line

• Psilocybin: strongest evidence for depression and alcohol/tobacco addiction, especially when combined with psychotherapy and structured integration.

• Bufo/5-MeO-DMT: powerful, short-acting, and promising; observational data show reductions in depression, anxiety, and trauma-related symptoms, with a favorable short-term safety profile—though large RCTs are still needed.

• Having an expert psychotherapist as facilitator: bridges the mystical with the clinical, ensuring the deepest safety and the highest chance of true, durable healing.

• With rigorous screening, ethical sourcing, sacred ceremony, and faithful aftercare, these medicines can help people move from cycles of trauma and addiction into freedom and wholeness.

Selected References

• Carhart-Harris RL, et al. (2021). Trial of psilocybin vs escitalopram for depression. New England Journal of Medicine.

• Bogenschutz MP, et al. (2022). Psilocybin-assisted therapy for alcohol use disorder: a randomized clinical trial. JAMA Psychiatry.

• Johnson MW, et al. (2014). Pilot study of psilocybin for tobacco dependence. Journal of Psychopharmacology.

• Davis AK, et al. (2020). Effects of psilocybin-assisted therapy on major depressive disorder. JAMA Psychiatry.

• Uthaug MV, et al. (2019). A single inhalation of vaporized 5-MeO-DMT in a naturalistic setting is associated with sustained improvements. American Journal of Drug and Alcohol Abuse.

• Davis AK, et al. (2019). 5-MeO-DMT used in a naturalistic group setting is associated with improvements in anxiety, depression, and stress. The American Journal of Drug and Alcohol Abuse.

• Reckweg J, et al. (2024). Clinical pharmacology, safety, and therapeutic potential of 5-MeO-DMT: a systematic review. Frontiers in Pharmacology.

• Garcia-Romeu A, Richards WA. (2022). Potential of psychedelics for compulsive sexual behavior disorder: A clinical perspective. Sexual Addiction & Compulsivity.