This document discusses considerations for assessment and risk management in providing ibogaine therapy. It emphasizes the importance of thorough client assessment, addressing physical, mental, spiritual and social well-being. A minimum of 6 assessment sessions pre-ibogaine therapy is recommended to build trust and develop an individualized treatment plan. Integrating ibogaine therapy into existing healthcare services through consistency, transparency and professionalism is discussed. The document also highlights priorities for providers like self-education, cultural knowledge, and avoiding anti-establishment thinking.

2. Ibogaine Aotearoa/NZ
A Path to Integration with
Considerations on Assessment & Risk
By Tanea Paterson
Director/Provider Ibogaine Aotearoa Charitable Trust I.ACT
Applied Addictions Practitioner DAPAANZ Registered

3. "E nga mana, e nga reo, e nga waka, e tau
nei.”
To all the chiefs, all the dialects, all the
waka that have gathered here.

4. Ko Tinana toku waka
Ko Hereweka toku mauka
Ko Mata-Au toku awa
Ko Tanea Paterson toku ikoa
No Otepoti ahau
No reira
Tena koutou, tena koutou, tena koutou katoa

5. Tanea Paterson
• Born in
Otepoti/Dunedin
• Spanish, Scottish
and English
• Two Sons, Josef 13
and Salem 8
• Solo Mum/Student
for 13 years
• Methadone
program for 7
years, 6 years free
• Qualified Addiction
Practitioner

6. • 2008-09 Certificate in Health at Otago Polytechnic
• 2009 Ibogaine Fora North & South Island
• 2011 Set up Ibogaine Aotearoa Charitable Trust or
I.ACT
• 2011 Attended Cutting Edge National Addiction
Conference & won award for my poster
• 2011 Voluntary intern at Salvation Army ‘drop in
centre’
• 2011 Registered as an Addiction Practitioner with
DAPAANZ
• 2012 Completed Te Taketake Applied Addictions
Practitioner Paper through Moana House
• Current - Work at DIVO Dunedin IV Organisation
• Comprehensive 1st aid and level 4 Resus Certification

7. Risk Management
What Risk?
• Provider
• Client
• Movement
• West Africa –
culture &
resources

8. Addiction Training and the
Importance of Personal Growth
• Transference and Countertransference
• Self Disclosure “who is benefitting from it?”
• Supervision (not limited by geography)
• Naïve Benevolence – doing goodwill without
considering potential risks. When it is ok to
say no or not yet
• ‘Rescuing’ without proper assessment.
(Karpman Drama Triangle, 1968)

9. Persecutor,
Rescuer and Victim
Dance

11. Rescuers get caught up in enabling.
Doing too much for someone else is
rationalized because "I care so much."
Rescuers are often unaware that pity and
disrespect are the fuel for this role. "I
know what's best for you.” (thus moving
into the persecutor role)
Backing up from the rescuer role means
learning that indifference can be a useful
tool.
Wait and see if the person you’re trying to
rescue steps forward for themselves,
increasing self efficacy on the way.

12. So next time you feel that brief flash of irritation
at the start of a conversation or are left with a
negative feeling after a conversation just stop
and ask yourself “Was I just sucked into a
Drama Triangle?” and then consider the
question ”And to what extend was I
unconsciously colluding?”. The tactic to avoid
the Drama Triangle is to learn to recognise the
emotional “hook” that signals the invitation to
play the Game; and to consciously deflect
it before it embeds into your unconscious
mind and triggers an unconscious, habitual,
reflex reaction. Anyone able to “press your
button” is hooking you into a game.

13. Priorities for Providers to Reduce Risk
to Self and Others
• Education, research and self growth
‘having a baby does not make you a
midwife’
• Bwiti Tikanga, respect and
knowledge of West Africa and
source of the medicine we use
• Negative thinking towards ‘the
system’ slows progression

14. Anti-establishment
thinking slows
progression

15. Ibogaine Therapy Integration NZ
• The Feb 2010 scheduling of ibogaine as a
non-approved prescription medication allows
integration into health services
• Prior to this ibogaine was ‘underground’
therefore often dismissed by healthcare
providers
• Exposing clients to risk -uninformed primary
health workers = unsupported clients
• Ibogaine is ONE part of a therapeutic plan

16. Developing and Maintaining Trust
with Existing Health Services
Consistency of
• Provision
• Protocol
• Professionalism
Transparency of practice

17. Code of Ethics DAPAANZ Example
Drug and Alcohol Practitioners
Association of Aotearoa/NZ
THE DAPAANZ CODE – THE MAIN ETHICAL
PRINCIPLES
In the DAPAANZ Code there are 10 main
principles and/or core values.

18. Structural and Core Elements
DAPAANZ
1. Self responsibility and practitioner
status
2. Responding to clients and community
3. Professional practice within agencies
and organisations

19. Assessment – Why Do It
• Who is this person?
• How can we best serve their needs?
• How is their mind, body, spirit and
social network.
• Minimum of 6
assessment/counselling/preparation
sessions pre ibo

20. The Importance of Assessment
• Builds therapeutic alliance
• A holistic picture of the client enables a more
individualized therapy plan
• Identifies strengths and build on these for
increased sense of self worth & efficacy
• Identifies history and extent of drug use and
this also allows for opportunities to increase
the clients’ awareness around substances
• Can be therapeutic in itself, allows for
reflection and communication with whanau

21. Western Model vs Eastern
Orthodox/Maori Model
Western - Humanity in Eastern - Humanity &
control our relationship with
the universe
• Relationship to the issue • Relationship to each other
• Scientific explanation • Spiritual explanation
• Evidence based • Nature of breach
intervention (imbalance)Realignment
Scientia - Takes a Snapshot, Spirituality - Moving Model,
Seeks Answers Seeks questions

22. Te Whare Tapa Wha (Durie, 1982)
• A model of Maori health
• Allowed Maori to reclaim a sense of
ownership over health
• Shifted away from a focus on disease and
medical expertise
• Recognised health as a balance between
wairua, hinengaro, tinana, whanau, the four
walls of a house
• Used within areas of health, education and
social services in Aotearoa/NZ

24. Balancing Wellness
As in Te Whare Tapa Wha all four areas
must be considered
Ibogaine alone has the capacity to heal
physically, spiritually and psychologically
to an extent.
It doesn’t change the person’s
social/whanau interactions.

25. Taha Tinana - Body
• Medical/physical exam
• Exercise
• Illness
• Supplements
• Diet
• Physiological sensitivity to ibogaine
• Mind body link
• Overdose, using during tx or directly after
‘Break up sex’

26. Taha Hinengaro - Mind
• Psychiatric assessment/meds
• Counsellor/therapist engagement
• Fears listened to
• Hopes listened to
• Reassurance
• Cognition and thoughts
• Understanding and acceptance of process
• Motivational Interviewing & Relapse
Prevention Plan

27. Taha Whanau – Family/Social
• Genogram/genetic predisposition
• Who know’s? Who cares?
• Work/education
• Whanau inclusive practice = support,
education & therapy
• Communication
• Relationships, respect. Reduce stigma
• Aftercare & Social participation

28. Taha Wairua - Spirit
• Beliefs and how they can be supported
throughout therapy
• Values
• Rituals
• Reassurance, Dignity and Respect
• Cultural identity
• Personal contentment
• Spirituality
• Stages of Change, Prochaska & DiClemete

30. Considerations on Assessment and
Alliance
• Surroundings, compliance more likely in
a clinical setting – go for a walk
• Senses, Cognition – does the person
really understand. Have they had
enough time to ask questions?
• Negotiate access to substances during tx
(inc cannabis, cigarettes, supplements)
• Paradoxical effect of medications i.e
benzodiazapine

31. Honouring Origins by Assessment
“initiatory process in addiction
therapy”
• Spending the time with people prior to
therapy not only builds trust and truth, it
also allows greater respect for
iboga/ibogaine (minimum 6 weeks)
• I see assessment and therapy planning as a
kind of initiatory process
• This time spent prior to ibogaine increases
long term efficacy thus lessens the amount
of ibogaine used – sustainability

32. Importance and Benefits of
Integrated Care
• Assessment and Therapy Planning
• Common language and synchronized therapy
plans within sector
• Insight and understanding into existing
services for individual needs when planning
• Legitimacy and availability of ibogaine
therapy grows with awareness and
commonality of care
• Best Practice

33. Why Follow Best Practice?
Cui Bono?
To whose benefit?
Who profits by it?

34. ~50yrs on - Many ‘mistakes’ have been
made, all with good intentions, to
honour those pioneers we should not be
making the same mistakes.
We, and future generations of
providers and healers, therefore
clients, all benefit from
Best Practice.

35. Creative Commons Potential
• Creative Commons for collective input from
providers
• “Our vision is nothing less than realizing the
full potential of the Internet — universal
access to research and education, full
participation in culture — to drive a new era
of development, growth, and productivity.”

36. He aha te mea nui o te ao?
He tangata! He tangata! He tangata!

37. Further Reading….
• DAPAANZ Code of Ethics
• Karpman Drama Triangle
• Te Whare Tapawha Maori Model, Durie
• Relapse Prevention Planning, Marlett &
Gordon
• Motivational Interviewing, Miller & Rollnick
• Stages of Change, Prochaska & DiClemente