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Long-term adverse experiences following psychedelic use can persist for weeks, months, or even years, and are relatively unexplored in psychedelic research. Our convergent mixed-method study gained quantitative and qualitative data from 608 participants who reported extended difficulties following psychedelic experiences. Data was gathered on the context of use, the nature and duration of the challenges they experienced (including a written description of these), plus a range of possible risk factors and perceived causes. The most common forms of extended difficulty were feelings of anxiety and fear, existential struggle, social disconnection, depersonalization and derealization. For approximately one-third of the participants, problems persisted for over a year, and for a sixth, they endured for more than three years. It was found that a shorter duration of difficulties was predicted by knowledge of dose, drug type and lower levels of difficulty reported during the psychoactive experience, while a narrower range of difficulties was predicted by taking the drug in a guided setting. Implications for psychedelic harm reduction are discussed.

Psychedelic induced mystical experiences have been largely assumed to drive the therapeutic effects of these substances, which may in part be mediated by changes in metaphysical beliefs. However, there is growing evidence that psychedelic experiences can also trigger long lasting distress. Studies of persisting difficulties suggest a high prevalence of ontological challenges (related to the way people understand reality and existence). We conducted semi-structured interviews with 26 people who reported experiencing existential distress following psychedelic experiences. We explored the phenomenology of participants’ difficulties and the ways they navigated them, including what they found helpful and unhelpful in their process. Thematic analysis revealed that participants experienced persistent existential struggle, marked by confusion about their existence and purpose and preoccupation with meaning-making. Along with cognitive difficulties stemming from the ungrounding of their prior frameworks for understanding, participants’ ontologically challenging experiences also had significant emotional, social, bodily and other functional impact. Participants managed to alleviate their distress primarily through ‘grounding’: practices of embodiment and the social and cognitive normalisation of their experience. Our findings suggest that psychedelic experiences act as pivotal mental states that can facilitate transformative learning processes, challenging and expanding the ways individuals make meaning. This research contributes to the growing field of psychedelic integration by exploring the complex pathways through which people reestablish coherence and grow following ontologically challenging psychedelic experiences.

Rivers constitute a major tourism resource, providing spectacular settings, recreation facilities, a means of transport, a sense of heritage and adventure, and links with the environment and natural world. River tourism accounts for a significant proportion of the world’s tourism consumption, with activities such as Nile cruises and rafting holidays making it an economically important area of tourism demanding in-depth analysis. This book explores river tourism from a range of perspectives including uses, heritage, management, environmental concerns, and marketing