This chapter is based on over 15 years of field observation by the authors and the findings of a theoretical and qualitative empirical study that included interviews with 15 therapists who used ayahuasca professionally in the treatment of addictions, as well as with 14 substance-dependent individuals who participated in ayahuasca-assisted treatment in varying contexts. The chapter will address the value of ayahuasca for substance-dependence treatment from a psychotherapeutic perspective, and the variables that may influence treatment outcome. Special attention is placed on the role of ritual and integration. © 2014 Springer-Verlag Berlin Heidelberg. All rights are reserved.