Metzner (1998) points to the significant differences in the use of psychedelic medicines within the non-Western traditions in contrast to the Western adaptations in psycholytic and psychedelic therapies. He also points to similarities in modern psychiatric uses of psychedelic medicines and commonalities with shamanic traditions in the induction of profound ASC that provides the experience of a transcendent reality; the use of a skilled guide or therapist to direct the set and setting—the circumstances, expectations, and intentions that guide the therapeutic processing of the experiences; and the “amplifier analogy,” nonspecific psychedelic drug effects that enhance the significant underlying emotional dynamics of the person and situation (Metzner 1998). Adoption of some aspects of the shamanic traditions of the psychedelic medicines is illustrated in what Metzner calls hybrid therapeutic-shamanic rituals which blend understandings of indigenous shamanic practices with the Western psychotherapeutic approaches. These approaches include a number of elements he views as traditional to shamanic healing such as participants sitting or reclining in a circle; a central area of an altar or fire or other ritual focus; the preference for nighttime and low light activities; the guidance by an elder and other assistance; the invocation of spiritual powers from fundamental directions as guidance for the activities; the focus on constructing the appropriate set and setting, typified in having clear intentions for the divinatory and therapeutic encounter; the use of music, drumming, chanting, and a variety of percussive instruments such as rattles; engaging in a variety of mental psychospiritual practices such as meditation, body awareness, focused attention, and other processes designed to enhance therapeutic insights. These shamanic principles are also manifested in what can be called “Neoshamanic Ayahuasca Traditions.” The therapeutic applications of shamanic principles enhanced by ayahuasca have been manifested in the development of an international tourism, what some (Dobkin de Rios 1994) have critiqued as “drug tourism.” North Americans and Europeans, educated about the potentials of ayahuasca, seek out these sessions in the international marketplace for ayahuasca ceremonies, particularly in South America. The ayahuasca purveyors, primarily in Peru but also through other Amazonian countries, engage an internal clientele who seek of the legendary powers of ayahuasca. In a study based on interviews with some of these so-called “drug tourists,” Winkelman (2005) discovers people in search of the kinds of powerful personal and spiritual healing that ayahuasca can provoke. Contrary to the search for hedonistic highs implied by the characterization as “drug tourists,” their principal motivations are characterized by seeking spiritual relations and personal spiritual development; various forms of emotional healing, particularly unresolved traumas; and the development of personal self-awareness, including some sense of direct contact with a sacred nature, God, spirits, and plant and natural energies produced by the ayahuasca. Their motivations for their journeys and the perceived benefits that they report obtaining both point to transpersonal concerns. The principal perceived benefits involve increased self awareness, personal insights, and access to deeper levels of the self that enhanced personal development and expressions of the higher self, providing personal direction in life (Winkelman 2005). Based on his use of ayahuasca among many of these seekers, Luna (2006) characterizes the use of ayahuasca as engaging an “other,” a plant teacher. This provides a cognitive potential, a tool for engaging an “existential intelligence” that provokes a heightened capacity for awareness of grand cosmological dimensions of the human condition. This increased awareness of cosmological issues and mysteries of human nature engages us with some of the central questions that have perennially occupied the deepest thought of humans who have come to profoundly contemplate the human condition and our understanding of reality. However, it is generally the case that the modern practices have yet to fully engage the shamanic dynamic. The biological bases of shamanism suggests that the classic features of shamanism such as social isolation and vision questing, diet and sexual abstinence, animal powers and identities, dream incorporation, personal identification with nature, and the death-and-rebirth experience can provide important additions to help achieve a “best uses” approach to psychedelic medicine.