Liester and colleagues have described several hypotheses for potential mechanisms by which ayahuasca use may be useful in the treatment of addictions. One suggested mechanism is that ayahuasca use reduces dopamine levels in the mesolimbic pathway, thereby reducing activity in the reward pathway in the brain. A second hypothesis is that the reduced dopamine signaling interferes with synaptic plasticity that is associated with learning and development and maintenance of addiction. A third hypothesis suggests that ayahuasca use contributes to improved decision-making ability. The final hypothesis is that the ayahuasca-induced transcendent experiences allow the user to overcome problematic substance use. These recent findings suggest that further research is needed into the potential efficacy of ayahuasca in the treatment of psychiatric and substance use disorders as well as to clarify risks of use. Furthermore, the increasing discussion of ayahuasca in the media and the growing popularity of its consumption are indications that clinicians must be prepared to discuss this substance with patients.