Neurologic Basis of Addiction & Treatmentby Dr. Heath McAllister
In trying to determine how best to treat someone with addiction, its important to know several things. First what is the addicting substance: alcohol, cocaine or amphetamines, opiate drugs, etc. These substances act on the brain in similar ways in the sense they trigger a release of dopamine and serotonin. However the withdrawal symptoms that can result from going off these drugs are very different. A general rule of thumb is that when going off of a stimulant (cocaine, methamphetamines, crack) the person will tend to feel more depressed and lethargic. Conversely when withdrawing from a depressant, like alcohol or opiates, (opium, heroin, morphine, hydrocodone, oxycodone) the person will tend to experience agitation, tension, and nervousness. Therefore how these withdrawal symptoms are managed needs to be viewed in terms of what kind of drug is the addicting agent.
There are several prescription agents that can and are used to help wean people off of addicting drugs like methadone for opiate drugs, benzodiazepines like Valium to help with feelings of agitation, and SSRIs like Prozac to help increase serotonin in the brain. And while these medications can be helpful, from my experience working at a drug and alcohol rehab facility, there is a massively untapped resource for treating addiction in natural therapies. Below is a summary of natural therapies that can be helpful in both treating withdrawal symptoms as well as helping restore normal neurologic function.
Managing Withdrawal Symptoms
Depressants - when someone is withdrawing from a depressant drug like alcohol or opiates, they often experience rebound tension, anxiety, insomnia, and agitation. To help someone through these difficult withdrawal symptoms that can sometimes last several weeks and longer, the strategy is to give natural substances that are calming and relaxing. Below are a list of the substances I’ve found most useful in helping manage these symptoms:
Ashwaganda (Withania somnifera) - This herb from India has a long reputation for helping increase someone’s energy and vitality while relaxing the nervous system. In modern research all human trials involving Ashwaganda have shown significant reduction in anxiety levels. I’ve used Ashwaganda in a great many patients with excellent results.
Schizandra (Schizandra chinensis) - This is a powerful herb from China that has a myriad of positive actions in the body. While being good for the lungs and adrenal glands, it also is very supportive of the liver which is the main detox organ in the body. Additionally Schizandra helps boost someone’s energy while keeping them feeling relaxed and calm. In modern research, Schizandra has been successful in reducing anxiety resulting from alcohol withdrawal.
Hops (Humulus lupulus) - Hops is a wonderful herb that most of us are already familiar with; it’s the main bittering agent used in beer. On its own, Hops has a powerful ability to relax the body and mind, promoting restful sleep, and decreasing anxiety. In one study, non-alcoholic beer was shown to have sedative qualities owing to the hops, and other studies have confirmed the relaxing effects of hops.
Valerian (Valeriana officinalis) - Valerian is well known for its sedating effects. It has been widely studied for its ability to relax the mind and body, improve sleep, decrease muscular tension, and decrease anxiety. In research Valerian has been shown to modulate GABA receptors and therefore reduce feelings of anxiety.
GABA (gamma Aminobutyric acid) - This is the main inhibitory neurtransmitter that’s found in the brain. That means it is secreted to help relax the mind and body and decrease tension and anxiety. It can help promote restful sleep and is very effective at decreasing agitation.
L-Theanine - this is an amino acid that has been extracted from green tea. It does not contain caffeine and in fact has the exact opposite effect of promoting a relaxed state of mind. I’ve used l-theanine extensively in patients who have too much resting anxiety; its very effective at cutting through mental chatter and promoting a greater sense of well-being. In clinical trials L-theanine has been shown to reduce anxiety and enhance mood in patients with mood disorders.
Inositol - this is another amino acid that has a very reliable ability to promote a relaxed state of mind and cut through anxiety. Its is not overly sedating and so it can be dosed without worry of putting someone to sleep. Rather it will help people feel more relaxed and even keep throughout the day. In clinical trials Inositol has shown marked promise in reducing anxiety and panic attacks, outperforming Fluvoxamine (an SSRI medication) wile having few known side effects.
Stimulants - when someone is withdrawing from stimulant drugs like crack, cocaine, methamphetamines, etc., they tend to experience drowsiness, poor concentration, and depressed mood. To help someone through these difficult withdrawal symptoms, the strategy is to give them substances to help boost their energy naturally. Below is a list of substances that I’ve found most helpful in managing these symptoms:
Ginseng (Panax ginseng) - this is one of the most widely studied herbs. It comes from China and has been used there for thousands of years to boost energy and vitality. Moreover Ginseng has a myriad of other health benefits from boosting the immune system to increasing athletic performance, etc. It is a powerful ally that I’ve used countless times in patients who need a boost in energy. Clinical trials have confirmed that Ginseng can indeed boost energy levels as well as decrease pain.
Rhodiola (Rhodiola rosea) - This is an herb that, like Ginseng, has a powerful ability to boost the energy naturally. Rhodiola tends to be quick acting and the results are usually felt after only a few days. Rhodiola helps boost adrenal gland function which are the organs in the body responsible for quick energy as well as helping us feel alert through the day. In clinical trials Rhodiola has been validated for ita ability to boost energy levels while decreasing stress levels.
Eleuthero (Eleutherococus senticosus) - Eleuthero is a widely studied herb from Russia that has been used to help boost energy, athletic performance, and improve immune function. It has been safely and effectively used with people needing a natural boost in energy and is one of the most reliable herbs for this.
Methylcobalamin (Vitamin B12) - B-12 is an essential vitamin that is needed for a great many functions in the body. It helps boost energy and is used by many people for this purpose. It also can help balance our neurotransmitters. It is consider to be a ‘methylation cofactor’ in the brain which is essential for the production of dopamine and serotonin. I recommend the methylcobalamin form of B12 since it is the most biologically active form, meaning it is in the form the body prefers and so can be used immediately.
Pyridoxal 5 phosphate (Vitamin B6) - Vitamin B6 is a very important nutrient used in a wide variety of functions in the body. Similar to B12 it is also a methylation co-factor and is used to help produce normal healthy levels of the neurotransmitters dopamine and serotonin. Vitamin B6 is also very important in supporting the adrenal glands which are responsible for giving us quick energy. I recommend the Pyridoxal 5 phosphate form of Vitamin B6 since it is the most biologically active and can be used immediately by the body.
EFAs - Essential Fatty Acids is a term that refers to Omega-6 and Omega-3 fatty acids. These lipids play an integral role in cell membranes making them more flexible and therefore easier for substances like serotonin to pass through them. Two important Omega-3 fatty acids known as DHA and EPA have been shown to be in markedly lower concentrations in depressed populations. These two Omega-3 fatty acids are found in high concentrations in fish oil and have been used to help stabilize mood, improve concentration, and may decrease addiction relapse.
Phospholipids - these are substances that are also found in cell membranes like essential fatty acids and include phosphatidyl choline and phosphatidyl serine. They are involved in intraneuronal cell signaling. They have a variety of therapeutic functions including increasing acetylcholine in the brain, improving memory and cognition, and may addiction decrease relapse.
5HTP - 5-Hydroxytryptophan is a precursor molecule to the neurotransmitter serotonin. It can be used to boost low serotonin levels. Low serotonin has been proposed as one of the factors involved in addiction and mood disorders like anxiety and depression.
Tyrosine - this is an amino acid which can be converted in the brain to dopamine, one of the main neurotransmitters thought to be involved in addictive behavior. When addictive substances are taken in, invariably there is a surge of dopamine released in the brain, inducing pleasure and acting as a reward system. By supplementing with tyrosine, patients withdrawing from particularly opiate drugs experience less anxiety, anger, and improved mood.
Folic acid - Folic acid is a B-vitamin that is vitally important in its role in helping produce normal healthy amounts of neurotransmitters. It is considered a methylation cofactor and is used to convert precursor substances into dopamine and serotonin. Vitamins B6 and B12 are also methylation cofactors. More and more research is coming out about the importance of methylation and we are finding that a great many people have problems with this biochemical pathway. Supplementing folic acid has shown promise in reducing symptoms of depression and is a major nutrient deficiency in alcoholics.
Bacopa (Bacopa monniera) - This is an herb from India that has been used for thousands of years to improve memory, cognition, and to enhance overall mental functioning, benefits that have been shown in modern clinical trials. Bacopa has also been used to reduce stress and improve mood and may be a powerful herbal treatment in treating addiction.
Avena (Avena sativa) - Milky oat-seed extract has long been used by herbalists for helping to rebuild a damaged nervous system ravaged by chronic stress. Drug addiction is a massive stress on the nervous system, both physiologically and psychologically. There is some evidence that milky oat extract can decrease addictive cravings, and anecdotally many herbalists and alternative practitioners find this one of the most useful herbs in dealing with addiction.
Mucuna (Mucuna pruriens) - This is an herb from India that has long been used for mood disorders. More recently it has been shown to have the ability to raise dopamine levels in the brain. It is therefore used with great success in Parkinson’s patients who have an extreme dopamine deficiency. Considering dopamine is the pleasure and reward molecule released from the brain when addictive drugs are used, this herb can be safely given to gently raise levels thus improving addiction and craving. Additionally Mucuna seems to have a normalizing and restorative effect on the brain, which could be extremely valuable in rehabilitation from drug abuse.
Gotu kola (Centella asiatica) This is an herb from India that has been used for thousands of years to improve memory, cognition, and improve concentration. In studies it has been shown to improve acute anxiety as well as improve memory and has neuroprotective effects. Gotu kola was classically used in India to help improve the depth and quality of their meditation. I have found Gotu kola to be an excellent addition to my regimens in treating patients with addiction.
There are many other therapies that can be extremely beneficial in treating addiction. My personal philosophy is that addiction is a complex multi-factorial disorder, and similarly the treatment should be a multi-prong approach in order to achieve the best results. Below are several applied psychotherapy and mindfulness techniques that I have found extremely beneficial in the treatment of addiction.
EMDR - Eye Movement Desensitization and Reprocessing therapy
This is an applied psychotherapy technique developed by a psychologist, Francine Shapiro during which dysfunctional patterning can be corrected and the reactivity from painful memories and experiences can greatly be reduced. The process involves a typical counseling session to identify core issues or beliefs that may be underlying the addictive or reactive behavior. Then alternating side to side eye movements are engaged as specific times during the visit to help integrate the processing of these memories and experiences better, effectively taking the emotional charge off of them. I have found this therapy to be supremely effective for a wide variety of problems and conditions.
Guided Imagery - This is a simple yet profound therapy during which you are guided into state of progressive relaxation. It is like a cross between meditation and hypnosis, and the results are felt almost immediately. There are a variety of guided imagery resources for various conditions.
Mindfulness meditation - Mindfulness meditation is the pinnacle form of self-mastery. It involves sitting quietly and observing the mind and body from a neutral space without judgment. Meditation has been shown to have innumerable healthy benefits from reduced anxiety and depression decreased violent behavior, increased well being, decreased food binging, decreased alcohol binging, decreased pain, and offer a valuable tool to help overcome drug and alcohol addiction.
J Altern Complement Med. 2014 Nov 18. [Epub ahead of print]
Chin Med J (Engl). 2014 May;127(10):1935-40.
PLoS One. 2012;7(7):e37290. doi: 10.1371/journal.pone.0037290. Epub 2012 Jul 18.
Phytomedicine. 2006 Sep;13(8):535-41. Epub 2006 Jul 24.
BMC Complement Altern Med. 2014 Jul 28;14:267. doi: 10.1186/1472-6882-14-267.
J Clin Psychiatry. 2011 Jan;72(1):34-42. doi: 10.4088/JCP.09m05324gre. Epub 2010 Nov 30.
J Clin Psychopharmacol. 2001 Jun;21(3):335-9.
PLoS One. 2013 Apr 17;8(4):e61271. doi: 10.1371/journal.pone.0061271. Print 2013
Int J Neurosci. 2013 Jul;123(7):480-6. doi: 10.3109/00207454.2013.764499. Epub 2013 Feb 11
Support Care Cancer. 2010 Feb;18(2):179-87. doi: 10.1007/s00520-009-0642-2. Epub 2009 May 6
J Clin Psychiatry. 2005 May;66(5):625-32
Rev Bras Psiquiatr. 2013 Mar;35(1):21-8
Holist Nurs Pract. 2014 Mar-Apr;28(2):149-54. doi: 10.1097/HNP.0000000000000014.
Phytother Res. 2012 Aug;26(8):1220-5. doi: 10.1002/ptr.3712. Epub 2012 Jan 6
Rees AM, Austin MP, Parker G (April 2005). "Role of omega-3 fatty acids as a treatment for depression in the perinatal period". The Australian and New Zealand Journal of Psychiatry 39 (4): 274–80
Arch Gen Psychiatry. 1999;56(5):407-412. doi:10.1001/archpsyc.56.5.407
Alexandra J. Richardson, Jennifer R. Burton, Richard P. Sewell, Thees F. Spreckelsen, Paul Montgomery. Docosahexaenoic Acid for Reading, Cognition and Behavior in Children Aged 7–9 Years: A Randomized, Controlled Trial (The DOLAB Study). PLoS ONE, 2012; 7 e43909 DOI: 10.1371/journal.pone.0043909
Psychiatry Res. 2003 Aug 30;120(1):29-35.
J Nutr. 1995 Jun;125(6):1484-9.
J Nutr. 1995 Jun;125(6):1484-9.
Curr Pharm Des. 2013;19(40):7036-49.
J Huazhong Univ Sci Technolog Med Sci. 2012 Jun;32(3):422-7. doi: 10.1007/s11596-012-0073-z. Epub 2012 Jun 9.
Br J Psychiatry. 2006 Feb;188:109-21.
Phytother Res. 2014 Apr;28(4):551-9. doi: 10.1002/ptr.5029. Epub 2013 Jun 21
J Pharm Pharmacol. 1975 Feb;27(2):92-8.
Ayu. 2014 Jan;35(1):90-7. doi: 10.4103/0974-8520.141949.
Parkinsonism Relat Disord. 2010 Aug;16(7):458-65. doi: 10.1016/j.parkreldis.2010.04.015. Epub 2010 May 31.
Phytother Res. 2004 Sep;18(9):706-12.
Recent Pat Endocr Metab Immune Drug Discov. 2011 Jan;5(1):33-49.
CNS Drugs. 2013 Apr;27(4):301-19. doi: 10.1007/s40263-013-0059-9.
Fitoterapia. 2013 Jun;87:69-77. doi: 10.1016/j.fitote.2013.03.023. Epub 2013 Apr 2
Recent Pat Endocr Metab Immune Drug Discov. 2011 Jan;5(1):33-49.
Med Care. 2014 Dec;52 Suppl 5:S25-31. doi: 10.1097/MLR.0000000000000224.
Med Care. 2014 Dec;52 Suppl 5:S19-24. doi: 10.1097/MLR.0000000000000202.
Behav Modif. 2008 Sep;32(5):622-37. doi: 10.1177/0145445508315854. Epub 2008 Mar 24
J Behav Med. 2014 Nov 23. [Epub ahead of print]
Psychol Addict Behav. 2014 Nov 17. [Epub ahead of print]
Pain Med. 2014 Nov 7. doi: 10.1111/pme.12605. [Epub ahead of print]
Front Psychiatry. 2014 Oct 9;5:139. doi: 10.3389/fpsyt.2014.00139. eCollection 2014.