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Sunday, September 14, 2014
13 Valuable Alternative Treatments for Addiction
The Fix lists some outside-the-box modalities that are playing increasingly important roles in substance abuse treatment.
It’s safe to say that alternative treatments for addiction are no longer, actually, alternative in the “outside of the mainstream” sense. These days, many treatment facilities and therapists offer an array of these types of "supplemental" therapies, including acupuncture, equine (horse) therapy, neurofeedback, biochemical restoration, hypnotherapy, yoga, watsu (water therapy), meditation, ropes courses, sound therapy, and many more. Additionally, researchers are proving that experimental treatment with psychedelic drugs—though still illegal in the U.S.—can have profound effects on reducing cravings and preventing relapse.
There still remains controversy among many recovery professionals as to whether "alternative" treatments can hold their own. The dominant view in the profession is that such treatment modes can be highly effective complements to traditional treatment, helping recovering addicts and alcoholics to muscle through early sobriety. But these techniques can’t do the recovery job alone; a “holistic” therapy such as meditation, for example, should be used in conjunction with traditional treatment-as-usual approaches. “I am not aware of any research supporting the sole use of holistic treatments for chemical dependency,” says rehab center program director Leslie Sanders.
Even so, advocates of many of the treatment modes argue they can have a profound if not crucial influence on recovery. What follows is a guide to some of the dominant and most promising alternative treatment modes and the evidence of their effectiveness, either as stand-alone or supplementary treatment strategies.
Nicotinamide adenine dinucleotide (NAD) is a coenzyme derivative of vitamin B3 - otherwise known as niacin—found in all living cells. NAD is a key agent in metabolism, as well as many other basic cellular processes. Because it is essential to the production of energy in our bodies, it has become a valuable resource for helping addicts, especially when used in mega-doses, for rapid detox. In many cases of substance abuse, the body’s reserves of protein and vitamins—precursors to NAD—are low, resulting generally in low energy.
The mega-dose treatment is in IV form. It is thought to reduce cravings and withdrawal symptoms in patients without using replacement therapies. According to reports, it has been used successfully to treat addictions to prescription drugs including opiates, benzodiazepines, and stimulants, alcohol, cocaine, marijuana, suboxone, and methadone. Results may include improved mental clarity, increase in cognitive function, returned focus and concentration, more energy, better mood, and more positive outlook. Advocates claim it opens addicts up to participate in effective therapy. Bill Wilson, the founder of AA, became an advocate of large doses of vitamin B and once claimed that it was the most effective help he had ever received. The AA board refused his appeal that AA should promote the concept to its members.
Neurofeedback is a process by which electroencephalography (EEG) sensors are attached to one’s head which allows the brain’s activity to be fed back into a computer that displays brain waves in real time. The subject can then interact with her brain waves in order to alter them, directly impacting their frequency.
The procedure is a form of biofeedback, and it has been used for treating a variety of conditions, namely PTSD. Over the past five years, neurofeedback has been gaining traction as a form of alternative treatment at leading recovery and rehab centers. Some addicts claim that it helps with everything from anger to insomnia—key triggers for relapse. The limited science on it is positive but funding for a range of credible controlled studies has been hard to come by.
In essence, neurofeedback can increase or decrease states of arousal—a level of neural activity linked to brain wave frequency. An anxious person would obviously aim for a calmer state (a lower frequency) in a neurofeedback session; someone depressed would seek to create higher frequency and more neural arousal. “It can help keep [addicts] from leaving treatment early,” says Matt Morgan, a neurofeedback treatment specialist. While neurofeedback has a 40-year history, it is still in its infancy as a treatment form for substance disorders. Morgan says there is “no medication out there with such a wide [therapeutic] use.”
Ibogaine is an alternative treatment for opiate addiction. The product of the root bark of an African rainforest shrub, Tabernanthe iboga, ibogaine is used ceremonially by the Bwiti tribe of Western and Central Africa to induce visions and shamanic experience. While it has been categorized as a psychedelic, it is more intense and longer lasting than LSD or mushrooms. It can have dissociative effects as well as sometimes serious effects on motor control, similar to those of the anesthetic ketamine. In the brain, it affects multiple neurotransmitter pathways, making it difficult to discern which effects are most significant.
While animal and human research data show that ibogaine undoubtedly does relieve opioid withdrawal—and the drug is now being used in dozens of clinics around the world, often illegally—it is important to know that ibogaine is apparently not as safe as was once believed. It mixes poorly with many pharmaceuticals as well as narcotic drugs and alcohol. It is illegal in the U.S., although Canada, St. Kitts and Mexico have government-regulated facilities that offer it legally. In Mexico it is considered an “experimental” drug and the most advanced medical clinics only use it with patients who have passed a battery of medical tests.
Outside the U.S. it is used to treat addiction to methadone, heroin, alcohol, cocaine, methamphetamine, anabolic steroids, and other drugs. Ibogaine is also used to treat depression and PTSD. Derivatives of ibogaine that lack the substance’s psychedelic properties are under development.
Meditation is the art of practicing mindfulness, and 12-step programs and counselors alike recommend it as a method to prevent relapse. Gaining mindfulness helps substance abusers become aware of their thoughts and feelings, good and bad, but not react to the negative ones—a key step forward in preventing relapse.
Mindfulness meditation is also a good way to help regulate mood. It can lower the levels of stress hormone cortisol, increase immune system compound interleukin, and assist in the body’s ability to detoxify itself of harmful chemicals, which can affect neurotransmitter receptors and alter mood.
Different types of mindfulness meditation exist. Vipassana meditation teaches the mind not to react to the emotions and thoughts that result in harmful behavior. Some adherents claim that with enough practice, it’s possible to become permanently free of all negative behaviors—addiction included. The Transcendental Meditation organization claims that controlled studies demonstrate that TM “compared to other forms of meditation and relaxation significantly reverses physiological and psychological factors which lead to substance abuse. Compared to control conditions, TM significantly reduced the use of alcohol, cigarettes and illicit drugs in general population as well as among heavy users. Over time abstinence was maintained or increased.”
In fact, an increasing number of studies indicate that mindfulness-based relapse prevention techniques do reduce cravings and prevent relapse as well as, if not better than, traditional treatment. The journal Substance Use & Misuse published an entire special issue in April, 2014, focused on mindfulness-based interventions for substance use disorders. Katie Witkiewitz, an associate professor of psychology at the University of New Mexico, published two studies this year that found that mindfulness-based relapse prevention was more effective than a traditional relapse prevention program in decreasing substance use and heavy drinking up to one year later. “There have been several randomized clinical trials, as well as smaller controlled studies, that have found meditation to be as effective or more effective than existing treatments for addiction,” she says.
Biochemical Restoration and Nutrition
A new type of treatment, biochemical restoration, aims to repair the biochemical imbalances that cause cravings, depression, anxiety, and the unstable moods that lead to—and perpetuate—addiction.
There are certain biochemical imbalances that make a person more prone to addiction and which this treatment—a form of chemical nutrient therapy—strives to improve. These include imbalances of neurotransmitters in the brain, nutrient deficiencies, amino acid imbalances, hypoglycemia, inflammatory and oxidative stress, and adrenal fatigue.
Once biochemical imbalances are assessed, an individualized biochemical restoration plan can be established. This can include a personal nutrition plan, a micronutrient supplement including amino acids (sometimes with a futuristic approach of micronutrient injections), and prescribed physical activity and relaxation. Once balance is restored, other addiction treatment modalities such as counseling and relapse prevention can be tackled more effectively.
David Wiss, a Registered Dietitian Nutritionist who operates a consulting company, Nutrition in Recovery, in Los Angeles, believes the single most ignored aspect to treating addiction is treating nutritional deficiencies. Many other nutritionists second this. Recovering addicts tend toward highly palatable foods that can provide a temporary reprieve from negative feelings. These are almost invariably processed foods with added sugar, salt, and vegetable oil fats; refined carbohydrates, and caffeine—rather than high-nutrient foods. Unfortunately, these foods destabilize blood sugar, spur inflammation, and deplete the brain of essential neurotransmitters that play a large role in stabilizing moods.
Wiss believes that “nutritional interventions [should be] based on real food rather than supplementation.” He recommends a “never hungry, never full” approach of eating six small meals a day, or every two to four hours. Addicts should strive for more protein, fiber, and healthy fats like those found in fatty fish, nuts, and flax seeds. Certainly, learning about nutrition, how to cook healthful meals, and making good food choices are accessible options for the majority of people in recovery.
From a nutritional perspective, an individual in early recovery can improve mood and fight off depression, anxiety, and stress by incorporating foods that contain an ample amount of omega-3 essential fatty acids, complete proteins, and antioxidant and anti-inflammatory vitamins and minerals. These foods will also help the recovering addict’s mind—provide essential building blocks for depleted neurotransmitters, for example—as well as the body, promoting healing of all systems and tissues damaged by malnutrition.
For a superb, science-based chart of eating do’s and don’ts click to see nutrition investigator David Asprey’s "Bulletproof Diet Roadmap."
Yoga, which means “union” in Sanskrit, combines three aspects: physical postures, breath work, and meditation. The philosophy of yoga is to bring the mind, body, and spirit together in a united alignment. This can promote a state of inner peace that might assist recovering addicts in preventing relapse. Many studies indicate yoga can relieve anxiety, stress and depression.
The physical aspect teaches bodily awareness and how to release pent-up emotions and stuck energy. For many in recovery, there has been a disassociation from the body through the use of drugs, alcohol, food, or other substances. Through practicing the physical “asanas,” recovering addicts can become aware of their outdated behavioral patterns and make the conscious decision to change.
Breath work can be a key aspect of healing and recovery from addiction. The lungs are the link between the circulatory and nervous systems, and they provide detoxification, energy, and a built-in relaxation response.
Meditation is important because it allows recovering addicts a deeper sense of self-awareness. By becoming less influenced by the world around them, addicts can learn to shrug off cravings and embrace their inner strength without the need for external validation through substances.
A network of yogis called Yoga of Recovery offers courses and retreats for recovering addicts at leading yoga centers all over the country, including Sivananda and Yogaville.
Daily exercise, even in small doses, can boost mood—what most recovering addicts need in the absence of their substances of abuse. Starting an exercise regimen can help fill the void of using,lending a sense of purpose and offering a substitute, but natural, high.
Generally speaking exercise, whether aerobic or otherwise, has well-known health benefits, including improvements in the function of the cardiovascular, pulmonary, and endocrine systems. Physical exercise has many cognitive benefits that can specifically help recovering addicts. For one, it leads to increased neurotransmitter levels, improved oxygen and nutrient delivery, and increased neurogenesis in the hippocampus. It can have a positive effect on learning and memory. Executive control processes—working memory, multitasking, and planning—are more positively affected in comparison to other regions of the brain.