(Note: The following article was published on Thefix.com. TooMuchRx.org can not confirm the accuracy of the contents or endorse the treatments contained within.)
By Jeanene Swanson 09/08/14
The Fix lists some holistic alternatives that are playing increasingly important roles in addiction 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.
Nearly 40 years after recreational use of hallucinogens was made a crime, addiction research is showing that three of these drugs—namely LSD, psilocybin, and MDMA—can be useful in treating substance use disorders. Moreover, the South American plant medicine ayahuasca is gaining popularity among some therapists even while rarely being used in test conditions. (Because many clinics outside the U.S are treating addicts with another plant medicine, ibogaine, it is reviewed here separately.)
A dozen or more studies of LSD, psilocybin (the active ingredient in magic mushrooms) and MDMA (ecstasy) are ongoing in the U.S., Britain, Israel and Switzerland; a handful of others have recently concluded. Most of the patients involved in these studies are veterans with PTSD, the terminally ill who are afraid of death, people with treatment-resistant depression, and alcoholics.
Psychedelics-based approaches are reported to improve mood and help people open up and change their self-limiting and negative beliefs along with their moral values. In part, the sense of a supportive "divine order" that can be experienced using these substances under properly-guided “journeys” can alter reactivity and increase an individual’s sense of safety in the world. People with substance use disorders and their counselors report reduced cravings and an increased motivation to stay clean.
On a neurobiological level, because many hallucinogens have chemical structures similar to those of natural neurotransmitters, these drugs act on brain cell receptors that are thought to play a role in addictive behavior. Brain imaging techniques have shown a reduction in blood flow in areas involved in processing emotions and higher thinking—it is thought that hallucinogens “open the mind” by reducing anxiety and depression, as well as dampening down ruminative and self-focused thought patterns. Drawbacks to experimenting with these drugs to treat addiction disorders can include bad trips and flashbacks.
While acupuncture as a helpful treatment for addiction has less of an evidence base than meditation (though a strong one for dealing with pain), it has grown in popularity for treating addiction and related emotional imbalances such as anxiety and depression. In the 1970s, Michael Smith of New York’s Lincoln Hospital developed a five-point acupuncture protocol that focused on the ear alone. Called the Acu-detox method, or National Acupuncture Detoxification Association (NADA) protocol, the auricular acupuncture treatment has been shown to be primarily effective in treating cravings during opiate withdrawal.
“Anecdotal evidence abounds that acupuncture can make detoxification less painful, help control cravings, and decrease anxiety, among other benefits,” addiction specialist David Sack says. “The studies that exist have been hampered by poor controls and small study sizes.” Sacks notes that a 2003 WHO report showed a therapeutic effect of acupuncture on alcohol dependence and detoxification, and on opium, heroin, cocaine, and tobacco dependence, and called for further studies to prove clinical efficacy.
As with all forms of acupuncture, the technique stimulates specific acu-points on the body. The best-known method is penetration by thin needles; others include application of heat, pressure, or laser light and may be accompanied by cupping therapy. A form of complementary and alternative medicine in the West, acupuncture is a key component of traditional Chinese medicine (TCM). In TCM ideology, stimulating specific acupuncture points corrects imbalances in the flow of a body energy form called “qi” through channels known as meridians.
Among several theories about how acupuncture works are these: it modulates neurotransmitters; it stimulates the endocrine system, resulting in relaxation; it stimulates circulation and tends to reduce inflammation. As a whole, a TCM program stimulates the body to correct itself through restoring balance in what TCM considers to be the five body systems: heart, liver, lungs, kidneys, and digestion. Advocates argue it gives recovering addicts the ability to process material that may be at the root of their addictions.
Claudia Voyles, an acupuncturist and clinical supervisor at AOMA Graduate School of Integrative Medicine in Austin, Tx., says that while addiction is not an actual diagnosis in TCM, acupuncture can help addicts. “Sometimes I am supporting the withdrawal process, minimizing the symptoms and craving," she says. "Sometimes we are working on the underlying complaints [or] triggers—stress, anxiety, depression, history of trauma [or] abuse. People in recovery…often have chronic pain or other imbalances that will undermine their recovery [or] quality of life if not addressed.”
According to Margot Chambers, a California state-licensed TCM doctor and head of a rehab facility pain management program, acupuncture is only effective as part of a comprehensive treatment program. In fact, she says, TCM is actually a five-pronged treatment system that incorporates nutrition, herbs, acupuncture, a type of massage called Tui na, and a type of meditation called qigong. Chambers believes that making lifestyle changes is the most important in effecting healing, and number one on her list is nutrition. “I can put needles in someone all day long, but [not] if you keep eating fast food,” she says. “The treatment will last, but it won’t last as long as it should if it’s interrupted by toxins.”
Animal Contact / Pet Therapy
As an assist to more traditional types of addiction treatment, animal/pet therapy works by helping recovering addicts focus outside of themselves in the care of someone else—or “something” else, in this case. Its advocates in the rehab community believe that by caring for a dependent creature, a person in recovery discovers the nurturing side of himself and thereby cultivates a deeper sense of what it means to be nurtured.
Evidence suggests there are are many benefits to spending quality time with pets or companion animals. These include lower stress levels, a reduction in anxiety and depression, lower blood pressure and heart rate, higher self-esteem, and even a reduction in the severity of painful physical symptoms of illness.
Equine therapy, for instance, originally started as a program that used riding horses as a therapy for individuals with physical disabilities. Since then, many recovering addicts (and their therapists) claim to have benefited from interactions and bonding with horses—which appears to build confidence, trust, patience and self-esteem. Horses are naturally responsive and have some similar interactive communication styles to humans, such as nuzzling.
Gardening / Horticulture Therapy
Technically known as horticulture therapy (HT), gardening is used to promote well-being. The therapy is now utilized in a wide range of treatment settings including prisons, psychiatric hospitals, mental health programs and addiction rehab. By offering a recovering substance abuser a caregiving role, gardening provides a sense of purpose, similar to animal therapy.
Evidence shows that gardening can have a positive effect on a range of problems, including reducing aggression, lowering cortisol levels, improving self-esteem, helping people to feel less anxious, reducing the severity of depression, and improving concentration in people who are depressed.
Virtual Reality Therapy
Virtual reality therapy, or VRT (sometimes called “immersive multimedia”), is a form of exposure therapy that uses virtual reality technology to simulate real-life experiences. Pilots, for instance, are trained with it, and for some time it has been used to treat patients with anxiety disorders and phobias, specifically as a treatment for PTSD. Now, newer applications are allowing it to be used for treating addiction and other behavioral problems, in part because of its ability to generate virtual sensory experience for all five senses.
At the University of Houston, for example, researchers are building realistic virtual worlds that re-create triggers, as a way to help participating addicts beat cravings for nicotine, alcohol, marijuana, and heroin. The treatment can be likened to exposure therapy, in which addicts are deliberately triggered while being guided by a counselor. VRT is considered by its adherents, with some supporting evidence—to be more effective than encouraging addicts to avoid the people, places, or things that can trigger a desire to use.
Considered an activity-based therapy like animal therapy and gardening, this can include art or music therapy or certain construction projects. In all instances, this type of treatment encourages the addict to get outside herself through the process of nurturing or creating. It can build self-esteem and self-confidence. Studies have shown that art therapy can reduce relapse rates for several psychiatric disorders while music therapy can lower depression, stress, anxiety, and anger in patients attending rehab for substance abuse.