October 1, 2015

By: Dr. Virender Sodhi, NMD, MD (Ayurved)

Introduction:

Drug addiction has been recognized as a society-wide problem in United States since the 1970s; when we saw the beginning of the “War on Drugs.” In 1971, President Nixon declared drugs “Public enemy number one.” Since then, billions of dollars have been poured into the criminal justice system and research to gain ground on America’s problem with addiction.

illicit drug use 2013 Despite more than 40 years of work, a 2013 study found illicit drug use is still prevalent among 24.6 million Americans—9.4% of the population.[1] More than 9 million people have issues with drug dependence and abuse.

specific illicit drug use 2013 Addiction is one of the most misunderstood diseases in our society. Addiction scientist Dr. Nora Volkow explains the stigma against drug abusers: Some believe that “addiction is a moral failure,” caused by weak willpower. In her TED talk, Dr. Volkow describes how many addicted patients can’t curb their abusive behavior even after drugs are no longer pleasurable. So the question arises: What causes this uncontrollable behavior?

The Science of Addiction:

Addiction is defined as “a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use—despite harmful consequences.”[3] Individuals affected by addiction have many risk factors that lead to their initial drug use. People take drugs for a variety of reasons:

  1. “To feel good.” Most drugs provide a feeling of intense pleasure and euphoria.
  2. “To feel better.” Some people who suffer from social anxiety or stress or depression begin abusing to feel better.
  3. “To do better.” People may use drugs to improve cognitive or athletic performance.
  4. “Because others are doing it.” Some people feel social pressure or choose to experiment out of curiosity.

Repetitive drug use can result in changing brain chemistry, causing loss of impulse control.

Dr. Volkow’s research demonstrates that drug use triggers a pleasure mechanism. In most cases, this is marked by a spike in dopamine release from certain centers of the brain.

Dopamine serves as the main “reward” neurotransmitter for the brain—producing the feeling of pleasure by activating various pathways. This is described as the “reward system” of the brain, which can be activated by serotonergic, opioid, endocannabinoid, GABAergic and glutamatergic receptors in the brain and other parts of the body.[4] These reward stimulations are intense; experiments show that animals on drugs will “ignore readily available food, water, toys and sexually-receptive animals of the opposite sex in order to self-deliver the brain-stimulation reward.”

When dopamine neurotransmitters are overstimulated, the brain slowly begins to reduce the number of dopamine receptors in various parts of the brain. However, with fewer receptors present, the body needs higher drug doses to get the same pleasure-reward on its next use. Ongoing, repetitive drug use causes individuals to crave higher doses and more frequent use—leading to dependence and abusive behavior.

Drug Effects:

Heroin: This drug binds to the opioid receptors of the brain that regulate pain, hormone release and feelings of well-being.[5] This results in the release of dopamine, causing a sensation of pleasure.[6] The initial rush of taking heroin includes: warm flushing of the skin, dry mouth and a heavy feeling in the extremities, which may be accompanied by nausea, vomiting and severe itching. Aftereffects include: drowsiness; mental function clouds; heart function slows; and breathing slows severely, sometimes enough to be life-threatening.[7] Long-term use causes imbalances of neuronal and hormonal systems, as well as loss of white matter of the brain. Physical dependence can cause symptoms of withdrawal including: restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps (“cold turkey”) and leg movements.

Ecstacy (MDMA): This “party drug” is prevalently used by young adults between ages 18 and 26, according to a 2014 study.[8] A small percentage of children begin experimenting as early as 12 years old. MDMA promotes the expression of three neurotransmitters: serotonin, dopamine, and norepinephrine.[9] Serotonin triggers release of oxytocin and vasopressin, which play an important role in love, trust, sexual arousal and other social experiences. Negative effects of serotonin surge are: confusion, depression, sleep problems, drug craving and anxiety. On the physical level, MDMA can cause increased heart rate and blood pressure, as well as an uncontrolled rise in body temperature. The resulting hyperthermia from an MDMA overdose can cause liver, kidney and cardiovascular system failure.

Cocaine:[10] This drug can be snorted in the powdered form called cocaine or smoked in the rock crystal form called “crack” cocaine. It is a strong brain stimulant that instantly releases high levels of dopamine. Cocaine blocks the normal breakdown and re-absorption of dopamine, artificially flooding neurons with the chemical. To protect itself, the brain down-regulates its dopamine receptors. Therefore, people crave higher doses with each use—ultimately resulting in addiction. Physical effects include: constriction of blood vessels and dilation of pupils, as well as increases in body temperature, heart rate and blood pressure. Cocaine-related deaths often result in cardiac arrest or breathing arrest. People using cocaine are also at higher risk of contracting HIV.

Prescription Drugs:[11] There are three major classes of prescription drugs that can be addictive or abused commonly. These include:

  1. Opioids Drugs: These pain relievers bind to the opioid neurotransmitter, similar to heroin—promoting pain relief by activating the pleasure and reward systems.
  2. Central Nervous System Depressants: These slow down brain activity, resulting in a sense of numbing or detachment. Depressive activity is similar to the “date-rape drug,” GHB, by over-activating the GABA neurotransmitter of the brain.
  3. Stimulants: The mechanism of these drugs is similar to cocaine. Stimulating the dopamine reward system, they also improve alertness and activity, while lowering appetite.

Prescription drug abuse affects 6.5 million—more than 25 percent of drug abusers.

Stimulants, i.e. amphetamines, are often prescribed to children and teenagers for ADHD, and therefore, present a greater risk of abuse among minors. The National Institute for Drug Abuse (NIDA) article on the subject explains, “Most teenagers who abuse prescription drugs are given [drugs] for free by a friend or relative.”[12] On the other hand, opioid pain relievers are more commonly prescribed to adults; they also cause more deaths than all other illegal drugs combined among middle-aged individuals.

Deaths from opioid pain relievers Chart 3:[13] Deaths from opioid pain relievers are greater than other illicit drugs in all age groups…

Alcohol: This is the most commonly-abused substance in America. A 2013 survey found that over 56% of Americans reported drinking at least once per month.[14] Nearly 25% of Americans reported binge drinking once per month.[15]

Alcohol Abuse Disorder Prevalence[16]
16.6 million Americans of age 18 or over
Male Female
10.8 million men 5.8 million women

The effects of alcohol are seen in the brain, heart, liver and more.[17] Alcohol slows down communication among neurons of the brain, affecting coordination, mood and decision making. The heart can be affected directly or indirectly and succumb to conditions like cardiomyopathy (disease of the heart muscle), arrhythmia, stroke and high blood pressure. The liver’s detoxification process can become overwhelmed by heavy drinking; this can result in chronic liver inflammation and diseases like fatty liver, hepatitis, fibrosis and cirrhosis (liver failure). The inflammatory effect of drinking can also raise the risk of certain cancers: mouth, esophagus, throat, liver and breast.

Marijuana: This herb is the center of a complex conversation in our nation. While many depend on it for relief for severe conditions[18] like multiple sclerosis, schizophrenia, epilepsy, Crohn’s disease, chemo or radiation side effects and more, it is also easily used and abused as a recreational drug. Most of the medicinal benefits of marijuana, including pain relief, anti-anxiety, relief from muscle spasms, anti-psychosis, etc., are derived from CBD compound—the non-psychedelic aspect of marijuana.[19] Despite this, there is great potential for abuse among those who use the THC component of marijuana for various conditions.

Marijuana over-activates the part of the brain that is receptive to THC. The short-term effects can increase sensitivity, alter sense of time, affect decision-making, impede problem solving and impair short-term memory.[20] Marijuana smokers tend to have reduced blood flow and reduced volume of cerebral spinal fluid in the brain.[21 ]

Neurological testing of adolescents smoking marijuana reveals that this group has a lower concentration of neurotransmitters that contribute to activity of anterior cingulate cortex of the brain, which is involved in certain emotional experiences, pain activation, as well as attention and focus.[22] Another preliminary study demonstrated damage to the corpus callosum—a structure that supports communication between the left and right hemispheres of the brain. This is caused by heavy marijuana smoking.[23]

Treatments:

The National Survey of Drug Use and Health[8] estimated that 23.2 million Americans, age 12 and older, need treatment for their drug use. Of these, only 2.4 million received treatments at specialty facilities. That means, nearly 21 million people who needed treatment for illicit drug and alcohol use did not receive it.

This is a great deficit in the healthcare system and it is affecting some of the most vulnerable people in our society. The National Institute for Drug Abuse (NIDA) offers some Principles for Treatment of abuse and addiction.[14]

Principles for Treatment:

  • No single treatment is appropriate for everyone.
  • Treatment needs to be readily available.
  • Effective treatment attends to multiple needs of the individual, not just his or her drug abuse.
  • Counseling—individual and/or group—and other behavioral therapies are the most commonly-used forms of drug abuse treatment.
  • Medically-assisted detoxification is only the first stage of addiction treatment, and by itself, does little to change long-term drug abuse.
  • Drug use during treatment must be monitored continuously, as lapses during treatment do occur.

Withdrawals:

Symptoms of withdrawal are common when detoxifying from drugs and alcohol. Symptoms may include: restlessness, muscle and bone pain, insomnia, diarrhea, vomiting and cold flashes with goose bumps—all subject to vary depending on the substance.[15] Interventions are available to support the body from succumbing to severe reactions, while continuing to detox from the substance.

Signs You May Enabling Addiction:

It is absolutely essential that enablers recognize their role and the ways in which they enable friends, family or loved ones who are affected by addiction. By identifying this key problem, enablers can stop doing what addicted friends or family members are capable of doing for themselves.

The following questions can help determine if you are enabling addictive behavior:

  1. Do you take steps to cover up the addiction and help keep it hidden?
  2. Do you make excuses for your loved one’s addiction or behavior?
  3. Do you avoid confronting the addiction in an attempt to avoid conflict?
  4. Do you believe your loved one is just going through a phase?
  5. Do you believe the problem will eventually resolve itself without help?
  6. Do you handle responsibilities for your loved one?
  7. Have you bailed your loved one out of jail?
  8. Have you paid bills for your loved one, who likely used income on their addiction?
  9. Do you have a parent-child relationship with your loved one even though they’re your spouse?
  10. Do you enjoy the feeling of being ‘needed’ by your loved one?
  11. Are you guilty of giving second, third and fourth chances?
  12. Do you ever participate in risky behaviors alongside your loved one?

Answering yes to one or more of these questions could indicate that you have been an enabler in your loved one’s life. Even if your actions come from a place of love, care and concern, you could actually be prolonging your loved one’s addiction and even making it worse.

Stop Enabling Behavior:

It is never easy to stop enabling behavior—especially if you are the one who will be suffering consequences. You are sure to receive pushback and possibly experience retaliation. You may even worry about the outcome, fearing something bad will happen to your loved one without your help.

There may be short-term pain and difficulty, but it is nothing compared to the anguish and misery a long-term addiction can cause. After all, the person with an addiction will come to face the consequences of alcoholism or substance abuse at some point; enabling will only postpone that time—potentially making it worse.

Ending Enablement: Don’t Fear the Outcome:

Maybe you drive your husband to and from the bar, because you know that a DUI citation could make him lose his job and the income that supports your household. Or, perhaps you write your son’s college essay for him while he gets high, because you believe his drug use is just a phase and don’t want it to ruin his future. As noble as those deeds may seem, they are only perpetuating a problem rather than compelling your loved ones toward a solution.

Set Boundaries and Be Assertive:

In order to change your enabling behavior, you must be committed to the process. Start by establishing clear boundaries for yourself and your relationship with others who are prone to substance abuse. Let the person know that you still care for them, but will be saying ‘no’ to all requests for help. You may find it easier to speak to your loved one about your new boundaries before enablement situations arise.

Be assertive as you tell them that you:

  • Will not give them any more money, regardless of the need or circumstance
  • Will not lie on their behalf or make excuses for irresponsible behavior
  • Will not bail them out of jail
  • Will not fulfill commitments to others on their behalf
  • Will not handle their responsibilities at home, work or in other situations

Often, people close to a person who has addiction will find difficulty saying ‘no’ to requests for help—especially if they are fully capable of finding or creating a solution. If someone with addiction has always turned to you for help, expect that person to become angry or emotional when you deny that request. Do not give in to manipulation or threats—both of which are tools frequently used by people with addiction who have a need they want met.

Don’t Let Another Person’s Substance Abuse be a Threat to Your Well-Being

People with addiction are often unaware of the danger they cause to those around them. It is important to remember that the consequences of a loved one’s substance abuse should rest on them—not you or other people.

For instance, allowing a spouse who has a substance addiction to drive you or your children is very dangerous and could be potentially life-threatening. You should never ride in the car with a person under the influence. However, you shouldn’t offer a mutual solution either. Instead of offering yourself as a designated driver, allowing your spouse to drink or use substances free of accountability, take a separate car instead, forcing him or her to face the responsibility of those actions. If necessary, report hazardous driving to the authorities—it just may be the wake-up call your loved one needs.

Plan for Unreliability

When you stop enabling behavior, the people who once depended on you may become unpredictable in their own behaviors. They may act out against you, making you feel like a victim. It is important that you learn to expect unreliability and make plans to cope with it in advance. This type of preparation prevents you from being victimized and also deters any attempts at manipulating your choices.

For example, if your family is leaving on vacation, but a member is too sick for departure because they spent the previous night drinking or abusing drugs, do not postpone your trip. Instead, leave exactly as planned, allowing your loved one to experience the consequences of his or her actions. It must be a conscious choice you make out of confidence and control—not a last-minute decision in the height of emotion.

Don’t Concede to Threats

People who are in the throes of addiction use manipulation techniques to control their enablers. But when enablers stop facilitating those addictions, the person may become enraged, perhaps making threats in an attempt to regain control.

Never concede to a threat. Instead, stand firm on your decisions, taking action as necessary.

Threats are always made from a place of insecurity. Usually, the most severe threats come from a place of intense desperation—often a tipping point for people with substance abuse. If your daughter threatens to drop out of college and move in with her boyfriend because you are no longer enabling her substance abuse with your money and resources; let her. It is not your responsibility to solve another person’s problems, accommodate their needs, or assume their responsibilities no matter how much it hurts.

Getting Real Help for Addiction

Just because you have decided not to enable your loved one’s addiction does not mean that you cannot still help them. Ultimately, their desire to change must come from within. Forcing them to face the harsh realities of substance abuse and its consequences may be just the incentive they need to seek real help. Encourage those whom you care for to seek treatment from an addiction rehab facility center as soon as possible. The road to recovery may not be easy and the journey may be long; but the help and support may be exactly what your loved one needs to begin the path to sobriety.

Natural Treatment Options:

These days, many treatment facilities offer therapies, including acupuncture, equine (horse) therapy, neurofeedback, biochemical restoration, hypnotherapy, yoga, watsu (water therapy), meditation, ropes courses, sound therapy and many more options. These treatment modes can be highly effective complements to traditional treatment, helping recovering addicts and alcoholics to muscle through early sobriety.

Vitamin B Treatment:

Nicotinamide adenine dinucleotide (NAD) is a coenzyme derivative of vitamin B3—otherwise known as niacin. 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, stimulants, alcohol, cocaine, marijuana, suboxone and methadone. Results may include improved mental clarity, increased cognitive function, returned focus and concentration, more energy, better mood and a more positive outlook.

Neurofeedback:

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 his or her brain waves in order to alter them, directly impacting their frequency.

The procedure is a form of biofeedback; 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.

Meditation and Yoga:

Meditation is the art of practicing mindfulness; 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. 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 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.

Mindful 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.

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 journalSubstance Use & Misusepublished 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.

Breath work (Pranayam) can be a key aspect of healing and recovery from addiction. The lungs are the link between the circulatory and nervous systems; they provide detoxification, energy and a built-in relaxation response.

Nutritional deficiencies can be another cause of addictions. Foods with salt, added sugar, vegetable oil fats, refined carbohydrates and caffeine—rather than high-nutrient foods—destabilize blood sugar, spur inflammation and deplete the brain of essential neurotransmitters that play a large role in stabilizing moods.

Daily exercise, even in small doses, can boost mood—what most recovering addicts need in the absence of their substances. Starting an exercise regimencan helplend a sense of purpose and offer a natural high.

Ayurvedic Herbs:

Ayurvedic herbs which can help addictions patterns are Holy basil, Bacopa monnieri, Centella asiatica, Ashwgandha, Mucuna pruriens and Triphla. In animal studies, these herbs have shown no withdrawal symptoms.

Addiction is a serious issue that needs to be addressed on many levels. Overcoming enabling behavior is the first step and counseling can be helpful for families. Those facing addiction can benefit from counseling, yoga, meditation, breathing exercises, supplements and the aforementioned Ayurvedic treatments.

References