Drug-Free Treatments For Opioid Use Disorder

Numerous studies point to nutritional therapy in impacting the ability of individuals recovering from substance dependence to remain drug-free. Substance use can seriously deplete or destroy bio-chemicals necessary for healthy functioning. Unless these nutrients are restored, the body will continue to crave the substances that it has been deprived of and the likelihood of relapse will remain high.

Malnutrition is a common problem among individuals struggling with addictions, and nutrient deficiencies only exacerbate existing substance use problems. Clinical signs of nutrient deficiency are diagnosed in about three quarters of actively using addicts and more than sixty percent suffer from multiple malnutrition. (Nazrul, 2002; Santolaria-Fernández, 1995)

One study revealed that 70% of addicts suffer from vitamin D deficiency, and another showed that 50% were deficient in at least three or more critical nutrients at the time of detox, particularly iron or vitamins A, C, and E. (Gambera, 1976; Ross, 2012; Salz, 2014) Given these deficiencies, it is not surprising that a significant number of addicts are plagued by biochemical, nutritional, and metabolic disorders, including anemia, hypoglycemia, adrenal dysfunction, Leaky Gut Syndrome, malabsorption of nutrients, food allergies, learning and memory deficits, and other related problems. (Finnegan, 1989; Miller, 2010; Peck, 2000; Tanusri, 2015)

Neuro-chemical imbalances manifest in poor functioning and unhealthy compulsions. As a result of the destruction of critical brain chemicals during prolonged drug use, individuals –particularly those in early recovery, are bombarded by abnormal mood spikes and dips that often lead to difficulty coping with everyday problems and decisions, inappropriate and impulsive behaviors, and inevitably to relapse. Rather than correct the problem, they often continue with dysfunctional eating patterns. Unless healthy eating patterns are restored, the brain will not receive the nutrients that are critical for its self-healing. Without the appropriate food-based building blocks, the brain’s ability to restore itself to its pre-existing healthy state is markedly diminished.

Some leading medical authorities in the addictive disorders field claim that biochemical imbalances actually cause substance use, and unless they are corrected, any benefits derived from psychological counseling will be marginal and relapse will be chronic. (Gant, 2010)

Nutrient therapy restores missing nutrients (vitamins, minerals, amino acids, proteins, carbohydrates, fats, etc.), rebalancing the brain’s chemistry –an intricately wired system of neurons (nerve cells); neurotransmitters (chemical agents that regulate body function –dopamine, glutamate, GABA, serotonin, norepinephrine, adrenaline, etc.); and receptors (reception sites for neurotransmitters). Balanced brain chemistry leads to greater stability, emotional control, increased energy, mental clarity, and the return of normal moods –all of which facilitate a more successful recovery. (Atkinson, 2009)

Many nutritional therapists have written about the deficiencies found in people who are drug and alcohol dependent, and the ‘recovery foods’ necessary to correct these deficiencies. Eating certain foods that restore depleted bio-chemicals is a critical factor in reducing or eliminating post-acute physical, mental, and emotional withdrawal symptoms. Additionally, nutrition-based detox formulas combining vitamins, minerals, amino acids and other nutrients have been found to significantly support recovery.

Recovery programs employing nutritional therapy protocols recommend a regimen of special supplements based on individual assessment to correct immediate deficiencies, followed by classes on nutrition, food-purchasing, and food preparation. Additionally, self-help books provide special recipes and nutritional tips to facilitate recovery. Studies found that patients were able to reduce withdrawal symptoms, lower cravings and relapse rates, and subsequently maintain high rates of long-term abstinence –by as much as seventy to ninety percent, when they applied nutritional therapy principles to their recovery. (Beasley and Knightly, 1994; Finnegan and Gray, 1990; Gant, 2010; Gunther, 1983; Miller, 2010; Phelps, Keller and Nourse, 1986)

BENEFITS

• Corrects biochemical, nutritional, and metabolic disorders which may have led to a pre-disposition for addiction (Gant, 2010; Miller, 2010)
• Vitamin and amino acid supplementation enhance recovery efforts –especially at the start of a recovery program when biochemical imbalances are at their highest (Miller, 2010)
• Decreases detox symptoms, particularly pain and muscle spasms (Cunningham, 2016)
• Reduces or eliminates the metabolic imbalances that cause cravings and subsequent relapse (Miller, 2009; Wiss 2014)
• Corrects malnutrition and the loss of endorphins and enkephalins in the brain –problems commonly associated with opiate addiction (Miller, 2009)
• Restores the production of important amino acids and proteins which contribute to the restoration of proper brain function and improved immune system (Cunningham, 2016)
• Normalizes neurotransmitters, stabilizes mood, and reduces stress in recovering individuals (Salz, 2014)
• Reduces fatigue, depression, irritability, mental derangement, and other conditions that block recovery and lead to a relapse (Miller, 2010) and increases control over behaviors symptomatic of relapse and substance use (Stitt, 2004)
• Replaces important antioxidants such as Vitamin C, Vitamin E and beta-carotene, which are significantly depleted during heroin use (Zhou, 2000)
• ‘Recovery foods’ can stabilize blood sugar levels, improve digestion, and enhance the absorption of nutrients  (Cunningham, 2016; Miller, 2010; Salz, 2014)
• Programs that correct nutritional deficiencies in alcoholics are reported to have a 70%-92% success rate –these outcomes show promise for nutritional solutions for other substances (Miller, 2010)

RISKS

• There are no risks associated with nutritional therapy

Traditional Acupuncture has been used in China for more than 2000 years. It is based on the premise that the root of all illness is caused by the blocked or imbalanced flow of energy within the body. By stimulating the energy pathways (meridians) that run throughout the body, energy imbalances can be corrected and blockages removed. Acupuncturists gently insert thin tiny needles through the skin at specific points along these meridians to treat a multitude of disorders and restore optimal health.

Western science has confirmed the efficacy of acupuncture for various maladies, particularly for relieving pain. These scientists theorize that the technique produces an analgesic effect resulting from the activation of pain-suppressing endorphins in the brain. Studies report that acupuncture is effective in reducing craving and withdrawal symptoms in patients recovering from opioid dependence, probably by stimulating nerve or connective tissue that promotes the release of neurotransmitters (chemical agents that regulate body function –dopamine, glutamate, GABA, serotonin, norepinephrine, adrenaline, etc.) at sites throughout the central nervous system. This leads to a reduction in cravings by blocking drug receptors in the brain.

Acupuncture is believed to have the dual effect of both negating the pleasure experienced by drug use and suppressing the pain associated with withdrawal, supposedly by decreasing the amount of dopamine released when the drug is used, while also increasing the release of dopamine during withdrawal. Clinical studies have demonstrated that it increases other stress and pain relieving chemicals in the central nervous system as well.

Although the World Health Organization accepted acupuncture as a treatment for drug dependence in 1996, studies have shown conflicting evidence to support the efficacy of acupuncture in actually decreasing substance use. According to the National Acupuncture Detoxification Association (NADA), it’s efficacy has been difficult to prove since “the treatment does not lend itself to the Western model of the randomized, double-blind, placebo-controlled trial because of the difficulty blinding both the recipient and the treatment provider and the fact that sham acupuncture has some effect.” (NADA, 2010) Still, many people report that acupuncture is helpful in relieving craving and physical withdrawal symptoms, as well as the anxiety, depression and insomnia associated with post-acute withdrawal.

Transcutaneous Electrical Acupoint Stimulation (TEAS) is an outgrowth of traditional acupuncture, and stimulates the same energy pathways –but instead of using needles, small electrodes are affixed to the skin at the same classical acupoints used in traditional acupuncture, and an alternating high- and low-frequency electrical current is applied. Randomized clinical trials have found that patients who receive active compared to sham stimulation experience less severe heroin withdrawal symptoms during inpatient detoxification.

Bridge Device is an electrical nerve field stimulator developed to target pain. It attaches to the back of the ear and tiny electrodes send electrical impulses to different parts of the ear. Neuro-stimulation with the Bridge Device is associated with a reduction in opioid withdrawal scores. It also significantly decreases the baseline firing of neurons in the brain that responds to pain.

BENEFITS

• Augments outcomes of other treatment methods (Bier et al, 2002; Carter, 2014; Carter et al, 2017; Chan et al, 2014; Han et al, 1994; Janssen et al, 2005; Meade et al, 2010; Montazeri et al, 2002; Shi et al, 2006; Skok et al, 2004; Stuyt and Voyles, 2016; Utley, 2016; Wu et al, 1995, 1999, 2001)
• Patients are more likely to complete treatment (Bullock, 1987, 1989; Russell et al, 2000; Santasiero and Neussle, 2005; Washburn, 1993)
• Reduces craving and substance use (Avants, 2000; Chan et al, 2014; Cowan, 2017; Janssen et al, 2005; Konefal, 1995; Utley, 2016)
• Helps prevent rapid relapse to drug use following detoxification (Brewington, 1994; Han et al, 2003, 2005, 2011; Meade et al, 2010; Shi et al, 2006; Shwartz et al,1999)
• Accelerates the production and release of endorphins –the body’s natural painkillers, as well as other neuropeptides in the central nervous system that interact with different opioid receptors –as such, it is an effective treatment for temporary or chronic pain (Beinfield and Korngold, 2013; Han, 2004; Han et al, 2011; Kalfus, 2013; Kim et al, 2005; Meade et al, 2010; Utley, 2016)
• Eases withdrawal symptoms and craving (Chang et al, 2010; Cowan, 2017; Han et al, 1994; Janssen et al, 2005; Meade et al, 2010; Otto, 2003; Shi et al, 2006; Utley, 2016; White, 2017; Wu et al, 1995; Yang et al, 2008)  Patients report significant reductions in severity of shakes, stomach cramps, nausea, hallucinations, muddle-headedness, insomnia, muscle aches, sweating, heart palpitations, and feeling suicidal (Janssen et al, 2005; King, 1981; Lin et al, 2012; Montazeri et al, 2002; Smith, 2012)
• Alleviates depression, agitation, anxiety, and anger/aggression, while facilitating increased mental clarity, improved inner harmony and calm receptive behavior, particularly in early recovery; assists in achieving mood stabilization and relaxation in later stages of recovery (Bergdahl, 2012; Berman and Lundberg, 2002; Cowan, 2017; de Lorent et al, 2016; Janssen et al, 2005; King, 1981; Smith, 2012; Utley, 2016)
• Improves disrupted sleep patterns and insomnia –symptoms commonly associated with opioid withdrawal (Ahlberg, 2016; Chan et al, 2014; Cowan, 2017; Janssen et al, 2005; Utley, 2016)
• Increases working memory –counteracting memory deficits resulting from chronic opioid use (Shi et al, 2006)
• Reduces inflammation, increases blood circulation, and promotes muscle relaxation (Kalfus, 2013)
• Contributes to improved physical health and overall functioning (Carter et al, 2017; Cowan, 2017; Meade et al, 2010; Oyola-Santiago, 2013; Shi et al, 2006; Smith, 2012)

RISKS

• There are no risks associated with traditional acupuncture
• Acupuncture that uses electrical impulse should not be used on patients who have a history of seizures, epilepsy, heart disease or strokes, or on patients with pacemakers.  It should also not be performed on a patient’s head or throat, or directly over the heart (www.acupuncturetoday.com)
• Has not been shown to be effective as a stand-alone treatment for drug or alcohol detox or as a replacement for further therapy (Jordan, 2006; Khalil et al, 2015; Lin et al, 2012; Riet et al, 1990; Utley, 2016)

Ablation of the Nucleus Accumbens is a procedure that involves drilling tiny holes in the skull, and inserting heated needles to burn small areas of brain tissue in the nucleus accumbens, the brain’s reward center –thought to be the origin of opioid craving. In 2003, on the basis of successful animal experiments, 28 opiate dependent patients in China underwent this brain surgery to alleviate cravings following detoxification. After 15 months, 11 had remained drug-free, and the researchers concluded that the surgery had a positive effect in reducing the rate of relapse in opioid dependent patients (Gao et al, 2003). Citing high risks and potential ethical issues, the Chinese government banned the practice in 2004, except for ‘research purposes’. In a later study with 60 opioid dependent patients, 47% were still drug-free after 5 years (53% had relapsed). Despite the ban limiting the surgeries for ‘research’, critics claim that thousands of these surgeries have been performed in China since then. Writing for the Lancet (2009), Jane Qui notes that, “The use of ablative brain surgeries for treating drug addiction and neurological disorders, such as schizophrenia, depression, and epilepsy, has spread across the country [China] like wildfire in recent years.” (Murray, 2012; Qiu, 2009; Szalavitz, 2012; Zamiska, 2007)

Brain surgery for mental disorders has been a controversial practice since at least the 1930s, when doctors began performing lobotomies, removing or altering parts of the brain. That procedure was eventually blacklisted. The difference with the surgery being done today, advocates say, is that the areas of the brain being targeted are more precise. (Zamiska, 2007)

International critics argue that Chinese neurosurgeons are going to extremes to eradicate addiction in a country where thousands have been executed for drug trafficking. They contend that brain surgery is not worth the risk, citing potential infection, disability, and death.

By destroying parts of the brain’s “pleasure centers” in heroin addicts and alcoholics, these neurosurgeons hope to stop drug cravings. But damaging the brain region involved in addictive desires risks permanently ending the entire spectrum of natural longings and emotions, including the ability to feel joy. (Szalavitz, 2012)

These doctors are attempting to erase motivation [to use] by erasing a part of the addict’s brain. And they are doing it in the face of worldwide condemnation and in the name of scientific research. (Murray, 2012)

Deep Brain Stimulation (DBS) is a surgical procedure whereby a device, similar to a pacemaker, is implanted under the skin so that electrical currents are continuously applied to specific areas of the brain to alter brain activity and treat brain disorders. Initially developed in the 1980s to treat Parkinson’s disease, DBS now treats depression, dementia, Tourette’s syndrome, obsessive-compulsive disorder, obesity, and substance use disorder. Small holes are bored into the skull and long thin probes, lined with tiny electrodes on the ends, are guided deep into the brain until they are within a millimeter of the targeted area. Wires run from the electrodes buried within the brain, up through the tiny holes in the skull, and along the outer skull, behind the ear and down to a battery pack surgically embedded near the collarbone or chest. Once turned on, electrical pulses are used to stimulate specific areas of the brain and alter the brain circuits thought to be at the root of the problem. In the case of chronic addiction, the procedure is used specifically to derail drug cravings. (Carter et al, 2012; Fisher, 2014; Hall and Carter, 2011; Krack et al, 2010; Kuhn et al, 2010).

DBS has been proposed as a potential ‘cure’ for intractable drug addiction. Although it involves the risk inherent in any brain surgery, DBS is much safer than ablation since the electrical stimulation can be adjusted or turned off if there are negative side effects, while surgical destruction of brain tissue is irreversible and permanent (Hall and Carter, 2011; Szalavitz, 2012). The efficacy of DBS for resolving addiction was discovered accidentally when researchers noticed that patients receiving DBS for other psychiatric disorders also reported unanticipated spontaneous remission from addictions to alcohol, nicotine and heroin (Bauer et al, 2008). It was not long before scientists were testing DBS on morphine-dependent rats, and case studies began appearing in scientific journals. Although most studies showed significantly decreased or completely eradicated use, other studies showed that DBS exacerbated addiction (Carter et al, 2012). In one case study, the electrical stimulation intensified the desire for heroin (with intake nearly doubling) –but after researchers adjusted the pulses, the cravings diminished and heroin use was drastically reduced (Fisher, 2014). In an analysis of medical research prior to 2010 citing the efficacy of DBS, patients who were treated for various psychiatric disorders showed vast improvements in primary symptoms by as much as 35% to 70% (Kuhn et al, 2010).

Despite these successes, the procedure has attracted critics, with some calling for a halt to the research altogether. The risks, although rare, include brain hemorrhage, infection, cognitive impairment, depression and suicidal behavior, or death (Fisher, 2014; Hall and Carter, 2011, 2013). Estimates of surgical complications vary markedly, largely due to differences in the competence of the medical teams performing the operation, and procedural variation. One analysis of scientific literature estimates that approximately 11% of patients experienced adverse effects from the brain surgery. (Carter et al, 2012; Carter and Hall, 2013; Kuhn et al, 2010)

Transcranial Direct Current Stimulation (tDCS) and Transcranial Magnetic Stimulation (TMS) are procedures that deliver either a mild electric current (tDCS) or electromagnetic pulses (TMS) to a patient’s scalp to stimulate the brain without requiring invasive surgery –with the goal of altering electrical activity in the brain. This continuous or repetitive electrical pulse is thought to activate drug-damaged neural pathways, “like a reboot on a frozen computer” (Smith, 2017). These techniques are currently being tested by researchers around the world for their efficacy in facilitating addiction remission. (Coss, 2017; Smith, 2017)

After spending decades probing the brains of drug-loving lab animals and scanning the brains of human volunteers, scientists have developed a detailed picture of how addiction disrupts pathways and processes that underlie desire, habit formation, pleasure, learning, emotional regulation, and cognition. Addiction causes hundreds of changes in brain anatomy, chemistry, and cell-to-cell signaling, including in the gaps between neurons called synapses, which are the molecular machinery for learning. By taking advantage of the brain’s marvelous plasticity, addiction remolds neural circuits to assign supreme value to cocaine or heroin or gin, at the expense of other interests such as health, work, family, or life itself… Stimulating the region of the human brain responsible for inhibiting behavior, in the prefrontal cortex, might quell an addict’s insatiable urge to get high. (Smith, 2017)