| |
|
|
CASE
REPORT
Integrated
Approaches To Addiction
Robert A. Nash, MD
ABSTRACT
Background Acupuncture can be effective in detoxifying, minimizing
craving, and reducing recidivism in the abuse of illicit drugs, prescription
medications, and alcohol and nicotine.
Objective To describe the outcomes of 2 patients addicted to
crack cocaine who underwent integrated therapy.
Design and Setting Case report from physician acupuncturist's
practice.
Intervention An integrated treatment regimen of acupuncture, pharmaceuticals,
and vitamins.
Main Outcome Measure Patient use or abstinence from crack cocaine.
Results Patient 1 had several lapses in crack cocaine use, but
has been drug-free since September 1999. Patient 2 also experienced
relapses, but successfully remained cocaine-free until he was lost to
follow-up in September 1999.
Conclusions In combination with medication such as selective
serotonin reuptake inhibitors to balance chemicals in the brain, and
vitamin supplementation, acupuncture can be used successfully to detoxify
addicted patients in an outpatient setting.
KEY
WORDS
Addiction, Acupuncture, Auriculotherapy, Serotonin, Endorphins, Detoxification,
Selective Serotonin Reuptake Inhibitors (SSRIs)
INTRODUCTION
Acupuncture has been shown to be helpful in chronic alcoholism1 as well
as 90% successful in nicotine detoxification. During the past 7 years
treating approximately 20 patients per year, I have had similar success
rates. I use acupuncture as part of an integrated program that also
addresses a presumed genetic low serotonin state and a presumed micronutrient
deficiency state. Serotonergic medications must be continued for very
lengthy periods (usually years) for the detoxification efforts to be
most rewarding. Long-term nutritional supplementation for micronutrient
balance is strongly recommended.
METHODS
Auriculotherapy and Acupuncture
Successfully using the auricular and the American and French systems
together for nicotine detoxification, I vary only 1 or 2 auricular points
depending on the substance. For crack cocaine detoxification, the auricular
points I use are Shen Men, Sympathetic, Point Zero, Master Sensory Point,
LU 1, LU 2, KI 2, and LR 1 (optional). I also use GB 8 and 18 with SP
3. Electrical stimulation for 45 minutes is used on low frequency (5.5
Hz) with the negative lead to SP 3 and the positive lead to GB 18. I
also use GV
20 Si Seng Cong with LR 3 and LI 4 to maximally boost levels of the
endorphins, serotonin, and anxiolytics.
Acupuncture is performed daily for 5 consecutive days (Monday through
Friday) during the first week, and then decreased to 3 times during
the second week (Monday, Wednesday, Friday). It is further decreased
to twice during week 3 (Monday and Thursday); then, once on Monday during
week 4. Acupuncture during weeks 3 and 4 is for psychotherapy support
as well as for the serotonergic and endorphinergic boost.
Medications
Fluoxetine hydrochloride (Prozac), 10 or 20 mg every morning, with trazodone,
50 mg at bedtime for 4 days and then 100 mg at bedtime, is my choice
drug regimen. The dosages are adjusted upward on a weekly basis as warranted.
Multivitamin and mineral supplement in megadoses is recommended as well
as high-dose vitamin C, 1000 mg 4 times daily.
Nash Serotonergic Index
Patients are asked detailed histories including family history of addiction
or other obsessive-compulsive behaviors. Integration of the above along
with more than 2 decades of clinical experience, I developed a 13-question
inquiry for each patient.
The
index was devised to quickly determine if serotonin or norepinephrine
was deficient; I view these 2 neurochemicals as being on opposite ends
of a seesaw. When an individual is balanced and in good health, the
"yes" and "no" answers are fairly balanced. When
someone is deficient in norepinephrine, they may answer only 1 to 3
questions "yes" and the remainder "no." They tend
to be true panic attack patients with low norepinephrine levels and
high anxiety states. These patients should receive norepinephrine medications
and never serotonergic medications, which might exacerbate the imbalance.
The opposite is often seen in patients with low serotonin levels, who
may have obsessive-compulsive disorder, addictions, chronic pain, sleep
disturbances, and poor impulse control. They may answer 1 to 4 questions
"no" and the rest "yes." Since vigorous exercise
increases levels of both serotonin and endorphin, if the patient answers
question 13 "yes," then low serotonin may be considered regardless
of the number of "yes" answers. If an individual answers question
12 "yes," likewise, low serotonin may be considered.
CASE
REPORTS
Two illustrative crack cocaine cases indicate the importance of acupuncture
along with the continuing need for serotonergic medications and micronutrient
support.
Case 1
A 54-year-old woman had been a daily crack cocaine user from 1991 until
shortly before she presented in early November 1998. She was hospitalized
by her family in September 1998 and underwent the standard detoxification
and 12-step detoxification program. The patient reported feeling weak
as an individual and recalled little if any education about nutrition
or neurochemical balance. After 4 to 5 weeks of hospitalization at a
cost of $43,000, she was drug-free for less than 24 hours after discharge.
The woman abstained from using crack cocaine for 3 days before her first
office visit. I immediately implemented my integrated program. She remained
completely drug-free until March 1999. The patient had 2 lapses in that
month, each of 1 day's duration. She felt well enough to decrease and
stop taking the serotonergic medications without my knowledge. I resumed
her medications in April; she remained drug-free until late August 1999,
when her dentist identified a possible cancer in her mouth. (The patient's
adoptive mother died of mouth cancer.) Fearing the worst (and forgetting
there was no blood relationship to her adoptive mother), the patient
lapsed into using crack cocaine for 2 consecutive days. Once an oral
surgeon gave her a clean bill of health and coupled with another week
of acupuncture, she has remained drug-free since early September 1999.
Overall, the patient used crack cocaine for a total of 4 days in a calendar
year at an approximate cost of $1,000 for the integrated program.
Case 2
A 39-year-old man had been a chronic crack cocaine addict since 1993.
Divorced and with no medical insurance, the patient worked only enough
to cover his cocaine habit and minimal expenses. He stated that his
12-year-old son was being raised by his assertive, dominant mother.
The patient's diet encompassed fast-foods with no micronutrient supplementation.
His longest abstinence from the substance had been 4 months, with severe
daily craving. The same protocols were followed with him as in Case
1. The patient remained drug-free through February 1999 with no cravings.
However, he, also, stopped taking his serotonergic medications and multivitamins
due to costs and a feeling of wellness. He began to use crack cocaine
again in March 1999. Medication and supplementation were restarted and
a 3-day course of acupuncture was given. He remained drug-free until
late June 1999, again using crack cocaine.
In late June 1999, the same protocol was stressed and 2 successive days
of acupuncture were administered. The patient relocated and was lost
to follow-up.
DISCUSSION
The cost differential and outcomes of these 2 recent patients is impressive.
My approach stresses the genetic predisposition to addiction due to
low serotonin levels and possible inadequate micronutrition. I believe
that alcohol, barbiturates, benzodiaze-pines, and narcotics act in unknown ways at the g-aminobutyric acid
(GABA) gate to inhibit the production of endorphins, which are maximized
at delta sleep. This theory is based on reports by Moldofsky and others3-6
that showed an alpha (brain frequencies, 8-12 Hz)-delta (0-4 Hz) sleep disturbance in approximately 80%
of patients with chronic pain. Once patients slowly discontinue all
habit-forming medications, including alcohol, they experience a rapid
decrease in their pain.
Serotonin and endorphins are related to acupuncture biochemical reactions.
My conclusion is that the deep muscle relaxation and maximal production
of endorphins that occur at delta sleep are markedly disturbed by the
ingestion of alcohol, narcotics, and other drugs. While the mechanism
of action is unclear, the GABA gate of the neuron appears to be involved.
Once restorative sleep is re-established with the serotonergic medication
and aided by the acupuncture, most patients do well (approximately 70%-80%
success rate).
CONCLUSION
In a complex process such as addiction, an integrated treatment approach
increases the success rate. Acupuncture may boost the levels of serotonin
and endorphins. This, along with the micronutrients and serotonergic
medications, brings rapid neurochemical balance, restorative sleep,
and reduces or eliminates cravings. The medications and supplementation
must be continued for years or possibly, for a lifetime. There is increasing
evidence that all addiction may have low serotonin levels as a common
denominator, which is easily treated medically (David Horrobin, MD,
PhD, oral communication, October 1999). My experience reinforces the
cost-effectiveness and known mechanisms of acupuncture in the treatment
of addiction.
REFERENCES
1. Bullock ML, Culliton PD, Olander RT. Controlled trial of acupuncture
for severe recidivist alcoholism. Lancet. 1989;1:1435-1439.
2. Nash RA. The serotonin connection. J Orthomolecular Med. 1996;2:
35-44.
3. Moldofsky H. Sleep-wake mechanisms in fibrositis. J Rheumatol.
1989; 16(suppl 19):47-48.
4. Moldofsky H. Pain and sleep. Presented at: Sleep Disorders
Confer-
ence; Phoenix, Ariz; 1992.
5. Moldofsky H, Lullis C, Lue F. Sleep related myoclonus in rheumatic
pain modulation disorder (fibrositis syndrome). J Rheumatol. 1986;13:
614-617.
6. Moldofsky H, Saskin P, Lue F. Sleep and symptoms in fibrositis
syndrome after a febrile illness. J Rheumatol. 1988;15:1701-1704.
AUTHOR
INFORMATION
Dr Robert Nash is a physician acupuncturist Board-certified in Neurology,
Pain Medicine, and Chelation Therapy. Dr Nash specializes in pain relief,
sleep disturbances, acupuncture, and reversal of vascular disease symptoms.
Robert
A. Nash, MD, FAAN, LPAc
5589 Greenwich Rd., Suite 175
Virginia Beach, VA 23462
Phone: 757-490-9311 Fax: 757-490-9266
E-mail: pprevent@rcn.com
|
|
|
|