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Nutrition’s Supporting Role in Addiction Recovery

Addiction Addiction
Longevity By Nature
 
EuroMedica

When implemented as part of an integrated addiction treatment program, nutritional foods, nutraceuticals and natural supplements can play an integral role in restoring health and well-being and in supporting a client on their journey through the addiction recovery process.

Walking a person through addiction recovery requires a multidisciplinary team approach. A client-centered focus, meeting the individual where they’re at, establishing a relationship of trust and addressing the whole person’s physiological, emotional, mental and spiritual needs, are key to helping someone along their journey to recovery. Once a client has been evaluated and a treatment plan determined—dietary plans, nutritious foods, nutraceuticals and supplements, can all serve to play a supportive role in restoring health and balance to an individual as they detox, recover and reconfigure their lifestyle. Away from addictive patterns and substance abuse—towards healing, wellness and wholeness.

Defining Addiction

According to Elizabeth Drew, MD, medical director of Summit Behavioral Health in Doylestown, PA, “The American Society of Addiction Medicine has defined addiction as a primary chronic disease of brain reward, motivation memory and related circuitry.”

Dr. Keith Kantor, CEO of Georgia-based Named Program LLC, described two categories of addiction: substance addiction and process addiction. “The first type of addiction, substance addiction,” explained Dr. Kantor, “involves direct manipulation of pleasure through the use of products that are ingested into the body, including drug use disorders and food-related disorders. Drugs of misuse often are grouped into categories such as cigarette smoking, alcohol use and illicit substance use.1 The second type, process addiction, comprises a series of potentially pathological behaviors that expose individuals to ‘mood-altering events’ by which they achieve pleasure and become dependent,2” he said. Process addictions include gambling, types of internet use, love, sex, exercise, work and compulsive spending.

A Focus on Alcohol and Drug Abuse

The incidence of alcohol and drug abuse is on the rise in the United States and yet access to treatment to date has been limited.

“In 2010 the Partnership for Drug Free Kids reported 23.5 million Americans are addicted to alcohol and drugs,” cited Dr. Kantor. “That’s approximately one in every 10 Americans over the age of 12—roughly equal to the entire population of Texas.”

“Alcohol is still the most commonly abused substance and the substance of abuse we treat the most,” added Constance Scharff, PhD, director of addiction research at Cliffside Malibu in California. “We are also seeing a lot of prescription medication abuse and heroin, which is often a drug of choice for people who can no longer easily get their hands on prescription painkillers. Also, we get a lot of mixing of substances, people who abuse alcohol and other drugs together,” she explained. Deni Carise, PhD, chief clinical officer at Recovery Centers of America noted, “The greatest increase in the last five to eight years has been in opiate abuse. Prescription drugs and heroin abuse. This is an increasing problem for youth 18-26 years old. The number of deaths and dependence on these drugs has skyrocketed,” she said.

“According to the U.S. statistics, the most common addiction for which treatment was sought was alcohol alone at 23 percent,” observed Dr. Drew. “The other addictions requiring treatment were alcohol plus another drug 18.3 percent, heroin and other opiates 20 percent and cocaine and other stimulants 17.8 percent.” Dr. Carise pointed to The National Survey on Drug Use and Health report that every year, 23 million people over the age of 12 meet the criteria for substance abuse or substance dependence. “That represents 9 percent of the population,” she said. Of these, 2.5 million get treatment, which represents a 10 percent penetration rate—which is an unheard of percentage for disease treatment.”

Addiction’s Physical Impact

Physiologically, the effects of addiction, substance abuse and resulting lifestyle choices, can lead to a malnourished and biochemically out of balance body; and a brain that is structurally and functionally altered.

When it comes to substance abuse, Dr. Carise noted, there are three ways in which addiction can affect the body: “1. The effects of the drug itself—which can lead to loss of appetite, liver vulnerability, malabsorption of fat soluble vitamins A, D, E, K, calcium and iron; 2. Poor eating habits—resulting in dehydration, inadequate intake of carbohydrates and nutrient-dense foods; and 3. Risky behaviors—such as unsafe sex, which can lead to the contraction of hepatitis and HIV.”

“In any substance abuse there will most likely be a deficiency of amino acids and if this occurs for a long period of time the body may be irreversibly damaged,” acknowledged Dr. Kantor. “Stimulant use results in overall malnutrition and electrolyte imbalances due to the body being up for days at a time, weight loss and dehydration,” he said.

“Individuals in the active disease of addiction are seldom making other healthy choices,” added Dr. Drew. “Nutrition is likely poor and in some specific addictions such as alcohol, lack of thiamine and folate can create a dangerous situation in recovery.” Severe vitamin B1/thiamine deficiencies resulting from heavy alcohol use can lead to the development of Wernicke-Korsakoff Syndrome, or ‘wet brain.’”

Actual changes in the brain due to addiction are being revealed through PET Scans and imaging studies. “What we’re learning,” said Dr. Scharff, “is that while biochemistry is important, the lasting and important changes are to both the structure and function of the brain. Part of the addiction process is that the brain is co-opted in the areas of decision-making (among others), making it difficult if not impossible for the addict to make healthy decisions or follow through on decisions to stop abusing substances. The brain becomes wired to continue the using behavior. In recovery, we work to rewire the brain, actually changing its structure and function, so that the addict can make better decisions and engage in healthy behaviors. This is possible because of the neuroplasticity of the brain,” she added.

“Drugs of abuse affect multiple neurotransmitters in the brain, including GABA, glutamate, dopamine, serotonin, norepinephrine and endogenous opioid peptides,” revealed Dr. Drew. There are correlations between certain drugs and neurotransmitters such as alcohol and benzodiazepine with GABA, glutamate; cocaine and stimulants with norepinephrine; and opiates with endogenous opioid peptides. “However, all of these appear to ultimately work through dopamine and be associated with the pleasure and reinforcing effects of most drugs of abuse,” she said.

“The increase in dopamine through use of drugs is far greater than with other behaviors,” continued Dr. Drew. “This increase is seen not just when obtaining the drug of choice but in anticipation of the reward. This can turn neutral stimuli into a trigger. For example, if dopamine is released when you drive by the bar and your impulse control is diminished because of dysfunctional circuitry, relapse becomes almost inevitable.”

Dopamine, in particular, plays a role in how the addiction cycle perpetuates changes in the neurological system, which subsequently impacts behavior. Dr. Kantor explained, “Drug addiction has been diagnosed, as a disorder that moves from impulsivity to compulsivity in a summarized cycle of addiction comprised of three stages: preoccupation/anticipation, binge intoxication, and withdrawal/negative affect. As addiction develops the changes in the neurological system also adapt and increases in brain reward thresholds also grow as abuse of substances and behaviors increase. Dopaminergic function has been identified as a key common element of addiction, lending support to what became a strong program on the role of dopamine and opiate receptors in addiction, treatment and research. As the brain reward thresholds increase it will control all thoughts and behaviors, reducing the ability to maintain relationships, career, finances and everyday tasks.”

“Methamphetamine and cocaine use directly impacts dopamine levels,” specified Dr. Carise. “It increases the amount of dopamine in the body. The body’s system then reacts by dealing with extra dopamine by increasing the brain’s receptors for dopamine and decreasing the body’s own dopamine production,” she said. “When a person comes off the drugs and the amount of dopamine in the body decreases, people often develop anhedonia—a loss of pleasure in everyday life,” she added.

The Role of Nutrition and Diet

Many integrative treatment programs have recognized the importance of good nutrition and dietary guidelines in supporting someone through recovery. The approach of several experts is to get clients on a regimen of high quality, enjoyable nutritional foods and establish a regular eating schedule, in conjunction with an exercise program and quality sleep patterns, early on in treatment. Most agree that this is best when initially done in a controlled environment, if possible.

At Cliffside Malibu, “Substance abusers usually come to treatment malnourished,” observed Dr. Scharff. “Addicts don’t think about eating when they’re using. Many don’t eat regularly at all or eat heavily processed, fast foods. Our focus is on teaching them to eat healthfully. All of our residents are provided with high quality, nutritionally balanced meals using organic ingredients whenever possible, prepared by our chef. We provide good food that residents want to eat. In some of the more extreme cases we have used orthomolecular interventions during treatment, but the focus is on managing lifestyle in a way that is easy to continue outside of residential treatment,” she said.

“A healthy diet is very important,” concurred Dr. Carise. “Carbohydrates, tryptophan-rich foods such as dairy and meat, folic acid, vitamins B6 and B12 and foods that help to increase serotonin levels. It is important to increase their ability for pleasure and to sleep well. The inability to sleep is a big complaint during recovery. Dietary supplements are good, but nutrient-dense fresh food is also important. Good nutrition is an integral part of ensuring they buy-in to all of the steps to recovery.”

“Nutrition is often the overlooked component of addiction and recovery yet, one of the most powerful,” emphasized Dr. Kantor, creator of the N.A.M.E.D. Program. “Nourishing the body with optimal foods, vitamins, minerals and hydration will give the patient more control, due to the reduction in cravings and suppression of opiate receptors. A craving for food can often be mistaken for a craving for the once abused substance,” he said.

The main focus of his nutritional menu plans, shared Dr. Kantor, is to optimize the pH balance in the body, reduce inflammation, suppress opiate receptors to avoid any cravings, incorporate high quality amino acid therapies and address nutrient deficiencies. “The plan is caffeine free, gluten free, low sugar, no refined sugar, low dairy, high fiber and macro nutrient balanced with healthy anti-inflammatory fats, high quality proteins and complex slow acting carbohydrates,” he said. Recommended tips for following the nutritional program are:

• Develop a meal and snack schedule and adhere to the routine daily to reduce cravings while keeping the body in a state of balance.

• Aim to eat nine to 11 servings of fruits and vegetables daily. Preferably a ratio of one fruit to three vegetables. This keeps fiber intake at optimal levels, and provides vitamins and minerals in their most raw form.

• Drink at least half of your body weight in ounces of stable alkaline water daily. This will promote optimal organ function, electrolyte balance and reduce cravings.

• Include a high quality source of protein, a heart healthy fat and fibrous carbohydrate at each meal. This is the most absorbable form of amino acids, which have been shown to be critical in addiction and recovery.

• A high quality multivitamin and mineral supplement, B complex, vitamin D, omega-3 fish oil, and a probiotic are all recommended to take daily with meals for optimal absorption. More specific supplements and herbs can be recommended individually based on assessment and laboratory values.

• Reduce/stop caffeine and stop smoking.

“Nutrition in recovery is essential,” agreed Dr. Drew. “Proper nutrition is key in supporting the body so it can heal and repair. Specific types of nutrients are key in bringing back balance and should be based on individual needs; however, most individuals will benefit from a B complex containing thiamin and folic acid, vitamin C and zinc supplements. Milk thistle can also be used to provide liver support and kava kava can come in handy for anxiety,” she said. “Nutritional guidelines for recovery involve a well-balanced meal plan specific to the client’s individual needs that focuses on blood sugar control through proper food combining, portion control and cutting back on processed and sugary foods.”

“We help the addict in recovery to make better lifestyle choices—and that’s where proper nutrition comes in,” said Dr. Scharff. “When we eat well, our bodies become healthier and stronger and we feel better about ourselves. It’s that physical health and self-worth that are important to develop in addicts…because people who feel really good about themselves are less likely to relapse than those who don’t.”

Using Nutraceuticals for Extra Support

Illinois-based Redd Remedies and Puricorp in Florida both offer nutraceuticals and natural supplements formulated to help support the challenges of the addiction recovery process. The goal in developing these natural products was to provide emotional and physiological support and to aid in the suppression of cravings.

Crave Stop

Crave Stop box

According to Stacey Littlefield, lead product formulator at Redd Remedies, “Redd Remedies discovered a need for natural alternatives to promote emotional health through Dr. Gregory Jantz, founder of The Center—A Place of Hope. At the Center, Dr. Jantz specializes in whole-person care for co-occurring issues including depression, eating disorders and addictions. In partnership with Dr. Jantz, we created INJOY, an all-natural approach to emotional strength and wellness, and Crave Stop for healthy eating habits,” she said.

“The key effective ingredients in INJOY, At Ease and Crave Stop are adaptogens. Adaptogens are a group of unique herbal medicines that balance the HPA Axis and protect the brain and the body against the negative effects of the allostatic load. By helping the brain and body adapt, ingredients such as Schisandra chinensis, Panax quinquefolius and holy basil establish a greater resistance to emotional stress and promote balance between body and mind,” she explained.

At Ease

At Ease box

Puricorp offers an extensive line of products for addiction recovery support including: Declinol for alcohol cravings; Snack!/Apiquel for food cravings; Inabrex for smoking cessations support; and Puridone for support of withdrawal from pain medication. LifeMode lifestyle sprays (Relax!, Awake!, Sleep!, Focus!, Immune!, Happy! and Snack!) are designed to be used as second-level support as needed.

Puricorp’s director of marketing, Jon Kirven, described their approach to product development: “Those of us at Puricorp have all been impacted in our lives by over-use issues. We wanted to invent and provide access to non-pharmaceutical products that all people could afford regardless of their financial or health insurance status, and that could enhance existing recovery programs by accelerating the individual’s ability to control their cravings during the program, and helping to control cravings after the program, which is what normally leads to relapse.”

In Joy

In Joy box

“Each product is in the dietary supplement/nutraceutical category and are formulated with key natural ingredients,” stated Kirven. “For example, Declinol uses a clinically-studied combination of kudzu root isoflavones, gentian and bitter herbs (along with several other support ingredients) that in combination were found to support reduced alcohol cravings and the physiological changes associated with reduced alcohol intake. The primary mechanism for the “over-use” products is craving suppression. The prolonged use or repetitive behaviors of just about anything causes the craving to do more of it,” he said. “If you can target the cravings centers of the brain and reduce the cravings, the individual is better able to help themselves reach their target goal and stay at it.”

Kirven added that, “Puricorp products are very compatible with recovery programs because they assist, they don’t replace the program. Because they help reduce cravings quickly, the client has an easier time integrating the program information and can make faster progress and can be more ‘present’.”

Treating the Whole Person is Essential

Recognizing that addiction treatment requires a multi-disciplinary approach and working in conjunction with other health care professionals as a team to treat the whole person is critical. Addressing the immediate medical needs, determining the underlying pain or conditions that led to the addiction, nourishing and bringing the body back into balance, alleviating the cravings, helping to rewire the brain, providing emotional support, and guiding them towards healthier lifestyle choices, are all essential components of an integrated and complementary treatment plan. A plan in which nutrition and nutraceuticals can play an important supportive and transformational role throughout the recovery process.

For More Information:
Deni Carise PhD, (610) 239-6100, www.recoverycentersofamerica.com
Elizabeth Drew MD, (215) 589-7111, www.summithelps.com
Dr. Keith D. Kantor, (770) 814-6900, www.namedprogram.com
Puricorp, (321) 297-9099, www.puricorp.com
Redd Remedies, (888) 453-5058, www.redremedies.com
Constance Scharff, PhD, (800) 501-1988, www.cliffsidemalibu.com

References:

1 Sussman S, Ames SL. Drug abuse: Concepts, prevention and cessation. New York, NY: Cambridge University Press; 2008.

2 Robinson TE, Berridge KC. The psychology and neurobiology of addiction: An incentive-sensitization view. Addiction. 2000;95:91-117.

3 Koob GF. Allostatic view of motivation: Implications for psychopathology. In: Bevins RA, Bardo MT, editors. Motivational factors in the etiology of drug abuse (series title: Nebraska symposium on motivation. Vol. 50. Lincoln NE: University of Nebraska Press; 2004. pp.1-18.

4 Volkow ND, Fowler JS. Addiction, a disease of compulsion and drive: Involvement of the orbitofrontal cortex. Cerebral Cortex. 2000;10:318-325. [PubMed]

5 Volkow ND, Li TK. Drug addiction: The neurobiology of behavior gone awry. Nature Reviews Neuroscience. 2004;5:963-970. [PubMed].