Holistic approaches to substance use disorder
DISCLAIMER: All the following information is for educational purposes only. This article is not intended for medical or therapeutic advice, or directions of use for specific ailments.
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Overview of Substance Use Disorder (SUD)
Substance dependency develops from prolonged or excessive use of certain substances and is classified as a multifaceted illness largely determined by an interplay of biological mechanisms, attributed to altered neurotransmission commonly exacerbated by preceding genetic-environmental predisposition(s) (Ausmed, 2019). There are many reasons why people cease substance use and experience withdrawal so when treating the client, a person-centred approach is essential including ongoing bio-psycho-social and spiritual support with integrative therapy, especially in cases of treatment-resistant or chronically relapsing SUD. Complementary medicine (CM) interventions for active withdrawal from substances are versatile depending on the experience of the practitioner, with research showing great potential for herbal medicines to act as adjuvant agents in managing drug tapering and detoxification. Despite this, primary medical guidance and supervision should be sought before cessation/tapering and prescribing of natural remedies if possible, particularly in long-term dependency and withdrawal from central nervous system depressants or tranquilisers (ADF, n.d.).
Physiological Manifestations of Substance Withdrawal
Substance use disorder and/or dependency affects all body systems at varying severities depending on the person, substance(s) and level/duration of use.
Below are some physical manifestations that may occur in acute withdrawal of particular substances, listed with some of the treatment aims health professionals may consider when assisting a person through these uncomfortable phases.
Medically-assisted substance withdrawal is recommended as sudden cessation of certain substances can be life-threatening or detrimental depending on the aforementioned factors. It is recommended to seek out professional advice and/or guidance before attempting to cease substance use.
| SIGNS & SYMPTOMS | SUBTANCES | TREATMENT AIM | HERBAL ACTION |
|---|---|---|---|
| Pain (muscle, bone, skin) / headaches |
Opiods, amphetamines, benzos (ADF, n.d.) | Reduce hypersensitisation of central nervous system (CNS) via modulating neuroendocrine (HPA) function & increase oxygen and blood flow to the brain, thereby assisting replenishment of depleted neurotransmitters (NT), enkephalins and other neuromodulators (Owens, 2019). |
Analgesic, inflammatory-modulator, neuroprotective |
| Tremor / convulsions / muscle spasms / restless legs |
Alcohol, opioids, amphetamines, benzos, cannabis (ADF, n.d.) | Improve release of endorphins & enkephalins to reduce excessive firing of motor neurons causing dyskinesia and pain (Owens, 2019); Relax smooth and skeletal muscle via downregulating innervation and replenishing electrolyte stores to reduce incidence of spasm and cramps. |
Anticonvulsant, antispasmodic, relaxing nervine |
| Tachycardia / Excessive sweating / fever / chills |
Opioids, amphetamines, cannabis (ADF. n.d.) | Improve thermoregulation via supporting hypothalamic-pituitary-adrenal/ovarian (HPA/O) axis whilst facilitating a productive fever (shortening duration) to eliminate toxins; Support the vasculature & the heart; Replete lost electrolyte stores to enhance mitochondrial functioning. |
Hypotensive, cardio-protective, adaptogen, diaphoretic |
| Irritability / anxiety / depression / mood swings / cravings / apathy |
Amphetamines, alcohol, nicotine, cannabis, benzos, cocaine, tranquilisers (ADF, n.d.) | Downregulate neuroimmune & gastrointestinal (GI) inflammation & microbiome support via addressing dysbiosis, elimination of any parasites, modulation of pro-inflammatory cytokines and stimulation of adrenergic & endocannabinoid (ECB) receptors; Support parasympathetic function to improve neurotransmission; Provide precursors for neurotransmitter (NT) synthesis (incl. tyrosine, phenylalanine, tryptophan (the precursor to serotonin) and the vitamin, niacinamide) (Sarris & Wardle, 2019). |
Anxiolytic, adrenergic, dopaminergic, thymoleptic, inflam-modulator, adaptogen |
| Hallucinations / paranoia / delusions / confusion |
Amphetamines, opioids, benzos (ADF, n.d.) | Support liver function & restoration to relieve internal wind / tension & potential damage to hepatocytes (liver cells); Improve dopamine balance and receptor sensitivity to reduce sporadic influx via reducing neurooxidative stress (Van Der Gaag, 2006). |
Neuro-tropho, hepato-tropho, antioxidant, dopaminergic |
| Insomnia / nightmares |
Opioids, amphetamines, cannabis, benzos, cocaine (ADF, n.d.) | Support HPA axis and brain plasticity via facilitating synthesis and modulation of neurotransmitters (GABA, melatonin, serotonin, dopamine) & brain-derived neurotrophic factor (BDNF); Improve HPA functioning and regulate diurnal cortisol rhythms for assisting sleep onset & maintenance (Sarris & Wardle). |
GABA-mimetic, sedative, hypnotic |
| Nausea & vomiting |
Opioids, benzos (ADF, n.d.) | Modulate the enteric nervous system via balancing sympathetic and parasympathetic nervous activity to coordinate peristalsis & rhythmic muscle contractions. |
Antiemetic, carminative |
| Diarrhea / constipation / hepato-biliary dysfunction / loss of appetite |
Opioids, alcohol, nicotine (ADF, n.d.) | Support detoxification pathways thereby facilitating elimination of metabolic waste products; Downregulate sympathetic dominance to reduce bowel laxity or constriction; Decrease transit time by supporting enzyme release to increase bile production. |
Choleretic, carminative, mild laxative, antidiarrheal, antioxidant |
Keywords:
CNS - Central Nervous System
HPA - Hypothalamic-Pituitary-Adrenal axis
HPO - Hypothalamic-Pituitary-Ovarian axis
NT - Neurotransmitters
GI - Gastrointestinal
GABA - Gamma-aminobutyric acid
BDNF - Brain derived neurotrophic factor
Examples of Useful Herbal Interventions
Below are some of the safer, conventional herbal medicines to assist the body through the withdrawal process.
Stronger, more specific herbs that require particular knowledge and training on how to administer them safely are not listed here.
| COMMON NAME | LATIN NAME & ENERGETIC | MECHANISM OF ACTION TO TREATMENT AIMS (above) | DUAL HERBAL ACTIONS |
|---|---|---|---|
| Passionflower | Passiflora incarnata (cooling, bitter) |
Via sympathetic nervous inhibition and hypotensive actions, passionflower sinks the vital force, calms the mind, relieves anxiety & promotes rest; relaxes constraint & relieves pain by clearing internal wind & stops spasm (flavonoids & indole alkaloids); opens the chest & relieves wheezing and coughing; reduces inflammation & pain with a sedative effect on hyperactive nervous activity as seen in substance withdrawal, thereby assisting with sleep (Holmes, 2007). A double-blind RCT (Kashani, Mobaseri, Hosseini, Nikzad, Khani & Akhondzadeh, 2001) found passionflower to be an effective adjuvant with clonidine in acute opioid withdrawal. |
Hypnotic Sedative GABA-mimetic Inflam-modulator Hypotensive Anxiolytic Antispasmodic Anodyne |
| Lavender | Lavandula spp. (somewhat bitter, cooling w/ some warming potential, dry) |
Volatile oils of lavender administered as a capsule in carrier oil, has shown anxiolytic activity on par with benzodiazepines (Woelk & Schläfke, 2010); possesses thymoleptic (mood-elevating) potential which could assist in uplifting mood, especially combined with other relaxing (aromatic) nervines. |
Anxiolytic Thymoleptic Choleretic Carminative |
| Saffron & Rhodiola | Crocus sativus & Rhodiola rosea (somewhat bitter, cooling, dry) |
Both possess strong evidence for monoamine modulation, which may assist in reducing depressive symptoms and dopamine deficit that may be driving self-medication (Sarris & Wardle, 2019); Rhodiola stimulates serotonin and dopamine production whilst restoring neuroendocrine-immune functions, applicable in chronic & acute forms of stress & cerebral deficiency; CAUTION: rhodiola should not be used if psychosis or underlying Bipolar Disorder is present (Holmes, 2007) |
[Saffron] Thymoleptic [Rhodiola] Adaptogen Antioxidant |
| California Poppy | Eschscholzia californica (somewhat bitter, cooling) |
Helps to take edge off pain & discomfort via its pseudo-opioid (non-addictive) compounds; indicated in referred pain from any functional disorder that fails to respond to salicylates or CNS/peripheral analgesics, insomnia from pain (in adult or older child), burning/shooting pain associated with nerve damage, neuro-excitability, anxiety, stomach pain & cramping, colic, muscle aches, skin hypersensitivity (Green, 2007). |
Anxiolytic Analgesic Hypnotic Hypotensive |
| Baical Skullcap | Scutellaria baicalensis (bitter, dry, cold) |
Baical skullcap's flavonoid content helps to reduce inflammation in the brain, boosts neuroplasticity/BDNF to stimulate regeneration and it specifically protects and regenerates damaged dopaminergic pathways alleviating anxiety, insomnia & headaches; significant antioxidant & anti-inflammatory actions in alcoholic liver disease (Sarris & Wardle, 2019); better used after major withdrawal symptoms have calmed and nutritional replenishment is underway; treats liver congestion & biliary dyspepsia (Holmes, 2007). |
Thymoleptic Anxiolytic Nervine tropho Nootropic Choleretic |
| Common OR Mexican Valerian | Valeriana officinalis OR V. edulis (warming, stimulating) |
Cold-type insomnia (high doses work better for disruptive sleep - not so effective for sleep onset); anxiety, despondency & nervousness in those whose face & skin look pale and lifeless or and body feels cool; uterine & gastrointestinal tension (gas, cramps, constipation, conditions related to IBS), shakes & other symptoms of alcohol withdrawal (Green, 2007); recommended for those with poor blood circulation in general, particularly throughout the gut-brain axis, excellent intestinal relaxant and carminative while also working on uterine tension (Holmes, 2007); valerenic acid has demonstrated GABA-A receptor agonism & partial agonism of 5-HT thereby increasing reuptake and decreased degradation of GABA (Sarris & Wardle, 2019). |
Sedative GABA-mimetic Analgesic Hypnotic Antispasmodic Carminative |
| Oat seed & green | Avena sativa (semen & folia) (oily, warming, moist) |
Works on the HPA/O axis, stimulating the release of many neural secretions as well as hormones such as oestrogen, thyroxine and growth hormone; specific for spasmodic and nervous disorders (with exhaustion), cardiac weakness, nervous debility of convalescence, neuroendocrine deficiency, tensive articular swellings; can provide systemic support in cases of stress, anxiety and drug withdrawals; nervous exhaustion in normally strong people, from sympathetic adrenergic burnout or abuse of stimulants (Holmes, 2007; Moore, 1996). |
[Immature seed] Nervine tropho Thymoleptic Nutritive (more stimulating than greens) [Green] Nerve tonic & tropho Antispasmodic Anxiolytic |
| Korean ginseng OR American ginseng | Panax ginseng (somewhat bitter, warm, dry) OR P. quinquefolium (somewhat bitter & sweet, cool, moist) |
Korean ginseng has potential to lessen the symptoms of withdrawal and behavioural effects of drugs such as methamphetamine, cocaine and alcohol via neural hyperactivity inhibition and ginsenoside’s modulation of dopaminergic transmission (Lu, Liu, Zhu, Shi, Liu, Ling, & Kosten, 2009), particularly indicated when fatigue w/ LOW and wasting is present (Holmes, 2007); American ginseng could also be considered, possessing similar properties with a less stimulating effect (Lu et al, 2009). |
Neuroendocrine restorative Adaptogen Choleretic Hepato-protective Nutritive (P. quinquefolium) |
| Schisandra | Schisandra chinensis (sour, salty, bitter, warming, dry) |
Whilst protecting the liver and modulating the HPA axis, schisandra berry has shown to directly stimulate nerve cells, increasing cognitive performance incl. co-ordination & sense perception thereby indicated in neurasthenic conditions (incl. headaches, sleep disorder, memory loss, psychoses, cerebellar ataxia etc.); may also prove useful in clearing rhinorrhoea common in opioid withdrawal (Holmes, 2007). |
Adaptogen Hepato-protective Mucostatic Nervine tropho Astringent |
| Milk thistle | Silybum marianum (bitter, warm, dry, sweet, oily) |
Vitalises the blood by decongesting the liver, vein & capillaries of stagnant fluids and toxins; promotes digestion, relieves jaundice; warms the interior, stimulates circulation, dispels cold (Holmes, 2007); promotes tissue repair via hastening protein synthesis; the silymarin complex (highest in the seed), prevents toxins (incl. viruses & drugs) from penetrating the hepatocytes, thereby preventing & treating liver damage (Wood, 2008). |
Hepatoprotective Hepato-tropho Antioxidant Nephroprotective Cholagogue Anti-hepatotoxic |
References
ADF. (n.d.). Drug Facts. Australian Drug Foundation. https://adf.org.au/drug-facts/
Ausmed. (2019). Drug and Alcohol Withdrawal: An Insight. Retrieved from: https://www.ausmed.com.au/cpd/articles/drug-and-alcohol-withdrawal
Green, J. (2007). The Male Herbal. Crossing Press: Berkley.
Holmes, P. (2007). Energetics of Western Herbs (vol I & II). Snow Louts Press: Cotati, CA.
Kashani, L., Mobaseri, M., Hosseini, S. H., Nikzad, S., Khani, M., & Akhondzadeh, S. (2001). Passionflower in the treatment of opiates withdrawal: A double-blind randomized controlled trial. Journal of Clinical Pharmacy and Therapeutics, 26(5), 369–373. https://doi.org/10.1046/j.1365-2710.2001.00366.x
Lu, L., Liu, Y., Zhu, W., Shi, J., Liu, Y., Ling, W., & Kosten, T. R. (2009). Traditional medicine in the treatment of drug addiction. American Journal of Drug and Alcohol Abuse, 35(1), 1–11. https://doi.org/10.1080/00952990802455469
Malcolm, B. J., & Tallian, K. (2017). Essential oil of lavender in anxiety disorders: Ready for prime time? Mental Health Clinician, 7(4), 147–155. https://doi.org/10.9740/mhc.2017.07.147
Owens, D. (2019). Tardive dyskinesia update: The syndrome. BJPsych Advances, 25(1), 57-69. doi:10.1192/bja.2018.45
Sarris, J., & Wardle, J. (2019). Clinical Naturopathy: An Evidence-based Guide to Practice. Sydney, Australia: Churchill Livingstone/Elsevier.
Van Der Gaag, M. (2006). A neuropsychiatric model of biological and psychological processes in the remission of delusions and auditory hallucinations. Schizophrenia Bulletin, 32(SUPPL.1). https://doi.org/10.1093/schbul/sbl027
Woelk, H., & Schläfke, S. (2010). A multi-center, double-blind, randomised study of the Lavender oil preparation Silexan in comparison to Lorazepam for generalized anxiety disorder. Phytomedicine, 1794-99. doi:10.1016/j.phymed.2009.10.006
Wood, M. (2008). Earthwise Herbal. North Atlantic Books, Berkeley, CA.
