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Addiction Recovery

We see patients in our practice on a daily basis that has been struggling for years with addiction issues. They have been in numerous rehab facilities, had years of counseling, faithfully attended recovery meetings and yet continue to relapse. This is devastating to the patient and their family. By addressing the biochemical imbalance contributing to the cravings and subsequent relapse we help our clients achieve longer periods of sobriety,  with little to no relapses.

Addictive drugs stimulate the same neural pathways that are involved in learning normal behaviors. The neurological sense of reward and the emotional sense of pleasure are also stimulated by addictive drugs. Drugs cause a much higher degree of neuronal pathway stimulation and neurotransmitter release. Due to this higher than normal level of neurotransmitter release, the strength of the behaviors learned and extent of neural adaptation associated with drug rewards are much stronger than those of normal biological rewards. This flood of neurotransmitters causes prolonged changes in the brain’s neurocircuitry responsible for sensing satisfaction and reward, and appears to play a key role in causing addiction.

 As frequency and /or intensity of drug use increases, the imprint of chemical connection occurs more rapidly. In fact, as illicit drugs users will attest, there is a euphoric response simply thinking about the drug of choice. This is caused by an imprinted recall of expected response which produces the neurotransmitters just as if the drug had been ingested. Euphoric recall often will produce a greater and more satisfying result than drug us itself, due to physical tolerance.

A consequence to prolonged drug use is an increase in the overall reward threshold which desensitizes the brain to rewards obtained from normal biological cues. This helps to explain why drug seeking behavior can take over a person’s life and can cause them to abandon their friends, family, and jobs, or engage in illegal behaviors to obtain the drug.

Emotionally, the addict is no longer able to feel the positive reinforcement or pleasurable feelings from natural rewards like food, water, or intimacy. They are only able to feel pleasure or perhaps, only feel normal if using the drug. This inability of someone who is drug-dependant to feel pleasure or outright depression emerges as part of the withdrawal syndrome. To avoid this, the user goes back to the drug.

Dopamine and Addiction

 It was once thought that alcohol and drugs cause neurotransmitter pathways to be fired rapidly, dumping large amounts of dopamine, epinephrine, GABA , acetylcholine, and serotonin into the brain, thus giving a  tremendous sensation of well- being, until the supply of neuronutrients and neuronutrition substrates is depleted. The result is a rush of pleasure.

    

The current research suggests that amphetamine and cocaine actually create new pools of dopamine. Food, sugar, chocolate, caffeine, nicotine, purging or exercise binges can also trigger the production of neurotransmitters. A characteristic of nearly all addictive drugs is their ability, directly or indirectly, to increase dopamine, a neurotransmitter involved in pleasure and reward. Most simply, the development of addiction occurs upon increased dopamine signaling within the pleasure sensing nucleus accumbens by neuronal projections from the ventral tegmental area. As this pathway is reinforced through repeated drug exposures, the prefrontal cortex learns and eventually initiates the behaviors that led to the drug induced neurotransmitter release. Those sensitive to behavioral habituation to the point of dysfunction in areas like gambling, oral abuse , overeating, sex, pornography, thrill-seeking, violence,etc, are thought to have a similar reaction with endogenous neurotransmitters.

Drug Cravings and Glutamate

The desire to seek out drugs, or cravings, can persist for years after discontinuing the drug. They are especially strong during times of stress or when the individual is exposed to people, places, or things that were associated with or remind them of past drug use. This high potential for relapse is a significant obstacle in drug recovery programs. Stress and environmental cues are processed by neurons in the prefrontal cortex in the brain. This region does not use dopamine as a neurotransmitter, but instead uses glutamate. The prefrontal cortex has a primary role in risk assessment and decision-making that occurs prior to the manifestation of behavior. Through neuron projections to the core of the nucleus accumbens and the motor coordination circuits of the ventral palladium, the prefrontal cortex influences or determines choice.

Glutamate influences normal adaptive behaviors, or everyday living skills like walking, talking, getting dressed, going to school, driving to work, baking a meal, etc. Adaptive behaviors are skills a person learns in the process of adapting to his/her surroundings. A person’s behavior, good or bad, is determined by this interaction. Unfortunately, drugs significantly change a person’s perception of risk, reward, and social acceptance so a decision to buy drugs instead of groceries hardly seems to matter.         

           

1.The neural circuits of the ventral tegmental area (VTA), the nucleus accumbens, and the prefrontal cortex are critical in learning both natural and drug reward behavior. Upon exposure to either a naturally rewarding stimuli or a drug, there is a increase in dopamine signaling from the ventral tegmental area (VTA) to the nucleus accumbens. The nucleus accumbens “perceives” this dopamine signal and measures the “goodness” of the agent or the natural reward based on the size of the dopamine release. 2.Glutamate projections from the nucleus accumbens instruct the prefrontal cortex to remember the environment and behaviors which lead up to the occurrence of the “goodness”. 3. In addiction, excess signaling of glutamate neurons in the prefrontal cortex stimulate the nucleus accumbens, triggering drug seeking behaviors at the expense of naturally rewarding or good behaviors.

   

  

Amino Acids And Brain Neurotransmitters  

Just as family dynamics contribute to development of addictive behaviors, so does nutrition, particularly as it is involved in supplying precursors for neurotransmitters - chemicals which facilitate activity within the central nervous system such as tyrosine and tryptophan.

Amino acids are required to produce brain neurotransmitters and are found in both protein foods and carbohydrates. Tryptophan found in carbohydrate sources is better utilized by the brain better than that in protein sources producing more serotonin. Insulin production, which increases after eating carbohydrates, increases tryptophan absorption via the blood brain barrier. Also, other nutrients found in carbohydrates are required for all neuronal processing.

Homocysteine

Homocysteine (Hcy) is an intermediate in the transition of methionine to cystine. Without adequate vitamin B6, vitamin B12, and folate to convert Hcy to cysteine, Hcy builds up in the blood and even the brain. For those in recovery this buildup in the brain prevents healthy brain flow and “relaxing” neurotransmission. More profoundly, reports are correlating high levels of Homocysteine with acute withdrawal symptoms from alcohol. It is suspected and argued that continued elevated Hcy level may aggravate chronic post acute withdrawal symptoms to potentiate relapse. Nutrition treatment can reduce or resolve homocysteinemia. The nutrition treatment of homocysteinemia is found to reduce neural death, dementia, depression, neuropathy and aggressive behavior.

Glutamine

Glutamine is a conditionally essential amino acid necessary for energy, nitrogen transport, gut integrity and immune function and plays a role in chemical dependency. Excessive glutamate prevents the metabolism of glutamate to glutamine, decreasing serum levels of glutamine, which is now defined as “glutamine deficiency syndrome.” Glutamate stimulates withdrawal and craving but also lends to increased glutathione and high levels of Homocysteine, both risk factors for drug craving and relapse.

 Glutathione

Glutathione (GSH) is an antioxidant essential for cellular detoxification in the brain. Glutathione is related to neuronal cell death either in inadequate and/or excessive quantities and is related to neurodegenerative disease. Glutathione is a first line defense in the GI tract against drug, alcohol, and toxic substances.

 Eating vegetables and fruit are good food sources of glutathione. Low food sources of glutathione include potatoes, onions, garlic, spices, rice, and bread. These foods do not have much of a protective effect in the gut. Glutathione supplements taken by mouth are usually not effective

N-Acetyl-Cysteine (NAC)

It was shown that NAC reduced the rate of cocaine self-administration among laboratory rats previously allowed to self-administer cocaine in an experiment commonly used to evaluate drug relapse behavior.  Encouraged by these findings, studies utilized N-acetyl-cysteine-containing protocols in humans with cocaine addiction and reduced relapse rates were observed. The ability to reduce cravings with something as safe and well tolerated as an amino acid has generated significant excitement in the medical and scientific communities.  Thus, other models of addiction and compulsive behaviors have experimented with NAC and found benefit. For example, NAC administration has helped to reduce gambling among people with gambling addictions and also reduced hair pulling among patients with trichotillomania. A case report has also been published showing benefit for serotonin reuptake inhibitor- refractory Obsessive Compulsive Disorder (OCD). TheaNAC is a novel supplement which combines Theanine and NAC.

Supplemental Ingredient	Restored Brain Chemical	Addictive Substance Abuse	Amino Acid Deficiency Symptoms	Expected Behavior Change
D-Phenylalanine or DL-Phenylalanine	Enkephalins Endorphins	Heroin, Alcohol, Marijuana, Sweets, Starches, Chocolate, Tobacco	Most Reward Deficiency Syndrome (RDS) conditions sensitive to physical or emotional pain. Crave comfort and pleasure. Desire certain food or drugs.	Reward stimulation. Anti-craving. Mild anti-depression. Mild improved energy and focus. D-Phenylalanine promotes pain relief, increases pleasure.
L-Phenylalanine or L-Tyrosine	Norepinephrine Dopamine	Caffeine, Speed, Cocaine, Marijuana, Aspartame, Chocolate, Alcohol, Tobacco, Sweets, Starches	Most Reward Deficiency Syndrome (RDS) conditions. Depression, low energy. Lack of focus and concentration. Attention-deficit disorder.	Reward stimulation. Anti-craving. Anti-depression. Increased energy. Improved mental focus.
L-Tryptophan or 5 hydroxytryptophan (5HTP)	Serotonin	Sweets, Alcohol, Starch, Ecstasy, Marijuana, Chocolate, Tobacco	Low self-esteem. Obsessive/compulsive behaviors. Irritability or rage. Sleep problems. Afternoon or evening cravings. Negativity. Heat intolerance. Fibromyalgia, SAD (winter blues).	Anti-craving. Anti-depression. Anti-insomnia. Improved appetite control. Improvement in all mood and other serotonin deficiency symptoms.
GABA (Gamma-amino butyric acid)	GABA	Valium, Xanax,, Ativan, Klonopin, Alcohol, Marijuana, Tobacco, Sweets, Starches	Feeling of being stressed-out. Nervous. Tense muscles. Trouble relaxing.	Promotes calmness. Promotes relaxation.
L-Glutamine	GABA (mild enhancement) Fuel source for entire brain	Sweets, Starches, Alcohol	Stress. Mood swings. Hypoglycemia.	Anti-craving, anti-stress. Levels blood sugar and mood. GABA (mild enhancement). Fuel source for entire brain.