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From the Townsend Letter
February / March 2016

Updates on the Treatment of Drug Addiction
by Carolyn Ross, MD, MPH
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Patient with anxiety may benefit from:

  • L-theanine 200–400 mg per day as needed
  • Valerian – 300–400 mg 2 to 3 times daily

Insomnia can be treated with:

  • Melatonin – 1–3 mg at bedtime
  • Valerian – 900–1600 mg at bedtime
  • Kava-kava tea made from bulk root

Supplements for Individuals with Substance Use Disorders
Here are some other specific nutrients shown in research to have benefits to those with SUD:
1.  Taurine: 1 gram 3 times a day reduces the toxic byproducts found in alcohol and may decrease the severity of alcohol withdrawal symptoms. Taurine may also reduce the risk of addiction in cocaine abusers.
2.  Acetyl-L-carnitine (2 grams daily) may improve memory in abstinent alcoholics.14
3.  Co-Q10 may reduce neurotoxicity caused by methamphetamine and cocaine.
4.  N-acetyl cysteine (NAC) may reduce cravings for cocaine.15

Supplements for Gut and Brain Health

Dysfunctions in the "gut–brain axis" may be involved in a number of metabolic and mental disorders. The gastrointestinal tract has over 100 million neurons and has the second largest collection of neural tissue in the body (after the brain). Stress can affect the homeostasis between the gut-brain and the stress hormone cortisol can increase gut permeability. As well, imbalances in the gut microbiome can produce inflammatory molecules called cytokines that can have a significant effect on brain function, leading to depression, anxiety, and cognitive dysfunction.16 GI complaints are present in half of individuals with substance use disorders and eating disorders. It is often difficult to distinguish true GI diseases from complaints related to eating disorders, the majority of which resolve with refeeding.17 Some GI complaints in those with SUD will be resolved with abstinence but this may take time. Supplements can help improve gut function sooner:

  1. The use of pancreatic digestive enzymes may be useful in conditions associated with poor digestion, including eating disorders. Digestive enzymes help break down carbohydrates, fat and protein. A small study done in an inpatient eating disorder unit of patients on a combination of a plant-based pancreatic enzyme product and probiotics resulted in a decrease in reports of GI complaints (from 15% to 5%) and a decrease in the use of conventional medications (from 15% to 2%) to treat GI complaints.18
  2. Constipation is a common side effect in opiate use disorder. The easiest treatment is the daily use of magnesium oxide 400–800 mg at bedtime. This should be taken as a preventive therapy rather than only taken when constipation occurs.
  3. Studies in probiotics used in individuals with eating disorders and SUD showed a significant decrease in GI complaints.19 Probiotics have also been shown to restore bowel flora and improve liver enzymes in alcoholics.20 Consumption of foods high in probiotics can also improve brain function.21 Bacteria in probiotics also produce anti-inflammatory cytokines that can have a positive impact on mood. The use of probiotics and a friendly yeast (Saccharomyces boulardii) enhance the production of salivary IgA (sIgA) which can be decreased by emotion, frustration and stress. sIgA helps fight inflammation that can cause depression.
  4. To reduce inflammatory cytokines, use vitamins C, E, and N-acetyl cysteine, green and black tea, and curcumin.

Brain Healing
Brain-derived neurotrophic factor (BdNF) is a protein that is important for survival of nervous system neurons and can serve as a marker of brain health. The more BDNF present, the healthier the brain is. Exposure to the stress hormone cortisol has been shown to decrease BdNF. BdNF regulates the psychological dependence in drug addiction. It is involved in the brain reward circuitry that is negatively affected by drugs of abuse. Stress, smoking, poor sleep, inflammation in the body, and low or high blood sugar all decrease BdNF. Modern foods and the modern lifestyle accelerate brain decay by decreasing BdNF.22
A newer supplement for brain healing is the natural product Synaptamine, developed by Ken Blum, who has been a noted researcher and coined the phrase reward deficiency syndrome to describe the impulsive and compulsive disorders and personality disorders associated with a decrease in dopamine (DRD2) receptors in the brain.
Synaptamine contains amino acids, cofactors, and vitamins that help improve reward deficiency syndrome. It is unclear at present whether long-term abstinence is better with the use of Synaptamine; however, it has some anecdotal reports of efficacy in detoxing patients from opiates and other drugs. Studies on earlier versions of this product showed efficacy in obese patients who had been on severe calorie-restricted diets (Optifast) in terms of reducing weight regain and binge behavior.  This product is available online and shows a lot of promise in helping the brain heal from addictions.

Substance use disorders, particularly opiate use disorder, are a significant problem in our society. An integrative approach to treating SUD and their cooccuring disorders can enhance modalities such as Twelve-Step meetings, psychotherapy, and other approaches. Below are listed a summary of recommendations that form the basis of this approach.

1.  Avoid rancid fats and trans fats; use good fats such as olive oil and omega-3-containing foods.
2.  Eat more foods that are anti-inflammatory such as fruits, vegetables, nuts, and seeds.
3.  Add spices that are anti-inflammatory; e.g., ginger and turmeric.
4.  Green and black tea should be part of an anti-inflammatory diet.
5.  Consume probiotics: bifidobacteria, lactic acid bacteria, Saccharomyces boulardii.
6.  Take a good multivitamin and -mineral product to replace missing nutrients and offer antioxidants such as Vitamins C and E as noted above.
7.  Support mood with omega-3 fatty acids, a B-complex vitamin, and vitamin D.
8.  Consider Synaptamine to help the brain heal.
9.  Use specific supplements as listed in this article for insomnia, depression, anxiety, constipation, etc.
10.  To increase BdNF:

  • Exercise regularly.
  • Keep your blood sugar steady by eating frequent small meals and decreasing your intake of sugary foods and processed foods.
  • Get enough sleep.
  • Take omega-3 fatty acids.

1.     Smith PC et al. A single-question screening test for drug use in primary care. Arch Intern Med. 2010 Jul 12;170(13):1155–1160
2.     Anstine D, Grinenko D. Rapid screening for disordered eating in college-aged females in the primary care setting. J Adolesc Health. 2000;26:338–342.
3.     Ibid.
4.     Rösner S, Hackl-Herrwerth A, Leucht S, Vecchi S, Srisurapanont M, Soyka M. Opioid antagonists for alcohol dependence. Cochrane Database Syst Rev. 8 December 2010;12:CD001867. doi: 10.1002/14651858.CD001867.pub2.
5.     Lieber CS. The influence of alcohol on nutritional status. Nutr Rev. 1988;46(7):241–254.
6.     Santolaria-Fernandez et al. Nutritional assessment of drug addicts. Drug Alcohol Depend. 1995 Apr;38(1):11–18.
7.     Althaus CB. The glucose factor: diet and addiction. Foodservice Director. 2001;14(10):62.
8.     Grant LP et al. Nutrition eduction is positively associated with substance abuse treatment outcomes. J Am Diet Assoc. 2004 Apr;104(4):604–610.
9.     Quintero-Platt G, et al. Vitamin D, vascular calcification and mortality among alcoholics. Alcohol Alcohol. 2015 Jan;50(1):18–23.
10.   Schneider B. Substance use disorders and risk for completed suicide. Arch Suicide Res. 2009;13(4):303–316.
11.   Sublette M et al. Omega-3 polyunsaturated essential fatty acid status as a predictor of future suicide risk. Am J Psychiatry. 2006;163:1100–1102.
12.   Song BJ, et al. Prevention of alcoholic fatty liver and mitochondrial dysfunction in the rat by long-chain PUFAs. J Hepatol. 2008 Aug;49(2):262–273.
13.   Buydens-Branchey L and Branchey M. n-3 polyunsaturated fatty acids decrease anxiety feelings in a population of substance abusers. J Clin Psychopharmacol. 2006 Dec;26(6):661–665.
14.   Lake J. Alcohol and Drug Abuse: The Integrative Mental Health Solution.2015. Available at
15.   La Rowe SD et al. Is cocaine desire reduced by NAD? Am J Psych. 2007;164(57):1115–1117.
16.   Montiel-Castro AJ et al. The microbiota-gut-brain axis. Front Integr Neurosci. 2013;7:70.
17.   McClain CJ, Humphries LL, et al. Gastrointestinal and nutritional aspects of eating disorders. J Am Coll Nutr. 1993;12(4):466–474.
18.   Ross C, Herman PM, et al. Evaluation of integrative medicine supplements for mitigation of chronic insomnia and constipation in an inpatient eating disorders setting. Explore. 2008;4(5):315–320.
19.   Ibid.
20.   Kirpich IA et al. Probiotics restore bowel flora and improve liver enzymes in human alcohol-induced liver injury: a Pilot study. Alcohol. 2008 Dec;42(8):675–682.
21.   Changing gut bacteria through diet affects brain function, UCLA study shows [online press release]. EurekAlert.
22.   Crawford M, Cadogan OU. Nutrition and Mental Health: a Handbook. Pavilion Publishing (Brighton) Ltd.; 2008, 2009.

Carolyn Ross, MDDr. Ross is a nationally known author, speaker, and expert in the field of eating disorders and integrative medicine. She went to the University of Michigan Medical School, completed a residency in preventive medicine at Loma Linda University, and set up practice in San Diego, California, where she eventually opened three women's centers, and practiced primary care and office gynecology. These centers integrated the best of Western medicine with complementary and alternative therapies such as yoga, acupuncture, chiropractic, and nutrition counseling. She developed and ran a weight management program for weight loss therapy that offered a holistic approach to treating obesity. During that time, she also served as the medical director of the Rader Institute's inpatient eating disorder program. Dr. Ross later completed a two-year fellowship the University of Arizona's Center for Integrative Medicine, studying with Dr. Andrew Weil. Her path then led her to work as the head of the Eating Disorders Program and the Integrative Medicine Department at world-renowned inpatient hospital Sierra Tucson, where she pioneered the integrative medicine approach to eating disorder treatment. She currently works in private practice in Denver, Colorado, as a weight loss therapist, addiction medicine specialist, and Suboxone doctor who specializes in opioid addiction treatment. She also is a consultant for treatment centers across the country on eating disorders and integrative medicine. Her most recent book is The Binge Eating & Compulsive Overeating Workbook: An Integrative Approach to Overcoming Disordered Eating.

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