All addictions are associated with a complex series of neurocircuits in the brain that fail to generate satisfactory amounts of a brain chemical known as dopamine. Dopamine is responsible for feelings of pleasure. It also reduces negative feelings.
Dopamine is what addicts crave. When the neurocircuits are not allowing for a sufficient release of dopamine, individuals may crave substances or pursue activities to lessen their negative feelings. Eventually something goes awry and the craving for that “dopamine rush” becomes insurmountable. For some people, the net result is compulsive behaviour and addictions to smoking, sexual activity, gambling, alcohol, and/or drugs. How can this vicious cycle stop?
Step 1: Getting help
The quintessential first step in recovery is to admit there is a problem and help is needed. This usually means reaching a major low point (hitting rock bottom). If the desire to change is there, many organizations can be contacted for help (see sidebar, page 53).
Step 2: Rehabilitation
Successful recovery usually involves completing some type of addiction program, whether that is a rehab facility or an outpatient program. Short-term inpatient or outpatient drug-free treatment is associated with reductions in drug use and criminal behaviour, better employment status, and less utilization of health services. Long-term research shows practically the same results, with fewer relapses among participants who have completed a program, as well as better health.
Step 3: Peer support
Regular involvement in groups such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) helps to maintain sobriety and provide essential peer support. These groups are free, incredibly accessible, and provide unlimited support. By interacting with people having similar addictions and life problems, the person in recovery becomes more reflective, less self absorbed, and more capable of seeing other perspectives.
Attending groups such as AA results in increased abstinence, reduced alcohol-related consequences, improved long-term outcomes, and increased life purpose.
Step 4: Wellness
Key to achieving wellness and maintaining sobriety is to participate regularly in relaxation-based therapies, including yoga, mindfulness, and physical exercise.
Yoga helps to build body awareness and is excellent at calming the nervous system. It involves numerous postures that integrate or unify the body and mind. According to a 2011 study, yogic practices “enhance muscular strength and body flexibility; promote and improve respiratory and cardiovascular function; promote recovery from and treatment of addiction; reduce stress, anxiety, depression, and chronic pain; improve sleep patterns; and enhance overall well-being and quality of life.”
Mindfulness training is a form of meditation that brings the focus on the present by broadening attention to one’s breath and bodily sensations. It helps people to focus attention on the present and encourages a positive attitude toward that experience. People with addictions tend to be rather diffuse in their ability to stay present and often ruminate about negative things, which fosters more negative feelings and compulsive behaviours. Mindfulness training insulates one’s thoughts to be more present, positive, and life-affirming.
Recent scientific research reveals exercise’s incredible impact on addiction. Such effects include reduced cravings for cigarettes and managed withdrawal from nicotine dependence, reduced urges for alcohol, decreased anxiety and depression among problem drinkers, and even reduced withdrawal and anxiety among heroin users on morphine.
Physical exercise facilitates recovery by increasing blood flow to the brain, stimulating the release of feel-good chemicals such as endorphins and the neurotransmitters norepinephrine, dopamine, and serotonin. In addition, physical activity has been shown to protect brain cells, provide a healthy distraction, and reduce self-esteem issues.
In treating depression, often associated with addiction, regular physical exercise might be as effective as psychotherapy and is perhaps more effective than other behavioural interventions. No pill has more therapeutic value than regular physical exercise.
Step 5: Diet
Those suffering from addictions generally eat poorly and overconsume refined sugar, junk food, fast food, caffeine, and saturated fats. Their diets are uniformly rich in table sugar and relatively poor in vitamins and minerals. These concerns are also very common in people in recovery. Increased sugar consumption increases inflammation within the body and may reinforce inebriation and addiction. In addition, it is hypothesized that excess sugar reduces dopamine-mediated signalling, which may stimulate food or drug addiction.
Those who are in recovery should eat a diet moderately high in good sources of protein and fat, such as lean chicken, lamb, organic beef, and butter. Including more healthy sources of protein and fat should stabilize blood sugar, reduce hypoglycemic episodes, decrease sugar cravings, and also lessen compulsive behaviours.
The diet should contain about 40 percent carbohydrates, 30 percent protein, and 30 percent fat. These proportions are similar to healthy diets of hunter-gatherer populations. The diet should be very colourful and contain plenty of nutrient-dense fruits, vegetables, nuts, seeds, and legumes. To facilitate this, consult a registered dietitian or holistic nutritionist, who can tailor your plan specifically to your needs.
Step 6: Supplements
Many people in recovery are not meeting their nutritional needs as a result of poor intake, increased metabolic need, malabsorption problems, or the toxic effects from substances such as alcohol and nicotine. This may lead to increased irritability and extreme mood swings. Those in recovery may benefit from taking specific supplements to offset these adverse consequences.
A broad-spectrum multivitamin and -mineral supplement helps to prevent insufficiency states. Once-a-day supplements are fine, but for men, the formula should not contain iron unless iron deficiency has been diagnosed, as men typically do not require additional iron.
Omega-3 essential fatty acids help to stabilize mood, improve nerve-to-nerve communication, and support the survival and growth of brain cells. The daily dose of omega-3 essential fatty acids should provide at least 1,000 mg of eicosapentaenoic acid and 300 to 750 mg of docosahexaenoic acid.
Vitamin B complex
B vitamins support the nervous system by enhancing mood, decreasing anxiety, reducing cravings, and increasing energy. Since people in recovery are typically stressed, they require increased amounts of B vitamins to support their metabolic needs. A well-rounded B-complex supplement includes 50 to 100 mg of vitamins B1, B2, B3, B5, and B6; 200 to 500 mcg of vitamin B12; and 200 to 1,000 mcg of folic acid. An effective dose is one to three pills daily with meals.
Vitamin C helps the body maintain biochemical homeostasis or balance. Many addictions increase the body’s metabolic need for vitamin C, which makes it an important antioxidant nutrient to protect against physiologic stress and tissue damage.
An effective and normally tolerable dose is 1,000 mg three times daily with meals, but some people in recovery might have to take considerably more than this amount.
The amino acid N-acetylcysteine (NAC) is emerging as one of the most important supplements to support recovery. A leading theory of compulsive behaviour is that the glutamatergic system within the brain is underfunctioning, which increases cravings and compulsive behaviour. Because NAC regulates the glutamatergic system in the brain, it satisfies the brain’s reward centres, and reduces cravings and compulsive behaviour.
Numerous reports, pilot studies, and randomized controlled trials have confirmed the efficacy of NAC for nicotine addiction, pathological gambling, cannabis dependence, and cocaine addiction. An effective dose is 2,000 to 2,400 mg once daily about 30 to 45 minutes prior to breakfast. It must be taken without food or else the amino acids derived from dietary protein will interfere with NAC’s effectiveness. There are normally no side effects with NAC, but some patients have complained of gastric upset.
The herbal medicine rhodiola is a very effective and important intervention since it attenuates depression, anxiety, and fatigue. Rhodiola might be helpful in treating all addictions, even though preliminary work with animals has only shown it to be effective against nicotine and opioid addiction.
Rhodiola works by increasing feel-good brain chemicals such as serotonin, norepinephrine, and dopamine. It also moderates stress by making the body (and mind) more resilient to the harmful physiological effects of stress, such as increased cortisol levels.
It is one of the more impressive herbal medicines since it has little downside. It is not known to interact with any mainstream psychotropic medications and often helps many patients who take it.
The therapeutic dose range is between 500 and 650 mg of a standardized extract containing 3 percent total rosavins and 1 percent salidrosides. Although many authorities recommend rhodiola on an empty stomach, it can cause considerable nausea and possibly vomiting. To avoid this side effect, take it in the morning with breakfast.
About the writer:
Jonathan Prousky, BPHE, MSc, ND, is chief naturopathic medical officer of the Canadian College of Naturopathic Medicine. He operates a private clinic that focuses on naturopathic care for mental health disorders.
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