Addiction+Withdrawal


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Definition:
The signs and symptoms that develop in a patient during the time he/she is abstaining from a drug he/she is physically dependent on.

Etiology:
Drug dependence may be physiological (the state of adapting to a drug associated with the development of tolerance and clinically seen by a withdrawal or abstinence syndrome); or psychological (feelings of contentment while on the drug therefore creating a strong desire to experience repeated drug administrations to achieve pleasure or avoid pain). The withdrawal syndrome is defined as "unpleasant physiologic changes that occur when the drug is discontinued abruptly or when its effect is counteracted by a specific antagonist." (Merck).

The phenomena, therefore, may be metabolically or psychologically based.

Nutrition:
» alcohol withdrawal: eating principles: • after patient is stabilized, a short alkaline fast is recommended, highly supervised. Good dietary habits are a must.

therapeutic foods: • increase foods that cool the Xue (Blood) and clear Heat, soothe the Liver • beets and beet tops, bamboo shoots, spinach, banana, grapefruit, mulberry, persimmon, strawberry, white mushroom, apple, ginseng, white fungus (Ni, pp. 28, 35, 36, 48, 56, 61, 64, 66-69, 96) • daikon radish, pear, mandarin orange, black soybeans, dandelion, burdock, chlorophyll, artichokes, garlic, onions • increase Zinc-rich foods, Magnesium-rich foods, foods with Vitamins Bl and B6; in beginning detoxification, supply with enough fruit juices to get lift when needed and enough liquid

fresh juices: • carrot (Walker, p. 145) • carrot, beet, and lettuce (Walker, p. 145) • carrot and spinach (Walker, p. 145) • dandelion tea (Shefi) • beet top tea (Ni, p. 28) • daikon • persimmon juice or tea (Ni, p. 68)

specific remedies: • pour boiling water into teapot containing 15 g tea leaves, steep 10 minutes and drink all at once (Lu, p. 149) • boil 60 g black soybeans in water and drink as soup (Lu, p. 149) • put 15 g sugar in 30 ml rice vinegar; add a little hot water to dissolve the sugar. Drink all at once (Lu, p. 149) • boil 30 g hyacinth beans in water. Drink as soup (Lu, p. 149)

avoid: • cinnamon and other Heating foods, spicy foods, coffee (long term), sweets and sugary foods, high fat diet, fried foods, candies, simple carbohydrates, fatty foods, rich foods, chocolate, nuts, smoking, stress, constipation, hot foods, chili, spicy foods

» smoking and drug detoxification: • All rules from alcohol detoxification apply and fasting is recommended. For smoking detoxification, increase all foods rich in vitamin A • An alkalinizing diet to reduce nicotine cravings is recommended

specific remedies: » smoking withdrawal: • grate a fresh radish and mix with 2 tsp. honey and drink as juice (Lu, p. 150) • prepare 100 g fresh tofu and 50 g black sugar; make a few holes in the tofu and put the sugar into the holes. Steam the tofu, then eat a few tsp. tofu when feeling the urge to smoke (Lu, p. 150)

Botanicals
note: sections are divided into alcohol, drugs, and smoking

alcohol: • Apocynum cannabinum (toxic): to settle stomach, strengthen heart during delirium tremens or after abuse (Ellingwood, p. 231) • Avena sativa: nervine, helps overcome habit (Ellingwood, p. 205) • Capsicum frutescens: delirium tremens; steadies patient, promotes sound sleep (Felter and Lloyd, p. 435) • Chamomilla spp.: sedative • Chionanthus virginicus: gastrointestinal or hepatic disorders (Felter, p. 287) • Conium maculatum (toxic): antispasmodic, anodyne, soothes in delirium tremens (Ellingwood, p. 231) • Datura stramonium (toxic): delirium tremens, enraged, inclined to hurt him/herself or others (Felter and Lloyd, p. 1840) • Gelsemium sempervirens (toxic): according to indications (Ellingwood, pp. 74, 75) • Humulus lupulus: delirium tremens, excitement, aids digestion (Felter and Lloyd, p. 999) • Hydrastis canadensis: to overcome craving (Harper-Shove, p.164, Felter and Lloyd, p. 1026) • Hyoscyamus niger (toxic): delirium tremens; violent delirium, face pale and sunken, twitching of every muscle (Harper-Shove, p. 26) • Passiflora incarnata: insomnia; sedative • Scutellaria lateriflora: delirium tremens, nervine: insomnia, nightmares, restlessness (Sherman)

Ellingwood also recommends: Claviceps purpurea (toxic), Lobelia inflata (toxic), Panax quinquefolius

see: alcoholism, hangover

drug withdrawal: • Avena sativa: helps overcome habit (alcohol, morphine, opium) (Ellingwood, p. 204) • Chamomilla spp.: sedative • Datura stramonium (toxic): opium habit; delirium: furious, raging, destructive (Harper-Shove, pp. 26, 177) • Gelsemium sempervirens (toxic): for drug habit, opium (Harper-Shove, p. 177) • Panax ginseng • Scutellaria lateriflora: sedative, muscle twitchings see: nightmares or appropriate mental/emotional state

smoking: • Acorus calamus (toxic): sedative, for withdrawal (Sherman) • Avena sativa: nerve tonic, helps overcome habit (Ellingwood, p. 205) • Chionanthus virginicus: (Ellingwood, p. 314) • Foeniculum vulgare: helps expel mucous secretions (NCNM Botanicals) • Glycyrrhiza glabra: irritations of mucosa • Lobelia inflata (toxic): for withdrawal, expectorant • Nepeta cataria: nervous irritability (NCNM Botanicals) • Passiflora incarnata: nervine, insomnia • Prunus virginiana: sedative, quiets irritation of mucosa (NCNM Botanicals) • Sassafras variifolium (oil): to overcome (Harper-Shove, p. 177) • Scutellaria lateriflora: nervine • Sterculia acuminata (Kola-nut): depressive states, melancholia (British Herbal Pharmacopoeia, p. 71) • Tussilago farfara: to substitute habit (Harper-Shove, p. 177)

Chinese Formulae
Lotus Seed C.: Internal Heat: Deficient Spleen, Lung, Kidney Disorders caused by excessive indulgence. (Hsu, 1980, p. 164; Dharmananda, 1986, p. 306) Bupleurum and Dragon Bone C. (Chai Hu Jia Long Gu Mu Li Tang); Ardisia 16 (patent): For the mental stress: nervousness, insomnia, heart palpitations, digestive disturbances, tense pulse (Bupleurum: Hsu, 1980, p. 340; Dharmananda, 1986, p. 154; Bensky and Barolet, p. 387; Ardisia: Dharmananda, 1990, p. 36) Licorice and Jujube C. (Gan Mai Da Zao Tang): Shen Disturbance: absentmindedness, moodiness, crying spells, restless sleep (Hsu, 1980, p. 347; Yeung, p. 102; Dharmananda, 1986, p. 110; Bensky and Barolet, p. 383) Ginseng and Longan C. (Gui Pi Tang): Heart Xue Xu (Blood Deficiency) and Spleen Qi Xu (Deficiency): palpitations, insomnia, dream-disturbed sleep, anxiety anorexia (Hsu, 1980, p. 425; Yeung, p. 112; Dharmananda, 1986, p. 244; Bensky and Barolet, p. 255) Fu-shen 16 (patent) plus Zizyphus 18 (patent): Heart Fire Blazing causing Shen Disturbance (Dharmananda, 1990, Fu-shen, p. 68; Zizyphus, p. 29)

Acupuncture
after assessing the person and palpating, consider these patterns: Kidney Yin and/or Yang Xu (Deficiency); Liver Yin Xu (Deficiency); Spleen Yang Xu (Deficiency); Shen Disturbance; Heart Xue Xu (Blood Deficiency) and Spleen Qi Xu (Deficiency); Heart Fire Blazing causing Shen Disturbance; Shi (Excess) of the Du Mai (Governing Vessel)

» therapeutic note: The effective treatment of withdrawal as a generic condition can be surprisingly effective with a minimal protocol. However, the therapeutic process will be greatly enhanced through the individualization of treatment. Just as no single type of individual is the addictive type so must such treatment be directed toward addressing the uniquity and depth of the individual once the more physiologically determined experience of withdrawal itself has been passed.

» point combinations to consider for detoxification/withdrawal involving alcohol : • GV-20, an mian, PC-6, St-3 and Sp-6 for associated nausea and vomiting (Eisen)

Homeopathy
• Lac Humanum: history of difficult mother-child relationship; issues of nourishment

from alcohol: • Aconitum napellus: fear, tossing about • Avena sativa: nervous, sleepless • Cannabis sativa: violence, mind active and talkative, sense of exaggeration, delusion, hallucination; perspiration and flushing of face • Capsicum frutescens: morning vomiting, sick stomach, intense craving, agitation, frightful visions and delirium • Hyoscyamus niger: loquacious, tremulous; insomnia with sexual excitement, outbursts of laughter alternating with weeping • Nux vomica: nervous, headache, frightful visions, irritability, gastric upset

from tobacco: • Aconitum napellus: severe headache and nausea • Caladium seguinum: for craving • Chamomilla: giddiness, fainting, vomiting of bile • Cocculus indicus: violent convulsions • Pulsatilla: sickness of stomach • Staphysagria: uneasiness and nausea • Tabacum

from cocaine, morphine: • Apomorphia: vomiting preceded by nausea, with lassitude; increased secretion of sweat, saliva, mucus and tears; dilated pupils • Avena sativa: nervous exhaustion, sexual debility • Belladonna: stupefied • Chamomilla: pains that remain

Mind/Body
• It is generally believed that people who are addicted to alcohol, cigarettes, or drugs have a chemical addiction, meaning their cells are hooked on the drug(s). But at the level of the body's chemistry, we find that heroin or nicotine fits into the same receptors on the cell walls that everyone has. An addict does not have receptors that exhibit abnormal cravings. The truth seems to be that the cell's memory for the addictive substance is what is hooked, and it keeps creating distorted cells that reflect its weakness. In other words, an addiction is a distorted memory. If you take an addict, detoxify his body, and keep him away from alcohol or drugs for several years, all the old cells that used to be 'chemically addicted' are totally gone. Yet the memory persists, and if you give it a chance, the memory will latch onto the addictive substance once again. (Chopra, p. 88) (related materia medica listings: state-dependent learning) • Conflict between a primary and a secondary process in which one uses increasing quantities of a drug to support a secondary process in order to overcome the primary one. (Mindell, 1988, p. 173) (related materia medica listings: process oriented paradigm; holographic paradigm) • Many addicts have a primary process in which they actually identify with the drug of choice; they are the drug, and they will produce that drugs' effects around them - people who are coffee addicts begin to produce high strung, hyperactive coffee-like effects on those around them, just as alcoholics produce an alcoholic environment around them (warm, sympathetic, relaxed, loss of relativity). (Mindell, 1988, p. 114, 125) • Being an alcoholic or an addict means having a preference for a certain state of consciousness. It is not drug dependent but can be accessed as an altered state. Only one of the parts is drunk or stoned. There is always another part which can be accessed. With a drugged person, however, accessing any secondary process when the primary one is drunk will be a very sobering experience because drunkenness is only a primary process. For example, the person may find the courage to look closely and soberly at their responsibility. (Mindell, 1988, p. 122, 131) • Running from the self. Dislike of the self. (Hay, 1988, p. 10) • Alcoholism: Feeling of futility, guilt, inadequacy; self-rejection. (Hay, 1984, p. 151) • Lynn Andrews, in "Mirroring the Life Force" states: 'Life force pours out of you through the holes in your life called addictions, whether they be to substances or emotions (sadness, chaos, poor self-esteem).' (Carlson, p. 44)

related materia medica listings: addiction: psychosocial approach

Chinese psychophysiology: • Heart ~ Xin houses the Shen (Spirit) and reveals itself through the brightness in the eyes; governs Fire and Heat; rules the Xue (Blood) and its vessels and directs the circulation; opens into the tongue and controls speech; and relates to the integration of the organs and the personality. » Healthy expressions are warmth, vitality, excitement, inner peace, love, and joy. » Heart Xu (Deficiency) signs include sadness; absence of laughter; depression; fear; anxiety; shortness of breath (Seem, p. 28); cold feeling in the chest and limbs; palpitations; cold sweat; inability to speak; memory failure; nocturnal emissions; and restless sleep. Chronic Yin Xu (Deficiency) predisposes to Empty Fire, acute and chronic. » Heart Shi (Excess) signs include false or facile laughter; sobbing; agitated spirit; insomnia (Seem, p. 28); frightful dreams; anxiety; tongue feels numb and heavy; heavy chest; hot sweat; and orange-colored urine. » The Heart is the Emperor of the bodily realm so that when the Heart is disturbed all the other organs will be disrupted.

• Spleen ~ Pi governs digestion; transforms food into Qi and Xue (Blood); governs the Xue (Blood); resolves Dampness and Phlegm; maintains upbearing; and relates to the ability to assimilate, stabilize, and feel centered and balanced. » Healthy expressions are fairness, openness, deep thinking, and reminiscence. » Spleen Xu (Deficiency) signs include slightness (deficient "form"); abundant elimination; morning fatigue; cold, wet feet (Seem, p. 28); abdomen taut and distended like a drum; craving for sweets; flatulence; nausea; mild edema; memory failure; heavy feeling in legs; pale lips; loose stools; muscular weakness; and eventually obesity. » The excessive use of the mind in thinking, studying, concentrating, and memorizing over a long period of time tends to weaken the Spleen and may lead to Xue Yu (Blood Stasis). This also includes excessive pensiveness and constant brooding. (Maciocia, p. 241) Likewise, inadequate physical exercise and excess consumption of sweet and Cold foods will also deplete the Spleen. Environmentally, the Spleen is highly susceptible to attack from external Dampness and Cold.

• Kidney ~ Shen stores Jing (Essence) and governs birth, growth, reproduction, development, and aging; houses the Zhi (Will); expresses ambition and focus; provides the "Fire of Life" through its Yang functions; provides the nourishing and stabilizing qualities of Yin and Water that balance the Yang and the Fiery qualities, especially of the Heart; nourishes the brain to sustain concentration, clear thinking, and memory; manifests through the teeth, head hair, ears and equilibrium; and displays the effects of sexual dissipation, overwork, aging, chronic debilitation, and extreme stress. » Healthy expressions are gentleness, groundedness, and endurance. » Kidney Xu (Deficiency) signs include indecisiveness; confused speech; dreams of trees submerged under water; cold feet and legs; abundant sweating (Seem, p. 28); fearfulness; apathy; chronic fatigue; discouragement; scatteredness; lack of will; negativity; impatience; difficult inhalation; low sex drive; lumbago; sciatica; and musculoskeletal irritation and inflammation, especially when worse from touch. As always, chronic Yin Xu (Deficiency) predisposes to Empty Heat and/or acute inflammation. » Intense or prolonged fear depletes the Kidney. Often chronic anxiety may induce Xu (Deficiency) and then Fire within the Kidney. (Maciocia, p. 250) Overwork, parenting, simple aging, and a sedentary or excessively indulgent lifestyle all contribute significantly to Kidney Xu (Deficiency).

• Liver ~ Gan is the home of the Hun (Ethereal Soul); it relates to decisiveness, control, and the principle of emergence; stores and cleanses the Xue (Blood); maintains smooth flow of Qi and Xue (Blood); opens into the eyes; and expresses itself in the nervous system; and reflects emotional harmony and movement. » Healthy expressions are kindness, spontaneity, and ease of movement. » Liver Xu (Deficiency) signs include impotence; frigidity; pain in thighs, pelvic region, and throat; ready tendency to "the blahs" (Seem, p. 28); timidity; depression; irritability; vertigo; pruritus; dry eyes, skin, and/or tendons; asthma; aching at the waist; hernia; and difficulty raising head up and down. Liver Yin Xu (Deficiency) predisposes to Shi (Excess) conditions such as Liver Yang Rising, and Liver Fire Blazing. » Liver Qi Stagnation reflects and accentuates emotional constraint as the Liver's function of facilitating smooth flow in the body is constricted. Stagnation is associated with frustration, irritability, tension, and feeling stuck. With time this pattern tends to produce a gloomy emotional state of constant resentment, repressed anger or depression, along with tightness in the chest, frequent sighing, abdominal tension or distension, and/or a feeling of a lump in the throat with difficulty in swallowing. (Maciocia, p. 216) » Liver Shi (Excess) signs include discontent; anger; pain in lumbar region and genitals (Seem, p. 28); muscular tension; excessive sex drive; insomnia; moodiness; excitability; genital diseases; red, tearing eyes; compulsive energy; and bitter taste in the mouth. Chronically suppressed anger can implode and give rise to Fire in the Liver and Gall Bladder with symptoms of irritability, bitter taste, headaches, etc.

Integrative Therapies
Quit Smoking

Tobacco smoking tends to prevent the immune system from working properly and increases susceptibility to disease. In addition, a burning cigarette transmits a large amount of reactive molecules (called free radicals) that can bind and destroy cells within your body. Cigarette smoking has been implicated in causing or worsening depression, high blood pressure, osteoporosis, arthritis, and heart disease. Other implications include tooth and gum diseases, ulcers, panic disorders, and several types of cancer, as well as other diseases.

Pregnant women should be especially concerned about cigarette smoking, because it has been linked to the increased chance of having a baby with a low birth weight or with death of the fetus in the womb.

Nicotine is the major addicting ingredient in cigarette tobacco. It acts as a stimulant to the heart and the nervous system. Over time, cigarettes also come to serve emotional and social functions such as relieving anxiety and encouraging social interaction.

Many people are able to establish their own personal program and give up smoking. Withdrawal from nicotine includes symptoms such as restlessness, constipation, sweating, headaches, irritability, hunger, and inability to concentrate. Symptoms occasionally last up to 2 weeks, but they usually decrease quite a bit after the second or third day of quitting. The following is a helpful guide to quitting and can be applied to other addictions as well:

THE FOLLLOWING SUPPLEMENTS ARE USED AND CAN BE TAKEN WHILE WITHDRAWING FROM TOBACCO: 1. A multivitamin can be taken daily according to the product label instructions. If you are pregnant, use prenatal vitamins. 2. Glutamine – 500 to 1,000 milligrams 4 times per day between meals. This can help reduce the craving for nicotine and other drugs. 3. B-complex vitamins – 25 to 50 milligrams a day. These help reduce stress and tiredness. 4. Vitamin C – 1,000 milligrams, 4 times a day for a week. Then take 1,000 milligrams twice a day. Decrease the dosage if diarrhea develops.

THE PROPER DIET WILL INCLUDE: 1. Paying attention to what you eat and when. To keep up your energy level and to cut down on craving, eat something every 2 hours. Regular meals can be supplemented with nutritious snacks such as popcorn, unsweetened fruit, carrot and celery sticks, plain yogurt, and nuts with no added salts or fats. If weight gain is a concern, listen to our program on weight loss (number 934), but do not try to go on a weight loss program at the same time. 2. Water will help flush nicotine out of your system. Increase your consumption of water to 8 to 10 glasses of distilled, well, or spring water daily. 3. Be sure to get enough high-quality protein. Replace red meat with fish and chicken as much as possible, and include beans, nuts, and seeds in your diet. 4. Caffeine can bring on anxiety, nervousness, and irritability as well as depression. Decrease or eliminate consumption of caffeine, found mostly in coffee, black tea, chocolate, and some over-the-counter medications. 5. As much as possible, avoid sugar foods such as candy, cake, cookies, and soda pop and refined carbohydrates such as white flour products.

HERBS USED FOR QUITTING SMOKING: 1. Lobelia tincture, which is a liquid herbal extract – 10 drops, as needed, to reduce craving. If nausea develops, discontinue. Lobelia should not be taken during pregnancy. 2. Chamomile tea or Sleepy Time tea – 4 to 6 cups a day. 3. Milk Thistle seed tincture – 20 drops or 2 capsules, 3 times per day. This can help clear toxins from the body. 4. Valerian – 1 to 2 capsules, 4 times a day to reduce anxiety and irritability and to aid in relaxation.

PHYSICAL THERAPY MEASURES FOR SMOKING INCLUDE THE FOLLOWING: 1. The effects of stress need to be reduced through stress management and relaxation techniques such as visualization and meditation. Counseling and support groups are strongly suggested. For more information, refer to the article on stress reduction. 2. It is important to exercise regularly. At least 30 minutes 3 times per week should be engaged in physical exercise that will get your heart working vigorously. Brisk walking, aerobics, swimming, tennis, and racquetball are all excellent forms of exercise. If you have not been very physically active recently, you can start off with brisk walks for as little as 5 or 10 minutes twice a day. Work up to your best rate of activity by adding 2 minutes to the time spent exercising every other day until you're doing it for 1/2 hour to 1 hour. 3. Saunas and steam baths are recommended to relieve tension and cleanse the system. Your local YMCA or health club usually has these available.

HOMEOPATHY: Few homeopathic remedies have been traditionally used for tobacco cravings. From the following homeopathic medicines, choose the one that best matches your symptoms. Dissolve 3 pellets under the tongue throughout the day, up to 6 times a day.

• Nux vomica 12C: For extremely irritability, constipation, and strong craving for cigarettes, alcohol, or other stimulants. • Caladium 12C: If you suffer from headaches that are worse from smoking. • Tabacum 12C: For nausea that is made worse by cigarette smoke. • Daphne 12C: If you suffer from bad breath and a strong craving for tobacco.

ADDITIONAL MEASURES: 1. Avoid the use of nicotine completely. Quitting all at once has been shown to be a more successful strategy than just tapering down your usage. Forget low tar and nicotine cigarettes and go "cold turkey." Without cigarettes, the nicotine will clear out of the body in about 48 hours. This will help diminish cravings and give the body systems a chance to heal.

2. Read the literature about smoking and the problems it can cause. This will help strengthen your resolve.

3. Give yourself a deadline, and decide on the particular date you will begin to give up smoking. The day you pick to stop smoking should be during a weekend or at the start of a vacation. It should be a time when there is minimal stress and strain in your life.

4. Establish a new routine. Since smoking is often connected with other regular daily activities, changing your routine will help break up old habit patterns that are associated with smoking.

5. Fill the time that used to be spent smoking with other activities and associations. For example, if you have been a heavy morning smoker, try establishing a morning exercise routine, taking a long bath or shower, or going on a brisk morning hike or walk.

Other activities you can begin to incorporate into your life include starting a diary, reading, sewing, gardening, remodeling, learning a new skill or craft, creative arts activities, listening to music, taking music lessons, joining clubs, taking classes, or other social activities.

You may feel "down in the dumps" or generally sad and upset for several days. Depression is a common reaction to nicotine withdrawal. However, if you find that the depression is lasting longer than 2 or 3 days or if you find that it is greatly interfering with your daily life, it is necessary to consult a healthcare practitioner or a counselor.

If any of the withdrawal symptoms are causing extreme discomfort or seem to be getting worse even though several days have passed since you started to quit, consider a medical examination.

6. The fear of increased weight gain deters many people from giving up cigarettes. However, the majority of people actually lose weight or maintain their existing weight during the time they are working to stop smoking. Any weight gain is usually temporary and may be beneficial. Follow the dietary recommendations given in this program to help improve eating habits.

Footnotes

BarShalom R, Soileau J. (eds.) Natural Health Hotline. Beaverton, OR: Integrative Medical Arts, 1991-1999.