Addiction is a topic that is deeply personal to me. My grandmother was an alcoholic and killed herself when my mother was 15. A few years earlier, she had received a penknife from Alcoholics Anonymous congratulating her for 7 years of sobriety. She had relapsed, and was put on experimental antidepressants which were removed from the market later for causing suicide. She was 49 when she died, the age I am now. And my eldest is 15. Those numbers are not lost on me as I write this. This tragedy reverberated across generations of my family, impacting my mother of course, myself, and my own children. This website is inspired by her, and dedicated to her and to all the millions of people suffering from addiction and mental health issues.
Today, an integrative approach to her addiction might have saved her — when I looked at her medical records, it showed clear signs of hormone imbalance due to perimenopause and blood sugar issues. All low hanging fruit for integrative and functional medicine practitioners. She also had TBI from a car crash in her early adulthood – another factor which integrative practitioners would look at and treat.
Prevalence of addiction and poor outcomes of treatment
I look around our societies and see addiction in many different forms – some more extreme, some milder, depending on where we find ourselves on the spectrum; some to substances (illegal such as cocaine and heroin; legal such as alcohol and tobacco; prescription such as opiates and benzos) and some to behaviours (sex, shopping, gambling, technology, social media).
When reading Dr. Arwen Podesta’s book “Hooked: A Concise Guide to the Underlying Mechanics of Addiction and Treatment for Patients, Families, and Providers” to prepare for our interview on The MindHealth360 Show this month I was shocked to hear the poor prognosis of addiction treatment centres, rehabs and programmes, which have success rates which tend to hover around 30% to 40%, depending on the type of treatment and amount of time spent in treatment.
The relationship between addiction and mental health
To me, the line between addiction and mental health is a very fine one. We become addicted to substances and behaviours as ways of medicating our mental health symptoms and states of depression, mood swings, anxiety, insomnia, irritability, poor memory, poor attention, lethargy and exhaustion, anger, and emptiness.
The interesting thing to me has always been the question of what causes these symptoms and states in the first place — the discomfort of which can then lead to addiction? As we have often outlined in this website, these symptoms and states can be caused by:
Psycho-spiritual factors such as:
- a dysregulated nervous system
- psychological trauma and adverse childhood experiences (ACE)
- difficult economic and environmental circumstances
- difficult relationships
- isolation and disconnection
Biochemical factors such as:
- toxins (moulds, pesticides, heavy metals)
- infections (Lyme, EBV, bartonella)
- gut issues
- poor nutrition status
- food allergies
- genetic factors
- methylation issues
- TBI (traumatic brain injury)
- disrupted circadian rhythms
Lifestyle-Behavioural factors such as:
- poor sleep
- lack of appropriate exercise
- stress, especially chronic
- poor breathing
- lack of nature and natural light
Therefore, it is imperative to look at ALL the factors that may be contributing to the unpleasant mental health symptoms and states that can lead to addiction to substances and behaviours.
Why an integrative approach is essential
Just as mainstream psychiatry needs to move beyond treating mental health issues with pills and some talk therapy, addiction treatment needs to move beyond treating addiction with pills, talk therapy and 12-steps. I am not knocking any of these modalities of treatment. But I am saying they are not enough on their own.
To improve chances of successfully treating addiction long term, an integrative approach is essential. There are plenty of addicts valiantly white-knuckling through sobriety, while being undermined by untreated and silent biochemical imbalances. This is the approach taken by Dr. Arwen Podesta and Dr. Joe Mather, who team up to look at all angles of addiction, providing medically-assisted withdrawal, and a full biochemical workup to look at the gut issues (such as leaky gut, dysbiosis), toxic load (such as heavy metals and moulds), nutrition status (low D, low zinc, high copper, low Bs) methylation issues (especially of folate the and B vitamins), genetics, and lifestyle factors (such as sleep, exercise, and stress levels), coupled with nervous and limbic system retraining and trauma therapies.
An integrative approach case study
One of my best friends is an ex-heroin addict who struggled with addiction to various drugs since his early teenage years. In his thirties, having cleaned up his heroin habit with the help of a dedicated martial art practice, he became a benzodiazepine addict. Benzos, according to him, are a harder habit to kick than heroin. The withdrawal from benzos is apparently much longer, more treacherous and difficult. Not only was he using benzos to medicate his underlying anxiety, but the benzos were undermining his own endogenous production of calming neurochemicals (especially GABA, the calming neurotransmitter) as well as the integrity of his gut (benzos can cause irritation of the gut lining and leaky gut).
In order to make his sobriety easier to sustain, we took an integrative approach and looked at what may have been causing his underlying anxiety, which in his case was childhood trauma, gut dysbiosis, incredibly low cholesterol (low cholesterol is correlated to suicidality, aggression and other mental health issues), a vegan diet with low protein and poor amino acid supply (therefore, poor building blocks for key neurotransmitters), and low B12 amongst other things.
We helped him boost his biochemistry with supplements and nutrition, as well as some NAD IV therapy, to help balance his hormones, neurotransmitters, gut bacteria, fats, proteins and micronutrients, therefore lessening his anxiety and his need for the benzos, and to repair the damage done by the benzos. This has been a long and slow process, but his ability to stick with the 12-step programme and stay sober for almost a year so far, has been greatly enhanced by his more balanced biochemistry. Somatic therapies such as sensorimotor psychotherapy, somatic experiencing and EMDR, if available, would have been a vital addition to this treatment programme. He also followed a method of breathing and ice baths which have been shown to act on the opiate and endorphin system.
My plea to the addiction treatment community
There is no doubt that a more integrative and functional medicine approach would greatly improve patient outcomes, and yet few rehab and treatment centres seem to be practicing this approach completely. While some of them go further than others, the price tag is prohibitive. While this approach can be more expensive, it needn’t be prohibitively expensive.
My plea to the addiction and rehab treatment communities is therefore this: adopt an integrative approach to addiction — combining biochemical, with psycho-spiritual and lifestyle approaches — in order to improve recovery rates and outcomes.