10_0702PT_Lake.ps 1/23/07 4:01 PM Page 10 10 PSYCHIATRIC TIMES FEBRUARY 2007 www.psychiatrictimes.com INTEGRATIVE MEDICINE Nonconventional and Integrative Treatments of Alcohol and Substance Abuse by James Lake, MD he high cost to society of alcohol and drug abuse reflects plements to compensate for a proba- a useful preventive a crisis of epidemic proportions that has not been ade- ble alcohol-related malabsorption syn- intervention in this drome, to mitigate the toxic effects of high-risk popula- quately addressed by conventional treatment approach- 23 alcohol abuse on the body and brain, tion. Taking L-tryp- T es, including mainstream pharmacologic treatments, and to reduce craving and the severity of tophan before drink- psychotherapy, and social programs. The annual costs associat- withdrawal. ing may reduce the ed with alcohol and drug abuse in the United States were esti- severity of the cog- Amino acid deficiency nitive impairment mated to be $246 billion in 1992, the most recent year for which Malnutrition and malabsorption in associated with al- 1 data are available. Results of controlled trials and patient surveys persons who chronically abuse alcohol cohol use.24 confirm that many of the conventional pharmacologic and psy- often lead to deficiencies in important Available evidence suggests that chosocial treatments for alcohol and drug abuse or dependence amino acids including taurine, S-aden- safety problems are seldom reported are only moderately effective in terms of discontinuation rates osylmethionine (SAMe), tyrosine, when typically used therapeutic doses L-tryptophan, and acetyl-L-carnitine. of quality-brand amino acid supple- 2-4 and long-term abstinence. In this context, it is important for psy- Supplementation with amino acids ments are combined with conventional chiatrists and other mental health professionals to learn about helps lessen the severity of withdrawal psychiatric medications.25,26 However, promising nonconventional and integrative treatment strategies. symptoms, protect the liver, and restore rare cases of serotonin syndrome have normal brain function been reported when L-tryptophan, 5- In this 2-part column, I will concise- with an alcohol use dis- in patients with chronic HTP, or SAMe were used concurrently ly review the evidence for nonconven- order who improve their Part 1 alcoholism. with serotonergic drugs. Therefore, pa- tional and integrative treatments for general nutrition proba- Taurine supplementa- tients using this integrative strategy symptoms related to alcohol and drug bly have a better chance of maintaining tion may lower the serum level of should be closely monitored for emerg- abuse, dependence, and withdrawal. sobriety than those who do not.6,7 Find- acetaldehyde, a toxic metabolite of al- ing adverse effects.27,28 Safety concerns Part 1 covers nonconventional and inte- ings from animal studies suggest that cohol that can interfere with normal have not been reported when combining grative treatments, the beneficial effects low serum thiamine levels may be re- mental function.14 In an early controlled taurine or acetyl-L-carnitine with con- of which are achieved through a discrete lated to increased alcohol craving.8 trial, 60 patients hospitalized for acute ventional psychiatric medications. biologic or pharmacologic mechanism Niacin taken in the form of nicotina- alcohol withdrawal were randomly as- of action. These modalities include di- mide (1.25 g) with a meal before drink- signed to supplementation with taurine, Herbal treatments etary modifications; supplementation ing may protect the liver against the 1 g 3 times daily, versus placebo. Sig- Several herbs are used in traditional with specific vitamins, minerals, and acute toxic effects of alcohol in persons nificantly fewer severe withdrawal Chinese medicine to diminish alcohol amino acids; and use of medicinal herbs who are unable to abstain.9 symptoms, including delirium and hal- craving, lessen alcohol absorption from disparate world systems of medi- When a patient is unable to stop lucinations, were observed in the tau- through the gut, or reduce symptoms of cine. Part 2 will review the evidence for drinking, taking antioxidant vitamins rine-treated group.15 withdrawal.29 Kudzu (Radix puerariae) nonconventional and integrative treat- close to the time of alcohol consump- SAMe that is normally present in the has been used as a treatment for alcohol ments that are known to be beneficial tion may reduce or prevent hangover liver is depleted by chronic alcohol abuse and dependence in Chinese med- but for which there is no evidence of di- symptoms by neutralizing the metabo- abuse. Persons who abuse alcohol but icine for almost 2000 years. Kudzu ex- rect biologic or pharmacologic effects. lites of alcohol that cause oxidative who take SAMe at dosages of 400 to tract significantly reduces alcohol crav- Modalities that will be reviewed in Part damage to the brain.10,11 Taking vitamin 800 mg/d may have less severe liver ing in dependent animals.30 The reduced 2 include exercise, mindfulness train- C (2 g) 1 hour before alcohol consump- damage.16-18 Because of its established alcohol craving is probably related to ing, cranial electrotherapy stimulation, tion increases the rate at which alcohol antidepressant effects, SAMe is a logi- the high plant concentrations of daid- virtual reality graded exposure therapy, is cleared from the blood, possibly re- cal choice when treating patients with zein and daidzin—2 biologically active light exposure therapy, acupuncture, ducing acute toxic effects on the liver.12 depression who abuse alcohol.19 Pre- molecules categorized as isoflavones.31 and qigong. Deficiencies in zinc, copper, manga- liminary findings suggest that SAMe In a weeklong placebo-controlled nese, and iron are common in persons supplementation may also reduce alco- study, 14 heavy drinkers were pretreat- Nutrition and supplements who abuse alcohol and worsen with hol intake.20 ed with 1000 mg tid of kudzu versus Persons who chronically abuse alcohol continued heavy drinking. Magnesium Patients with alcohol use disorders placebo. Participants were given the op- are frequently malnourished because of supplementation at 500 to 1500 mg/d who were abstaining were treated with portunity to drink beer during the study. malabsorption of essential nutrients may improve the neuropsychological acetyl-L-carnitine at dosages of 2 g/d for Persons who were pretreated with through the mucosa of the stomach and deficits associated with chronic alcohol 3 months. These patients performed kudzu consumed significantly fewer small intestines, which results in re- abuse by improving cerebral blood better on tests of memory, reasoning, beers; however, they did not report di- duced serum levels of thiamine, folate, flow, which is often diminished in these and language compared with a matched minished alcohol craving. More studies 5 13 21 and vitamin B6. Malnutrition contrib- patients. There are no contraindica- control group. Preliminary findings are needed to confirm the effects of utes significantly to both the medical tions to dietary modifications or sup- suggest that tyrosine may be a useful kudzu on reducing alcohol consump- and the psychiatric consequences of plementation with the vitamins and adjunctive therapy in treatment of co- tion in at-risk populations. Findings chronic alcohol abuse. Hypoglycemia minerals discussed here when taking caine abuse.22 Low serum levels of from a small open trial suggest that results from the toxic effects of alcohol conventional drug therapies for relapse L-tryptophan were correlated with low Mentat, a proprietary Ayurvedic com- on the liver and can manifest as con- prevention or the management of crav- serotonin levels in a subset of persons pound herbal formula, may reduce the fusion, anxiety, and impaired cognitive ing or withdrawal. with alcohol use disorders who were at risk of relapse in abstinent alcoholics.32 function. All persons who struggle with alco- increased risk for early-onset alco- Using Chinese medicinal herbs and Rational approaches to the problems hol abuse, or who are in recovery fol- holism associated with antisocial be- conventional Western drugs concur- noted above include avoidance of re- lowing chronic abuse, should be strong- havior. This suggests that long-term rently poses complex issues, and few fined carbohydrates and increased con- ly encouraged to optimize their nutri- supplementation with L-tryptophan (or studies have been performed in this sumption of complex carbohydrates and tional status by changing their eating 5-hydroxytryptophan [5-HTP], the im- area.33 Until research findings suggest quality food sources of protein. Persons habits and taking the appropriate sup- mediate precursor to serotonin) may be that specific combinations of Chinese 11_0702PT_Lake.ps 1/23/07 4:01 PM Page 11 FEBRUARY 2007 11 herbs and conventional drugs have pos- 13. Thomson AD, Pratt OE, Jeyasingham M, Shaw GK.Al- cohol and brain damage. Hum Toxicol. 1988;7:455-463. itive synergistic effects, it is prudent to 14. Watanabe A, Hobara N, Nagashima H. Lowering of liv- advise patients to use only convention- er acetaldehyde but not ethanol concentrations by pre- treatment with taurine in ethanol-loaded rats. Experien- al Western medications or a specific tia. 1985;41:1421-1422. Chinese herbal formula under appropri- 15. Ikeda H. Effects of taurine on alcohol withdrawal. ate medical supervision. Lancet. 1977;2:509. 16. Lieber CS. Role of oxidative stress and antioxidant Ashwagandha (Withania somnifera) therapy in alcoholic and nonalcoholic liver diseases. Adv is another important herb in traditional Pharmacol. 1997;38:601-628. 17. Lieber CS. ALCOHOL: its metabolism and interaction Ayurvedic medicine. Animal studies with nutrients. Annu Rev Nutr. 2000;20:395-430. and case reports in humans suggest 18. Lieber CS. Alcoholic liver disease: new insights in that ashwagandha lessens the severity pathogenesis lead to new treatments. J Hepatol. 2000;32 (suppl 1):S113-S128. of withdrawal symptoms from mor- 19. Agricola R, Dalla Verde G, Urani R, et al. S-adenosyl- phine.34,35 Because of its sedating prop- L-methionine in the treatment of major depression com- plicating chronic alcoholism.