The Truth About Addiction Treatment

By John Giordano, DHL, MAC, CAP

The Truth About Addiction Treatment

Addiction is a chronic, incurable, life-threatening illness that can be managed. We have learned more on the subject of addiction in the last thirty-years than all prior accumulative knowledge. We now know that addiction is hardwired to our brain’s reward circuitry which is influenced by genetics and environment. Addiction is a hiccup in the way the brain’s ‘happy chemical’ messenger, dopamine, communicates the ‘all is well in the world’ memo to the rest of the reward center in our brain. These people suffer from a condition described in the SAGE Encyclopedia of Abnormal Psychology as Reward Deficiency Syndrome (RDS). They do not feel the rewards from everyday life; nor do they feel calm or at ease. Therefore, addicts who do not receive dopamine’s ‘all is well in the world’ memo, search out ways to stimulate dopamine pathways in the brain, whether it be drugs or risky behavior, that will improve their dopamine function so they can feel at ease.

Perhaps one of the most astounding facts regarding addiction treatment that – in my opinion – contributes greatly to the high recidivism rates in addicts is that there are no national treatment standards to assure quality care. Addiction treatment is the only field in medicine without treatment standards. In the United States alone there are approximately 14,500 clinics and programs dedicated to providing treatment for Reward Deficiency Syndrome. A Google search ranked the top ten addiction treatment programs in America in 2015 [1]. A review of their information revealed that only one cited ASAM guidelines as their evidence–based approach, but at least six of the ten relied on the 12-steps (an 80 year old program) as an important aspect of their aftercare policy. None of the top ten programs listed provided any inference for evidence- or neuroscience-based approaches to healing the brain. If we are to have effective addiction treatment, we believe the huge gap between science and practice must be closed.

Additionally, I question the efficacy of 30 day addiction treatment paradigm. In a recently published study, researchers found that “Brain dysfunction associated with heroin addiction is sustained even after at least 3 years of abstinence, according to the first brain imaging study to evaluate long-term outcomes of former addicts.” [2] Although there is no scientific evidence at this time to support the speculation that other opiates/opioids, including the FDA approved MAT drugs, have the same shelf-life; it is reasonable to suggest they share similar long-term affects on the brain. These facts clearly demonstrate the need for longer residential treatment combined with long-term aftercare. Certainly expectations need to
be adjusted to conform with reality.

The best example of effective addiction treatment is the Physicians Heath Program (PHP). The program is a minimum of 90 days that can extend to 180 days of residential treatment and followed up with long-term comprehensive aftercare. Quoting a study titled: ‘Setting the Standard for Recovery: Physicians’ Health Programs;’ researchers reported ‘Remarkably, 78% of participants had no positive test for either alcohol or drugs over the 5-year period of intensive monitoring. At post-treatment follow-up 72% of the physicians were continuing to practice medicine’ [3]. The PHP program is abstinence-based. The physicians in the program were subject to frequent random tests typically lasting for 5 years. Failing a test led to swift and significant consequences including the possibility of losing their license to practice medicine. There are some who will say that the program is cohesive, yet there is no arguing with the results.

I am also concerned about the use of toxic FDA approved MAT drugs in long-term (1 year or more) treatment. A number of these drugs work by blocking brain receptors and may even induce down regulation of dopamine. Moreover, there is even evidence of suicide with these drugs and in a number of cases severe withdrawals, if not adequately tapered. While I accept FDA approved MAT drugs as a short-term therapy and good idea to attach to other holistic approaches, we cannot stand behind long-term utilization of dopamine blockade.
In the latest breakthrough study – conducted by lead author Dr Kenneth Blum, co-discoverer of the first known addiction gene, and included world renowned scientists and researchers including John Giordano – involving laboratory testing on rats – whose brains are strikingly similar to the human brain – the amino acid nutraceutical KB220Z – a non-toxic, non-addictive or habit-forming amino acid nutraceutical made from things found in nature – demonstrated a significant improvement to resting state functional connectivity across the brain’s reward circuitry. ‘Resting state functional connectivity” is the gold standard among scientists and researchers. KB220Z seemed to effectively restore dopaminergic functionality, or “dopaminergic homeostasis,” in the brain reward circuitry. This means that messengers like dopamine can communicate their message – in this case calm and wellbeing– through neural pathways in the reward center with greater ease compared to previous difficulties – and perhaps for the first time reach its final destination. Additionally, this study showed that KB220Z increased brain volume recruitment (connectivity volume) referred to as neuroplasticity. This is noteworthy because this amino acid nutraceutical causes greater activity in key regions of the brain that control relapse, cravings and cognition – all critical elements that support a healthy and enduring recovery. This same effect in the rat was also shown in abstinent heroin addicts. KB220Z is unlike the FDA approved MAT drugs in that it has little to no known undesirable side-effects. Treatment facilities are using this nutraceutical to detoxify heroin addicts to great success [4].

Ibogaine – extracted from the root of the Iboga shrub found in West Equatorial Africa – also presents a natural option to the toxic drugs used in detoxification. There are some who claim its efficacy is superior to the drugs used today. Ibogaine – a naturally occurring psychoactive substance – is used in its native country where it is known as “Holy Wood” and has been central to indigenous spiritual, divinatory and diagnostic practices for thousands of years. In the United States, Ibogaine is classified as a Schedule I controlled substance along with other psychedelics. However, it remains unregulated and unlicensed in most other countries. Canada, Mexico, the Netherlands, South Africa, and New Zealand have taken the lead in using Ibogaine in detoxification and the treatment of addiction to a great extent and continued success.

American and European addict self-help groups claim that ibogaine promotes long-term drug abstinence from addictive substances, including psychostimulants and opiates.

In a study published fifteen-years ago in the National Institutes of Health, Dr. Mash (et al.) stated: We report here that ibogaine significantly decreased craving for cocaine and heroin during inpatient detoxification. Self-reports of depressive symptoms were also significantly lower after ibogaine treatment and at 30 days after program discharge. Because ibogaine is cleared rapidly from the blood, the beneficial aftereffects of the drug on craving and depressed mood may be related to the effects of noribogaine on the central nervous system [5].

Although the research is on going, acupuncture has shown great promise in detoxification and long-term treatment programs. The use of acupuncture in addiction treatment was accidently discovered in 1972 by Dr. Wen of Hong Kong. Dr. Wen reported that acupuncture combined with electrical stimulation at 4 body points and 2 ear points relieved the symptoms of opioid withdrawal in persons with opiate addiction [6].

Dr. Wen’s discovery was later adopted in many clinical settings in Western countries. In 1985 Dr. M. Smith, head of the US National Acupuncture Detoxification Association (NADA), developed a protocol based on Dr. Wen’s findings. The NADA protocol advises that 5-point auricular acupuncture relieves withdrawal symptoms, prevents symptoms of craving, and increases patient participation rates in long-term treatment programs [7]. Also, several brain neurotransmitter systems such as serotonin, opioid and amino acids including GABA have been implicated in the modulation of dopamine release by acupuncture.

A comprehensive study conducted by World Health Organization (WHO) revealed that environmental pollution is the underlying cause of 80% of all chronic degenerative diseases. It is well established that heavy metals are the cause of many neurological issues, yet testing for heavy metal toxicity is not a standard diagnostic procedure. In an unscientific survey conducted at G & G Holistic addiction Treatment Center in North Miami Beach Florida, it was discovered that over 85% of the patients participating in the study tested positive for heavy metals.

Heavy metal toxicity is one of many contributors to addiction that is overlooked by most treatment programs. The nervous system is the principal target for a number of metals. Inorganic compounds of aluminum, arsenic, lead, lithium, manganese, mercury, and thallium are well known for their neurological and behavioral effects in humans. The alkyl derivatives of certain metals–lead, mercury and tin–are especially neurotoxic. [8].

Heavy metals can cause depression and anxiety by disturbing brain chemistry. Lead poisoning in particular disturbs GABA balance. When it becomes deficient, GABA can contribute to anxiety, lead also dulls your intelligence. Lead, cadmium (from smoking) and arsenic disturb dopamine, the primary neurotransmitter of reward and pleasure. Mercury, lead and aluminum disturb acetylcholine, this neurotransmitter gives the brain a sharpness and good memory. Heavy metals can also significantly weaken the immune system [9]. Although the empirical data is lacking, it is the observation of the authors that chelation therapy has contributed to the continued clean time of many addicts.

It’s well established that drug abuse over an extended period of time causes neuronal damage. Alcohol and drug abuse starves the brain of oxygen. Hyperbaric Oxygen Therapy (HBOT) – the medical use of oxygen at a level higher than atmospheric pressure– has been used to a great extent and success in treating traumatic head injuries. There have been several studies showing the positive effects HBOT has in the treatment of addiction. One study published in the National Institutes of Health over twenty-years ago found that: Hyperbaric oxygenation was used in the treatment of 340 patients with narcomania, toxicomania, and alcoholism in the post-intoxication and abstinence periods; 223 of these were alcoholics, 68 toxicomaniacs, and 49 opium narcomaniacs. A group of 185 patients administered drug therapy alone were controls. Exposure to hyperbaric oxygenation had a favorable effect on the patient’s status during sessions and persisted for some time after them [10].

It is the opinion of the author that although we’ve made great strides in understanding addiction and the development of effective ways to treat it, only a handful of treatment centers apply modalities based in science. In saying this, I believe a minimum national addiction treatment standard would go a long way in improving treatment outcomes. It is also our belief that there are many holistic treatment options – including the ones outlined above – that have shown promise but for many reasons – including, but not limited to, lack of funding and insurance reimbursements – have stalled. In an effort to end America’s second opiate/opioid epidemic, I would like to encourage our government to increase funding for the research of these modalities as it has in the past with other diseases. I’m not hoping for a magic pill that cures addictions, but rather additional components to improve treatment outcomes and ebb the tide of this wretched epidemic.

References:
[1] http://www.quitalcohol.com/guides/top-10-alcohol-treatmentcenters.html#sthash.y4qDxLs6.dpuf]
[2] http://www.medscape.com/viewarticle/851116
[3] http://www.ncbi.nlm.nih.gov/pubmed/19161896
[4] http://www.ncbi.nlm.nih.gov/pubmed/25526228#
[5] http://www.ncbi.nlm.nih.gov/pubmed/11085338
[6] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3296192/
[7] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3296192/
[8] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1474439/
[9] http://www.balancingbrainchemistry.co.uk/peter-smith/28/Heavy-Metal-Toxicity-Depression-&-Anxiety.html
[10] http://www.ncbi.nlm.nih.gov/pubmed/7653862

CONFLICT OF INTEREST

It is acknowledged that Dr. Blum is the owner of US and foreign patents related to KB220Z a nutraceutical shown to reduce drug and alcohol withdrawal, reduce stress response in patients in recovery, enhance focus in healthy volunteers, reduce craving for alcohol, heroin, cocaine, nicotine, reduce inappropriate sexual behavior, reduce post-traumatic stress (PTSD) symptoms such as lucid nightmares and significantly reduce relapse rates following intravenous administration. https://lavitards.com/

In addition, Dr. Blum is paid consultant and stock holder of RDSS LLC. Reward Deficiency Solution System is a complete and all inclusive aftercare program consisting of the following: Genetic Addiction Risk Score, Comprehensive Analysis of Reported Drugs (CARD), Dopamine Agonist Therapy (KB220z etc.), Pre/post mRNA analysis of gene expression, many holistic and psychological additions (yoga, dopamine boosting foods, meditation, trauma therapy, brain spotting etc.), 12 step programs and traditions.

Dr. Blum is a paid consultant of Rivermend Health, Atlanta Ga. and Victory nutrition International LLC, the Chief Scientific Advisor of Dominion Diagnostics, LLC and owner of Igene Inc. There are no other known conflicts.

John Giordano DHL, MAC, CAP is a thirty-year veteran of clinical addiction treatment. Mr. Giordano is the founder and former owner of G & G Holistic Addiction Treatment Center, a 62 bed JCAHO accredited facility located in North Miami Beach, Fl.; and has contributed to sixty-five papers on addiction and its treatment published in peer-reviewed scientific and medical journals and is considered by Research Gate to be one of the top researchers in the country.