A Gut Feeling on The Future of Addiction Treatment

John Giordano, Doctor of Humane Letters, MAC, CAP

inside of stomache and brain

What I find concerning in most modern addiction treatment programs is the lack of integration of new scientifically proven effective modalities with self-help programs. Let me be clear in saying self-help programs are essential to addiction treatment. However, there have been major advancements and breakthroughs in understanding addiction that have produced evidenced-based and scientifically proven effective modalities that can complement the existing programs.

Perhaps one of the most significant discoveries in recent times is the outsized effect our second brain in our gut has on our moods, emotions, behavior and addiction. Although we’ve known about it for over a hundred years, we’ve only just now started to research it in earnest over the last thirty or so years, which is mind boggling in itself.

Regardless, what we do know about the Enteric Nervous System is challenging some of the most basic and core tenets of modern medicine.

This is a relatively new field of science called Neurogastroenterology. Here are a few things these researchers have discovered.

Our second brain, or technically known as the Enteric Nervous System (ENS), is not going to be balancing your check book any time soon or be much help in appreciating the finer aspects of a Mozart concerto; but it can inspire you to act or behave in a particular way.

The ENS is a mesh-like system with some 100 million neurons in the gut that governs the function of the gastrointestinal tract. That may sound like a lot of neurons but it is only one twohundredth of the number of neurons in the human brain. The ENS stretches all the way from the esophagus to the anus and is about nine meters long. It also uses more than 30 neurotransmitters (neurotransmitters are largely responsible for our behavior, attitude, and energy) that are identical to those found in the brain including dopamine, and serotonin. In fact, 95 percent of the body’s serotonin and 50% of its dopamine are synthesized in the gut and regulated by the microbiota – a.k.a. flora – also found in the gut.

The microbiota is important for nutrition, immunity, and effects on the brain and behavior.

The human microbiota consists of a wide variety of bacteria, viruses, fungi, and other single-celled animals that live in the body. It contains both good and bad bacteria and is vital to normal health. The ideal balance for our bodies is around 85% good to 15% bad.
The interaction between microbiota and Gut Brain Axis (GBA) appears to be bidirectional. Microbiome is the name given to all of the genes inside these microbial cells.

That’s the background, now here is where things get interesting.

What researchers are finding is that the brain in our gut connected with the one in our skull partly determines our mental state and plays key roles in certain diseases throughout the body.

The brain in your gut can operate independently and interdependently with the brain in your head. They communicate through various channels known as the gut-brain axis (GBA). It links the emotional and cognitive centers of the brain with intestinal function, and vice-versa.

Your head and gut are in constant communication, most of which is one way with 90 percent traveling from the gut to the head. When those messages go awry for one of a variety of reasons — including poor diet, stress or illness — the result can be physical health problems such as digestive disorders and obesity or mental health issues such as but not limited to anxiety or depression.

There is research (mostly in the laboratory, but some in humans) strongly suggesting that ‘emotions can affect the gut microbiota, and that, conversely, certain gut microbes can be mind-altering.’ There is also strong evidence showing that mental illness such as bipolar, depression, anxiety, and psychotic disorders – all conditions associated with addiction – can be inflammatory conditions related to the function of the immune system and the health of the gut.

Dr. Michael Gershon, author of “The Second Brain” and one of the leading authorities of the Enteric Nervous System, stated in a New York Times interview that, “drugs like morphine and heroin attach to the gut’s opiate receptors, producing constipation. Indeed, both brains can be addicted to opiates.” In a separate interview, Dr. Gershon noted, “the second brain and how it interacts with the first one is a key factor in our physical and mental well-being.”

Dr. Emeran Mayer, professor of medicine, physiology and psychiatry, bio behavioral sciences and director of the UCLA Oppenheimer Center for Neurobiology of Stress and Resilience, has spent over forty years studying how the two brains interact. His decades of work have led him to think that in coming years’ psychiatry will need to expand to treat the second brain in addition to the one in our heads.

There is enough convincing research and evidence that strongly suggests a link between gut health and addiction/ recovery exists.

From 1999 to 2016, more than 630,000 Americans have died from a drug overdose. With so many Americans dying preventable deaths, a reasoned person might think that the situation calls for all hands-on deck and addiction treatment protocols based on gut health should be researched posthaste. In the early 90’s congress moved heaven and earth to grant the FDA special powers to approve HIV/AIDS experimental drugs at a faster pace with less scrutiny. Their actions were met with great success and saved hundreds of thousands of American lives.

But it doesn’t work that way today. Sound, reasoned judgment has been usurped by finances and profit.

In 2007, The National Institutes of Health (NIH) launched the Human Microbiome Project to better understand the microbial species that affect humans and their relationships to health. But the research has been limited by funding.

The insurance industry refuses to pay for any experimental treatment regardless of how promising they might be. In fact, many insurance companies are currently engaged in the practice of clawing back payments made to treatment centers for services rendered years ago – putting the mom and pop facilities on shaky financial footings. Furthermore, they’re standing squarely between the patient and their doctor. Insurance case managers – often with little to no medical or health background whatsoever – sitting in some cubical hundreds and even thousands of miles from the patient, determine their progress and length of stay at the treatment center, most often over the patient’s doctor’s orders. The less time a person spends in a treatment center means more money to the insurance company’s bottom line.

If you’re getting a pit in your stomach right about now, you are not alone. The lack of research funding combined with insurance company’s devotion to their bottom line and the unusual lag of time of new modalities from discovery in the laboratory to practice in the treatment field – leaves us with a little more than old world technology to treat addiction.

If there is anything that gives me solace in these turbulent times, it is in knowing that there are many small facilities that have taken the initiative to incorporating gut health into the treatment programs. And every treatment facility should. Probiotics, prebiotics, enzymes and fermented foods are relatively inexpensive and produce a big result. They’re something everyone can benefit from, regardless if they’re abusing drugs/alcohol or not.

John Giordano is the founder of ‘Life Enhancement Aftercare Recovery Center,’ an Addiction Treatment Consultant, President and Founder of the National Institute for Holistic Addiction Studies, Chaplain of the North Miami Police Department and is the Second Vice President of the Greater North Miami Beach Chamber of Commerce. He is on the editorial board of the highly respected scientific Journal of Reward Deficiency Syndrome (JRDS) and has contributed to over 65 papers published in peer-reviewed scientific and medical journals. For the latest development in cutting-edge addiction treatment, check out his websites