If you were in need of heart surgery, you probably wouldn’t be satisfied with choosing a method devised between 1939 (the year AA’s Big Book was published) and 1953 (the year in which NA was founded). But in the field of drug detox, many providers, patients, and professionals are content to adhere to the established model of cold turkey, talk therapy, and regular attendance at 12 Step meetings. While this model has worked for thousands upon thousands of sufferers, it has also allowed many people to fall through the cracks, their needs unmet and their challenges too great to be adequately addressed by these detox/treatment modalities.
New strategies and techniques for detoxing off of drugs are sprouting up every day, but many in the treatment field are still relying heavily on either cold-turkey or methadone and other long-term opioid replacement drugs which can create as many problems as they solve. At Tabula Rasa Retreat, we feel that it’s worthwhile to take a long look at all of the other strategies, methods, resources, and treatments available for those looking to detox from their addiction. There are a lot of alternatives out there, and some of them are worth exploring, particularly if other treatments haven’t worked.
Ayahuasca
Ayahuasca is a powerful psychoactive substance that has been used for religious and medicinal purposes in the Amazon basin for millennia. Addiction expert Dr. Gabor Mate has sparked debate by using the substance to treat addiction. Advocates claim that it can help people to explore and heal from the traumas and stresses that have fed their addictions while prompting meaningful connections with others, as well as spiritual growth. As with most psychedelic and oneirogenic treatments, ayahuasca treatment doesn’t just involve using the substance, but it is generally accompanied by pre- and post-treatment therapy sessions, as well as being guided through the use of the substance by an experienced practitioner. Ayahuasca’s effects include changes to the amygdala and insula that have been reported to reduce depression and anxiety, and it also helps to normalize levels of serotonin, a chemical that regulates mood and effects pleasure-seeking urges which are related to substance use. The substance appears to be particularly helpful in treating alcohol and cocaine dependence.
Cannabis
Recent medical studies have found that cannabis is capable of reducing the effects of opioid withdrawal. While the evidence is still described as “nascent” by researchers, numerous studies have shown that cannabis and cannabinoids decrease the symptoms of acute opiate withdrawal. In some studies, those going through withdrawal reported that cannabis had alleviated withdrawal symptoms when their opioid replacement drugs were not sufficient. But other studies have produced conflicting evidence, and the process through which cannabis aids in withdrawal is reportedly “murky and complex.” Meanwhile, studies conducted on rats have found that CBD “has been shown to reduce the rewarding aspects of multiple drugs of abuse, such as cocaine, amphetamines, and nicotine.” While cannabis and cannabinoids show potential, it’s too early to determine how much they can aid in withdrawal.
Harm Reduction Vs. Abstinence
Abstinence-based models for treating addiction are based on the total avoidance of all mood and mind-altering substances. Abstinence based models are focused on creating a lifetime of sobriety and generally base themselves on the 12 Steps. They define addiction as a chronic and incurable condition which can become dormant but will require treatment and maintenance over a lifetime. Abstinence-based models would dismiss pharmacological and psychoactive substances that aid in lessening the symptoms of withdrawal.
Harm reduction, on the other hand, is focused on minimizing the effects of drug use rather than emphasizing the importance of sobriety. Harm reduction principles are based on the idea that abstinence might not be the best answer for all individuals and communities, and that services and resources for addiction should not be judgemental or coercive. Advocates of harm reduction feel that condemning drug use and drug users are counterproductive strategies, and that drug use is a fact of life which is intimately connected to socio-economic realities. They would recommend treatment strategies that employ psychoactive substances which can aid with withdrawal and treatment.
Heantos-4
Heantos-4 is a compound of herbs that is currently used to treat opioid addiction in Vietnam. It is reported to have beneficial effects on withdrawal and relapse prevention, as well as providing sedative effects during detox. Studies on animals have shown that the compound has neurological and physiological effects that correlate with the anecdotal evidence of its benefits to the addicted. Advocates claim that the substance boosts the production of GDNF hormones in the brain, creating enhanced neuroplasticity that can offer a wide range of benefits to the addicted. Meanwhile, there are reports that this compund has caused numerous deaths in treatment at Vietnamese clinics.
Ibogaine
Ibogaine is the root bark of the tabernanthe iboga plant native to west and central Africa. It has been used for centuries in the region’s Bwiti spiritual tradition for medicinal and ritualistic purposes. Decades ago, American heroin addict Howard Lotsof used the substance to break free from heroin addiction and has spent the years since advocating for its use as a medicine. Ibogaine has been proven to dramatically reduce withdrawal symptoms from opiates and opioids, as well as reducing cravings for a time ranging from 3 months to one year following its use. It has also been shown to increase the brain’s production of the GDNF hormone and reset dopamine receptors to a pre-addicted state. In large doses it has caused seizures, and it can exacerbate pre-existing heart conditions, but it still appears to be safer to use than methadone.
Kambo
Kambo use is associated with traditional rituals from the Amazon region which use a poison (Kambo) secreted by giant monkey frogs in order to facilitate a number of health benefits. Proponents claim that benefits include increased stamina, heightened senses, and cleansing properties. Kambo contains small proteins called tachykinins which affect “reward, motivation, and stress responses in the brain.” These proteins can bind to receptors in the brain, which can, theoretically, have a profound effect on addiction. However, Kambo skeptics would point out that the substance is a poison which can have serious, and even fatal, side effects, and that a lack of clinical evidence on its workings makes its use unsafe at this juncture.
Ketamine
Most people think of ketamine as a drug of abuse, but it is also a potent painkiller that is regularly used by anesthetists and pain specialists. There is evidence of ketamine being used to treat patients who had developed a dependence on opioid-based painkillers such as oxycontin. In many cases, ketamine use minimized the effects of opioid withdrawal, and then patients were weaned off of ketamine with minimal withdrawal symptoms. While ketamine use has the potential to create a new addiction, it could be the lesser of two evils for patients who’ve developed opioid dependence.
Kratom
Kratom is a tropical plant grown in Southeast Asia which has long been used as a painkiller and mild stimulant. It is also an opioid agonist, meaning that it stimulates the same receptors as opioids, and is now being used to lessen the symptoms of opioid withdrawal. Its effects have been praised by many recovering addicts, but it can create dependence if used heavily, and side-effects can include hallucinations, paranoia, hypothyroidism, and liver damage. Because kratom is currently sold as an herbal supplement in many countries, it is easily accessible, but should be used with caution. The evidence for kratom’s effectiveness is currently just anecdotal, since clinical studies have yet to be completed.
NAD+
NAD+ is a naturally occurring co-enzyme of niacin which has demonstrated promise as a treatment for substance abuse disorders. Studies have shown that addicts generally have very low levels of NAD+ in their systems, and many of the physical and mental disorders that frequently co-occur with addiction have been proven to deplete the body’s store of this essential nutrient. Proponents of the treatment tout its ability to restore the balance of neurotransmitters, which is disrupted by the process of withdrawal, decreasing withdrawal symptoms and cravings
NAD+ works in theory because it creates “neuroplasticity”, the brain’s ability to create new neural pathways and heal itself. Years of addiction condition the brain to release dopamine when given substances of abuse, and to respond to stress, pain, and anxiety by treating them with drugs and alcohol. NAD+ can help to change the structure of the brain, offering addicts the chance to gain pleasure from activities other than substance abuse and to find new ways to cope with the stresses of life.
Psilocybin
As with many of the substances on this list, psilocybin therapy is associated with increased neuroplasticity and beneficial changes in brain chemistry. Various studies have found that psilocybin therapy helps those suffering from depression and alcohol dependence, though the exact mechanisms by which it works aren’t yet known. As a participant in one study on psilocybin’s effects on alcohol abuse noted, his experience wasn’t focused on his dependence on alcohol, but rather on the stresses, guilt, and happiness which his relationship with family members created. His recovery wasn’t motivated by a desire to avoid alcohol, but rather by the prospect of improving his relationships with loved ones. He reported being effortlessly abstinent for months afterward, before beginning to drink moderately once again but with “a conscientiousness he had never experienced with alcohol before.” Two years after the study his drinking remained under control. The changes to the ego, a renewed sense of connection with others and with one’s true self, and changes in brain chemistry are all touted by advocates of psilocybin therapy, and the news is reaching the mainstream, as this recent “60 Minutes” report shows.
Rational recovery
Rational Recovery is a program created by California social worker Jack Trimpey which is designed as an alternative to 12 Step programs. It appears to be based somewhat on CBT, as it identifies what is referred to as the “Addictive Voice” as the driver of substance abuse. The Addictive Voice is essentially a thought process that steers the addict towards the object of addiction without regard for consequences, health, or responsibilities. Rational Recovery aims to teach the addict to recognize and ignore thoughts and impulses created by the addictive voice, and to create patterns of thought and behavior which enable a healthy life. Rational Recovery did not include religious or spiritual principles and regarded addiction as a voluntary behavior rather than a disease. Although the movement officially ended in the early 2000s, many of the ideas espoused were adopted by SMART Recovery.
SMART Recovery and Twelve-Step Programs
We’ve written before about the contrasts between these two models for peer support organizations, and both have a lot to offer addicts in recovery. Philosophically, one of the major differences is that SMART Recovery is built on a foundation of scientific principles, while 12 Step Programs favor spirituality. Because of this, 12 Step groups encourage their members to admit that they’re powerless in the face of addiction and call on a higher power, while SMART Recovery uses the principles of Cognitive Behavioral Therapy to encourage individuals to take control of their own thoughts, behaviors, and actions to build a positive life.
Proponents of the 12 Step model also believe that the principles they follow are universally applicable to all addicts, while SMART Recovery allows members to create their own approach based on age, gender, emotional needs, and other considerations. 12 Step meetings are generally facilitated by peers who have no special status or authority, while SMART Recovery meetings are led by professional therapists. The principles of SMART Recovery also allow for the idea of being “recovered’, while 12 Step adherents feel that addiction is an incurable disease which the addict must live with and manage for their entire life. In our view, the greatest advantage of 12 Step groups is the presence of a sponsor, a peer experienced with life in recovery who commits to offering you guidance and personal support. SMART Recovery, on the other hand, benefits from being committed to evolving with the latest advances in pharmacology and neuroscience, adapting its approach to treatment as we learn more about the nature of addiction.
Explore Your Options
As you can see, you have a plethora of options to choose from if you feel you need a push down the road to recovery. While we at Tabula Rasa Retreat wouldn’t recommend every new approach that’s out there, we do advise all addicts to find an approach that matches their unique needs. It won’t be easy, but with the right approach, you can beat your addiction. If you’d like to discuss any method for living a healthy, sober life with us, we’d be happy to open a dialogue with you!
For further information visit www.tabularasaretreat.com or call PT +351 965 751 649 UK +44 7961 355 530