Amino acid deficiency
Malnutrition and malabsorption in persons who chronically abuse alcohol(Drug information on alcohol) often lead to deficiencies in important amino acids including taurine(Drug information on taurine), S-adenosylmethionine (SAMe), tyrosine, l-tryptophan, and acetyl-l-carnitine. Supplementation with amino acids helps lessen the severity of withdrawal symptoms, protect the liver, and restore normal brain function in patients with chronic alcoholism.
Taurine supplementation may lower the serum level of acetaldehyde, a toxic metabolite of alcohol that can interfere with normal mental function.14 In an early controlled trial, 60 patients hospitalized for acute alcohol withdrawal were randomly assigned to supplementation with taurine, 1 g 3 times daily, versus placebo. Significantly fewer severe withdrawal symptoms, including delirium and hallucinations, were observed in the taurine-treated group.15
SAMe that is normally present in the liver is depleted by chronic alcohol abuse. Persons who abuse alcohol but who take SAMe at dosages of 400 to 800 mg/d may have less severe liver damage.16-18 Because of its established antidepressant effects, SAMe is a logical choice when treating patients with depression who abuse alcohol.19 Preliminary findings suggest that SAMe supplementation may also reduce alcohol intake.20
Patients with alcohol use disorders who were abstaining were treated with acetyl-l-carnitine at dosages of 2 g/d for 3 months. These patients performed better on tests of memory, reasoning, and language compared with a matched control group.21 Preliminary findings suggest that tyrosine may be a useful adjunctive therapy in treatment of cocaine abuse.22 Low serum levels of l-tryptophan were correlated with low serotonin levels in a subset of persons with alcohol use disorders who were at increased risk for early-onset alcoholism associated with antisocial behavior. This suggests that long-term supplementation with l-tryptophan (or 5-hydroxytryptophan [5-HTP], the immediate precursor to serotonin) may be a useful preventive intervention in this high-risk population.23 Taking l-tryptophan before drinking may reduce the severity of the cognitive impairment associated with alcohol use.24
Available evidence suggests that safety problems are seldom reported when typically used therapeutic doses of quality-brand amino acid supplements are combined with conventional psychiatric medications.25,26 However, rare cases of serotonin syndrome have been reported when l-tryptophan, 5-HTP, or SAMe were used concurrently with serotonergic drugs. Therefore, patients using this integrative strategy should be closely monitored for emerging adverse effects.27,28 Safety concerns have not been reported when combining taurine or acetyl-l-carnitine with conventional psychiatric medications.
Herbal treatments
Several herbs are used in traditional Chinese medicine to diminish alcohol craving, lessen alcohol absorption through the gut, or reduce symptoms of withdrawal.29 Kudzu (Radix puerariae) has been used as a treatment for alcohol abuse and dependence in Chinese medicine for almost 2000 years. Kudzu extract significantly reduces alcohol craving in dependent animals.30 The reduced alcohol craving is probably related to the high plant concentrations of daidzein and daidzin—2 biologically active molecules categorized as isoflavones.31
In a weeklong placebo-controlled study, 14 heavy drinkers were pretreated with 1000 mg tid of kudzu versus placebo. Participants were given the opportunity to drink beer during the study. Persons who were pretreated with kudzu consumed significantly fewer beers; however, they did not report diminished alcohol craving. More studies are needed to confirm the effects of kudzu on reducing alcohol consumption in at-risk populations. Findings from a small open trial suggest that Mentat, a proprietary Ayurvedic compound herbal formula, may reduce the risk of relapse in abstinent alcoholics.32
Using Chinese medicinal herbs and conventional Western drugs concurrently poses complex issues, and few studies have been performed in this area.33 Until research findings suggest that specific combinations of Chinese herbs and conventional drugs have positive synergistic effects, it is prudent to advise patients to use only conventional Western medications or a specific Chinese herbal formula under appropriate medical supervision.
Ashwagandha (Withania somnifera) is another important herb in traditional Ayurvedic medicine. Animal studies and case reports in humans suggest that ashwagandha lessens the severity of withdrawal symptoms from morphine(Drug information on morphine).34,35 Because of its sedating properties, caution should be exercised when ashwagandha is used in combination with benzodiazepines or other conventional sedative-hypnotics.
Preliminary findings suggest that ginseng (Panax ginseng) may reduce the tolerance and dependence associated with the long-term use of cocaine, methamphetamine, or morphine.36-38 The mechanism of action that is responsible for reduced tolerance observed with ginseng may involve inhibition of narcotic-induced depletion of dopamine(Drug information on dopamine) in the brain.39 Early findings suggest that glycosides derived from Aristeguietia discolor, a plant used in traditional Peruvian medicine, reduce withdrawal symptoms in morphine-dependent persons.40
Dr Lake is in private practice in Monterey, Calif, and is on clinical faculty in the department of psychiatry and behavioral sciences at Stanford University Hospital. He co-chairs the American Psychiatric Association Caucus on Complementary, Alternative, and Integrative Care (www.APACAM.org) and is author of the Textbook of Integrative Mental Health Care (Thieme).
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