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Nonconventional and Integrative Treatments of Alcohol and Substance Abuse

Nonconventional and Integrative Treatments of Alcohol and Substance Abuse

The high cost to society of alcohol and drug abuse reflects a crisis of epidemic proportions that has not been adequately addressed by conventional treatment approaches, including mainstream pharmacologic treatments, psychotherapy, and social programs. The annual costs associated with alcohol and drug abuse in the United States were estimated to be $246 billion in 1992, the most recent year for which data are available.1 Results of controlled trials and patient surveys confirm that many of the conventional pharmacologic and psychosocial treatments for alcohol and drug abuse or dependence are only moderately effective in terms of discontinuation rates and long-term abstinence.2-4 In this context, it is important for psychiatrists and other mental health professionals to learn about promising nonconventional and integrative treatment strategies.

In this 2-part column, I will concisely review the evidence for nonconventional and integrative treatments for symptoms related to alcohol and drug abuse, dependence, and withdrawal. Part 1 covers nonconventional and integrative treatments, the beneficial effects of which are achieved through a discrete biologic or pharmacologic mechanism of action. These modalities include dietary modifications; supplementation with specific vitamins, minerals, and amino acids; and use of medicinal herbs from disparate world systems of medicine. Part 2 will review the evidence for nonconventional and integrative treatments that are known to be beneficial but for which there is no evidence of direct biologic or pharmacologic effects. Modalities that will be reviewed in Part 2 include exercise, mindfulness training, cranial electrotherapy stimulation, virtual reality graded exposure therapy, light exposure therapy, acupuncture, and qigong.

Nutrition and supplements
Persons who chronically abuse alcohol are frequently malnourished because of malabsorption of essential nutrients through the mucosa of the stomach and small intestines, which results in reduced serum levels of thiamine, folate, and vitamin B6.5 Malnutrition contributes significantly to both the medical and the psychiatric consequences of chronic alcohol abuse. Hypoglycemia results from the toxic effects of alcohol on the liver and can manifest as confusion, anxiety, and impaired cognitive function.

Rational approaches to the problems noted above include avoidance of refined carbohydrates and increased consumption of complex carbohydrates and quality food sources of protein. Persons with an alcohol use disorder who improve their general nutrition probably have a better chance of maintaining sobriety than those who do not.6,7 Findings from animal studies suggest that low serum thiamine levels may be related to increased alcohol craving.8 Niacin taken in the form of nicotinamide (1.25 g) with a meal before drinking may protect the liver against the acute toxic effects of alcohol in persons who are unable to abstain.9

When a patient is unable to stop drinking, taking antioxidant vitamins close to the time of alcohol consumption may reduce or prevent hangover symptoms by neutralizing the metabolites of alcohol that cause oxidative damage to the brain.10,11 Taking vitamin C (2 g) 1 hour before alcohol consumption increases the rate at which alcohol is cleared from the blood, possibly reducing acute toxic effects on the liver.12

Deficiencies in zinc, copper, manganese, and iron are common in persons who abuse alcohol and worsen with continued heavy drinking. Magnesium supplementation at 500 to 1500 mg/d may improve the neuropsychological deficits associated with chronic alcohol abuse by improving cerebral blood flow, which is often diminished in these patients.13 There are no contraindications to dietary modifications or supplementation with the vitamins and minerals discussed here when taking conventional drug therapies for relapse prevention or the management of craving or withdrawal.

All persons who struggle with alcohol abuse, or who are in recovery following chronic abuse, should be strongly encouraged to optimize their nutritional status by changing their eating habits and taking the appropriate supplements to compensate for a probable alcohol-related malabsorption syndrome, to mitigate the toxic effects of alcohol abuse on the body and brain, and to reduce craving and the severity of withdrawal.

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