This technology is in early development and requires further study. Cranioelectrotherapy stimulation CES uses a weak electrical current e.g., 100 Hz given to the ears or scalp. CES is reported to reduce anxiety in substance abusers during withdrawal from drugs, but most clinicians are likely to have difficulty referring to therapists experienced in this technique and treatments are not reimbursable by insurance. Biofeedback can also ameliorate anxiety during the withdrawal phase. Data on acupuncture for drug detoxification from alcohol, nicotine, and opiates is mixed. Studying the effect of acupuncture is complicated by the observations that merely inserting needles anywhere in the body not in specific meridians can release endogenous opiates in the brain which have beneficial effects for many stress-related conditions.
INTEGRATIVE APPROACHES Correct nutritional imbalances with thiamine, folate, multi-B vitamins, and an A-Z multivitamin. Brewer’s yeast, taken as two rounded tablespoons twice a day Lewis Labs, is an inexpensive source of B vitamins and trace minerals. For additional neuroprotection, administer 3,000 to 6,000 mg/day fish oils omega-3 fatty acids; 600 to 800 mg/day magnesium; and 1,000 to 3,000 mg/day acetyl-L-carnitine. Refer to self-help support groups such as Alcoholics Anonymous and Adult Children of Alcoholics. Refer family members to Alanon. Prescription medications that may be helpful include the following: Naltrexone, acamprosate, or both for alcohol dependence. Topiramate 200 to 400 mg/day or isradipine may reduce craving for alcohol, cocaine, and other drugs. Rimonabant is being used for marijuana dependence. It must be ordered from Canada or Europe while awaiting approval by the U.S. FDA. Informed consent includes possible depression as a side effect. Valproate is useful for bipolar patients with alcoholism. Evaluate the patient for possible ADD/ADHD. In such cases, stimulants may reduce drug dependence. Refer the patient to easily accessible mind-body-spirit practices such as yoga, Qigong, vipassana meditation, dialectical behavior therapy with mindfulness, or others.
SAMe may be used to improve mood, liver function, immune function, for neuroprotection, and to help reduce alcohol intake. The risk of SAMe induced mania in bipolar patients must be considered. In formulating the treatment plan, the following factors should be considered: Discuss with the patient the treatment options and prioritize the target symptoms Determine the feasibility of doing the intervention, taking into account the cost and likelihood of compliance. Mind-body-spirit programs can improve emotion regulation, reduce physical symptoms of withdrawal, and enhance motivation and compliance. Many patients in recovery report that these programs help them reconcile feelings about their past, including guilt, shame, anger, and remorse. They may also discover a new purpose and meaning in life. Patients with substance abuse problems should be encouraged to participate in mind-body-spirit practices. The time frame and phase of treatment may determine the immediate goals The first two weeks may be focused on detoxification, physical stabilization, and engagement in treatment.
The first three months require reduction in dysphoria and craving as well as keeping the patient in treatment. During the first year of abstinence significant brain recovery can occur. FETAL ALCOHOL SYNDROME Fetal alcohol spectrum disorders FASD are due to brain damage from prenatal alcohol exposure. The patients may have mental retardation, hyperactivity, behavioral and sexual disorders, and abnormal craniofacial development. Multiple mechanisms probably contribute to the neuronal damage including oxidative damage, mitochondrial damage, activation of caspase enzymes leading to apoptosis, cell death, and depletion of PUFAs polyunsaturated fatty acids Das, 2006. Damage is most marked in the hippocampus and cerebellum. Cholinergic neurons in the brain are particularly subject to injury and apoptosis. Despite public health efforts at prevention, 15 to 20% of women in the United States admit to drinking alcohol during pregnancy.
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