National Acupuncture Detoxification Association
I had the pleasure and privilege of being on Scott Cluthe’s show on Lime Radio this evening. It’s on Sirius Satellite Channel 114, and if you are interested in the new holistic worldview that is emerging all over the planet, I highly recommend Scott’s show and, in fact, all the shows that I have heard on Lime. I have also had a link to Lime website for some time now, and it always has a great deal of excellent material.
There were some excellent questions from listeners, and one caused me to do some research. The question was about the National Acupuncture Detoxification Association (NADA). The Association is a nonprofit that conducts training and provides public education about the use of acupuncture as an adjunctive treatment for addictions and mental disorders.
There is a substantial body of research literature on the topic of using acupuncture as part of a package of measures for treating substance abuse, and although it is still considered controversial in some quarters, it is being used in over 1,500 places around the world, and that does not include China and Japan, where I have seen acupuncture used a great deal in addictive disorders.
My own experience has been mixed. I have had little success I treating smoking addiction with acupuncture, though I have many colleagues who say that it is extremely helpful. I have had more success in using thought field therapy and homeopathy for treating smoking addiction, even though there is so far no good research data on the use of either for smoking.
If you are interested in the use of acupuncture as an adjunctive treatment for substance abuse, the NADA website if a good place to start.
Decision Making and Internal Balance
Many of us run into problems when we try to make decisions. In a special section in the October 26 issue of the journal Science, Martin Paulus who is a professor in the Department of Psychiatry at the University of California in San Diego, has marshaled a growing body of evidence that human decision-making is inextricably linked to an individuals’ need to maintain a homeostatic balance.
He goes on to suggest that psychiatrists may need to approach the treatment of psychiatric patients from a new direction: by understanding that such individuals’ behavior and decision-making are based on an attempt to reach an inner equilibrium, in the same way that we try to being our temperature or blood pressure back to a set point. And if the thermostat is broken we may see mental illness and substance abuse.
This makes good sense: in the past decision-making process as a considered series of options and values, but that is not what we see in the clinic. People with addictions and some mental illnesses keep making bad choices, despite being intelligent and insightful.
Recent neuroimaging research shows strong support for the homeostatic nature of decision-making:
The insula is involved in processing interoceptive information: the body’s internal state or sense of balance
Damage to the insula stops addiction to cigarettes
Some of the same brain structures implicated in the urge to take drugs are involved in other biological urges
The question addressed in part by this paper are whether changes in decision-making behavior and associated brain functions are a result of pre-existing characteristics – which may predispose individuals to use drugs – or occur as a consequence of long-term use.
This is certainly an interesting idea, and we shall have to see how it fits as we collect further data.
“The quality of a decision is like the well-timed swoop of a falcon which enables it to strike and destroy its victim.”
–Sun Tzu (Chinese Military Strategist and Author of the “Art of War”, c.400-c.430 B.C.E.)
“The risk of a wrong decision is preferable to the terror of indecision.”
–Maimonides (a.k.a. Rabbi Moses ben Maimon, Spanish-born Jewish Philosopher and Physician, 1135-1204)
“All you have to decide is what to do with the time that is given you.”
–J.R.R. Tolkien (South African-born English Writer, Linguist, Oxford Don and a Member of C.S. Lewis’ Literary Group, “The Inklings,” 1892-1973)
“Decisions are doorway to change and change starts from a moment of decision. One decision can change your life forever!”
–Tony Robbins (American Motivational Speaker and Writer, 1960-)
“Nothing is more difficult, and therefore more precious, than to be able to decide.”
–Napoleon Bonaparte (Corsican-born French Military Strategist, General and, from 1804-1814, Emperor of the French, 1769-1821)
Marijuana and Psychosis
A number of my friends and colleagues in London have shown how cannabis (marijuana) may trigger a psychotic illness. A team at the Institute of Psychiatry gave healthy volunteers the active ingredient tetrahydrocannabinol (THC).
They then recorded reduced activity in an area of the brain called the inferior frontal cortex that keeps inappropriate thoughts and behaviors in check. The inferior frontal cortex is part of the self-regulatory systems of the brain that stop us swearing inappropriately, and help us to realize that people are not looking at or spying on us. In other words the inferior frontal cortex checks the environment and stops us jumping to conclusions that could lead to paranoia.
The THC was given to healthy volunteers who had not abused marijuana. The effects were short-lived, but more sever in some people than others, suggesting a genetic vulnerability.
In another study from Yale University, THC was given intravenously. Even at fairly low doses, 50% of healthy volunteers began to show symptoms of psychosis. As expected, people who had a previous history of psychosis were particularly vulnerable to the effects of THC.
A separate study has shown that one of these ingredients – cannabidiol (CBD) – has the potential to dampen down psychotic symptoms, and could perhaps form the basis of new treatments.
Whenever people start talking about the possible association between psychiatric problems and using marijuana, there are always loads of people who protest, “But I’ve used it for years and it’s never done me any harm.”
They may be right, but that objection misses four important points:
- People vary in their sensitivity to marijuana. Mental illness is the result of both genes and environment. Somebody who is very stressed but has no known genetic predisposition may run into trouble, while somebody with strong genetic loading and a minimal amount of stress can get very ill very quickly. And that stress can be anything from marijuana to abuse. There is also a lot of variation in how people respond to specific types of stressors
- If people have already had some psychological trouble, marijuana can be like pouring gasoline on a fire
- The age at which marijuana is used is all important. There seem to be “critical periods” in brain development, when marijuana can be particularly risky. There is a strong correlation between the number of times someone uses it under the age of eighteen and their subsequent risk of developing psychosis later in life. This relationship does not seem to hold with regular cigarettes, alcohol or any of the other street drugs looked at so far, suggesting that this is not just a matter of young people who are self-medicating. We cannot prove “causality” any more than we can “prove” that cigarette smoking causes lung cancer. Trying to prove a single cause for an illness is a tricky business. There are some examples, for instance illnesses caused by a single gene, but they are few and far between
- The marijuana available today is very different from the anemic material that was available in the 1960s and 1970s. Today’s is far powerful
This research provides the strongest evidence yet that modern marijuana can have a significant impact on the brain. Proving a long-term effect would be extremely difficult: it would be neither ethical nor feasible to stimulate long-term psychosis in volunteers.
But clearly if something has an active effect in inducing the symptoms of psychosis after one dose, it would not be at all surprising if repeated use could induce a chronic problem, particularly if someone is genetically predisposed.
Mindfulness and Eating Disorders
There is a very interesting report about a study that is going on at Griffith University in Brisbane, Australia.
They are using a psychological technique called "mindfulness" that is firmly rooted in Buddhist philosophy, in which a person becomes intentionally aware of his or her thoughts and actions in the present moment, non-judgmentally. Mindfulness is applied to both bodily actions and the mind’s own thoughts and feelings.
The idea is to help them understand and deal with the emotions that trigger their binges. Unlike many other therapies used in the treatment of eating disorders, there is less focus on food and controlling eating and more on providing freedom from negative thoughts and emotions.
Psychologists Michelle Hanisch and Angela Morgan said that women who binged were often high-achievers and perfectionists and when they perceived that they didn’t measure up to self-imposed standards or were not in control of situations, they indulged in secretive eating binges.
It is well known that many women with eating disorders develop elaborate methods of hiding the evidence of their binges. Some feel so guilty afterwards they also induce vomiting, overuse laxatives or exercise excessively to counteract the effects of the binge.
The researchers say, "Binge eating is largely a distraction – a temporary escape from events and emotions that nevertheless can cause long-term physical problems including electrolyte imbalances. Instead, women need to learn how to react in a different way… Women who have been through the program report less dissatisfaction with their bodies, increased self-esteem and improved personal relationships," and "They learn that thoughts and emotions don’t have any power over us as they are just passing phenomena and aren’t permanent."
Mindfulness involves techniques and exercises that are very similar to meditation. They could help people live more in the moment, and develop a healthy acceptance of self and become aware of potentially destructive habitual responses.
There is quite a large literature on the use of mindfulness in a variety of clinical situations including substance abuse, oncology, chronic stress, reducing symptoms after organ transplantation, chronic headache and perhaps anxiety.
It will be interesting to see the final results of this study: I shall keep you informed about this and other studies on mindfulness, meditation and acceptance and committment therapy (ACT).
“Peace can be reached through meditation on the knowledge which dreams can give. Peace can also be reached through concentration upon that which is dearest to the heart.”
–Patanjali (Indian Philosopher said to be the Compiler of the Yoga Sutras, Dates Unknown)
"Meditation is not to escape from society, but to come
back to ourselves and see what is going on. Once there is
seeing, there must be acting. With mindfulness, we know
what to do and what not to do to help.”
Thich Nhat Hanh (Vietnamese Buddhist Monk, 1926-)
“Generosity is another quality which, like patience, letting go, non-judging, and trust, provides a solid foundation for mindfulness practice. You might experiment with using the cultivation of generosity as a vehicle for deep self-observation and inquiry as well as an exercise in giving. A good place to start is with yourself. See if you can give yourself gifts that may be true blessings, such as self-acceptance, or some time each day with no purpose. Practice feeling deserving enough to accept these gifts without obligation — to simply receive from yourself, and from the universe.”
–Jon Kabat Zinn (American Mindfulness Meditation Teacher and Associate Professor of Medicine at the University of Massachusetts Medical School, 1944-)
Methamphetamine
We have been seeing some of the terrible consequences of methamphetamine abuse.
Where I live it is normally called and sold as "Crystal meth," and it is the worst type of drug that I have ever seen: and I’ve seen most things over a busy career during which I’ve consulted in many countries.
Apart from the personal cost, there can be few things more devastating to a family than discovering a loved one destroying their life with this highly addictive group of compounds.
I thought that you may be interested in a resource published a couple of months ago on PsychiatricResourceForum.blogs.com.
There is also another article on the same blog about some of the new principles of helping the recovery of people with chronic mental illness. But interestingly, many of the same principles apply when helping people with addictions.
These are very useful resources. Though designed for healthcare professionals, they will, I think, be of value to anyone who comes into contact with drug using people.
And that is far more of us than most people ever realize.
Cannabis And Mental Illness
The debate about a possible relationship between smoking cannabis and developing mental illness – in particular schizophrenia – has been going on since the 1960s. For a long time it looked to many people as if "Cannabis psychosis" was a myth. But I’ve never been so sure. I have seen too many people who have smoked a lot of cannabis and then become psychotic.
The whole issue is now becoming clarified. We have known for years that cannabis can precipitate psychosis in people already suffering from mental illness, but over the last five years, a series of papers (article 1, article 2, article 3 –there are many more) from Scandinavia have looked at young army conscripts and found an association between the number of times that they had used cannabis and their subsequent risk of developing schizophrenia. If they had smoked more than 50 times by the age of 18, their risk of developing schizophrenia was as much as six times higher. A new study from Cambridge in England has found that repeated use in children is also associated with a 2-3 fold increased risk.
I once talked about some of this data at a meeting in Northern California and had a "vigorous" debate with some indignant colleagues who claimed that cannabis was perfectly safe. Perhaps it is in well-adjusted adults, but I’m not so sure.
And this new research raises a number of important points:
1. The cannabis that is now used by young people is much stronger than that which was on offer in the 1960s and 1970s, and is sometimes also adulterated with other substances.
2. The age at which cannabis is smoked appears to be crucial: the data suggests that it is a problem if used during the vulnerable period of brain development that occurs during early and mid-adolescence.
3. Can we say that the cannabis is having a causal role in triggering mental illness? The answer is that we can no more prove it than prove that smoking causes lung cancer. In my book Healing, Meaning and Purpose I discuss the myth of "uni-causality," the idea that there is one cause for an illness. Apart from trauma, there are extremely few examples of one illness being caused by just one deranged gene, one missing nutrient or one external toxin. There will likely be genetic, social and environmental factors that will together determine whether or not cannabis could cause psychosis.
4. Could this just be self-medication? People taking cannabis to try and treat their symptoms? That is possible, though we then have to ask why we are not seeing a similar relationship with any other substances like alcohol or Ecstasy.
5. Finally, there is some recent evidence that one of the key active ingredients in cannabis, tetrahydrocannabinol (THC), can disrupt the normal development of the microtubules that guide the development of neurons in some regions of the brain.
The moral of the story? Cannabis isn’t good for you, and it can be REALLY BAD for people during the vulnerable period of brain development.
Addendum Dec. 22, 2005: Hot off the presses! Another article on cannabis and schizophrenia.
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Addiction, Learning and Genes
Many of us have been mourning the death of George Best at the age of just 59. Arguably one of the most skillful players ever to kick a soccer ball, he finally succumbed to the slow suicide of alcohol abuse. Yet in the midst of all the opinion pieces that have tried to unravel the reasons for his alcohol abuse, all seem to have missed out on something very important. It has been missed because so many people have become wedded to the simple notion that there is one cause for one problem.
We have all seen so many television programs on which people have tearfully recounted the traumas that have befallen them, and we are then told that their current problems, whether of addiction, or of an inability to trust, or of serial infidelity, are all the result of having learned these behaviors, usually in childhood. So a person becomes an alcoholic because they saw their father drinking. An awful lot of therapy, and self-help is based upon that faulty premise. Why is it faulty? Because these people also share the same genes, and because, try as we might, we cannot reduce the whole of human behavior to ONLY learning, or ONLY genes. Most of the genes in the brain do not so much force you into behaving in a certain way; they instead predispose you to the way that you will handle something in your immediate environment.
So in the case of George Best, virtually all the tributes have said that the poor man become an alcoholic because he could not deal with all the fame, adulation and pressure that accompanied becoming soccer’s first real superstar. And doubtless, those were factors. But there is something else: his mother also died of complications of alcoholism, when she was 58 years old. Her drinking was attributed to watching her son succeed and then crash and burn. Possibly. But it is far more likely that it happened because they were both genetically predisposed to alcoholism.
When we try to understand a problem like this, it is essential not just to focus on the obvious cause: stress, or trauma, but also to look at the physical predisposition to reacting to the stress or trauma. Some people can be assailed by the most dreadful events, and come out smiling, while others have their lives ruined. It is also essential to look at the social context. George Best was brought from Belfast to Manchester when he was only 15 years old, and went home after two days because he was so homesick. He was persuaded to return to Manchester, and everyone tried to create a surrogate family for him, but it was obviously very difficult for him. It is also important to know that alcohol and substance abuse can cause havoc in the subtle systems of the body. That is why, when we treat people suffering form these illnesses, we encourage them to do some work, like Qigong or Yoga, to strengthen their subtle systems. Finally there is often a spiritual component to these problems. It is no coincidence that “spirits” as in alcohol and “spirit” as in spirituality, come from the same Latin root, in recognition of the ancient worship of the god Bacchus. Bill Wilson and Bob Smith recognized this link when they founded Alcoholics Anonymous in 1935. Many people who have struggled with addictions have been able to achieve sobriety once they discover and acknowledge the spiritual aspect of their lives, or in some cases that their substance abuse has been a reaction to a deep spiritual hunger.
Newsweek has an excellent article on the progress being made in our understanding of the physical components of addiction. The article highlights the complexity of the illness and the extraordinarily high relapse rates of sufferers.
There is only one quibble that I have with the article, and that is that it perpetuates the idea that substances of abuse hijack the “reward systems” of the brain. The reason why this is not quite correct is that it is a bit of a misnomer to talk about “reward systems.” These days we prefer to talk about salience systems. What does this mean? If something pleasurable happens to you, then the dopamine and GABA systems of the brain are indeed stimulated. And it appears that in substance abusers this system does not respond properly. So that they self-medicate because they have a form of sensory deprivation in these systems and that is the only way to get the dopamine levels that they need. But we now learn that dopamine also rises in the self same regions of the brain in response to threat. So what this system is doing is deciding what is salient, or important in the environment, and then focusing on and responding to it. It is these salience systems that seem to be under some genetic control, and can predispose someone to becoming a substance abuser.
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