How to Quit the Holistic Way

They've been minimized and they've been marginalized, but the fact is holistic therapies—including acupuncture, homeopathy, massage therapy, aromatherapy, yoga, nutrition therapy, and dozens more—have been gaining greater mainstream acceptance. According to a 1993 survey published in the New England Journal of Medicine, in 1991, about 21 million Americans made 425 million visits to practitioners of these types of alternative medicine; that's more than the estimated 388 million visits we made to all primary care physicians that year. Now a holistic approach where an individual's situation and particular way of coping is addressed—and going cold turkey may not be necessary—is slowly beginning to influence the way people with addictions are treated. Holistic therapies are helping to bridge the gap between conventional, exclusively abstinence-oriented approaches and the newer, more controversial harm-reduction philosophy.

When addressing an addiction, all holistic techniques begin with the same basic philosophy: people develop addictions to correct an "imbalance" within them. Addicts become stuck, unaware, and unable to deal with their thoughts, feelings, and actions. They may drink, take drugs, or eat to excess to disassociate from their deficiency. Holistic therapies work to restore balance by connecting mind and body. They take away some of the underlying causes of abuse by helping people become aware of and take responsibility for the way they think, feel, and act.

The goal of many holistic therapies is to restore the body to its naturally healthy state. The best treatments are not offered in isolation; they're carried out with psychotherapy or group therapy—especially when it's open to the holistic view of treating the entire person, not just the addiction—and other holistic therapies.

Holistic philosophy overlaps with the harm-reduction approach to addiction, which evolved out of a desire to slow the spread of HIV/AIDS and hepatitis among injection drug users by dispensing clean needles. People running syringe exchanges realized they had an opportunity to provide additional services to drug users. Now a number of harm-reduction centers—offering programs including acupuncture, massage therapy, and substance use counseling; referrals to detoxification and treatment facilities; and caseworkers to help with housing, food stamps, and medical care have sprung up in cities like New York, Chicago, Portland, Seattle, Los Angeles, Santa Cruz, San Francisco, and Oakland. Run by current and former drug users, for current and former drug users, these centers don't demand that clients remain abstinent. From experience they know that no one can be forced into dealing with a problem, and that people who are treated with respect and who are educated about their choices can and often do elect to help themselves.

Holistic therapies do have their skeptics, of course. There's concern that these therapies haven't been properly studied or regulated. "As a general rule, holistic therapies are most helpful when they're used in conjunction with—not in place of—other treatments," says Barrie R. Cassileth, Ph.D., an adjunct professor of medicine at the University of North Carolina at Chapel Hill and Duke University, who has written extensively on alternative therapies and cancer treatment. Cassileth sees the need for methodologically sound, rigorous clinical tests before any claims about the capabilities of holistic treatments can be made. Frank Gawin, M.D., scientific director of a laboratory examining addictions at the University of California Los Angeles, agrees. He's currently involved in a six-city study—the largest involving an alternative therapy—to determine the effectiveness of acupuncture on cocaine addiction. Dr. Gawin believes that holistic therapies should continue to be practiced while studies are underway, so long as people receive psychotherapy and are fully informed that these treatments have not been proven effective. "There are no magic bullets," Cassileth concludes. "People ought to be wary of those who say they have one."

MASSAGE

It's too simplistic to say an addiction can be massaged away, but the power of this hands-on therapy is being tested on people dealing with anorexia, bulimia, smoking, and other addictions, with impressive results. The mind-body connection is all-important in massage, says Elliot Greene, M.A., past president of the American Massage Therapy Association. Greene says people with addictions can become trapped in a cycle of avoiding their problems and disassociating from their bodies. The experience of massage where someone touches, respects, and cares for a person's body—can break that cycle, helping addicts reconnect physically and center themselves emotionally. The effect is a newly empowered person more able to talk about and come to terms with an addiction.

Massage may also have a powerful chemical impact on the body. By massaging the soft tissue, therapists release tension and get energy moving. The loosening of tight muscles sends the body a signal to cut down production of stress hormones, such as cortisol. This neurological response has a calming effect on body and mind. In addition, massage moves lymph through the body, assisting the body's natural cleansing process.

Various research is now testing the effectiveness of massage therapy. At the Touch Research Institute at the University of Miami Medical School, 48 different studies are currently underway to determine the effectiveness of massage on problems such as anorexia and bulimia, drug addiction, asthma, and diabetes. In one ongoing study looking at massage's effects on tobacco addiction, smokers were taught to massage their ears and hands when they craved a cigarette. After one month, they had reduced the number of cigarettes smoked and their cravings for them by 40 percent. There will be a follow-up at three and six months to see if the results hold. "Massage provides a distraction that takes away from the nervous-habit aspect of smoking," says Tiffany Field, Ph.D., the institute's director.

HATHA YOGA

Hatha yoga, the yoga of postures—where people hold positions for varying lengths of time, stretching and contracting their muscles and breathing deeply—is one component of the ancient practice of yoga. It simulates the relaxing effects of the parasympathetic nervous system and removes tension from all the major muscle groups. According to Joseph LePage, founder and director of Integrative Yoga Therapy in Aptos, California, certain postures actually massage internal organs, helping dispel toxins that may have built up in the liver and kidneys from substance abuse.

"Hatha yoga allows people to get back in touch with themselves, and get into a frame of mind where they can experience what it is to be well, and not drug dependent or anxious," explains Peter Stein, M.A., addictions specialist at the North Charles Institute for the Addictions, a private treatment facility in Boston, Massachusetts. According to a recently completed clinical trial by Howard Shaffer, Ph.D., director of the Division on Addictions at Harvard Medical School, hatha yoga is as effective as traditional group therapy in treating heroin addicts enrolled at a Boston methadone maintenance clinic. Those who practiced yoga for 75 minutes once a week and received individual therapy once a week reduced their drug use, criminal activity, and cravings as much as those who went to group therapy once a week and had individual counseling.

Joyce, 37, a manager at a gourmet food store in the Boston area, has combined hatha yoga with talk therapy for four years as a part of her methadone maintenance program. Although methadone has been essential to her getting off heroin, she now wants to give it up. "Yoga helps me become more aware physically, and then become aware mentally of what's going on with me, and of how the things I do affect other people," she says. "Five years ago, I'd have told you I'd be on methadone for the rest of my life. But now I'm in a different frame of mind."

Joyce has begun slowly detoxing off methadone, which is itself a physically addicting drug whose withdrawal symptoms are cold sweats, inability to sleep, impatience, and discomfort. "In yoga, you have to hold postures for so long, and while you're holding them, you're saying to yourself 'I know this hurts, but I know I have to do it, I can and want to do it myself.'" That experience of feeling and withstanding the physical pain in hatha yoga helps Joyce know she can withstand the physical pain of methadone withdrawal.

NUTRITION THERAPY

"When people think of nutrition, I want them to think of the biochemical substances that are essential for maintaining optimal brain chemistry," says nutritionist Joan Mathews-Larson, Ph.D., founder of the Health Recovery Center (HRC), a private abstinence-based addiction clinic in Minneapolis, Minnesota. After people change their diets and supplement their food intake with the right amount of amino acids, essential fatty acids, vitamins, and minerals, they can begin to deal with their alcoholism, drug abuse, anorexia, or bulimia, says Julia Ross, M.A, executive director of Recovery Systems, a private eating-disorder and drug-abuse facility in San Francisco, California.

With the proper nutrition and supplements, the brain manufactures chemicals—like norepinephrine, a neurotransmitter that seems to increase energy and boost mood; serotonin, another important neurotransmitter; and endorphins, the brain's natural opiates—that are needed to regulate mood and behavior.

Optimal nutrition may also correct the possible deficiencies that contribute to alcoholism or substance abuse. "The question," says Alan Gaby, M.D., editor of the Nutrition and Healing newsletter, "is what are the proper supplements? I treated an alcoholic who couldn't control his drinking, but with glutamine, an amino acid, he was able to go back to social drinking and handle it." For cocaine addiction, Dr. Gaby says the amino acid tyrosine is often recommended. Tyrosine is a building block for norepinephrine.

Richard Firshein, D.O., a New York City osteopath whose holistic practice emphasizes nutritional healing, says one theory is that addiction may be triggered by low levels of serotonin. By restoring healthy levels, one of the underlying causes of addiction can be taken away. Firshein prescribes a combination of amino acids and a high-carbohydrate diet to boost tryptophan, the building block for serotonin.

Vitamin C is sometimes used by nutrition therapists to moderate both the physical and emotional withdrawal symptoms of detoxification. "It was being used for some time with narcotics addicts," says Dr. Gaby. "The most dramatic case I've seen was a patient who sniffed morphine every day. He came to me on his second day of withdrawal. His shakes were so bad that he couldn't sit still. I gave him an intravenous injection of about 4 grams of vitamin C, along with magnesium, calcium, and B vitamins. About halfway through the injection he calmed down, and ultimately his withdrawal symptoms subsided. That lasted about 36 hours. He had to come back for three more injections over five days, but he essentially went through withdrawal without symptoms."

After detoxification, nutrients such as niacin, chromium, and magnesium are given to alleviate hypoglycemic reactions, which a high percentage of alcoholics, as well as a lesser number of amphetamine and heroin users, experience. Hypoglycemia, a metabolic condition that results in low levels of glucose in the brain, can cause depression, anxiety, panic attacks, and mood swings, perhaps bringing about more substance abuse.

For three years, Rita, now 34, tried unsuccessfully to stop drinking. First, she tried a traditional 28-day treatment center, where, she says, "they kept saying, 'You're helpless, you're helpless.' And to me that meant I might as well drink." After losing her job and having her husband give up on her, Rita eventually wound up at HRC. During the six-week program, she learned she had high levels of histamine—a neurotransmitter that regulates mood and energy—in her brain. This abnormally high level made Rita's mind race, and contributed to her obsessive-compulsive behavior. "I used alcohol to calm and soothe myself," she says.

By taking one methionine pill each day—an amino acid that reduces the effects of histamine on the brain—Rita says she no longer needs alcohol to stop her mind from racing. She also participated in cognitive-behavioral counseling to develop new ways of thinking and acting. "I don't feel I could've taken the nutrients without having some counseling," she says. "But I also know talk therapy alone wouldn't have been enough, because I've tried that." Three years later, Rita continues to take methionine and has remained sober. She and her husband reconciled, and their first child was born this past summer.

Rita's is not an exceptional case, according to Mathews-Larson, who claims that 75 percent of the people who complete her program are "abstinent and stable" three years after completing treatment.

ACUPUNCTURE

Acupuncture's use as a treatment for addiction was discovered in 1972 by Wen, a Hong Kong neurosurgeon. Testing its use as an anesthetic, he accidentally determined—because many of his volunteers were opium addicts—that it reduced withdrawal symptoms such as nausea and the shakes. Since Wen's discovery, acupuncture has become the most widespread holistic therapy for treating addictions to cocaine, alcohol, nicotine, and heroin.

Like much of traditional Chinese medicine, acupuncture works on the theory that networks of energy, called chi, flow through the body along natural pathways, and disease grows when that energy is out of balance or blocked. By inserting needles at precise positions along these pathways, acupuncturists aim to stimulate the body's flow of energy, restoring balance.

Acupuncturists learn how to touch and relate to their patients, respect their space, and express sympathy. In addition to the biological effects of acupuncture, this kind of care gives patients a sense of confidence, calmness, and motivation to start or continue treatment, says Michael O. Smith, M.D., a psychiatrist and director of Substance Abuse at the Acupuncture Clinic at Lincoln Hospital in New York City, where between 3,000 and 4,000 auricular acupuncturists have been trained.

Acupuncture is used at all stages of an addiction, from the time people seek help to the time they are abstinent. It can ease the discomfort of withdrawal symptoms including insomnia, muscle ache, profuse sweating, and nausea for heroin; depression, cravings, and fatigue for cocaine; and seizures, diarrhea, and hypertension for alcohol. Additionally, acupuncture may help people stay off drugs after they've gone through withdrawal. By enabling people to clear their minds and decrease stress, anxiety, depression, and cravings, acupuncture can help people deal with the issues that caused their addiction. "It helps people settle down and center themselves so they can participate in their own internal growth," says Dr. Smith. "They're less defensive, more thoughtful, and more open-minded."

In the last five years, acupuncture's use in addiction has spread to more than 300 clinics. Even the government has given its tacit approval of the therapy: almost half of the drug treatment facilities linked to U.S. drug courts include acupuncture in their programs. Yale University Medical School's Arthur Margolin, Ph.D., who, along with Dr. Gawin, is part of the six-city project looking into the effectiveness of acupuncture on cocaine abuse, says funding for this research came about because there's no pharmacological treatment for cocaine addiction—a vaccine has proven effective in rats—while heroin addicts are often treated with methadone. The problem, says Margolin, is that accurate clinical trials are difficult to design and assess. For example, the placebo in an acupuncture trial requires inserting needles into inactive points, but scientists are not certain which points are truly active.

HYPNOSIS

Hypnosis seems helpful in treating addictions, and the depression and anxiety associated with them, according to Michael Yapko, Ph.D., a psychologist with a specialty in hypnosis, and author of Trance Work. Hypnosis aids people with addictions because of its ability to facilitate a heightened state of consciousness.

"During hypnosis," Yapko says, "people are intensely focused and their awareness deepened. But even in a trance they can have a conversation."

Not only does hypnosis help people develop specific techniques for changing their addictive behavior, but these techniques seem to take hold more strongly. "Situations, like being in a bar, feel more real than when you're just talking them through in therapy," says Helmut Relinger, Ph.D., a Berkeley, California, psychologist and hypnotherapist. "So people get to rehearse coping with their urges to use," which usually last only one to two minutes. The chance to imagine and truly feel yourself dealing with cravings while hypnotized can help you cope with them at other times.

Brian Alman, Ph.D., a psychologist and creator of Six Steps to Freedom, a program that incorporates self-hypnosis, meditation, and visualization to treat various addictions, says self-hypnosis "allows people to take a unique observer perspective on their own life. They can step back and watch what's going on without judging or criticizing themselves."

When it comes to nicotine addiction, hypnosis results have been mixed, in part because not everyone can be hypnotized. It's been known for 20 years that people who are easily hypnotized are twice as likely to cut their smoking in half as those who aren't able to go under. Other research indicates the ability of hypnosis to control the pain of drug withdrawal symptoms. Studies on migraines, childbirth and dentistry show that hypnosis allows people to gain control over their fear and anxiety, thereby reducing pain.

HOMEOPATHY

Homeopathy, a 200-year-old system of natural medicine, uses minuscule or extremely diluted amounts of substances that in their original concentration might actually produce symptoms of the disease being treated. This philosophy of "like cures like" doesn't mean a little heroin cures a heroin addiction. In fact, Ed Gogek, M.D., a licensed homeopath, cautions that homeopathy doesn't cure chemical dependencies. But it does work on other problems, like pain, anxiety, depression, and restlessness. In other words, homeopaths don't treat chemical dependencies, they treat the causes and consequences of addiction, whether to nicotine, cocaine, or food.

A homeopath takes into account a person's mental, emotional, and physical symptoms and uses remedies derived from plant, mineral, and animal sources that best fit a client's particular condition. For drug addiction, these substances may include tuberculinum, argentum, nitricum, arsenicum, or other materials equally unknown to most people. "Substances used in homeopathy help to express and dispel symptoms and regain balance," explains Martha Oelman, media liaison for the National Center for Homeopathy.

The effectiveness of homeopathy is still not clear. So far, the approximately 15 separate studies that have been rigorously reexamined show positive results for conditions like chronic pain, respiratory infections, and trauma.

A 1993 study by Susan Garcia-Swain, M.D., addiction specialist at St. Peter's Chemical Dependency Center in Olympia, Washington, examined 700 people overcoming drug addictions over a three-year period at the Starting Point addiction clinic in San Diego, California. One-third of her patients received counseling and one of 19 homeopathic remedies for addiction withdrawal symptoms; one-third received counseling and a placebo; and the last group received counseling only. The patients who received homeopathic remedies, says Dr. Garcia-Swain, were twice as likely as the others to remain sober after 18 months. Dr. Garcia-Swain says those people treated with homeopathic remedies were better able to benefit from other talk therapies because they were less guarded, more confident, and more inclined to continue in the program.

With a holistic approach to addiction, people with dependencies are given an opportunity to find their own rhythm to recovery. And when you're trying to kick a habit of any sort, that kind of flexibility can be the difference between success and failure.