Substance Withdrawal – Clinical Herbal Protocols: Alcohol & Stimulants.
Presented by: Phil Rasmussen
Date: November 2015
Watch the webinar here.
People use psychoactive substances for many different reasons. Substance use results in addiction or dependency when the person continues to use on a regular basis despite obvious harmful consequences. All substance dependency syndromes involve contributions from both physical and psychological factors.
Stimulants:
- Caffeine
- Ephedrine
- Khat (Catha edulis)
- Cocaine
- Amphetamine & Methamphetamine
- MDMA (Ecstasy)
- Methylphenidate (Ritalin)
- Other synthetic stimulants
Methamphetamine (Meth, P):
- Known as speed.
- First synthesized in 1887, used in the 1930s for asthma treatment.
- Once widely prescribed as an appetite suppressant and for depression.
- Today, derivatives are used for treating narcolepsy and ADHD.
- Produces feelings of well-being, increased energy lasting several hours.
- Crystalline methamphetamine (P) is a purified, stronger form.
- Usually smoked, causing rapid absorption and pronounced CNS effects.
- Powder form can be snorted, injected, or swallowed.
- Most methamphetamine used in New Zealand is manufactured in illegal ‘P labs’ using OTC ingredients like pseudoephedrine.
Health Effects of Methamphetamine Use:
- Social and public health problems.
- Cardiovascular damage.
- Respiratory tract damage.
- Cognitive dysfunction.
- Infectious disease.
- Increased likelihood of Parkinson's disease.
Global Use:
- Global amphetamine use rose 40% between 1995-1997 and 2000-2001.
- Ecstasy use increased by 70% during the same period.
- In 2013, 7% of Australians aged 14+ had ever used amphetamines; 2.1% in the past year.
- 1.1% of New Zealanders used amphetamines in 2013-2014.
Withdrawal Symptoms:
- Usually resolve within a week.
- Depression, anxiety attacks, nightmares, irritability, anger, and violent behaviour.
Treatment:
- Start treatment ASAP following the last dose.
- More emphasis on group therapy.
- Drug interventions limited; antidepressants used to stabilize neurotransmitters.
Research on Psychological and Pharmacological Treatments:
- Reviewed 4 RCTs (125 participants).
- Amineptine improved discontinuation rates but did not reduce withdrawal symptoms.
- Mirtazapine's effects were unclear.
Herbal and Nutritional Support:
- Antidepressants, adaptogens, anxiolytics, sedatives, cognitive enhancers, respiratory & cardiac tonics.
- Herbs such as St. John's Wort, Rosemary, Withania, Ginkgo, Valerian, Kava, Holy Basil, Corydalis, Lemon Balm, Kudzu used in treatment.
Case Study - Methamphetamine User:
- 35-year-old male, used Meth for 13 years, stopped 3 weeks ago.
- Smokes ~15 cigarettes daily, low motivation.
- Herbal treatment included Withania, Ginkgo, Hypericum, Glycyrrhiza.
- Showed gradual improvement with counselling and lifestyle changes.
Alcohol Use Disorder:
- Defined as a pattern of alcohol use with problems controlling drinking, preoccupation with alcohol, and withdrawal symptoms.
- Binge drinking defined as consuming 5+ drinks for males or 4+ for females within 2 hours.
Alcohol Use in New Zealand:
- 72% of cases at Auckland RADS involved alcohol dependency.
- 15% of NZers aged 15+ had a hazardous drinking pattern in 2012-13.
- 600-800 alcohol-related deaths annually.
Alcohol Withdrawal:
- Symptoms include agitation, trembling, disturbed sleep, lack of appetite.
- Severe cases involve seizures, hallucinations, and delirium tremens.
- Primary management includes GABA agonists (benzodiazepines).
Medications for Alcohol Withdrawal:
- Disulfiram, Acamprosate, Nalmefene, Naltrexone, GHB, Benzodiazepines, Anticonvulsants, Antidepressants.
Herbal Support for Alcohol Withdrawal:
- Adaptogens, anxiolytics, cognition enhancers, sedatives, hepatoprotectives.
- Herbs such as Kudzu, Dan Shen, St. John's Wort, Shatavari, Kava, Valerian, Skullcap, Passionflower, Withania, Ginkgo, Holy Basil.
Kudzu and Alcohol Reduction:
- Kudzu extract shown to reduce alcohol intake in studies.
- May act by inhibiting acetaldehyde dehydrogenase and modulating opioid receptors.
- Effective in binge drinkers but less so in chronic alcoholics.
Case Study - Alcohol Dependence:
- 29-year-old female, history of binge drinking and alcohol dependence.
- Underwent detox, herbal treatment included Hypericum, Valerian, Matricaria, Lavandula.
- Improved over time with lifestyle changes, counselling, and herbal support.
- Eventually returned to controlled drinking but later relapsed.
Conclusion:
- Identifying and removing triggers is key.
- Counselling, relaxation techniques, exercise, and herbal support beneficial.
- Herbal treatments show promise for withdrawal management but should be integrated with lifestyle and psychological support.