Substance Withdrawal - Alcohol & Stimulants

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.
Back to blog