Related Terms

• Addict, addiction, alcohol dependence, alcoholism, central nervous system stimulants, cigarettes, CNS stimulants, cocaine, compulsive behavior, compulsive gambling, depression, drug addiction, drug dependence, drug use, gambling, heroin, illicit drug use, injection drug use, intervention, methamphetamines, physical dependence, psychological dependence, psychotherapy, rehabilitation, rehabilitation program, self-help groups, stimulants, substance abuse, support groups, withdrawal, withdrawal symptoms.

Background

• Addiction occurs when an individual becomes physically or psychologically dependent on something, such as alcohol, drugs (legal or illegal), or gambling. Individuals may become addicted to or have compulsive behaviors in regard to almost anything, including sex, food, exercise, shopping/spending money, work, and the Internet. The principles and consequences of addictions are generally the same, even if the particular addiction is different.

• Substance abuse(drug addiction): Substance abuse occurs when individuals use drugs (which may or may not be illegal) for recreational purposes. Commonly abused drugs include alcohol, central nervous system stimulants (such as nicotine, caffeine, and methamphetamine), cocaine, heroin, and marijuana. Drugs can be taken by mouth, injected into a vein, snorted through the nose, inhaled, or smoked.

• When individuals abuse drugs, they are at risk of becoming physically and/or emotionally addicted. Over time, individuals begin to develop a tolerance for the drugs. As a result, they may start to use larger amounts of the drug more frequently. However, individuals can become addicted to substances without abusing them. Drug addictions cause compulsive drug cravings. Severe addictions may cause individuals to seek drugs, even at the expense of their jobs, families, and other important parts of their lives.

• Drug addiction is considered a treatable disease if individuals want treatment and have the motivation and will power to stay sober. For many people, drug addiction is chronic, and it may last for years before they are willing and able to get help. Some individuals (not all) experience relapses after completing treatment programs.

• Gambling addiction: Gambling addiction, also called compulsive gambling, occurs when individuals are unable to control their gambling behaviors. Some individuals are constantly trying to win back lost money, and they may go to extremes to hide their gambling. Others who compulsively gamble for the thrill and excitement of it, rather than for the actual winnings. Some individuals who are addicted to gambling may go to extreme lengths to perpetuate their addiction when money is scarce. In serious cases, this may include lying, stealing, cheating, or fraud.

• Patients with gambling problems may develop associated conditions, such as alcohol dependence or drug addictions.

• Stopping substance abuse or gambling addictions is often difficult. Fortunately, rehabilitation programs and support groups are available to help patients overcome their addictions. However, many patients relapse one or more times, even after long periods of abstinence from the drug or gambling. Support groups and social networks are available to help individuals overcome their addictions.

Causes

• General: Most experts agree that a combination of biological, psychological, and environmental factors may predispose certain individuals to developing addictions.

• It has also been suggested, but not scientifically proven, that individuals who are addicted to drugs or gambling may have addictive personalities. Supporters of this theory believe that this psychological trait may predispose someone to developing an addiction. However, this idea is the subject of much debate in the research community.

• Substance abuse: Initially, individuals may abuse drugs to get high. This desire to get high may stem from underlying causes, such as depression, bipolar disorder, stress, or low self-esteem. Others may try drugs out of curiosity or peer pressure. Once a person becomes addicted to a substance, it causes chemical changes in the brain that leads to intense drug cravings.

• Recent studies suggest that trauma, substance abuse, and sexual risk behaviors are all interrelated For instance, women who were sexually abused (as a child or as an adult) may have a hard time refusing unwanted sex and may use drugs as a coping mechanism.

• Some research suggests that genetics may play a role in certain types of drug addictions. For instance, people with family histories of alcoholism are more likely to begin drinking before the age of 20 and to become alcoholics.

• Individuals who experiment with illegal drugs and alcohol before the age of 16 have an increased risk of becoming drug addicts.

• It has also been suggested that tobacco, alcohol, and marijuana are gateway drugs that may lead to experimentation with more serious drugs, such as heroin or cocaine. However, this theory has not been proven, and it is considered controversial.

• Gambling addiction: The exact cause of gambling addiction remains unknown. It has been suggested that chemicals in the brain, called serotonin, norepinephrine (noradrenaline), and dopamine, may be involved. These chemicals, also called neurotransmitters, allow nerve cells in the body to communicate. Serotonin helps regulate mood and behavior, norepinephrine helps the body handle stress, and dopamine causes the sensation of pleasure. It has been suggested that all three of these neurotransmitters may be involved in compulsive gambling.

Signs and Symptoms

• General: Because individuals with addictions often deny they have problems, it is important for friends, family, coworkers, and others to watch for warning signs of addiction. When people are aware that a friend or loved one has a drug or gambling problem, they should try to persuade the person to undergo screening for drug or gambling addiction. If the person is still unable to recognize and seek help for their addiction, a group intervention may be planned to help the patient overcome the addiction.

• Many patients who have substance abuse or gambling addictions share many of the same behavioral signs and symptoms. For instance, they may lie about their behaviors, deny they have problems, or use drugs or gamble in secret.

• Substance abuse: Individuals who are addicted to drugs typically experience compulsive drug cravings. In serious cases, these cravings may cause individuals to continue to seek drugs, even if means risking their jobs, families, or other important parts of their lives. Specific symptoms of drug addiction depend on the substances that are being abused. Most substances cause a change in the patient's consciousness, usually a decrease in responsiveness. Other signs and symptoms may include the inability to relax while sober, mood swings and change in attitude, saying things that do not make sense, and sudden changes in performance at school or work. Individuals may spend less time with friends and family members and/or stop participating in activities that they used to enjoy.

• When individuals stop using drugs they are addicted to, withdrawal symptom often develop. In general, symptoms of withdrawal may include irritability, headaches, nausea, vomiting, and mood swings. The severity of withdrawal symptoms varies, depending on the specific drug. For instance, individuals who are psychologically addicted to marijuana may experience symptoms of irritability, anxiety, and decreased appetite when they stop using the drug. In contrast, individuals who abuse methamphetamines experience much more severe withdrawal symptoms that may even be life threatening. Examples of these symptoms include intense cravings for the drug, psychotic reactions, anxiety, moderate to severe depression, intense hunger, irritability, fatigue, mental confusion, and insomnia.

• Gambling addiction: Signs and symptoms of a gambling problem typically include a preoccupation with gambling, taking time away from work or loved ones to gamble, hiding gambling behaviors from friends and loved ones, feeling guilty or remorseful after gambling, borrowing or stealing money to use for gambling, and failed attempts to limit or stop gambling behaviors.

Complications

• General: Many complications associated with addictions, including drug addictions and gambling addictions, are the same. For instance, drug and gambling addictions may lead to social or interpersonal problems. Serious addictions may cause some patients to do things they normally would not (such as lie or steal) to fulfill their addictions. If this occurs, the person may have strained relationships with friends, family members, and loved ones.

• Substance abuse: Studies have shown that individuals who use illegal drugs (such as heroin or cocaine) typically engage in riskier behaviors than non-drug users. For instance, users may trade sex for drugs or money, or they may engage in behaviors that put them at risk for developing infectious diseases (such as HIV or hepatitis) while under the influence of drugs. However, this is not true of all drug users.

• Substance abuse during pregnancy may lead to serious birth defects or even prenatal death or stillbirth. If a women uses drugs during pregnancy, the baby may be born with a drug addiction and go into withdrawal.

• Individuals who are addicted to substances may have difficulty caring for loved ones, such as children or elderly parents.

• Sharing intravenous needles with others increases the risk of transmitting or acquiring infectious diseases, including HIV, hepatitis B, and hepatitis C.

• Drugs that are being abused may interact with other medications, herbs, or supplements and have serious medical consequences. For example, diabetics should not consume alcohol because it can affect blood sugar levels.

• Amphetamines and cocaine have been shown to cause impotence in men.

• Long-term abuse of stimulants changes the way the brain functions, and may lead to severe mental disorders and memory loss. Long-term abuse of alcohol may lead to cirrhosis of the liver or liver failure.

• Some drugs, including alcohol, heroin, cocaine, and methamphetamines, can be fatal if they are taken in high doses. Signs of an overdose include loss of consciousness, slowed or faint heartbeat, decreased blood pressure, slowed breathing, and chest pain. Individuals who experience any of these symptoms after using drugs should be taken to the nearest hospital immediately.

• Gambling addiction: Over time, compulsive gamblers typically find that it takes more and more money to make them feel excited when they gamble. As a result, some individuals may lose substantial amounts of money, become bankrupt, or be in serious debt.

• Gambling may lead to drug abuse or alcohol dependence. This is because alcohol and drugs, like gambling, are often used to escape from problems.

Diagnosis

• Substance abuse: Drug addiction is typically diagnosed after an evaluation by a psychiatrist, psychologist, or a professional addiction counselor. If drug addiction is suspected, the healthcare professional will ask many questions related to their drug use. For instance, if the patient has felt like he/she uses drugs too frequently or if he/she has ever felt guilty about using drugs, it may suggest a drug addiction. Also, if friends or family members have criticized the patient's drug use, or the patient has used drugs first thing in the morning, it may also indicate a drug problem.

• Drug screening tests are available for most substances. These tests can help a healthcare provider determine if drugs are present in the patient's body. These tests are especially helpful when drug use is suspected, but the patient denies it. However, the presence of a drug does not necessarily indicate a drug addiction. A doctor may take a sample of blood, urine, or hair from the patient. This sample is then analyzed in a laboratory for certain drugs. Over-the-counter (OTC) drug kits are available at most local pharmacies for home testing. Some drugs stay in the body for longer periods of time than others, regardless of how frequently the drugs are taken. For instance, marijuana can be detected in the blood for up to one month, while alcohol may be present in the blood for one to 12 hours.

• Gambling addiction: For compulsive gambling to be diagnosed, at least five of the following signs and symptoms must be present. 1) The patient is preoccupied with gambling. For instance, the individual may be constantly thinking about ways or places to gamble. 2) The patient has tried to stop or limit his/her gambling behaviors without success. 3) The patient needs more and more money to become excited about gambling. 4) The patient continues gambling in an effort to win back lost money. 5) When the patient tries to limit his/her gambling, he/she feels irritable. 6) Gambling is used as a way to escape or temporarily forget problems. 7) The patient lies to friends, family members, and/or loved ones about his/her gambling problem. 8) The patient commits crimes, such as theft or fraud, to get more gambling money. 9) The patient asks others for financial help when they run out of money. 10) The patient risks an important relationship or career or educational career because of their gambling addiction.

Planning An Intervention

• General: An intervention is a process that helps a drug addict recognize the seriousness of their problem. This technique is typically used when a patient does not realize the extent of his/her problem and has been unwilling to receive help up to this point. An intervention allows the individual to evaluate his/her own behavior through the eyes of others. During an intervention, friends and loved ones provide objective and non-judgmental feedback of the patient's behavior.

• A group of friends and family members who plan to organize and conduct an intervention should receive guidance and counseling from a professional who is experienced with interventions. Friends and family members can also hire a qualified interventionist to moderate the intervention. This helps ensure that the intervention is safe. The interventionist also serves as an unbiased third-party for the patient.

• Form a group: A group of the patient's closest friends and family members get together to plan an intervention. A leader should be chosen if an interventionist is not hired as a moderator. This person will serve as the moderator during the intervention.

• Research: Individuals involved in the intervention should do as much research as possible before the intervention to learn about addiction, potential treatment options, and rehabilitation programs.

• Make a plan: The group that plans to do the intervention usually meets several times before the intervention takes place. The members share what they plan to say to the patient. They also choose a date and safe and comfortable location (usually a friend or family member's home) for the intervention.

• Element of surprise: The element of surprise is essential for an intervention. If the individual knows that an intervention will take place he/she is unlikely to attend, especially if he/she does not believe he/she has a problem.

• How to approach the addict: Each person involved in the intervention has a chance to speak with the addict. It is generally recommended that each person starts off by telling the addict how much he/she is cared for, followed by how his/her actions have affected the lives of others. Next, state the consequences. Experts recommend telling the addict that unless he/she gets help, there will be consequences to face. These consequences are not to punish the addict, but to protect the friend or family member from the harmful behavior of the abuser. For instance, a friend may say they will no longer give the addict any money unless they agree to receive help.

• Listen: After each person talks, the addict should have an opportunity to speak. The addict may have questions about treatment options. It is important that the interventionist, friends, and family members are prepared to provide the addict with information about professionals to contact for help.

• If the person is still unwilling to accept help after the intervention, friends and family members should follow through with the consequences they discussed earlier. The person has to want help in order to be effectively treated.

Treatment

• General: Substance abuse it typically treated with rehabilitation programs and support groups. Gambling additions are typically treated with psychotherapy, medications, and support groups. Risk reduction programs may also be beneficial for addicts.

• Even with treatment, individuals may experiences relapses. It is estimated that about 33% of compulsive gamblers relapse within three months of initial treatment. Relapse statistics for drug addicts vary significantly depending on the specific drug used. Whenever possible, friends, family members, and loved ones should be included in therapy and treatment to provide support and help prevent relapses.

• Rehabilitation programs: Rehabilitation treatment programs are available to help patients recover from addiction. Treatment may include group therapy, motivational interviewing, family therapy, and one-on-one counseling. The duration of most rehabilitation programs is one to several months. Programs are tailored to specific individuals.

• In addition to receiving treatment for the drug addiction, patients also receive treatment for the underlying cause. There are treatment centers that are specialized to help addicts with associated problems. For instance, some centers help drug addicts that have been sexually abused. Patients may receive psychotherapy and family counseling during rehab. Other centers specialize in drug addicts with psychological illnesses, such as bipolar disorder or depression. These rehab centers may include psychotherapy and drug therapy to manage symptoms of their psychological disorders.

• During rehabilitation, medications, called narcotic antagonists, have been found useful in treating substance abuse specifically. In addition, medications, such as buprenorphine, may be prescribed to overcome withdrawal symptoms of opiate addictions.

• Support groups: Self-help and support groups are often beneficial for both substance abusers and gambling addicts. These groups provide support to individuals who are in the recovery process. National programs, such as Alcoholics Anonymous, Narcotics Anonymous, and Gamblers Anonymous, are some of the more widely known support groups that are available. However, many other programs are also available. Some support groups may include aspects of spirituality or religion. Others may be more specialized to meet the needs of addicts who also have psychological disorders or have been abused.

• Support groups may also be beneficial for the friends and family members who are trying to rebuild relationships with the addict.

• Not all support groups require face-to-face meetings. There are also many online support groups, which include chat rooms and message boards. This allows individuals to talk with others who share the same challenges.

• Risk reduction programs: Risk reduction programs may also be beneficial for drug addicts and compulsive gamblers. These programs have trained counselors and advisors who teach skills to help individuals avoid unwanted consequences related to drugs or gambling. Drug risk reduction programs may also help prevent individuals who are predisposed to addictions from becoming dependent on drugs or gambling.

• Psychotherapy: A form of psychotherapy, called cognitive behavior therapy (CBT), is often used to treat patients with compulsive gambling problems. During therapy, the patient meets with a qualified mental health professional to replace unhealthy and irrational beliefs and behaviors with positive ones. Counselors may also help patients learn how to manage stress, improve self-esteem, and deal with other factors that can potentially trigger relapses.

• Group therapy also may be helpful. During group therapy sessions, the patient talks with other people who share the same challenges. This provides the patient with feedback and support from others.

• Patients with drug addictions may also undergo various forms of psychotherapy during and after rehabilitation.

• Medications: Patients with gambling addictions may benefit from some types of medications. For instance, antidepressants and mood stabilizers are often used to treat compulsive gambling. These medications may also help treat underlying psychological problems, such as depression or bipolar disorder. Also, medications, called narcotic antagonists, may help treat compulsive gambling.

Integrative Therapies

• Good scientific evidence:

• Vitamin B1 (Thiamine): Thiamine is a B-vitamin that may decrease problems associated with acute alcohol withdrawal. Patients with chronic alcoholism or experiencing alcohol withdrawal are at risk of thiamine deficiency and its associated complications.

• Thiamin is generally considered safe and relatively nontoxic. Avoid if allergic or hypersensitive to thiamin. Rare hypersensitivity/allergic reactions have occurred with thiamin supplementation. Skin irritation, burning, or itching may rarely occur at injection sites. Large doses may cause drowsiness or muscle relaxation. Use cautiously if pregnant or breastfeeding.

• Yoga: Preliminary research suggests that yoga may be beneficial when added to standard therapies for the treatment of substance abuse. Additional studies are needed before a strong recommendation can be made.

• Yoga is generally considered to be safe in healthy individuals when practiced appropriately. Avoid some inverted poses with disc disease of the spine, fragile or atherosclerotic neck arteries, risk for blood clots, extremely high or low blood pressure, glaucoma, detachment of the retina, ear problems, severe osteoporosis, or cervical spondylitis. Certain yoga breathing techniques should be avoided in people with heart or lung disease. Use cautiously with a history of psychotic disorders. Yoga techniques are believed to be safe during pregnancy and breastfeeding when practiced under the guidance of expert instruction (the popular Lamaze techniques are based on yogic breathing). However, poses that put pressure on the uterus, such as abdominal twists, should be avoided in pregnancy.

• Unclear or conflicting scientific evidence:

• 5-HTP: Early study suggests that 5-HTP may lessen alcohol withdrawal symptoms. Further research is needed to confirm these results.

• Avoid 5-HTP if allergic or hypersensitive to it. Signs of allergy to 5-HTP may include rash, itching, or shortness of breath. Avoid with eosinophilia syndromes, Down's syndrome, and mitochondrial encephalomyopathy. Use cautiously if taking antidepressant medications such as TCAs, MAOIs, SSRIs, nefazodone, trazodone, venlafaxine, mirtazapine, bupropion; 5-HTP receptor agonists such as sumatriptan, rizatriptan, naratriptan, zolmitriptan, eletriptan, imotriptan, and frovatriptan; and carbidopa, phenobarbital, pindolol, reserpine, tramadol, or zolpidem. Use cautiously with renal (kidney) insufficiency, HIV/AIDS (particularly HIV-1 infection), epilepsy, and/or with a history of mental disorders. Avoid if pregnant or breastfeeding.

• Acupressure: The practice of applying finger pressure to specific acupoints throughout the body has been used in China since 2000 BC, prior to the use of acupuncture. Acupressure techniques are widely practiced internationally for relaxation, wellness promotion, and the treatment of various health conditions. Shiatsu means finger (Shi) pressure (Atsu) in Japanese. Shiatsu can incorporate palm pressure, stretching, massaging and other manual techniques. Early study indicates that auricular acupressure (pressure to points on the ear) may help with smoking cessation. Preliminary evidence also suggests that acupressure may be a helpful adjunct therapy to assist with prevention of drug addiction.

• With proper training, acupressure appears to be safe if self-administered or administered by an experienced therapist. Serious long-term complications have not been reported, according to scientific data. Hand nerve injury and herpes zoster ("shingles"), carotid dissection, and retinal and cerebral artery embolism, cases have been reported after shiatsu massage. Forceful acupressure may cause bruising.

• Acupuncture: Acupuncture is commonly used to treat various forms of substance abuse such as alcoholism, opiate addiction, and cocaine dependence, although clinical studies have reported mixed results. Clinical study compared the readmission rates of a six-month treatment at residential detoxification programs (used by 6,907 clients) versus at outpatient acupuncture programs (used by 1,104 clients). Acupuncture clients were less likely to be readmitted for detoxification within six months.

• Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders, medical conditions of unknown origin, or neurological disorders. Avoid if taking drugs that increase the risk of bleeding (e.g. anticoagulants). Avoid on areas that have received radiation therapy and during pregnancy. Use cautiously with pulmonary disease (e.g. asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics, or with history of seizures. Avoid electroacupuncture with arrhythmia (irregular heartbeat) or in patients with pacemakers because therapy may interfere with the device.

• Aromatherapy: Aromatherapy may be as effective as some types of acupuncture in treating alcohol withdrawal symptoms. More study is needed in this area.

• Essential oils should be administered in a carrier oil to avoid toxicity. Avoid with a history of allergic dermatitis. Use cautiously if driving/operating heavy machinery. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if pregnant.

• Astragalus: Astragalus (Astragalus membranaceus) is commonly used in traditional Chinese medicine (TCM). Limited available study has reported positive benefits in smoking cessation. However, more human studies are needed.

• Avoid if allergic to astragalus, peas, or any related plants or with a history of Quillaja bark-induced asthma. Avoid with aspirin or aspirin products or herbs or supplements with similar effects. Avoid with inflammation (swelling) or fever, stroke, transplants, or autoimmune diseases (like HIV/AIDS). Stop use two weeks before surgery/dental/diagnostic procedures with a risk of bleeding and avoid use immediately after these procedures. Use cautiously with bleeding disorders, diabetes, high blood pressure, lipid disorders, or kidney disorders. Use cautiously with blood-thinners, blood sugar drugs, or diuretics or herbs and supplements with similar effects. Avoid if pregnant or breastfeeding.

• Black pepper: Sensory cues associated with cigarette smoking can suppress certain smoking withdrawal symptoms, including the craving for cigarettes. Inhalation of black pepper essential oil may reduce cravings and physical symptoms associated with cigarette smoking cessation.

• Avoid if allergic or hypersensitive to black pepper (Piper nigrum), its constituents, or members of the Piperaceae family. Use cautiously if taking anti-asthmatic drugs, cholinergic agonists, cyclosporine A or digoxin, cytochrome P450 metabolized agents, oral herbs or drugs, phenytoin, propranolol, rifamipicin (rifampin), or theophylline. Use cautiously with gastrointestinal disorders. Avoid if pregnant or breastfeeding.

• Borage seed oil: Borage oil may help treat or prevent alcohol-induced hangovers, although additional study is needed in this area. Avoid if allergic or hypersensitive to borage, its constituents, or members of the Boraginaceae family. Use cautiously in patients with bleeding disorders or in those taking warfarin or other anticoagulant or antiplatelet (blood thinning) agents. Use cautiously in patients with epilepsy or in those taking anticonvulsants. Avoid in patients with compromised immune systems or similar immunological conditions. Avoid in pregnant patients as borage oil may be contraindicated in pregnancy given the teratogenic and labor-inducing effects of prostaglandin E agonists, such as GLA, present in borage oil. Avoid if breastfeeding.

• Coenzyme Q10: Coenzyme Q10 (CoQ10) is produced by the human body. It is needed for the basic functioning of cells. A combination of Coenzyme Q10 and L-carnitine has been studied for reduction of cocaine dependence, but results are inconclusive. More research is needed in this area.

• Allergies associated with Coenzyme Q10 supplements have not been reported in the available literature. However, rash and itching have been reported rarely. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Use cautiously with a history of blood clots, diabetes, high blood pressure, heart attack, or stroke. Use cautiously if taking anticoagulants (blood thinners) or anti-platelet drugs, blood pressure drugs, blood sugar drugs, cholesterol drugs, or thyroid drugs. Avoid if pregnant or breastfeeding.

• Colon therapy/colonic irrigation: Colon therapy is the use of herbs or water to clean out the colon or large intestine to treat certain health conditions. Limited available study of unclear methodology suggested that colonic irrigation employing Chinese herbs may augment dihydroetorphine (DHE) and methadone therapy in heroin addicts going through drug withdrawal, possibly resulting in more rapid detoxification. However, the data provided are insufficient for making any definitive conclusions. More studies are needed.

• Excessive treatments may allow the body to absorb too much water, which may cause electrolyte imbalances, nausea, vomiting, heart failure, fluid in the lungs, abnormal heart rhythms, or coma. Infections have been reported, possibly due to contaminated equipment or as a result of clearing out normal colon bacteria that destroys infectious bacteria. There is a risk of the bowel wall breaking, which is a serious complication that can lead to septic shock and death. Avoid with diverticulitis, ulcerative colitis, Crohn's disease, severe or internal hemorrhoids, rectal/colon tumors, or if recovering from bowel surgery. Avoid frequent treatments with heart or kidney disease. Colonic equipment must be sterile. Colonic irrigation should not be used as the only treatment for serious conditions. Avoid if pregnant or breastfeeding due to a lack of scientific data.

• DHEA: DHEA (dehydroepiandrosterone) is a hormone that is produced by the adrenal glands. Preliminary study shows that DHEA is not beneficial for cocaine withdrawal, but further study is needed before a firm conclusion can be drawn.

• Avoid if allergic to DHEA. Use cautiously with adrenal or thyroid disorders, depression, panic disorder, bipolar disorder, psychotic disorders, heart disorders, polycystic ovary syndrome, anovulatory infertility, steroid 21-hydroxylase deficiency, gynecomastia, overactive thyroid, bacterial infections, or diabetes. Use cautiously if at risk for prostate cancer, liver cancer, breast cancer, or ovarian cancer. Use cautiously in HIV patients with Kaposi's sarcoma or in patients who have received flu shots. Use cautiously if taking alprazolam, amlodipine, anastrozole, benfluorex, beta-adrenergic antagonists, calcium channel blockers, canrenoate, danazol, diltiazem, growth hormone, methylphenidates, metopirone, nitrendipine, or hormones or dietary supplements with hormone-like effects (e.g. chromium picolinate). Avoid if pregnant or breastfeeding.

• Eucalyptus oil: Nicobrevin is a proprietary product marketed as an aid for smoking cessation that contains quinine, menthyl valerate, camphor, and eucalyptus oil. Despite use of this product, there is currently a lack of evidence suggesting benefit for smoking cessation.

• Avoid if allergic to eucalyptus oil or with a history of seizure, diabetes, asthma, heart disease, abnormal heart rhythms, intestinal disorders, liver disease, kidney disease, or lung disease. Use caution if driving or operating machinery. Avoid with a history of acute intermittent porphyria. Avoid if pregnant or breastfeeding. A strain of bacteria found on eucalyptus may cause infection. Toxicity has been reported with oral and inhaled use.

• Ginkgo biloba: Ginkgo biloba has been used medicinally for thousands of years. Today, it is one of the top selling herbs in the United States. It is not clear whether ginkgo is helpful in treating cocaine dependence. More study is needed.

• Avoid if allergic or hypersensitive to members of the Ginkgoaceaefamily. If allergic to mango rind, sumac, poison ivy or oak or cashews, then allergy to ginkgo is possible. Avoid with blood-thinners (like aspirin or warfarin (Coumadin®)) due to an increased risk of bleeding. Ginkgo should be stopped two weeks before surgical procedures. Ginkgo seeds are dangerous and should be avoided. Skin irritation and itching may also occur due to ginkgo allergies. Do not use ginkgo in supplemental doses if pregnant or breastfeeding.

• Globe artichoke: Globe artichoke (Cynara scolymus) may help the digestive system to function better. An extract of artichoke has been used and marketed as a remedy for alcohol-induced hangover. However, there is insufficient available evidence to form a clear conclusion in this area. Artichoke extract may be taken immediately before and following consumption of alcohol.

• Do not use artichoke with gall bladder or liver problems, unless under the supervision of a doctor. Use cautiously if allergic/hypersensitive to members of the Asteraceae or Compositae family (e.g., chrysanthemums, daisies, marigolds, ragweed, arnica), due to possible cross-reactivity. Use cautiously with cholelithiasis or biliary/bile duct obstruction or kidney disease. Avoid if pregnant or breastfeeding.

• Guided imagery: In contemporary times, the term "guided imagery" may be used to refer to a number of techniques, including metaphor, story telling, fantasy, game playing, dream interpretation, drawing, visualization, active imagination, or direct suggestion using imagery. Therapeutic guided imagery may be used to help patients relax and focus on images associated with personal issues they are confronting. Based on early study, guided imagery in addition to education and counseling sessions may be helpful for long-term smoking cessation and abstinence in adult smokers. Further study is needed to confirm these results.

• Guided imagery is usually intended to supplement medical care, not to replace it, and guided imagery should not be relied on as the sole therapy for a medical problem. Contact a qualified healthcare provider if mental or physical health is unstable or fragile. Never use guided imagery techniques while driving or doing any other activity that requires strict attention. Use cautiously with physical symptoms that can be brought about by stress, anxiety, or emotional upset because imagery may trigger these symptoms. If feeling unusually anxious while practicing guided imagery, or with a history of trauma or abuse, speak with a qualified healthcare provider before practicing guided imagery.

• Hypnotherapy: Hypnosis is associated with a deep state of relaxation. Although used by psychotherapists, there is inconclusive evidence for the use of hypnotherapy in alcohol dependence and drug addiction. Additional research is needed in this area.

• Use cautiously with mental illnesses like psychosis/schizophrenia, manic depression, multiple personality disorder or dissociative disorders. Use cautiously with seizure disorders.

• Kudzu: Kudzu (Pueraria lobata) is well known in the southern United States as an invasive weed. Research indicates that extracts of kudzu may be effective in treatment of alcoholism, such as with decreasing the cravings of alcohol. Clinical studies report positive benefits when using kudzu for alcohol craving. However, more research needs to be performed.

• Use caution with anticoagulants/anti-platelet and blood pressure lowering agents, hormones, antiarrhythmics, benzodiazepines, bisphosphonates, diabetes medications, drugs that are metabolized by the liver's cytochrome P450 enzymes, mecamylamine, neurologic agents, and methotrexate. Well designed studies on the long-term effects of kudzu are currently unavailable. Avoid if allergic or hypersensitive to Pueraria lobata or members of the Fabaceae/Leguminosae family. Avoid if pregnant or breastfeeding.

• L-carnitine: L-carnitine (also known as acetyl-L-carnitine) is an antioxidant and may help blood flow, as well as neurological function. Early studies suggest that acetyl-L-carnitine may be of benefit in the treatment of alcoholism. Well-designed clinical trials are required before recommendations can be made in this field.

• Avoid with known allergy or hypersensitivity to carnitine. Use cautiously with peripheral vascular disease, hypertension (high blood pressure), alcohol-induced liver cirrhosis, and diabetes. Use cautiously in low birth weight infants and individuals on hemodialysis. Use cautiously if taking anticoagulants (blood thinners), beta-blockers, or calcium channel blockers. Avoid if pregnant or breastfeeding.

• Massage: Massage shows promise as an adjunct to traditional medical detoxification for alcohol dependence. Further research is needed to confirm these results.

• Avoid with bleeding disorders, low platelet counts, or if on blood-thinning medications (such as heparin or warfarin/Coumadin®). Areas should not be massaged where there are fractures, weakened bones from osteoporosis or cancer, open/healing skin wounds, skin infections, recent surgery, or blood clots. Use cautiously with a history of physical abuse or if pregnant or breastfeeding. Massage should not be used as a substitute for more proven therapies for medical conditions. Massage should not cause pain to the client.

• Meditation: Available evidence does not indicate conclusively whether meditation can help with smoking cessation, cocaine dependence, or alcoholism. More studies are needed.

• Use cautiously with underlying mental illnesses. People with psychiatric disorders should consult with their primary mental healthcare professional(s) before starting a program of meditation, and should explore how meditation may or may not fit in with their current treatment plan. Avoid with risk of seizures. The practice of meditation should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses.

• Melatonin: Melatonin is a hormone produced in the brain and is involved in the sleep wake cycle during light and darkness. Levels of melatonin in the blood are highest prior to bedtime. A small amount of research has examined the use of melatonin to reduce symptoms associated with smoking cessation, such as anxiousness, restlessness, irritability, and cigarette craving. Although preliminary results are promising, due to weaknesses in the design and reporting of this research, further study is necessary before a firm conclusion can be reached. Early research has also examined the use of melatonin to assist with benzodiazepine tapering, such as with diazepam (Valium®) or lorazepam (Ativan®).

• Melatonin is not to be used for extended periods of time. Melatonin can cause drug interactions, and healthcare professionals recommend not using in pregnancy or breastfeeding.

• Nopal cactus: Limited available clinical study found that nopal cactus (Opuntia ficus-indica) may prevent alcohol-induced hangover, likely due to nopal's ability to inhibit the production of inflammatory mediators. More clinical studies are needed to confirm this finding. Avoid if allergic/hypersensitive to nopal (Opuntia spp.), any of its constituents, or to members of the Cactaceae family. Use cautiously if taking medications that alter blood sugar, cholesterol, or blood pressure. Use cautiously with thyroid dysfunction and rhinitis (runny or congested nose), or asthma. Avoid with immunosuppression or impaired liver function. Avoid if pregnant or breastfeeding. The nopal plant should be handled cautiously, as it is covered in long sharp spines and shorter soft-appearing barbs of glochids, which may be painful and difficult to remove once they are imbedded in the skin. It is recommended that oral doses of dried nopal be taken with at least eight ounces (250mL) of water.

• Prayer: Traditional forms of prayer have been widely used for alcohol or drug dependency and smoking cessation. However, early study results are unclear. Additional research is needed to make a conclusion.

• Prayer is not recommended as the sole treatment approach for potentially serious medical conditions and should not delay the time it takes to consult with a healthcare professional or receive established therapies.

• Psychotherapy: Several studies suggest that psychotherapy may be beneficial for smoking cessation, alcohol abuse, or drug abuse. However, there is not enough available evidence to make a conclusion. More research is needed to better determine effectiveness.

• Psychotherapy is not always sufficient to resolve mental or emotional conditions. Psychiatric medication is sometimes needed. The reluctance to seek and use appropriate medication may contribute to worsening of symptoms or increased risk for poor outcomes. In order to be successful, psychotherapy requires considerable personal motivation and investment in the process. This includes consistent attendance and attention to treatment recommendations provided by the practitioner. Not all therapists are sufficiently qualified to work with all problems. The client or patient should seek referrals from trusted sources and should also inquire about the practitioner's training and background before committing to work with a particular therapist. Some forms of psychotherapy evoke strong emotional feelings and expression. This can be disturbing for people with serious mental illness or some medical conditions. Psychotherapy may help with post-partum depression, but is not a substitute for medication, which may be needed in severe cases.

• Qi gong: Qi gong is a type of traditional Chinese medicine (TCM) that is thought to be at least 4,000 years old. It is traditionally used for spiritual enlightenment, medical care, and self-defense. A recent study looked at the effectiveness of Qi gong therapy versus medical and nonmedical treatment for heroin detoxification. Results showed that Qi gong may be beneficial in heroin detoxification without side effects, although the possibility of the placebo effect cannot be completely eliminated. Other treatments have been better studied for heroin detoxification and are recommended at this time. Qi gong may be used as an adjunct therapy.

• Qi gong is generally considered to be safe in most people when learned from a qualified instructor. Use cautiously with psychiatric disorders. In cases of potentially serious conditions, Qi gong should not be used as the only treatment instead of more proven therapies, and it should not delay the time it takes to see an appropriate healthcare provider.

• Relaxation therapy: Early research reports that relaxation with imagery may reduce relapse rates in people who successfully completed smoking cessation programs. Better study is needed in this area before a firm conclusion can be reached.

• Avoid with psychiatric disorders like schizophrenia/psychosis. Jacobson relaxation (flexing specific muscles, holding that position, then relaxing the muscles) should be used cautiously with illnesses like heart disease, high blood pressure, or musculoskeletal injury. Relaxation therapy is not recommended as the sole treatment approach for potentially serious medical conditions, and should not delay the time to diagnosis or treatment with more proven techniques.

• Fair negative scientific evidence:

• Acupuncture: Numerous studies of acupuncture for smoking cessation have been conducted, and the quality of studies has varied widely. There may, however, be some benefit in reducing side effects of withdrawal such as irritation, cigarette craving, and headache. Additional research is needed.

• Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders, medical conditions of unknown origin, or neurological disorders. Avoid if taking drugs that increase the risk of bleeding (e.g. anticoagulants). Avoid on areas that have received radiation therapy and during pregnancy. Use cautiously with pulmonary disease (e.g. asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics, or with history of seizures. Avoid electroacupuncture with arrhythmia (irregular heartbeat) or in patients with pacemakers because therapy may interfere with the device.

• Hypnotherapy: Hypnotherapy involves suggestion by therapists during periods of deep relaxation. Although used for smoking cessation with some positive results, there is currently a lack of scientific evidence for hypnotherapy as a valid treatment for this indication.

• Use cautiously with mental illnesses like psychosis/schizophrenia, manic depression, multiple personality disorder or dissociative disorders. Use cautiously with seizure disorders.

• Traditional or theoretical uses lacking sufficient evidence:

• Detoxification therapy: Detoxification is a broad concept that encompasses many different modalities and substances used in cleansing the body's systems and organs. Detoxification therapy has been historically used to treat alcoholism and drug addiction. However, scientific evidence is lacking. Until research is conducted in this area, a firm conclusion cannot be reached.

• In cases of illness, the various forms of detoxification should be used under professional guidance.

• Milk thistle: Although not supported for use in alcoholism by clinical studies, milk thistle (Silybum marianum) is widely known as an antioxidant and detoxifying herb for the liver.

• Avoid if allergic to plants in the aster family (Compositea, Asteraceae), daisies, artichoke, common thistle, or kiwi. Use cautiously with diabetes. Avoid if pregnant or breastfeeding.

• Omega-3 fatty acids: Omega-3 fatty acids have been suggested as a possible therapy for alcoholism. Alcoholics have been reported to have decreased amounts of the omega-3 essential fatty acids, particularly DHA or docosahexaenoic acid. Omega-3 fatty acids, such as found in fish oils, may be used as a supplement to the diet.

• Avoid if allergic or hypersensitive to fish, omega-3 fatty acid products that come from fish, nuts, linolenic acid or omega-3 fatty acid products that come from nuts. Avoid during active bleeding. Use cautiously with bleeding disorders, diabetes, low blood pressure or drugs, herbs or supplements that treat any such conditions. Use cautiously before surgery. The Environmental Protection Agency (EPA) recommends that intake be limited in pregnant/nursing women to a single 6-ounce meal per week, and in young children to less than 2 ounces per week. For farm-raised, imported, or marine fish, the U.S. Food and Drug Administration recommends that pregnant/nursing women and young children avoid eating types with higher levels of methylmercury and less than 12 ounces per week of other fish types. Women who might become pregnant are advised to eat 7 ounces or less per week of fish with higher levels of methylmercury or up to 14 ounces per week of fish types with about 0.5 parts per million (such as marlin, orange roughy, red snapper, or fresh tuna).

Prevention

• General: Risk reduction programs may help prevent individuals who are predisposed to addictions from becoming dependent on drugs or gambling. These programs have trained counselors and advisors who teach skills to help individuals avoid unwanted consequences related to drugs or gambling.

• Substance abuse: Having knowledge about drug abuse is the key to preventing drug addictions.

• Individuals who feel depressed, suffer from psychological disorders, or were abused should seek help. Treating such conditions promptly reduces the chances that the patient will self-medicate with drugs.

• Individuals who are recovering from drug addictions should avoid the temptation to use drugs. Individuals should not spend time with others who are using drugs or expose themselves to environments where drugs are present.

• Individuals who use intravenous drugs (such as heroin) should not share needles with others. Sharing needles increases the risk of transmitting or acquiring infectious diseases, including HIV and hepatitis.

• Gambling addiction: There is currently no known method to prevent gambling addictions. However, individuals may decrease their risks of developing gambling problems by limiting the amount of time they spend gambling.

• It is also important to seek help as soon as a problem is identified. This may help prevent the addiction from worsening.

• Individuals who have gambling addictions should avoid temptations to gamble. Recovering compulsive gamblers who suddenly feel the urge to gamble should talk to their healthcare providers to prevent a relapse from occurring.

Author Information

• This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

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