Post–Acute Withdrawal Syndrome,Relapse Prevention,and Homeopathy

Post–Acute Withdrawal Syndrome

When a person is detoxed, the recreational or prescription drugs that the neurotransmitters of the body have come to rely on are stopped, causing the body to experience a sudden reduction in life-sustaining neurochemicals. This is the process called withdrawal, and the subsequent overwhelming physical phenomena called drug cravings often begins. As the body begins healing and resuming a natural production of neurotransmitters, often taking months, the deficit of neurotransmitters produces an intense physical need for more neurotransmitters, referred to as drug cravings. The lack of sufficient neurotransmitters often causes intense irritability, sleep problems, and obsessive thoughts of drug use—a lingering phenomenon referred to as post–acute withdrawal syndrome (PAWS). ¹ It is this phenomenon that often leads to relapse. ²

Introduction to Homeopathy

Classical homeopathy is a 200-year-old system of healing developed by the German physician Samuel Hahnemann. ³ It is holistic and works with the person's natural ability to heal. Although known for centuries, it is often rejected by modern medicine as a placebo effect or quackery because the medicines are highly diluted, with the material composition well below the material dose (Avogadro's number) thought to be effective. In this age of nanoparticles when conventional medications are being experimented with in very small doses, ⁴ this concern seems irrelevant in light of the observed beneficial effect.

Homeopathy differs from herbal medicine in that it uses animal and mineral substances, not simply plants, and they are highly diluted. The action of a specific homeopathic medicine is understood by administering it to healthy individuals, observing symptoms produced, and thus compiling a “remedy picture.” This is a process known as a homeopathic proving. Hahnemann is often cited as one of the first in modern medicine to use an experimental approach rather than a theoretical approach (e.g., the physicians of his time practiced bloodletting based on the belief that “humors” in the body had to be kept in balance for good health).

When someone presents with a health issue, his/her symptom picture (mental, emotional, and physical) is correlated to a remedy picture, and the homeopath gives that medicine. As an example, homeopathic coffee (Coffea cruda) is an effective medicine for someone who cannot sleep at night ⁵ because the mind is too excited—just as someone using a material dose of coffee might experience. This phenomenon has given rise to homeopathy's principle of “like cures like.” That is, the patient is given the substance that in nature might cause the symptoms.

In the field of complementary and alternative medicine, now called integrative medicine, homeopathy falls within the broad category of both alternative medicine systems and energy medicine. ⁶

The Homeopathic Medicine Nux vomica as a Treatment for PAWS

One of the best medicines for hangover symptoms (a much lesser version of PAWS experienced by non-addicted people) is a plant medicine called Nux vomica. The homeopathic medicine Nux vomica is prepared from the seed of the Strychnos nux-vomica tree (or poison nut), which is native to India and Southeast Asia. The seed's medicinal uses in small doses and its toxic effects in larger doses (as a source of strychnine) have been known since ancient times in India. In the 1790s, homeopathy's founder Samuel Hahnemann conducted provings of Nux vomica for use as a homeopathic medicine. ⁷

Nux vomica has an affinity for the neurological system. People who need it often display some combination of disorientation, irritability, chilliness, spasms, cramping, insomnia, headache, and hypersensitivity to light, noise, and touch. Nux vomica is often called “the hangover remedy” because it can help those who suffer with the above symptoms after overindulgence in alcohol, food, or drugs. Nux vomica is also useful for people with disordered digestion, including nausea, vomiting, or constipation with straining and ineffectual urging, especially when some of the above neurological symptoms are present.

As a psychologist and homeopath with extensive experience in the addiction field, the author selected Nux vomica as a possible intervention for addicted clients experiencing PAWS. When invited by several substance abuse treatment programs based in Boston, MA, a team of homeopaths explored the use of Nux vomica with post-detox, very early recovery clients.

Application with Three Cohorts: Patients and Methods

There were three cohorts of clients, all women aged 18–70 years, of varied ethnic backgrounds, and all with long-term addiction to multiple recreational and prescription drugs. The first two cohorts were women living at a six-month residential substance treatment program in Boston, MA. The third cohort resided in a 28-day treatment program in Boston, MA. In each of these cohorts, clients who self-selected decided whether to take a single dose of homeopathic Nux vomica 200C, after receiving information as to its benefit to reduce cravings and the minimal risk of adverse effects (in fact, none of the women experienced a single adverse effect). The 200C refers to the potency: this is a stronger potency than the 30C potency typically found in retail stores. However, all potencies of Nux vomica are regulated as over-the-counter medications by the Food and Drug Administration (FDA).

Nux vomica Preparation

The homeopathic remedy Nux vomica 200C was prepared by Hyland's Homeopathic Laboratories in compliance with standard FDA guidelines, as specified in the Homeopathic Pharmacopoeia of the United States. Homeopathic medicines are prepared by taking a solution of the starting substance (made with water and/or alcohol and known as the mother tincture) and serially diluting it many times with succussion/shaking at each step, a process called potentization. This dilution/potentization process is repeated 200 times to make the 200C potency. The mother tincture is extracted from the seeds of Strychnos nux-vomica, a tree of the Loganiaceae family. The general public uses Nux vomica as a treatment for overindulgence in alcohol, exhibiting symptoms of headache, nausea, digestive upset, increased irritability, and sensitivity to noise, light, and odors.

Results

From 2006 to 2008, a team of homeopaths ran a homeopathic substance abuse treatment clinic at two locations of the Women's Substance Abuse Treatment Center in Boston, MA. This was a post-detoxification residential program for women aged 18–70 years who were addicted to multiple drugs (alcohol, heroin, cocaine, meth, etc.). It was a six-month program for women to stabilize their recovery, develop life skills, reunite with their children, and move out to a stable home, job, and recovery.

The women arrived at the treatment program after three to five days of medical detoxification. Universally, these women were still suffering from PAWS, with symptoms of severe cravings for drugs, irritability, mental confusion, low energy, sleep problems, and lingering detox symptoms such as diarrhea and stomach upset. Cravings and general discomfort post detox typically result in early dropout from treatment and relapse into further drug use.

Using research from an animal study, ⁸ knowledge of homeopathic Materia Medica, and the history of homeopathic use of Nux vomica for symptoms of hangover relief and alcohol problems, a protocol was instituted using a genus epidemicus ^* model of treatment, that is, identification of a medicine based on the collective signs and symptoms of a group rather than personalized individuated case analysis. ⁹ All clients entering the program were offered a single dose of Nux vomica 200C after being briefly introduced to homeopathy and the understanding of its usefulness in reducing cravings for alcohol and other drugs.

Since dropout during early phases of treatment due to drug cravings is common, the goal was to reduce PAWS and to stabilize the women enough so that they could complete the treatment program (six months for the first and second cohorts, one month for the third cohort) and thus increase the likelihood of continued sobriety.

As this was a treatment program and not a research project, data were kept, but these were insufficient for the purpose of analysis. The rough data with two separate cohort groups (2006 and 2008) showed that women who chose the homeopathic protocol (a self-selected sample) completed the program at a percentage of 66% (for the first cohort) and 63% (for the second cohort) versus 33% and 37% for those who did not choose homeopathy. No adverse events were reported. Both cohorts were women aged between 18 and 70 years, with a wide range of ethnicities, and all were multiple drug users with long histories—a very promising finding. These findings were similar to data identified in research noted by Bakshi. ¹⁰

In December 2010, the author was invited to open a similar homeopathic clinic at a large publicly funded treatment center, the Kitty Dukakis Substance Abuse Treatment Program at Shattuck Hospital in Boston, MA.

This was a 28-day program—a much shorter time with extremely high dropout rates. The same protocol was again instituted. This time the staff statistician compiled the data. Demographics for client population were again similar to the two previous groups.

With only three months of data (mid-December 2010–mid-February 2011) and a small sample (18 used homeopathy, while 43 did not), the results showed similar trends. There were some other interesting comparisons: those who did not use homeopathy left against clinical advice shortly after entry or were discharged for noncompliance (e.g., fighting or flagrant violation of program rules) at a higher percentage than those who did use homeopathy.

A full year of clients and analysis (December 2010–December 2011) continued to show the same trend of successful completion of treatment. A significant number of clients who used homeopathy (n = 58; 77%) completed treatment compared to those who did not select homeopathy (n = 130; 53%). ¹¹ No adverse events were reported.

Conclusion

Although the sample was self-selected and the data from the first two cohorts were collected as clinical data rather than formal research results, the trend of similar percentages in all three cohorts is remarkably similar and reflects data from other studies. ^8,12

Despite the paradigmatic differences between homeopathic and conventional Western medical approaches to post-detox cravings, these data are strong enough to warrant a large-scale formal research project.