Many practitioners have a misconstrued view of what addiction really is, according to Loretta Butehorn, PhD, CCH. Butehorn is a psychologist and homeopath who has worked in substance abuse for over 40 years, and says integrative therapies are most effective in early addiction recovery. She will be presenting “Integrative Therapies for Relapse Prevention in Opioid Treatment” at the Integrative Healthcare Symposium February 22 to 24 in New York City. The following discussion is a preview of her presentation.
Q: Can you provide an overview of what you’ll be discussing during your session?
A: With the opioid epidemic being so widespread, one of the things many people don’t realize is what exactly addiction is. Addiction is a biological response to a certain category of drugs. Most drugs don’t necessarily cause an addiction, but drugs that have a certain chemical structure [cause addiction].
When you detox from these drugs, it takes your body a period of time to readjust and, in substance abuse treatment, that’s called post-acute withdrawal syndrome (PAWS). PAWS is a period of time when the body experiences terrible cravings for drugs. As a result, it is very easy for people to relapse.
Most detoxes now are somewhere in between three and five days. PAWS lasts anywhere from a month, very intensively, to six months. If you had knee replacement surgery, you’d have an intense period of discomfort for a short period of time, and while the knee is healing you’ll have extended discomfort. That discomfort, when it’s an addiction, comes in the form of severe cravings, sleep disturbances, and other bodily disturbances, and that period of time is when people relapse.
There are a number of different kinds of integrative therapies that work extremely well for cravings—acupuncture, tai chi and other forms of martial arts, homeopathy, and others. Part of what I want to do is talk about what our current understanding of addiction is from a medical point of view, what PAWS is, and what integrative therapies are available that actually work very well in helping people through early recovery. There’s no medication that’s really effective for what people go through right after detox.
Q: For PAWS, how does one begin to identify behavioral, emotional, and physical symptoms?
A: The chemicals in drugs that are addictive are extremely close to our own neurotransmitters. If you’ve ever had the experience of having a hangover, for example, if you drink too much, because your body is flooded with “look-alike” neurotransmitters, your body stops making those transmitters for a period time, so you wake up the next morning and you have a dry mouth, a stomach ache, a headache, etc. If you don’t have an addiction, the body starts to say, “oh I need to make more neurotransmitters,” and the body kicks back in.
If you have an addiction, it’s like the neurotransmitter “pump” is broken. For someone who is addicted, after they are detoxed, their body is responding and they [some physical symptoms], but mostly a severe craving for the drugs. If you’ve ever had a craving for chocolate, multiply that by a thousand times and that’s what a drug craving is like. If you’re in need of chocolate, you’re not addicted in the same way as if you were addicted to heroin or cocaine because it hasn’t knocked out your neurotransmitters.
What’s interesting is that this syndrome was first documented in the 1950s, and in the 1980s, substance abuse treatment programs started to talk about motivational interviews and it really adapted to alert clients that, when they got the drugs out of their system, it would take them a period of time before they were really comfortable. They haven’t really addressed giving people the tools to cope with [PAWS].
Q: Can you describe the most effective integrative approach for treating addiction?
A: It varies. It’s not one-size-fits-all. Here in Massachusetts, we have five or six regular detoxes, where they use pharmaceuticals, and we also have three acupuncture detoxes. The acupuncture detoxes are very effective for detoxing. However, the drawback is the person has to get a treatment every day for about three weeks, so it’s very time-intensive. Acupuncture is great for cravings.
There’s been some really interesting research done on tai chi and yoga in terms of soothing the body as it’s going through the state of PAWS. I’ve also been doing some work for about 11 years now using homeopathy for people, and what we do is we give the person a homeopathic remedy, which they can take as needed, and it cuts down the cravings tremendously.
There are a number of different things people can use, but the most important thing is for the person who has the addiction to be aware of [what is going to happen when they come out of detox and how they can manage the cravings]. All too often, the client isn’t prepared for the onslaught of feelings, and the reaction, and they have a knee-jerk reaction. One of the most important things practitioners can do is help the people be conscious of what they’ll be experiencing and how they can manage their symptoms.
Q: How can providers begin to implement these approaches in their own practices?
A: What I’ve found is that many practitioners have very faulty ideas about what addiction is. There’s still a lot of people who think it’s a weakness of character when, in reality, we’re dealing with a medical issue.
I think the first step for providers is to be fairly sophisticated in terms of their understanding of what the person is actually dealing with, and then to be encouraging about the fact that there are things that you can do to minimize discomfort along the treatment continuum. This awareness can be very helpful.
Many doctor’s offices now are putting counseling components in place, so if someone is not keeping up with their diabetes regimen, or if someone had open heart surgery and needs to do exercise and diet as part of their recovery, they have someone who is working in the counselor role to educate the consumer and give them some information on how best to recover or deal with their illness. I think that the practitioners need to know that these kinds of services are available.
Editor’s note: This Q&A was edited and condensed. Click here for more information on Butehorn and her presentation at the Integrative Healthcare Symposium Annual Conference.