Addicts are known for their clichés like “I’m sick and tired of being sick and tired” or “one is too many and 100 is not enough.” But how often do health professionals get to the bottom of the “feeling crappy syndrome” and the seemingly insatiable physical cravings that addicts and chronic substance abusers experience? And can the “normal” people in our population learn anything from their as yet unresolved pain?
Most addiction professionals are not looking deep into the physical health of an addict and many are quick to attribute the root cause of “feeling sick and tired” to substance abuse. After all, anyone who has had a rough night on the South Side or partied into the night after Super Bowl XL knows that heavy alcohol or drug use can take its toll for a good day or two. So it makes sense to assume that anyone who has been using alcohol or drugs consistently and excessively for months or years is going to feel like hell for a bit after the party ends. But just because it makes sense, should we simply not investigate further? Should we just chalk up an addict’s discomfort to, “They did it to themselves so they get what they deserve?” Well if the “feeling crappy” persists long enough for an addict to believe falling off the wagon is the only chance at relief, perhaps a more thorough investigation is in order.
Substance abuse has been repeatedly cited as the number one most expensive healthcare issue in our society, more than diabetes and obesity put together. At over $500 billion, substance abuse costs us more than our nation’s 2010 published defense budget. So if junkies and drunks are costing us more each year than keeping our nation safe, perhaps we should try to figure out what is going on in their bodies that makes staying off the sauce so difficult.
First off, national relapse rates for addiction (40 to 60%) are comparable to those for chronic illnesses such as diabetes (30 to 50%) and asthma (50 to 70%). This suggests that addicts experience the same likelihood of relapse as those afflicted with other chronic diseases. But despite continued evidence that demonstrates addiction is a chronic and ongoing disease, treatment programs and insurance companies continue to provide and reinforce an acute episodic treatment model. Can you imagine a doctor prescribing a diabetic a 28 day inpatient program where they attend group therapy and take psychotropic medications? Yet this is precisely the treatment model prescribed to addicts every day.
Next let’s consider the fact that addiction has been classified by virtually every recognized medical, psychological and psychiatric organization as a chronic DISEASE. Furthermore, when you see someone experiencing heroin or alcohol withdrawal, there is no denying that the resulting symptoms are physical in nature. These people aren’t making this stuff up in their mind and acting it out for our amusement – they’re straight up sick. But why are they sick? What kind of problems are occurring in their body to 1) make them so severely ill when they stop using drugs and 2) make them continue feeling unwell, anxious or depressed for months and even years of sobriety?
One thing we need to remember is, the absence of heroin or alcohol in our bodies DOES NOT make us sick. Similarly, the absence of Prosac or Paxil does not make us depressed. If our bodies do not require alcohol, heroin or psychotropic medications to feel well, then its not just the absence of the drug that makes us sick. Now let’s consider that drugs and alcohol are toxins. The definition of the word toxin is widely debated and varies according to the scientific discipline that serves as context for the discussion. For our purposes, a toxin is a substance that can be ingested but does not sustain life, provide energy or promote growth to the human body. Toxins must be processed out of the body by the liver and kidneys if a person is to avoid being poisoned by the perpetrating substance. Again it appears rational to assume that drugs and alcohol are toxic to the human body and require additional effort on the part of the liver, kidneys and gastrointestinal tract in order to prevent the body from becoming dead.
However, when a person ingests large amounts of drugs and alcohol (toxins) over a period of years, is the damage to the body simply limited to the liver and kidneys? Anyone who has spent time with a lifelong addict or alcoholic is likely to respond in the negative to this question. We know that the GI tract is charged with eliminating toxins from the body. After years of consistent substance abuse, the GI tract and liver will begin to perform poorly at this task. The liver also begins to malfunction as its processes fall out of balance. Phase one of the liver (which converts alcohol into the flammable neurotoxin called acetaldehyde) begins to speed up in an effort to get the toxins out of the body faster. But phase II (which converts acetaldehyde into acetic acid to be dispelled in the urine) keeps its pace. The result is a build-up of highly toxic and dangerous drug byproducts and metabolites in the system. The constant ingestion of chemicals and the increasing toxic build up causes the body to stop absorption in the intestines in an effort to reduce the intake of toxins. Unfortunately this also halts the absorption of nutrients, causing substance abusers to grow more and more malnourished over time. These nutrients serve as the raw materials for every chemical synthesis and reaction in the human body. Severe deficiencies in vitamins, minerals and amino acids cause the body to slow or even stop production of necessary enzymes, neurotransmitters and other essential body chemicals. This is in great part what causes addicts to experience severe symptoms throughout withdrawal and even months after substance abuse has stopped.
Since chronic substance abuse results not only in GI damage and dysfunction, but a more ubiquitous problem of severe malnutrition, every system in the body can be compromised and even damaged by addiction. When our bodies are starving, we crave nutrients. Our brains have learned that high fat, high sugar foods relieve our nutrient cravings faster than lean proteins and nutrient vegetables, even if they don’t solve the underlying problem. While a quick bag of chips and bottle of soda certainly hits the spot when you are on the run and missing a meal, we all can agree that it’s not a Doritos and Coke deficiency that these foods have resolved. Addicts also experience the mental trickery that goes on when we quench a legitimate nutrient craving with illegitimate food sources. In the case of an addict however, the illusion of nutrients is achieved through drugs, not junk food. Through extended periods of substance abuse, addicts have conditioned their brains to believe that their cravings are a desire for drugs, not nutrients. But as I stated earlier, the human body doesn’t crave heroin or Oreos, it craves nutrients and our brain translates the craving by placing it in a familiar context of immediate gratification – like junk food or drugs.
Perhaps you think that because you are not addicted to heroin, alcohol or cocaine, this information is irrelevant to you. Advances in modern chemistry have proven otherwise. In the past twenty years, the amount of toxins in our environment, our food and our bodies has increased substantially. From preservatives to chemical sweeteners, from air pollution to prescription drugs, our bodies are becoming more overloaded with toxic garbage. Studies continue to link pesticides with hormone problems and breast cancer in women and increases in prostate cancer and decreased sperm count in men. It becomes increasingly more difficult to ignore this problem when virtually all types of cancer have seen a dramatic increase in occurrence over the past twenty years. Furthermore autism, autoimmune disorders, asthma, allergies and digestive complications all continue to increase as citizens of industrialized nations move further from home grown, home cooked foods toward mass produced prepackaged meals and fast food. The malnutrition syndrome that has plagued addicts for years is now seeping into the general population as more Americans are eating more chemicals and less food.
If you still aren’t convinced, then examine your television where the proof is really in the pudding – or in this case the yogurt. Have you noticed the number of yogurt and supplement companies touting the benefits of Probiotics for good GI health? Isn’t anyone curious why corporate America is finding it financially viable to sell products that help improve gut function? Most likely it’s because some marketing research statistician in a small cubicle found that more of us are suffering from GI issues. I have yet to hear a sound argument to explain this phenomenon other that our anti-food loaded diets and chemical infested environments. But there is more to these health issues than mere yogurt can repair.
Finally, keep in mind that despite the severe segmentation of our healthcare industry, your head IS attached to your body. Mental health and physical health are very closely related. If your body is toxic and therefore not absorbing essential nutrients, it also does not have the raw materials to make neurotransmitters. These are the chemicals in the brain that keep you feeling well. They are synthesized from amino acids by adding different vitamins. Studies have shown that 85% of depressed patients are vitamin B deficient. B vitamins are absolutely necessary for your body to synthesize serotonin and therefore not feel depressed. Considering that serotonin is the primary neurotransmitter involved in depression treatment (Prosac is known as a Selective Serotonin Reuptake Inhibitor) and B vitamins are required to synthesize serotonin, shouldn’t doctors be giving nutrient infusions of B vitamins before putting someone on a medication? But nutritional analysis costs money and insurance companies have yet to deem adequate nutrient supply as a worthy goal in the disease care process. At this point my local mechanic seems smarter that our healthcare system. If I gave him a car with no gas and complained it wouldn’t start, I bet he’d fill it up before he ripped the engine apart. Too bad Exxon doesn’t make vitamin B.
Erin McClelland has over 12 years of experience in the addiction field and has worked as a counselor, program director, researcher, process improvement specialist and entrepreneur. She started her career researching alcohol and smoking addiction at the University of Pittsburgh and substance abuse wrap around services at St. Francis Medical Center. Her clinical career includes addressing addiction in methadone maintenance programs, outpatient drug-free programs and specialized services such as women, family and prevention program development. In 2002, Mrs. McClelland began a private practice in which she developed a community based prevention program designed to reach parents and educators through school and community seminars and home sessions. She also began developing a more holistic treatment approach that included diet and exercise evaluation. As a certified personal trainer and certified lifestyle and weight management consultant, she believes diet and exercise are paramount to attaining a true, maintainable recovery. In 2003, she was hired as the Practice Improvement Collaborative Manager at the Institute of Research Education and Training in Addiction (IRETA). In her time at IRETA, she was trained by the Pittsburgh Regional Healthcare Initiative (PRHI) to implement the Toyota Production System in healthcare settings in order to reduce waste and errors and improve performance. This training consisted of the case method training approach of Harvard Business School (HBS) and TPS case studies created by HBS professor Steven Spear, who wrote the first article interpreting the TPS for implementation in the US. In 2006, she conceived and developed Arche Wellness, the first licensed orthomolecular addiction treatment program in Pennsylvania. Together with Dr. Ralph A. Miranda, they have created an intense biochemical recovery approach that begins with the body’s fuel system, the gastrointestinal tract. By starting repair in the GI tract, they are able to quickly and efficiently help their patient’s overcome the severe physical damage caused by years of addiction. The GI concentration in the Arche Wellness model is now one of the most advanced and intensive addiction treatment processes in the world. Her experience and unique education in process improvement strategies have helped to make Arche Wellness a state-of-the art learning organization dedicated to achieving perfect patient care.