The utility of hormonal replacement therapy
and other proactive longevity medicine practiced by A4M physicians not only
improves the quality of life in patients, it also prevents unnecessary
depression, anxiety and insomnia disorders all of which cause subsequent
addiction.
Normalizing brain chemistry with medication,
bio-identical hormone replacement and nutraceutical supplementation balances
brain activity and eliminates craving and self medication with alcohol and
drugs. Patients utilize drugs and alcohol either to stimulate under-active
brain regions or relax over-active brain systems. The aberrant electrical
activity in the addicted patient’s brain is typically caused by inherited or
acquired biochemical and hormonal deficiencies.
Accurate diagnosis based on neurotransmitter,
hormonal and neuro-imaging studies allows effective treatment of underlying
biochemical and electrical imbalances.
Effective treatment of anxiety, attention deficit disorders, depression,
insomnia, fatigue and other addiction causes frequently eliminates alcohol and
drug addictions.
Although hormonal and neurotransmitter balancing frequently
eliminates or decreases alcohol and drug addiction, some patients suffering
autoimmune disease due to genetic, microbial or environmental toxins may
require additional testing and treatment.
Mycoplasma, Lymes, Babesia, Bartonella, Erlichia, heavy metal toxicity,
mold neurotoxicity and viruses, including HSV, EBV, HH6, and CMV can also cause
pain, fatigue, impaired concentration and other symptoms requiring additional
testing and treatment.
Correcting Hormonal Deficiency Can Eliminate
Addictions
The average age of menopause in American women
is 51 years; however, female progesterone levels begin to decline approximately
eight years prior to estrogen. Northrup, C. (2006) When progesterone production
declines in middle age females, they begin to experience new found anxiety and
insomnia. Retrospective studies at Florida Detox and Wellness Institute have
demonstrated that the “progesterone drop out” phenomenon is a common etiology
of alcohol and drug abuse, with causation in over forty percent of our addicted
middle age females.
The biochemical explanation is that
allopregnanolone, a metabolite of progesterone, enhances GABA-A receptivity. Torres and Ortega (2003)
When females experience a loss in
GABA-receptivity, via diminished progesterone levels, they can develop excess
electrical activity in both the central and peripheral nervous system. Their
newfound anxiety and insomnia disorders precipitate subsequent addiction
issues.
These progesterone deficient females will
begin to utilize alcohol for it’s GABA-A receptor activation. The woman
who historically drank only a glass of wine with dinner will insidiously
progress over a few years to two bottles of wine per night as the wine has now
become “medication.”
She may be courageous enough to visit a
physician, however, if the physician has limited knowledge regarding hormonal
replacement therapy, he/she will not appreciate the gravity of the patient’s
situation. The doctor will practice “symptom medicine” and readily prescribe
her addicting medication such as Xanax or Klonopin instead of investigating
hormonal imbalance.
Another common scenario observed at Florida Detox is that the
progesterone deficient female will begin to abuse Vicodin or Oxycontin because
the calcium channel blockade effect of the opiate will down regulate the
increased “brain voltage” derived from the lost GABA-A receptivity.
Unfortunately, when she chooses this option, she will eventually develop Mu
receptor tolerance, begin increasing her 24 hour opiate dose and subsequently
develop hypothalamic-pituitary-ovarian axis suppression further exacerbating
her original hormonal deficiency. Santen, F. et al. (1975)
Clinical investigations, in 2009, at Florida Detox revealed that 100 percent,
thirty of thirty females, ages 21-29, years old, who were prescribed 80 mg
methadone per 24 day, were amenstrual, suffering “flat line” ovarian output.
Testosterone, Progesterone and Estradiol were pathetically at menopausal
levels.
Measurement of LH and FSH in these females
revealed suppression to pre-puberty levels demonstrating the severity of
methadone induced hypothalamic-pituitary dysfunction. This pituitary
suppression derived from chronic consumption of opiate pain medication frequently
causes coincident hypothyroidism in both females and males, with greater
prevalence in females.
Fortunately, when progesterone levels are
restored using bio-identical progesterone, the anxiety and insomnia disorders
subside as does “craving” for GABA-ergic drugs like alcohol and Xanax; nor do
these progesterone treated females need the calcium channel blockade effect of
Vicodin/Oxycontin to “turn down the “excess brain voltage.”
It is paramount for pediatricians to become
more astute regarding the principles of A4M medicine as much addiction can be
prevented in adolescent females.
Susan is a 21 year old female who presented to
Florida Detox in May, 2006. When admitted to our detox unit, she was
consuming two liters of vodka per day, 1,000 mg of Oxycontin per day and 20 mg
of Xanax per day.
She and her mother, Mary, had chosen Florida
Detox because our website discussed what appeared to be a more scientific
approach to addiction treatment. Susan had already completed and failed eight
28 day “talk therapy” programs from Arizona to New York , each costing over
thirty thousand dollars. The only diagnosis Susan had received from all of the
previous treatment centers was drug addict, alcoholic and personality disorder while
undergoing severe withdrawal symptoms.
Susan began drinking at age12 initially
raiding her parents liquor cabinet. By age 14, she was admitted to her first 28
day “treatment program.” In high school Susan was introduced to Xanax and
“Oxy’s”, both of which “calmed” her anxious brain without the unfavorable
gastrointestinal symptoms she experienced with alcohol.
Upon reviewing Susan’s history, I discovered a
pertinent chronological correlation. Susan had begun her menses at age 12, the
same age at which she allegedly began to drink alcohol “to calm her nerves.”
Her menses were always much heavier than her
friends and usually lasted seven days. Susan bled so severely that she was
anemic throughout high school and periodically required intravenous infusions
of iron. Her menses were also extremely painful, unlike her best friends. She
had seen several different gynecologists and pediatricians none of whom
discussed or measured hormones.
Susan’s symptoms were classic for unequal
ovarian output from the very onset of her menses, with progesterone levels
inadequate to modulate estrogen excess. Anxiety disorders in America have equal
prevalence in males and females up to age 13 after which females experience two
to three fold the incidence of anxiety verses their male counterparts. Vesga-López, et. al. (2008) The causation
of the gender discrepancy cannot be
solely attributed to adolescent peaked interest and interaction with the male
gender – My wife might challenge this statement.
The balancing GABA-ergic effect of
progesterone is more critical when estrogen function is activated than when
both estrogen and progesterone are at pre-puberty levels.
When Susan’s progesterone deficiency was
appropriately treated along with the multiple hormonal and nutritional
deficiencies caused by nine years of alcohol and drug abuse, her craving for
both drugs and alcohol stopped. Susan has been drug and alcohol free for almost
three years.
Susan and her family suffered years of
unnecessary psychological and financial trauma because her gynecologists,
psychiatrists and addictionologists were not trained in A4M medicine. As more
pediatricians, gynecologists and family physicians enroll in A4M, the future
Susans will not be robbed of their youth.
Estradiol Deficiency
Another hormonal deficiency that frequently serves as the
etiology of alcoholism and drug addiction in females is estradiol deficiency.
Estradiol enhances serotonin receptivity in the female brain. Kugaya, A. et. al.
(2003), Fink, G. et. al. (1996)
While the literature states that “normal” estradiol levels
fluctuate during the menstrual cycle between15 pg/dl and 315 pg/dl, estradiol
levels below 60 pg/dl cause compromised serotonin receptivity. Furthermore,
estradiol has monoamine oxidase inhibitor activity and therefore increases both
serotonin and dopamine levels in the brain. Klaiber, E., et. al. (1996)
These biochemical findings facilitate
understanding of the common symptomatology associated with premenstrual
syndrome, post partum depression, and the midlife onset of psychological issues
such as depression, anxiety and insomnia in females. It becomes then obvious
that untreated estradiol deficiency plays a pivotal role in causation of new
onset addiction issues in middle age females.
The increased anxiety associated with
suboptimal serotonin activity has so eloquently been elucidated by my esteemed
colleague and good friend, Daniel Amen, M.D., the founder and medical director
of the Amen Clinics.
Through SPECT brain imaging, Dr. Amen has
demonstrated that patients with suboptimal serotonin activity, whether
inherited or acquired suffer from excess activity in two different regions of
the brain, the limbic system or “emotional center” and the anterior cingulate
gyrus, normally considered the brain’s gear shifter.
Furthermore, normal serotonin activity
inhibits the release of the excitatory neurotransmitter, norepinephrine, from
the locus coeruleus. When serotonin receptivity is compromised by estradiol
deficiency, female patients can develop excessive sympathetic tone in both the
central and peripheral nervous systems which further exacerbates anxiety and
insomnia disorders. As with the anxiety and insomnia produced by progesterone
deficiency, females with estradiol deficiency often medicate their overactive
brain regions with alcohol, benzodiazepines or opiate pain medication.
Linda is a 45 year old school teacher from
Atlanta who presented to Florida Detox and Wellness Institute in July of 2007
with a history of new onset alcoholism, approximately three years, claiming she
developed anxiety for the first time in her life at age forty two.
Neurotransmitter assessment excluded
biochemical causes of anxiety such as serotonin deficiency, norepinephrine
excess, dopamine excess, glutamate excess or GABA deficiency, Her histamine
levels were excessive which is common in alcoholic patients secondary to
alcohol induced systemic Candidiasis and leaky gut syndrome.
This monoamine, histamine, like dopamine, can
when in excess, produce increased “electrical voltage” in the brain causing
subsequent anxiety. But, was it the original cause of Linda’s self-medication
with alcohol or did it develop because of the alcoholism?
Amen brain questionnaires were negative for
the typical anxiety profile seen with low serotonin activity, but, positive for
a more typical profile of “generalized anxiety” often seen in patients with
excess histamine or progesterone deficiency. Hormonal evaluation revealed
adequate estradiol and testosterone levels; however, progesterone levels were
post menopausal.
Following medical detoxification, Linda’s
progesterone levels were restored, her GI tract was detoxified of yeast, her
leaky gut was treated with an herbal glutamine mixture and histamine reduction
was accomplished via SAMe, high dose vitamin C and Vitamin B6, pyridoxine.
Following this treatment regimen, Linda reported that her anxiety had abated
and she had no more alcohol craving.
Linda remained alcohol free for one year when
she suddenly began experiencing a combination of depression and anxiety which
precipitated a short relapse to alcohol. Fortunately, Linda returned to Florida
after just two weeks of drinking and did not require an inpatient medical
detoxification.
Linda’s new evaluation revealed normal
neurotransmitters levels including serotonin, however, she now had developed
menopausal estradiol levels and her Amen brain questionnaires revealed a
classic low serotonin anxiety and depression profile, one that the Amen Clinic
defines as laden with excessive worry and continuous rumination over negative
things.
Even though Linda had maintained normal
serotonin production, she had now lost serotonin receptivity with her estradiol
drop out and she began to suffer a different type of anxiety from that she had
previously experienced when her progesterone production had ceased.
Linda responded well to bio-identical
estradiol enhancement and 5-hydroxy tryptophan, a serotonin precursor. We have
now referred her to an anti-aging doctor in the Atlanta area.
Severe depression can be precipitated by the
diminished MAO inhibitor effect and subsequent reduction of brain dopamine
levels that accompanies estradiol “drop out.” Reduced brain dopamine can have a
negative effect on cognition, but often of more importance, can decrease activation
of our nucleus accumbens or “pleasure/hunger center” which is dopamine driven.
Specifically, it’s the activation of the D2
dopamine receptor in the nucleus accumbens that gives us pleasure, satiety and
motivation. In an interview printed in the Charlottesville Daily Progress,
May 31, 2006, Dr.
Bankole Johnson, Chairman of Psychiatric Medicine, at University of Virginia,
stated “Dopamine is responsible for a lot of pleasurable
experiences.” Eating triples dopamine levels. “Sex is 10 times the
normal surge and cocaine is 100 times the normal surge. If you told someone to
give up sex, it would be very hard, so you can imagine how hard it is to ask
someone to give up cocaine.” Chiara and Imperato (1988) observed dramatically
increased dopamine release following administration of amphetamine, cocaine, nicotine,
alcohol, morphine and methadone.
Clinical studies at Florida Detox validate
that the diminished dopamine activity that accompanies midlife estrogen drop
out, frequently precipitates self medication with any drug that temporarily
releases dopamine from the vesicles [brain cell storage units] to the brain
neuron synapse, the area between two brain cells.
Drugs of choice are food, nicotine, alcohol,
opioid pain pills and marijuana. Other drugs that block synaptic re-uptake of
dopamine such as methamphetamine and cocaine are less commonly utilized in this
particular female population.
In summary, this article is written with the
intent to further validate the importance of expanding the reach of A4M
education to all physicians by elucidating yet another dimension of human
suffering, drug and alcohol addiction that can be prevented with the
implementation of quality anti-aging and longevity medicine.
Marvin (Rick)
Sponaugle, MD
Board Certified in
Addiction Medicine and Anesthesiology
Founder and Medical
Director, Florida Detox and Wellness Institute
Florida Detox and Wellness Institute in Tarpon
Springs , Florida has successfully
treated over 5000 addicted patients since our inception in 1998. While most
“treatment” centers continue to ignore the scientific and biochemical basis for
addiction, we have successfully proven that over ninety percent of addicted
patients self-medicate with drugs and alcohol in their attempt to balance
their brain chemistry and “feel more normal”.
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