Mental health issues and mood disorders are common in addiction, with a few examples being such things as anxiety, depression, irritability, worry, mental lethargy, and obsessive thoughts. Mood disorders differ from normal emotional responses if they linger for a time longer than normal, for no apparent reason.
The Brain and Addiction/Substance Abuse
Substance abuse is often the sanctuary of mood issues and poor mental health. Issues that often lead one to ‘self-medicate’ to overcome or alleviate imbalanced brain chemistry.
“If we demand behavioral change from our patients without allowing them to bring their brain chemistry into more positive balance, we simply set them up for failure.” Terry Neher, DDS, CCDC III[17]
What are neurotransmitters?
Neurotransmitters are responsible for dictating moods and emotions. The brain, in concert with brain-like areas of the heart and gut, transmit feelings through neurotransmitters. These neurotransmitters are responsible for various functions in the body, regulating everything from digestion, hormone release, movement, cognition and mood. The nervous system controls everything in the body, primarily though neurotransmitters. These chemicals can become imbalanced and cause neurodegenerative diseases (i.e. Parkinson’s and schizophrenia), and symptoms such as depression, anxiety, irritability, worry and obsessive thoughts (to name a few).
When one neurotransmitter becomes abnormal it usually results in other neurotransmitters getting disrupted. Vitamins, minerals, amino acid supplementation, and fatty acid supplementation often help those with substance abuse issues as they are often depleted of these nutrients (see diet for recovery in section V). Amino acids are one of the most crucial nutrients, if not the most crucial, for early and sustainable recovery. One of the reasons behind the importance of amino acid supplementation in recovery is that the SAD diet does not often include adequate protein intake, and studies show that alcoholics often show evidence of protein calorie malnutrition.[18],[19]
Specific Neurotransmitters and The Role of Amino Acids
Serotonin, the catecholamines, GABA, and endorphins are the main mood neurotransmitters as well as performing other functions in the body. Through the course of the day these neurotransmitters work together to balance emotions and emotional responses. Mood suffers, and addiction can ensue and persist, when the brain is deficient in any of these. Genetics, hormone imbalances, chemical addiction, stress and diet are responsible for deficiencies. In one study, long-term exposure to alcohol leads to an imbalance in different excitatory (i.e.- catecholamines) and inhibitory amino acids (i.e.- GABA).[20]
Amino acids, which are smaller by-products broken down when we consume protein, are the building blocks of protein and neurotransmitters. Healthy neurotransmitters and mood are often dictated by adequate protein consumption (typically need a minimum of ½ gram of protein for each pound of body weight) along with healthy digestion and utilization of amino acids. Note that it is important that one assess their digestive capability as simply consuming adequate protein may not be enough if it is not utilized in the body.[21] There are twenty-two different amino acids that can be found in high protein foods such as beef, chicken, fish, and eggs. These amino acids all have unique functions in the body, based on their structure, but only a few aid in the production of neurotransmitters and subsequent mental health. A number of these amino acids can be taken as supplements, to aid with all four neurotransmitters that cause mood imbalances and subsequent cravings for drugs and alcohol. (For vegans, consuming a combination of such things as rice and beans can provide the needed amino acids.)
“If there’s a drug that can alter the brain’s biochemistry, there’s usually a combination of nutrients that can achieve the same thing without side-effects,” – Pfeiffer’s Law from the work of Dr. Carl C. Pfeiffer, MD, PhD.[22]
Brief overview of the four neurotransmitters and corresponding amino acid:
Serotonin: has a calming and ‘feel good’ effect, and is considered the brain’s natural antidepressant. This is manufactured from the amino acid L-tryptophan and its precursor, 5-HTP. Ninety percent of the serotonin in the body is made and used in the intestines where it is involved in digestive activities such as peristalsis and hunger signaling. Alcoholics have severely depleted levels of tryptophan, which may explain both the depression and the sleep disturbances common in alcohol dependence, since brain serotonin levels depend on circulating tryptophan levels. Alcohol impairs tryptophan transport into the brain and increases the enzyme that breaks down tryptophan.
Catecholamines (pronounced ‘cat a coal a meens’): energizing and excitatory neurotransmitters that influence concentration, pleasure, drive and thought clarity. Dopamine, norepinephrine, and epinephrine are all catecholamines. Norepinephrine and epinephrine are both released during sympathetic nervous system stimulation or the ‘fight or flight’ response. Dopamine is used throughout the body, regulating mood and cognition as well as muscle movement. These are all manufactured by the amino acid l-tyrosine, therefore, low levels of tyrosine can have an impact on these. Tyrosine is also responsible for producing thyroid hormone, which can also heavily influence mood and energy. (for thyroid hormones T3 and T4, the ‘T’ stands for tyrosine). Note that all drugs indirectly or directly affect dopamine.
GABA (gamma amino butyric acid): this is one of the primary inhibitory (calming/anti-stress) neurotransmitters, essentially helping to filter out the background noise in the brain. This increases mental focus and a calm, relaxed outlook. In some circles, it is considered too large of a molecule to pass through the blood brain barrier. However, it is often helpful during the initial phase of addiction recovery because inflammation exists in the brain of the addict. This inflammation leads to a ‘leaky’ blood-brain-barrier (similar to leaky gut) which allows GABA to reach the brain. Low GABA is often caused by chronic stress, which can come in the form of both physical or emotional stress. Adrenal fatigue (addressed later), caused by chronic stress, often precedes low GABA levels. In a vicious circle, low GABA aggravates stress by making it difficult to calm down. GABA helps both sleep and relaxation, both of which are difficult when constantly feeling stressed. Amino acids for production of GABA are listed below.
Endorphins: these neurotransmitters control pain, both emotional and physical pain. Phenylalanine (‘fee nil al a neen’) is an amino acid. The life span of endorphins, which are pain relieving chemicals, are extended by D- phenylalanine. (L-phenylalanine is a form that stimulates the nervous system). Found in most health food stores, D-phenylalanine is a non-stimulant and powerful pain reliever. It is often found in the mixed form called DL-Phenylalanine. Low endorphins can be caused by many things, including stress, genetics, too much emotional or physical pain, gender and opiate drug use. Women tend to have less endorphins than men. Women’s endorphin levels typically peak around ovulation, but levels diminish in those with PMS, thus contributing to the weepiness associated with PMS.
Adapted and Abbreviated from the Encyclopedia of Natural Medicine[23]; Kathleen Demaisons, Potatoes Not Prozac[24]; Barbara Reed Stitt, Food and Behavior[25]
Treating Neurotransmitter Imbalances with Nutrient Therapy
Neurotransmitter imbalances, and subsequent therapy with amino acids/other nutrients/herbs, can be identified by unique symptoms per the following drug/alcohol connection:
Antidepressant Addiction- linked to serotonin and helpful nutrients below
Symptoms of Low Serotonin
- Tendency to be negative
- Worry and anxiety
- Obsessive tendencies
- Irritability, impatience, anger
- PMS or menstrual moodiness
- Insomnia
- Sweet cravings
- Depression
- Obsessive, repetitive, angry or useless thought that cannot be turned off
- Depression
- Self-Deprecation
- Panic
- Anxiety
- Cravings worse in afternoon/evening
- Sensitivity to heat
- Minimal Sense of humor
- Seasonal affective disorder
Substances That Relieve Symptoms
- Sweets
- Starches
- Fatty foods (chips, eggs, milk)
- Chocolate
- Alcohol
- Marijuana
- Tobacco/nicotine
- Ecstasy
- Other antidepressants not listed
- Use of prescribed SSRI drugs like Lexapro, Zoloft, Paxil, Prozac or SNRI drugs like Effexor or Cymbalta
Helpful Nutrients
- 5-HTP (100-200 mg 2-3X/day)
- Tryptophan (500-1000 mg 1-2X/day, some find one dose late afternoon helpful)
- Saint-John’s-wort
- Melatonin
- Brief process of serotonin production and important nutrients (zinc, B vitamins etc)
Stimulant Addiction- linked to catecholamines and helpful nutrients below
Symptoms of Low Catecholamines
- Feeling depressed- the flat, bored, apathetic kind
- Low physical or mental energy (fatigue)
- Difficulty concentrating or focusing
- Need a lot of sleep or slow to wake in the morning
- Tendency to put on weight easily
- Crave coffee, chocolate, and other forms of caffeine
- Lack of motivation
- Depressed
- Possible ADD diagnosis
Substances That Relieve Symptoms*
- Sugar
- Chocolate
- Caffeine
- Aspartame (Nutrasweet)
- Alcohol
- Cocaine
- Other Uppers
- Marijuana
- Tobacco
- Opiates (ie- heroin)
- Other stimulants not listed, ie- meth
- Participate in risky behavior such as gambling or unsafe sex to raise catecholamine levels and feel more alive
- Use of Prescribed Ritalin, Wellbutrin, or Adderall.* All of above stimulate the nervous system
Helpful Nutrients
- L-tyrosine
- L-phenylanine
- Omega-3 fats
- SAM-e
- Brief process of serotonin production and important nutrients:
NOTE: Don’t take L-tyrosine if you have had melanoma, Grave’s Disease, or phenylketonuria (PKU). Be cautious about taking L-tyrosine if you have migraines, Hashimoto’s Thyroiditis, high blood pressure, or manic depression (bipolar disorder)
Tranquilizer Addiction- linked to GABA and other helpful nutrients below
Symptoms of Low GABA
- Constantly feeling pressured, dead-lined, or overworked
- Body feels stiff, uptight, and tense
- Difficulty relaxing or loosening up
- Easily upset, frustrated, or snappy under stress
- Feel weak or shaky
- Sensitive to bright light, noise, or chemical fumes
- Turn to drugs or alcohol to calm down
- Anxiety
- Tension (emotional and physical)
- Feeling overwhelmed by stress
Substances That Relieve Symptoms
- Sweets
- Starches
- Alcohol
- Tobacco/Nicotine
- Marijuana
- Valium and other tranquilizers
- Painkillers
- Other items not listed used to relax
- Use of prescribed tranquilizers like Valium, Neurontin, Xanax, and Ativan.
Helpful Nutrients
- GABA
- Taurine
- Glycine
- Glutamine
- Chromium
- Adrenal Support (discussed more)
Painkiller Addiction- linked to endorphins and helpful nutrients below
Symptoms of Low Endorphins
- Extreme Sensitivity
- Easily upset and cry easily (TV and commercials)
- Tend to avoid dealing with painful issues
- Difficulty getting over losses or grieving
- Cravings for pleasure, comfort, reward and enjoyment
- Chronic pain
- Emotionally fragile
- Particularly sensitive to pain
Substances That Numb Feelings
- Sweets
- Starches
- Chocolate
- Alcohol or Tobacco
- Heroin
- Marijuana
- Other substances not listed
- Use of prescribed pain relievers like Vicodin or Oxycotin.
Helpful Nutrients
- DL-phenylalanine
- D-phenylalanine
- B vitamins
- Vitamin C
- Magnesium
- 5-HTP
Note that exercise boosts endorphins which accounts for the ‘runner’s high’ and positive emotional lift after physical activity. Continuous exercise contributes to the brain’s release of endorphins, which reduce the intensity of pain sensed by the brain.
“unless the biochemical imbalances which are the true causes of substance problems are corrected, the benefits of psychological counseling will be marginal for most people.”- Dr. Charles Gant
“Although we all eat, few really think about what we are eating and what it can do to our bodies. We rely on very incomplete, simplistic, and often incorrect bits of nutritional ‘knowledge’ in making our food choices, and we expect our bodies to cope with whatever we give them. In recovery, this kind of behavior simply doesn’t cut it.” – Dr. Beasley
“If there’s a drug that can alter the brain’s biochemistry, there’s usually a combination of nutrients that can achieve the same thing without side-effects,” – Pfeiffer’s Law from the work of Dr. Carl C. Pfeiffer, MD, PhD
Above was adapted and abbreviated from Pam Killeen, Addiction the Hidden Epidemic[26]; Kathleen Demaisons, Potatoes Not Prozac[27]; Julia Ross, The Mood Cure[28]; Jack Challem, The Food-Mood Solution[29]; and the study from Phillipe De Witt, Addiction Behavior, Imbalance Between Neuroexcitatory and Neuroinhibitory[30] (Note that another useful tool, when looking at neurotransmitter deficiency issues, is the Neurotransmitter Assessment Form (NTAF)- this form can be found on the internet. It is important to review the NTAF document with a practitioner at THHW, or one who is familiar with the NTAF subsections.)
Rather than one becoming addicted to prescription medications, simply trading drugs/alcohol for prescriptions, the emphasis throughout this article is to look for specific nutrients needed to overcome imbalanced brain chemistry and assist with on-going recovery or active substance abuse.
Food largely impacts neurotransmitter synthesis and brain activity, both of which influence mood. Allergies, blood sugar dysregulation, protein and overall nutrient deficiencies, and high sugar diets all wreak havoc on mood (addressed next in this article). While genetics can impact mental health, mood disorders and addiction, anywhere from 5-25% is hereditary which means that 75-95% of our genetic expression is largely due to environmental factors, bringing diet and lifestyle back to the forefront.[31],[32]
Food culture tends to run in families (i.e. family members tend to eat the same kinds of food). If this consists of processed convenience food, the entire family could suffer from similar or different types of mood disorders. Nutrition alone often is not enough. Amino acid supplementation can be a key to recovery, or at least during the early phase when digestive health and protein intake may be inadequate. It often is a multi-dimensional approach to recovery, looking at blood sugar, thyroid, adrenals, nutritional deficiencies and so on, but many in the field of recovery admit that amino acid therapy is truly the secret to their success and biochemical restoration for addiction and mood disorders.
Depression and anxiety, which often accompanies addiction and substance abuse, is not a Prozac or Lexapro deficiency. To produce levels of neurotransmitters needed for recovery, we need adequate levels of amino acids along with some of the other nutrients listed above. Addiction and mental disorders are a sign that we are not producing adequate levels of neurotransmitters. Again, it bears repeating Dr. Pfeiffer’s law mentioned above, “if there’s a drug that can alter the brain’s biochemistry, there’s usually a combination of nutrients that can achieve the same thing without side-effects.” Pharmacological agents produce adverse side effects, including addiction, and it is by getting adequate amounts of protein and using amino acid supplementation (at least in early recovery) that we can create an environment in which the body can Thrive, rather than just survive, and keep relapse and substance abuse on the sideline.
Citations
[18] Jack Challem, The Food-Mood Solution, 39-56
[19] Hugh Calvey, Michael Davis and Roger Williams, Journal of Hepatology, 1985; 1:141-151 141
Elsevier, Controlled Trial of Nutritional Supplementation, With and Without Branched Chain Amino Acid
Enrichment, in Treatment of Acute Alcoholic (Liver Unit, King’s College Hospital and Medical School, Denmark Hill, London SE5 9RS (U.K.)
[20] Philippe De Witte, Imbalance between neuroexcitatory and neuroinhibitory amino acids causes craving for ethanol, Addictive Behaviors 29 (2004) 1325 – 13392004
[21] Elizabeth Lipski, Ph.D, CCN, CHN, Digestive Wellness, fourth edition, 2012, 105-123
[22] http://orthomolecular.org/hof/2004/cpfeiffer.html
[23] Michael T. Murray, ND, Joseph Pizzorno, The Encyclopedia of Natural Medicine, 2012, 478-502, 265-275
[24] Kathleen Demaisons, Ph.D., Potatoes Not Prozac, 2008,63-88
[25] Barbara Reed Stitt, Food and Behavior- A Natural Connection, 2004, 50-53
[26] Pam Killeen, Addiction- The Hidden Epidemic, 2010, 151-170
[27] Kathleen Demaisons, Potatoes Not Prozac, 2008,63-88
[28] Julia Ross, M.A.; The Mood Cure; 2002, 257-281
[29] Jack Challem, The Food-Mood Solution, 75-80
[30] Philippe De Witte, Imbalance between neuroexcitatory and neuroinhibitory amino acids causes craving for ethanol, Addictive Behaviors 29 (2004) 1325 – 13392004
[31] Amy Myers, The Autoimmune Solution, 2015, 34
[32] Bruce H. Lipton, Ph.D, Biology of Belief, 2008, 42