Healthy notes

Addictions and natural ways to beat them

Addiction: a matter of willpower?

10-15% of the adult population is estimated to suffer from an addiction. It crosses all socio-economic boundaries.

In the old days, people thought of addictions as a lack of willpower. Therefore, the addicted person could be blamed for his behavior. In other words, addicted people were treated like criminals. Luckily, we know better now. 


As more research was done, it became clear that addictions can be considered a neuropsychiatric disorder. Hence, a person can no longer be blamed for his addiction like someone who got cancer for instance.


Most of the time, someone starts using drugs out of his own free will. Curiosity plays a role and in the beginning, it feels good. Shortly after the ‘high’, many other positive effects follow.


But it doesn’t always start recreational. Opioid painkillers are often prescribed after surgery, in chronic pain conditions or cancer. Benzodiazepines are all too much prescribed for anxiety and sleeping disorders. Other people will try to handle their problems by drinking or using cannabis. Furthermore, it doesn’t stop with substances. Gaming and even shopping are used to feel better and escape the torment of daily life. Addiction is a flight reaction.


People believe that they can control their addiction, but soon it takes over their life and self-control is lost. This is one of the main features of addictions. Other characteristics are craving for the substance or behavior, continuing involvement despite negative consequences and tolerance.


Addiction is often accompanied by depression and anxiety. Both are a risk factor for addictions as well. It is not easy.

Let me break it down for you

What are we talking about anyway?

Addiction is a disorder that changes both the shape and function of the brain. They say that addiction hijacks the brain.

The brain registers all pleasures the same way, whether it comes from drugs, having a delicious meal or a great conversation. The neurotransmitter or chemical messenger dopamine and the reward system in the brain play a key role.

Normally, reward comes with time and effort. It is designed to produce pleasurable feelings in response to stimuli that promote our survival like food, sex, social interactions… Those feelings make us look for more of those stimuli.

However, addictive substances and behaviors create a shortcut. They stimulate and overload the reward system, fast and furious. Over time, stimuli that promote our survival bring no more joy.

Are you at risk for addiction?

One person is more susceptible to addictions than others. This higher sensitivity is the result of a combination of factors that are not all under our control. For 50 to 60 % genetic factors play a role. But biology doesn’t paint the whole picture, 40 to 50 % of the risk is due to:
  • traumatic experiences and chronic stress - especially in childhood - dysregulate the HPA or stress axis often permanently, with the result that these people live with a constantly hunted feeling and seek relief in various ways
  • environment
  • education
  • psychological vulnerability
  • age
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In this figure, you can see that the PFC keeps the amygdala under control. In conditions where the PFC is not functioning optimal – in adolescence or under chronic stress for instance – the amygdala is no longer suppressed.
Teenagers are very vulnerable to addiction because their brain is still developing. At the age of 6, the brain has developed for about 90 – 95 % of the adult brain. But it can’t function as an adult brain yet. First, a lot of remodeling must be done which occurs in adolescence and continues until mid-twenties. Unused connections are cut away while other connections are formed or strengthened. This pruning process starts at the back of the brain and ends at the prefrontal cortex (PFC), which is responsible for impulse control and good judgment. Because teens rely more on the amygdala to make decisions, adolescents are inclined to display risky behavior. For example, they have seen that the amygdala plays a role in binge drinking.

“The teenage brain is built to seek out new experiences, risks and sensations – it’s all part of refining those brain connections.”

On top of that, there is a storm of hormones raging through a teenager’s body.
Because they need to take risks to grow and develop, it is best to choose healthy risks. Sports and travel, instead of smoking and reckless driving for instance.
Teenagers are also very susceptible to peer influence.

A developing brain is more vulnerable to stress factors such as the divorce of parents, starting in a new school, the death of a loved one, alcohol and other drugs…

As an adult, prolonged stress, depression and anxiety can leave you prone to addictions. As seen above the PFC regulates and controls our emotional responses and blocks inappropriate actions. But under stress conditions, the amygdala takes over control and we lose prefrontal cognitive abilities. Chronic stress also damages the hippocampus, as we will see below.
What does stress have to do with it?

Normally, the prefrontal cortex (PFC) and the stress system (were hippocampus, amygdala, hypothalamus take part) work closely together: when our subconscious detects a threat, the fast stress system takes over and when the danger has passed, the PFC regains control. The PFC calms down the amygdala. The amygdala, on the other hand, activates the stress axis.

In the figure, we see what happens when danger is detected, the stress system is activated which consists of 2 responses:

Short-term stress response 
> acts fast (in a second) but short (a few minutes):

  • the brain receives a stress signal
  • the hypothalamus sends a message via the spinal cord to the kidney glands
  • the adrenal medulla or kidney cores release epinephrine or adrenalin (80%) and norepinephrine (20%)
  • those 2 neurotransmitters prepare our body for action: they rise the heartbeat and blood pressure, divert the blood to the brain, heart and muscles, liberate sugar from the liver to provide extra energy, open the lungs, increase metabolic rate, decrease digestion and urine production

Long-term stress response 
> if the threat isn’t gone after a few minutes, a second system keeps your body in survival mode:

  • the hypothalamus secretes the corticotrope releasing hormone (CRH)
  • CRH stimulates the pituitary gland to produce adeno corticotrope hormone (ACTH)
  • ACTH travels through the blood to reach the adrenal cortex
  • the adrenal cortex secretes cortisol into the bloodstream
  • cortisol liberates sugar from the liver to provide extra energy and suppresses the immune system
  • cortisol activates the hippocampus, that shuts down the stress system

When the stress is gone, the parasympathetic nervous system relaxes the body.
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Researchers have seen that it’s not the level of stress but the duration that causes problems. After a stress attack, recovery substances are released that bring the body back to a normal state. However, if you are continuously stressing - as often occurs in modern society - your body can’t recover. Even worse: chronic stress and fear can damage and structurally change prefrontal neurons and hippocampus. The amygdala gets hyperactive which keeps the stress reaction going.
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The Top 5 and more

The 5 most addictive substances in the world according to CNN Health in 2019:
  • heroin and other opioids: fentanyl, morphine, oxycodone, hydrocodone, …
  • alcohol
  • cocaine
  • benzodiazepines and barbiturates
  • nicotine

The 10 most common addictive substances worldwide according to the Addiction Center are tobacco, alcohol, marijuana, painkillers, cocaine, heroin, tranquilizers (like benzodiazepines), stimulants (like methylphenidate), inhalants ( like gasoline, aerosols, glue) and sleeping pills (like zolpidem).

The 5 most addictive behaviors, also called non-substance addictions, according to Business Insider in 2014:
  • gambling
  • compulsive eating
  • internet/ mobile phone and gaming
  • sex and watching porn
  • shopping and hoarding

Non-substance addictions are a new rising problem in modern society. They involve similar reward circuits in the brain as in substance abuse. A lot of research is still ongoing to get to the bottom of this.

It’s all in your head

The brain regions involved in addictions are:

  • the nucleus accumbens (NAC): central processor of the reward circuit
  • the ventral tegmental area (VTA): a major dopaminergic area in the brainstem, involved in cognitive and emotional processes; responds to neurotransmitter glutamate; releases dopamine to NAC and PFC
  • the substantia nigra (SN): the second major dopaminergic area, involved in movement, reward and motivation
  • the prefrontal cortex (PFC): our most evolved brain region, involved in executive function, focusing attention, planning, logical reasoning and our personality
  • the amygdala: emotional memories and the processing of strong emotions like fear and pleasure; our ‘alarm camera’: activates the fight or flight response; makes us react very fast without having the time to think logically
  • the hippocampus: mainly involved in learning and new-memory function; calms down the hypothalamus; reduced hippocampal volume is associated with severe stress and mood disorders

The neurotransmitter dopamine plays a key role in addiction, while serotonin (5-HT) and glutamate have regulatory roles in reward circuit activity.
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The blue lines represent the dopamine pathways with the following functions:
  • reward and motivation
  • pleasure and euphoria
  • compulsion
  • persistence
  • motor function

The pink lines represent the serotonin pathways with the following functions:
  • mood
  • memory processing
  • sleep
  • cognition
  • appetite
  • learning
  • attention
You can see that addictions touch many parts of our brain.

Intense activation of the reward system by addictive substances or behavior overwhelms the brain’s receptors.

Because our body is highly adaptive, repeated abuse will cause the brain cells to release less dopamine and reduce its receptors. The dopamine that is released has less effect on the brain’s reward system. This explains tolerance: you need more drugs to feel the same level of pleasure.

Repetitive abuse suppresses the reward system and activates the stress response. An addicted person is no longer capable to feel pleasure in normal circumstances and is left depressed and irritated. This is an incentive to continue the abuse.
The brain systems involved in reward are also related to memory. An addicted person remembers the desired effect and intensely longs for it. Hippocampus and amygdala also store information about environmental factors that are associated with the abuse. This creates a conditioned response called craving whenever the person encounters the same environmental factors. For example, a person who was addicted to alcohol in the past can relapse after seeing a bottle of wine.

“Once you know something, it cannot be forgotten.”

The brain of an addicted person is wired differently. Luckily, thanks to the brain’s plasticity, you can beat your addiction. But it requires a lot of work and professional assistance is advised. Unfortunately, you will have to be on your guard for the rest of your life. Triggers can make you relapse even after a long period.
Want to check if you’re addicted?

The answer is ‘yes’ if you recognize yourself in at least 3 of the following criteria:

  • you are unable to moderate or cease the use of the substance or the activity
  • you’re constantly working on the means to achieve a certain effect
  • you need more and more to obtain the same effect: tolerance
  • desire or craving creates a repeating pattern that is difficult or impossible to break
  • it has a negative effect on your daily functioning
  • you feel ashamed and you isolate yourself from family and friends
  • normal enjoyable daily things can’t give you pleasure anymore
  • you are irritated, anxious and depressed

Let’s take a closer look at some addictive substances.


Alcohol

Alcoholism is a problem that increases worldwide. It has a big impact on all levels of society. It increases suicide, crime, traffic deaths, disability and health burden.

In many countries, drinking alcohol daily is part of the culture. It is socially acceptable to drink alcohol at restaurants, when visiting a bar and even at home. People drink to socialize, celebrate, complement meals and relax. When people around us are drinking alcohol, we are inclined to join them. It acts as a social lubricant.

Alcohol is a sedative. It causes mild euphoria, reduces anxiety and improves sociability.
However, drinking is often used as stress-relief or to escape daily misery.

According to the Independent Scientific Committee on Drugs in the UK (The Lancet 2010), alcohol is number one in causing harm to others.

Despite its legal status, alcohol can cause more problems than other drugs.

Fermented drinks, like beer and wine, contain from 2% to 20% alcohol. Distilled drinks, however, like whiskey or vodka, contain from 40% to 60% alcohol.

Drinking regularly small amounts of alcohol has shown an increased breast cancer risk. 

Drinking large amounts of alcohol can lead to acute alcohol poisoning and even death. The ethanol in alcoholic drinks is transformed by the liver into acetaldehyde. This substance is more toxic than ethanol itself.
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Alcohol use disorder (AUD) or alcohol dependence causes craving, a loss of control and a negative emotional state when not drinking.

Binge drinking - more than 4 or 5 alcohol consumptions in 2 hours – can lead to AUD. 
Heavy drinking can lead to certain cancers (mouth, esophagus, pharynx, larynx, liver, and breast), liver diseases, damage to the brain and other organs. In 2017 they estimated that 1.4 percent of the global population have an AUD (ourworldindata.org).

Withdrawal symptoms include trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, and sweating. Severe cases experience fever, seizures, or hallucinations.
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Opioids

Opium, also called ‘God’s own medicine’, is the dried latex obtained by scoring the unripe seedpods of the poppy plant, Papaver somniferum. Opium contains morphine, codeine and other substances like thebaine. This last one is used to industrially produce codeine, hydrocodone, oxycodone, hydromorphone, naloxone, buprenorphine, … Fentanyl is a synthetic opioid and one of the most powerful painkillers. It is used to treat chronic pain in patients who no longer respond to morphine or oxycodone. 

In the late nineteenth century laudanum was the most important Western medicine. It was made of opium mixed with wine, saffron, cinnamon and cloves.

Opium sedates both physical and mental pain, which explains its popularity. Recreational use is forbidden in most countries since the early twentieth century. Today, it is only available on prescription. Not in the form of opium of course, but rather as its derivates. They are the most effective painkillers today and are - when used correctly – safe.

Let’s explain 2 terms first:
  • opiates are substances derived from opium-like morphine, codeine and semi-synthetic derivates heroin, hydromorphone and oxycodone
  • opioids are all the substances that bind on the opioid receptors in the brain: our very own painkiller and ‘happy hormone’ endorphin, methadone, fentanyl, tramadol but also loperamide (against diarrhea), dextromethorphan (against dry cough), …

All opiates are opioids. A person can become addicted to all those substances. I will focus on 2 of them.
Morphine

  • a constituent of opium
  • named after the Greek God of dreams, Morpheus
  • bind to endorphin receptors in the brain where it causes euphoria and a dream-like state
  • blocks the transmission of pain signals: it is used to treat moderate, severe, and chronic pain after surgery or in cancer
  • sedative: it reduces anxiety and induces relaxation
  • it also binds to receptors on the brain stem, where autonomic processes like breathing, heartbeat, blood pressure, etc are suppressed
  • creates rapid tolerance
  • overdose can lead to unconsciousness, coma or slowed breathing to the point of death
  • in our body, codeine is transformed into morphine; the amount depends on the individual

Morphine is made in our bodies as well and it goes like this: L-tyrosine (an amino acid) >> dopamine >>>>> thebaine >> codeine > morphine. It is used as a communication molecule.
Heroin

  • also called diamorphine; a morphine derivate developed in 1874
  • better fat-soluble than morphine; when injected, it enters the brain more easily where it is metabolized into morphine; this makes it more potent, more addictive and more toxic
  • it is mixed with other substances such as starch, caffeine, paracetamol, … to increase the street value; because of its illegal production, there is no quality control and the amount of pure heroin can vary, leading often to overdose
  • the use of heroin is decreasing while fentanyl users are rising

When patients stop opioid therapy after a long period of use, they can suffer from opioid-induced hyperalgesia (OIH). Simply put: there is an abnormally increased sensitivity to pain. This complicates withdrawal from opioid addiction.

Other withdrawal symptoms are agitation, anxiety, sore muscles, sleeping problems, sweating, yawning, excessive tears and runny nose. In a later stage, people can experience belly cramps, diarrhea, nausea, vomiting, dilated pupils and goosebumps.
Nicotine

Nicotine is a very powerful neurotoxin present in the tobacco plant, Nicotiana tabacum, which belongs to the same family as tomatoes and potatoes. Nicotine has been used as an insecticide. They abandoned this practice due to too many acute intoxications with respiratory paralysis. In high doses, it acts as a sedative.

In low doses, nicotine acts as a stimulant. It is best known in the form of cigarettes. One cigarette contains about 10 mg of nicotine on average. Only 1 -2 mg is inhaled and enters the bloodstream through the lungs. It reaches the brain in 7 seconds. There, it binds on specific receptors and activates the reward system. The smoker feels energized and relaxed at the same time. It also reduces anxiety and improves focus.

Nicotine stimulates the release of adrenaline and noradrenaline. This narrows the arteries, increases blood pressure and blood sugar, stimulates heart rhythm, breathing rate and bowel contractions. It suppresses the taste.

Nicotine is highly addictive and a multifactorial problem: there is the physical addiction to nicotine as well as the psychological addiction to the act of smoking. Going outside for a break, the deep and slow breathing work both relaxing and enhance one’s productivity.

Next to nicotine, there are hundreds of harmful components in tobacco smoke, like carbon monoxide and formaldehyde. This makes smoking a dangerous habit not only to the smoker himself but to bystanders as well.

“Almost a third of deaths from coronary heart disease are due to smoking and second-hand smoking.” American Heart Association

Moreover, research showed that there is a link between nicotine consumption and binge drinking.

Withdrawal symptoms are restlessness, anxiety, irritability, difficulty concentrating, depressed feelings, sleep disturbances and an increased appetite.

Nicotine dependence and smoking can be treated by giving the individual controlled levels of nicotine in various forms. The amount of nicotine is gradually reduced so that the body can adapt without experiencing withdrawal symptoms.
Cocaïne

Coke is an alkaloid found in the leaves of the coca plant, Erythroxylon coca. The indigenous people of South America chew on the leaves to stimulate them and suppress hunger.

After isolation, it has been used in the past as a local anesthetic and to treat morphine addiction.

Cocaine is a stimulant: a euphoric high is followed by feelings of power, self-confidence, increased energy and improved focus. Hypersensitivity to light, sound and touch, irritability and paranoia come with it. As are constricted blood vessels, dilated pupils, augmented temperature and blood pressure, fast and irregular heartbeat, tremor, restlessness, nausea and decreased appetite.

Cocaine overdose can lead to a heart attack, stroke, seizure and this is often followed by death.

On the street, it is sold as a white powder which contains cocaine mixed with other substances such as corn starch, talcum, flour or even fentanyl. People use it in combination with alcohol or other drugs, which makes it even more dangerous.

Withdrawal symptoms are mostly psychological. People will experience difficulties to think and concentrate, fatigue, exhaustion, anxiety, suicidal thoughts, nightmares, inability to experience sexual arousal, increased appetite, chills and muscle pain.
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“The European prevalence studies show that, excluding alcohol, benzodiazepines are along with cannabis the psychoactive substances most prevalent in the driving population.”
Benzodiazepines

Benzodiazepines like diazepam and z-benzos like zolpidem are sedatives or tranquilizers. They are prescribed for anxiety and sleep disorders, muscle spasms, epileptic seizures and replaced barbiturates because they are less toxic. However, in combination with alcohol and opioids they can be lethal. Benzos are also used for withdrawal symptoms from alcohol and other drugs.

The most infamous benzo is flunitrazepam also known as Rohypnol® or the date rape drug.

They should be used in the lowest dose possible and for a short period of time. Tolerance and dependence are seen already after one week! Although this is common knowledge, doctors are still prescribing them chronically to addicted patients. Especially the elderly and more women than men.

In 2005, Belgium and France were the biggest users of benzos in Europe. In 2011, diazepam was one of the most widely prescribed drugs of all time, worldwide.

Recreational use is a growing problem. Benzos are consumed in high doses often in combination with other drugs.

They enhance the effect of γ-aminobutyric acid (GABA), the most important inhibitory neurotransmitter in the central nervous system.

Adverse effects are numerous:
  • 6 to 10 x higher risk of car accidents caused by decreased alertness and motor skills because a person took a benzo the evening before
  • falling (and breaking bones) on the way to the toilet at night
  • anterograde amnesia (the inability to absorb new information), blackouts and inappropriate behavior such as shoplifting
  • a decline in cognitive abilities
  • paradoxical behavior such as depression with or without suicidal tendencies, phobias, panic, aggression, hallucinations and delusions
  • increased risk of dementia
  • decrease of deep (slow-wave) sleep and REM sleep

Withdrawal symptoms consist of anxiety, head- and muscle aches, sleeping problems, irritation and restlessness, rebound. In severe cases: confusion, hallucinations, convulsions and hypersensitivity to light, sound and touch.

Natural ways to beat addictions

Before you go cold turkey…

According to Adi Jaffe, an expert on mental health and addiction, the abrupt cessation of alcohol, benzodiazepines and opiates should always be supervised and done in a controlled setting because they can be lethal. While going cold turkey on cocaine, marihuana or nicotine is very unpleasant but not dangerous.

Create a new life!

The first thing you should do when trying to beat an addiction is to change the way you live. Because just stop using an addictive substance or engaging in addictive behavior isn’t enough. You must create a new life in which you don’t need to use anymore.

“Evaluate your life and make the necessary changes.”

Dr. Melemis set 5 rules to prevent relapse:
  1. change your life: start a new hobby and make new friends; change your job; learn new skills; adopt a dog which will obligate you to have daily walks
  2. be completely honest, especially to yourself: because addiction requires lying and denying
  3. ask for help, because you’re not alone: a combination of a substance abuse program and self-help group is the most effective
  4. practice self-care: stress and tension are common triggers of relapse, as are negative thinking and worrying. Mind-body relaxation has been proven effective. Think of yoga, mindfulness, tai chi and qi gong. Intensive body exercise releases endorphins and endocannabinoids, also known as the ‘runners high’.
  5. don’t bend the rules: don’t ignore the advice given by health professionals or resist change
Forest therapy

Spending time outdoors in a natural environment has been proven effective for many diseases and disorders, including addiction. Forest therapy is becoming very popular.
We are designed to live in nature. A city is full of sharp corners, unnatural noise, light, colors and smells. It activates our stress system. While spending time in nature has a calming and stress-reducing effect that is universal. 

Already after minutes, we experience the following effects:
  • decreased muscle tension
  • lowered heart rate and blood pressure
  • improved mood
  • calmer mind
  • increased ability to concentrate

In the nineteenth century, people with tuberculosis were sent to sanatoria at sea to recover.

Shinrin yoku or forest bathing emerged in the 1980s in Japan where the rate of chronic stress is very high. It is even prescribed by doctors. 

Forest bathing differs from a walk in the forest by the way you do it. It is done alone and you take the time (so slowly!) to absorb the forest with all your senses.

In Finland, metsämieli or forest mind is well known: a program of exercises designed to utilize and intensify the natural healing effects of forests.

More and more centers of addiction recovery all over the world provide outdoor activities. To experience natural highs and gain some ‘vitamin N’.

“Exposure to greenery alleviates cravings.”

There is a growing interest in the preventive and therapeutic effects of forest therapy. It is low-cost with no side effects. Research is ongoing.
Connect with people

Johann Hari says that the opposite of addiction is connection. He remarked that people with happy and connected lives do not have addictions.

Bonding and connecting are in our nature as human beings. Thanks to our social and communication skills, we are the only human species left on earth. Working together made us so successful. However, modern society has become more and more individualistic. Social isolation and loneliness are associated with a 29% rise in mortality, according to a meta-analysis from 2015.

 “Western culture is the loneliest society ever.”

Social prescribing is designed to improve mental health and physical well-being. Examples are cooking classes, community gardening, volunteering, group sports, art activities and group learning. Create your own tribe!
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Plant power

Numerous plants can be helpful to support withdrawal, beat addictions and restore the body. Let’s check out some herbal remedies. Kudzu (Pueraria lobata) roots has been used as an anti-intoxication agent in China since 200 BC. It suppresses the need for alcohol consumption and cravings. Studies on rats confirm this. Kudzu also can restore hippocampal function. It works as an anti-oxidant as well.

The roots of Red sage (Salvia miltiorrhiza) are used in Eastern medicine to maintain and restore cardiovascular health. When it comes to addictions, they show anti-relapse properties in rats. Red sage also protects the liver.

A plant that is worth mentioning when it comes to liver protection and restoration is Mary thistle (Silybum marianum). It can prevent a hangover in cases of acute alcohol poisoning and acts as a natural remedy for fatty liver disease due to chronic alcohol consumption.
I would like to elaborate on Asian ginseng (Panax ginseng), also called The King of herbs. This plant grows in the mountain forests of eastern Asia and is well-known as an adaptogen and tonic.

A group of steroidal saponins, ginsenosides, are considered the major active components of ginseng. They act as a prodrug and must be transformed into pharmacologically active rare ginsenosides. Some examples of ginsenosides are Rb1, Rg1, Rc… Examples of rare ginsenosides are Rg3, Rg5, Rk1, Rh2…
How can ginseng help you?

If we look at the studies that have been conducted with ginseng related to the topic, we see the following:

  • a study with rats suggests that red ginseng extract can significantly reduce the gastrointestinal absorption of alcohol and that way reduce the alcohol intoxication symptoms
  • alcohol-intoxicated mice were protected from memory failure and excitation due to red ginseng extract
  • a randomized crossover study in healthy men showed that red ginseng relieves the symptoms of alcohol hangover by accelerating alcohol clearance
  • in Traditional Chinese Medicine ginseng is used to stop morphine tolerance, -addiction, to adapt the regulation of bodily functions and to relieve withdrawal symptoms
  • in a preclinical study, ginseng blocked the analgesic effects of morphine and suppressed the development of its tolerance. Therefore, it may be useful clinically for the prevention of dependence on opioids
  • a wild ginseng extract was tested in morphine-addicted rats; the ginseng extract was able to cure or alleviate withdrawal symptoms and to prevent relapse
  • Rh2, Rg3 and Compound K decreased morphine-dependent behavioral patterns in mice and rats
  • Panax ginseng attenuates the physiological effects of drugs of abuse including morphine in pre-clinical studies
  • a clinical trial from 2008 found that the root of Panax ginseng was both safe and effective for the treatment of moderate-to-severe acute heroin withdrawal
  • many drugs stimulate the release of dopamine and lead to a change in dopaminergic transmission, as we have seen. Cessation of repeated nicotine use leads to restlessness, agitation, concentration problems, fear, sleep disorders, depressive moods and increased appetite. Ginsenosides can inhibit post-synaptic dopamine receptor super-sensitivity in nicotine-treated mice
  • a study on rats give the following findings: inhibition of nicotine-induced dopamine release and dopamine-2 receptor binding, along with behavioral inhibition of nicotine-induced sensitization
  • a review from 2017 on Chinese Herbal Medicine for the Treatment of Drug Addiction concludes that ginseng may be useful as a therapeutic agent for nicotine addiction
  • animal studies show that ginseng and ginsenosides modulate appetite and reduce energy uptake in the intestine, inhibit lipid synthesis and stimulate energy use in muscles and liver
  • Rb2, the most abundant ginsenoside in Panax ginseng and precursor of Rg5 (a rare ginsenoside), decreased obesity and metabolic disorders by activating brown fat and inducing the browning of white fat in mice
  • In vitro studies showed that Rg3 inhibits the nicotinic acetylcholine receptor channel activity and catecholamine release in the nervous system; it regulates also GABAA, 5-HT3 and NMDA receptor channels
  • Rg3 and Rg5 protect neurons in case of stress by regulating Na+-channels
  • Rg3 and Rh2 have shown an anxiolytic-like effect in animals
  • a review from 2017 of stress-related depression, anxiety and the hypothalamic-pituitary-adrenal axis concluded that ginseng could help reduce anxiety caused by stress
  • a clinical trial showed that ginseng has antifatigue effects, partly due to its antioxidant properties
  • a study from 2015 on mice indicated that Rg3 has antidepressant-like effects by normalizing the hyperactivity of the HPA-axis; from all ginsenosides tested, Rg3 has the strongest effect on regulating noradrenalin, ACTH and corticosterone levels
  • Rg5 proved to be a new potential antidepressant in a study conducted on mice

TO CONCLUDE

There are many substances and behaviors a person can get addicted to. 10-15% of the adult population is estimated to suffer from addiction and it crosses all socio-economic boundaries. Addiction is now considered as a neuropsychiatric disorder that changes both the shape and function of the brain.

Adolescents are especially vulnerable to addictions because their brain is still remodeling.
People can become addicted for many reasons but very often it is to escape their situation. Chronic stress, depressive state and anxiety are both a risk factor and a consequence of addictions.

The most addictive substances are opioids like heroin, cocaine, nicotine, benzodiazepines and alcohol.

It is important to create a new life to prevent relapse. Forest therapy, social subscribing and herbal remedies like Panax ginseng are some natural ways to help overcome addictions.
REFERENCES

(1) Lee Y J, Pantuck C B & Pantuck E J. Effect of ginseng on plasma levels of ethanol in the rat. Planta Medica. 1993; 59(01), 17-19.
(2) Tomczyk M, Zovko-Koncic M & Chrostek L. Phytotherapy of alcoholism. NPC. 2012; 7(2), 273-280.
(3) Takahashi M & Tokuyama S. Pharmacological and physiological effects of ginseng on actions induced by opioids and psychostimulants. Methods Find Exp Clin Pharmacol. 1998; 20(1), 77-84.
(4) Yarnell E, et al. Botanical Remedies for Nicotine Addiction. Alternative and Complementary Therapies. 2001; 7(6), 337-340.
(5) Caria M A M, et al. Potential use of medicinal plants in the treatment of alcoholism. Fitoterapia 71 2000; S38-S42.
(6) Kim H J, et al. Effects of ginseng on CNS disorders. J Ginseng Res. 2013; 37(1), 8-29.
(7) Tabatabai S M, et al. Phytotherapy of opioid dependence and withdrawal syndrome: a review. Phytotherapy Research. 2013.
(8) Li Z & Geun E J. Ginseng and obesity. J Ginseng Res. 2018; 42, 1-8.
(9) Hong Y, et al. Ginsenoside Rb2 Alleviates Obesity by Activation of Brown Fat and Induction of Browning of White Fat. Front Endocrinol. 2019.
(10) Kim T W, et al. Anxiolytic-like Effects of Ginsenosides Rg3 and Rh2 from Red Ginseng in the Elevated Plus-Maze Model. Planta Medica (75) 08, 836-839.
(11) Seung-Yeol Nah. Ginseng ginsenoside pharmacology in the nervous system: involvement in the regulation of ion channels and receptors. Frontiers in physiology. 2014.
(12) Lee J H, et al. Modifications of aliphatic side chain of 20(S)-ginsenoside Rg3 cause an enhancement or loss of brain Na+ channel current inhibitions. Biol Pharm Bull. 2008, pp. 480–486.
(13) Xu D, et al. Antidepressant-like effects of Ginsenoside Rg5 in mice: involving of hippocampus BDNF signaling pathway. Neuroscience Letters, 2017.
(14) Zhang A et al. Antidepressant-like effects of ginsenosides: A comparison of ginsenoside Rb3 and its four deglycosylated derivatives, Rg3, Rh2, compound K, and 20(S)-protopanaxadiol in mice models of despair. Pharmacology, biochemistry and behaviour. 2015.
(15) Lee S, Rhee D-K. The effects of ginseng on stress-related depression, anxiety, and the hypothalamic-pituitary-adrenal axis. Journal of Ginseng Research. 2017.
(16) Kim H-G, et al. Antifatigue Effects of Panax ginseng C.A. Meyer: A Randomised, Double-Blind, Placebo-Controlled Trial. PloS One. 2013. 8(4).
(17) Bilkei-Gorzo A, et al. A Common Genetic Predisposition to Stress Sensitivity and Stress-Induced Nicotine Craving. Biological Psychiatry. 63(2), 15 January 2008, Pages 164-17.
(18) Meletis C D & Zabriskie N. Natural approaches to treating addiction. Alt and Compl Therapies. 2008. 14(6).
(19) Kim H-S, Kim K S, Oh KW. Ginseng total saponin inhibits nicotine-induced hyperactivity and conditioned place preference in mice. Journal of Ethnopharmacology. Volume 66, Issue 1, July 1999, Pages 83-90.
(20) Lu L, et al. Traditional Medicine in the Treatment of Drug Addiction. Am J Drug and Alcohol Abuse. 35:1-11,2009.
(21) Kim H J, et al. A comprehensive review of the therapeutic and pharmacological effects of ginseng and ginsenosides in central nervous system. J Ginseng Res. 2013.
(22) Zhu W, et al. Chinese Herbal Medicine for the Treatment of Drug Addiction. International Review of Neurobiology, Volume 135. 2017.
(23) https://www.neuroscientificallychallenged.com/blog/know-your-brain-reward-system
(24) https://www.drughulp.be/drugthema-verslaving-onbewust
(25) https://www.geestelijkgezondvlaanderen.be/verslaving
(26) https://www.vad.be/artikels/detail/waarom-is-een-verslaving-moeilijk-te-doorbreken
(27) https://www.knack.be/nieuws/gezondheid/verslavingsgedrag-beter-begrijpen-een-complex-samenspel-van-factoren/article-longread-1388165.html?cookie_check=1582793927
(28) https://www.hersenstichting.nl/hersenaandoeningen/gedragsverslaving/
(29) https://www.medischcontact.nl/nieuws/laatste-nieuws/artikel/verslaafde-hersens.htm
(30) https://www.addictioncenter.com/community/behavioral-addictions/
(31) https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/drug-misuse-addiction
(32) https://raisingchildren.net.au/pre-teens/development/understanding-your-pre-teen/brain-development-teens
(33) Albert D, Chein J & Steinberg L. The Teenage Brain: Peer Influences on Adolescent Decision Making. 2013. Current Directions in Psychological Science, 22(2), 114–120.
(34) https://neurosciencenews.com/alcohol-reward-system-women-6461/
(35) https://www.health.harvard.edu/newsletter_article/how-addiction-hijacks-the-brain
(36) Arnsten A F T. Stress signalling pathways that impair prefrontal cortex structure and function. Nat Rev Neurosci. 2009 Jun 10(6); 410-422.
(37) Melemis SM. Relapse Prevention and the Five Rules of Recovery. YALE JOURNAL OF BIOLOGY AND MEDICINE 88 (2015), pp.325-332.
(38) National Scientific Council on the Developing Child (2010). Persistent Fear and Anxiety Can Affect Young Children’s Learning and Development: Working Paper No. 9. http://www.developingchild.net
(39) MacNicol B. The biology of addiction. Can J Anesth/J Can Anesth (2017) 64:141–148.
(40) https://www.drugabuse.gov/drugs-abuse/alcohol
(41) https://www.progressreport.cancer.gov/prevention/alcohol
(42) https://wijzijnmind.nl/psychipedia/verslaving/kenmerken-verslaving-1
(43) https://ourworldindata.org/grapher/number-with-mental-and-neurodevelopmental-disorders-by-type
(44) https://medlineplus.gov/alcoholusedisorderaud.html
(45) Shen W Y, et al. Moderate Alcohol Consumption During Adult Life, Drinking Patterns, and Breast Cancer Risk. JAMA. 2011;306(17):1884-1890.
(46) Levy Joel. Poison – a social history. 2011, Quid Publishing.
(47) Batmanabane G. Why patients in pain cannot get "God's own medicine?". J Pharmacol Pharmacother. 2014 Apr;5(2):81-2.
(48) http://www.emcdda.europa.eu/media-library/motion-graphic-heroin-production-explained_en
(49) https://www.addictioncenter.com/benzodiazepines/
(50) https://www.researchgate.net/figure/Fig-2-Heroin-metabolism_fig2_23136802
(51) https://www.drugbank.ca/drugs/DB01452
(52) https://www.drugpolicy.org/drug-facts/difference-heroin-fentanyl-morphine-oxycodone
(53) Locker AR, Marks MJ, Kamens HM, Klein LC. Exposure to nicotine increases nicotinic acetylcholine receptor density in the reward pathway and binge ethanol consumption in C57BL/6J adolescent female mice. Brain Res Bull. 2016 May; 123:13-22.
(54) https://www.drugabuse.gov/publications/drugfacts/cocaine
(55) https://americanaddictioncenters.org/cocaine-treatment/withdrawal
(56) https://www.noria-research.com/no-more-opium-for-the-masses/
(57) https://www.theguardian.com/world/2019/may/02/fentanyl-use-could-end-the-opium-era-in-mexico-the-only-crop-that-paid
(58) Richtlijnen bij het voorschrijven van benzodiazepines aan illegal druggebruikers. http://www.emcdda.europa.eu/attachements.cfm/att_231098_EN_BE03_benzos_inhoudprefin.pdf
(59) Spanemberg, L.; Nogueira, E.L.; Belem da Silva, C.T.; Dargel, A.A.; Menezes, F.S.; Neto, A.C. High prevalence and prescription of benzodiazepines for elderly: Data from psychiatric consultation to patients from an emergency room of a general hospital. Gen. Hosp. Psychiatry 2011, 33, 45–50.
(60) http://www.emcdda.europa.eu/publications/drug-profiles/benzodiazepines_en
(61) Song C, Ikei H & Miyazaki Y. Physiological Effects of Nature Therapy: A Review of the Research in Japan. Int. J. Environ. Res. Public Health 2016, 13(8), 781
(62) https://www.addictioncenter.com/news/2019/08/exposure-nature-addiction-cravings/
(63) http://metsamieli.fi/Forestmind-fi/
(64) https://www.cirquelodge.com/treatment/recovery/nature/
(65) https://www.treehouserehab.org/getting-back-to-nature-to-support-addiction-recovery/
(66) https://www.silvermistrecovery.com/treatment/holistic-therapy/nature-therapy/
(67) Cawston P. Social prescribing in very deprived areas. Br J Gen Pract. 2011 May; 61(586): 350.
(68) Holt-Lunstad, J et al. Loneliness and Social Isolation as Risk Factors for Mortality: A Meta-Analytic Review. Perspectives on Psychological Science, 10(2), 227–237. 2015.
(69) Verhelst Geert. Groot Handboek Geneeskrachtige Planten. 3de druk. 2008, Mannavita.
(70) Eldahshan, Omayma & Elsakka, Ahmed & Singab, Abdel Nasser. Medicinal Plants and Addiction Treatment. Medicinal & Aromatic Plants. 05. 10.4172/2167-0412.1000260. 2016.
(71) Lee M-H, et al. Red ginseng relieves the effects of alcohol consumption and hangover symptoms in healthy men: a randomized crossover study. Food Funct., 2014,5, 528-534.
(72) Bombi L, et al. Wild Ginseng Attenuates Anxiety- and Depression-Like Behaviors During Morphine Withdrawal. J. Microbiol. Biotechnol. (2011), 21(10), 1088–1096.
(73)Abenavoli L, et al. Phytotherapeutic approach to alcohol dependence: New old way? Phytomedicine 16 (2009) 638–644.
(74) Yayeh T, et al. Morphine dependence is attenuated by red ginseng extract and ginsenosides Rh2, Rg3, and compound K. J Ginseng Res 2016;40:445-452. 2016.
(75) Guo M, Wu CF, Wang JH, Pei G. Effects of ginsenosides on the actions of morphine. Zhongguo Zhong Yao Za Zhi 29:299–301. 2004.
(76) Takahashi M, Tokuyama S. Pharmacological and physiological effects of ginseng on actions induced by opioids and psychostimulants. Methods Find Exp Clin Pharmacol 20:77–84. 1998.
(77) Shi J, Xu G, Liu T, et al. A comparative clinical study of the effects of the traditional Chinese medicine Jinnui capsules and lofexidine on acute heroin withdrawal symptoms. Am J Drug Alcohol Abuse 34:792–800. 2008.
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