Introduction
The USA’s drug and alcohol abuse problem has become a national emergency. In most developed countries, alcohol-use disorder (AUD) is the most common substance use disorder (SUD), and its major clinical implications, including liver problems, are linked with high death rates and several co-occurring mental and physical conditions (Mohamed & Kobeissy, 2022). Relative to the rates among those aged 18-25 (3.1 million) and those aged 26 and over (11.0 million), the prevalence of alcohol use disorder among those aged 12-17 (414,000) in 2019 is surprisingly low (SAMHSA, 2020). These numbers demonstrate the continued high prevalence of SUD in the United States and the consequent critical need for cutting-edge treatment approaches. Managing SUD is difficult because patients often exhibit symptoms across several dimensions (psychological, behavioral, physical, and cognitive). Therefore, the treatment of SUD needs to include a wide range of therapies that may specifically address each area.
Nutrition
Alcohol and diet are capable of interacting on numerous levels. According to Barve et al. (2017), consuming large amounts of alcohol may impede normal nutritional processes, leading to either general malnutrition or deficits of vital micronutrients like zinc. Neurotransmitters responsible for sensations of reward, pleasure, contentment, and relaxation are important for the functioning of an addicted brain. A person’s likelihood to use alcohol or caffeine increases when there is an imbalance of neurotransmitters in the brain owing to, for instance, heredity, persistent anxiety, or a poor diet.
Enhancing the nutritional health of people with alcohol use disorder (AUD) is typically overlooked or a minor component of the rehabilitation assistance provided by outpatient programs. This contradicts evidence showing that substance abuse often results in undernourishment, metabolic diseases that impact nutrition (Barve et al., 2017), unbalanced body composition (Dubinkina et al., 2017), and deteriorating psychological well-being (Jacob et al., 2021). Consequently, diet should play a crucial role in treating SUDs. Indeed, this has been supported by research showing that rehabilitation outcomes may be enhanced by nutrition therapy and proper diet (Wiss, 2019). Restoring normal gut function is crucial for enhancing gastrointestinal nutrient absorption before any nutrition therapy may be effective.
People with AUD are more likely to experience the metabolic conversion from glucose to acetate after ethanol intoxication. A decrease in acetate levels is associated with decreased energy production and potential neurotoxicity when people withdraw. Consumption of a ketone ester or ketogenic food boosts ketone bodies (acetone, acetoacetate, and beta-hydroxybutyrate) in the brain and plasma, triggering nutritional ketosis (Mahajan et al., 2021). Both animal and human research have demonstrated that this has an anti-alcohol impact, decreasing alcohol withdrawal effects, drinking cravings, and alcohol intake (Mahajan et al., 2021). Accordingly, nutritional ketosis may provide a novel therapeutic approach for AUD: a dietary intervention utilized alone or in conjunction with pharmaceuticals.
Similarly, those with AUD may benefit nutritionally from a low-glycemic-load diet, which can curb cravings and promote general health. Eating moderate meals on blood sugar concentrations has a stabilizing effect, which can reduce stress in persons with alcohol use disorder. A diet rich in sweets, refined carbs, and processed meals causes blood sugar to fluctuate, disrupting neurotransmitter communication and depleting the brain of calming neurotransmitters, which are crucial for avoiding stress, panic, and restlessness (Coulston et al., 2017). People with AUD may benefit from a low glycemic diet by eating meals that gradually release sugar into the bloodstream. Some measures include switching to whole grains and avoiding sugary sodas and other processed foods.
The brain’s cells and the routes that provide them with energy are supported by amino acids, which are also the basic components of neurotransmitters. Taking supplements with the proper nutrients to treat specific deficiencies may help ease abstinence difficulties, based on the substance or addiction, without producing adverse consequences or reliance on medicine. Amino acid treatment, which involves supplementing specific proteins to help reinstate normal neurochemistry, may be an appropriate method of assisting the brain in recovering from its ‘reward deficiency’ and rebuilding its built-in system for creating a mood boost (Coulston et al., 2017). Supporting cell energy generation paths and increasing sensitivity to neurotransmitters like GABA are among the many benefits of amino acid therapy.
The results of animal studies suggest that many different kinds of dietary supplementation, notably antioxidants, are beneficial. Unfortunately, there is a lack of high-quality research involving humans that uses either targeted nutrients or a combination of therapies, and the findings are often mixed or poor. More extensive investigations with strong methodology are needed.
Stress management: Meditation
Scientific research has shown that mindfulness-based approaches help people better manage stress and drink less. Mindfulness’s two foundational components, memory and awareness, stem from the virtuous eightfold journey, a fundamental Buddhist principle. Memory concentrates on recalling virtues to achieve internal purity through an intense examination of feelings, body, mind, and phenomena, from which awareness of a person’s impure body image, anguish, fragility, and constantly-changing self originates (Channuwong et al., 2018). These may be obtained via mindfulness practice, especially meditation, which results in understanding inherent traits, including emotional reactions and inadequacies (for example, greed). Consequently, mindfulness has been widely accepted for mental and physical health therapies in organizational and individual contexts, spanning a broad age range from toddlers to the elderly (Zhang et al., 2021). Its efficacy against drug misuse and substance-linked mental disorders garners interest in the medical sector.
There are many characteristics of mindfulness mediation related to substance abuse. Included in this list are the five tenets of observing (paying attention to one’s internal and external surroundings), describing (putting one’s thoughts and feelings into words), acting with awareness (engaging in the practices at hand), non-judging (not assigning value to one’s emotions and thoughts), and non-reactivity to inner experiences (allowing feelings and thoughts to flow freely) (Cheng, 2016). Mindfulness and meditation help improve these areas, which have been shown to have a negative association with things like alcohol cravings and stress. A meta-analysis of 54 randomized controlled studies indicated that mindfulness-based interventions effectively lowered addiction-related symptoms including dependency and desire, and raised control over one’s emotions when they were out of control (Sancho et al., 2018). In another research, individuals who received eight weekly, 2-hour supportive counseling sessions from a seasoned medical social worker trained in mindfulness meditation exhibited a decreased risk of opioid misuse after treatment ended (Garland et al., 2017). These studies show that mindfulness enhances openness and awareness while decreasing connected cognition. As a result, cue reactivity is controlled, and alcohol impulses are disengaged. These qualities also promote improved executive regulation and a reduction in thought avoidance.
Individuals with AUD can practice transcendental meditation to achieve the above effects. Transcendental meditation is a silent form that ideally takes place for twenty minutes twice daily (Dudeja, 2017). Transcendental meditation is a quiet meditation that may be done while sitting down and should be practiced twice daily for 20 minutes. Although it utilizes a mantra, it is not regarded as “mantra-based” due to its quiet nature (Dudeja, 2017). The purpose of practicing transcendental meditation is to reach a level of profound inner calm that culminates in a heightened state of consciousness.
Physical activity: Yoga
The ancient Indian practice of yoga was developed to help individuals achieve a heightened sense of inner peace and awareness. Yoga is a set of postures and breathing techniques designed to harmonize the mind and body (Walia et al., 2021). Although it may seem counterintuitive, practicing yoga can assist in rehabilitation from alcoholism. Evidence has shown that when combined with more conventional therapies, yoga may help people recover from drug and alcohol addiction in a multidisciplinary strategy that benefits their whole health (Walia et al., 2021). To maintain long-term sobriety, recovering addicts and alcoholics need to address the underlying problems that triggered their addiction. Furthermore, one has to develop novel ways of dealing with stress. Practicing yoga may help in problem-solving and teach individuals new ways to cope with daily stressors.
Positive emotional regulation is facilitated by yoga practice. Practicing yoga and meditation may help people with AUD gain more control over their minds and behavior. This, along with the recovery of the individual’s brain and neurological system, helps them better deal with stressful situations (Park et al., 2021). A yoga practitioner will sit down on their carpet in times of stress to relax and unwind. In turn, the temptation to use substances like alcohol or drugs is substantially mitigated.
Few studies have tried to assess the effect of yoga on outcomes of alcohol-use disorders. Studying the effects of Kripalu-based Hatha Yoga on 38 alcoholics with PTSD, researchers found that after 12 sessions, the yoga cohort had significantly lower scores on the Drug Use Disorders Identification Test (DUDIT) and the Alcohol Use Disorders Identification Identification Test (AUDIT) (Reddy et al., 2014). In contrast, in the control group, DUDIT and AUDIT scores rose (Reddy et al., 2014). Maintaining sobriety is easier when one’s physical, mental, and social health are healthy. Yoga is an excellent complement to a comprehensive therapy plan since it simultaneously targets the body, mind, and spirit.
Energy Modalities: Reiki
Reiki is a Japanese stress reduction and relaxation technique with potential therapeutic applications. This approach entails practitioners transferring universal energy from their hands to their clients (Valdovinos et al., 2019). It is widely accepted that addiction is a chronic illness that affects people’s thoughts and behaviors and that effective therapy relies on the individual’s unique needs and mindset. Reiki treatment is considered an alternative medicine due to the limited empirical in its support for addiction treatment. However, it has proved successful for some individuals, albeit likely only where it is tailored to the specific requirements and values of the individual (Valdovinos et al., 2019). Moreover, the treatment of addiction requires more than just one approach. Thus, it must be supplemented with methods grounded in science to be effective.
The lack of studies on Reiki as an alternative medicine prevents it from being considered a viable therapy for treating AUD. However, when the Reiki program is implemented as a type of treatment in nursing, positive outcomes such as improved self-esteem and family well-being have been observed (Valdovinos et al., 2019). Similarly, when incorporating Reiki into nursing care, there have been changes in alcohol addiction use between the before- and after-intervention periods (Valdovinos et al., 2019). These findings show the promising potential of Reiki in helping individuals with AUD.
Neurofeedback Therapy
The use of neurofeedback in addiction treatment is supported by research demonstrating altered electroencephalography (EEG) function and associated brain alterations in substance abusers. Neurofeedback is often utilized in AUD therapy to alter EEG frequency sequences associated with alcoholism’s pathophysiology (Thibault et al., 2018). Resultantly, neurofeedback evaluations for AUD were created to efficiently control the deficient brain signals and abnormal brain activities in alcoholic individuals. Nevertheless, there are several neurofeedback protocols for addiction problems, with a few focused on sensorimotor rhythm protocol (SMR), which has been related to enhanced concentration (Da Silva & De Souza, 2021). Similarly, the benefits of combination treatments on brain function, medication utilization, mood, indicators of attentiveness, and personality have been identified (Marlats et al., 2019). Neurofeedback therapy may be used to alter problematic patterns of brain activity without the need for direct training, or it can be paired with other interventions to strengthen behavioral and cognitive coping mechanisms.
In particular, studies have shown that neurofeedback, as a non-pharmaceutical intervention, can be a beneficial supplemental technique for addiction rehabilitation and is feasible in clinical therapy contexts. For instance, Dalkner et al. (2017) found that in male patients with alcohol use disorder, the addition of neurofeedback training to normal therapy over the course of 6 weeks resulted in a substantial reduction in Avoidant Personality Accentuation. Further, the researchers concluded that it showed promise in ameliorating clients’ stress-related personality features associated with AUD (Dalkner et al., 2017). There is a large body of research examining the relationship between EEG alterations and medical results in substance use disorder, but these studies vary widely in their neurofeedback evaluations and their supply of conclusive data.
Conclusion
Alcohol use disorder is a serious public health concern contributing significantly to a high global death rate. Notwithstanding this, there is a shortage of effective treatment alternatives for alcohol and associated SUDs. People with substance use disorders can exhibit symptoms over a wide range of areas, making it challenging to provide effective treatment. In this context, techniques in complementary and integrative health (CIH) may be advantageous, particularly when combined with conventional therapy for SUDs. Additionally, they may successfully enhance self-care, which is essential for SUD rehabilitation. Based on the empirical evidence presented in this paper, the CIH therapies examined have promising potential in treating AUD. However, a major barrier to their utility is the lack of scientific evidence to support their application in clinal settings. In the case of Reiki treatment, for instance, there is no empirical evidence to support the existence of the “life force energy” supposedly transferred from therapist to patient. Another obstacle is that most studies on the modalities (e.g., neurofeedback) use different protocols, making them controversial and inconsistent. These issues may lead to skepticism and reluctance among practitioners to use CIH modalities. To ensure their success, more studies are required to confirm their efficacy as potential SUD interventions.
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