Exploring a Functional Medicine Approach to Overcoming Addiction

What is Functional Medicine? Functional Medicine is an approach to healthcare that focuses on the root cause of disease and actively engages the patient in their healthcare plan and goals.  Functional Medicine seeks to find the “upstream” causes of disease.  For example, a person may have taken a significant amount of antibiotics as a child that disrupted the health and balance of the gut bacteria (microbiome).  If this is not corrected and time goes on, other conditions such as IBS or depression may develop.  Functional Medicine practitioners take a deep dive into an individual’s history to elicit root causes, that may have occurred years prior, to fully correct the problem. 

Substance abuse and addiction have many different root causes that can originate from many different organ systems.  Functional Medicine seeks to understand genetics, environment, and lifestyle factors and develop a personalized treatment plan plan.  Functional Medicine views addiction not as a moral failing, rather a condition that can be caused by dysfunction of several different organ systems.  Here is a brief overview of major root causes associated with addiction:

1. GENETICS

Humans are born with a genetic DNA sequence that remains the same throughout their lifetime.  However, often there are variations in a single protein building block of the DNA called a Single Nucleotide Polymorphism (SNP).  Current research indicates that there may be many of these variants that influence a persons’ cravings and compulsive behavior and affect the brain's reward, stress, and motivation systems.

Some examples include:

DRD2 (dopamine receptor D2)

This gene plays a major role in regulating dopamine (the reward chemical).  A variant of this gene (or SNP) can weaken the brain’s natural reward system, causing a person to misuse substances such as alcohol, nicotine or opioids to feel the same level of satisfaction or reward as others. Low dopamine levels are associated with depression, particularly the inability to feel pleasure, as well as a mood swings and a lack of motivation or concentration.

The GABRA2 (Gamma-aminobutyric acid A2)

This gene plays a major role in regulating GABA, the brain's primary inhibitory neurotransmitter or "brake pedal" that helps reduce nervous tension and anxiety. Variants of this gene that impact GABA receptors are well-documented in alcohol use disorders.  These variants can promote general risk-taking behaviors and effect impulse control.

The OPRM1 (Opioid Receptor Mu 1)

This gene is associated with Endorphins.  Endorphins activate the brains opioid system and are the body's natural painkillers and "feel-good" molecules.  Variants of this gene can change how the body responds to pain, causing people to require higher doses to get the same effect, thereby promoting alcohol and opioid medication cravings. 

There have been approximately 66 genetic SNPs identified in the human genome that are associated with substance abuse and approximately 700 associated with depression. Testing for these variants (or SNP’s) is an easy process using a simple saliva swab which can be done at home.  Genetics can predispose an individual to addiction; however, adverse lifestyle and environmental factors often compound the physiology behind the addiction. Therefore, Functional Medicine practitioners use personalized nutritional support, lifestyle optimization, and stress management to manage these variants. 

2. GUT HEALTH AND THE GUT-BRAIN AXIS

The gut is often referred to as the "second brain" because it produces a significant portion of the body's neurotransmitters. In fact, approximately 90% of serotonin is produced in the gut. Serotonin is considered “the happiness chemical,” as it helps regulate anxiety, happiness, mood and digestion. Alcohol and opioids profoundly disrupt the intestinal environment causing intestinal permeability (leaky gut), an imbalance of the gut bacteria (dysbiosis) and damage to the lining of the gut, adversely affecting the function of neurotransmitters such as serotonin and dopamine.   Chronic substance use also significantly lowers overall bacterial diversity, which is fundamental to a healthy gut and microbiome. Damage to the intestinal lining from drug and alcohol can further impact the absorption of nutrients into the body by disrupting the digestive enzymes needed to break down the nutrients. This depletion of vital nutrients negatively impacts brain chemistry, worsening mood disorders and cravings.  

About 70% of the immune system lies within the gut and when the immune system is activated by a foreign substance it almost always triggers an inflammatory response. These inflammatory signals travel to the brain, disrupting dopamine and serotonin pathways, fueling cravings and leading to relapse. Chronic systemic and central nervous system inflammation is increasingly recognized as an underlying trigger for substance use disorders, as it impairs mood regulation and decreases stress tolerance predisposing an individual to self-medicate. 

The Gut-Brain axis refers to a bidirectional communication network, with approximately 90% of that communication traveling from the gut to the brain through the Vagus nerve (considered the rest and digest nerve). Poor gut health blunts the Vagus nerve signals of rest, promoting anxiety and triggering cravings, which ultimately cause a chronic loop of dysfunction.  There are many ways to stimulate the Vagus nerve such as taking in a deep inhalation or humming.

Chronic substance abuse can also change the brain’s ability to adapt.  A healthy brain can reorganize itself with new neural connections based on experiences and this is called Neuroplasticity.  Substance abuse causes the neural pathways to learn the habits of cravings and compulsive habits negatively impacting Neuroplasticity.  The good news is that there are ways to improve Neuroplasticity and improve cognitive function.

One can see how important gut health is and testing to include such markers as enzyme production, microbiome health and leaky gut can easily be done with a home test.  Functional medicine practitioners take a comprehensive look at these individual gut functions to create a personalized plan of nutrition and lifestyle.

3. NEUROTRANSMITTER IMBALANCES

Chronic substance abuse disrupts "feel-good" brain chemicals like dopamine, serotonin, and GABA. When the brain doesn't receive enough reward signals, it can cause intense cravings causing individuals often to self-medicate to artificially trigger this feeling.  Over time, chronic use reduces the brain's natural ability to produce and respond to these chemicals, causing a need to produce even more “feel good” chemicals artificially.   There are many ways to test for neurotransmitters and hormones, both with home testing and standard laboratory testing. 

4. TRAUMA

Research indicates a strong and well documented relationship between the number of childhood traumas experienced and the severity of later substance abuse. The research surrounding ACE (Adverse Childhood Experiences) performed by the CDC and Kaiser Permanente is one of the largest public health investigations assessing how early-life trauma is linked to lifelong health and well-being.  An ACE self-test can be found by going to the Kaiser Permanente website.  Some statistics from these studies reveal that adults with any history of ACEs have a 4.3-fold higher likelihood of developing a substance abuse problem compared to those with none. An ACE score of 5 or higher increases the likelihood of illicit drug use and addiction by 7 to 10 times. Women with ACEs face a 5.9-fold increased risk of alcohol use disorder, while men face a 5.0-fold increased risk of illicit drug use disorder.  

Functional medicine uses the standardized, CDC-Kaiser ACE Questionnaire along with referrals to therapists to address the physiological toll of those experiences.  Lab testing can also be helpful, for example, to look for markers of stress.  Stress in general affects the adrenal glands which produce cortisol.  Overproduction of cortisol can lead to anxiety, irritability, and poor decision-making. Individuals often turn to drugs or alcohol to self-soothe and cope when cortisol levels are high. Although testing for cortisol levels can be done with standard lab testing, often only morning or night levels are evaluated, whereas a home Salivary Cortisol test will measure levels 4-6 times during the day, offering a more compressive view of cortisol function.

5. CHRONIC PAIN AND THE OPIOID SYSTEM

For many, addiction originates from an effort to self-medicate chronic physical pain. Although Oxytocin is often called the “love hormone” it is also closely associated with pain, acting as a natural analgesic that dampens pain signals while also reducing the associated stress and anxiety. Functional Medicine practitioners analyze the opioid system (the body's natural pain-relief network) and look for underlying causes of chronic pain.  Causes can include structural misalignment, inflammation, nutritional deficiencies and more. Functional medicine practitioners are trained to address and treat these possible causes.

6. NUTRITIONAL DEFICIENCY

Substance abuse can lead to severe deficiency in amino acids as well as many vitamins and minerals that are building blocks for neurotransmitters such as dopamine and serotonin.  In addition, low blood sugar can cause fatigue and mood swings and trigger cravings, both contributing to relapse. The appropriate food plan and supplementation plan can help restore these depleted nutrients and reduce cravings and mood swings.  Functional Medicine practitioners often use a specialized nutrient test that can reveal long-term nutrient deficiencies, verses a standard lab serum test, which is more short-term and may simply reflect a few recent meals.  

7. TOXIC BURDEN

According to the CDC nearly all Americans carry a toxic burden from man-made chemicals in the environment.  This is a problem that is often overlooked and is typically not addressed in standard care.  Even our current food supply is loaded with Ultra-processed foods that are filled with man-made chemicals that contribute to toxic burden and contain ingredients designed to make us want to eat more of them.   The liver and gut are primary organs that manage the removal of these unwanted substances.  Accumulated environmental toxins can cross the blood-brain barrier, leading to neuroinflammation that alters mood regulation, increases cravings, impairs decision-making and ultimately causes tissue damage.  When we consider the increase in chronic disease, environment and man-made pollutants are a logical and documented contributor.  Testing for heavy metals and toxins can be done at home and depending on the toxin or heavy metal, specific protocols can be implemented.

As one can see understanding the root cause of substance abuse is very complicated and may seem overwhelming.  Fortunately, Functional Medicine offers a very methodical, systems biology approach, to investigate and uncover the cause (and often the causes) that lead to substance abuse and offer personalized treatment plans to help patients work toward full recovery.  For further information on Functional Medicine visit the Institute of Functional Medicine website (IFM.org). 

Dr. Leah Griswold

www.gvcwellness.com