Anti-aging/Longevity Medicine Reduces the Prevalence of Alcoholism and Drug Addiction

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".

References

Di Chiara, G. and  Imperato, A. (1988) Drugs abused by humans preferentially increase synaptic dopamine concentrations on the mesolimbic system of freely moving rats. Proc Natl Acad Sci U S A  Jul;85(14):5274-8.

Fink, G., Sumner, B., Rosie, R., Grace, O., Quinn, J. (1996 ) Estrogen control of central neurotransmission: effect on mood, mental state and memory.  Cell Mol Neurobiol. Jun;16(3):325-44.

Klaiber, E  Broverman, D. Vogel, W. Peterson, L.   Snyder, M.  (1996) Individual differences in changes in mood and platelet monoamine oxidase (MAO) activity during hormonal replacement therapy in menopausal women.  Psychoneuroendocrinology. Oct;21 (7):575-92

Kugaya, A. Epperson, N. Zoghbi, S.  van Dyck, C.  Hou,  Y.  Fujita, M.  Staley,  J.  Garg, P. Seibyl, P.  Innis, R.  (2003) Increase in Prefrontal Cortex Serotonin2A Receptors Following Estrogen Treatment in Postmenopausal Women.  Am J Psychiatry; 160:1522-1524

Northrup, C. (2006) The Wisdom of Menopause.  Bantom: New York. p 114-115.

Santen F, Sofsky J, Bilic N, Lippert R.  (1975) Mechanism of action of narcotics in the production of menstrual dysfunction in women.  Fertil Steril. Jun;26(6):538-48.

Torres, J. and  Ortega, E. (2003)  Alcohol Intoxication Increases Allopregnanolone Levels in Female Adolescent Humans.  Neuropsychopharmacology  28, 1207-1209

Vesga-López, O. Schneier, F.  Wang, S. Heimberg, R.  Liu, S.  Hasin, D. Blanco, C.  (2008)  Gender differences in generalized anxiety disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).  J Clin Psychiatry. Oct;69(10):1606-16. Epub 2008 Sep 23.