The Case For a Health & Wellness Approach to Addiction

Allison Futter ’23

Community Member: Yvette Williams; Faculty Advisor: Susan Masino

The Case For a Health & Wellness Approach to Addiction 

1. The Pressing Issue of Substance Use Disorder
   1a. Substance Use Disorder, Prevalence, and COVID-19 Impact
   1b. Community Partnership: 2 Your Health, LLC
   1c.  Treatment Rates and Approaches
   1d. Research Purpose
   1e. Research Questions
2. Methodology
   2a. Literature Review
   2b. Interviews Conducted
3. Results and Discussion
   3a. The 5 Most Bio-Active Holistic Remedies
   3b. The Big Picture
   3c.  Key Ideas From Interviews 
4. Conclusion and Future Directions
5. Research Limitations
6. References

*Click on any quick link above to navigate to that main or subtopic below.
*Click on any Figure/image below to enlarge it.

1. The Pressing Issue of Substance Use Disorder  

1a. Substance Use Disorder, Prevalence, and COVID-19 Impact

Substance use disorders (SUD) are conditions based on continued substance use despite negative consequences. Illicit drug use and lack of treatment causes an undue burden nationally and in the state of CT. Within the past year, there was an increase in the percentage of those who used illicit drugs, reaching 20.8 percent from 17.8 percent in 2015, as well as 20.4 million people who had a SUD (SAMHSA’s 2019 National Survey on Drug Use and Health (NSDH), 2020).

Figure 1.
Substance use disorder definition and prevalence rates

Figure 2.
CT vs US opioid overdose death rates

Source: KFF analysis of CDC Multiple Cause of Death 2008-2018 from: “Mental Health and Substance Use State Fact Sheets.” KFF, Kaiser Family Foundation, Nov. 19, 2020, https://www.kff.org/statedata/mental-health-and-substance-use-state-fact-sheets/connecticut.

The COVID-19 pandemic has been worsening the substance use epidemic and is expected to increase the rate of overdose deaths by 18% (Yeager, 2020). Isolation, limited treatment options, and economic pressures have intensified because of the pandemic and have resulted in increased challenges for those with substance use disorders. Just within the first three months of 2020, drug overdose deaths have increased more than 10%.

Figure  3.
First three months of 2019 vs 2020’s overdose death rates

Source: Stephenson, Joan. “Drug Overdose Deaths Head Toward Record Number in 2020 on CDC Warns.” JAMA Health Forum, JAMA Network, Oct. 20, 2020,  https://jamanetwork.com/channels/health-forum/fullarticle/2772241

I think it’s [COVID-19] having a huge impact on the addiction population … isolation is the worst thing you can do for an addict, even for one in recovery.- Interviewee #2, Narcotics Anonymous Interviewee 

1b. Community Partnership: 2 Your Health, LLC

The founder of 2 Your Health, LLC, Yvette Williams, through years of research and integrative therapy, was able to overcome life-threatening illnesses. Understanding the value of a health and wellness approach, 2 Your Health offers non-clinical health consultation and education as well as its own vegetarian food truck. 

2 Your Health, LLC is working towards piloting an all-natural approach to addiction recovery. The foundation of this approach includes nutritionally dense foods, supplements, and botanicals paired with supportive mental and physical activities, without the use of regulated or synthetic substances or medication. This type of intervention works to support the body’s own detoxification, nourishment, and healing abilities. Offering a natural approach will help combat the urgent need for an effective alternative response to addiction. 

Figure 4.
About 2 Your Health, LLC 

1c. Treatment Rates and Approaches

Among people aged 12 or older in 2019, 21.6 million people needed substance use treatment in the past year. Yet, only 4.2 million people received any substance use treatment.

Figure 5.
Number of people who received substance use treatment vs who needed it

Source: “Key Substance Use and Mental Health Indicators in the United States: Results from the 2019 National Survey on Drug Use and Health.” SAMHSA Substance Abuse and Mental Health Services Administration, Sept. 2020, https://store.samhsa.gov/product/key-substance-use-and-mental-health-indicators-in-the-united-states-results-from-the-2019-national-survey-on-Drug-Use-and-Health/PEP20-07-01-001.

The all-natural pilot study will utilize an integrative/ holistic approach. This approach differs from conventional medicine.

Figure 6.
Conventional vs Holistic Remedies/Therapies

1d. Research Purpose

In order to pilot and demonstrate the efficacy of its natural, holistic addiction treatment approach, 2 Your Health has been seeking grant funding. An important first step towards obtaining funding is to show the existence of preliminary, empirical research that supports the proposed holistic approach. Accordingly, identifying, organizing, summarizing, and graphically representing the existing evidence-based research was the main goal of the project.

The focus was on the research related to 17 holistic remedies that are included in protocols or recipes (e.g. Nutrition, Hydrotherapy, Turmeric, Exercise). Empirical research was evaluated along with reports from cultural/traditional uses regarding the efficacy of these holistic methods to improve health and treat 53 typical substance abuse issues/problem symptoms (e.g. Drug cravings, Poor health, Insomnia, Anxiety). 

Figure 7.
Holistic remedies researched and examples of substance abuse problem symptoms examined

The field of natural, unconventional medicine is vast. Confidence continues to grow in various natural/integrative remedies. More and more empirical studies continue to reveal the efficacy of these remedies, though as is common in research, not all results are affirmative.  

1e. Research Questions

The guiding research questions throughout the literature review were:

1. To what extent does the existing evidence-based research support the effectiveness of the 17 holistic remedies in treating addiction-related issues?
2. Of the investigated therapies, which appear to be the most bioactive? 

The answers to the two questions above will inform the development of grant applications from 2 Your Health, LLC and will hopefully help to secure funding to pilot the holistic addiction project.

2. Methodology

2a. Literature Review

Figure 8.
Literature review and data collection process

Empirical research articles were gathered using databases such as PsycINFO, PsycARTICLES, and Google Scholar. 17 specific natural health remedies were researched: chlorophyll, glutathione, antioxidants, turmeric, wheatgrass, milk thistle, dandelion root, hydrotherapy, social connectedness, natural/outdoor therapy, acupuncture, spiritual belief/support, massage, MCT oil, CBD oil, exercise, and nutrition. In cases where there were initially few results returned after a search, different keyword searches were used, substituting “substance abuse treatments” with “health benefits” for example. After summarizing, or using direct quotes, from references, generalized and specific health benefits were isolated. The health remedies were then evaluated against 53 substance abuse issues/symptoms/ sequelae. To indicate the strength of support provided by the primary and secondary empirical research sources for each addiction issue, a color-coded rating system was created, with the 53 typical addiction problem symptoms found on the left and the 17 health therapies on the top. The color-coded rating system was then used within a matrix to demonstrate correlations between the 53 addiction problem symptoms, listed in column one, and the 17 holistic remedies, listed in row one.

Figure  9.
Color-coded rating system used to correlate addiction problem symptoms to holistic remedies

• Red checkmark meant that the research showed a strong indication that a particular remedy would relieve the issue it was associated with
• Blue checkmark meant that the research showed indicative evidence that a particular remedy would relieve the issue it was associated with
• Green meant that the effectiveness of the remedy in relieving an addiction issue was deduced through student analysis because of similar functions and properties
• Black meant that the remedy has been reportedly used in traditional/historical/anecdotal/cultural medicine

Figure 10.
Example of the natural remedies correlated to the addiction problem symptoms they help

2b. Interviews Conducted

Two 30 minute interviews were conducted via zoom, to gather broad but substantive feedback and insight into the drug addiction epidemic in the Hartford area as well as the impact of the coronavirus pandemic on a problem that was already at crisis level. Interviewee #1, a specialist in addiction and infectious disease treatment at Hartford Hospital, was asked 10 questions addressing addiction, its prevalence in Connecticut, the type of drugs abused, current treatment available, and holistic treatment. Interviewee #2 is a member of Narcotics Anonymous (NA) who was asked the same 10 questions, but from the perspective of someone who has gone and continues to go through recovery and treatment. 

3. Results and Discussion 

Figure 11b.

The 50-69% Addiction Problem Symptoms to Remedy Correlation is also broken down. There were 424 opportunities for these 8 remedies to help one of the 53 addiction issues. Research indicated they may help 222. Level of effectiveness: Strong: 43, Indicated: 105, Deduced: 74, Blanks: 74

Figure 11c.

Finally, >90%  Addiction Problem Symptoms to Remedy Correlation is broken down. There were 53 opportunities for the 1 remedy to help one of the 53 addiction issues. Research indicated they may help 50 times. Level of effectiveness: Strong: 20, Indicated: 22, Deduced: 8, Blanks: 3 

The most Bio-Active Protocols were: Nutrition, Turmeric, Acupuncture, Exercise, and Glutathione.                     The least Bio-Active Protocols were: Social Support, MCT and CBD Oil, Milk Thistle, and Spiritual Support.

Figure 12.
Symptom “hits” and “misses” for the most and least bio-active remedies

3a. The 5 Most Bio-Active Holistic Remedies:

Figure 13.
Benefit summarization for the most bioactive remedies

3b. The Big Picture:

• A heatmap was created based on the analysis done and described under the ‘Methodology’ section to provide a big picture, at-a-glance summary image of our research findings.
• Through its numerous shaded cells, the heatmap below shows the likelihood that one or more of the 17 holistic remedies (row #1) will help with each of the 53 addiction problem symptoms (column #1).

Figure 14a.
Heatmap legend 

Figure 14b.
Summary Heatmap: Shadings indicate likely help from remedies (row #1) for addiction issues (column #1)

3c. Key Ideas From Interviews 

Figure 15.
Key takeaways from interviewee #1 (addiction specialist) and interviewee #2 (NA member)

It’s [using drugs] a coping strategy for many people. If you take away a mechanism that people are using to cope with life and you don’t help train them on something to replace it with by teaching them other coping strategies, then it’s hard to expect them to do well. But people, even after they stopped using drugs, they can continue to have difficulty sleeping, have mood changes, have less appetite, and have cravings and they’re still at high risk of having a relapse. It really needs to be multimodal [intervention]. Medications do have best track record at helping people have the best success over time. There may be a role for nutritional interventions and other integrative approaches as a complement to medication therapies or as more of the mainstay for people who may not be interested in taking medications. It’s a conversation that they should have with their health care provider to see what the best fit is.- Interviewee #1, addiction specialist 

*Listen to full interviews using the links below:
Interviewee #1:
https://trincoll.mediaspace.kaltura.com/media/interview1/1_zmvz125s 
Interviewee #2:
https://trincoll.mediaspace.kaltura.com/media/interview2/1_ye5y5k83

4. Conclusion and Future Directions  

Through the process of conducting this research review, we learned how to refine our searching strategies in cases where the available research initially appeared to be very limited. Listening to the perspective of a clinical practitioner and a person in recovery from the Hartford area, helped us understand the struggles with substance use disorder people are dealing with right around us. We also were able to gain a better understanding of how people facing addiction may view the holistic addiction treatment approach developed by 2 Your Health, LLC. The literature review revealed that numerous holistic remedies, proposed by 2 Your Health, LLC, hold promise for treating symptoms and sequelae of addiction. Nutrition, Exercise, Acupuncture, and Turmeric appeared to be the most bioactive of all the interventions which means they are expected to help the highest number of the 53 addiction-related issues we reviewed.

Given the high prevalence of substance use disorders and their related challenges, we strongly believe that other interventions besides conventional approaches need to be employed. This belief is supported by the results of a public survey conducted by 2 Your Health in 2019.  More than 200 people were surveyed, a high majority of whom answered the specific questions on which the following statistics are based. 86% of respondents thought that drug addiction was either a serious issue or a crisis.  In the same survey, 73% of respondents thought that current treatment options were inadequate compared to the need and 96% said they would prefer an effective, science-supported, all-natural addiction recovery approach over a medication-driven one. Accordingly, the overall result of the preliminary research described above, strongly indicates that utilizing a holistic/integrative approach, whose components have empirical research support for their effectiveness, has a real potential to help people with substance use disorder, even those who may have become discouraged.

The ultimate goal and ideal next step would be to conduct controlled, human, evidence-focused research that employs the most bioactive holistic interventions above simultaneously to assess and hopefully validate their effectiveness in treating addiction symptoms and sequelae.

5. Research Limitations 

• This research did not focus on a comparison between conventional addiction recovery treatment and a holistic approach as data is generally unavailable on holistic program outcomes. Rather, the goal was to gather, assess the effectiveness, organize and present the strength of the existing evidence-based research on a number of remedies that are part of 2 Your Health’s natural addiction recovery program.
• The documented evidence-based research is clear; however, the ranking of its strength is subjective since it is the assessment of the research reviewers.
• There is confidence in the deduced assessments of the remedies’ effectiveness; however, these conclusions are subjective as they are the extrapolation of the research reviewers.
• The bioactive level of a remedy does not necessarily predict the level of the positive health impact.  It is conceivable that a remedy can be active and effective against a single major addiction symptom and provide a greater level of recovery benefits because of the breadth and depth of its primary and secondary impacts upon a person’s addiction problem symptoms.

6. References 

Bengmark, S. (2006). Plant-derived Health-Effects of Turmeric and Curcumenoids. KUWAIT MEDICAL JOURNAL, 9.