This is the fourth installment in a series of posts on non-pharmacologic approaches to alcohol and drug abuse. Previous posts reviewed the evidence for weak electrical current for reducing symptoms of opioid and alcohol withdrawal. This post is offered as a concise review of promising herbal and other natural product treatments of alcohol craving and withdrawal, narcotic withdrawal and benzodiazepine withdrawal.
Traditionally used herbal medicines may reduce alcohol craving, lessen alcohol consumption and reduce symptoms of withdrawal
Three herbs are used in Chinese medicine to diminish alcohol craving, lessen alcohol absorption through the gut, or reduce symptoms of withdrawal. Kudzu (Radix puerariae) has been used as a treatment of alcohol abuse and dependence in Chinese medicine for almost 2000 years. Animal studies suggest that Kudzu extract significantly reduces alcohol craving (Keung 1993). A recent placebo-controlled human study found that individuals who had the opportunity to binge drink significantly reduced their drinking after taking 2gm of a standardized Kudzu extract 2 1/2 hours before starting to drink (Penetar 2015).
Salvia miltiorrhiza is a widely used herb in Chinese medicine that may reduce absorption of alcohol through the stomach. Animal studies suggest that S. miltiorrhiza reduces alcohol seeking behavior in rats genetically engineered to prefer alcohol. Blood alcohol levels were reduced by 60% in rats that had been pre-treated with S. miltiorrhiza. Aralia elata is a component of a compound Chinese herbal formula traditionally used to prevent or mitigate alcohol intoxication. Animal studies suggest that the herbal A. elata is a potent inhibitor of alcohol absorption (Yoshikawa 1996). Ibogaine is a naturally occurring alkaloid extracted from the root of an African shrub (Tabernanthe iboga). Preparations of the herb have been used as a stimulant in traditional African culture for centuries. Animal studies suggest that ibogaine and its primary metabolite, noribogaine, significantly reduce alcohol consumption in rats genetically engineered to prefer alcohol. Cannibis indica, an important Ayurvedic medicinal herb, may be an effective treatment for delirium tremens, a potentially fatal complication of acute alcohol withdrawal. Case reports from as early as the mid-19th century suggest that Cannibis indica provides rapid relief from symptoms of delirium tremens when administered orally in sequential doses over a 24-hour period (Godfrey 1996) (Please see full citation in references). The findings of an open trial suggest that Mentat, ™ a proprietary Ayurvedic compound herbal formula, may reduce the risk of relapse in abstinent alcoholics (Trivedi 1999). (Please see full citation in references)
Ashwagondha, Ginseng, and other natural products may reduce the severity of withdrawal from opiates, and reduce tolerance to cocaine, methamphetamine and morphine
Ashwagondha (Withania somnifera) is an important herb in traditional Ayurvedic medicine. Anecdotal reports and findings of animal studies suggest that Ashwagondha lessens the severity of withdrawal from morphine. Mice pre-treated with Ashwagondha for ten days did not develop tolerance to analgesic effects of morphine, suggesting that Ashwagondha may have similar beneficial effects in human heroin addicts (Ramarao et al, 1995; Kulkarni & Ninan, 1997). Ginseng (Panax ginseng) is widely used in both Chinese medicine and Western herbal medicine. Animal studies suggest that Ginseng may reduce tolerance and dependence associated with the long-term abuse of cocaine, methamphetamine or morphine. Repeated use of cocaine or methamphetamine results in chronically depleted dopamine. The mechanism of action responsible for reduced tolerance observed with Ginseng may involve inhibition of narcotic-induced depletion of dopamine in the brain.
Valerian extract and a proprietary Ayurvedic formula may reduce the severity of benzodiazepine withdrawal
Valerian (Valeriana officinalis) extract may lessen withdrawal symptoms and facilitate return to a normal sleep pattern following prolonged use of benzodiazepines such as clonazepam and lorazepam. The findings of animal studies show that Valerian in doses of 12mg per kilogram attenuates withdrawal symptoms in diazepam-dependent rats (Andreatini 1994). Mentat™, a proprietary Ayurvedic compound herbal formula, has been found to reverse effects of acute benzodiazepine withdrawal in dependent mice, and may provide similar benefits in humans (Kulkarni 1994; Kulkarni 1992).
Melatonin may help individuals discontinue benzodiazepines following prolonged use
Melatonin may facilitate discontinuation of benzodiazepines when there is dependence following chronic use. In a 12-week single-blind placebo-controlled study patients receiving controlled release melatonin 2mg/night were more likely to discontinue benzodiazepines compared to patients taking a placebo (Garfinkel 1999). Patients taking melatonin reported significantly greater improvements in subjective sleep quality compared to the placebo group. Most patients who continued to take controlled release melatonin at night remained off benzodiazepines six months after the end of the study. In view of these findings individuals who are attempting to taper and discontinue benzodiazepines following prolonged use for insomnia should be encouraged to take a nightly 2mg dose of controlled release melatonin. The above findings should be viewed in the context of a 2105 systematic review and meta-analysis that found no evidence that melatonin facilitated benzodiazepine discontinuation and inconsistent effects of melatonin on sleep quality (Wright 2015) .
Polyenylphosphatidylcholine (PCC) may reduce liver damage in chronic alcohol abuse
Polyenylphosphatidylcholine (PPC) is a natural product that is believed to reduce induction of liver enzymes associated with alcohol intake. Animal studies suggest that PPC reduces liver damage when taken before alcohol consumption (Lieber 1997; Aleynik 1999). HepatoPro ™ and other commercial products containing PPC are currently used before drinking in West European countries to protect the liver from damage.
Supplementation with fatty acids may reduce the severity of alcohol withdrawal, and improve mood and overall cognitive performance
Chronic alcohol use causes depletion of Omega-3 fatty acids and related molecules in nerve cell membranes, which in turn, may predispose alcoholics to depressed mood and other menta; health problems (Hibbeln 1995). In a small double-blind placebo-controlled trial supplementation with Omega-6 fatty acids in the form of Evening Primrose oil reduced the severity of withdrawal from alcohol, normalized liver enzymes, and significantly improved cognitive performance (Glen 1984). (Please see full citation in references).
Most studies on herbals and other natural supplements for reducing alcohol or drug use, reducing craving and managing withdrawal were small, conducted many years ago and have not been replicated by large placebo-controlled studies. Nevertheless, there is evidence that some herbal medicines widely used in Chinese medicine, Ayurveda (the system of medicine used in India) may significantly reduce craving and consumption of alcohol and may reduce the severity of alcohol withdrawal. A natural product called polyenylphosphatidylcholine may reduce liver damage in chronic alcohol abuse and fatty acid supplementation may reduce the severity of alcohol withdrawal while improving mood and overall cognitive performance. There is also evidence that the herbals ashwagondha, Ginseng, and select other natural products may reduce the severity of withdrawal from opiates, and reduce tolerance to cocaine, methamphetamine and morphine. Valerian extract and a proprietary Ayurvedic formula may reduce the severity of benzodiazepine withdrawal however, melatonin is probably not effective for facilitating discontinuation of benzodiazepines or improving sleep quality following chronic use.
If you are struggling with an alcohol or drug abuse problem it is prudent to consult with a mental health provider or an addiction specialist before considering any natural product supplement.