In The News

From time to time our facility, doctors and clinicians are featured in the news/media, published in articles, or featured in documentaries. Look for excerpts here to follow our team In the News.

New Press Release Featuring The Launch Of Our Women’s Only Program

One of Arizona’s leading drug and alcohol addiction recovery centers, The River Source, has announced the creation of an all-new residential treatment program that specifically caters to women. The new program will be located in downtown Mesa, Arizona, the third-largest city in the state.

The River Source Women's Program Press Release“We’re excited to offer our unique model of healing to an exclusively female audience,” The River Source CEO Phill Westbrooks said. “Studies show that women are more likely to complete a treatment program within a single-gender environment. Plus, this program will allow us to provide some services that aren’t available at our co-ed adult residential facility in Arizona City.”

In addition to integrative medical detox and holistic therapy services, the new program for women 18 years and older will include accommodations for pregnant mothers, as well as couples treatment and family therapy sessions. The women-only compound in Mesa features such amenities as a yoga ramada, dry sauna, basketball hoop, outdoor fire pit, lounge area with television, quiet seating areas and beautiful desert landscaping.

“We chose the Mesa location because of its year-round warm weather, sunny skies and great views of the nearby mountains,” Westbrooks said. “Hiking excursions will be offered as part of our holistic therapy services, since exercise is a key component of healing and recovery.”

The River Source accepts clients who live in Arizona and all over the nation, offering customized recovery plans and the ability to treat co-occurring disorders. Located roughly 20 minutes from Phoenix Sky Harbor International Airport, the new women’s program will house clients for up to 90 days. The River Source also offers a recovery guarantee, meaning if any client completes 90 consecutive days of inpatient treatment or the Full Continuum of Care and relapses within one year, they can return to The River Source for additional treatment free of charge.

Founded in 2003, The River Source also boasts a co-ed residential treatment facility in Arizona City (about an hour’s drive from the women’s facility) and an intensive outpatient center near downtown Mesa.

Learn More About Our Women’s Only Treatment Program

Revived to life: A Case of Methadone Detox

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Revived to Life: A Case of Methadone Detox (Chad Goetz, ND), as seen in Naturopathic Doctor News & Review, December, 2008 Issue

With dazed eyes, a dribbling of saliva coming out of her half-opened mouth, a greatly disheveled appearance and extreme tooth decay, all 84 pounds of Shannon slowly shuffled into the clinic at The River Source Naturopathic Treatment Center in March of 2007 as a last ditch effort to help break her devastating cycle of opiate dependency. Just a few short hours earlier, she had been discharged from a local Phoenix, Arizona area hospital for bilateral pneumonia, with additional diagnoses of malnutrition, depression, anxiety, heart palpitations, hyperthyroidism, and opiate withdrawal. Having unsuccessfully attempted to get off of the powerful and long-acting opiate methadone at local community detox facility prior to her admission to the hospital, her family researched the alternatives and discovered The River Source. Upon hospital discharge they brought her directly to us for detoxification and treatment. Admittedly, I had great trepidation to accept her as a patient upon seeing her extremely ill state, and yet in that moment I knew that if something was not done for her that the possibility that she would die within the ensuing weeks was very high, as neither the hospital nor the detox facility had afforded her the level and type of care that she really needed to be given a new lease on life. My colleague Dr. Dave Arneson, N.D., who also worked at The River Source at that time, and with whom I shared the responsibility of treating Shannon during her stay, later commented that it was by far the worst case of a methadone withdrawal he had ever seen.

Medication overload and adjustment, the allopathic standpoint

Such was the initial introduction I had to Shannon, a 35 y/o female who had a 5 year history of opiate use which began with prescriptions of oxycodone and morphine by her physician for the treatment of fibromyalgia which was diagnosed in 2001. At the height of using these medications, she was taking 60mg of oxycodone BID along with 15mg of instant-release morphine about every 3 hours for breakthrough pain. Because of this regimen, opiate dependency quickly became an issue as her daily routine began revolving solely around the use of the medications. She eventually lost her job and friends and became, in her words, a hermit—living alone in her apartment, rarely venturing out unless absolutely necessary. Eventually the oxycodone and morphine combination was abandoned when she was switched over to the extremely potent opiate methadone—dosed at 160mg per day over the course of two years before coming to the realization that she wanted more out of life.

Shannon came to us on the following oral medication regimen which was initiated by her hospital physicians: Effexor XR 75mg QD for depression, Buspar 15mg BID also for depression, Ativan .5mg TID for anxiety, Megace 40mg QD for appetite stimulation, Pepcid 20mg QD for possible stomach ulcer, methadone 5mg BID to abort the opiate withdrawals, and Levaquin 750mg QD for pneumonia. Upon arrival to the River Source, the methadone was immediately discontinued, as was the Effexor and Buspar. The main reason for discontinuing the antidepressants—aside from philosophically disagreeing with the need for antidepressants in general—is that depression is certainly to be expected in this situation, as anyone experiencing what she was in that moment could be nothing but extremely disheartened and depressed. Trying to mask this with more chemicals is extremely counterproductive and only potentiates the mentality of relying on medications to address deeply rooted issues—a mentality that is, of course, extremely common within the drug addict population.

Given that extreme anxiety is a very common symptom of opiate withdrawal, and given that I have had only limited success with specific homeopathics for this issue with these cases in the past, I agreed to keep her on the prescribed Ativan regimen, while adding Xanax 2mg QHS to help facilitate sleep—a medication similar to Ativan, but generally with more sedative potential, as persistent insomnia is always one of the more troubling symptoms of withdrawal. Phenergen 25mg q6-8h as needed was also added initially to help afford some temporary relief from nausea that would soon begin. The remaining medications of Megace, Pepcid, and Levaquin were all discontinued later on during her first week in treatment.

From a physical standpoint, Shannon presented with severe cachexia. Initial vital signs revealed a blood pressure of 98/68, temperature of 99.9, respirations 16, and pulse 80 with regular rate and rhythm. A focused physical exhibited normal heart sounds, no murmers, clicks, gallups, or rubs; a soft, non-tender abdomen with bowel sounds in all 4 quadrants; and diminished breath sounds in both lungs with mild crackles in the bases bilaterally, a finding which resolved over the ensuing weeks. Her vitals remained stable throughout her stay, with the exception of tachycardia (which returned with the removal of the methadone), which was confirmed to be due to hyperthyroidism with subsequent laboratory evaluations and which was treated after her stay at the River Source.

Opiates and the Opiate Withdrawal Syndrome

Oxycodone and morphine are both potent opioid analgesics derived from the opium poppy (Papaver somniferum) with a high potential for physical dependency and abuse. Although the opium poppy has about 25 different alkaloids, it is only codeine, morphine, thebaine (from which oxycodone is derived), and papaverine which exhibit the most biological activity upon the central nervous system.1 The synthetic opiate methadone was developed in Nazi Germany initially for military use as an analgesic substitute to morphine on the battlefront in the late 1930s.2 Despite the fact that the Germans concluded that methadone was too toxic and had too much addictive potential for general use, the drug made its way into the United States in 1947 as an inexpensive analgesic. Although methadone continues to be used for pain management by allopathic physicians, it is more well-known for its use in aborting the opiate withdrawal syndrome of heroin addicts, a purpose for which it has been employed in the United States since the 1960s—this despite the fact that a detox from methadone is far more difficult than one from heroin.

Typically, opiate withdrawal begins within 6-12 hours after the last dose in the case of the shorter-acting opiates, whereas with the with long-acting opiate methadone it may take up to 24-36 hours to begin noticing symptoms. The duration usually lasts around 7-10 days in the case of heroin, morphine, hydrocodone, and oxycodone, whereas the withdrawal of methadone lasts a minimum of 14 days, but it is not uncommon for it to continue for up to 4-8 weeks without adequate treatment. During the acute withdrawal phase, all of the following physical symptoms are usually exhibited—and Shannon was no exception: rhinorrhea, anorexia, nausea, vomiting, diaphoresis, lacrimation, bone pain, diffuse muscle aching, abdominal cramping, leg cramping, piloerection, yawning, diarrhea, anxiety, tachycardia, extreme restlessness, and insomnia. This conglomeration of symptoms is so incredibly uncomfortable for most individuals that they simply give up and go back to using opiates just to feel normal. With naturopathic and homeopathic treatment, however, as Shannon’s experience exhibits, this unfortunate conclusion for many simply does not need to be the case.

The Naturopathic and Homeopathic steps taken on the road to recovery

From the start, it was clear that Shannon would require a much higher level of treatment than is normally necessary in the vast majority of opiate withdrawal cases. The first step was to provide all that we could nutritionally via the intravenous route, given her anorexia. Her first treatment involved 500mL lactated ringers for rehydration with 4cc (500mg/mL) of extra magnesium to help relax her (which provides exceptional temporary relief to anxiety, restlessness, and muscle cramps in these cases), followed by a 250mL sterile water nutrient IV bag with the following ingredients: 2cc B-complex, 2cc Dexpanthenol (250mg/mL), 2cc Pyridoxine (100mg/mL), 3cc Magnesium (500mg/mL), 2cc Calcium gluconate (20mEq/mL), 20cc Ascorbic acid (500mg/mL), 1cc Folic acid (10mg/mL), 2cc Cyanocobalamin (1000mcg/mL), 5cc Selenium (40mcg/mL), and 5cc Zinc (1mg/mL). This combination of lactated ringers followed by a nutrient IV was continued on a daily basis during the first month of treatment. In addition to this was the limited use of separate IV lipid drips to provide a source of fats and calories, as well as the periodic alternating use of 20cc of dextrose 50% and 60cc of free amine proteins added in to her nutrient IV bags. These protocols produced noticeable results in only the first week as evidenced by the obvious improvement in her skin color, increase in energy, and mental affect. As her overall health status improved, the frequency and intensity of the IV regimen was reduced significantly during the second month of her stay to one basic 250mL nutrient IV (at half the strength of the above protocol) three to four times per week.

In addition to the heavy use of IVs was the use of frequent doses of homeopathic Opium. I have attempted countless times to provide homeopathic relief to opiate withdrawal cases and have only a few times observed the ‘strange, rare, and peculiar’ symptoms that clearly pointed to specific remedies such as China officinalis, Phosphorus, or Arsenicum album, which for those cases did extremely good work. For the vast majority, however, an individual’s experience involves the symptoms as described above without any uniquely defining characteristics. In over a year and a half of attempting to deal with these difficult cases, and feeling that each time I was giving apparently well-indicated remedies that ended up doing virtually nothing, I became frustrated and ultimately decided to try homeopathic Opium as a last resort. And it is unfortunate that I had not tried it much sooner, as the results were quite impressive. Clearly, this is more isopathic than homeopathic, but in an acute opiate detox anything that provides such obvious relief can only be welcomed. This is not to suggest that the Opium instantaneously removes every symptom, but it affords great relief for most of them in my experience. The more resistant symptoms are the anxiety and insomnia, which was also the case for Shannon. She was started the first night on Opium LM20 in a 4oz dropper bottle dosed 2 droppers under the tongue every 15-30 minutes while awake. This may appear to be an extreme dosing regimen, but without such repetition the withdrawal quickly regains its footing and comes back with vengeance. At one point Shannon had dropped the glass remedy bottle and went almost an entire day without it, and that same night she had a return of recurrent and powerful episodes of vomiting bile and extreme diarrhea. Once the remedy was restarted, the troubling setback of symptoms resolved. Shannon required steadily increasing strengths of Opium over the course of two months, moving from LM20, to LM30, to LM40, and finally to LM50 after which point it was discontinued entirely as she was restored to health. Usually in methadone detox cases, an individual only needs to be on the Opium for about two, maybe three weeks, and usually at a lower strength than what Shannon required—but given the severity of her situation overall, she was unique in requiring higher and higher strengths given over a longer period of time.

By the end of her first week, Shannon was improving such that she could tolerate a limited amount of food without vomiting, so Dr. Arneson was able to begin her on his oral supplement protocol for opiate detoxification cases. This includes a comprehensive amino acid formulation (L-tyrosine, L-lysine, L-methionine, and 5-HTP) to help restore the neurochemistry circuits of the brain by balancing out the monoamines (serotonin and dopamine) and the catecholamines (norepinphrine and epinephrine), a high-potency multivitamin / multimineral, fish oils to support general cellular integrity and functionality, and an adrenal support formula to help facilitate the restoration of the hypothalamus-pituitary-adrenal axis that is disrupted in cases of long-term opioid abuse. Additionally, a natural source of L-dopa is utilized in the form of Mucuna pruriens to further enhance the restoration of the dopamine neurochemistry circuit. This protocol, along with the IVs, is very important in helping to rebuild an individual on the nutritional, biochemical level, as they are always depleted when they come in for treatment.

Treatment resolution

As the saying goes, a journey of a thousand miles begins with a single step. By agreeing to come to the River Source in March of 2007 Shannon took the first step, and only two short months later she had completed the most dangerous terrain of her long journey toward sobriety from opiates. Through the focused use of the appropriate naturopathic, homeopathic, and allopathic therapies, combined with the utilization of the 12-step approach to drug addiction and counseling that was provided, Shannon, who now weighed 117 pounds, found herself restored to a level of physical, mental, emotional, and spiritual well-being she said she had not enjoyed for years. Shortly after being discharged from our care, Shannon reentered society as a very happy and productive member—evolutionary leaps above the decrepit state she occupied before being introduced to our medicine, to which she remains ever grateful.

References:

1) “Opium.” www.wikipedia.com

2) “Methadone.” www.wikipedia.com

Author information:

Chad Goetz, ND, graduated from SCNM in 2004 and shortly after graduation began to work with drug recovery specialist Dave Arneson, ND. Since May of 2007, he has been the Medical Director at the River Source and routinely performs medical detoxes from all drugs of abuse. Homeopathy is his passion, and in seeking to advance his application of Hahnemann’s methods, he has studied with Jeremy Sherr, R.S. Hom, as well as the highly regarded Master Homeopath Vega Rozenberg, R.S.Hom at his ESSH School of Homeopathy.

Contact information: 108 East 2nd Avenue, Mesa, AZ 85210. Phone: 480.827.0322. Email: info@theriversource.org. Website: www.theriversource.org.

New: Constitutional Hydrotherapy

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Constitutional Hydrotherapy Cho Long Elizabeth Kim, NMD

Constitutional hydrotherapy is a special technique in which alternating hot and cold compresses are applied to the torso and abdomen which greatly improves recovery from various illnesses, both acute and chronic by stimulating our vis medicatrix naturae, our own body’s natural ability to heal itself.

During the treatment the patient lies comfortably on a soft table while hot towels are applied over the upper torso to warm the body. Once the body is warm, a single cold towel is applied in exchange for the hot one. This process occurs twice: once on the front of the body, and again, on the back.

The hot compress causes local vasodilation (widening of the blood vessels), causing blood to be drawn away from the core and to rise toward the blood vessels closer to the skin. Then, the alternating cold compress causes vasoconstriction (narrowing of the blood vessels) which drives the blood back into the core of our body. In addition, the cold compress (also called a warming compress) is kept on the torso for 10 minutes, allowing body to warm it. This process increases circulation and immune function. Some sources state that this warming process increases white blood cell production and lymph flow throughout the body. This increase in circulation is very beneficial for detoxification and excretion of toxins from the body, and increasing tone of the vessels.

At the River Source Treatment Center, we add another dimension to the traditional constitutional hydrotherapy to enhance its benefits. Hydrotherapy researchers have shown that an increase in blood flow is delivered to the underlying organs in response to stimulation of the skin above it. For this reason, electrodes from a sine wave machine are applied to the skin above the adrenal glands and abdomen to deliver a mild, soothing current to those organs. Stimulating the adrenals and intestines increase the body’s ability to recover from stresses at an optimal rate. The adrenal support is vital for our clients because prolonged use and abuse of pharmaceutical and illicit substances have been known to decrease the function of this crucial gland, responsible for the direct production of vital hormones in our body, and linked to our brain’s signaling pathways (via the Hypothalamus-Pituitary-Adrenal Axis). Long term use of Opiates and other substances have also been known to decrease immune function, especially by disrupting the intestinal flora and its tissue: the Gut Associated Lymphoid Tissue (GALT) and Mucosa Associated Lymphoid Tissue (MALT), which account for 70% of our body’s immune system. Enhancing the function of the GALT and MALT would allow the body to protect itself from foreign pathogens so that it may divert more of its energy to healing and rebuilding the body during their stay at the River Source.

Patients who receive Constitutional Hydrotherapy report improved sleep, increased vitality, decreased recovery time from colds and flus, and an overall peaceful and serene detoxifying experience. As with all therapies, consult your Naturopathic Physician before receiving constitutional hydrotherapy and receive all treatments under a physician’s supervision for your safety.
If you or a loved one is looking for treatment for any type of substance abuse, please call NOW: 1-888-687-7332 or 480-827-0322 (your call is confidential)

Are you tough enough to be my parent?

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ARE YOU TOUGH ENOUGH TO BE MY PARENT?

Are you tough enough…

I am a son or daughter who needs guidance. I don’t need a friend. Friends can be manipulated and it makes me feel unsafe.

I don’t need you to care take me, as I get older it keeps me from growing up and enables me to not be responsible.

I don’t need you to rescue me when I do something wrong. How else will I learn the difference between right and wrong? When this happens, you give me permission to do the same behaviors over again.

I don’t need you to yell at me because when you yell at me I won’t be listening. If I do something wrong teach me what I did and help me to do better.

Don’t baby me. Babies always get their way and I’ll take advantage of you. And speaking of getting my way, it’s not something I need all the time. Nobody likes an adult baby. They are never satisfied with life and are easily bored. They will become emotional vampires and emotionally drain those around them. So don’t baby me! (When we baby our children we turn them into the very babies others will resent later in their lives).

If I don’t receive these lessons by the very people who should teach me them, I have to learn them from those who are not so invested in me as I get older. Judges, Jail, or worse yet, prison, Probation Officers or Parole Officers. I don’t want this.

I will get angry with you——————————————————-Do it any way! I will fight you every step of the way—————————————-Do it anyway! I will try to make you feel sorry for me————————————-Do it any way! I will blame, try to manipulate you and make you feel guilty———-Do it any way, Do it because you love me enough to challenge me to make the right decisions, to do the right things and to be a better person in my life. The truth is I love you and although lessons are hard I must learn them and with you at my side I know you will gently guide me in the direction I need to go.

SO AGAIN I ASK YOU, ARE YOU TOUGH ENOUGH TO BE MY PARENT? Signed: Your Son or Daughter

IF SOMEONE YOU LOVE HAS AN ALCOHOL OR DRUG PROBLEM, STOP LOVING THEM TO DEATH AND GET THEM HELP. CALL River Source at 1888-687-7332; info@theriversource.org or JOHN A. CARTER, L.I.S.A.C. (602)-576-9548 OR E-MAIL HIM: jacarteraz@msn.com

Methadone/Opiate Withdrawal

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Methadone/Opiate withdrawal Dr. David Arneson, NMD thesourcenmc@msn.com ‘There is no free lunch.’ Last updated 10/01/08

Some 6 years ago I wrote this original document in response to an endless stream of questions involving methadone detox. How it got imbedded on the net I don’t know. I did not write this article to talk you out of doing methadone—especially if methadone gives you some sense of normalcy in your life. Yet is rare over the long term for individuals to want to stay on any mind altering drug—and methadone is certainly mind altering. If you are on any opiate therapy your biochemistry/neurochemistry is impaired. This impairment can last an extended period of time even when one chooses to end their relationship with the opiate treatment. I have spent the last 8 years of my life assisting patients in detoxing from methadone and opiates as well as other drugs and alcohol. I have never seen any thing close to a death in doing so. This is a testament to utilizing nutritional treatment as the mainstay of treatment. One must look at this as repairing the house that has been damaged in the storm—and the only repair materials that the body/mind knows comes from nutritional biochemistry.

I believe in the search for truth…the following monograph is what I know to be true about the use and withdrawal from methadone. I also understand that in life, the truth is constantly evolving. My 22 years on the road to recovery probably taints my judgment somewhat…but friends—I know recovery from the bottom rung. I’ve written countless e-mail replies to those of you who wish to discontinue methadone. In order to save myself time I’ve decided to write as much as I can on one, or two, pages…the truth as I see it…to assist you in your endeavor. I will be adding and subtracting as more information is made available. Certainly, you may perceive your truth to be different. If you think that going to the methadone clinic every morning to get your dose for the rest of your life…gives you quality of life…then read no further and God bless you. I assure you, the standard medical establishment does not have an answer for withdrawal. In fact, the new way of thinking is that many of you will have to be on methadone for the rest of your lives. Nothing could be farther from the truth. They will try and convince you that sudden withdrawal will cause your untimely demise. Another falsehood, although the truth is you may feel like you’re dying. I consistently work with people stopping cold turkey and have better luck than lowering the dose over time. I’ve had an fewer than 2% of our in-house methadone withdrawal cases leave the program early…all have gone cold turkey from 60-300 mg per day…Many do this without the aid of other mind-altering prescriptive drugs…even though I’m licensed to prescribe these drugs. There are exceptions, for those that I detox out-patient, and for those that are on other medications when they come in for treatment…I’ll cover those medications in the following paragraphs. Personally, I urge all to consider in-house detox for methadone…especially if going cold turkey. Although in my personal experience I’ve never seen any advantage in lowering the dose over time. Especially, if one is at 45 mg or less per day. Methadone Detox can normally be accomplished in 3-4 weeks. For information on natural methadone detox, in-patient, Please call 602-276-3999 and talk to the staff at World Addiction and Health Institute…the web site is being generated as I write this…The most important issue in treatment for withdrawal is not so much treating the disease state but treating the individual. One specific protocol designed to treat a disease is standard medicine’s answer to all disease states. This is mechanistic medicine. It does not take into account our genetic variability…we respond to treatment in different ways…not just through biochemistry, but also on the emotional and spiritual levels. For the last 4 years I’ve been using nutrition—Intravenous and oral—to rebuild and repair the biochemistry pathways in the body and mind. Over four years experience —this includes heroin, and all other street drugs, alcohol, and prescription medications–has taught me that natural detox works 100 times better than detox formulated and predicated by the use of other mind altering chemicals. It is also important to recognize that there are many of you that were prescribed methadone for chronic pain. Yet one must recognize that the end result is the same—and therefore the remedies for withdrawal are the same.

One more important point is that emotional and spiritual supports are necessary in this journey back to health. It would be rare that a person is not stretched to the absolute limit—body, mind, and spirit–in the process of withdrawing from methadone. Those who chose to do this alone, rarely succeed. The support of family, friends, or even the 12-step programs are important adjuncts to this journey.

One final point needs to made about the use of methadone. There are those that were put on methadone for pain management. This occurs because opiates in general—while good acute therapy—are not good choices for chronic long-term pain. The body adjusts to opiate therapy by down regulating opiate receptors and the patient will eventually build a tolerance to the standard opiates like vicodin, percocet, or oxycontin just to name a few. Methadone is the last ditch effort to control pain…unfortunately, the use of methadone usually creates more long-term health problems. The other unfortunate aspect of taking someone off methadone—those that have been using it to treat chronic pain—is what will be used to control pain in the future. There has been some movement in treating pain with anti-depressants with poor results. Furthermore, long term opiate use eventually create what is termed the opiate pain syndrome…which simply is the fact that the receptors are so down regulated that the opiate have nothing to act on…and that’s why opiate therapy doesn’t work over the long term…For many of those with chronic pain, choices have to be made…and the withdrawal from methadone will be especially trying…but it can be done following the protocols listed below…as your body heals and the receptors are synthesized in the body your own enkephlins and endorphins (natural body opiates) will start to be interactive in pain management…this may not be enough…yet many cases of chronic pain will subside if serotonin levels in the brain can be increased—the reason for doing amino acid therapy is to increase these levels. Anti-depressants don’t increase the production of anything over the long term…in fact it is well known that in the long term they decrease levels of neurotransmitters such as serotonin. Amino acids therapies work well on most cases of fibromyalgia even though many of these patients will fall victim to the use of methadone which just creates more problems. The good news is that if a fibromyalgia patient will start the following protocols to get off methadone…these are the same basic protocols for treating Fibromyalgia…

Those who choose to eliminate methadone from their lives must be made aware of the post acute withdrawal syndrome…in the literature this is called PAWS…if one just quits methadone, or any other drug or alcohol, it takes the average person 6 months to two years to reach some sense of bio/neurochemical normalcy…that’s if one does nothing…one must look at this as remodeling or repairing the house that has been damaged in the storm…the body/mind house only knows nutrition…for sure one must focus this nutrition to repair and rebalance these bio/neurochemical pathways as quickly as possible…step downs will benefit from some level of nutritional input…the next few paragraphs will line that out for you… Many have contacted me via the internet and I have responded to each and every e-mail that I have received. I will continue to do so but have written this addendum to address the issue of proper supplementation to reduce the severity and time associated with methadone withdrawal. As I stated in my original article-there is no free lunch—but there are ways of minimizing the time and discomfort.

For those who are stretched to their financial limits the following is the basic minimum requirements and many over the internet succeed with this simple list of supplements

1) Go to the health food store and get a product called Emergen-C…this is a powdered electrolyte drink, which also contains vitamins and minerals, do three of these drinks per day…THIS IS ONE OF THE MOST IMPORTANT ITEMS IN EARLY DETOX…this will treat dehydration and the loss of critical electolytes during the early phases of detox

2) Get the best quality protein powder you can and do 3 doses per day mixed with fresh fruit or veggie juices

3) Get flax seed oil in capsules, or fish oil, these are the omega essential fatty acids you will need to re-stabilize membrane function of all cells…they also are essential in chronic pain patients to reduce inflammation…do 3000 mg twice per day

4) Get a good quality multivitamin in capsular form…do the recommended daily dosing The above will save my a lot of future pounding on the key board—yet I assure you I will continue to respond to each mail…with respect—dr dave

1) Most Methadone clinics are for profit, private enterprises, do you really think they want you off the methadone. The cost of a dose of methadone is about $1.00…what are they charging you?

2) Since all associated therapists and counselors that work the methadone clinics are trained and get their information from the standard medical establishment…do you really think they know the truth…no one is saying that they are not caring individuals–but they don’t know the truth anymore than the people who prescribe the medication to you. If fact most of them think we’re idiots because we doubt and ask questions. The fact is that we do not know the long range effects of methadone on the human body and mind…many are now thinking that the longer you are on the methadone the more profound, and possibly irreversible these changes may be…In fact we don’t know the exact mechanism of action of many psychotropic drugs—just review the Physicians Desk Reference on Prozac…along with the countless other caustic chemicals we insist on putting in the human body.

3) Methadone is one of the most physically dependent medications invented in the 20th century. The reason for this is a) its long half-life (24-36 hours)…b) it is a synthetic morphine, c) the diabolic symptomology associated with withdrawal and the length of the withdrawal symptoms. Methadone, like all opioids creates profound changes to gastrointestinal function… In layman’s terms this means that regardless of the food you eat–absorption of the vital nutrients is impaired. If nutrients cannot be absorbed in sufficient quantities and associated quality…all biochemical pathways in the body are affected negatively. Chronic fatigue, sleeplessness, aches and pains, depression, anxiety, are all signs and symptoms of these deficiencies. Methadone also has profound effects on brain neurotransmitter production and function. It is also known that it creates havoc in what is called the hypothalamic-pituitary-adrenal axis…which accounts for the chronic fatigue. And like all opiates, methadone down-regulates opiate receptors in the human body thus the long lasting aches and pains associated with withdrawal. Methadone withdrawal is particularly insidious because, left untreated; these symptoms can last literally for months. Also the longer you are on methadone the more profound these changes in body and mind function.

4) Regardless of the level you decrease the dose before quitting…you will suffer some level of withdrawal…Frankly, I’ve never been able to discern much difference in the withdrawal intensity between 1 mg or 80 mg…it’s always difficult. The withdrawal is unique to each individual…I’ve had some come off 65 mg or more, and while uncomfortable, hardly seem to break a sweat. Others coming off low doses and be in pure agony. One must treat the individual, not the disease.

Nutritional treatment is essential in the recovery and withdrawal phase of any type of drug or alcohol dependency. To clarify nutritional treatment, consider the following statement:

The body on methadone, or any other mind altering drug or alcohol, is like the house that has been damaged in a storm. If you were repairing the house what building materials would you need? You would need lumber, sheet rock, shingles, and etc for the major supplies…these are the equivalent of the bodies need for protein, carbohydrates, and fats. How would you hold everything together?…nuts and bolts, nails, and screws—these are the equivalent of the bodies need for vitamins and minerals. To make the repairs we need the proper tools to cut the lumber and fit it into place…one would need the saws, the equivalent of the bodies production of enzymes…these are made from the proteins we eat…one can draw analogy after analogy to explain the necessity for nutritional treatment to facilitate one back to health…only one thing needs to be clearly understood…you put back into the body the things it needs to come back to health.

Any nutritional therapy should be adhered to for at least 90 to 180 days regardless of how you feel. Just like it takes time to alter profoundly the body’s biochemistry with drugs…it takes time to repair with proper nutrition. Oral nutrition is best but often is difficult for those in their first week of detox and recovery. Proteins, complex carbs, and essential fatty acids are necessary building blocks for repair and return of proper function of organ systems and brain neurochemistry. Vitamins and minerals are “co-factors and co-enzymes” which work on the building blocks to do repair and rebuilding. Additionally, it is always counter-productive to move from the complex to the simple…my philosophy is to start simple and move to the level of complexity that works for you…remember all patients are unique in the way they process nutrients and in their ability to maximize therapy. The following I suggest for those who wish to detox out-patient:

1) Pharmaceuticals: Vistaril 50-100mg…three times daily…this is a sedating antihistamine which helps with anxiety and sleep…down side is that after 10 days or so it loses its therapeutic efficacy; phenergan 25 mg tab…one every 6 hours for nausea and cramps. I may use these medications on my out/in-patient clients depending on the severity of symptoms. Imodium A/D works well for diarrhea. In some cases, especially in-house, we do utilize low dose benzodiazepine therapy—not without some reticent—these are drugs that have a high degree of potential for addiction…one must go here with caution

2) Intra-Venous Nutritional therapy: In patient or out-patient…typically every day for the first 5-6 days, than every other day until the symptomology has subsided. These nutrient bags can contain proteins, vitamins, electrolytes, and other elements necessary for the body-mind to heal. The advantage of IV therapy is that all essential cofactors bypass compromised gut function. Only when the healing occurs will the symptoms of withdrawal disappear totally. Diarrhea is uncommon in those that receive IV nutrient therapy…but for those not so fortunate, Imodium A-D seems to work well in most. If your are a medical professional and wish I.V. treatment protocols contact me at thesourcenmc@msn.com

3) Oral nutrition: Increase the right proteins!!!!Proteins are the building blocks for neurotransmitters and neurotransmitter receptors…as well as the building blocks for your natural opiate receptors · For 3 weeks you must remove all red meats from your diet. Red meat has chemical components that increase inflammation and pain. Fish, chicken, eggs are good sources of protein. If you are having a hard time taking in solid foods go to a health food store and buy protein powders that can be made into smoothies or drinks. You absolutely must have increased protein intake…proteins are the building blocks for all enzymes, neurotransmitters, and enzyme receptors in the body. No chemical works in the body without receptors. Just like opioids have to have opioid receptors—which are down regulated during methadone use—this is the reason people have long-lasting pain and aggravation coming off methadone…this isn’t much of a problem with heroin use because of it’s short half-life…proteins are essential for the repair work in recovery…I now use a formulation that I specifically formulated myself. This formulas are called Tyrosine Plus and Tyrosine/Mucuna…generally the formula Tyrosine with Mucuna works well for those coming off of methadone, methamphetamines and benzodiazepines or any drug for that matter… I treat all my methadone withdrawal patients with this formula…the Tyrosine Plus and the Tyrosine with Mucuna formulas have all the amino acids listed below…the advantage is that you get the same dosing with fewer capsules to take and generally the formula will be cheaper over all than the singular amino acids. For those that choose to find their own supplements that following are suggested

  • L-Methionine—a sulfur bearing amino acid…necessary for the production of S-Adenosyl-methionine (SAM-e)…SAM-e is a necessary cofactor in the production of the master neurotransmitters—serotonin, dopamine, adrenalin, and nor-adrenalin…this must be added to any amino acid therapy directed at rebuilding neurotransmitter production and function…500 mg—two twice per day
  • 5-HTP the basic building block to produce serotonin…100-150 mg twice per day
  • L-tyrosine the basic building block for dopamine, norepinephrine, and epinephrine—1000-1500 mg twice per day
  • Increase your intake of raw fruits and vegetables…you get little or nothing from canned foods…fresh fruits and veggies are loaded with fiber which help bind and remove toxins from your body…they also normalize gut function
  • Stay off candy, and other sugar heavy foods
  • Drink lots of good water, green teas are good for the antioxidants and anti-inflammatory properties…no cokes or soda waters for three weeks
  • When capable you must start exercising…swimming is best because it is low impact exercise…yoga…tai chi…walking daily…detoxing or otherwise…exercise is a normal component of good health

 

Supplements: Some need less and some more…remember the efficacy of all nutrition and supplement use is ultimately guided by your genetics…and we are all different to some degree…This is the value of seeing a good Naturopathic physician in the state you are in…The fact is that very few Medical Doctors know anything about nutrition…70%-75% of the standard medical schools in this country have absolutely no nutritional classes what-so-ever…in the other 25 %–nutrition is often a 14-20 hour block of education and this is commonly an elective…Naturopathic physicians that are educated in a medical school environment are taught nutrition extensively with the associated biochemistry.

I use the following with all types of drug and alcohol recovery….

  • Multivitamin with a strong mineral component: in gel caps only…an excellent quality multivitamin is absolutely necessary…remember that vitamins and minerals are cofactors, coenzymes for repair, healing, and normal function of the body…most times I have patients double up on multivitamins for the first 3-4 weeks
  • Mineral complex: see above
  • Fish oils, or flax seed oil: necessary for repair and proper function of cellular membranes…anti-inflammatory…these need to be mixed omega 3, omega 6, omega 9 oils—4000 to 6000 mg per day in split doses…although some can be purchased as liquids and mixed with your smoothies.
  • If you don’t do the drinks…get proteins as free amino acids…double up
  • L-Glutamine 500mg caps…at least 2000-3000 mg per day…split the dose so that your doing it at least twice per day…helps heal the gut and the building block for GABA…the primary inhibitory neurotransmitter…helps slow things down…Do not take GABA as a supplement…GABA is make in the brain…when out side the brain the molecule is to large to cross the blood brain barrier…the building block for GABA is L-Glutamine or Glutamic acid…these building blocks readily cross the blood brain barrier.
  • Valarian Root 450 mg: Botanical that reduces anxiety and helps one to sleep…Kava, Jamaican Dog Wood, Lemon Balm, Avena are all nervine botanicals which can be used together or by self…I find the doses for each individual varies but typically 1000 to 1500 mg every 4 hours.
  • Melatonin…dosages vary…this is a hormone released from the pineal gland in the human body at night time for sleep…this is essential for those coming off opioids…in my experience as little as 1 mg to 30 mg has been effective…do what you have to do…I’ve had addicts coming off $100.00 a day habits sleep 4 hours the first night…start low and add 3-5 mg every half-hour till sleep…research on healthy volunteers using up to 100 mg of melatonin in a single dose shows little side effects…Melatonin is also known as a very strong antioxidant with 1000 times the potency as Vit E…Take only at night when you would be going to bed at the regular time…the room must be dark…that’s the way this hormone is released in the natural state…
  • Full Spectrum antioxidants: relieves inflammation and helps normalize inflammatory pathways and reduces damaging molecules (free radicals) present in the system while detoxing
  • Vitamin C: 2000-3000 mg per day divided doses…
  • Reduced L-Glutathione 300mg per day: Helps liver detox metabolites of methadone…Detoxing agents can be found in many products…most in combinations…
  • Adrenal Support: Research has shown that methadone, and drug use in general, has profound effects on the adrenal glands. In fact, research shows that there is a profound negative effect by methadone on the hypothalamic-pituitary-adrenal axis. This is why those that withdraw from methadone have protracted fatigue and problems with anxiety and insomnia. I often use freeze dried adrenal extracts in treatment with fairly good results. You’ll find these products listed under names such as Adrenal Plus, or Adrenplus…the starting dose is around 1000 mg per day in split doses.
  • Milk Thistle with alpha-Lipoic Acid is one combination that I use extensively for liver repair and detoxification…1200 to 1500 mg of milk thistle and 400 mg of lipoic acid per day in split doses

This is the basics. There is absolutely no way to eliminate all the problems associated with withdrawal from methadone…one must have a supportive environment and often with daily visits from a compassionate health care provider…This will not kill you…it will be a miserable event…what kills most is the movement back to street drugs to ward off the side effects of withdrawal. If fact, cold turkey deaths coming off opioids and methadone are rare and usually associated with other health problems, or overdosing on prescription medications…withdrawal from methadone is much less of a risk than total withdrawal from alcohol. I wish you all luck on this endeavor…My compassion and empathy goes out to you…Ultimately, I know that you can do this…after all…it has to be done.

TYROSINE PLUS & TYROSINE with MUCUNA

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FORMULA’S by Dr. David Arneson, NMD thesourcenmc@msn.com

I’ve spent the last 8 years detoxing and treating all forms and levels of alcoholism and drug addiction. I also have treated patients for all levels of psychiatric drug withdrawals including anti-depressants, anti-anxiety, and other psychotropic medications. The key to returning brain neurochemistry to some sense of normalcy is to use the proper repair materials. Consider the following statement:

If we truly want to treat the deficiencies created by the use of alcohol and drugs, or any other drug that has a negative affect on brain neurochemistry, then we need to understand one thing clearly – like a house that has been damaged in a storm, we need proper building and repair materials. The body/mind house only knows nutritional building materials. One cannot say absolutely that all will respond completely to such nutritional treatment regimes. Yet in our experience, well more than 80% do respond favorably to such nutritional focus. The reason for this is quite clear: The only way to repair the damage, or to facilitate the return to normal function, is to utilize the knowledge of nutritional biochemistry. In holistic medicine, this is known as functional medicine, molecular medicine or cellular medicine.

Our first formulas had basic issues—mainly cost and the number of capsules that had to be done daily. It wasn’t uncommon in the first year or so for a patient to be taking 15- 20 capsules twice per day. 4 years ago we generated our first amino acid kits—lowering the cost by 40% and reducing the number of capsules to 12 or less twice per day. Yet, the cost and the number of capsules still seemed to be an issue…also we wanted to add a mineral complex to the basic regimes. Our latest endeavor has succeeded in lowering the cost and reducing the caps to no more than 7 twice per day—and yet we believe that this is the best formula. These formulas are based on one fact. The primary neurotransmitters—master neurotransmitters—are serotonin, dopamine, nor-epinephrine, and epinephrine. GABA can also be considered in this process. Every biochemical process in the human body depends on the proper levels of these neurotransmitters. When we bring these back into balance most other biochemical and neurochemical processes come back into balance. These neurotransmitters do not exist only in the brain—in fact only 5% of the serotonin is found in the mind. Serotonin is the primary gut neurotransmitter and also regulates clotting function and has a role in cardiovascular health. Nor-epinephrine and epinephrine also are produced in the adrenal glands to help us deal with stress. Nor-epinephrine is also critical in the production of the sleep hormone melatonin and the production of sex hormones. These are ‘Global” neurotransmitters involved in every major function of the biochemical reactions in the human body/mind. It is rare that we can treat just one of these neurotransmitters and expect everything to work normally—nothing works in a vacuum—and every biochemical process is intrinsically tied to every other process. Get the master neurotransmitters balanced, and in tune with the others, and all other processes move toward balance. In the past we used multiple formulas for multiple issues. The more that I reviewed this process over the last few years the more I thought how simple this could really be. The type of drug was not the major issue—bringing back the balance in these neurotransmitters was the issue.

The formulas derived are based on the knowledge of how any one drug or alcohol works on the brain. Tyrosine Plus was generated to address problems that occur with the use of alcohol, marijuana, SSRI antidepressants, benzodiazepines, and other less caustic mind altering chemicals. TYROSINE with MUCUNA has an added component which is the mucuna—other than that they’re basically the same formula. Mucuna is a plant derived extract of a natural form of l-dopa. L-dopa is an intermediate product made from tyrosine. L-dopa eventually becomes dopamine, which becomes norepinephrine, which then becomes epinephrine. The problem in treating a dopamine deficiency is that tyrosine to L-dopa is a rate limited reaction—this means that it doesn’t matter how much tyrosine you put into your system you can only make so much L-dopa—therefore only so much dopamine, etc. Yet, L-dopa to dopamine is not rate limited—this means that the reaction needed to repair the dopamine circuit can go on unimpeded. This formula is what we use on opiate dependency, methamphetamine, cocaine, antidepressants such as Effexor or others that act principally on nor-epinephrine neurotransmitters circuits. The formula works well on depression that is a result from a dopamine deficiency.

There are a phase one formulas that we suggest for the first few months of treatment. Phase two formulas are generally maintenance formulas. I have quit labeling the kits as opiate, alcohol, methamphetamine, etc. This is for privacy and anonymity issues. From now on they’ll simply be marked with the neurotransmitter labels. If you have any questions please do not hesitate to contact me via the e-mail address is supplied above.

The following is a list of the component parts of each formula—with an explanation as to why it is needed.

1) Multiple Vitamin—the definition of a vitamin, and many minerals, is “an essential co-enzyme”. Vitamins and minerals push biochemical reactions forward. As an example, Vitamin C is an essential co-enzyme in the formation of all the neurotransmitters. To do amino acid therapy without a vitamin complex is akin to trying to cut a board with a circular saw that is not plugged into an electrical outlet.

2) Omega Complex—these omega fatty acids are derived from fish oil. If one has sensitivity to fish oil the kit can be made up with flax seed oil the only herbal source of mixed omega oils. Omega 3’s and Omega 6 fatty acids have many roles in the human body/mind. There are known to have a greater efficacy in treating depression than anti-depressants in general. The reason is clear—these fatty acids embed in every cellular membrane in the human body/mind. This gives the membrane integrity and stability. The idea is to return each cell, whether a skin cell or a nerve cell, back to some sense of normal functioning. If we can regenerate normal cellular membrane function the patient will return to some sense of normal functioning.

3) Tyrosine Plus and Tyrosine with Mucuna…

a) The minerals and vitamins listed are either essential co-enzymes or co-factors needed to push the reaction forward to optimize performance of the neurochemical pathways. For example—Calcium is not a co-enzyme—it is a co-factor…the release and re-absorption of the neurotransmitter is calcium dependent.

b) 5-hydroxytryptophan (5-HTP) is the amino acid necessary for the production of serotonin and melatonin. Serotonin is essential in healthy gut function and cardiovascular function. It is also the neurotransmitter that allows for balanced mental health.

c) Tyrosine is the amino acid that converts into L-dopa. L-dopa than is converted to dopamine. Dopamine is converted to nor-epinephrine and that is eventually converted to epinephrine.

d) Mucuna ( in the Tyrosine with Mucuna formula only), bypasses the rate limited reaction that limits the tyrosine to L-dopa reaction—this allows for a more dramatic boost in production of dopamine (the feel good neurotransmitter), and also the increase in production of nor-epinephrine and epinephrine which are critical for the healthy reactions to stress.

e) Methionine is the amino acid that converts directly to S-Adenosyl methionine—or SAM-e which is a critical co-enzyme necessary for the conversion of dopamine to nor-epinephrine.

f) Glutamine is the amino acid that converts to GABA. GABA is the primary inhibitory neurotransmitter which keeps the stimulatory neurotransmitters in check. In fact, GABA receptors are where anti-anxiety medications (such as valium, etc) work. Glutamine also helps to keep gut cells healthy so that absorption of nutrients are maximized.

4) Adrenal support capsule—almost all patients that need the Tyrosine with Mucuna formula are adrenal fatigued…this cap supports adrenal function until the systems are normalized. Not in the phase two formulas.

Communication: Since I am hearing impaired I rarely take phone calls to address questions. Yet, I want anyone utilizing these formulas to feel absolutely free in contacting me via the internet. Unless I am out of town I answer emails 6 days per week. I have full confidence in the products that we have developed. These are exactly the same formulas that we use on our in-house patients.

With respect, Dr. Dave

CURRICULUM VITAE

David Arneson was born on September 22, 1949 in Sidney, Montana. He graduated from Philomath High School in Philomath, Oregon in 1967. He entered the U. S. Army in 1968 and was honorably discharged in 1970. After his Army service, he went to Oregon State University for one year where he majored in Liberal Studies. In 1971 he moved to El Paso and worked for several years in the customer service industry. In 1976 he started his own contracting business to which he sold majority interest in 1992 and the remaining limited interest in 1996. In 1988 he took the opportunity to return to school and entered the University of Texas at El Paso where he received his Bachelor of Science degree in 1992 with a double major in Biology and Psychology, graduating with Honors. From 1994 to 1996, he continued his education at the University of Texas at El Paso and the El Paso Community College. In 1994 he received the necessary training to be certified by the American Board of Hypnotherapy in clinical and regression hypnotherapy. In 1996 he entered into his medical training at the Southwest College of Naturopathic Medicine where he received his Doctorate in Naturopathic Medicine in August 2000. From 1988, he has worked in both the volunteer and employee capacity in the field of addiction, as well as with the seriously mentally ill, working extensively with both adult and adolescent populations. Since October of 2000, to July 2002, he served in the capacity of Clinical/Medical Director at the Naturopathic Detox Program, a non-profit 14-28 day residential naturopathic drug and alcohol detoxification facility. Presently, he is Medical Director of The River Source Naturopathic Detox and Treatment Program in Mesa, Arizona. He is currently a part time Clinical Instructor of Naturopathic Medicine at the Southwest College of Naturopathic Medicine and Health Sciences where he supervises and trains student doctors in clinical settings. He also maintains a private practice, focusing on treatment of alcoholism, drug dependency, and chronic disease.

The Six Principles That Guide the Therapeutic Methods and Modalities of Naturopathic Medicine

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First, Do No Harm (primum non nocere) Naturopathic medicine uses therapies that are safe and effective

The Healing Power of Nature (vis medicatrix naturae) The human body possesses the inherent ability to restore health. The physician’s role is to facilitate this process with the aid of natural, non-toxic therapies.

Discover and Treat the Cause (tolle causam) Physicians seek and treat the underlying cause of a disease, not just the effect. Symptoms are viewed as expressions of the body’s natural attempt to heal. The origin of disease is removed or treated so the patient can recover.

Treat the Whole Person (tolle totum) The multiple factors in health and disease are considered while treating the whole person. Physicians provide flexible treatment programs to meet individual health care needs.

The Physician as Teacher (docere) The physician’s major role is to educate, empower, and motivate patients to take responsibility for their own health. Creating a healthy cooperative relationship with the patient has strong therapeutic value.

Prevention is the Best Cure (praevenire) Naturopathic physicians are preventive medicine specialists. Physicians assess patient risk factors, heredity and susceptibility and intervene appropriately to reduce risk and prevent illness.

Naturopathic Scope of Practice

The legal aspects of practicing naturopathic medicine vary from state to state in the U.S. and from province to province in Canada. In those states in which naturopathic physicians may be licensed as primary health care providers, N.D.’s (or N.M.D. in Arizona) may see patients for general health care and for the diagnosis and treatment of acute and chronic conditions. Their scope of practice may include, but is not limited to, nutritional science; botanical medicine; naturopathic manipulation; physical medicine; acupuncture; homeopathy; mind-body medicine; natural childbirth; minor surgery; prescription rights for most legend drugs (requiring a prescription) listed in the Physician’s Desk Reference; and all methods of laboratory, x-ray and clinical diagnosis. The State of Arizona offers the widest scope of practice for naturopathic physicians in the U.S.

-With respect, Dr Dave

A guide to focused amino acid therapy: TYROSINE PLUS&TYROSINE with MUCUNA FORMULA’S by Dr. David Arneson, NMD thesourcenmc@msn.com

I’ve spent the last 8 years detoxing and treating all forms and levels of alcoholism and drug addiction. I also have treated patients for all levels of psychiatric drug withdrawals including anti-depressants, anti-anxiety, and other psychotropic medications. The key to returning brain neurochemistry to some sense of normalcy is to use the proper repair materials. Consider the following statement:

If we truly want to treat the deficiencies created by the use of alcohol and drugs, or any other drug that has a negative affect on brain neurochemistry, then we need to understand one thing clearly – like a house that has been damaged in a storm, we need proper building and repair materials. The body/mind house only knows nutritional building materials. One cannot say absolutely that all will respond completely to such nutritional treatment regimes. Yet in our experience, well more than 80% do respond favorably to such nutritional focus. The reason for this is quite clear: The only way to repair the damage, or to facilitate the return to normal function, is to utilize the knowledge of nutritional biochemistry. In holistic medicine, this is known as functional medicine, molecular medicine or cellular medicine.

Our first formulas had basic issues—mainly cost and the number of capsules that had to be done daily. It wasn’t uncommon in the first year or so for a patient to be taking 15- 20 capsules twice per day. 4 years ago we generated our first amino acid kits—lowering the cost by 40% and reducing the number of capsules to 12 or less twice per day. Yet, the cost and the number of capsules still seemed to be an issue…also we wanted to add a mineral complex to the basic regimes. Our latest endeavor has succeeded in lowering the cost and reducing the caps to no more than 7 twice per day—and yet we believe that this is the best formula. These formulas are based on one fact. The primary neurotransmitters—master neurotransmitters—are serotonin, dopamine, nor-epinephrine, and epinephrine. GABA can also be considered in this process. Every biochemical process in the human body depends on the proper levels of these neurotransmitters. When we bring these back into balance most other biochemical and neurochemical processes come back into balance. These neurotransmitters do not exist only in the brain—in fact only 5% of the serotonin is found in the mind. Serotonin is the primary gut neurotransmitter and also regulates clotting function and has a role in cardiovascular health. Nor-epinephrine and epinephrine also are produced in the adrenal glands to help us deal with stress. Nor-epinephrine is also critical in the production of the sleep hormone melatonin and the production of sex hormones. These are ‘Global” neurotransmitters involved in every major function of the biochemical reactions in the human body/mind. It is rare that we can treat just one of these neurotransmitters and expect everything to work normally—nothing works in a vacuum—and every biochemical process is intrinsically tied to every other process. Get the master neurotransmitters balanced, and in tune with the others, and all other processes move toward balance. In the past we used multiple formulas for multiple issues. The more that I reviewed this process over the last few years the more I thought how simple this could really be. The type of drug was not the major issue—bringing back the balance in these neurotransmitters was the issue.

The formulas derived are based on the knowledge of how any one drug or alcohol works on the brain. Tyrosine Plus was generated to address problems that occur with the use of alcohol, marijuana, SSRI antidepressants, benzodiazepines, and other less caustic mind altering chemicals. TYROSINE with MUCUNA has an added component which is the mucuna—other than that they’re basically the same formula. Mucuna is a plant derived extract of a natural form of l-dopa. L-dopa is an intermediate product made from tyrosine. L-dopa eventually becomes dopamine, which becomes norepinephrine, which then becomes epinephrine. The problem in treating a dopamine deficiency is that tyrosine to L-dopa is a rate limited reaction—this means that it doesn’t matter how much tyrosine you put into your system you can only make so much L-dopa—therefore only so much dopamine, etc. Yet, L-dopa to dopamine is not rate limited—this means that the reaction needed to repair the dopamine circuit can go on unimpeded. This formula is what we use on opiate dependency, methamphetamine, cocaine, antidepressants such as Effexor or others that act principally on nor-epinephrine neurotransmitters circuits. The formula works well on depression that is a result from a dopamine deficiency.

There are a phase one formulas that we suggest for the first few months of treatment. Phase two formulas are generally maintenance formulas. I have quit labeling the kits as opiate, alcohol, methamphetamine, etc. This is for privacy and anonymity issues. From now on they’ll simply be marked with the neurotransmitter labels. If you have any questions please do not hesitate to contact me via the e-mail address is supplied above.

The following is a list of the component parts of each formula—with an explanation as to why it is needed.

1) Multiple Vitamin—the definition of a vitamin, and many minerals, is “an essential co-enzyme”. Vitamins and minerals push biochemical reactions forward. As an example, Vitamin C is an essential co-enzyme in the formation of all the neurotransmitters. To do amino acid therapy without a vitamin complex is akin to trying to cut a board with a circular saw that is not plugged into an electrical outlet.

2) Omega Complex—these omega fatty acids are derived from fish oil. If one has sensitivity to fish oil the kit can be made up with flax seed oil the only herbal source of mixed omega oils. Omega 3’s and Omega 6 fatty acids have many roles in the human body/mind. There are known to have a greater efficacy in treating depression than anti-depressants in general. The reason is clear—these fatty acids embed in every cellular membrane in the human body/mind. This gives the membrane integrity and stability. The idea is to return each cell, whether a skin cell or a nerve cell, back to some sense of normal functioning. If we can regenerate normal cellular membrane function the patient will return to some sense of normal functioning.

3) Tyrosine Plus and Tyrosine with Mucuna…

a) The minerals and vitamins listed are either essential co-enzymes or co-factors needed to push the reaction forward to optimize performance of the neurochemical pathways. For example—Calcium is not a co-enzyme—it is a co-factor…the release and re-absorption of the neurotransmitter is calcium dependent.

b) 5-hydroxytryptophan (5-HTP) is the amino acid necessary for the production of serotonin and melatonin. Serotonin is essential in healthy gut function and cardiovascular function. It is also the neurotransmitter that allows for balanced mental health.

c) Tyrosine is the amino acid that converts into L-dopa. L-dopa than is converted to dopamine. Dopamine is converted to nor-epinephrine and that is eventually converted to epinephrine.

d) Mucuna ( in the Tyrosine with Mucuna formula only), bypasses the rate limited reaction that limits the tyrosine to L-dopa reaction—this allows for a more dramatic boost in production of dopamine (the feel good neurotransmitter), and also the increase in production of nor-epinephrine and epinephrine which are critical for the healthy reactions to stress.

e) Methionine is the amino acid that converts directly to S-Adenosyl methionine—or SAM-e which is a critical co-enzyme necessary for the conversion of dopamine to nor-epinephrine.

f) Glutamine is the amino acid that converts to GABA. GABA is the primary inhibitory neurotransmitter which keeps the stimulatory neurotransmitters in check. In fact, GABA receptors are where anti-anxiety medications (such as valium, etc) work. Glutamine also helps to keep gut cells healthy so that absorption of nutrients are maximized.

4) Adrenal support capsule—almost all patients that need the Tyrosine with Mucuna formula are adrenal fatigued…this cap supports adrenal function until the systems are normalized. Not in the phase two formulas.

Communication: Since I am hearing impaired I rarely take phone calls to address questions. Yet, I want anyone utilizing these formulas to feel absolutely free in contacting me via the internet. Unless I am out of town I answer emails 6 days per week. I have full confidence in the products that we have developed. These are exactly the same formulas that we use on our in-house patients.

With respect, Dr. Dave

Chronic Pain and Methadone/Opiate Pain Management

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Dr. David Arneson, N.M.D. (Naturopathic Medical Doctor) Chronic Pain and Methadone/Opiate Pain Management Methadone (dolophine) is a synthetic long acting morphine (Last updated on 8/1/08) thesourcenmc@msn.com

I’ve decided to write a few words about this subject since it seems that I’m spending and inordinate amount of time responding to the unfortunate that have found themselves in this impossible situation. There will some who think this is the answer—more so because they have been told this is the answer to their long-term problems. It is interesting that of the in-house patients that I have detoxed from methadone, and all manner of opiates, those put there for pain management, a full 85% are out of pain within 3-6 weeks after their last methadone/opiate dose. It is also true that there are some that can be on opiate therapy for years and it seems to continue to work for them. These words are not meant to convince anyone that they should, or should not be, on pain medications. If it works for you over the long term and your physical ailments are irresolvable then by all means do what needs to be done. Yet there seems to be more questions than answers involving pain management. So this small addendum is an educational forum, if you will, on what is known and unknown about this subject matter. All these facts are documented in current literature.

First of all, Methadone, as well as all opiates, have a caustic, negative affect on what is called the hypothalamic/pituitary/adrenal axis…it also acts as nor-epinephrine and serotonin reuptake inhibitor in the brain not unlike being on a anti-depressant or other psychotropic drug for months or years. Literally what this means is that methadone negatively affects all hormone/neurotransmitter driven systems in the human body/mind…especially negatively affected is the adrenal glands—located on the superior margins of each kidney…all this leads to the cardinal symptoms of chronic fatigue, depression, anxiety, and other related symptoms. In other words, ALL methadone patients suffer from chronic adrenal fatigue. In addition, since methadone has a negative affect on the production of neurotransmitters, ALL methadone patients will eventually suffer from depletion of neurotransmitters and the receptors that these neurotransmitters work on leading to chronic depression and anxiety. More importantly, since sufficient amounts of serotonin are needed to block the production and release of a brain molecule called Substance P—which positively affects the pain pathways—methadone users will suffer increased levels of pain over the long term…eventually leading to more methadone which eventually just makes things worse for the patient. In my clinical experience treating methadone patients detoxing off the drug…when using focused high dose amino acid therapies to rebuild the serotonin and dopamine circuits…I find that a full 85% of these patients are pain free in 3-6 weeks…it is an extremely rare case for the pain not to diminished greatly in the others. This includes all fibromyalgia cases that have been put on any class of opiate therapy for pain. The reason for this is clear. One cannot make more serotonin with anti depressants such as Prozac or others of their class—and methadone certainly causes these negative affects on brain neurochemistry. When one is depressed over their emotional/life conditions, due to the chronic pain, or because of on-going caustic drug therapy—the traditional treatment is an anti-depressant. Anti depressants DO NOT MAKE MORE serotonin, dopamine, norepinephrine, or epinephrine. Initially, they just move around what you have…and the patients is more than likely already depleted or low on these vital brain chemicals…these drugs only take from one place and put it in another. Fundamentally, all this does is set up the mind to try and reach some sense of normalcy. The DNA is the master blue print—it is set up to keep things in some set of boundaries so survival is optimized in each human being. In a normal functioning human brain neurotransmitters are released from one nerve (into what is called the synaptic space) to interact with the receptors on the next nerve and than reabsorbed with in manners of micro seconds (150-250 one/one thousand of a second). When any drug, or situations occurs, that impedes this process the mind reads this as having too much neurotransmitter. When this happens the brain starts producing a molecule called monoamine oxidase which breaks down the “excess” serotonin or dopamine (both are monoamines). Since dopamine is the precursor building block for nor-epinephrine and epinephrine these neurotransmitters also get down regulated. Why this doesn’t make any sense to the standard medical profession defies all logic. Yet these types of therapies are all they know. It is sad the in most of these cases they do more harm then good. The answer for the majority of patients facing these issues is simple—nutritional biochemistry.

The lack of interest and the basic ignorance of good oral nutrition by the “best medical system” in the world are beyond belief and comprehension. The only way the body/mind can truly heal, to the level it is capable of healing itself, is by the very nutrients you take in everyday. This is not discounting that some have genetic problems severe enough to require modern chemistry. We see these people in crisis management and typically they are danger of self or the community at large. As was stated earlier, 15 % of the patients on a particular psychotropic probably need to be there. The other 85% need other alternative therapies. Yet even in those that need chemical therapy it rarely works well. We managed, more that anything, to utilize the medications as chemical straight jackets. And rarely do we even consider nutritional therapy. In my four years working with the severely mentally ill in crisis stabilization I never once saw a person allowed to do a multiple vitamin with the exception of the occasional pregnant female who was allowed folic acid. In fact, if the patient came in with vitamins there were ceased as contraband and return only on their discharge from the facility. There are cases where supplementing a B-complex vitamin has totally reversed the symptomlogy of bi-polar disease. There are studies now that show the addition of Vitamin B-12 and folic acid makes Prozac more effective in those that don’t respond well to the medication. The question should be why we didn’t start with the B-12 and folic before the Prozac since it is common scientific knowledge that deficiencies in B-12 and Folic are found in some cases of depression.

Methadone, as with any opiate, negatively affects critical physiological processes in other organ systems in the human body. One of the most negatively affected organ systems is the gastro intestinal tract. Normal gut function does not exist in a methadone treated patient. It matters not whether this is treatment related to opiate drug abuse or treatment related to chronic pain or post surgery. Methadone also slows heart rate and therefore decreases blood flow through the GI tract. If the GI tract is fundamentally unsound how does one absorb the necessary nutrients needed for repair to take place any where else in the body—or the mind? I’ve seen opiate therapy patients that have gone through back surgery where the primary incision takes months to heal—a process that should be completely in 10-14 days at the maximum. As long as one is on opiate therapy (methadone or otherwise), these physiologic processes will NEVER work at their optimum. So if we truly want to treat the deficiencies than we need to understand one thing clearly…like the house that has been damaged in the storm we need the proper building and repair materials. The body/mind house only knows nutritional building materials…one cannot say absolutely that all will respond completely to such nutritional treatment regimes…yet in our experience, well over 80% or more do respond favorably to such nutritional focus. The reason for this is quite clear…the only way to repair the damage, or to facilitate the return to normal function, is to utilize the knowledge of nutritional biochemistry…in wholistic medicine this is known as functional medicine, or molecular medicine, or in some circles–cellular medicine…a logical question put forward by many is, “why doesn’t standard medicine utilize this nutritional knowledge to facilitate the return of health to the individual?” The Harvard medical school looked at this issue and discovered that over 70% of their doctors received no nutritional biochemistry in medical school…other studies calculate that only 5% or so of the standard medical doctors in this country have any nutritional biochemistry in medical school…this is usually an elective of 20 hours or less. There is absolutely no financial reward to the pharmaceutical companies, or the doctors that rely on these same companies for their income—to do anything different for the patient.

Methadone is a long acting synthetic morphine. Its recognized half life is 24-36 hours on the average. This means if you are doing 100 mg of methadone, and you have liver function capable of metabolizing the dose in 24 hours—than 24 hours after taken 100 mg that you will still have 50 mg of the original dose in your system. In the next 24 hour period you will still have 25 mg in the body. Extrapolate this out and one can see that on the average it takes 7-10 days just to get the methadone out of the human body. Remember, 24-36 hours for the average person. Some are poor metabolizers and some are rapid metabolizers. When one abruptly quits methadone the onset of the acute withdrawal symptoms can take from 3-12 days in the cases I’ve seen. I call this—“hitting the methadone withdrawal wall”…it is different for everyone. It is crucial in the detoxing of this drug that nutritional treatment begin early and last for 2-3 months.

As long ago as 1969, terms were being used about a protracted withdrawal syndrome. Today, this is known as post acute withdrawal syndrome (PAWS). The idea behind PAWS is that the average patient continues to have underlying symptoms of withdrawal long after the original drug or alcohol has been metabolized out of the system. These symptoms can include depression, lack of concentration, mental fogginess, anxiety, sleep issues, fatigue and immune system dysfunction. It is also noted in the literature that these symptoms can last from six months to two years in the average patient if they do nothing more than just quit the drug or alcohol.

The level of signs and symptoms of this withdrawal are different with respect to the following conditions: 1) type of drug, 2) amount of drug taken, 3) duration of drug use, and 4) genetic makeup of the individual. Without a doubt, withdrawal symptoms are the primary reason for chronic relapse into the drug of choice. In my clinical practice, both in-patient and outpatient, it is rare to see these symptoms last longer than three to six weeks in the average patient utilizing focused nutritional biochemistry as the primary treatment. Yet, nutritional therapy is a complex issue. Clinicians that wish to pursue this level of treatment for their clients must understand extensive information on metabolism and genetic function. Without understanding the intricacy of molecular functions and how they are activated and manipulated through nutritional treatment, the clinician is likely to create more harm than good. Even if harm is not caused to the client, treatment often fails to produce the desired result. Just taking one particular vitamin or amino acid to address health issues in detoxification and recovery is much akin to supplying the client with just Prozac to “cure” their depression. Majid Ali, MD, says it best: “… No molecule exists in biology alone, functionally or structurally. This is self evident. And yet we physicians insist in diagnosing ‘a nutrient deficiency’ to understand ‘a disease’ which we can then treat with ‘a nutrient therapy’ … The central issue here is: Mono-nutrient therapy has no place in the clinical practice of molecular medicine.”

ALL levels of opiate therapy, whether methadone or others, will cause the body to down regulate the production of the bodies own internal opiates (enkephalins and endorphins) and also the receptors these opiates work on to block pain transmission (this is called building tolerance to the dose or the drug). The longer one is on opiate therapy…the more down regulated these systems become—necessitating the need for higher and higher doses to obtain the same affects. One day, as many of the patients on these therapies find out, it seems as if nothing works…once again necessitating higher and higher doses. What becomes evident is that all long term opiate therapy patients remain in chronic low grade pain…many times this pain is found away from the original injury. Because there are not sufficient amounts of opiate receptors left to interact with the opiates, whether these are internal opiates generated naturally by the body or taken externally, to help us through the day from the normal wear and tear that occurs on our muscular-skeletal system. Opioid-induced hyperalgesia[1] or opioid-induced abnormal pain sensitivity[2] is a phenomenon associated with the long term use of opioids such as morphine, hydrocodone, oxycodone, and methadone. Over time, individuals taking opioids can develop an increasing sensitivity to noxious stimuli, even evolving a painful response to previously non-noxious stimuli. Some studies on animals have also demonstrated this effect occurring after only a single high dose of opioids.[3] The need for dose escalation in opioid therapy may be as a result of tolerance, as a result of opioid-induced hyperalgesia, or, more likely, a combination of both. Thus patients receiving medications to relieve pain may paradoxically have more pain as a result of their medication.

This phenomenon likely results from changes in NMDA receptors in the dorsal horn of the spinal cord. Research on the mechanisms underlying this phenomenon is ongoing, as are attempts to identify NMDA receptor antagonists, which may be able to prevent or attenuate this effect.

If an individual is taking opioids for a chronic non-cancer pain condition, and requires increasing doses, yet still do not achieve pain relief, they may be experiencing opioid-induced hyperalgesia. If so, they may benefit from complete withdrawal from opioid therapy. Many individuals report reduced pain levels when opioids are withdrawn.[4]

References

1. Angst, MS & Clark, DJ: Opioid-induced hyperalgesia: A qualitative systematic review. Anesthesiology 2006; 104:570–87

2. Mao J: Opioid-induced abnormal pain sensitivity: Implications in clinical opioid therapy. Pain 2002; 100:213–7

3. Celerier E, Laulin J-P, Corcuff J-B, Le Moal M, Simonnet G: Progressive enhancement of delayed hyperalgesia induced by repeated heroin administration: A sensitization process. J Neurosci 2001; 21:4074–80

4. Wuitchik, M. & Feehan, GG: Opioid withdrawal versus opioid maintenance for persons with chronic non-cancer pain: The experience of the Canmore Pain Clinic. Rehab Review 2006; 2:19-21

All this being said, two things must be understood before starting…1) Keep it simple…movement from the simple therapy to the complex therapy will allow the physician, or patient, to move to the level of complexity needed in any particular case without overwhelming the patient, 2) Stay the course…many get discouraged because they want to be “well” now. Ask yourself, “How long did it take me to get here…” and more importantly, “how long, am I willing to commit to this process of healing and recovery?” I have my patients commit to 6-weeks of intensive nutritional therapy…we assess every two weeks and change what is necessary. At 6-weeks, I ask for another commitment of 6-months to one year. Approximately 80% of those who make the initial 6-weeks make the longer commitments. Remember, it takes time to reestablish and heal adequate neurotransmitter/biochemical function…one day at a time.