Foundation of Addiction Medicine 2019

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701

ALTERNATIVE SYSTEM OF
MEDICINE & ADDICTION

Dr GEETHA L - BAMS, MD – AYURVEDIC PSYCHIATRY

[email protected] 70
2

Outline

● INTRODUCTION
● AYURVEDA
● YOGA
● MEDITATION
● SUDARSHAN KRIYA
● CONCLUSION

703

● Ayurveda – concepts – dosha/dhatus
● Manifestation of any disease

body & mind
Addiction – not just psychological

704

● Addiction in Ayurveda
Based on dosha (vata, pitta and Kapha)– intake of

alcohol
● Ojo kshaya
● Many of the drugs used in medicine too

705

● Concept of satmya
Drug dependence is an adaptive state that develops
from repeated drug administration, and which results in
symptoms of withdrawal upon cessation of drug use.

● Concept of satva
Rajah - dukha, adhriti, ahamkāra, akāruńya, harsha,

kāma, krodha, matsara,
● Tamovriddhi - vishāda, nāstikya, adharmaśeelata,

budhirnorodham, aňjanam, bhayam, akarmaśeelata

706

? The Padansik kram is a unique method described in
Ayurveda to stop the any
harmful or non harmful substance which homologus to
human being, can be stopped by tappering up.

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TREATMENT

708

? Stop the abuse drug by replacing it by Ayurvedic
medicine having same effects like abused drug
Tadarthakaari chikitsa

? Decrease by Quad-part-manner (padanshik kram) or
abused drug itself.

? finally fully stop the drug.
‘Padanshik Krama’ to avoid the harmful effect due to
sudden withdrawal of Satmya Substance.

? If the withdrawal symptoms are appears then they are
treated symptomatically.

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Sr.No. Addicted Drugs of Day Method of Period
Withdrawal Withdrawal/ 7 day
1 Alcohol Drugs Replacement D1 Replacement
D2 & D3 100ml TDS
Shrikhandasav D4 to D6 50ml BD
D7 50ml HS
25ml

Shiro Abhyanga (Head to Massage).

Abhyang (Massage) –

Shirodhara-

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Shiroabhyanga

? Improving quality of sleep, relaxation of body & mind -
shiroabhyanga

Amitabha Mapdar et al. Int. Res. J. Pharm. 2018, 9 (11)

? Primary insomnia :-

A comparitive study of shiroabhyanga & karnaabhyanga in the management of
nidranasha (primary insomnia)
Journal of scientific & innovative research 2016;5(5):168-173

711

Shirodhara

? Reduces fatigue - shirodhara

Perke B.M. Int. Res.J.Phar.2013,4(3)

? Reduces headache, anxiety, depression,,
level of stress

clinical assesment of impact of shirodhra with water in the management
of primary headache with associated anxiety depression

Annals of ayurvedic medicine vol 7- issue- 1-2jan – june, 2018

? sleeplessness

Godugdha shirodhara – non pharmalogical treatment of nidranasha

Gotmare ashish et al/Int.J.Res.Ayurveda Pharm.4(4), july – Aug 2013

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PANCHAKARMA

Basti

Vamana Virechana

Raktamokshana Nasya

713

Study on ADS pts were done – panchakarma - vamana
Significant improvement were in the symptoms of
Appetite
Sleep disturbance
Giddiness
Nausea,
Withdrawal tremors

A comparitive clinical study in the management of madataya – IJRAP 3(1)
jan feb 2012
Dr Geetha, dr Manjunath, dr Baldev

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ANTICRAVING

Nasya
Rasayana
Rasaadi dhatu vardhaka

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REHABILATATION

? RELAXING TECHNIQUES OF PANCHAKARMA
? YOGA
? MEDITATION
? SUDHARSHANA KRIYA
? AASHWASANA - COUNSELLING

716

YOYoGgAa

717

YOGA

718

? In rehabilitation of drug addicts
yoga found to be very effective

? Yoga has been suggested as a complementary therapy in
addiction treatment to enhance recovery and prevent
relapse

(Harris, 2015; Khanna & Greeson, 2013; Posadzki, Choi, Soo Lee, & Ernst,
2014; Sarkar & Mohit, 2016)

719

The efficacy of yoga with addiction – a systematic review

Matu raki 9th national addiction reserch symposium 2018

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The Role Of Yoga In Reducing Substance

Use

? Substance‑related craving (especially in nicotine‑use
disorders) in short term.

? Self Confidence Inventory and Optimistic Pessimistic
Attitude Scale were used

? Statistically significant results were observed in yoga
therapy program

? group than control group. This study concludes that
yoga therapy is effective in the rehabilitation of drug
addicts.

Journal of Neurosciences in Rural Practice | Published by Wolters Kluwer –

Medknow- Role of Yoga in Management of Substance‑use Disorders: A Narrative

Review

GRA - GLOBAL RESEARCH ANA - Volume : 2 | Issue : 7 | July 2013 • ISSN No 2277 –

8160

Effect of yoga therapy in rehabilitation of drug addicts 721

SUDARSHANA KRIYA

Simple Breathing Technique
Taught as part of Art of Living (AOL)

part-1 Course across the World
Founded by H.H. Sri Sri Ravi Shankarji
Non Religious, Easy to practice, No known
side effects,
It can practice anybody who is breathing

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SUDARSHANA KRIYA
Research

Antidepressant Effect

Ref : Janakiramaiah.N, NIMHANS Journal, 1998

Anxiolytic Effect

Ref : Sharon Sageman, Science of Breath, 2002

Increased Prolactin Level

Ref : Sudarshan, M.D Thesis, 2002, NIMHANS

Decreased Cortisol Level

Ref : Janakiramaiah.N, NIMHANS Journal, 1998

P300 cognitive study

Ref : Venkatesh Murthy,. Biol Psychiatry, 1997, 1998.

723

SUDARSHAN KRIYA YOGIC BREATHING IN THE TREATMENT OF STRESS,
ANXIETY AND DEPRESSION:Part II- Clinical Applications & Guidelines

Medium and rapid SK cycles activate

thalamic projection that excite Yogic breathing is a unique method for balancing the

sensorimotor cortex. autonomic nervous system and influencing

SK influence diverse fiber groups within physiologic and stress related disorders.

the vague nerves, which in turn induce Part I of this series presented a neurophysiologic

physiologic changes in organs,glands and theory of the effects of SK

lipid system. Part II will review clinical studies,clinical

observations,guidelines for the safe & effective use of

NUEROPHYSIOLOGIC MODEL yoga breath techniques in a wide range of clinical
Strengthening, balancing and stabilizing conditions.

the autonomic and stress response SY as a potentially beneficial,low risk adjunct for the

systems. treatment of stress,anxiety,PTSD,depression,stress

Activation of the limbic systems leading related medical illnesses and substance abuse & for
rehabilitation of criminal offenders.
to stimulation of forebrain rewards

systems and emotional release; and Daily practice will enhance the benefits of SK.

Increased release of prolactin and

oxytosin enhancing feelings of calmness

and social bonding

Richard P Brown,M.D and Patricia L Gerbarg, M.D The Journal of Alternative and

Complementary Medicine 724

BIOLOGICAL EFFECTS OF SUDARSHAN KRIYA ON
ALCOHOL-DEPENDENT PATIENTS

Significant changes in Stress Hormones in Alcoholic Rehabilitation after SKY

Adreno Cortico Tropic Prolactin Cortisol Depression
Harmone

Before Before
After After
Before Before
After After
Before

After
Before
After
Before
After
Before
After

Before Significant changes in Anxiety and Depression after SKY
After
Anxiety
Before
After BACKGROUND: Sudarshana Kriya Yoga (SKY) has demonstrable antidepressant effects. SKY was
tested for this effect in inpatients of alcohol dependence.
METHODS: Following a week of detoxification management consenting subjects (n=60) were equally
randomized to receive SKY therapy or not (controls) for a two-week study. SKY therapy included
alternate day practice of specified breathing exercise under supervision of a trained therapist. Subjects
completed the Beck Depression Inventory (BDI) before and after the two weeks of this intervention.
Morning plasma cortisol, ACTH and prolactin too were measured before and at the end of two weeks.
RESULTS: In both groups reductions in BDI scores occurred but significantly more so in SKY group.
Likewise, in both groups plasma cortisol as well as ACTH fell after two weeks but significantly more so in
SKY group. Reduction in BDI scores correlated with that in cortisol in SKY but not in control group.
LIMITATIONS: Antidepressant effects of SKY were demonstrated in early abstinence that also had
substantial spontaneous improvement. It is not known if this effect contributes to sustained abstinence.
CONCLUSION: Results extend the antidepressant effects of SKY in alcohol dependence subjects.
Reduction in stress-hormone levels (cortisol and ACTH) along with BDI reductions possibly support a
biological mechanism of SKY in producing beneficial effects.

Journal of Affective Disorders Volume 94, Issues 1-3, August 2006, Pages 249-253. 725

Meditation

? Centeredness
? Increasing feelings of inner security
? Contentment
? Regular practice

726

YOGIC BREATHING AND MEDITATION:WHEN THE
THALAMUS QUIETS THE CORTEX AND ROUSES THE

LIMBIC SYSTEM

CHANTING OF “OM” RESULTS: ENDOCRINE CHANGES

ACTIVATION OF THALAMUS SIGNIFICANT REDUCTION IN
CORTISOL (ONE MEASURES OF
DECREASED METABOLISM STRESS RESPONSE SYSTEM
ACTIVATION IN THE BRAIN)
DECREASED HEART RATE
INCREASE OF CORTICOTROPHIN-
INCREASED RELEASING HORMONE.
PERIPHERALVASCULAR
RESISTANCE 5 FOLD INCREASE OF VASOPRESSIN
ASSOCIATED WITH
(SIGN OF INCREASED MENTAL MEDITATION.(THERE IS EVIDANCE
ALERTNESS) THAT VASSOPRESSIN IS DECREASED
IN DEPRESSION)

Richard P. Brown,M.D Assoc. Clinical Prof. Of Psychiatry,Columbia University, College

of Physicians and Surgeons, NYC,USA 727

Theta Activity and Meditative States: Spectral Changes during Concentrative Meditation

[Sahaj Samadhi meditation ]

PURPOSE: to investigate the temporal dynamics of oscillatory changes during Sahaj Samadhi
meditation

Sahaj Samadhi meditation-a concentrative form of meditation - part of SKY.

EEG was recorded during SKY meditation for meditators

Relaxation was given for controls.

Spectral & coherence analysis was performed for the whole duration & from the initial,
middle & end portions of Sahaj Samadhi meditation or relaxation.

Increased theta band activity during deep meditation in the frontal areas.

Meditators also exhibited Increased theta coherence compared to controls.

RESULT: Interestingly, Increased frontal theta activity was accompanied, decreased activity
in parietal-occipital areas signifying → decreased processing associated with self, space and
time.

Shruti Baijal and Narayanan Srinivasan,Centre of Behavioral and Cognitive Sciences,University of Allahabad.India
Journal Cognitive Processing Volume 11, Number 1 / February, 2010

728

Navachetana shibir

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EXPLORING: BREATH WATER AND SOUND COURSE AS AN ADJUNCT INTERVENTION
FOR OPIATE DEPENDENT PATIENTS.

Opioid dependence - chronic
relapsing disorder.
Aim: To study impact of
Navchetna shivir on drug use,
quality of life &motivation on
heroin dependent patients
Methodology: A Navchetna
-shivir was for 5 days
15 cases and 14 controls were
assessed.

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Results:

Both the groups were compared.
Significant change in experimental group in physical &
psychological domain.
Patients reported ↑ enthusiasm & happiness.
↑ desire to work.
↑ better control over emotions &
↓ need for agonist and hypnotic medication.
+VE changes in QOL & Motivation within 2 weeks
after NavChetna- Shivir.

Anju Dhawan,Seema Yadav, Hem Sethi, Anita chopra,National drug Dependence Treatment Centre,
AIIMS,Ansari Nagar, New Delhi.

Evidence Based Complementary & Alternative Medicine 28-Feb-2007

731

732

CONCLUSION

? Concepts of Ayurveda can the adapted in the
treatment of addiction
? PANCHAKARMA - always need to be under proper

supervision for better results
? Para Panchakarma effective in craving other

psychological symptoms
Yoga, mediation & SKY – both in withdrawal &

rehabilitation - enhance the recovery & relapse

733

Thyaonuk

734

Effective Family therapy

Ms. Silpa S. Viswanath
PSW, Ph. D. Scholar
Centre for addiction medicine

735

What is Family Therapy

Family therapy is a type of psychological
counseling (psychotherapy) that can help
family members improve communication and

resolve conflicts

(Mayo clinic)
736

Introduction

• Collection of therapeutic approaches
• Belief in family based assessment and

interventions
• Purpose

1. To use families strengths and resources to find
ways to live without substance use

2. To ameliorate the impact of chemical dependency
on both patient and family.

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Cont.

• Treatment unit: family
• Therapist facilitates discussions and

problem solving sessions.
• Consideration should be given to problems

such as criminal activity, joblessness,
intimate partner violence and child abuse

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Systemic Model

• Focuses on the unconscious communications
and meanings behind family members’
behaviors.

• The therapist in this form of treatment is
neutral and distant, allowing the family
members to dive deeper into their issues and
problems as a family;

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Systems theory

• Interrelated elements and structure
• Predictable patterns of interaction
• Boundaries
• Subsystems

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Indications and contraindications

• Indication

– Presence of open and stressful conflicts in the
family

– Problems in relationship which leads to
dysfunctional behaviour

– family members encourages the perpetuation
and continuation of the disorder

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• Contraindications

– Violence
– Extreme anger

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STRUCTURAL APPROACH

• Structural therapy focuses on adjusting and
strengthening the family system to ensure that the
parents are in control and that both children and adults
set appropriate boundaries.

• Therapist “joins” the family in order to observe, learn,
and enhance their ability to help the family strengthen
their relationships;

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STRUCTURAL APPROACH

• The most influential family therapy
approach

- Salvador Minuchin

• BOUNDARIES:

– Invisible barriers that regulate contact
– Rules defining who participates and how in a

transaction

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• POWER:

– Relative influence of each family member on the
outcome of an activity

– Who decides what is going o happen in the family

• ALLIANCES

– Joining or opposition of one member of a system to
another in carrying out an operation

– inevitable

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• COALITIONS:

– usually form across generational boundaries

• COMPLEMENTARITY:

– Balanced relationship between two individuals
that often results in good team work

746

Goals of Structural Approach

• Increased flexibility
• Adaptability to developmental change
• Balance between connectedness &

differentiation
• Sub system functioning
Common strategies & techniques:
• Joining
• Enactment
• Unbalancing

747

BOWEN FAMILY SYSTEMS
APPROACH

• Best suited for situations in which

individuals cannot or do not want to

involve other family members in the

treatment.

• Bowenian therapy is built on two core

concepts: triangulation (the natural

tendency to vent or distress by talking to a

third party) and differentiation (learning to

become less emotionally reactive in family

relationships); 748

BOWEN FAMILY SYSTEMS
APPROACH

• Murray Bowen
• Monica McGoldrick

Core concepts:
• Differentiation of self
• Triangulation
• Emotional cutoffs

749

Techniques:

• Use of Genogram
• Therapist as a ‘Coach’
• Education about multigenerational family

processes
Goals of Bowen Family System:
• Increased differentiation
• Detriangulation
• Cutoffs resolved
• Improved ability to manage anxiety

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