Addictions

• Vitamin B1 (Thiamine) : Thiamine is a B-vitamin that may decrease problems associated with acute alcohol withdrawal. Patients with chronic alcoholism or experiencing alcohol withdrawal are at risk of thiamine deficiency and its associated complications.
• Thiamin is generally considered safe and relatively nontoxic. Avoid if allergic or hypersensitive to thiamin. Rare hypersensitivity/allergic reactions have occurred with thiamin supplementation. Skin irritation, burning, or itching may rarely occur at injection sites. Large doses may cause drowsiness or muscle relaxation. Use cautiously if pregnant or breastfeeding.
• Yoga : Preliminary research suggests that yoga may be beneficial when added to standard therapies for the treatment of substance abuse. Additional studies are needed before a strong recommendation can be made.
• Yoga is generally considered to be safe in healthy individuals when practiced appropriately. Avoid some inverted poses with disc disease of the spine, fragile or atherosclerotic neck arteries, risk for blood clots, extremely high or low blood pressure, glaucoma, detachment of the retina, ear problems, severe osteoporosis, or cervical spondylitis. Certain yoga breathing techniques should be avoided in people with heart or lung disease. Use cautiously with a history of psychotic disorders. Yoga techniques are believed to be safe during pregnancy and breastfeeding when practiced under the guidance of expert instruction (the popular Lamaze techniques are based on yogic breathing). However, poses that put pressure on the uterus, such as abdominal twists, should be avoided in pregnancy.

C Unclear or conflicting scientific evidence

• 5-HTP : Early study suggests that 5-HTP may lessen alcohol withdrawal symptoms. Further research is needed to confirm these results.
• Avoid 5-HTP if allergic or hypersensitive to it. Signs of allergy to 5-HTP may include rash, itching, or shortness of breath. Avoid with eosinophilia syndromes, Down's syndrome, and mitochondrial encephalomyopathy. Use cautiously if taking antidepressant medications such as TCAs, MAOIs, SSRIs, nefazodone, trazodone, venlafaxine, mirtazapine, bupropion; 5-HTP receptor agonists such as sumatriptan, rizatriptan, naratriptan, zolmitriptan, eletriptan, imotriptan, and frovatriptan; and carbidopa, phenobarbital, pindolol, reserpine, tramadol, or zolpidem. Use cautiously with renal (kidney) insufficiency, HIV/AIDS (particularly HIV-1 infection), epilepsy, and/or with a history of mental disorders. Avoid if pregnant or breastfeeding.
• Acupressure : The practice of applying finger pressure to specific acupoints throughout the body has been used in China since 2000 BC, prior to the use of acupuncture. Acupressure techniques are widely practiced internationally for relaxation, wellness promotion, and the treatment of various health conditions. Shiatsu means finger (Shi) pressure (Atsu) in Japanese. Shiatsu can incorporate palm pressure, stretching, massaging and other manual techniques. Early study indicates that auricular acupressure (pressure to points on the ear) may help with smoking cessation. Preliminary evidence also suggests that acupressure may be a helpful adjunct therapy to assist with prevention of drug addiction.
• With proper training, acupressure appears to be safe if self-administered or administered by an experienced therapist. Serious long-term complications have not been reported, according to scientific data. Hand nerve injury and herpes zoster ("shingles"), carotid dissection, and retinal and cerebral artery embolism, cases have been reported after shiatsu massage. Forceful acupressure may cause bruising.
• Acupuncture : Acupuncture is commonly used to treat various forms of substance abuse such as alcoholism, opiate addiction, and cocaine dependence, although clinical studies have reported mixed results. Clinical study compared the readmission rates of a six-month treatment at residential detoxification programs (used by 6,907 clients) versus at outpatient acupuncture programs (used by 1,104 clients). Acupuncture clients were less likely to be readmitted for detoxification within six months.
• Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders, medical conditions of unknown origin, or neurological disorders. Avoid if taking drugs that increase the risk of bleeding (e.g. anticoagulants). Avoid on areas that have received radiation therapy and during pregnancy. Use cautiously with pulmonary disease (e.g. asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics, or with history of seizures. Avoid electroacupuncture with arrhythmia (irregular heartbeat) or in patients with pacemakers because therapy may interfere with the device.
• Aromatherapy : Aromatherapy may be as effective as some types of acupuncture in treating alcohol withdrawal symptoms. More study is needed in this area.
• Essential oils should be administered in a carrier oil to avoid toxicity. Avoid with a history of allergic dermatitis. Use cautiously if driving/operating heavy machinery. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if pregnant.
• Astragalus : Astragalus (Astragalus membranaceus) is commonly used in traditional Chinese medicine (TCM). Limited available study has reported positive benefits in smoking cessation. However, more human studies are needed.
• Avoid if allergic to astragalus, peas, or any related plants or with a history of Quillaja bark-induced asthma. Avoid with aspirin or aspirin products or herbs or supplements with similar effects. Avoid with inflammation (swelling) or fever, stroke, transplants, or autoimmune diseases (like HIV/AIDS). Stop use two weeks before surgery/dental/diagnostic procedures with a risk of bleeding and avoid use immediately after these procedures. Use cautiously with bleeding disorders, diabetes, high blood pressure, lipid disorders, or kidney disorders. Use cautiously with blood-thinners, blood sugar drugs, or diuretics or herbs and supplements with similar effects. Avoid if pregnant or breastfeeding.
• Black pepper : Sensory cues associated with cigarette smoking can suppress certain smoking withdrawal symptoms, including the craving for cigarettes. Inhalation of black pepper essential oil may reduce cravings and physical symptoms associated with cigarette smoking cessation.
• Avoid if allergic or hypersensitive to black pepper (Piper nigrum), its constituents, or members of the Piperaceae family. Use cautiously if taking anti-asthmatic drugs, cholinergic agonists, cyclosporine A or digoxin, cytochrome P450 metabolized agents, oral herbs or drugs, phenytoin, propranolol, rifamipicin (rifampin), or theophylline. Use cautiously with gastrointestinal disorders. Avoid if pregnant or breastfeeding.
• Borage seed oil : Borage oil may help treat or prevent alcohol-induced hangovers, although additional study is needed in this area. Avoid if allergic or hypersensitive to borage, its constituents, or members of the Boraginaceae family. Use cautiously in patients with bleeding disorders or in those taking warfarin or other anticoagulant or antiplatelet (blood thinning) agents. Use cautiously in patients with epilepsy or in those taking anticonvulsants. Avoid in patients with compromised immune systems or similar immunological conditions. Avoid in pregnant patients as borage oil may be contraindicated in pregnancy given the teratogenic and labor-inducing effects of prostaglandin E agonists, such as GLA, present in borage oil. Avoid if breastfeeding.
• Coenzyme Q10 : Coenzyme Q10 (CoQ10) is produced by the human body. It is needed for the basic functioning of cells. A combination of Coenzyme Q10 and L-carnitine has been studied for reduction of cocaine dependence, but results are inconclusive. More research is needed in this area.
• Allergies associated with Coenzyme Q10 supplements have not been reported in the available literature. However, rash and itching have been reported rarely. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Use cautiously with a history of blood clots, diabetes, high blood pressure, heart attack, or stroke. Use cautiously if taking anticoagulants (blood thinners) or anti-platelet drugs, blood pressure drugs, blood sugar drugs, cholesterol drugs, or thyroid drugs. Avoid if pregnant or breastfeeding.
• Colon therapy/colonic irrigation : Colon therapy is the use of herbs or water to clean out the colon or large intestine to treat certain health conditions. Limited available study of unclear methodology suggested that colonic irrigation employing Chinese herbs may augment dihydroetorphine (DHE) and methadone therapy in heroin addicts going through drug withdrawal, possibly resulting in more rapid detoxification. However, the data provided are insufficient for making any definitive conclusions. More studies are needed.
• Excessive treatments may allow the body to absorb too much water, which may cause electrolyte imbalances, nausea, vomiting, heart failure, fluid in the lungs, abnormal heart rhythms, or coma. Infections have been reported, possibly due to contaminated equipment or as a result of clearing out normal colon bacteria that destroys infectious bacteria. There is a risk of the bowel wall breaking, which is a serious complication that can lead to septic shock and death. Avoid with diverticulitis, ulcerative colitis, Crohn's disease, severe or internal hemorrhoids, rectal/colon tumors, or if recovering from bowel surgery. Avoid frequent treatments with heart or kidney disease. Colonic equipment must be sterile. Colonic irrigation should not be used as the only treatment for serious conditions. Avoid if pregnant or breastfeeding due to a lack of scientific data.
• DHEA : DHEA (dehydroepiandrosterone) is a hormone that is produced by the adrenal glands. Preliminary study shows that DHEA is not beneficial for cocaine withdrawal, but further study is needed before a firm conclusion can be drawn.
• Avoid if allergic to DHEA. Use cautiously with adrenal or thyroid disorders, depression, panic disorder, bipolar disorder, psychotic disorders, heart disorders, polycystic ovary syndrome, anovulatory infertility, steroid 21-hydroxylase deficiency, gynecomastia, overactive thyroid, bacterial infections, or diabetes. Use cautiously if at risk for prostate cancer, liver cancer, breast cancer, or ovarian cancer. Use cautiously in HIV patients with Kaposi's sarcoma or in patients who have received flu shots. Use cautiously if taking alprazolam, amlodipine, anastrozole, benfluorex, beta-adrenergic antagonists, calcium channel blockers, canrenoate, danazol, diltiazem, growth hormone, methylphenidates, metopirone, nitrendipine, or hormones or dietary supplements with hormone-like effects (e.g. chromium picolinate). Avoid if pregnant or breastfeeding.
• Eucalyptus oil : Nicobrevin is a proprietary product marketed as an aid for smoking cessation that contains quinine, menthyl valerate, camphor, and eucalyptus oil. Despite use of this product, there is currently a lack of evidence suggesting benefit for smoking cessation.
• Avoid if allergic to eucalyptus oil or with a history of seizure, diabetes, asthma, heart disease, abnormal heart rhythms, intestinal disorders, liver disease, kidney disease, or lung disease. Use caution if driving or operating machinery. Avoid with a history of acute intermittent porphyria. Avoid if pregnant or breastfeeding. A strain of bacteria found on eucalyptus may cause infection. Toxicity has been reported with oral and inhaled use.
• Ginkgo biloba : Ginkgo biloba has been used medicinally for thousands of years. Today, it is one of the top selling herbs in the United States. It is not clear whether ginkgo is helpful in treating cocaine dependence. More study is needed.
• Avoid if allergic or hypersensitive to members of the Ginkgoaceae family. If allergic to mango rind, sumac, poison ivy or oak or cashews, then allergy to ginkgo is possible. Avoid with blood-thinners (like aspirin or warfarin (Coumadin®)) due to an increased risk of bleeding. Ginkgo should be stopped two weeks before surgical procedures. Ginkgo seeds are dangerous and should be avoided. Skin irritation and itching may also occur due to ginkgo allergies. Do not use ginkgo in supplemental doses if pregnant or breastfeeding.
• Globe artichoke : Globe artichoke (Cynara scolymus) may help the digestive system to function better. An extract of artichoke has been used and marketed as a remedy for alcohol-induced hangover. However, there is insufficient available evidence to form a clear conclusion in this area. Artichoke extract may be taken immediately before and following consumption of alcohol.
• Do not use artichoke with gall bladder or liver problems, unless under the supervision of a doctor. Use cautiously if allergic/hypersensitive to members of the Asteraceae or Compositae family (e.g., chrysanthemums, daisies, marigolds, ragweed, arnica), due to possible cross-reactivity. Use cautiously with cholelithiasis or biliary/bile duct obstruction or kidney disease. Avoid if pregnant or breastfeeding.
• Guided imagery : In contemporary times, the term "guided imagery" may be used to refer to a number of techniques, including metaphor, story telling, fantasy, game playing, dream interpretation, drawing, visualization, active imagination, or direct suggestion using imagery. Therapeutic guided imagery may be used to help patients relax and focus on images associated with personal issues they are confronting. Based on early study, guided imagery in addition to education and counseling sessions may be helpful for long-term smoking cessation and abstinence in adult smokers. Further study is needed to confirm these results.
• Guided imagery is usually intended to supplement medical care, not to replace it, and guided imagery should not be relied on as the sole therapy for a medical problem. Contact a qualified healthcare provider if mental or physical health is unstable or fragile. Never use guided imagery techniques while driving or doing any other activity that requires strict attention. Use cautiously with physical symptoms that can be brought about by stress, anxiety, or emotional upset because imagery may trigger these symptoms. If feeling unusually anxious while practicing guided imagery, or with a history of trauma or abuse, speak with a qualified healthcare provider before practicing guided imagery.
• Hypnotherapy : Hypnosis is associated with a deep state of relaxation. Although used by psychotherapists, there is inconclusive evidence for the use of hypnotherapy in alcohol dependence and drug addiction. Additional research is needed in this area.
• Use cautiously with mental illnesses like psychosis/schizophrenia, manic depression, multiple personality disorder or dissociative disorders. Use cautiously with seizure disorders.
• Kudzu : Kudzu (Pueraria lobata) is well known in the southern United States as an invasive weed. Research indicates that extracts of kudzu may be effective in treatment of alcoholism, such as with decreasing the cravings of alcohol. Clinical studies report positive benefits when using kudzu for alcohol craving. However, more research needs to be performed.
• Use caution with anticoagulants/anti-platelet and blood pressure lowering agents, hormones, antiarrhythmics, benzodiazepines, bisphosphonates, diabetes medications, drugs that are metabolized by the liver's cytochrome P450 enzymes, mecamylamine, neurologic agents, and methotrexate. Well designed studies on the long-term effects of kudzu are currently unavailable. Avoid if allergic or hypersensitive to Pueraria lobata or members of the Fabaceae/Leguminosae family. Avoid if pregnant or breastfeeding.
• L-carnitine : L-carnitine (also known as acetyl-L-carnitine) is an antioxidant and may help blood flow, as well as neurological function. Early studies suggest that acetyl-L-carnitine may be of benefit in the treatment of alcoholism. Well-designed clinical trials are required before recommendations can be made in this field.
• Avoid with known allergy or hypersensitivity to carnitine. Use cautiously with peripheral vascular disease, hypertension (high blood pressure), alcohol-induced liver cirrhosis, and diabetes. Use cautiously in low birth weight infants and individuals on hemodialysis. Use cautiously if taking anticoagulants (blood thinners), beta-blockers, or calcium channel blockers. Avoid if pregnant or breastfeeding.
• Massage : Massage shows promise as an adjunct to traditional medical detoxification for alcohol dependence. Further research is needed to confirm these results.
• Avoid with bleeding disorders, low platelet counts, or if on blood-thinning medications (such as heparin or warfarin/Coumadin®). Areas should not be massaged where there are fractures, weakened bones from osteoporosis or cancer, open/healing skin wounds, skin infections, recent surgery, or blood clots. Use cautiously with a history of physical abuse or if pregnant or breastfeeding. Massage should not be used as a substitute for more proven therapies for medical conditions. Massage should not cause pain to the client.
• Meditation : Available evidence does not indicate conclusively whether meditation can help with smoking cessation, cocaine dependence, or alcoholism. More studies are needed.
• Use cautiously with underlying mental illnesses. People with psychiatric disorders should consult with their primary mental healthcare professional(s) before starting a program of meditation, and should explore how meditation may or may not fit in with their current treatment plan. Avoid with risk of seizures. The practice of meditation should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses.
• Melatonin : Melatonin is a hormone produced in the brain and is involved in the sleep wake cycle during light and darkness. Levels of melatonin in the blood are highest prior to bedtime. A small amount of research has examined the use of melatonin to reduce symptoms associated with smoking cessation, such as anxiousness, restlessness, irritability, and cigarette craving. Although preliminary results are promising, due to weaknesses in the design and reporting of this research, further study is necessary before a firm conclusion can be reached. Early research has also examined the use of melatonin to assist with benzodiazepine tapering, such as with diazepam (Valium®) or lorazepam (Ativan®).
• Melatonin is not to be used for extended periods of time. Melatonin can cause drug interactions, and healthcare professionals recommend not using in pregnancy or breastfeeding.
• Nopal cactus : Limited available clinical study found that nopal cactus (Opuntia ficus-indica) may prevent alcohol-induced hangover, likely due to nopal's ability to inhibit the production of inflammatory mediators. More clinical studies are needed to confirm this finding. Avoid if allergic/hypersensitive to nopal (Opuntia spp.), any of its constituents, or to members of the Cactaceae family. Use cautiously if taking medications that alter blood sugar, cholesterol, or blood pressure. Use cautiously with thyroid dysfunction and rhinitis (runny or congested nose), or asthma. Avoid with immunosuppression or impaired liver function. Avoid if pregnant or breastfeeding. The nopal plant should be handled cautiously, as it is covered in long sharp spines and shorter soft-appearing barbs of glochids, which may be painful and difficult to remove once they are imbedded in the skin. It is recommended that oral doses of dried nopal be taken with at least eight ounces (250mL) of water.
• Prayer : Traditional forms of prayer have been widely used for alcohol or drug dependency and smoking cessation. However, early study results are unclear. Additional research is needed to make a conclusion.
• Prayer is not recommended as the sole treatment approach for potentially serious medical conditions and should not delay the time it takes to consult with a healthcare professional or receive established therapies.
• Psychotherapy : Several studies suggest that psychotherapy may be beneficial for smoking cessation, alcohol abuse, or drug abuse. However, there is not enough available evidence to make a conclusion. More research is needed to better determine effectiveness.
• Psychotherapy is not always sufficient to resolve mental or emotional conditions. Psychiatric medication is sometimes needed. The reluctance to seek and use appropriate medication may contribute to worsening of symptoms or increased risk for poor outcomes. In order to be successful, psychotherapy requires considerable personal motivation and investment in the process. This includes consistent attendance and attention to treatment recommendations provided by the practitioner. Not all therapists are sufficiently qualified to work with all problems. The client or patient should seek referrals from trusted sources and should also inquire about the practitioner's training and background before committing to work with a particular therapist. Some forms of psychotherapy evoke strong emotional feelings and expression. This can be disturbing for people with serious mental illness or some medical conditions. Psychotherapy may help with post-partum depression, but is not a substitute for medication, which may be needed in severe cases.
• Qi gong : Qi gong is a type of traditional Chinese medicine (TCM) that is thought to be at least 4,000 years old. It is traditionally used for spiritual enlightenment, medical care, and self-defense. A recent study looked at the effectiveness of Qi gong therapy versus medical and nonmedical treatment for heroin detoxification. Results showed that Qi gong may be beneficial in heroin detoxification without side effects, although the possibility of the placebo effect cannot be completely eliminated. Other treatments have been better studied for heroin detoxification and are recommended at this time. Qi gong may be used as an adjunct therapy.
• Qi gong is generally considered to be safe in most people when learned from a qualified instructor. Use cautiously with psychiatric disorders. In cases of potentially serious conditions, Qi gong should not be used as the only treatment instead of more proven therapies, and it should not delay the time it takes to see an appropriate healthcare provider.
• Relaxation therapy : Early research reports that relaxation with imagery may reduce relapse rates in people who successfully completed smoking cessation programs. Better study is needed in this area before a firm conclusion can be reached.
• Avoid with psychiatric disorders like schizophrenia/psychosis. Jacobson relaxation (flexing specific muscles, holding that position, then relaxing the muscles) should be used cautiously with illnesses like heart disease, high blood pressure, or musculoskeletal injury. Relaxation therapy is not recommended as the sole treatment approach for potentially serious medical conditions, and should not delay the time to diagnosis or treatment with more proven techniques.

D Fair negative scientific evidence

• Acupuncture : Numerous studies of acupuncture for smoking cessation have been conducted, and the quality of studies has varied widely. There may, however, be some benefit in reducing side effects of withdrawal such as irritation, cigarette craving, and headache. Additional research is needed.
• Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders, medical conditions of unknown origin, or neurological disorders. Avoid if taking drugs that increase the risk of bleeding (e.g. anticoagulants). Avoid on areas that have received radiation therapy and during pregnancy. Use cautiously with pulmonary disease (e.g. asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics, or with history of seizures. Avoid electroacupuncture with arrhythmia (irregular heartbeat) or in patients with pacemakers because therapy may interfere with the device.
• Hypnotherapy : Hypnotherapy involves suggestion by therapists during periods of deep relaxation. Although used for smoking cessation with some positive results, there is currently a lack of scientific evidence for hypnotherapy as a valid treatment for this indication.
• Use cautiously with mental illnesses like psychosis/schizophrenia, manic depression, multiple personality disorder or dissociative disorders. Use cautiously with seizure disorders.