Approaching substance use disorder (SUD) with integrative therapies

Substance use disorder (SUD) is a multi-faceted condition that requires a multi-faceted approach to treatment, according to Ravi Chandiramani, ND, naturopathic physician, founder of the Integrative SUD Medicine (IAM) approach, and chief medical officer at Soul Surgery Integrative Medicine Addiction Center in Scottsdale, Ariz.

“In the vast majority of cases, you're dealing with a multifactorial disease process that manifests on the physical, mental, emotional, and psychospiritual planes simultaneously,” he said.

Additionally, most patients who suffer from SUD will benefit greatly from trauma-informed care, he said.

“There are schools of thought that say every case of [SUD] is rooted to some degree in some kind of trauma,” he said, “and that if you haven't identified it, it’s just because you're not looking hard enough.”

He added that since many patients won’t necessarily equate certain experiences with trauma, it’s important for practitioners to screen for it.

Christine Gibson, MD, is an author, speaker, and specialist in SUD and trauma who works in SUD clinics in Calgary, Canada. She said that many physicians miss the connection between substance use and trauma.

“A lot of people choose an [SUD] in order to disassociate,” she said. “It’s a really good tool to help you disassociate when life gets hard. It's an effective coping strategy, and it's a coping strategy that has a lot of consequences.”

SUD and trauma often go hand-in-hand and can occur in surprising demographics, said Gibson.

“I'm seeing far more cases of young women,” she said. “Someone might have a great corporate job, but then they take the week off — let's say they go to a mountain cabin with their family — and they don't bring alcohol with them. They’ll go into withdrawal and wonder what’s happened. They had no idea how physiologically dependent they were,” she said.

Gibson draws from several trauma-focused tools to treat SUD, including somatic, psychotherapeutic, and neurobiological approaches. Likewise, the practitioners at Soul Surgery, where Chandiramani facilitates all patient protocols, offer holistic treatments, wellness education, and psychotherapeutic approaches.

Brainspotting

Gibson uses brainspotting, a relatively new and underused technique that involves working with patients to identify points in their vision that are attached to memories and feelings.

“It’s based on the understanding that points in your visual field relate to every emotional experience and every memory, and that you can find them,” she said.

According to a brainspotting website, practitioners guide patients to hone in on a feeling or experience, then note where the patient's eyes focus, also known as the brainspot. They’ll then guide the patient to focus on the spot and process the emotions then come up. The technique works on the neurobiological level and can be used to treat trauma, disassociation, and distressing emotions.

Gibson uses it to treat SUD by linking the spot for craving and the spot for consequence, which creates a stronger neural pathway between the two. This is helpful because, for most people, the neural pathway linking cause and consequence is weakened via disassociation, she said.

Once someone has gone into a stress response, their amygdala bypasses the prefrontal cortex and leaves little room for foresight,” she said. “In this effort to soothe overwhelming distress, they don’t really think too much about consequences. That's not how [SUD] works.”

Brainspotting has effectively been used to treat conditions related to SUD, according to a 2017 study in the Mediterranean Journal of Clinical Psychology, which found it reduced symptoms of PTSD. It also significantly reduced severe PTSD symptoms in a 2022 study in Archives of Psychiatry & Psychotherapy

Biofeedback

Biofeedback is a technique for helping patients who get hijacked by intense anxiety, panic, or other overwhelming emotions, said Chandiramani. This is critical since most people with SUD experience some level of nervous system dysregulation.

“The top three things that people [we treat] complain of are anxiety, depression, and insomnia,” said Chandiramani. “It's almost universal, regardless of what their substance of choice is.”

Patients at Soul Surgery can experience a biofeedback session in a few ways: through guided meditation, video, or audio. Lying in a vibrating bed, they’ll be guided to tune into their autonomic responses like breathing and heart rate. They’ll then select a guided journey that calms and relaxes them.

“[When they’re experiencing a heightened state of anxiety] they’re going to want a pill from us,” he said. “We’ll steer them away from that and towards the biofeedback. We tell them, ‘Try this first, and if it doesn't work, you still have the option for a pill.’ But more than 50 percent of the time, they don't go into the nurse's office after the biofeedback session.”

Biofeedback isn’t just helpful for acute stress, or within the context of a treatment center, he said. The interplay between patient and biofeedback technology is also part of the neural and biological rewiring that helps them become more emotionally regulated and build the capacity to make better choices over time, he said.

Additional Integrative Approaches

Gibson draws many other modalities from her trauma toolkit to treat SUD, including specialized offerings like:

• Emotional Freedom Technique (EFT)
• Havening or Delta Wave Therapy
• Guided Imagery
• Accelerated Resolution Therapy
• Somatic Experiencing

Likewise, patients can also benefit from equine therapy, art therapy, acupuncture, mindfulness, and chiropractic care.

By drawing from the modalities most appropriate to the patient and that they resonate the most with, Chandiramani said practitioners can more effectively treat SUD.

“The goal is that they engage in the modality while they're here,” he said. “They can do that on a daily basis if they want, and that can, in addition to all the other things that are being done in parallel, condition their previous default behaviors or thinking patterns out of them.”