Hormonal replacement therapy not only improves the quality of life in patients, it also prevents unnecessary depression, anxiety and insomnia disorders all of which can lead the path to an addiction. Over ninety percent of addicted patients self-medicate with drugs and alcohol/sugar in their attempt to balance their brain chemistry and feel normal.

The often overlooked part of a rehabilitation program usually does not address normalizing brain chemistry with medication, bio-identical hormone replacement, whole food nutrition, and nutraceutical supplementation to replete the malnutrition which accompanies addiction. Patients usually take drugs, alcohol/sugar either to stimulate under-active brain regions or relax over-active brain systems. The aberrant electrical activity in the addicted patient’s brain is typically caused by inherited or acquired biochemical and hormonal deficiencies, differences in the number and quality of receptor sites…….

Female Progesterone levels begin to decline approximately one decade prior to Estrogen. When Progesterone production declines, females begin to experience new found anxiety and insomnia. We often see that when Progesterone declines so precipitously it is a precursor to the etiology of alcohol/sugar and drug abuse, with causation in over forty percent of addicted middle age females.

The biochemical explanation is that Allopregnanolone, a metabolite of Progesterone, enhances GABA-A receptivity (think Xanax, Valium, Klonopin). When females experience a loss in GABA-A receptivity via diminished Progesterone levels, they can develop excess electrical activity in both the central and peripheral nervous system. Both men and women often utilize alcohol for it’s GABA-A receptor activation.

Many Progesterone deficient women will begin to abuse Vicodin or Oxycontin because the calcium channel blockade effect of the opiate will down regulate the increased “brain voltage” derived from the lost GABA-A receptivity. Unfortunately, many develop Mu receptor tolerance, and begin increasing their opiate dose which then subsequently suppresses the hypothalamic-pituitary-adrenal axis suppression further. Now we have a panhormonal deficiency. There will be multiple hormonal deficiencies that will require someone well trained in how to achieve hormonal balance.

I was surprised to learn that Methadone (legal treatment for Heroin addicts) causes a dysfunction in the hypothalamic-pituitary-adrenal axis as well. Frequently, one finds accompanying hypothyroidism. Hypothyroidism is grossly under treated in this country.

Another hormonal deficiency that frequently serves as the etiology of alcoholism and drug addiction in females is Estrogen deficiency. Estrogen enhances Serotonin receptivity in the female brain. What this means is that if your Serotonergic antidepressant is not working, you may not need to add Abilify, you may need to add Estrogen. With enough Estrogen, the Serotonin can gain access to the receptor site. Of note is that Estrogen has monoamine oxidase inhibitor activity and therefore increases both Serotonin and Dopamine levels in the brain.

What one sees upon observing a SPECT (brain scan) is that with deficient Serotonin, two areas of the brain light up like the Christmas tree at Rockefeller Plaza. Notably, the limbic system or emotional center, and the anterior cingulate gyrus which is normally considered the brain’s gear shifter.

When Serotonin levels are adequate, there is appropriate inhibition of the excitatory neurotransmitter, Norepinephrine, from the locus ceruleus. When Serotonin cannot be taken up by the receptor site because it is deficient in Estrogen, females can change a lot. And not in a good way. Many husbands have thanked me for giving their wife back to them.

Neurotransmitter levels may be tested for: Serotonin deficiency, Norepinephrine excess, Dopamine excess, Glutamate excess, GABA deficiency, or Histamine excess (a monoamine neurotransmitter which was always measured at the Princeton Bio Center). The monoamine Histamine, like Dopamine, can when in excess, produce increased “electrical voltage” in the brain causing subsequent anxiety. I call this increased electrical voltage an emotional seizure.

In a panoramic treatment program, nutritional depletion is replaced, hormonal deficiencies are replaced, GI tracts are detoxified of yeast, leaky gut is treated with Glutamine, Histamine reduction is accomplished with SAMe, high dose Vitamin C, and B6 (Pyridoxine). Note that if your second toe is longer than your big toe you may want to consider replacing B6 with Pyridoxal 5 Phosphate which is the active form of B6. Those born with a longer second toe, called Morton’s toe, cannot convert B6 to the active form called Pyridoxal 5 Phosphate. B6 makes brain chemicals.

Severe depression can be precipitated by the diminished MAO inhibitor effect and subsequent reduction of brain Dopamine levels that accompanies Estrogen deficiency. Reduced brain Dopamine can have a negative effect on cognition, but often of more importance, can decrease activation of our nucleus accumbens or pleasure/hunger center which is Dopamine driven.

Specifically, it is the activation of the D2 Dopamine receptor in the nucleus accumbens that gives up pleasure, satiety, and motivation. A 2006 University of Virginia PET scan study comparing D2 Dopamine activity, before and after – eating, orgasm, and cocaine consumption revealed that D2 Dopamine activity was elevated three times normal with eating, ten times normal with orgasm, and one hundred times normal with cocaine.

A National Institute of Drug Addiction study in 2003 demonstrated that nicotine was more Dopaminergic than HEROIN AND COCAINE and preferred by rhesus monkeys over cocaine and heroin.

Diminished Dopamine activity that accompanies midlife Estrogen deficiency frequently precipitates self medication with any drug that temporarily releases Dopamine from the brain. Some drugs which increase Dopamine are food, nicotine, alcohol, opioid (pain pills) marijuana, shopping, sex…..

There is much more to do after the addictive substance has been removed to help the patient heal, and to prevent relapse. Addiction is biochemical disease. Perhaps we can do more to help patients.