involving both opioids and cocaine fared better
if they were randomly assigned to receive
bupropion versus placebos and CM versus no
psychosocial intervention.^294 Other research
points to the potential utility of combining an
antidepressant* with CM for patients with
addiction involving opioids and cocaine who are
maintained on buprenorphine.^295 Patients who
received this combined therapy provided more
drug-free urine samples during treatment and
achieved a period of continuous abstinence that
was, on average, twice as long as patients with
addiction involving opioids and cocaine who
were in the control conditions.† 296 Preliminary
evidence also suggests that daily doses of
naltrexone‡ combined with CBT may be
effective for treating addiction involving alcohol
and cocaine, particularly among men.^297
Nutrition and Exercise ...............................................................................................
A healthy nutrition and exercise regimen can
mitigate the symptoms of withdrawal, enhance
the effects of evidence-based treatment and help
sustain successful treatment outcomes.^298
Furthermore, because different addictive
behaviors can share common causes, patients in
treatment for addiction involving nicotine,
alcohol or other drugs may substitute unhealthy
foods in an attempt to satisfy addictive
cravings.^299 This is particularly evident in the
common case of weight gain following smoking
cessation. As such, a comprehensive approach
to addiction treatment includes interventions
aimed at ensuring good nutrition and exercise.
Nicotine, alcohol and other drug use also disrupt
normal body functioning--resulting in nutritional
deficiencies, dehydration or electrolyte
imbalance--and often lead to unhealthy lifestyle
changes such as poor diet and irregular eating
habits.^300 Providing patients in addiction
treatment with nutritional programming may
help them to reverse some of the damage that
smoking, drinking and using other drugs can
inflict on their bodies. The improvements in
- desipramine
† Who took placebos combined with CM,
desipramine without CM or placebos without CM.
‡ 150 mg.
general health and mood that may result from
healthy eating habits also could help patients
maintain their abstinence.^301Some individuals in treatment attempt to
compensate for the lack of alcohol, for example,
by consuming significant amounts of sugar and
other carbohydrates which may increase
serotonin§ levels.^302 A healthier approach,
according to one theory, suggests that eating
foods that are rich in the precursors of the
neurotransmitters which are depleted when a
substance user abstains will reduce cravings for
those substances and facilitate the treatment
process.^303 These include protein-rich foods
such as meat, fish, dairy products and nuts.^304Exercise also stimulates brain cells that reinforce
dopamine-related reward pathways.^305 This
reinforcement may allow substance users to
experience pleasurable effects from exercise
which potentially could reduce their substance-
related cravings.^306 Exercise generally is
beneficial in reducing symptoms of depression
and anxiety that often co-occur with and
contribute to addiction.^307 Another theory
regarding the utility of exercise in a
comprehensive treatment program is that as
individuals develop a mastery of exercise
techniques, they increase their self-efficacy--the
belief that one can master new skills--which can
be applied to disease management strategies.^308
Patients who exercise in group settings also may
benefit from social support networks and social
interactions that do not involve tobacco, alcohol
or other drug use.^309Exercise moderates the effects of nicotine
withdrawal symptoms including reductions in
cravings, negative mood,^310 sleep disturbances^311
and tension.^312 One study found that exercisers
in a smoking cessation program were twice as
likely as those who did not exercise to
demonstrate continual abstinence by the end of
the three-month program, and three and 12
months following treatment completion. After a
year, exercise participants were 36 percent less§ A neurotransmitter involved in mood, emotion,
sleep, appetite and some aspects of addiction.