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In previous issues of The Vine, we have discussed working with smokers and with pot smokers. In this issue, we will look at the much more difficult issue of working with alcoholics. In a typical Ayurvedic practice, we are unlikely to see the flagrant, rock-bottom alcoholic--unless one of our clients relapses after being sober for some time. Alcoholism is difficult to work with because it is so often covert. For purposes of this discussion, we will consider anyone who uses alcohol on a regular, daily basis as, at the very least, a mild alcoholic. Try a simple test--tell them that their Ayurvedic herbs will not be effective a long as they are using alcohol on a regular basis. The defensiveness and denial with which your suggestion that they give up alcohol is met will soon tell you of the hold the substance has over them.
When a patient fails to improve despite appropriate treatment, if may be worthwhile to consider whether they are a closet alcoholic and are hiding this obstacle to their healing from you. One client we saw insisted that he has stopped his daily wine habit, yet failed to make progress with his complaints of hyperacidity and indigestion. Growing impatient with his lack of improvement, he sought out other practitioners, with no greater success. It was his wife, also a client, who alerted us to the fact that both of them were still drinking on a daily basis. Another patient failed to improve on her Ayurvedic regimen and had not admitted to any substance issues. The only indication of her alcoholism was a persistent habit of being late for her appointments or canceling at the last minute as well as a tendency to be sometimes warm and sometimes extremely cold and unapproachable.
Another tricky group of alcoholics are the sporadic users or binge alcoholics. These individuals may be sober during the week and drunk on the weekend or refrain from alcohol for extended periods of time, punctuated by bouts of intense binging. In this group of users, denial runs rampant, since they are always "sober" between binges. Yet, difficult as it may be, it is essential for the individual to admit their addiction, to themselves and to you, in order to start on the road to recovery.
Alcoholics who are on Antabuse offer a particular challenge to the Ayurvedic practitioner. We recommend that Ayurvedic herbal regimens be given to such individuals only by an Ayurvedic physician with a good grounding in Allopathic pharmacology or an Ayurvedic practitioner who is also a medical doctor. Herb-drug interactions are extremely complex and understanding them requires a knowledge of Pharmacodynamics--the science of how drugs and herbs are transported, distributed, metabolized and excreted. However, such clients can be helped by ancillary therapies such as diet and lifestyle counseling, abhyanga, shirodhara, marma point massage using Sandalwood oil, and herbal dusting.
The people most likely to be drawn to alcoholism are of course pitta individuals, although kapha may be strongly attracted to beer. Pitta seeks out alcohol to alleviate stress and tension. It is the quest of the mood altering effect that marks the difference between a harmless use and an addiction. It is particularly important to appreciate that pitta individuals suffering from depression or manic depressive disorder may self-medicate with alcohol.
In general, Ayurvedic therapies will not be successful until the client is sober, as attempts to balance the doshas cannot be effective when a prajnaparadh, or crime against Ayurvedic wisdom, continues. Thus, as a rule, it is important to emphasize that sobriety is a precondition for Ayurvedic treatment. "You want to be rid of your allergies? Please return when you are ready to quit alcohol, and than we can definitely deal with your allergies."
The patient in question waited three months before returning to announce, "I'm sober. Now let's work on the allergies." However, in the case of the person self-medicating for depression or manic depressive disorder, it is usually necessary to institute treatment for depression prior to withdrawal of alcohol. This can be approached by giving Brahmi tea one teaspoon per cup three times daily or by using Mental Clarity Formula. This formula lends itself well to work with alcoholics since it contains not only Brahmi and Bacopa but also Shankhapushpi, an important liver herb which is also effective for depression.
For anyone who has used alcohol to the point of being blind drunk or having blackouts, the esoteric aspect of Ayurveda points to the danger of bhutas or elementals which may have attached to the aura of during the episode of near-unconsciousness. Such energies may impact the individual's ability to reform and engage in genuine recovery, since it is in the interests of the energy for the alcoholism to continue. A simple way to remove bhutas from the aura is to mix Shankhapushpi in ghee and burn it in the presence of the affected individual. If the client concerned might think that talk of bhutas is hocus-pocus, they can be told, accurately enough, that Shankhapushpi smoke is a good remedy for depression and addictions.
As soon as the client has embarked on a course of sobriety, an Ayurvedic detoxification program should be instituted. For two weeks, the client should eat kitcheri for lunch and dinner, accompanied by a sabji (cooked vegetable dish) of carrots, beets, daikons and bitter greens, seasoned with cumin, turmeric and cilantro. Abundant cilantro should be used to balance the dish for pitta. For breakfast and mid-afternoon snack they should have juice of carrot, beet, daikon, cucumber and cilantro. The amount of beet and daikon used in the juice should be small relative to the other ingredients, to avoid provoking pitta. Each morning, they should take a half teaspoon of Mahasudarshan mixed in honey, followed by warm water, or, if preferred, Mahasudarshan tablets. This should be taken at least twenty minutes before breakfast. At bed time they should take half a teaspoon of Triphala steeped for ten minutes in boiling water and strained. If Triphala tea is not well tolerated, Amlaki tea or tablets can be substituted. This detoxification program is not only effective in cleansing the liver; it is also dramatic enough to signify a passage to a new, sober, life.
Following the detoxification program, it is essential to rebuild the liver. Liver Formula, which includes cleansing herbs such as Musta and Manjista, hepato-protectives such as Kutki and liver rejuvenatives such as Bhringaraj, is an ideal choice for this situation. An excellent anupan to ensure the optimum effectiveness of Liver Formula is Aloe Vera, two tablespoons with each dose of Liver Formula. Mahasudarshan can be continued for up to a month after the detoxification program. If the client has a "beer belly" or has gained excess weight as a result of the alcohol habit, Trim Support could be used after a six week course of Liver Formula. For those who have been heavy users of alcohol, a peri-diabetic condition may be observed, including weight gain, blood sugar swings and sweet cravings. In this case, Sweet Ease can be used along with Trim Support, or an individualized formula can be prepared using herbs such as Shardunika to regenerate the pancreas, Turmeric to balance blood sugar and Chitrak to kindle agni and improve metabolism. Brahmi tea or Mental Clarity formula can be continued for some months if mood swings or depression are an issue. In some cases, alcoholism may have led to periodontal disease. This can be managed with organic sesame oil mouthwash.
Pancha Karma will be of great value for the recovering alcoholic, but timing is an important consideration. Unless the alcoholism was extremely mild, it is often wise to wait at least six months before initiating pancha karma. This gives the individual time to become stable in their sobriety. Nothing is more dangerous than an alcohol relapse during or immediately following pancha karma. Typically, Pitta Massage Oil could be used for abhyanga in this situation. If alcoholic liver damage is an issue, the client will not be able to do internal oleation. In this case, Panchamrit can be substituted for the usual internal oleation. Amlaki is the best substance for virechan and Guduchi for basti in this case.
½ bowl fresh homemade yogurt
1 tsp honey
1 tsp turbinado sugar
1 tsp tulsi power
2 Tbsp lukewarm milk
1 tsp ghee
Alcoholism arises from a state of depression, emptiness, meaninglessness or stress. Hence it is important to introduce stress-reducing practices such as yoga and pranayama and to encourage pursuit of meaning through meditation and selfless service. Nurturing lifestyle practices are necessary to fill the empty space left by the alcohol. For example, marma point aromatherapy can be done using Champa or Jasmine attar, while for diffusion aromatherapy Sandalwood oil can be used. A bed-time foot massage with
Bhringaraj oil or coconut Brahmi oil, a cup of warm milk with cardamom and cinnamon or a dose of Stress Ease with some soothing rose and coriander tea can replace an alcoholic "nightcap". The former weekend alcoholic can substitute a weekend self-nurturing routine such as abhyanga and shirodhara.
Continuous support from the Ayurvedic practitioner is essential in the process of recovery. This should be supplemented by attendance at Alcoholics Anonymous or by individual counseling. Through herbal therapies and pancha karma the physical and mental aspects of detoxification and recovery can be effectively addressed, while through subtle therapies and rejuvenation practices, the client can be helped to fill the inner void and find new meaning in life.