Taking a brain-health approach to addiction treatment
What if substance-use disorders could be treated more effectively by starting with brain healing?
That’s the approach UCLA Health addiction psychiatrist Timothy Fong, MD, suggested at the recent Emerging Behavioral Health Conference in Westwood.
Instead of immediately diving into addressing addictive behaviors with his patients, he likes to begin by encouraging basic practices such as sleep and exercise to help heal the brain.
Dr. Fong shared the story of a patient seeking treatment for disordered use of alcohol and benzodiazepines, as well as anxiety and depression. The patient had a 12-year history of recovery and relapse, spending more than $300,000 on treatment without sustained success.
“I said, ‘I’m not going to talk to you about alcohol, pills or any of that stuff,’” said Dr. Fong, also a clinical professor of psychiatry at the Jayne and Terry Semel Institute for Neuroscience and Human Behavior at UCLA. “We’re only going to talk about brain health strategies.”
For this patient, that included prioritizing sleep, incorporating regular physical activity, following a Mediterranean diet – which emphasizes plant-based foods and healthy fats – and “simplifying her psychiatric medications down to one FDA-approved medication for alcohol use disorder,” Dr. Fong said.
Today, this patient has more than 3½ years of sobriety, has gotten to a healthier weight and is thriving in a fulltime career, he said.
During this time, the patient’s brain healed, Dr. Fong said, particularly in the realms of sleep, self-control and “frontal lobe functioning,” responsible for managing thoughts, emotions and judgment.
Understanding addiction’s effects on the brain has evolved in recent decades. Scientists now know that the human brain can form and repair neural connections throughout the life span — a concept known as neuroplasticity — which means the brain can generally heal from the damage and dysfunction caused by substance use.
“More and more studies are showing that when you get into recovery, your brain heals,” Dr. Fong said.
Speaking to an audience of behavioral health clinicians, Dr. Fong suggested three areas of focus when working with individuals with substance use disorders:
Medications have been underutilized to help patients with substance use disorder, Dr. Fong said.
“Medication lays the groundwork for recovery,” he said. “Too often, patients don’t quite hear that message.”
He tells patients that the medications he recommends aren’t necessarily permanent, but can help “contain the signs and symptoms of substance use disorder so that you can do the work of recovery,” which may include mindfulness, 12-step programs and connecting with community.
Dr. Fong likes to inspire his patients to incorporate regular physical activity into their recovery efforts because exercise “profoundly impacts the body, brain and mind.”
He might say to a patient: “Did you know that physical movement actually changes your brain by stimulating the feel-good chemical dopamine that you have been getting from your substances or from your addiction? It manufactures more dopamine, it releases it more efficiently, it changes the enzymes that metabolize dopamine.”
He reminds patients that something as simple as a one-minute walk can help bring about this kind of brain change.
He generally recommends that whatever physical movement patients choose, it’s best to exercise with another person rather than alone. Social connection benefits brain health.
The “sleep centers” of people with addictive disorders have been damaged not just by the toxicity of the substances they’ve used, but by sleep deprivation, Dr. Fong said.
He knows firsthand what sleep deprivation does to mental health. During his days as a medical resident, he said, he’d often stay awake for 36 hours straight.
“By hour 28, I had no empathy. I couldn’t pay attention to anything,” he said. “Because the brain was literally swimming in oxidants and free-radical damage.”
During sleep, the brain releases hormones that restore and repair cells. Blood pressure and heart rate decrease, Dr. Fong said, “and your body and brain opens up the channels to flush out the toxins, so you are literally flushing out the toxins in your body.”
With patients, Dr. Fong likes to approach sleep as a skill that can be improved. He might encourage them to keep a sleep diary, use a weighted blanket and keep their bedroom cool.
“We have tremendous amounts of sleep technology that we can add into behavioral health other than, simply, ‘Get more sleep’ or ‘Try to go to bed earlier,’” Dr. Fong said.
Framing these practices — medication, physical activity and sleep — as ways to improve brain health empowers patients to have personal agency in their recovery.
“As a physician,” he said, “I’m approaching this idea of helping to heal your brain, your mind and your soul.”