Thursday, August 20, 2009

The Alcohol Metaphor, Ayurveda, and Yet Another View: Part One

Alcoholism is a global disease.

There are hundreds of thousands of alcoholics in this world.

To confine their treatment to the models devised in Western cultures is to deny innovation that may, one day, lead to a universally successful treatment; a treatment which cuts across cultural and social barriers and delivers surcease of suffering without stigma.

Current treatment is largely symptomatic, in which effort is directed toward a cause. Yet, due to the very character of alcoholism, it is my belief that we should look beyond, and learn how the symptomology of alcoholism fits into a patient's individual somatotype. I believe alcoholism is but one part of a larger somatic imbalance that affects all aspects of a patient's life.

In his landmark study of Chinese medicine, The Web That Has No Weaver, American author Ted J. Kaptchuk introduces the differences between Western and Chinese medicine through reference to a clinical study involving sixty-five patients. All sixty-five were diagnosed by Western medical science as suffering from a single malady: peptic ulcers. Yet, when these same patients were examined by Chinese traditional medical science, six different categories of disorder were discerned. Chinese doctors gave each patient individually-tailored treatment, with an average duration of two months. Results were complete recovery in 81.5%, significant improvment in 10.8%, some improvement in 3.1%, no change in two patients and worsening in one patient due to complications unrelated to treatment.

This example underscores why we need to examine treatment for alcoholism in new ways. Currently, the emphasis is on small group operant conditioning (Alcoholics Anonymous), with scant attention to somatic treatment such as vitamin therapy, herbal therapy, or diet. Patients are run through a literal "assembly line," known as the "Twelve Steps," and are then left to fend for themselves physiologically.

Nevertheless, alcoholism is, in my view, primarily a disease of the body and I believe that treating this somatic disorder by cookie-cutter socio-psychological means is treating a symptom rather than a whole person.

I also believe we need to break out of the Western mold and incorporate treatment approaches encountered in other medical traditions.

This is why I write these words.

Small Group Operant Conditioning

If we learn to accept A.A. for what it really is---a pseudo-therapy founded on a turn of the century Christian religious cult (the Oxford Group) that relies on small group operant conditioning---then we can discard any notion of its usefulness in the treatment of alcoholism.

In every scientifically responsible study of A.A. conducted during the past thirty years, the program is evaluated as a failure...and according to internal A.A. studies....even a danger.

Consider these facts:
(1) The death rate among A.A. participants is higher than among non-participants.
(2) The relapse rate among A.A. participants is higher than among non-participants.
(3) The overall "success" rate among A.A. participants is lower than the normal rate of spontaneous remission.
(4) The re-arrest rate among previously arrested A.A. participants is higher than among non-participants.
As a statistical issue, you have a better chance of ceasing alcohol consumption if you do not participate in A.A. than if you do participate.

Yet, A.A. has so infected alcohol treatment it is almost impossible to escape its influence. This has prevented the development of more effective therapies and raised false expectations in both the medical and criminal justice communities.

Below, I have provided links to two resources that, if read critically, will underscore the several reasons why A.A. doesn't work.

I commend these to your attention.

If you are an alcoholic, and you want to mitigate the damage that drinking does to your life, and you feel you need help, do not call A.A.

Instead, find a competent practitioner of complementary and alternative medicine and put yourself in his or her hands.

Alcoholism isn't solved by brainwashing.

Alcoholism is, more often than not, solved by appropriate nourishment and lifestyle changes that must be carefully and specifically tailored to your particular situation.

For a quick introduction to the old Buddhist Alcohol Study Group, (called Sarpashana), click here. For the Sarpashana Sourcebook, click here.

Alcoholism In Ayurveda

Here is an excerpt from the Ayurveda Saukhya of Todarananda, the chapter on Madatyaya, or alcoholism. This particular work dates to the 16th century, but draws upon a much older body of literature:

Alcohol and Poison
"The attributes of alcohol are similar to those of poison. Therefore, by improper use of alcohol, a serious type of ailment called alcoholism takes place."

Food Value
"But, alcohol by nature is like food. If taken improperly, it causes disease, and if taken properly, it is like ambrosia."

Proper and Improper Use
"The life of living beings is dependent upon food. But, improper use of food kills the individual. Poisons cause death of human beings, but if taken appropriately, they also work as rejuvenating agents."

Proper Methods
"Intake of alcohol according to the appropriate procedure, dose, and time, along with appropriate food, according to the strength of the individual and in a pleasant mood, produces salutory effects like ambrosia."

Good Effects
"If alcohol is taken along with unctuous food and eatables containing meat, then it promotes longevity, strength, and nourishment of the body."

Improper Method
"If alcohol, which is like food, is taken by an ignorant person in inappropriate quantity, then while being digested, it suppresses the digestive power, and along with digestive enzymes, it produces intoxication. By this intoxicating effect, the sense organs become incapable of appropriate perception and therefore, the person loses control over himself and speaks out even his secret feelings."

Constitutional Effects
"In persons having kaphaja type of physical constitution and less of [fire] in the body, and in persons who take unctuous food and meat preparations, intake of alcohol does not cause much difficulty. Others, however, are affected seriously."

"Persons for whom alcohol is not suitable, can drink it in small quantity after diluting with excess of water. Otherwise it will produce edema, looseness of the body, burning syndrome and unconsciousness."

"If alcohol is taken according to the prescribed procedure, it has the attributes to produce liking by others, mental satisfaction, exhilaration, and bravery."

Different Stages of Alcoholism

"After intake of alcohol, during the first stage, there is promotion of intellect, memory, affection, happiness, desire to drink, appetite, sleep, and sexual desire. The individual during this stage likes to read and sing and he gets better voice. During this first stage, the person enjoys many desirable effects.

"During the second stage, after the intake of alcohol, there is impairment of intellect, memory, speech and activities. The person acts as if he has gone mad. He never remains peaceful. He becomes lazy and very frequently goes to sleep.

"During the third stage after the intake of alcohol, the person loses control over himself, and tries to engage in sexual intercourse with those who are unsuitable. He does not show proper respect to teachers; he eats such things which are normally prohibited; he loses consciousness and he speaks out secret things of his heart.

"During the fourth stage of alcoholism, the person becomes unconscious and inactive like a broken piece of wood. It becomes difficult for him to distinguish between things which should be done and those which should not be done. He becomes more than a dead person. Who is the person who would like to reach that stage which is the other form of insanity? This stage leads the person to commit many mistakes. He becomes inconscious and he loses control, as if entering into a deep forest.

"The person who indulges in drinking every day, without taking food and in a lonely place, succumbs to many serious types of diseases which may also result in his death."

Conditions In Which Alcohol Is Injurious

"If a person who is wrathful, fearful, thirsty, sorrowful and hungry, who is tired of exercise, carrying heavy weight and walking a long distance, who has suppressed the manifested natural urges, who is injured, who has taken less of food, who has taken ununctuous food, who is suffering from indigestion, who is weak, who is exposed to heat, takes alcohol, then he succumbs to several diseases [names untranslated] which are of a very serious nature. Their signs and symptoms will now be described:

Vatika Madatyaya
"Alcoholism associated with aggravation of vayu [i.e., rLung] is characterized by hiccup, dyspnoea, trembling of the head, pain in the sides of the chest, remaining awake and delirium."

Paittika Madatyaya
"Alcoholism associated with aggravation of pitta [i.e. mKhris-pa] is characterized by morbid thirst, burning sensation, fever, dyspnoea, unconsciousness, diarrhoea, giddiness, and green color of the skin."

Kaphaja Madatyaya
"Alcoholism associated with aggravated kapha [i.e. bad-kan] is characterized by vomiting, anorexia, nausea, drowsiness, dampness, heaviness, and feeling of cold all around the body."

Tridosaja Madatyaya
"In alcoholism associated with aggravated vayu, pitta and kapha, the signs and symptoms of the above three types may all manifest."

"Paramada, a type of alcoholism, is characterized by salivation, heaviness of the body, absence of taste in the mouth, suppression of stool and urine, drowsiness, anorexia, morbid thirst, headache, and pain in the joints."

"This form of alcoholism associated with indigestion is characterized by a serious type of distension of the abdomen because of accumulation of wind, eructation, burning sensation and such other signs and symptoms which are produced by aggravation of pitta."

"This type of alcoholism is characterized by pain in the cardiac region and different parts of the body, salivation, choking of the throat, fainting, vomiting, fever, headache and burning sensation all over the body. The patient develops hatred for alcoholic drinks and different types of food preparations."

"If one lip becomes smaller and the other bigger, if the patient feels extremely cold, if there is excessive burning sensation, if the face looks like oil, then such a person is sure to die and he should not be treated. If the tongue, lips and teeth become black or blue, if the eyes become either yellow or red like blood, and if the patient suffers from hiccup, fever, vomiting, shivering, pain in the sides of the chest, cough and giddiness, then he succumbs to death.

"Thus ends the diagnosis of the different types of alcoholism."

Five hundred years ago, or more, Ayurvedic physicians already had a rich palette of treatment options for alcoholism.

Among the more novel approaches was "Milk Therapy."'

Here is another excerpt from Ayurveda Saukhya of Todarananda:

Milk Therapy

"If by the administration of the above-mentioned therapies the patient does not get relief, then he should be administered fasting therapy as a result of which kapha is reduced and he gains strength. Thereafter, milk should be given to the patient.

Milk, Ojas and Alcohol

"Attributes of the milk are the same as those of the ojas and they are contrary to those of alcohol. Therefore, in small quantities milk and alcohol should be administered, one after the other.

"Before distillation, marica [piper nigrum, Linn., black pepper] and ghanasara [camphor(!) although I do not immediately understand to which camphor they refer, i.e. Cinnamomum camphora, or Dryobalanops aromatica], or the decoction of the seed of dadima [punica granatum, Linn., pomegranate] are added to the alcoholic recipe. Intake of this cures alcoholism. Alcoholism is also relieved by the kissing and embracing of passionate ladies."


Before we dismiss this out of hand, or take too much glee from the reference to "passionate ladies," we might want to examine the logic involved and see what sort of sense we can make of this treatment.

The first interest comes in the reference to camphor. If the reference is to Cinnamomum camphora,as I suspect it is, we recognize that this affects the CNS, and is toxic at around 2 grams (sometimes quite less in cases of sensitivity). Usually associated with external application as a rubefacient, it is taken internally as a carminative. There are over fifty chemicals, but the principal constituent is quite simply camphor. Maybe I have mistranslated ghanasara, as usually camphor is known as kapur, or kapura.

The principal constituents of black pepper are piperine, chavicine, piperidine and piperettine. You also get thiamine, niacin, potassium, etc. It is employed as a stimulant, and as a stomachic. It has bateriostatic and fungistatic qualities. The motive seems to be stimulation of the digestive process; particularly nutrient absorption in the small intestine. Pepper also dispels wind.

Pomegranate is, I think, so well known in Ayurvedic medicine as to require no further introduction. The treatment calls for the seeds, so if you want to interpolate that, click the link and then study the chemicals in the seeds.

In trying to understand the logic, I consulted an older (and seminal) reference, the Caraka-Samhita, which theoretically dates to around 1,000 B.C.E.

This is a much more specific work, and it explains that milk therapy involves two stages: the first where alcohol is discontinued, and the second where it is gradually resumed in small doses, but notes, "One who after discontinuing intake of wine starts taking it in excessive quantities suffers from the diseases named dhwamsaka and viksaya. They are curable with difficulty, particularly in one debilitated by disorders."

The recommended treatment for the above, which is what I would recognize as "true alcoholism," is enemas, intake of ghee, use of milk and ghee, massage, bath and suitable food and drink. The text further notes, "Disorder due to drinking does not arise in a person who takes wine properly."

The Caraka-Samhita seems to indicate that they are trying to dimish phelgm (bad-kan) long enough to let wind (rLung) and bile (mKhris-pa) rise to dominance, and then nourish the body with milk. As to the advice on pleasing companions, it is almost as if they are advising to let the ladies wear one out so that the real work can begin. Pepper, pomegranate, et al are being used to clean out the channels and stimulate the appetite, and simply thus.

Four Treatises

Vagbhata's Astanga Hrdayam, which probably dates to around 550-600 C.E. at the latest, also delves into the mysteries of alcoholism.

This is an extremely important and influential work. According to one school of thought, it is the foundation of the Tibetan Four Treatises, circa 728-786 C.E., and certainly reached Persia and Arabia by the late 700s to the mid 800s from whence it deeply influenced Unani.

Here are a few brief excerpts:

"He who is addicted to wine does not understand which is right and which is wrong; which is happiness and which is unhappiness; which is beneficial and which is non-beneficial for the present and future lives; which is suitable and which is unsuitable to his health and right living. With these bad effects, how do the wise indulge in it?

"In the wine reside delusion, fear, grief, anger and even death; so also insanity, infatuation, fainting, epilepsy, and convulsion. When loss of memory alone is present, then all the activities shall be improper. What to say when others are present?"

Yet, despite the tone of the above, Vagbhata does not ascribe alcoholism to moral failure; rather, he explains that there are four kinds of alcoholism, dependant upon the involved humor or combination thereof. He then goes on to observe:

"By proper, improper, and judicious use of wines accrue (or disperse) inseparable association of natural enemies such as infatuation, pride, anger, pleasure, etcetera; hence, only the judicious way of drinking should be adopted for moderation in these qualities.

"He who drinks wine, considering carefully his own strength and that of the wine; season, time of the day or night; place of residing and drinking; accustomed or unaccustomed type of drink; his own constitution; help from others; any disease he happens to be suffering from, and his age....suitable to all these...actually drinks nectar."

Vagbhata is very specific and direct about how alcoholism should be treated:

"Whichever dosa is found to be predominant should be treated first. When all the dosas are found to be equal in alcoholism, then treatment should be to the seats of kapha first, because alcoholism generally has aggravation of pitta and vata at its terminal stages.

"The disease alcoholism [emphasis added] which develops from inadequate, improper, and excess use of any one kind of wine, gets relieved by the proper use of same.

"Wine is similar to poison. Poison possessing powerful properties and actions such as penetrating deep into the tissues needs another kind of poison for the cure of disorders caused by the first poison.

"The treatment for alcoholism should be done for seven or eight days only. By that period, the wine localized in abnormal passages gets digested. The diseases which continue even after this period should be treated with appropriate therapies prescribed for alcoholism."

After describing these therapies, Vagbhata expounds at length on the subject of proper drinking. He suggests that two cups of wine may be taken if followed by a substantial meal of meat, sweet cake, butter, vegetables, and salt. He states that wine may be taken two or three times at night, in small quantities, "just to please the women." No more than this is recommended for anyone.

He is also specific regarding times of the day. People of kapha dominance should drink just before lunch; those of pitta right after lunch, and those of vata between lunch and dinner. People of perfectly balanced constitution may drink any time they wish.

But in no event should anyone drink the way most Western alcoholics drink: alone, constantly, and on an empty stomach.

Vagbhata's comment about wine "localized in abnormal passages," seems to be one of the earliest references to what we now call "detox." He gives the process seven to eight days.

He next jump-starts the digestion with diet, and when he has that accomplished, he retrains the body to process alcohol in a way that is not harmful. He also strictly limits the amount to be consumed.

Vagbhata also recognizes the role of environment and companions, and indeed devotes quite a lengthy set of remarks (which I have not yet posted).

I have a recollection that Vagbhata's method has recently been tried with some considerable success by a group that I am certain never read Vagbhata. I seem to recall a CBS Sixty Minutes piece to this effect a few years ago.

I will try to hunt it down. I don't think it was their item The French Paradox, although that was interesting. Of greater interest was this follow-up in the BMJ.

The item I recall was about a therapist who was employing two glasses of wine to control alcoholism among A.A. drop outs and achieving excellent results.

There are also a couple of other items worth mentioning:

(1) The Effectiveness of the Twelve-Step Treatment An intentionally enlightening study of why it doesn't work.

(2) The Six Major Roots of Alcoholics Anonymous An unintentionally enlightening study of why it doesn't work.

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7 reader comments:

Anonymous said...

This is very interesting lot of information you've posted. I intend to study it carefully. But to the extent that AA has a religious or quasi-religious component to it, and those who swear by it are 'believers', I think it is disingenuous to say dogmatically that "AA doesn't work", science and statistics notwithstanding. Why not then say that "Buddhism doesn't work"? Where are the statistics proving that it does?

One reason it works is that people believe in it and give it a chance to work. Everything in life is like that --Buddhadharma, AA, business, marriage and war. Even then, nothing always works.

Statistics in this case prove little, in my opinion. For example, let us suppose that the re-arrest rate amongst previous alcoholic offenders is greater amongst AA-goers than amongst those that do not go to AA. (One study you referenced claims to have statistics to that effect). Even if the statistics are meaningful -- and not all statistical studies are sufficiently well-constructed to be meaningful -- there is still the question of what it means to be an AA. How do we know, for instance, that acoholics who join AA and those who don't represent similar sample populations? For the statistic to be meaningful, that would have to be established beforehand. Otherwise the statistics on recidivism (AAs versus non-AA alcoholics) are dubious.

In my experience, AA goers on average have much worse problems with alcohol and drugs than your run-of-the-mill alcoholic. I.e., someone that drinks to excess and does things they shouldn't because of it, or damages their health. Lots of those people never ruin their lives. They pick up and move on. The ones that go to AA have, more often than not, lost everything by the time they get there. If they have a higher rate of recidivism it may well be that they have a more desperate problem to deal with than other alcoholics who would not take the same step. Or perhaps they are more lonely than other alcoholics. Or (and anecdotally, this appears true) more AAs have previously existing psychiatric conditions. A very large number of them, in my observation, fall well within the diagnostic boundaries of bipolar disorder and ADHD.

I'd like to believe that ayurveda might cure me and make a responsible drinker out of me again. (I was, once upon a time). That may be so. But is definitely not the case that "AA doesn't work". Try telling that to stadium full of recovered alcoholics! You might as well go to Lourdes and try to tell them faith healing is impossible. It certainly is impossible, if you totally disbelieve it.

Vaidya said...

I've read your post on alcoholism and ayurveda. It was interesting, but at some point you've made several mistakes. The part of you extracted form Ayurvedic text is nothing about alcoholism, but it was about alcoholic intoxication, its signs and symptoms caused by excessive intake of alcohol. Madatyaya, chang nad in Tibetan, is not alcoholism, it must be alcoholic intoxication.
As I know, it is a serious problem in Mongolia,which inherited from their communist past

Lhadron said...

OK. This is a lot of information. I had a boyfriend who was an alcoholic. We were only together for about six weeks but it was a complete disaster. I knew he had a problem when there were more beer bottles in the recycling than trash to take out! I don't know if he ever tried AA or anything for that matter, but whatever he was doing or tried to do it sure didn't work. I did however learn some valuable insights about myself, and as person who likes to see the silver lining, I see the relationship relative to "something."

AB said...

The article is interesting to read and provides info on what cures/treatments our ancestors hd for alcohol abuse. I know somebody in my family who needs treatment for alcoholism and I would like to probe on these alternative treatments. Who should I get in touch with? Where do I get people who practise these ancient alternative treatments. Please tell me of such experts who have actually treated patients of alcohol abuse.

TENPA said...

Start by finding an Ayurvedic physician in your area.

Alcohol poisoning symptoms said...

Really helpful information u mentioned in your blog. Thank you for the post.

Anonymous said...

As a recovered, notice recovered Alcoholic who was not brainwashed by AA, but given an opportunity through a relationship with a sponsor and the 12 steps to turn my life around, I would suggest that it is not that AA does not work but more that people do not actually often know what AA has to offer and what it is and what it is not. ".....AA is not allied with any particular faith, sect or denomination, nor do we oppose anyone" page X1V forward to the first edition of the book Alcoholics Anonymous. religiona religious