The human race has a somewhat convoluted relationship with substances of abuse. Some of these problematic substances have been around since the dawn of mankind but somehow we keep adding to the list of these potentially life-destroying substances. I think we need to start with a list of common substances of abuse:

1. Opiates including prescription narcotics, fentanyl and heroin.
2. Alcohol.
3. Marijuana.
4. Stimulants.
5. Benzodiazepines and other depressants.
6. Hallucinogens.
7. Nicotine.

What these substances have in common? Abuse of any of them can lead to multiple health problems including death. In my opinion the therapeutic use of any of these substances is very limited. These are the most common such substances:

1. Opiates or narcotics can be prescribed for either short term pain or chronic pain. They are very effective for short term pain such as trauma and post-operative pain. When I started to practice medicine this was the only way we could use narcotics. In 1990 a 100-word letter to the Editor of the NEJM stated that less than 1 % of patients at Boston Medical Center who received narcotics while hospitalized became addicted. Over the years this simple letter was cited hundreds of times to justify using narcotics for chronic pain. The drug companies who produced these substances jumped on the band wagon and began aggressively promoting narcotics for chronic pain to physicians. The rest is history. When patients no longer have access to narcotics they often turn to heroin laced with fentanyl and this often leads to fatal overdoses. Now heroin is dirt cheap and affordable for just about anyone looking to get high. In our state of Massachusetts last year, we had close to 2,000 fatal overdoses from narcotics. In the past 16 years 183,000 people have died in the US from narcotics overdoses. The truly sad part of this story is that narcotics don’t work well for chronic pain.
2. Alcohol. For years, the medical profession has been peddling the idea that alcohol in moderation protects you from developing cardiovascular disease. A recent article in the BMJ seems to back up this proposition. The findings suggest that moderate drinking is associated with a lower risk of several heart conditions.  Unfortunately, even at low doses alcohol is a bummer when it comes to your brain. A recent article once again in the BMJ suggests that alcohol is bad for your brain at any dose.  Who wants to trade a little heart health for a mushy brain? Don’t count me in this group.  At one point, we got smart and made alcohol illegal under prohibition. It didn’t take us long to get dumb again!
3. Marijuana. has been at the top of the list of addictive substances touted for medical use. There’s only one problem with this scenario—marijuana has absolutely no proven medical benefits. Certain chemicals in marijuana such as Marinol have been FDA approved for certain purposes but marijuana itself is like tobacco because it is loaded with hundreds of toxic chemicals. Marijuana has been touted for pain relief but there are no good controlled studies documenting that this is real. Marijuana may help to suppress nausea but the FDA drug Marinol has been shown to be effective at treating nausea without all the down side of exposure to marijuana. Marijuana has been shown to be addicting with adverse effects on mental disorders. Smoking marijuana carries the same risks as smoking cigarettes. Here in Massachusetts they have approved medical marijuana and recreational marijuana yet we can’t seem to figure out how to get everyone the health insurance they will need to pay all the marijuana related health problems. How many ways can you say dumb and dumber? In my opinion there the idea of “medical marijuana” is a complete myth.
4. Stimulants. Drugs like Adderall and Ritalin have been approved by the FDA to treat ADHD. There is only one problem with this approach—most people currently being diagnosed with ADHD don’t’ have it. Instead they have a form of food-induced brain dysfunction called Carbohydrate Associated Reversible Brain syndrome or CARB syndrome. This diet is triggered by consuming a diet loaded with highly processed food. People with CARB syndrome have depleted levels of dopamine, norepinephrine and serotonin in their brains so they develop symptoms that overlap with traditional disorders like depression or ADHD. The incidence of ADHD has doubled in the past decade. How is this possible? In my opinion it is because most of the new cases are CARB syndrome, not true ADHD. Although low dose drugs can be used to treat CARB syndrome, they must be used with neurotransmitter precursors like CARB-22 to be effective. Stimulants have also been used by young people as “study enhancers”, but the drugs can cause serious side effects so they should only be prescribed to people with true ADHD which turns out to be a relatively small group of people once you weed out the folks with CARB syndrome. Things complicated because some folks can have both true ADHD and CARB syndrome. For these people to do well, both diseases need to be treated, a topic that is beyond the scope of this post. Cocaine is also classified as a strong stimulant but because of its many dangerous side effects it has no valid therapeutic use.
5. Benzodiazepines and depressants. Drugs like Valium, Ativan and Xanax can play a key role in treating folks with diseases like panic disorder, generalized anxiety disorder and dysthymia. They are also used to treat alcohol withdrawal. They definitely have abuse potential and if they are suddenly stopped there can be a significant withdrawal syndrome. These drugs in low dose are also used to treat insomnia but daily use over a long time is probably not a good idea because of tolerance and addiction issues. I guess there is a reason why Valium was labeled as “mother’s little helper” years ago. Mom would get high to avoid dealing with the significant stress in her life. obviously this was not a good long term solution.
6. Hallucinogens. This group includes LSD, mescaline, psilocybin and others. They all share the ability to alter reality in unpredictable ways. Long term use of these types of drugs can result in psychotic behavior, sometimes leading to violent criminal acts. Apparently ISIS gives these drugs to their fighters prior to going into battle to make it easier for them to kill. There certainly doesn’t appear to be any reasonable therapeutic use for these drugs.
7. Nicotine. Nicotine is an example of a relatively benign brain enhancing drug that comes packaged with hundreds of dangerous chemicals in tobacco. It is also extremely addicting. If someone wanted to chew Nicorette gum to enhance their brain function, there would likely be little harm but I think this practice is rare. Most people are exposed to nicotine by smoking tobacco and I don’t need to outline all the health risks of doing so.

If you can’t safely get high by taking these substances, who should you do if you are searching for sustained feelings of contentment and well-being? People keep looking for elusive and safe ways to be “high on life”. I have good news for you. If you can figure out a way to naturally maximize your brain function, that’s about as good as it gets. Below is a list of safe and effective things you can do to attain this nirvana.

1. Consume a whole foods diet and avoid highly processed food. Some of the more popular variations of this type of approach are a Paleo diet, a ketogenic and the traditional Mediterranean diet. I also recommend doing your homework by reading Joseph Mercola’s new book “Fat for Fuel” or Robb Wolf’s “Wired to Eat”. Jimmy Moore’s “Keto Clarity” or Jason Fung’s “The Obesity Code” are also worth reading. I also recommend reading the books of Loren Cordain or Richard Johnson to complete your education.
2. Targeted supplements
   1. L-glutamine: If you take 1,000 mg of this amino acid 3-4x daily, it will help knock down pesky cravings for alcohol and sweet and starchy foods.
   2. DMAE bitartrate: This supplement is very safe and it enhances normal brain function. I recommend taking 150 mg daily.
   3. Cognitex: This combination supplement from Life Extension provides all the building blocks for optimal brain function.
   4. Omega 3 fatty acids: You also need to reduce your intake of omega 6 fatty acids mainly from vegetable oils. The best way to get you omega 3 fatty acids is to eat a lot of small fatty fish like sardines. You can also add a high quality omega 3 supplement like OmegaRx2 from Barry Sears. I recommend that monitor your AA/EPA ratio from OmegaQuant to keep it between 1 and 3.
   5. Lower your homocysteine: If your homocysteine is above 7, you will slowly cook your brain.  An easy fix is taking a minimum of L-methylfolate 5 mcg daily and the dose can be adjusted as needed. To knock down your homocysteine to below 7 you will also likely need two or three other B vitamins. You should take around 5,000 mcg of vitamin B12. I prefer the form that dissolves under your tongue. You should also take vitamin B6 100 mg daily. I personally prefer the more bioavailable form called pyridoxal 5’-phosphate 100 mg daily.
   6. CARB-22: I strongly recommend that you take this precursor supplement. Unlike psychiatric medications, it increases the levels of serotonin, dopamine and norepinephrine in your brain. It also helps to suppress alcohol, carbohydrate and sweat cravings. If you don’t have obvious CARB syndrome, I recommend taking 1-2 twice daily on an empty stomach to top off your neurotransmitters. Those with CARB syndrome should gradually increase the dose to 4 twice daily on an empty stomach.
3. There isn’t any down side to exercise. It is good for you brain and it helps to boost your mood. Any type of exercise seems to have these benefits and combining various types of exercise like aerobic exercise and strength training is likely optimal. For older individuals walking is a great way to get exercise and it is unlikely to lead to injuries that may be associated with more rigorous exercise. I like Dr. Mercola’s nitric oxide release workout. It doesn’t take much time and the result over time are fantastic!
4. Good Social Relationships. Bonding and interacting with other human beings is a great way to enhance your brain function and feeling of well-being. This approach costs you nothing other than your time so I recommend putting a lot of your eggs in this basket.
5. Adequate sleep. This is a tricky one. Many people try to get a good night’s sleep but become sidetracked by insomnia and poor quality sleep. Sound sleep depends of your circadian rhythms and these rhythms are primarily driven by the light dark cycle. Thus, when you go to bed keep your bedroom as dark as possible. I also recommend eliminate activating blue light from computers, cell phones and other sources using blue blocking glasses and programs to eliminate blue output from your computer, tablet or smart phone. Don’t follow President Trump who claims he only gets 1-3 hours of sleep every night! You can decide how that might be affecting the wellbeing of our nation. At bedtime you can also throw in some safe and inexpensive supplements like melatonin, 5-htp, L-theanine and L-tryptophan.
6. Reduce EMT (electromagnetic field) exposure. Exposure to EMT comes from cell phones and many electric appliances. Once again, I like Mercola’s discussion of EMT.

 In my opinion the best approach to these substances of abuse is to never start taking them. Once you become addicted you are dealing with a long and painful recovery if you are lucky enough to escape from these deadly substances.

As a final thought, you might consider some of the well-known people who have died because of these addictive substances:

• Prince.
• Elvis Presley.
• Janis Joplin.
• Michael Jackson.
• John Candy.
• John Belushi.
• Philip Hoffman.
• Whitney Houston.
• Heath Ledger.
• Ike Turner.
• Chris Farley.
• Kurt Cobain.
• Truman Capote.
• Jimi Hendrix.
• Marilyn Monroe.
• Hank Williams.