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Table of Contents
REVIEW ARTICLE
Year : 2020  |  Volume : 8  |  Issue : 1  |  Page : 14-20

Ayurveda perspectives toward prevention and management of nicotine and alcohol dependence: A review


1 Department of Kaumarabhritya, Mahatma Gandhi Ayurved College, Hospital and Research Centre, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharashtra, India
2 Department of Rasshastra Bhaishjya Kalpana, Mahatma Gandhi Ayurved College, Hospital and Research Centre, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharashtra, India

Date of Submission27-Dec-2019
Date of Decision17-Feb-2020
Date of Acceptance09-Apr-2020
Date of Web Publication2-Jul-2020

Correspondence Address:
Dr. Renu B Rathi
Department of Kaumarabhritya, Mahatma Gandhi Ayurved College, Hospital and Research Centre, Datta Meghe Institute of Medical Sciences (DU), Wardha, Wardha, Maharashtra.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISM.JISM_68_19

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  Abstract 

Nicotine and alcohol are the most widely consumed psychotropic drugs worldwide. The common use of both, increases the risk of noncommunicable diseases to many folds. Ayurveda has widely described Sadvritta (good conduct) and Satvavajay Chikitsa (Ayurveda psychotherapy), which can be applied in this context along with replacement therapy with medicines described in Madatyaya chapter of Charaksamhita Chikitsasthana. The aim of this study was to highlight the concepts of prevention and management of addiction by various principles of Ayurveda. Major causes of addiction in younger age include genetic predisposition, environmental factors, parental negligence, Pragyaparadh (intellectual blasphemy), Dushita Ahara (unhealthy diet regimen), and search of pleasure or stress reliever. If there is a delay in tackling these problems at early stages, these may turn into menace to health later. Achar Rasayan, Sadvritta, and Satvavajay Chikitsa are the preventive as well as curative measures of de-addiction. Ayurveda also advocates medicated smoke/Dhumpan and alcohol, that is, Drakshasav, Shrikhandasav, and so on, as replacement therapy; use of daily and seasonal regimen and Doshashodhan (elimination of vitiated humors) in day-to-day life is essential to prevent or treat addiction problems. In a nutshell, change in lifestyle, adoption of Ayurveda treatment principles, control on intellectual blasphemy, and environmental issues are directly concerned to deal with addiction problems. The measures adopted for the management of addiction ailments at initial stage also require strong willpower, meditation with counseling, and family–friends support.

Keywords: Addiction, alcohol dependence, Ayurveda, de-addiction, Madatyaychikitsa, nicotine, tobacco


How to cite this article:
Rathi RB, Rathi BJ. Ayurveda perspectives toward prevention and management of nicotine and alcohol dependence: A review. J Indian Sys Medicine 2020;8:14-20

How to cite this URL:
Rathi RB, Rathi BJ. Ayurveda perspectives toward prevention and management of nicotine and alcohol dependence: A review. J Indian Sys Medicine [serial online] 2020 [cited 2020 Oct 30];8:14-20. Available from: https://www.joinsysmed.com/text.asp?2020/8/1/14/288815




  Introduction Top


In India, 60% people are dependent on various products containing tobacco, whereas 30% with alcohol addiction, which is the main gateway of other more toxic drugs.[1] Nicotine and alcohol are the most common leading causes of preventable morbidity and mortality. Tobacco and alcohol consumption often together create more health hazards. Dependence on alcohol and tobacco is also correlated, as people who are dependent on alcohol are three times more likely to be smokers, and people who are dependent on tobacco are four times more likely than the general population to be dependent on alcohol.[2] The addiction causes not only physical morbidity but also mental and social one. Underage dependence on these toxic substances is becoming a new challenge and continuously is on rise in India. Owing to the environmental effect, if children adopt this habit, then it becomes difficult to get rid off with more hazardous effects on developing brain.[3] The harmful use of alcohol results in the death of 2.5 million people annually. Every year, the mortality rate due to consumption of nicotine is increasing in India.[4] Ministry of social justice and empowerment undertook different surveys to assess the addiction problem such as National Household Survey (NHS), Drug Abuse Monitoring System (DAMS), and Rapid Assessment Survey (RAS).[5] Nicotine is the main gateway to other drugs,[6] so needs to be prevented from getting addicted. There is not much description found in Ayurveda compendia and in research articles related to tobacco addiction, but the same Ayurveda principles can be applied as mentioned for alcohol to get de-addicted from both substances.

The main withdrawal effects of both the substances are anxiety, irritability, sleeplessness, anger, palpitation, perspiration, headache, muscle cramps, and so on.[7] It affects each and every organ of the body. Atherosclerosis and premature degeneration of vital organs lead to stroke, heart diseases, asthma, cancer, and neuritis.[8] The aim of this review was to carry out a root cause analysis along with the scope for prevention of dependence problems and to highlight the possible role of Ayurveda principles as multimodal approach at a time to tackle the same. This review may prove as a torchbearer to researchers and readers for the prevention and management of addiction problems through Ayurveda.


  Materials and Methods Top


This review work was based on the data collected from the classical literatures of Ayurveda—The Brihattrayee, that is, Charaka Samhita, Sushruta Samhita, and Astanga Hridaya and Kashyap Samhita, and research works related to de-addiction published in international journals from 1980 to 2019.

Observations and Results

In Ayurveda, addiction is mentioned under “Madatyay” chapter, which is about alcohol dependence.[9],[10],[11] Owing to overdrinking of alcoholic beverages, Vata, Pitta, and Raja, Tama get vitiated. People get addicted easily, demanding increasing doses for pleasant effect. Until and unless they do not get it, they remain restless and uneasy as its withdrawal effects appear fast. They become ready to do anything wrong for obtaining these drugs. Tobacco products are considered as constipation reliever but it is a myth. There is no description of tobacco plant (Nicotiana tabacum Linn.) found in Brihattrayees, and it is described very briefly in Bhavprakash Nighantu. It is warned that its leaves are addictive and dangerous to health except slight useful in toothache and for hot fomentation to reduce pain and swelling.[12] Regarding alcohol, Acharya have described in detail about Madatyaya symptoms, etiopathogenesis, complications, and its management. Vagbhata has mentioned Dhvansak and Vikshay diseases as complications.[10] Stagewise impact of alcohol consumption on human being is summarized in [Table 1].[9-11],[13] Tobacco and alcohol are pungent, astringent, and irritant in nature. They cause acidity, ulcer, headache, cramps, weakness, and body ache. Slowly they block personal, economic, and social development. Addicted person engages in a vicious cycle of physical and mental health hazards and may adopt antisocial behavior.[14] Owing to the overconsumption of various products containing nicotine such as tobacco, Gutkha, Kharrha, Khaini, Masala supari, Jarda, hookah, bidi, and cigarette, people may develop many symptoms. At first, difficulty in deglutition, lockjaw trouble in mouth opening, change in voice, and so on, but pain is totally absent, hence most of the times, these features get neglected.[15] Owing to its abuse, white patch called as leukoplakia or submucous fibrosis develops. However, if not treated and nicotine products are consumed regularly, then red patch appears called as erythroplakia, which later may turn into blackish one known as melanoplakia. It is cancerous, and nonhealing ulcer may appear in maxilla, mandibular region, or chin and oral cavity.[16] The harmful effects of smoking extend far beyond the smoker to peripheral public. Exposure to secondhand smoke can cause serious diseases and deaths. Pregnant and lactating mothers should prevent the use of all toxic drugs to avoid fetal congenital anomalies, miscarriages, still birth, premature birth, or withdrawal symptoms.[17]
Table 1: Impact of alcohol use on human beings[8],[9],[10]

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Role of Ayurveda Treatment Principles

Pragyaparadh means intellectual blasphemy, which is the major reason of any illness, and Sadvritta, Achar Rasayan (AR), and Satvavajay Chikitsa (SC) play an important role to prevent Pragyaparadh.[18],[19],[20],[21] Adoption of Ayurveda lifestyle (daily and seasonal regimen), body purification by Panchkarma (five major procedures of detoxification), meditation, and yoga along with medication as replacement therapy based on withdrawal symptoms are very safe tools to combat addiction of both the substances.[22]

In Ayurveda, some interventions have been advised such as simple moral principles and the right conducts under the heading “Sadavritta.[18]Achar means behavior and Rasayan means rejuvenation, thus AR results in rejuvenation of body and mind,[19] following these measures one can prevent addiction problems remarkably. It is the need of the hour to explore the role of Ayurveda in present context. According to Ayurveda, body and mind are same entity and directs their interrelationship, therefore diseases may affect vice versa to each other.[23]

Role of Change in Lifestyle (Satvavajay Chikitsa)

Acharya Charak suggested few measures to overcome the dependence such as inculcation of morals, habit of doing meditation, taking nutritious diet, and adopting Pranayama. According to him, body purification, good friend circle or peers, loving and caring ambiance, and change of job, which reminds addiction, with strong willpower are also helpful to get rid from the dependence of nicotine products and alcohol.[24]

SC is non-pharmacological Ayurved psychotherapy, which includes counseling, Pathya (diet) therapy, and controlled use of objects.[20],[25] It can be used in today’s practice with judicious way at home by an expert. Replacement therapy means medicated, congenial methodological use of wine, which is the best treatment of alcoholism as per Acharya. It can be contemplated under SC as controlled use of objects. Charaka has advised to adopt Padanshikkram,[26] which means small quantity should be reduced to avoid strong withdrawal symptoms. Bath, citric/pomegranate fruit juice, buttermilk, cold milk, light, desired eatable, and cold things should be used to reduce the burning effect of alcohol.[27] Milk is Ojovardhak, which is having opposite properties to that of alcohol, hence appreciated by many Acharya.[28] Sun exposure, hot, pungent, dry, heavy eatables, and drinks should be avoided, and lepan of herbs having cold potency, Shatdhutghrit application should be encouraged to decrease the burning.[27] These can be applicable in tobacco dependence too, as it is also hot and pungent.[12] Addition of Lavanbhaskarchurna or Trikatuchurna in wine with cold water or meat with sour substances and salt is less harmful.[27]Yuktivyapashraychikitsa–Madatyay is Tridoshajvyadhi, hence require to treat as per Dosha dominance by thorough management. It includes rational therapy, which means Shodhan/purification procedures or Shaman/pharmacological use as per dominance of vitiated Dosha.[29] Use of Sheet, Vata-Pitta pacifier, astringent property herbs such as Ushir, Chandan, Draksha, Kharjura, Tintidika, and Guduchi are useful. Vagbhat has given emphasis to maintain hydration owing to Pitta Vriddhi.[10],[30]Shatavaryadi, Punarnavadi Ghrit are also excellent in Pitta Shaman and Rasayan also. Puran Ghritkalpas play an important role in prevention and management of psychic, psychosomatic, and central nervous system (CNS) issues.[31] There are many herbal drugs in single or combination work as Medhya (intelligence booster), Balya (anabolic), Vatahar (Vata humor pacifier), and Bruhan Rasayana (rejuvenating), which are also useful to treat harmful effects of tobacco and alcohol addiction.[32]Eladimodak[24] and Shrikhandasav[33] are helpful to counteract ill-effects of withdrawal symptom as well as to reduce the doses of substance use. Ashwagandharishta,[34]Jyotishmati (Celastrus panniculata),[35]Jaharamohara,[36] and Sarpagandha have been found useful for de-addiction of alcohol.[37] If a person is strong enough then Shodhan /Panchkarma procedures such as Nasya (nasal instillation), Basti (medicated enema), Virechan (purgation), and Vaman (medicated emesis) can be carried out for alcoholism.[38] Pre-Panchkarma procedures such as Shirodhara, Shiropichu, Shiroabhyang, Shirobasti (relaxing procedures of head), and Snehan (body massage) are useful.[39]


  Discussion Top


In Ayurveda, three types of alcoholism have been mentioned, first one is Panatyay, which is due to over intake in empty stomach or before digestion of previously taken wine; second is Vibhram or Panapkram, which is due to consumption of agitating wine; and last one is due to sudden withdrawal of alcohol.[9],[10],[11] Sushrut has described three conditions Paramada, Panajirna, and Panavibhram due to dominance of Kapha, Pitta, and Vata, respectively. The treatment of all types of alcoholism is suggested with Amlaras or sour (lemon, dry grapes, pomegranate seeds, etc.), Chaturjat (medicines of Eladigana), salt, Trikatu, asafetida, cold astringent herbs separately or mixed with alcohol.[27] There is a good role of sour and salt, which produces sweetness, helps to reduce harsh effect on gut mucosa, and quick digestion of alcohol. According to Ayurveda, any Dravya (medicine) if taken in proper amount they act as a nectar otherwise poison, therefore Acharya have given emphasis on Sanskarit Madya (medicated alcohol).[40]Acharya Charak describes some important rules for taking alcohol such as preconditions of external and internal purification, right food, conduct, and time to cope up with the imbalance created by alcohol in the body and mind. Alcohol is just opposite with the characteristics of Oja, which has direct toxic effect on Satva of mind.[41] Ideally medicated alcohol should be tapered, and milk should be added in that tapering quantity. Human brain produces dopamine normally, and what alcohol does is activate the nervous system to promote dopamine formation. The brain thus remembers the taste of alcohol and nicotine by creating special cells called receptor cells. As a person increases the quantity of alcohol, these cells also increase in numbers. When the person wants to give up their addiction, these receptor cells agitate and create withdrawal symptoms. Also they produce unpleasant and even dangerous symptoms, hence sudden withdrawal creates Dhwansak-like complications. Alcohol in low doses activates GABA neurotransmitter, provides relaxing effect.[42] There is strong correlation between high level of alcohol and occurrence of lifestyle disorders.[43] In alcoholism, there is a predominance of Ama (indigested food), hence fasting is beneficial.[44] Psychological encouragement to make individual happy is the best treatment for alcoholism. Adoption of Ayurveda principles with medicated alcohol in Padanshik (reduced tapering quantity) may help by relaxing brain and releasing good hormones. This method helps keeping away agitation, anxiety, irritability, anger, and so on, to facilitate good conduct in daily life along with counseling, entertainment, and music.[45] However, separate evaluation of these concepts is needed to establish their role in maintaining mental health and in de-addiction. Charak has emphasized on the benefits of nonaddicted person instead of addicted as later addiction creates Ojonasha (destruction of tissue essence). For de-addiction, parent’s support is always needed to prevent doing Pragyaparadh again, owing to maintain strong will power also, family and friends support is essential to distract from addiction. [Table 2] shows the action of Ayurveda principles with characteristics. Likewise many herbs are crucial in de-addiction of nicotine and alcohol as mentioned in [Table 3], with their mode of action. As single herbs, combination of herbs, which is called as Kalp, is also helpful in quitting addiction as depicted in [Table 4]. Addiction creates many toxins and free radicals in the body with its increasing dose, hence requires timely elimination of these toxins to keep body free from its complications. Panchkarma is very useful for bio-purification and detoxification of body, which also indirectly keep mental health problems at bay, as depicted in [Table 5]. There are so many other factors that are also responsible and helpful for de-addiction, which are summarized in [Table 6]. For long-term use of Ayurveda medicines, procedures, yoga, pranayama, and counseling have an effective role in de-addiction of toxic drugs such as nicotine and alcohol.[55],[56] It is the need of the hour to say “no” to these toxic drugs and “yes” to life, hence efforts should be made by all to stop consumption and stay healthy. Community, psychiatrists, psychologists, various health providers of all pathies, different organizations, and government should take part to help de-addict an individual, willing to quit, and make India free from psychotropic drug dependence.
Table 2: Action of Ayurveda principles with characteristics

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Table 3: Researches depicting the action of herbal drugs on de-addiction

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Table 4: Researches depicting the effect of Ayurveda formulations on de-addiction

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Table 5: Action of pre-Panchakarma and Panchakarma procedures on addicted person for de-addiction

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Table 6: Research-based action for de-addiction showing the impact of other measures on de-addiction

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Role of Meditation and Yoga

Mindfulness breath meditation (Anapana—observation of the natural breath coming in and going out) in turn leads to academic improvement by enhancing memory and creativity.[58] It helps to take right decision, development of self-confidence, and courage. It also augments intelligence, social, emotional and physical quotient. Thus, develops healthy mind and body. Yoga relaxes and energizes both the body and mind.[56]

Role of Associated Trigger Management

A day is fixed to quit, placing a reminder image on mobile wallpaper. Person should be engaged in work or hobby such as sports, music, gardening, or remain social. Yoga, Pranayama, and meditation are excellent ways to tackle de-addiction, including Ayurveda psychotherapy/Satvavajay. Change in peer group, place, and way that reminds about drinking or nicotine use is helpful to overcome an addiction.[48],[50],[55]

Thus, this review has interpretation of various Ayurveda principles such as Satvavajay, AR, Sadvritta, use of wholesome food and lifestyle, good friend circle, support of family, and covering all environmental issues as Nidan of Madatyay. An amalgamation of all the three treatment modalities of Chikitsa—Yuktivyapashray, Daivavyapashray, and Satvavajay, has been included at a time to get de-addicted by psychotropic substance abuse of tobacco products and alcohol, which causes Tridosha and Raja-tama Prakopa/vitiation with Ojahar/poisonous accumulation of toxic substances. Yuktivyapashray Chikitsa related to dependence of tobacco and alcohol is bifurcated in Shamanaushadhis, Padanshik tapering with replacement therapy and Shodhan procedures (Panchkarma) with Pathya (wholesome food) and proper Vihar/lifestyle as adjunct modalities.


  Conclusion Top


In Ayurveda, there are no direct references related to the management of tobacco de-addiction; although alcohol de-addiction description is in detail. However, Ayurveda principles, such as daily good conduct, dietary guidelines, yoga, Panchakarma, and SC, are applicable in de-addiction of any substance abuse. The medicine therapy mentioned in the context of Madatyaya Chikitsa can be claimed as beneficial as there are experience-based evidences of utility of those formulations, specially replacement therapy with medicated reduced quantity of substance drug. To improve life and to explore further scope of Ayurveda in the management of this burning issue, scientific research are needed to be undertaken.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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