Integrative Manual Therapy in the Field of Addiction and Withdrawal Programs by Kimberly Burnham, PhD, IMTC, LMT and Suzanne Joseph, PT, IMTC

In the field of Integrative Manual Therapy, people with addictions to substances and processes are treated individually in a program supporting the client, medical doctor and medical team. The withdrawal program focuses on biomechanical, neural and cardiovascular dysfunctions that contribute to the addiction process and withdrawal symptoms.

Treatment centers around improving blood flow and normalizing the tensions affecting the nervous system, including the brain, and subcortical tissues, particularly the insula. Integrative Manual Therapy (IMT) practitioners also consider the blood nerve and blood brain barriers and the way in which substances in the blood stream are affecting the nervous system.

An over all approach to decreasing pain and the symptoms of substance withdrawal includes correcting biomechanical dysfunctions of the pelvis, sacrum, spine and cranium, thereby positively affecting the whole nervous system. Attention is also concentrated on improving cardiovascular function, blood vessel wall integrity and circulation.

Nutritional recommendations to decrease cravings and increase essential fatty acids in the diet are aimed at improving the blood brain barrier and physiologic function of the nervous system.

Specialized techniques called Blueprints are used to decrease the addictive process by focusing on normalizing areas of the brain that are part of the reward circuit, including the insula, subcortical tissue and brainstem. Kilts in a 2001 study concluded that "craving-related activation of a network of limbic, insula, paralimbic, and striatal brain regions, including structures involved in stimulus-reward association (amygdala), incentive motivation (subcallosal gyrus/nucleus accumbens), and anticipation (anterior cingulate cortex)." Integrative Manual Therapists are trained in palpating and treating reflex points and biological rhythms associated with subcortical structures.

Improved circulation to the brain and nervous system decreases withdrawl symptoms. In 2002 Pezawas found "a decrease in Regional Cerebral Blood Flow (rCBF) in most regions of interest in patients in comparison to controls. Long-term opioid dependence seems to decrease prefrontal CBF in particular. A right-greater-than-left CBF asymmetry in healthy subjects was reversed in patients. This change in CBF symmetry could reflect the different emotional status of opioid-dependent patients." Techniques to improve blood flow to the brain and nervous system include positional release techniques, known as Advanced Strain and Counterstrain that decreases the tension on contractile tissue, thereby increasing the ability of blood vessels to dilate and constrict appropriately. These techniques are used for example to decrease muscle tension in the neck and face, encouraging better drainage from the head and an improved arterial flow.

Disruptions of the membrane wall of blood vessels and nerve fibers, damaged due to substance abuse, infection or trauma contributes to the neurological symptoms and toxicity in the brain. Mattson noted that "membrane lipid peroxidation and oxidative modification of various membrane and associated proteins (e.g., receptors, ion transporters and channels, and signal transduction and cytoskeletal proteins) occur in a range of neurodegenerative disorders." While Egleton in 1998 looked at the contribution of opioid peptide transport and addiction noting that "peptide hormones and neurotransmitters play crucial roles in the maintenance of physiological function at both the cellular and organ level." IMT therapists use hands-on techniques focused on developing better integrity of membrane walls and the blood brain barrier.
In a self-care program developed by Sharon Weiselfish Giammatteo and written up in the book: Elimination Diet A New Health Care Tool, clients develop additional skills to decrease cravings and let go of addictive processes.

A client with trigeminal neuralgia and an addiction to pain killers reported, "I am currently doing better. No pain if I take only the regular amount of drugs. I am hoping for no drugs one day. The processing is yielding very subtle memories. I find your work very sublet which I appreciate. I feel real healing happens in almost indiscernible ways."

Another client, a lymphoma cancer survivor with a sugar addiction reported, "it wasn't until my wife and I were waiting for another test, a PET scan, when the technician said, "This is a glucose uptake test, we're going to inject you with glucose, it will collect in areas with cancer." "Cancer thrives on glucose." "Cancer thrives on glucose!" we said it at the same time to each other! That was day one of the sugar elimination diet. I gave up the things I loved, cold turkey....Food tastes better now, whole foods that is. I no longer desire processed foods. I don't crave dairy products and I'm slowly acquiring a taste for those fresh organic vegetables."

Copyright Kimberly Burnham is an Integrative Manual Therapist at CenterIMT in Bloomfield, Connecticut. She recently completed her PhD focused on Parkinson's disease and Integrative manual Therapy and can be reached at Kimburnham@CenterIMT.com. For more information see www.CenterIMT.com
---- Suzanne Joseph is the clinical manager at CenterIMT Chicago and specializes in addiction and chronic pain syndromes.

References
1. Ahmed, M. S., Abdelhamid, E. E., & Turner, D. (1983). Biochemical and pharmacological studies on the opiate receptors from human placenta. Life Sci, 33 Suppl 1, 207-210.
2. Burnham, K. (2005). Validity of Questionnaires in Evidence-based Research: The Assessment of Client’s with Parkinson’s Disease. Journal of Soft Tissue Manipulation, Vol. 12 No. 2(Winter 2005).
3. Crowell, T. (2005). The relationship between bone bruises and lymphedema after fracture: a case study. Townsend Letter for Doctors and Patients, Jan.
4. Drissche, T. V. (1996). Membrane and circadian rhythm: Springer.
5. Egleton, R. D., Abbruscato, T. J., Thomas, S. A., & Davis, T. P. (1998). Transport of opioid peptides into the central nervous system. J Pharm Sci, 87(11), 1433-1439.
6. Giammatteo, T., & Giammatteo, S. W. (2001). Reflection therapy. Berkeley, CA: North Atlantic Books.
7. Giammatteo, T., & Weiselfish-Giammatteo, S. (1997). Integrative manual therapy for the autonomic nervous system and related disorders : utilizing advanced strain and counterstrain technique. Berkeley, Calif.: North Atlantic Books.
8. Kilts, C. D., Schweitzer, J. B., Quinn, C. K., Gross, R. E., Faber, T. L., Muhammad, F., et al. (2001). Neural activity related to drug craving in cocaine addiction. Arch Gen Psychiatry, 58(4), 334-341.
9. Leger, S. (2004). Spinal cord injuries dissertation. Westbrook University.
10. Mattson, M. P. (2004). Metal-catalyzed disruption of membrane protein and lipid signaling in the pathogenesis of neurodegenerative disorders. Ann N Y Acad Sci, 1012, 37-50.
11. Pezawas, L., Fischer, G., Podreka, I., Schindler, S., Brucke, T., Jagsch, R., et al. (2002). Opioid addiction changes cerebral blood flow symmetry. Neuropsychobiology, 45(2), 67-73.
12. Weiselfish, S. (1993). Developmental manual therapy for physical rehabilitation for the neurologic patient. Ann Arbor, Michigan: UMI Dissertation Services.
13. Weiselfish-Giammatteo, S. (1994). Manual therapy with muscle energy technique. West Hartford, CT: ANA Publishing.
14. Weiselfish-Giammatteo, S., & Giammatteo, T. (2000). Ex 2 : functional exercise program for head and neck problems. Berkeley, CA: North Atlantic Books.
15. Weiselfish-Giammatteo, S., & Giammatteo, T. (2001). Integrative manual therapy, for the upper and lower extremities. volume II (Rev. ed.). Berkeley, Calif.: North Atlantic Books.
16. Weiselfish-Giammatteo, S., & Giammatteo, T. (2001). Ex 1 : functional exercise program for women's and men's health issues. Bloomfield, CT ; Berkeley, CA.: ANA Pub. : North Atlantic Books.
17. Weiselfish-Giammatteo, S., & Giammatteo, T. (2002). Body wisdom : light touch for optimal health. Berkeley, Calif.: North Atlantic Books.
18. Weiselfish-Giammatteo, S., & Giammatteo, T. (2002). Elimination Diet A New Health Care Tool. Bloomfield, CT: ANA Publishing.
19. Weiselfish-Giammatteo, S., & Giammatteo, T. (2003). Integrative manual therapy for biomechanics : application of muscle energy and 'beyond' technique : treatment of the spine, ribs, and extremities. Berkeley, Calif.: North Atlantic Books.
20. Wheeler, L. (2004). Advanced Strain Counterstrain. Massage Therapy Journal, 43(4).
21. Zamulaeva, I. A., Lekakh, I. V., Kiseleva, V. I., Gabai, V. L., Saenko, A. S., Shevchenko, A. S., et al. (1997). Natural hidden antibodies reacting with DNA or cardiolipin bind to thymocytes and evoke their death. FEBS Lett, 413(2), 231-235.